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					    HEMATOLOGY AND MEDICAL ONCOLOGY FELLOW TRAINING PROGRAM

                             Handout Signature Sheet




Physician name:____________________________________, M.D.


I have been given the "Information for Hematology and Medical Oncology Fellows, 2009-
2010" packet. I have read and understand the information and agree to follow the
guidelines set therein. I have also received a copy of the Scripps Clinic "Clinical
Fellowship Agreement". I understand and agree to abide by these policies and
procedures.



____________________________________________
Physician signature



____________________________________________
Date



____________________________________________
Program Director signature
Michael P. Kosty, M.D., F.A.C.P.
Director, Hematology/Oncology Fellow Training Program
Scripps Clinic




                                         1
                                                                    Hematology/Oncology
                                                             Fellow Orientation Handbook
                                                                   Policy and Procedures
                                                                               June, 2009
       INFORMATION FOR HEMATOLOGY AND MEDICAL ONCOLOGY FELLOWS
                        Academic Year 2009-2010


Welcome to the Division of Hematology and Oncology. We are pleased to have you with
us for the 2009-2010 academic year. We believe you will have a rewarding and
educational experience.

ORGANIZATION:

The training program in Hematology and Medical Oncology is organized around the
outpatient clinic. You will be assigned clinics with different faculty each half-day, which
will carry through for the entire year. Through this arrangement, you will be exposed to a
wide spectrum of disease states. In the outpatient setting, you will be seeing new
patients in consultation and following patients with attending physicians' supervision. This
system allows you to experience long-term follow up for a group of patients. Should any
of these patients require hospitalization, you will be responsible for contacting the
inpatient fellow, hospitalist or the Internal Medicine admitting resident (as appropriate).

Monthly, one fellow is assigned to the inpatient service, and a second to the
leukemia/transplant service. The inpatient fellow is responsible for admitting appropriate
patients to the Heme/Onc inpatient service, rounding on all Division inpatients, and
performing inpatient consultations. The leukemia/transplant fellow rounds on all patients
on the blood and marrow transplant unit. These rounds should be completed prior to
rounding with the attending faculty, which occurs daily at 11 am. Both the inpatient and
leukemia/transplant fellow will have afternoon clinics, and there may be frequent times
when some patient care and/or notes will need to be completed after the afternoon
clinics.

WORKING HOURS:

The minimum working day is 8 a.m. to 5 p.m. If you are to be absent from the Clinic for
any reason during the normal working hours, Dr. Kosty must be notified in advance,
otherwise the day will be charged as vacation time. Promptness for all clinical duties and
conferences is expected as part of appropriate professional demeanor. Please do not
expect to be paged by nursing staff to ask you to be where you are supposed to be.

OUTPATIENT CLINICS:

Fellows are required to be present in the clinic from 9:00 – 12:00 mornings, and 1:00 –
5:00 afternoons. Regardless of clinic patient load, fellow responsibilities will end promptly
at noon and 5:00, respectively. This is to allow adequate time to attend noon
conferences (for example Internal Medicine Grand Rounds) and have adequate time for
lunch or inpatient care issues. In order to optimize the educational experience, and to
show courtesy to patients and nursing staff, fellows should be present in the clinic
promptly at 9:00 a.m. and 1:00 p.m. respectively, without having to be paged. First-year
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                                                                         Policy and Procedures
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fellows will have a maximum of five (5) patient encounters per session for the first six
months.




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                                                                     Policy and Procedures
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Fellow clinics have a template, which allows for one new patient per hour or three return
visits per hour. This template will allow for adequate faculty teaching time. Charting
should be done after clinic hours, unless otherwise directed by the clinic-attending faculty,
to minimize interference with teaching time. All outpatient encounters are dictated (STAT)
on the #67 dictation line. All notes (inpatient or outpatient) need to be signed off within 7
days of dictation. This deadline allows staff 7 days to meet the institutionally required 14
signoff deadline.

A new outpatient schedule will be issued every four weeks. These four-week rotations
form a “block”. While afternoon sessions will be relatively static, the morning sessions will
vary with changes in the inpatient, leukemia/transplant responsibilities or fellow rotation or
vacation schedules.

No activity has precedence over the outpatient clinical experience except for (1) STAT
inpatient consultations – then with the approval of the clinic attending staff; (2) scheduled
basic science lectures; (3) required graduate medical educational meetings (for example
evaluation sessions). As a courtesy, in the case of (2) or (3) above, the attending staff
with whom the trainee works should be notified in advance to avoid any adverse patient
care issues.

When the attending staff to whom a fellow is assigned is absent, the fellow will be
assigned for that time period to see patients with the covering staff physician, allowing
continuity for that fellow's clinic. In no instance is the fellow to assume they have time for
non-outpatient activities.

Fellows will have one half day per week for non-patient care activities, designated “office”
on the clinic block schedules. These include research, reading, one-on-one meetings
with attending staff, etc. This time is not for personal errands, and fellows are expected to
be on site. We continue to expect fellows to be “in-house” by 8:00 a.m. and stay until
5:00 p.m.




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                                                                           Hematology/Oncology
                                                                    Fellow Orientation Handbook
                                                                          Policy and Procedures
                                                                                      June, 2009
INPATIENT SERVICE

Background

The inpatient service was created in response to concerns expressed by the
ACGME regarding fellow supervision for hospitalized patients. In the past,
fellows would round with each staff who had patients in the hospital. This created
difficulties in finding suitable time to round with multiple attendings, some of
whom had to round with multiple fellows. This condition was exacerbated by
attending staff who were in regional clinics or covering the transplant service.

The current inpatient service was initiated in March 2004 and functions well in
general. A number of unanticipated absences during the 2005-6 academic year
resulted in a number of inpatient fellow schedule revisions and an unequal
amount of inpatient activity by affected fellows. By design, first-year fellows are
supposed to be on the inpatient service 60% of the time, and second-year fellows
40%. The situation is reversed for the transplant service, giving fellows graded
responsibility commensurate with increasing level of skill.

From July 1, 2005 to May 31, 2009, the inpatient service census has varied from
zero to eleven patients. In several instances, the workload for the inpatient fellow
has become excessive, resulting in late hours and the potential for ACGME work
hour violations, although to date this has not occurred.

