Fellows Curriculum

First Year Experience

First Year Curriculum Rotations (13 months)

First Year Curriculum (13 months) includes the following rotations:

Inpatient Clinical Rotations (10 months)

During inpatient rotations the fellow will lead a team of medical trainees to provide care for our hematology oncology patients admitted to our inpatient service. Fellows spend one month at a time on each of the four different services (Hematology, Leukemia & Lymphoma, Solid Tumor/Neuro Oncology, and Bone Marrow Transplant). Fellows work closely with an attending assigned to the same inpatient service. New patients admitted or consulted upon will become the fellow’s primary patients. Each fellow will be in charge of the management and treatment of their primary patients, with the supervision of a primary attending. During inpatient rotations fellows are responsible for only inpatient clinical issues. All outpatient calls are fielded by case managers and outpatient physicians.

Outpatient Clinical Rotations (2 months)

During outpatient clinic rotation fellows are introduced to ambulatory hematology oncology. Fellows will perform bone marrow biopsies and aspirations, lumbar punctures and intrathecal chemotherapy administration in the procedure room daily during their clinic month. We have a dedicated anesthesiologist to provide sedation for procedures everyday in our outpatient clinic. Fellows also gain exposure to all of the comprehensive clinics (Sickle Cell/Thalassemia Clinic, Hemophilia, Thriving After Cancer, Cancer Genetics, Neuro Oncology, and BMT) during this month. While in outpatient clinic fellows will be responsible for fielding all outpatient consults with attending supervision. Outpatient parental calls will be triaged by case managers.

During the other outpatient month (Radiation Oncology/Clinical Lab), fellows will gain exposure to both proton and photon radiation oncology, as well as the many clinical laboratories that are utilized by hematology oncology providers (flow cytometry, blood banking, UCSD special coagulation lab, pathology, etc). We are one of the few Pediatric hematology oncology centers in the US that provides proton therapy to pediatric oncology patients in partnership with California Protons .

Research (1 month)

Fellows participate in a research month during the second half of their first year of fellowship. This month provides time for fellows to explore the multitude of research opportunities, and to finalize a strong research project and plan for their fellowship research years. Fellows do not have clinical duties other than their weekly half day of continuity clinic and calls during that month, to provide them with flexibility to meet potential PIs, attend lab meetings, work on IRB submissions, and prepare for their fellowship scholarly work.

Procedures, Calls, and Performance Evaluations

Procedures

Our fellows have many opportunities to learn and perform procedures that are involved in the care of our hematology oncology patients. During their outpatient clinic month they participate in procedures daily. Starting after their outpatient clinic rotation fellows will are assigned to clinic procedures monthly to continue to hone their skills through their fellowship. In addition, fellows perform procedures on their primary patients when needed in coordination with other sedated procedures.

Calls

The night and weekend calls are split mainly between the first and second year fellows, with each fellow taking one weeknight call per week, and one weekend call per month. Fellows always have an attending back-up scheduled with them, who is always available for any questions or assistance. The third year fellows have only a few calls to protect their research time.

Performance Evaluations

We strive to provide our fellows with timely, continuous feedback through many different channels. The attending on service sits down for one-on-one feedback sessions with the fellow through their inpatient rotations to provide informal feedback. Each attending completes an evaluation of the fellow with whom they have worked on service, which helps to guide our twice yearly milestone evaluations. Each fellow has a formal evaluation meeting with the fellowship program directors twice a year to review these written evaluations. The first year fellows also go through a 360 degree evaluation process, in which they perform a self-assessment, and receive feedback from not only faculty, but also nursing staff, case managers, patients and families. We also frequently elicit fellow feedback on the fellowship program to make changes and improvements to optimize each fellows’ experience. We offer a feedback training program for pediatric fellows, run by Dr. Jennifer Yu, in which fellows can learn and practice methods to give and receive feedback.

Psychosocial Aspects of Pediatric Hematology-Oncology

Fellows receive training to address psychosocial issues in the care of children and adolescents with life-threatening illnesses. Working with an experienced attending physician in the day-to-day care of patients, fellows learn how to provide optimal psychosocial support to patients and their families. In addition, the service has two-psychologists who are a resource for patients and families and provide support and advice to the fellows. We have a supportive care nurse, Joanne “Jo” Auger, and a palliative care team who are integral for families and patients with difficult situations or at the end of life. Our supportive care team organizes multidisciplinary conferences on patient and family management issues, debriefing sessions after difficult situations, as well as a fellows’ seminar that focuses on recognizing and dealing with the psychosocial aspects of care.

