Clinical Rotations

Hematology consults
Number of blocks: 3
Location(s): OHSU and PVAMC
Team: Attending (1), fellow (1), internal medicine resident (0-2), medical student (0-1)
Fellows will see consults at both OHSU and PVAMC, often with an even balance of the two on a daily basis. This mixture of patient populations provides an excellent and broad exposure to all manner of non-malignant hematology pathologies, including disorders of thrombosis and hemostasis, hemoglobinopathies, and all manner of cytopenias. In addition, the hematology consult service serves as the primary consulting team for all patients with hematologic malignancies admitted for chemotherapy at PVAMC; these patients are managed primarily by medicine teaching service and hospitalists with hematology consultants guiding care.

Oncology consults
Number of blocks: 3
Location(s): OHSU and PVAMC
Team: Attending (1), fellow (1), physician assistant (1), internal medicine resident (0-2), medical student 
Fellows will see consults at both OHSU and PVAMC, often with an even balance of the two on a daily basis. This mixture of patient populations provides an excellent and broad exposure to all manner of solid tumors and patient populations. Consults typically consist of: 1) new cancer diagnoses to help with appropriate staging and other workup, 2) assistance to primary teams in diagnosing and managing cancer and treatment-related complications, 3) assistance with palliative/end-of-life discussions with patients, family and other medical providers. 

Malignant hematology
Number of blocks: 2
Location(s): OHSU
Team: Attending, fellow, advanced practice practitioners (APP), pharmacist(s)
Fellows will participate in a multidisciplinary team caring for patients with all manner of hematologic malignancies admitted to OHSU for treatment and/or complications of care, including CAR-T and immune therapy. The malignant hematology service is split into three teams: 1) acute leukemia, 2) allogeneic transplant, and 3) autologous transplant. Fellows typically spend their first block on the acute leukemia service, and second block on the allogeneic transplant service, though fellows are able to tailor their second rotation depending on their clinical interests. Fellows will be the primary provider responsible for 5-6 patients at one time.

VA outpatient 
Number of blocks: 2
Location(s): PVAMC
Team: Fellow (1)
The VA outpatient block provides a structured schedule to rotate through a variety of multidisciplinary hematology and oncology clinics at PVAMC, including Lung, GI, GU, head & neck, as well as hematologic malignancies. This experience includes participation in the various sub-specialty, multi-disciplinary tumor boards at the VA. In addition, fellows will participate in addressing “e-consults” to the PVAMC heme/onc service, providing excellent experience in initial triage and response to various consult questions. 

Palliative care
Number of blocks: 1
Location(s): PVAMC
Team: Attending (1), heme/onc fellow (1), palliative care fellow (1), social work (1-2)
Fellows will participate in a multidisciplinary team seeing inpatient consults at PVAMC. Consults are typically for assistance in managing cancer-related symptoms, emotional suffering and end-of-life discussions. Fellows will receive see consults with heme/onc diagnosis. This rotation also includes participation in a weekly palliative care outpatient clinic, which often provides opportunities for fellows to see their own patients from their own VA heme/onc clinic panel in a structured palliative care setting.

Elective
Number of blocks: 1
Location(s): PVAMC
Fellows are provided a block to devote to educational, clinical or research activities of their choosing. Fellows are expected to design a learning and/or research plan before the start of this block. Examples of elective activities include intensive exposure in a single sub-specialty solid tumor clinic, a broad exposure to several different clinics, or intensive focus on a basic, clinical or translational research project. 

Clinic experience

VA fellow clinic
The OHSU hematology/oncology program prides itself on a unique and robust VA clinic experience, consistently reported by fellows to be the highlight of their training. Fellows serve as primary consultants for their own panel of veteran patients in a weekly clinic on Thursday mornings at PVAMC, continued throughout all three years of fellowship. Patients from are referred from Oregon as well as the greater Pacific Northwest region for ANY hematologic or oncologic disease; this provides a continual, broad exposure to pathologies. Fellows see patients and formulate workup and management plans independently. 2-3 attending physicians are always available in clinic with the sole purpose of staffing patients. Benefitting fellows in this clinic is an experienced group of hematology and oncology nurses, nurse practitioners, pharmacists, and social workers who make themselves available to assist fellows in effective an efficient longitudinal care of medically complex patients. Each fellow is assigned to one of three nurse practitioners, who can assist by seeing patients in between chemo cycles, monitoring for toxicities, and any number of other tasks. 

Fellow tumor board experience
A highlight of the VA outpatient fellow clinic is a weekly fellow tumor board. This event occurs every Wednesday afternoon, and is attended by all fellows, typically 3-4 attendings of various specialties, and a dedicated radiologist; pathologists and other specialties can be invited on a case-by-case basis. This tumor board exists solely for the benefit of the fellows, who are provided the opportunity to present new or challenging cases in preparation for clinic the following day. This venue facilitates real-time interpretation of imaging studies by the radiologist as well as robust discussion of supporting evidence for various management strategies. This unique conference has been widely hailed as a major strength of our program, positioning fellows as champions of their patients’ care and helping them confidently develop comprehensive management strategies ahead of time for new and difficult clinic cases. 