Inpatient Fellow Policies and Procedures

In response to the concerns enumerated above, the following policies and
procedures for the Hematology/Oncology inpatient service have been instituted:

   1.   The fellow on the inpatient service is responsible for rounding daily on all
        inpatients on the Hematology/Oncology service, those patients on other
        services for which subspecialty input is requested, and new consultations.
        All patients must be seen prior to rounding with the attending physician,
        which should begin promptly at 11:00. This may necessitate fellows
        beginning rounds at 7:00 am, and completing notes after the afternoon
        clinic. The majority of the time, it is anticipated that patient care activities
        can be completed prior to joint fellow/staff rounds. It is also anticipated
        that the inpatient fellow may occasionally need to stay until 7:00 pm to
        complete patient care on new admissions, consultations, etc. Inpatient
        fellows are required to attend all noon conferences.

   2.   The 11:00 attending rounds are primarily work rounds. The inpatient
        fellow and attending staff with jointly review the patient’s status and
        determine an appropriate treatment plan. This plan should be
        communicated to other physicians involved in the patient’s care by the
        fellow verbally (if appropriate), and by the fellow and attending staff in daily
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                                                                           Policy and Procedures
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     chart notes.

3.   In recognition of the fact that there are many factors which impact the time
     required for thorough and safe patient care (varying degrees of acuity,
     variable fellow efficiency, the service which the patient is on, etc.) no
     specific number of inpatients can be deemed “too many”. A similar
     difficulty occurs with admissions and consultations. If a fellow feels the
     current workload would require them to be present after 7:00 pm, that
     fellow is to discuss this with the on-call attending physician, with whom
     they are rounding. If there is general agreement that additional inpatient
     care time is required, the on-call attending will contact the fellow’s clinic
     physician, and arrange for the fellow to be excused early from clinic, but in
     no case before 3:30 pm. If there is a consultation which is a true
     emergency, the inpatient fellow should discuss the situation with both the
     inpatient attending and the clinic attending to determine the appropriate
     course of action. A consultation or admission does not automatically
     excuse the fellow from afternoon clinic early.

4.   Should the inpatient patient volume be excessive (exceed 7-8 patients),
     the inpatient fellow may discuss returning to the hospital from 1-2pm to
     complete patient care activities. This extra time will alleviate conflict
     between patient care requirements and fellow clinic responsibilities. If this
     additional hour is needed, the inpatient attending physician should be
     informed, as should the afternoon clinic attending physician.

5.   Fellow clinics are the backbone of the clinical portion of this program. To a
     degree, institution of the inpatient and transplantation fellow rotations has
     disrupted the continuity of fellow patient care and limited exposure of
     fellows to many important diseases. To minimize further disruption
     necessitated by (3), above and optimize patient care, fellows and attending
     staff should endeavor to:

        a. Admit all appropriate patients to the Internal Medicine teaching
           service;
        b. “Sign off” patients when Hematology or Oncology expertise is no
           longer required;
        c. Round on patients potentially eligible for discharge first to facilitate
           their early discharge;
        d. Verbally communicate to others involved in a patient’s care important
           information which may speed resolution of that patient’s condition or
           facilitate early discharge.

6.    Faculty need to recognize that the inpatient fellow will frequently be paged
     from Urgent Care, other services, inpatient nursing, etc. regarding patient
     care issues. This is an unavoidable consequence of having inpatients.
     Such interruptions should be handled by the staff in a collegial fashion.
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                                                                      Policy and Procedures
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7.    Finally, as mentioned in (5), above, the outpatient clinics are the strength
     of our educational program. On days where there are few inpatients,
     inpatient and bone marrow fellows are most encouraged to attend their
     regular morning clinics. If there are no inpatients or only one, this
     attendance is required, as rounds can be completed prior to the normal
     9:00 am clinic start time.




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                                                                        Hematology/Oncology
                                                                 Fellow Orientation Handbook
                                                                       Policy and Procedures
                                                                                   June, 2009
SICK LEAVE:

As in all professional settings, minor illnesses are not a sufficient reason to abandon
professional responsibilities. If your illness is severe enough to warrant absence from
work, jeopardizing your health or the health of your patients, you must speak directly with
the Program Director. Absences of more than two days will require a written letter from
your treating physician. If you have an illness which requires you to stay home, the
Program Director must be notified by telephone (858-554-9043).

VACATIONS AND MEETINGS:

Annually, each fellow is granted four weeks of vacation and/or professional leave to
attend professional meetings. Vacation and meeting time must be scheduled at least four
weeks in advance by submitting a request in writing, to Dr. Kosty. A form is included in
this binder.

All time off is subject to approval of the program director and such approval must be
obtained in writing. It is important to obtain approval for time off prior to purchasing
tickets or making any irrevocable plans. Such arrangements will not be grounds
for “automatic approval” and the program will not reimburse any fellow for costs
necessitated by such rescheduling. Leave time will not be approved for fellows on the
inpatient service, blood bank rotation, or hospice rotation. Leave time may be scheduled
during the radiation oncology or leukemia/lymphoma rotations with advance approval of
the respective attending physicians.

Typically, only one first and/or second-year fellow will be approved for vacation/meeting
time during any specific time interval. Every attempt will be made to coordinate requests
so that all may be accommodated. In no instance will requests for time off exceeding two
weeks be approved.

Professional leave is designated for organized meetings or professional examinations
only, not for recreational vacations. The meeting must be approved by the program
director and be relevant to hematology or medical oncology. We encourage each fellow
to attend one of the major subspecialty meetings, either ASH or ASCO, during each year.
 The Division of Hematology and Medical Oncology sponsors a meeting, "Clinical
Hematology and Oncology" each February. There are several good, relevant meetings in
Southern California each year, and you are encouraged to avail yourself of these
opportunities. Every attempt is made to fund fellow expenses to ASH and/or ASCO, but
such funding is not guaranteed. Funding will be limited to advanced registration fees,
advance purchase coach air fare, and hotel expenses Friday – Monday nights only.
Rental cars, taxis, hotel internet, meals, etc will not be reimbursed but may be charged to
the $1,000 TMD provided to each trainee by the Department of Graduate Medical
Education.

Any vacation time not used in a given academic year can be carried over to the following
year. Time may not be "borrowed" from the following year. Any time remaining at the
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                                                                        Policy and Procedures
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completion of the training program will be forfeited.


It is critical to understand that in order to have a creditable year, a fellow may not be
absent for more than four weeks. This is an ABIM requirement. This includes all time off:
vacation time, meetings, sick leave, maternity leave, etc. Time off in excess of four
weeks may require additional, unpaid time in training to successfully complete that year.

When a fellow is absent due to illness, vacation, meeting time or outside rotation (see
below) that trainee's duties will be assumed by the remaining fellows.




