This rotation is primarily focused on the ambulatory care of patients with cancer and blood disorders.
A. Fellows will spend three-month blocks either in the offices of Oncology Associates located in the Helen and Harry Gray Cancer Center or those of Connecticut Multispecialty Group in 100 Retreat Ave.
B. In the outpatient setting, the fellow will report to an assigned attending each day that he/she is in the office. This attending is responsible for assigning appropriate patients to the fellow for assessment and discussion. These patients may fall into the categories of routine follow-up, new outpatient or occasional inpatient consultations. It is expected the attending will provide some form of didactic summation at the end of the workday.
C. Appropriate information (x-rays, lab values, etc.) should be reviewed when possible prior to the presentation of the patient to the attending and a preliminary note should be written.
D. All orders for chemotherapy must be approved and countersigned by the attending.
E. The fellow will see patients for emergent care in the ER or Cancer Center as time allows.
Goals and Objectives: The fellow will demonstrate competency in ambulatory care for patients with cancer and blood disorders with: a) adequate patient assessment and management plans; b) appropriate time management skills; c) ongoing self assessment; c) integration of a multidisciplinary and systems based approach to patient care including an appreciation of charting issues specific to the care of the patient with cancer or blood disorders (i.e. flow sheets in patients receiving chemotherapy, chemotherapy order writing); d) excellent communication with patients, families and staff; e) clear written and oral communication with the referring physician(s); and e) a professional demeanor.
1. Patient Care:
a. Develop accurate history taking, particularly as it pertains to natural history of cancer and blood disorders;
b. Develop physical examination skills necessary to follow treatment effects, diagnose diseases in this sub-specialty and identify toxicities of therapy;
c. Construct a reasonable differential diagnosis;
d. Utilize efficient and cost-effective laboratory evaluation to substantiate a diagnosis or follow treatment effects;
e. Formulate a management plan including administration of chemotherapy, pain control, immunosuppressive therapy, anticoagulation therapy and transfusion management;
f. Provide compassionate care at end of life;
g. Write/order clearly out patient chemotherapy regimens.
2. Medical Knowledge:
a. Develop of an appropriate knowledge base for this subspecialty (see ASH and ASCO curricula);
b. Develop of the ability to understand and manage complex hematologic and oncologic diseases usually cared for in the ambulatory setting such as cancers of the breast, colon, lung, prostate, anemias, bleeding and clotting disorders, hematologic malignancies;
d. Understand the principles behind acute pain management and end of life issues (palliative care).
3. Practice based learning and improvement:
a. Develop the ability to assess and improve ones skills; recognizes the need for guidance and supervision;
b. Develop the ability to access and use advances in new technology related to medicine and molecular diagnostics and therapeutics;
c. Maintain timely, legible and functional medical records;
d. Become fluent with electronic medical record reporting and review;
e. Become fluent with computerized literature searches and the major electronic resources for hematology and oncology;
4. Interpersonal and Communications Skills:
a. Develop the ability to build a trusting relationship between patient and family especially in the setting of chronic disease management and long term relationships;
b. Develop a model of shared decision making with the patient and appropriate family members/significant others;
c. Develop an appropriate doctor-patient encounter by allowing the patient to complete an opening statement, eliciting a full set of patient concerns, and establishing and maintaining a personal connection;
d. Gather appropriate information by the use of open-ended and closed-ended questions, structuring, clarifying and summarizing information, and actively listening using verbal and non-verbal techniques;
e. Understand the patient’s perspective on their illness;
f. Share information with the patient by using language the patient can understand, checking for the patient’s understanding, and encouraging questions;
g. Reaching agreement about the patient’s problems and the doctor’s plans by encouraging patient participation in decisions, checking patient willingness to follow plans, and identifying resources and supports;
h. Develop appropriate time management in an ambulatory setting;
i. Provide appropriate closure to the clinical encounter by asking if there are other questions or concerns, discuss plans for follow up and summarizing the plan.
5. Professionalism:
a. Be truthful with patients and peers;
b. Be accountable to patients and colleagues;
c. Treat people with respect and compassion;
d. Adhere to best interests of the patient;
e. Work cooperatively and communicate effectively with other office staff (APRNs, nurses, social workers, medical assistants, nutritionists, physical therapists, clerical help, etc) to achieve common patient care interests.
6. Systems based Practice:
a. Efficiently access and utilize resources to provide comprehensive and effective care for patients. Resources include consultants, nutritionists, social workers, pastoral care workers, hospice care-givers, nurses, and others;
b. Participation in the reduction of errors in ambulatory patients and the development of patient safety guidelines;
c. Understand the utility of electronic medical record, flow sheets, etc.