Subspecialty clinics
In their second year of training, fellows rotate through subspecialty hematology & oncology clinics at OHSU and the VA. Fellows spend 3-4 weeks in each subspecialty, with emphasis on GI, breast, lung, hematologic malignancies, and non-malignant hematology. Fellows are expected to see patients from their attending’s clinic panels. Attending physicians consistently provide relevant literature on specific topics encountered during clinic. In addition, fellows attend the relevant weekly tumor boards for the subspecialty rotation to which they are assigned.  

Didactics

Grand Rounds
New this academic year, the OHSU heme/onc division is initiating a division-wide grand rounds on a quarterly basis. This session, meant to continue strengthening a sense of community, collegiality and creative vision for our division, will feature prominent guest speakers invited from across the globe to present and discuss relevant, timely and novel ideas and topics of interest to all disciplines within hematology/oncology. 

Rotating didactic session
When: Monday morning (8am-9am)
This session consists of a rotation of topics and often led by fellows, including morbidity & mortality conferences and case presentations, and also provides a venue for fellows to present ongoing or published research projects as well as practice job talks. This time also provides an opportunity to continue disease-specific didactics typically presented during Friday morning conferences.

VA fellow tumor board, board review, and FDA drug approvals
When: Wednesday afternoon (12pm-2pm)
This afternoon session includes the VA fellow tumor board from 12-1, followed by a board review session on a specific topic led by a fellow from 1-2, coordinated with disease-specific didactic sessions on Friday mornings (see below) to reinforce learning. On a monthly basis, the 1-2 slot is also dedicated to review of recently FDA-approved drugs in hematology & oncology, where fellows are expected to each prepare a short presentation on a newly-approved therapy and an interpretation of the data leading to its approval. This is also considered a highlight by fellows as a dedicated time to keep up to date on the rapidly expanding field of heme/onc therapeutics.

Tumor-specific “Master Class”
When: Friday morning (8am-9am)
The Master Classes consist of disease-specific lectures to review pathophysiology, diagnosis, staging and management. Fellows are expected to lead at least one of these sessions per year on a disease type of their choosing, with assistance from an appropriate faculty member who also attends the session to provide additional learning pearls. These topics are coordinated with weekly board review sessions to reinforce learning (see above).

Thrombosis & Hemostasis conference and “Thrombosis board”
When: Friday afternoon (12pm-1pm)
At this popular and heavily-attended weekly conference (pizza included!) chaired by Dr. Tom DeLoughery, all manner of topics in thrombosis and hemostasis are presented. Format is typically a patient case, followed by an open discussion of the workup and management. Topics discussed have included: High-risk thrombophilias (antiphospholipid antibody syndrome, heparin-induced thrombocytopenia, cancer-associated thrombosis), workup of the undifferentiated bleeding diathesis, discussion of anticoagulation reversal strategies, and difficult scenarios in hemophilia. Once per month, this time slot is dedicated to a “thrombosis board,” which provides an opportunity for any providers (fellows and attendings from both pediatric and adult backgrounds) to present interesting or challenging outpatient or inpatient cases for discussion, including review of labs and imaging in a group setting, in a manner similar to malignancy tumor boards. 

Journal clubs
When: Quarterly, evenings from 6:30pm-8:30pm
Journal clubs are hosted by attendings at their homes, and are attended by fellows and any interested faculty, with food and drink provided. Host attendings select 1-2 newly published, high-impact journal articles in their field of expertise to present to the group and discuss in an informal setting. 

Research

Fellows in the OHSU hematology/oncology program will be positioned to succeed in any area of basic, clinical or translational science research. The Knight Cancer Institute (KCI) has received the highest designation form the National Cancer Institute as a “Comprehensive Cancer Center,” due to the extensive breadth of research performed at our institution and the high quality of care delivered to our patients. Our fellows have been highly successful in applying for major career development grants, including two recent recipients of the ASH Research Training Award for Fellows (RTAF), ASCO/AACR Vail clinical trial design workshop, and Hemostasis & Thrombosis Research Society Fellow Consortium. Fellows in our program can academically thrive as a result of several key factors: 

1. Over 200 active clinical trials led by OHSU primary investigators across all disciplines of solid and liquid oncology and non-malignant hematology. 
2. The new Knight Cancer Research Building (KCRB), a beautiful center offering space for translational research collaboration and providing state-of-the-art technology 
3. The Oregon Clinical & Translational Research Institute, providing assistance on research design, implementation, medical writing and biostatistics, as well as offering multiple educational courses
4. Financial support to apply for, and attend, society meetings/conferences including ASH, ASCO and ISTH.