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                                                                       Hematology/Oncology
                                                                Fellow Orientation Handbook
                                                                      Policy and Procedures
                                                                                  June, 2009
ROTATIONS OUTSIDE THE DIVISION:

The first-year fellows will do a two-week rotation at in the SGH Department of
Hematopathology, the San Diego Blood Bank or the blood bank at Naval Hospital, San
Diego depending on scheduling availability. The second-year fellows will do two required
rotations: a four-week rotation in Radiation Oncology, and a two-week rotation at San
Diego Hospice. Satisfactory completion of these rotations is required for board eligibility.
These rotations will be assigned and scheduled by the program director. Other electives
may be scheduled with approval of the program director. Taking vacation and meeting
time off is strongly discouraged during these rotations. When a fellow is away on an
outside rotation, other fellows will assume their duties as discussed above.

While on a rotation outside the Division, the fellow will be required to attend one half-day
continuity clinic. Attendance at Friday morning hematology/oncology patient care rounds
is required, and participation in normal conferences is encouraged, but not required if it
conflicts with required rotation activities.

HEMATOPATHOLOGY:

Drs. Kelly Bethel and/or Bob Sharpe conduct a weekly hematopathology review.
Attendance at this review is mandatory for fellows in their first and second clinical years.
Third year fellows are strongly encouraged to attend. The schedule is attached.

REQUIRED CONFERENCES:

Monday        12:00 – 1:00 p.m.    1st/3rd: Hematopathology Review
                                   2nd/4th: Thoracic Tumor Board (Evans CR)

Tuesday       8:00 – 9:00 a.m.     1st/3rd: Breast Conference (CCCR)
              12:00 – 1:00 p.m.    3rd:     Cutaneous Oncology Tumor Board (CCCR)
              12:30 – 1:30 p.m.    1st:     Journal Club (CCCR)
                                    nd
                                   2 : Quality Assurance (quarterly)
                                            Head and Neck Tumor Board
                                    rd
                                   3 :      Hematology/Oncology Guest Speaker (CCCR)
                                   4th:     Head and Neck Tumor Board

Wednesday 12:00 - 1:00 p.m.        Scripps Clinic Grand Rounds (Auditorium)
                                   2nd/4th: Hematopathology Review

Thursday      8:30 – 9:00 a.m.     Research Conference (monthly) (CCCR)
              12:00 – 1:00 p.m.    General Tumor Board Conference (CCCR)

Friday        8:00 – 10:00 a.m.    Division Rounds/ Fellow Presentation (CCCR)
              3:00 – 4:00 p.m.     Fellow Core Lecture Series (CCCR)


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Additionally, you are encouraged to attend specialty cancer conferences, hematology
research conferences, and seminars, which are of interest to you. Schedules are
circulated monthly.

Friday at Hematology/Oncology patient care rounds one fellow will present a fifteen-
minute talk on a clinical topic which will be assigned or may be of their choosing. Each
fellow will make approximately one presentation every six weeks. This topic should be
discussed with an attending physician who will provide guidance and appropriate
references. Fellows doing laboratory or clinical research will present quarterly updates
of their work. These presentations should be presented in a formal fashion using
Power Point slides and are intended to provide each trainee with experience in
preparing and presenting a brief discussion. For every Friday patient care rounds
session, each fellow should come prepared to discuss an interesting outpatient case.
This is an informal presentation, however if there are interesting films, laboratory
findings or pathology, these will add to the interest and educational value of the case.
All presentations will be archived on the Program’s internal web site:
www.cytopenia.net. The username is scripps and password is 3north.

CALL SCHEDULE/MOONLIGHTING:

The divisional call schedule assignments will be prepared in advance by the senior clinic
fellow with the approval of the Program Director. While on call for the Division,
moonlighting activity is strictly forbidden. Permission of the Program Director must be
obtained, and the Scripps Clinic/Scripps Green Hospital Department of GME moonlighting
policy must be adhered to (attached – pages 27-8). Failure to follow this policy will result
in disallowance of moonlighting privileges for all fellows.

EVALUATIONS:

Each fellow will be evaluated on a quarterly basis by all faculty with whom they have
worked, nurses, medical assistants, secretaries and selected patients. These evaluations
will be summarized and the summary reviewed with each fellow by the program director.
Fellows on block rotations (e.g. blood bank) will be evaluated at the end of each such
rotation.

Fellows will also be asked to evaluate attending physicians and the program on a regular
basis (semi-annually). Such evaluations will be kept strictly confidential, and are an
important component of programmatic improvement. Fellow names are automatically
removed by the program, so confidentially is insured. All evaluations are completed on
line using the “New Innovations” web-based evaluation software. The web site is
http://www.new-innov.com/suite/default.asp.

Annually, the Department of Graduate Medical Education sends an evaluation to all
fellows regarding their program and the institution. Completion of all evaluations is
required, and is used for programmatic improvement.
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                                                                         Hematology/Oncology
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                                                                        Policy and Procedures
                                                                                    June, 2009
BOARD ELIGIBILITY:

The Hematology/Oncology training program at Scripps Clinic/Scripps Green Hospital is
fully accredited. Currently ABIM policy requires that if you wish to be eligible for boards in
both hematology and medical oncology, you must declare this in advance and notify the
ABIM. A copy of the ABIM brochure for trainees is available at www.ABIM.org. It is your
responsibility to maintain a procedure log and a log of all consultations, inpatient and
outpatient. This should be kept in a format which is easily accessible to any faculty
member and the ABIM, should they wish to review it. Complete and turn into the
fellowship secretary the monthly inpatient and outpatient consultation summaries (see
sample, attached).

IN-TRAINING EXAM

Annually, all fellows will participate in two in-training examinations put on by the National
Board of Medical Examiners, and sponsored by ASCO and ASH. The purpose of these
examinations is to allow teach fellow to assess their performance relative to their peers
nationwide.

Our goal is to provide a broad based training experience and to facilitate your career as a
clinician or researcher. Traditionally, our trainees have enjoyed their experience at the
Scripps Clinic, and have gone on to various successful careers.

Both Dr. Saven and myself invite your comments and we encourage you to communicate
any problems or concerns you may have to us. We wish you every success in the
coming year.



