Introduction to the Fellowship Program:
The mission of the fellowship program is to provide a balanced program of clinical training and clinical research experience and to develop excellent hematologists-oncologists who can function in an academic institution or a community-based practice. Our full-time attending physicians are dedicated to directly supervise each fellow's training experience.
The fellowship training program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) for subspecialty training as a combined hematology/oncology program. This three-year program will lead to eligibility in both hematology and oncology subspecialty certifying examinations.
Clinical training for medical oncology and hematology fellows focuses on an in-depth clinical experience that integrates fellows into the primary care of the division's patients.
The weekly outpatient schedule is divided into disease-specific clinics attended by faculty with expertise in these areas. Outpatient clinics are a major focus for our clinical training.
Rotation at the Combined Hematology and Oncology Program:
PGY-4 - Fellowship Program Year 1 (Oncology)
| Oncology Inpatient Unit and consult service: | 4 months |
| Outpatient Oncology Clinic: | 6 months |
| Radiation Oncology: | 1 month |
| Gynecologic Oncology: | 1 month |
| Continuity Clinic: | 12 months |
| Vacation: | 3 weeks |
PGY-5 - Fellowship Program Year 2 (Hematology)
| Hematology Inpatient Unit and Consult service: | 4 months |
| Bone Marrow Transplant (Inpatient & Outpatient clinic): | 2 months |
| Elective rotation (combined with Outpatient Hematology Clinic): | 3 months |
| Outpatient Hematology Clinic: | 6 months |
| Continuity Clinic | 12 months |
| Vacation: | 3 weeks |
Onsite elective rotations:
| Blood Bank/Pheresis: | 1 month |
| Hematopathology: | 1 month |
| Coagulation laboratory | 1 month |
PGY-6 - Fellowship Program Year 3
| Oncology Inpatient Unit and Consult service: | 2 months |
| Hematology Inpatient and Consult service: | 2 months |
| Continuity Clinic/Elective clinics: | 12 months |
| Vacation | 3 weeks |
Weekly Conferences:
Orlando Health Cancer Institute has several weekly conferences focused on both patient care and research activities. Fellows actively participate in these multidisciplinary conferences:
- Breast Cancer Conference
- Gastrointestinal Oncology Conference
- Thoracic Oncology Conference
- Genitourinary Oncology Conference
- Brain & Spine Oncology Conference
- Head & Neck Oncology Conference
- Melanoma/Sarcoma Conference
- Benign/Malignant Hematology Conference
- Gynecologic Oncology Conference
- Research meeting (tumor sections)
- M&M conference
- Oncology Journal Club
- Hematology Journal Club
- Core Lecture Series
Clinic Duties:
Outpatient Clinic:
The clinic operates Monday through Friday. First year oncology fellows and second year hematology fellows are assigned to groups of attending physicians and see patients in the out-patient clinics all week for six months. To ensure continuity of care, fellows rotate in two-month blocks. Third year fellows have four half-days clinic per week for 8 months. All fellows will start a half day continuity clinic at the beginning of their training that continues for three years.
Clinics are divided as follows:
- Hematology/Oncology continuity clinic I: Fellows start a continuity clinic at the beginning of the first year and continued through the third year. Continuity clinic can be for 12 months, changed yearly.
Fellows have one continuity clinic/week (4 hours session). Each clinic is staffed by one attending, one fellow and on occasions also attended by another internal medicine resident or a medical student. Fellows attend on average 2 new patients and 4-5 follow-up patients at each clinic. Each patient seen by the fellow must be seen by the attending physician. - Oncology ambulatory clinic II:
First year fellows spend 6 months in the oncology ambulatory clinics. Each fellow will have 8 clinics /week, each clinic is 4 hours and staffed by one attending. Fellows usually attend 2 new patients and 4-5 follow up patients. Each patient seen by the fellow must be seen by the attending physician. - Hematology ambulatory clinic III:
Second year fellows spend 6 months in the hematology ambulatory clinics. Each fellow will have 5 clinics /week during elective rotations and 8 half day clinics during the 3 months of the outpatient rotations. Each clinic is 4 hours. Each clinic is staffed by one attending physician. Fellows usually attend 2 new patients and 4-5 follow up patients. Internal medicine residents and medical students can attend these clinics. Each patient seen by the fellow must be seen by the attending physician. - Third year fellows attend one continuity hematology/oncology clinic, and three half day clinics /week, they rotate on a 1-2 monthly base between the different attending physicians.
Chemotherapy Infusion Unit:
Outpatient chemotherapy and blood component therapy is administered through the Ambulatory Treatment Center. Patients on active outpatient treatments are evaluated in the clinic, where their chemotherapy orders are written. The attending physician must review and co-sign all chemotherapy orders. All patients must sign an informed consent prior to each new chemotherapy regimen.
Medical Oncology and Hematology Inpatient Service:
The inpatient ward fellow is responsible for supervising day-to-day care of patients as well as providing chemotherapy orders and consent forms when appropriate. Admission notes and daily progress notes are required on all patients. Inpatient fellows must be available to present patient information when the attending starts inpatient rounds. The inpatient fellow is assisted by an inpatient nurse practitioner and an internal medicine resident.
First year fellows spend 4 months at the combined oncology inpatient and consult service. The fellow is responsible to coordinate with the assigned attending physician the care of all the patients admitted to the oncology service. Usually, the teaching service has an average of 20-30 patients. The fellow on service is responsible of evaluating patients at the consult service.
