7900/In-patient Oncology (Barnes-Jewish Hospital)
Goals: Upon completion of the 7900 rotation, the fellow should feel comfortable with the diagnosis, workup and management of common inpatient problems such as neutropenic infection, spinal cord compression, and pain management. As a consultant you will evaluate newly diagnosed patients and formulate a treatment plan.
The inpatient oncology rotation will provide that Fellow with an exposure to complications of cancers and therapies. The Fellow will supervise the Medicine Residents and act as a resource for problems related to patients' cancers. The Fellow will oversee the oncologic management of the service and formulate a treatment plan. Teaching rounds are conducted daily by the inpatient attending. During rounds, patients on the inpatient service are reviewed and the disease processes and treatment plans are reviewed. Bedside rounds are conducted with the entire team in order to review important physical findings.
The in-patient service includes the dedicated wards on 6900 and 7900, covered by teams of medicine residents and interns. It is the responsibility of the Fellow to oversee the in-patients and write all chemotherapy orders. All patients are covered at night by PMS, a night float resident. (Private Medical System is largely composed of "moonlighters" who can perform admitting H & P and attend to emergencies.) The Fellows' role should be to act as a supervisor (not micromanager) and educator of the residents (i.e., during rounds). The resident receives an evaluation from the attending physician assessing the points on the evaluation form. This evaluation is discussed with the resident and the form is forwarded to the Director, who places it in the resident's file. The attending physicians on this service are on the Medical Oncology faculty.
Oncology Consults
Oncology consults provide the Fellow with newly diagnosed cases of cancers. The Fellow will be expected to review the pathology and workup, will initiate any further testing, and make treatment recommendations.
It is the responsibility of the fellow to:
- Dictate the consult note in the BJ Medical Records system for documentation in clinical desktop and to meet the billing compliance requirements.
- Notify Helen Elledge via e-mail of consults daily (helledge@im.wustl.edu) the information she needs is patient name, DOB, DOV and which attending the patient saw.
The patients that you see as in-patients should be followed by you if possible longitudinally in your clinic. Patients followed by physicians in the SCC and admitted by a non-BCC physician are also followed by the consult team (including ICU's). The resident receives an evaluation from the attending physician assessing the points on the evaluation form. This evaluation is discussed with the residents and the form is forwarded to the Director, who places it in the resident's file. The attending physicians on this service are the Medical Oncology faculty.
The attending schedule will give you the correct contact information for the covering consult fellow, page them at their personal pager number if needed.
Hematology/Hemostasis
Goals: On the inpatient Hematology service, you will become adept at managing the complications of a variety of hematologic disorders, including sickle cell disease. On the consultation service you will evaluate and make treatment recommendations for common hematologic problems such as cytopenias and coagulation defects. You will perform and interpret marrow aspirates and peripheral smears.
This service acts as the primary team for the Hematology service (predominantly sickle cell patients) at Barnes-Jewish North as well as consultants for both Barnes-Jewish North and South. The team consists of one fellow, one or more internal medicine resident and often one senior medical student. You are responsible for admissions to the inpatient service from 7AM - 5PM. The Gold service admits and provides cross-coverage on hematology inpatients overnight. You are on call (home call) for outpatients and emergent consults Monday-Thursday. When being asked to see consults, it is often helpful to ask the requesting team to ensure that a peripheral smear is available for review.
Acute Leukemia/Marrow Transplantation Service
Goals: You will learn to diagnose and treat malignant hematologic diseases and will care for patients undergoing marrow transplantation for both hematologic malignancies and solid tumors. You will become comfortable with the management of these diseases and the complications of treatment.
You will spend 2 weeks as the BMT service fellow and 2 weeks as the Leukemia service fellow.
As the BMT fellow, you will act as the primary physician for patients admitted to the Transplant service on 5900. One fellow, a Medicine resident and a Gold physician, overseen by a BMT/Leukemia attending, provide care of the patients on the Transplant service, who are admitted to undergo autologous or allogeneic transplant or for the management of post-transplant complications. Because the 5900 unit has the capability of providing critical care, sicker leukemia patients may also be admitted or transferred to the BMT service.
As the Leukemia fellow, you will act as the primary physician for patients admitted to the Leukemia service, based primarily on 6900. One fellow and one Medicine resident, overseen by a BMT/Leukemia attending, provide care of the patients on the Leukemia service, who are admitted primarily for management of acute leukemia and other hematologic malignancies, as well as post-transplant complications.
Teaching rounds on both services are conducted daily by the inpatient attending. Inpatient call (home call) is shared among the BMT and Leukemia fellows, and the Medicine resident. Outpatient call is divided between the two fellows. ICU patients on 5900 must be signed out to the moonlighting fellow covering ICU patients. A Heme/Onc fellow must be present on the floor during transplants; occasionally a matched unrelated donor transplant will occur in the middle of the night.
As the BMT or Leukemia fellow, your primary responsibility will be the care of the inpatients assigned to you; however, as time permits, you are encouraged to attend clinic with the Bone Marrow Transplantation faculty. New patients are evaluated for consideration of marrow transplantation. Patients who have been discharged from the inpatient service are seen in follow-up. In addition, you may assist the inpatient fellow as needed or provide coverage when they are in clinic.
Patient Review Conference is held Thursdays at 12:00 in the BMT Conference Room, 5th floor Steinberg. Patients undergoing treatment or being considered for transplantation are discussed. Fellows rotating on the service are expected to be present.
VA Hospital
Goals: You will learn to care for patients with benign and malignant hematologic diseases as well as solid tumors as a consultant.
You are expected to serve as consultant for all patients with hematologic and oncologic problems. You will supervise the Medical House staff caring for these patients. You are expected to perform and interpret marrow aspirates and biopsies.
The Fellow rotating at the St. Louis VA Medical Center will see both hematology and oncology patients and will be given a major role in decision making. You will be responsible for all inpatient consultations and subsequent inpatient follow-up care. Patients requiring additional outpatient therapy or follow-up will be scheduled for return in either the fellow's or attending's clinic. The Fellow will be on call for the entire service 24 hours daily except for 4 days during the month. During that time, the attending physician will take calls.
Longitudinal Clinics
You will attend one-half day longitudinal clinic per week in Hematology and in Oncology.
Oncology Clinic
Goal: You will learn to manage patients in the outpatient setting. By following individual patients from their initial diagnosis, you will appreciate the natural history of disease processes. You will learn to write chemotherapy orders, provide supportive care, and manage patients through Home Health and Hospice.
You will be assigned to a single faculty member in Oncology who will see patients with you and offer suggestions for patient management. New patients will be assigned to your clinic. In addition, patients initially seen as inpatient consults, will be followed in your longitudinal clinic. The residents attend this clinic for all three years of this program.
Hematology Clinic
Goal: You will learn to manage patients with hematologic problems such as sickle cell disease, cytopenia, hemophilia and coagulopathies in the outpatient setting.
You will be assigned to a half-day clinic with Dr. Blinder who will evaluate patients with you and make suggestions for patient management. You will also see and evaluate patients with common hematologic problems in consultation. The residents attend this clinic for all three years of this program.