Michael P. Kosty, M.D., F.A.C.P.
Program Director




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                                                                           Hematology/Oncology
                                                                    Fellow Orientation Handbook
                                                                          Policy and Procedures
                                                                                      June, 2009
INFORMATION FOR HEMATOLOGY AND MEDICAL ONCOLOGY FELLOWS


                              Attachments



 Weekly Conference Schedule
 2008-2010 Fellow Clinic Schedule
 Chemotherapy Risk Documentation
 Consultation and Procedure Logs
 Lab Coats and Laundering
 Management of Inpatients
 Fellow Schedule Templates
 Order Writing Policy
 On-Call Procedures
 Radiology/Pathology Outside Review
 Request for Leave or Meeting
        Fellows Request for Meeting or Vacation Leave
 Referring Physician Addresses
 Senior Fellow Administrative Responsibilities
 Schedule II prescription forms/DEA Certificate
 Tumor Board Conferences
 Moonlighting Policy with Application




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                                                               Hematology/Oncology
                                                        Fellow Orientation Handbook
                                                              Policy and Procedures
                                                                          June, 2009
 HEMATOLOGY/ONCOLOGY FELLOW WEEKLY CONFERENCE SCHEDULE

MONDAY
Thoracic Oncology Conference
 nd       th
2 and 4 Mondays
12 Noon – Evans Conference Room
Hematopathology Review
 st      rd
1 and 3 Mondays
12 – 1 – Scope Room - W209

TUESDAY
Breast Oncology Conference
 ST       rd
1 and 3 Tuesday of every month
8:00 a.m. – 9:00 a.m. – Green Cancer Center Conference Room
Scientific Protocol Review Meeting
 nd
2 Tuesday of every month
8:00 a.m. – Green Cancer Center Conference Room
Journal Club
 st
1 Tuesday of every month
12:30 p.m. – Green Cancer Center Conference Room
Hematology/Oncology Grand Rounds
As scheduled
12:30 -1:30 p.m. – Green Cancer Center Conference Room
Cutaneous Oncology Conference
 rd
3 Tuesday of every month
12 Noon – Green Cancer Center Conference Room
Head and Neck/Neurooncology Tumor Board
 nd      th
2 and 4 Tuesday of every month
12 Noon – Radiation Oncology Conference Room

WEDNESDAY
Scripps Clinic Grand Rounds
12 – 1 – Timkin Amphitheater
Hematopathology Review
 nd       th
2 and 4 Wednesdays
12 - 1 – Scope Room - W209

THURSDAY
Clinical Research Conference
 st
1 Thursday of each month
8:15 a.m. – Green Cancer Center Conference Room
General Tumor Board
12 Noon – Green Cancer Center Conference Rooms)

FRIDAY
Hematology/Oncology Rounds
8:00 a.m. – Green Cancer Center Conference Room
Fellow Talk
Weekly on a rotating basis
Immediately following rounds – Green Cancer Center Conference Room
Core Lecture Series
3:00 p.m. – Green Cancer Center Conference Room




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                                                                            Hematology/Oncology
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                                                                           Policy and Procedures
                                                                                       June, 2009
                       Division of Hematology/Oncology
                          Fellow Clinic Assignments
                                           2009-2010
                                  Block 1 – June 29 – July 24


                                                                                          *
     AM           Monday        Tuesday       Wednesday       Thursday            Friday
Doraiswamy            -             -              -               -                 -
                                                                                            +
Naik              Andrey      Kroener           Kosty        Saven             Rounds/Mason
Torrey              InPt          InPt           InPt            InPt           Rounds/InPt
                                                         #
Vosganian           BMT           BMT         BMT/office         BMT            Rounds/BMT
Jhatakia          Kroener        Kosty       Research        Research         Rounds/Kroener
Miller             Saven         Mason         Research         Kosty         Rounds/Research
Schram              Lab           Lab            Lab             Lab            Rounds/Lab



                                                                                      *
     PM          Monday         Tuesday      Wednesday          Thursday       Friday
Doraiswamy          -               -            -                  -             -
Naik              Saven          Office       Kroener             Sigal        Kosty
Torrey           Kroener          Sigal      Kosty(RB)            Saven        Office
Vosganian         Kosty          Saven         Andrey            Kroener        Sigal
Jhatakia         Research       Research      Research          Research      Research
Miller           Research       Research      Research          Research      Research
Schram             Lab            Lab          Saven             Mason          Lab


   Friday Rounds from 8:00 - 10:00 AM

   Friday Clinic 10:00 AM – 3:00 PM with 12:00 Noon – 1:00 PM for lunch

   First year fellows have a maximum of five patients/half-day clinic

   RB = Rancho Bernardo; EN = Encinitas

   + = Clinic or BMU (when staff on BMU call)

   # = Office time after BMT inpatients

   Dr. Naik does not begin until July 6, 2009; Dr. Doraiswamy begins August 1, 2009.




June 2009

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                                                                            Policy and Procedures
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                        CHEMOTHERAPY RISK DOCUMENTAION

It is critical that you dictate a statement in the chart whenever a patient is beginning a new
chemotherapy regimen. This note should detail the regimen (drugs, does and schedule)
patient's body surface area, weight and if at all possible, a reference. A statement should
be made in the chart that you have explained the specific risks/benefits of the
chemotherapy including cytopenias and possible death and that the patient wishes to
proceed with the therapy. The intent (palliative or curative) and the tentative number
of cycles should also be clearly documented. This should be documented at the start
of each new chemotherapy regimen. If first course of therapy is as an outpatient, the
statement should appear in the outpatient chart. Similarly, if the first course is as an
inpatient it should be in the inpatient chart. Handouts on specific agents are available in
the treatment room. A generic folder describing patient support resources is also
available.

Doses should be recorded on the chemotherapy flow sheet, which will be kept in the
patient's outpatient chart. It is the fellow’s responsibility to insure that a flow sheet is in
the chart of each patient receiving chemotherapy, and that it is filled out and up to date.

At the completion of a particular course of therapy a treatment summary should be
dictated giving the regimen, treatment intent, side-effects experienced, and why the
regimen is being terminated (completed # of cycles, excessive toxicity, progressive
disease, etc.).

Verbal orders are never acceptable for chemotherapy.


                        CONSULTATION AND PROCEDURE LOGS

Each month please record consults and procedures which you have done and turn these
in to May Ann Crisologo at the end of each month. Note there are two forms: one for
consultations and one for procedures. Sample forms are included at the end of this
document.

We will be asking you to fill out these forms monthly. This information is being collected
so we can assess fellow performance and provide accurate documentation for program
accreditation. Time off and meeting time will not be approved if this documentation is not
submitted to the Fellow Secretary in a timely fashion.




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                            LAB COATS AND LAUNDERING

You are issued two white lab coats when you arrive at Scripps Clinic. If they do not fit
properly, we can either order a new size or in some cases have the coats altered for you.
 Your name is embroidered on the front of the coat. When you need to have them
cleaned, just place the coat in the white "Linen" bin located in the hall near the fellows'
office.