Second year fellows spend 4 months at the combined hematology inpatient/consult service, and 2 months at the bone marrow transplant service. The fellow is responsible to coordinate with the assigned attending the care of all the patients admitted to the hematology service. Usually each of the inpatient and consult service has an average of 20 patients.
At the inpatient and consult service all patients are seen and evaluated by the fellow and the attending physician. Fellows are required to arrange for presentations at several weekly conferences. Attending physicians are present at these conferences and provide help and guidance to the fellows.
At the end of each rotation the attending physician on service provides a written evaluation of the fellow’s performance and achievement. Evaluations are discussed with the fellows; similarly, fellows provide written evaluations of the different attending physicians.
Fellows will have close interaction with the internal medicine residents on the inpatient service or at the outpatient clinics. Fellows are responsible for providing the support and teaching to the internal medicine residents in addition to the teaching provided by the attending physicians.
Medical Oncology and Hematology Consult Service:
The medical oncology consult service is covered by the inpatient oncology fellow; the hematology consult service is covered by the hematology inpatient fellow. These teams must promptly respond to new consults received on weekdays from 8 a.m. to 5 p.m. Attending physicians and fellows on call are responsible for consults received during on-call hours. The fellow has the primary responsibility for evaluating patients and discussing the consult with the attending. Frequently patients are admitted to the hospitalist service, with whom fellows should establish a close working relationship.
Bone Marrow Transplant Unit:
Each hematology fellow is assigned to the BMT unit for two months, which includes coverage of inpatient and outpatient BMT services.
Responsibilities of the Third Year Fellows:
The senior year of fellowship is dedicated toward research, self-development and outpatient care consisting of four half-days of clinic per week. Each fellow is expected to develop a quality project and select one of the attendings in the division as a research mentor. Individual third year schedules are developed with the assistance of the fellowship program director.
On-Call Coverage:
Fellows while on call cover both hematology and oncology services from home. Fellows are responsible for triaging patient telephone calls as well as answering medical issues on the in-patient service when the staff requires assistance. The hematology and oncology on-call attendings are available all the time to help fellows as needed.
Calls are divided into two categories, weekday (Monday – Thursday) and weekend (Friday – Sunday) calls. Each fellow will have one weekend and 4 weekdays call/month.
Transition of care:
During the weekdays: The fellow on call will have access to all clinical patient data through the electronic medical record. A list of patients is constantly updated with the inpatient census. All patients for which oncology or hematology is the primary provider are clearly labeled and daily notes are available for home access with updates on the patient. The electronic system can be accessed at any time from the hospital or home.
Any patient’s lab result or imaging study that need to be followed or for any changes in a patient’s clinical status that need to be communicated to the on-call fellow is done by the fellow on inpatient service communicating directly with the fellow on call. This is also done through face to face sign out, phone sign out or the work e-mail which is secure and is always available through the work mobile device.
During the weekends: Each fellow who is on the Oncology or Hematology inpatient service will forward to the weekend on call fellow and attending the complete patient list via the work e-mail with a summary on each patient and specify which patients need to be seen, any clinical status concerns and any study results that need to be followed. This is also done through face to face sign out, phone sign out or the work e-mail.
At the end of the weekend the on-call fellow will forward via work e-mail a list with a summary of all the new patients seen and updates on the patients that were already on service to the fellow and attending on service.
Off service: Each fellow on the Oncology and Hematology inpatient service who will be coming out of the rotation will forward a list with a summary of all the patients on the service to the incoming fellow and attending.
Scholarly Activities and Research
Each fellow is required to complete quality project before graduation. Frequently these quality projects have been published as ASCO/ASH abstracts or posters. Each fellow is required before graduation to have published at a peer reviewed journal or national meeting.
Physicians at Orlando Health Cancer Institute are involved in clinical research. Clinical trials are either cooperative groups or pharmaceutically sponsored trials.
Fellows during the third year of fellowship will spend 60% of their time involved in a clinical research activity and completing a quality project.
Orlando Health supports travel to one national meeting yearly such as the American Society of Clinical Oncology or the American Society of Hematology.
Procedures:
- Bone Marrow Biopsy/Aspirate and Interpretation
- Plasmapheresis/Red Blood Cell Exchange Transfusion
- Intrathecal Chemotherapy Administration
- Indwelling Catheter Management
Oncology/Hematology Faculty:
| Avgeropoulos | Neuro-Oncology |
| Baidas | Benign and malignant hematology, Breast Cancer |
| Landau | Benign and malignant hematology, GU malignancy |
| Sarriera | Benign and malignant hematology |
| Kayaleh | GI malignancy |
| Thomas | GI malignancy, Melanoma, Sarcoma |
| Shah | Breast Cancer |
| Laughlin | Breast Cancer, Cancer Genetics, Quality |
| Rostorfer | Breast Cancer |
| Cuesta | Breast Cancer |
| Tseng | Lung cancer, Head & Neck Cancer |
| Johnson | Lung cancer, Head & Neck Cancer |
| Schimp | Gynecologic Oncology |
| Seward | Gynecologic Oncology |
| Meunier | Gynecologic Oncology |
| Kollas | Palliative care and pain management |
| Harding | Palliative care and pain management |
| Busowski | Palliative care and pain management |