At UCSD, trainees and faculty alike have access to the Healer Education Assessment and Referral (HEAR) Program. The HEAR program was created to offer confidential support and resources to those healthcare providers in need. The UCSD Pediatric Hematology Oncology Fellowship requires all fellows to undergo the confidential online assessment of burnout, depression and stress, and there are counselors that provide confidential services to those in need, free of charge.

Our fellows participate in a unique informed consent curriculum with the goal of enhancing communication skills. The workshop is led by our faculty members, Drs. Paula Aristizabal and Nicholas Gloude, and the UCSD Education, Simulation and Standardized Patient program. Our simulation-based curriculum has significantly increased our fellows’ self-reported confidence and skills in informed consent performance, and addresses research-related content and also management of parental emotional needs during the informed consent discussion. Our curriculum has been supported by the ASPHO Clinician-Educator Award.

Second and Third Year Experience

Clinical and Research Training

Clinical Training

Second and third year fellows continue to gain clinical experience during their one full day of continuity clinic each week (20% of their time), and scheduled weeknight and weekend calls. Their other clinical responsibilities include following up and managing their primary patients, with the supervision of an attending physician.

Research Training

The University of California, San Diego provides a wide range of research opportunities available to fellows. Each fellow has a faculty advisor, a research mentor and a scholarly oversight committee to advise and oversee the fellow's development into a scientific investigator.

Fellows can develop their research interests in basic science and translational science in the laboratories at:

Scholarly Oversight Committee (SOC)

Every fellow will meet with their SOC throughout their fellowship for research guidance and mentorship. SOC will help fellows with the following:

Selection of Research project and mentors Id
entifying the necessary resources for troubleshooting logistic or technical issues with the project
Time-line for completion of the project
Reviewing research manuscripts and personal statements
Career development

Quality Improvement Committee

Longitudinal Quality Improvement Curriculum for Pediatric Hematology/Oncology Fellows

The Accreditation Council for Graduate Medical Education (ACGME) requires that pediatric hematology/oncology (PHO) fellows participate in quality improvement (QI) and patient safety programs as part of their training. PHO fellows at the University of California San Diego/Rady Children’s Hospital participate in a multi-modal, project-based, and longitudinal QI curriculum.

The curriculum was designed on the principles of adult learning to guide fellows as they develop a basic understanding of QI as well as master key QI practices and tools while completing their own QI project. The curriculum includes: 1) QI basics and patient safety in Year (Y) 1; 2) Development of a mentored multi-disciplinary, feasible, and fellow-led QI project (Y2) and presentation of results to peers and faculty (Y2-3); 3) Completion of core modules and worksheets on project planning and QI tools to facilitate project development and execution (Y2) and 4) Mentored didactic sessions (Y1-3). The targeted QI curriculum for PHO fellows spans all three years of fellowship and is facilitated by three core PHO faculty (Paula Aristizabal, MD, MAS; Kelly Bush, MD and Courtney Thornburg, MD, MS) who have completed formal training in QI, as well as an advisor from the UCSD Pediatrics INQUIRY Program. At the end of their fellowship, trainees will obtain a Certificate in QI from the Department of Pediatrics.

Some of the projects led by fellows include:

Electronic health record tools to facilitate VTE prevention
Sickle cell pain action plans
Implementation of vitamin D screening and treatment
Increasing physical therapy in children with leukemia
Improving discharge plans for low risk febrile neutropenia
Implementing functional pain scores in sickle cell patients
Improving oncofertility services in adolescents

Clinical Research Enhancement through Supplemental Training (CREST)

Fellows interested in developing a clinical research project are able to be part of UCSD's Clinical Research Enhancement through Supplemental Training (CREST) Program. Through this program the fellow gains the knowledge needed to conduct clinical research and identifies a research mentor with experience in guiding trainees to a successful career in clinical research. The UCSD Pediatrics department funds fellows to attend classes for the CREST Program. At UCSD, there is also an option to extend the CREST certificate program into a full Master’s in Clinical Research .

Medical Education Track

FACET (Fellow as Clinician Educator Track)

Didactic Conferences

Educational Curriculum: Our Clinical experience is complemented by a structured didactic program which includes:

Introductory Pediatric Hematology-Oncology Fellowship Lecture Series (daily July-August)
Rady Children's Pediatric Fellows' Research Conference Series (monthly)
Tumor Boards (Neuro-Oncology and Solid Tumor) (weekly)
Pathology Rounds (weekly)
Hematology Rounds (bi-monthly)
Inpatient Hematology Didactic Session (weekly)
Inpatient Leukemia/Lymphoma Didactic Session (weekly)
Inpatient Solid Tumor Didactic Session (weekly)
Journal Club (monthly)
Fellows Board Review (monthly)
Interdisciplinary Lectures (monthly)
Clinical Trial Review Meeting (monthly)