Please note that due to the volume of laundering done for Scripps, it may take as long as
2 to 4 weeks to return cleaned coats. They should be returned to the department by
environmental services staff, and are usually hung on the back of the door in your office.




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                            MANAGEMENT OF INPATIENTS
                                (See also pages 4 -5)

The training program is structured so that there is an inpatient fellow, and a second
fellow who rotates on the inpatient leukemia/transplant service (3N). These fellows are
required to round on all inpatients on their respective services prior to attending rounds.
 Detailed schedules are attached. Patients may be admitted to the hospitalist service,
the Internal Medicine Teaching Service, or the Hematology/Oncology service.

Inpatients on the Internal Medicine teaching service are primarily managed by the
medicine residents, with Heme/Onc fellows acting as consultants. The Institutional policy
on order writing is delineated below.             It is entirely appropriate to have
hematology/oncology patients on the internal medicine teaching service. If a patient is on
the teaching service, fellows are expected to provide the ward teams with any assistance,
references, etc. which might enhance their educational experience.

For patients on the hospitalist service, the hematology/oncology service acts in a
consultative role. Heme/Onc fellows may co-manage these patients with the hospitalists.


The inpatient fellow with the supervision of the inpatient attending staff manages patients
on the Hematology/Oncology service. For any inpatient interaction, both fellows and staff
are required to write daily notes. Rounding is to occur at a defined time (see schedule),
however admissions or consultations which occur after these daily rounds should be
discussed with the attending physician that day. The attending physician must see all
patients within 23 hours of their admission. As both the inpatient fellow and the
leukemia/transplant fellow have required afternoon clinics, it is anticipated that some
patient care issues, consultations and admissions may need to be addressed after this
clinic is concluded.

If there is ever a doubt on whose service a patient should be admitted, the fellows
should err on the side of admitting to the Heme/Onc service. Fellows should never
argue with Urgent Care physicians, hospitalists or other attending physicians. If
there is an issue which might impact patient care, the attending physician on call
should be notified, and that individual will communicate, attending to attending,
and resolve the issue.




                                            18
                                                                         Hematology/Oncology
                                                                  Fellow Orientation Handbook
                                                                        Policy and Procedures
                                                                                    June, 2009
                        Leukemia/Transplant Fellow Schedule



      Monday       Tuesday       Wednesday      Thursday       Friday         Saturday      Sunday


                                                Inpatient
        IM                           IM
                    Breast                      Teaching/
8     Morning                      Morning                                       Off          Off
                    Conf.                       Research
      Report                       Report
                                                  Conf.       Heme/Onc
                                                               Division
     Multidisci-   Multidisci-    Multidisci-   Multidisci-    Rounds
      plinary       plinary        plinary       plinary
9
     Inpatient     Inpatient      Inpatient     Inpatient
      Rounds        Rounds         Rounds        Rounds



10
      Fellow/       Fellow/        Fellow/        Fellow/      Fellow/
     Attending     Attending      Attending      Attending    Attending
     Inpatient     Inpatient      Inpatient      Inpatient    Inpatient
     Teaching      Teaching       Teaching       Teaching     Teaching
      Rounds        Rounds         Rounds         Rounds       Rounds
11



                   Journal          Scripps
      Thoracic
                   Club,         Clinic Grand
     Oncology/                                       Tumor
12                 Invited         Rounds/                      Lunch
       Heme                                          Board
                   Speaker,      Heme Path
     Path Conf.
                   Cutaneous         Conf.
                   Oncology
1
                   Q/A, H&N
     Outpatient                  Outpatient     Outpatient    Outpatient
     Continuity                  Continuity     Continuity    Continuity
2      Clinic                      Clinic         Clinic        Clinic
                   Outpatient
                   Continuity
3                    Clinic
                                                               Fellow
                                                                Core
4
                                                               Lecture

5




                                                19
                                                                                  Hematology/Oncology
                                                                           Fellow Orientation Handbook
                                                                                 Policy and Procedures
                                                                                             June, 2009
                               Inpatient Fellow Schedule



      Monday      Tuesday      Wednesday      Thursday       Friday         Saturday      Sunday


                                              Inpatient
        IM                         IM
                   Breast                     Teaching/
8     Morning                    Morning                                     Fellow/      Fellow/
                   Conf.                      Research
      Report                     Report                                       Staff        Staff
                                                Conf.       Heme/Onc
                                                             Division       Inpatient    Inpatient
                                                             Rounds          Rounds       Rounds
                                                                            (On Call     (On Call
9                                                                            Fellow)      Fellow)
      Fellow       Fellow        Fellow            Fellow
       work         work          work              work
      rounds       rounds        rounds            rounds
                                                             Fellow
10                                                            work
                                                             rounds

      Fellow/      Fellow/        Fellow/       Fellow/      Fellow/
     Attending    Attending     Attending      Attending    Attending
11   Inpatient    Inpatient      Inpatient     Inpatient    Inpatient
     Teaching     Teaching      Teaching       Teaching     Teaching
      Rounds       Rounds         Rounds        Rounds       Rounds
                    Journal       Scripps
      Thoracic
                     Club,     Clinic Grand
     Oncology/                                     Tumor
12                  Invited      Rounds/                      Lunch
       Heme                                        Board
                   Speaker,    Heme Path
     Path Conf.
                  Cutaneous        Conf.
                  Oncology
1
                  Q/A, H&N
     Outpatient                 Outpatient    Outpatient    Outpatient
     Continuity                 Continuity    Continuity    Continuity
2      Clinic                     Clinic        Clinic        Clinic
                  Outpatient
                  Continuity
3                   Clinic
                                                             Fellow
                                                              Core
4
                                                             Lecture

5




                                              20
                                                                                Hematology/Oncology
                                                                         Fellow Orientation Handbook
                                                                               Policy and Procedures
                                                                                           June, 2009
                       Outpatient Fellow Schedule Template




      Monday      Tuesday      Wednesday      Thursday      Friday         Saturday      Sunday


                                              Teaching
        IM                        IM
                   Breast                     Rounds/
8     Morning                    Morning                                    Fellow/      Fellow/
                   Conf.                      Research
      Report                     Report                                      Staff        Staff
                                               Conf.       Heme/Onc
                                                            Division       Inpatient    Inpatient
                                                            Rounds          Rounds       Rounds
                                                                           (On Call     (On Call
9                                                                           Fellow)      Fellow)



