Heme_onc.doc by po6734

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									Pediatric Hematology/Oncology Goals and Objectives
I. Patient Care & II. Medical Knowledge 1) Evaluation and management of patients with anemia, neutropenia, and/or thrombocytopenia a. Be able to interpret a complete blood cell count b. Be able to recognize and understand the significance of common peripheral blood smear abnormalities c. Identify clinical signs associated with particular cytopenias d. Understand the various etiologies and describe an appropriate diagnostic differential for each type of cytopenia e. Determine what laboratory studies may be required to diagnose and manage each type of cytopenia f. Know the initial/emergent management of various types of cytopenias g. Know when a child needs referral to a hematologist Evaluation and management of patients with coagulation disorders a. Understand the different clinical presentations of patients with platelet disorders, factor deficiencies, and thrombotic disorders b. Be able to interpret basic coagulation screening tests including PT, PTT, platelet function assay, and von Willebrand screens c. Know when to appropriately order uncommon coagulation tests such as specific factor assays, D-dimers, fibrin split products, and platelet aggregation tests d. Understand the different chronic treatment approaches (prophylaxis vs. episodic treatment) of patients with hemophilia e. Understand the emergent treatment strategies utilized for a patient with hemophilia or von Willebrand disease and active bleeding f. Understand the treatment dilemmas that exist for patients with hemophilia who have inhibitors g. Understand the long term complications associated with patients with hemophilia and von Willebrand disease h. Be able to recognize and begin initial treatment of a patient with a deep vein thrombosis i. Know the long term complications and treatment strategies of patients following a thrombotic event j. Know the appropriate laboratory screening required for a pediatric patient with venous thrombosis Initial evaluation and management of leukemia and lymphoma a. Identify the clinical signs and symptoms of leukemia and lymphoma b. Describe an appropriate diagnostic differential for patients who present with lymphadenopathy and/or hepatosplenomegaly c. Be able to recognize the laboratory and radiographic abnormalities that are typically present in patients who present with leukemia or lymphoma. d. Understand the difference between acute and chronic leukemias e. Understand the difference in treatment strategies and prognosis between childhood acute lymphoblastic leukemia (ALL) and. acute myelogenous leukemia (AML) f. Know the basic clinical differences between Hodgkin’s Lymphoma and Non-Hodgkin’s lymphoma g. Be able to determine the urgency of referral of a patient with leukemia or lymphoma to a hematologist/oncologist h. Understand basic principles of administration of common chemotherapy agents
Revision Date: 9/12/2007

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Initial evaluation and management of leukemia and lymphoma (continued) i. Be aware of the long term complications and side effects associated with chemotherapy j. Understand indications for and techniques of bone marrow aspiration and intrathecal chemotherapy administration Initial evaluation and management of solid tumors, including intracranial, bone, and soft tissue masses a. Identify the clinical signs of various solid tumors b. Be aware that some solid tumors have specific molecular markers c. Describe an appropriate diagnostic differential for patients who present with a mass in the brain, head, neck, chest, abdomen, spine, or limb d. Understand the prognosis of various solid tumors e. Know the laboratory and radiographic studies that are required to evaluate a solid tumor f. Know the initial/emergent management of different solid tumors g. Be able to determine the urgency of referral of a mass to a hematologist/oncologist h. Be aware of the long term complications and side effects of chemotherapy Acute and chronic care of a child with sickle cell disease a. Be able to interpret a complete blood cell count, newborn screen and other screening blood tests in patients with sickle cell disease or other common hemoglobinopathies b. Understand the management of patients with sickle cell disease and fever c. Know that children with sickle cell disease under the age of 5 years are particularly susceptible to life-threatening bacterial illnesses and require prophylactic penicillin d. Be able to identify signs and symptoms of acute veno-occlusive crises including pain crisis, acute chest syndrome, stroke, splenic sequestration, priapism, and hyperhemolytic crisis e. Be able to identify a sickle cell patient with aplastic crisis f. Know the initial/emergent management of sickle cell patients who present in crisis g. Be aware of the types of treatment for sickle cell disease and its complications, with a focus on pain management h. Understand the appropriate use of therapeutic blood transfusion in sickle cell disease and the risks associate with the inappropriate use of blood transfusion i. Understand the long term complications and prognosis of patients with sickle cell disease j. Understand the critical role the primary care physician plays in the care of these patients, including attention to growth, immunizations, and cognitive development Initial evaluation and management of oncologic emergencies a. Identify the clinical signs of febrile neutropenia, symptomatic anemia and/or thrombocytopenia, tumor lysis syndrome, spinal cord compression, superior mediastinal syndrome, and increased intracranial pressure, and know why they are emergencies b. Interpret complete blood cell count and laboratory abnormalities associated with tumor lysis syndrome c. Know which tumors are most likely associated with particular oncologic emergencies d. Know the initial management of each type of oncologic emergency e. Understand appropriate use of cytokines and blood products in pediatric oncology f. Know when to refer patients to an oncologist or an intensivist

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Revision Date: 9/12/2007

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Management of common side effects of childhood cancer and chemotherapy a. Initial evaluation and management of pain b. Initial evaluation and management of nausea and vomiting c. Initial evaluation and management of constipation d. Understand the risk of renal, hepatic, cardiac, pulmonary, bone marrow, and central nervous system toxicity of common chemotherapy agents e. Understand common psychosocial effects of serious chronic illness on patients/families f. Understand care of central venous catheters and recognize signs of CVL infection

III. Practice-Based Learning & Improvement 1) 2) 3) Participate actively in all inpatient rounds and consultations Attend all available divisional educational sessions Understand the appropriate use of evidence-based medicine resources in making critical patient care decisions Attendance of 31 half-days is required to pass the rotation exclusive of continuity clinic and vacation. Self-study completed on premises will count as attendance.

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IV. Interpersonal and Communication Skills 1) 2) 3) 4) 5) Learn how to communicate a new diagnosis to a child and his/her family (i.e. parents/siblings) Learn the importance of updating the primary care physician of a child with a new diagnosis Learn how to communicate bad and good news Learn how to communicate with and care for a dying child and his/her family Learn how to communicate risks/benefits of procedures and transfusions to patients/families

V. Professionalism 1) 2) Understand the unique nature of the patient/physician relationship in pediatric oncology Understand the impact of culture on the delivery of care in pediatric hematology/oncology

Revision Date: 9/12/2007

VI. Systems-Based Practice 1) Learn how to coordinate care of complex patients with outpatient health including, home health, hospice care, laboratories, physical therapy, psychological therapy, family, and community pediatricians. Learn the steps involved in pronouncing the death of a child and the administrative steps required following the death of a patient in the hospital Learn how to approach the family and to arrange for an autopsy Know the importance of a provider seeking consolation for himself/herself after being present for a child’s death

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Revision Date: 9/12/2007


								
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