     Outpatient   Outpatient   Outpatient     Outpatient
10   Specialty    Specialty    Specialty      Specialty
       Clinic       Clinic       Clinic         Clinic
                                                           Outpatient
                                                           Specialty
                                                             Clinic
11



                    Journal       Scripps
      Thoracic
                     Club,     Clinic Grand
     Oncology/                                     Tumor
12                  Invited      Rounds/                     Lunch
       Heme                                        Board
                   Speaker,    Heme Path
     Path Conf.
                  Cutaneous        Conf.
                  Oncology
1
                  Q/A, H&N
     Outpatient                Outpatient     Outpatient   Outpatient
     Continuity                Continuity     Continuity   Continuity
2      Clinic                    Clinic         Clinic       Clinic
                  Outpatient
                  Continuity
3                   Clinic
                                                            Fellow
                                                             Core
4
                                                            Lecture

5




                                              21
                                                                               Hematology/Oncology
                                                                        Fellow Orientation Handbook
                                                                              Policy and Procedures
                                                                                          June, 2009
                     SCRIPPS CLINIC/SCRIPPS GREEN HOSPITAL
                             ORDER WRITING POLICY

Order writing protocols will adhere to the policy and procedures of the hospital or clinical
site at which the resident/fellow is working. This policy applies to written and computer
entered orders. Lines of responsibility will be reflected in the rotation curricula. Residents
and fellows will bear first responsibility for all patients on a teaching service. House
officers with primary responsibility for a patient’s care will write all orders for patients
admitted to teaching services. Supervising faculty (attendings) must be consulted on
issues of substantive import, including establishment of code status, and performance of
complex, high-risk procedures. It is the expectation that residents and attendings
performing consultations will not write orders unless requested to do so by the physician
requesting the consultation. There are certain exceptions to this policy:

     1. Simple pre- and post-procedure orders;
     2. Specific chemotherapy orders;
     3. Emergency orders where the resident or fellow caring for the patient is not
        immediately available and delay would jeopardize patient care.

In general, order writing on the Internal Medicine teaching service is the responsibility of
the PGY1 resident who is responsible for the care of the patient. The exception to this
would be outpatients who are under the primary care of a physician at another level.
Detailed Internal Medicine order writing policy can be found in the Scripps
Clinic/Scripps Green Hospital Internal Medicine Residency policy and procedures
manual.

Attending physicians and house officers at levels higher than PGY1 may write orders if
necessary for responsible patient care and if the PGY1 resident is not available. In all
cases, however, the PGY1 resident should be notified of the order as soon as possible.

For patients who are on teaching services other than the Internal Medicine teaching
service, orders will be written by the resident/fellow caring for the patient. Attending
physicians may write emergency

Orders may be written or entered by medical students, but they must be immediately co-
signed by physician who shares responsibility for the patient for whom the orders were
written or entered. Orders written by a medical student will not be honored if they are not
co-signed.

Telephone orders for inpatients may be given in accordance with the policies of the
institution. Telephone orders must be signed within 24 hours.

Do not resuscitate orders must be written according to hospital protocols.

 All orders must be dated, timed and signed to be considered valid.

                                              22
                                                                            Hematology/Oncology
                                                                     Fellow Orientation Handbook
                                                                           Policy and Procedures
                                                                                       June, 2009
                                ON-CALL PROCEDURES


When you are on call in the evenings and weekends you will be covering the practices of
up to 7 attending physicians. You will receive phone calls from individuals with a wide
variety of oncologic and hematologic conditions and you will have to make an assessment
as to what steps must be taken for the individual patient. Every attempt should be made
to resolve the problem over the telephone. If it is necessary to have the patient seen in
urgent care, you must contact the urgent care physician and notify them of the problem,
patient's name, etc. prior to the patient arriving at the UCC. If a patient obviously requires
admission, please arrange for admission. All cancer or treatment related problems
should be admitted to the hematology/oncology service. Non-cancer or treatment related
conditions may be admitted to the hospitalists, internal medicine or surgery services after
discussing with the appropriate physician(s). It is important that you document all calls on
the institutional multi-copy telephone messages, writing down the critical information
including any instructions and prescriptions. The next morning copies should be sent to
the medical record, as well as, to the attending physician. It is also helpful to leave a
voice mail or e-mail message to the staff physician regarding any significant patient
problems and all admissions.


                           OUTPATIENT CLINIC SCHEDULES


Attached, is the outpatient clinic schedule (page 13). Fellows are assigned to a specific
attending physician, in one-half day increments. This schedule is maintained throughout
the academic year, except for the morning, which varies with the inpatient/BMU schedule.

While working with a faculty physician, the fellow is expected to see new patient
consultations, return visits and patients previously seen in consultation, or other patients
the faculty feels might be interesting or in particular need of attention, and perform
procedures on patients as required. In addition, arranging admission from the outpatient
clinic for those patients requiring admission will be the responsibility of the fellow working
with that given attending physician.

No activities should be scheduled without prior permission of the attending
physician, which would interrupt or otherwise interfere with your outpatient clinic
activities.  These include appointments, patient care conferences, inpatient
procedures, and outpatient procedures for another attending physician, meetings,
etc.

Promptness is essential to maintain good patient rapport. Fellows should be in clinic by
9:00 a.m. for morning clinic, and 1:00 p.m. for afternoon clinic. Pages from the clinic,
treatment room, or inpatient ward should be answered promptly.

                                             23
                                                                           Hematology/Oncology
                                                                    Fellow Orientation Handbook
                                                                          Policy and Procedures
                                                                                      June, 2009
Finally, follow up has sometimes been problematic. On the super ticket (multipart blue
form) follow up should be indicated by noting, for example, "RV (return visit) with
Fellow/Doctor (Faculty) on Monday a.m. in three weeks". This will insure that the patient
returns to see the same fellow and staff physician during the same half-day they were
originally seen and allow for maximum continuity. If "RV with Doctor (Faculty)" is written,
the schedulers and patient may very well choose a time when the staff physician is not
with a particular fellow, thereby interfering with follow up. Staff physicians may, at their
discretion, ask fellows to see patients initially seen by other fellows who have not
appropriately arranged follow up.

We believe the schedule in place affords the greatest possibility of long-term follow up if
used appropriately.




                                            24
                                                                         Hematology/Oncology
                                                                  Fellow Orientation Handbook
                                                                        Policy and Procedures
                                                                                    June, 2009
                     RADIOLOGY/PATHOLOGY OUTSIDE REVIEW


Patients transferring care or coming for second opinions to Scripps Clinic often need to
have radiographic studies and/or pathologic material reviewed. These reviews can be
accomplished on an expeditious basis if the following procedures are followed:

       A.     Radiologic studies:

               Radiologic studies should be screened by the patient's physicians and
selected films/CD marked for review with paper clips or by some other means. According
to hospital by-laws, the Department of Radiology will not review any film that is not
accompanied by the original written radiology report. This is largely for medical/legal
reasons, however, it is a way for the radiologist to verify that, in fact, all films of a study
are available to them. It is also helpful to provide as much clinical information to the
radiologist as possible. Formal review is often not required if the patient is having a new,
similar study performed at the Clinic. For example, a patient having a new abdominal CT
scan can have new scan compared with old, outside scans to look for disease
progression and/or response to therapy at no additional charge. In fact, outside films are
often extremely useful to radiologists and there submission for inclusion into the patient's
Scripps Clinic radiology folder is encouraged, if available. Studies on CD ROM should be
kept by the patient and brought with them to the next relevant study. The radiologist will
then have the outside study for immediate review, lessening chances an outside study
might be misplaced.

       B.     Pathologic material:

              Outside slides can be reviewed by pathology. They must be accompanied
by a pathology specimen form. Providing as much clinical information as possible will
greatly assist the reviewing pathologist. They will not review any material which is not
accompanied by an original written report.

There is a charge for outside review of pathology and/or radiologic material which
is often substantial. Patients must be informed of this charge prior to the initiation
of such a review. This review is often not covered by insurance.




                                              25
                                                                           Hematology/Oncology
                                                                    Fellow Orientation Handbook
                                                                          Policy and Procedures
                                                                                      June, 2009
                        REQUESTS FOR LEAVE OR MEETING



Requests for leave or time to attend a meeting need to be made in writing and as far in
advance as possible but at least 3 to 4 weeks ahead of time. A sample form is
attached. You may obtain forms from the Fellowship Secretary and then return to her for
the Program Director’s approval. Please note that all information requested must be
provided. Failure to completely fill out the form will result in it being returned for
completion. It is the responsibility of the fellow scheduling leave to personally notify the
appropriate attending physician(s) and their medical secretaries of their leave time so it
can be noted on the attending physician's schedule.

Except under unusual circumstances, only one clinic fellow will be on leave at any one
time. Exceptions include national meetings, professional examinations (Internal Medicine
Boards, Subspecialty Boards) and the December holidays. Every attempt will be made to
balance leave requests over a three-year period and cooperation/coordination with
colleagues is encouraged.

All time off is subject to approval of the program director and such approval must be
obtained in writing. It is important to obtain approval for time off prior to purchasing
tickets or making any irrevocable plans. Such arrangements will not be grounds
for “automatic approval” and the program will not reimburse any fellow for costs
necessitated by such rescheduling.

It is reemphasized that when on an off-service rotation (blood bank, radiation/oncology,
Hospice, pediatrics, etc.) no leave will be approved except in unusual circumstances.

Approved leave will be included on an absence schedule, prepared weekly so that the
Division, nursing staff, telephone operators, etc. will be aware of a physician's absence.




                                            26
                                                                         Hematology/Oncology
                                                                  Fellow Orientation Handbook
                                                                        Policy and Procedures
                                                                                    June, 2009
                       REQUEST FOR MEETING OR VACATION LEAVE


Except for emergency situations, all requests for meeting or vacation time off must be submitted at least
four weeks in advance. Requests not received at least four weeks in advance are subject to
disapproval.


Name: ___________________________ Today’s Date: ___________________

Meeting:____________              Vacation:_____________

Dates of Vacation: _________________________________________________

Dates of Meeting: __________________________________________________

Name of Meeting: __________________________________________________

Location of Meeting: ________________________________________________
(Please attach a copy of the meeting brochure – not required for ASH or ASCO)

It is important to obtain program director approval for time off prior to purchasing tickets or making
any irrevocable plans. Such arrangements will not be grounds for “automatic approval” and the
program will not reimburse any fellow for costs necessitated by such rescheduling.

It is the responsibility of the fellow requesting leave to notify the appropriate attending physicians
and their secretaries of their absence.



(For office use only below this line)

Consult and procedure logs up to date? _______

Inpatient fellow during requested time off? _______

Inpatient medical records delinquent? _______

After above request:

Leave balance __________


Approved:_______________                Not approved*:________________

*Reason not approved:_____________________________________________________


Revised 6/06




                                                      27
                                                                                   Hematology/Oncology
                                                                            Fellow Orientation Handbook
                                                                                  Policy and Procedures
                                                                                              June, 2009
                          REFERRING PHYSICIAN ADDRESSES


Good communication in medicine is vitally important. All consultations are to be dictated,
and fellows are encouraged to dictate progress notes. Any dictated note is accessible by
computer; handwritten notes are not. When you are on call, it is nice to have as much
information available about patients with whom you are unfamiliar. Sending copies of any
dictation to the patient's internist/family practitioner and any other specialists involved in
their care is common courtesy and required for our patients.

The transcription department will automatically send a copy of all outpatient dictation to
referring doctors in-house. For staff physicians, transcription services will mail a copy of
any dictation. For non-Scripps Clinic physicians, please be sure to provide the referring
physician name, address (and telephone, if known) on all outpatient dictations. A FAX
number is also useful. If this information is left off the dictation, the transcriptionist will not
be able to send a copy to the referring physician.


                    SENIOR FELLOW ADMINISTRATIVE RESPONSIBILITES



       The senior fellow is responsible for:

       1.      The fellow call schedule,

       2.      Scheduling Friday morning fellow presentations,

       3.      Preparing the inpatient and leukemia/lymphoma fellow schedules,

       4.      Insuring fellows attend all required conferences and calling any concerns
               to the program director's attention.


       Dr. Jhatakia will function as the Senior Fellow from July 1, 2009 through
       December 30, 2009; Dr. Miller will function as the senior fellow from January 1,
       2009 through June 30, 2009.




                                                28
                                                                              Hematology/Oncology
                                                                       Fellow Orientation Handbook
                                                                             Policy and Procedures
                                                                                         June, 2009
        STATE OF CALIFORNIA CONTROLLED DRUG PRESCRIPTIONS/DEA

                                      CERTIFICATE


The State of California requires that all physicians have preprinted prescription forms to
prescribe schedule II narcotics and other (schedule III) controlled substances necessary
in the management of cancer patients. To order these forms you can call the fellowship
secretary.

Allow 4-6 weeks for all requests.

A current DEA certificate and California controlled drug prescriptions are required
for participation in the training program. Failure to promptly obtain these items will
interfere with your ability to provide adequate patient care, and may result in disciplinary
action.

Current laws require that copies of these forms be kept on file for a minimum of three
years.




                                            29
                                                                         Hematology/Oncology
                                                                  Fellow Orientation Handbook
                                                                        Policy and Procedures
                                                                                    June, 2009
                           TUMOR BOARD CONFERENCES


Quite often, patients will be seen in the Clinic or during the course of performing an
inpatient consultation who have an unusual presentation of a common disease, exhibit a
diagnostic dilemma, or are otherwise appropriate to present at one of our conferences.
The medical tumor board, which meets Thursday at noon, is an ideal forum for discussing
patients with solid tumors and non-hematologic malignancies. A brief form needs to be
completed, and submitted to Rachelle Graefen, no later than Monday of the week of the
Tumor Board. This form should be filled out as completely as possible, providing a
succinct history and physical, and more importantly indicating which radiologic studies,
and where performed (e.g. Torrey Pines, Rancho Bernardo, Carmal Valley, outside films)
and what pathologic material should be reviewed. This early deadline is required to allow
the Departments of Radiology and Pathology adequate time for review.

Other tumor boards include Head and Neck (2nd and 4th Tuesdays), Thoracic Oncology
(2nd and 4th Mondays) and Visible Tumor Board (Skin Tumors, 3rd Tuesdays). There is
also a Breast Conference every other Tuesday morning. Fellows are encouraged to
attend and present appropriate patients.




                                           30
                                                                       Hematology/Oncology
                                                                Fellow Orientation Handbook
                                                                      Policy and Procedures
                                                                                  June, 2009
                                 Scripps Clinic/Scripps Green Hospital
                               Department of Graduate Medical Education

                                  Resident/Fellow Moonlighting Policy
                                        Policies and Procedures

a) Moonlighting Definition:
   According to the ACGME, "moonlighting" is defined as the circumstance of working as a physician
   outside of one's authorized training program.

b) Moonlighting Cannot Be Required:
   The Program shall not require any trainee to participate in moonlighting activities.

c) Full-Time Obligation:
   Residency/Fellowship training constitutes a full-time obligation. The Internal Medicine Residency
   Program and Subspecialty Fellowship Programs must function as the resident’s primary professional
   and educational activity.

d) Hour Restrictions:
   No trainee may moonlight within the Scripps Clinic or Scripps Green Hospital during time periods
   where such moonlighting would result in the trainee working more than 30 consecutive hours in the
   provision of patient care and educational activities, except under special circumstances explicitly
   approved by the trainees’ program director. In other words, moonlighting activities must be restricted
   to Friday, Saturday, and Sunday and vacation days, and special circumstances where patient care will
   not be impacted. Moonlighting may be carried out during weekdays when the trainee is assigned to a
   research experience or non-clinical care experience if the moonlighting will not interfere with research
   activities and if it is explicitly approved of by the trainees’ program director.

e) Notification of PD:
   Trainees who are licensed to practice medicine in California and who wish to participate in
   moonlighting activity outside of the residency duty hours must provide prior written notice, which
   includes the number of hours of moonlighting per week, to the Program Director of their intent to do
   so. Such notification will be placed in the trainee’s evaluation folder. Combined work hours in the
   residency program and moonlighting hours must never exceed 80 hours per week.

f)   PD must monitor moonlighting activities:
     The Program Director must monitor the number of hours and the nature of the workload of residents and
     fellows engaging in moonlighting experiences.

g) Must Not Adversely Impact Education:
   Moonlighting activities must not interfere with the trainees’ educational and work activities related to
   the residency program. Moonlighting must not adversely impact a Trainee’s academic, cognitive,
   professional, or humanistic performance. If a Program Director deems that a trainee’s moonlighting
   activities are interfering with the trainee’s educational or patient care performance, the Program
   Director may require the trainee to cease moonlighting activity. If the trainee does not comply, the
   credit for the educational time in question may be denied.

h) Licensure and Insurance are the Trainee’s (not the Program’s responsibility):
   Both the trainee participating in any moonlighting activity and the entity or individual who has
   contracted with the trainee, are responsible for ensuring that the trainee (a) has all appropriate skills to
   carry out the assigned duties, (b) has appropriate liability insurance, and (c) is appropriately licensed.




                                                      31
                                                                                       Hematology/Oncology
                                                                                Fellow Orientation Handbook
                                                                                      Policy and Procedures
                                                                                                  June, 2009
                            MOONLIGHTING NOTIFICATION FORM
                          SCRIPPS CLINIC/SCRIPPS GREEN HOSPITAL




I,__________________________________, wish to inform my Program Director that I plan/do not plan
                 (print name)                                                                        (circle one)
to participate in moonlighting activities outside of my training program. I attest that between my clinical

work, in-house educational activities, and moonlighting hours that I will not participate in more than 30

consecutive hours of in-house training, patient care, and moonlighting. I attest that I will not participate in

more than 80 hours of in-house clinical care, educational activities, and moonlighting in any one-week

period when averaged over four weeks. I will make available to my program director, at his/her request,

accurate documentation of my moonlighting schedule.

___________________________________                _____________________
Trainee                                            Date


__________________________________                ______________________
Program Director                                  Date




 Nature of Moonlighting:__________________________________________________________

 Moonlighting Supervisor:_________________________________________________________

 Hours spent Moonlighting:
                 Per week:_________________________________

                   Averaged over 4 week period:_________________

 Performance monitoring:____________________________________

 Moonlighting status:
                   Active:____________________________________

                   Withdrawn: _______________________Date:_____________________




                                                      32
                                                                                        Hematology/Oncology
                                                                                 Fellow Orientation Handbook
                                                                                       Policy and Procedures
                                                                                                   June, 2009
                      Division of Hematology and Oncology
                                Consultation Log


Period covered: __________________________ to : ____________________________



  Date        Patient ID        Diagnosis        Inpt. (I)       Supervising
            (xxx-xx-xx-xx)                      Outpt. (O)          Staff




                                      33
                                                                Hematology/Oncology
                                                         Fellow Orientation Handbook
                                                               Policy and Procedures
                                                                           June, 2009
                                           Division of Hematology and Oncology
                                                       Procedure Log


Month: __________________________ Year: __________________

Fellow: __________________________


  Date          Patient ID     Diagnosis         Procedure      Indication   Complication   Supervising Staff
              (xxx-xx-xx-xx)




Revised – 06/25/07
Revised – 06/25/07

				
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