Clinical Rotations


Hematology/Oncology

Here is an example of a first year schedule.

Month Rotation
July 1-7 Orientation
July Leukemia
August Solid Tumor/Neuro-Oncology
September Pathology
October Hematology Inpatient
November Hematology Clinic
December Bone Marrow Transplantation
January Leukemia
February Solid Tumor/Neuro-Oncology
March Neuro-Oncology Clinic
April Hematology Inpatient
May

The St. Jude LIFE & After Completion of Therapy Clinic Presented by Kmart (ACT Clinic)

June Bone Marrow Transplantation


Scope of the Inpatient experience

The fellows have direct supervisory responsibility for care provided by residents, nurse practitioners, and physician assistants on all inpatient rotations. They review patient assessments and management plans and are responsible for assuring that protocol requirements are completed. The inpatient attending physician directly supervises the fellow on each rotation.


Inpatient Leukemia-Lymphoma

2 months. Each year, approximately 125 new patients with leukemia or lymphoma are seen at St. Jude. The fellow on service is responsible for the supervision of all inpatients on the Leukemia-Lymphoma service and becomes proficient at diagnosing leukemia and lymphoma, enrolling patients on treatment protocols, ordering chemotherapy, and providing supportive care. The fellow learns how to manage complications of therapy, including infectious complications in the immunocompromised host and complications of chemotherapy. The fellow also develops expertise at performing bone marrow aspirates and administering intrathecal chemotherapy.


Inpatient Solid Tumor/Neuro-Oncology Service

2 months. Approximately 175 patients with solid tumors are seen at St. Jude each year. Over 175 patients with newly diagnosed brain tumors are also seen each year. The fellow on service is responsible for the supervision of all inpatients on the Solid Tumor/Neuro-Oncology service and becomes proficient at diagnosing malignant solid tumors, including neuroblastoma, Wilms tumor, Ewing sarcoma, osteosarcoma, rhabdomyosarcoma and other soft tissue sarcomas, hepatic tumors, retinoblastoma, germ cell tumors, colon cancer, melanoma, and brain tumors, enrolling patients on treatment protocols, ordering chemotherapy, and providing supportive care. A major thrust of the clinical research is the development of new agents. Fellows are thus exposed to the details of Phase I protocols, methodologies and ethical considerations.


Inpatient Stem Cell Transplant Service

2 months. Approximately 150 stem cell transplants are performed each year. Patients are admitted to a specialized 16-bed BMT unit. During this rotation, the fellow cares for children and adolescents who are undergoing transplantation and gains experience with hematopoietic and solid malignancies, bone marrow failure syndromes, immunodeficiency disorders, inherited metabolic disorders, and complications of stem cell transplantation, including graft failure, infectious complications, and graft-versus-host disease.


Hematology Service and Clinics

2 inpatient months and 1 clinic month. Care for children and adolescents with nonmalignant hematologic disorders is provided at both Le Bonheur Children's Hospital and St. Jude. The fellow also participates in an active Hematology Consultation service at Le Bonheur and occasionally in the Newborn Nursery. Each fellow spends one month in the Hematology Clinics at St. Jude. These clinics include the general hematology, sickle cell, bone marrow failure, hemophilia, and thrombosis clinics. Through these clinical experiences, the fellow participates in the diagnosis and treatment of the entire range of common and rare hematologic disorders in children, including bone marrow failure syndromes, hemoglobinopathies, red cell membrane and metabolism disorders, hemolytic and nutritional anemias, white cell disorders, platelet and coagulation disorders, and immunodeficiencies.


The St. Jude LIFE & After Completion of Therapy Clinic Presented by Kmart

1 month. During this rotation, the fellow gains experience with the long-term effects of treatment. Fellows participate in ongoing studies of late effects of therapy on the skeleton; in evaluations of neurotoxic and cardiotoxic effects of therapy; and in investigations of risk factors for second malignancies.


Neuro-oncology

1 month. Each year, over 175 patients with newly diagnosed brain tumors are seen at St. Jude. This rotation provides education in the diagnosis and management of CNS tumors. Fellows also attend the weekly multidisciplinary brain tumor clinical conference where new patients and consults are presented and discussed.


Hematopathology

1 month. During this rotation, the fellow develops expertise in reading peripheral blood and bone marrow smears, and becomes familiar with modern ancillary diagnostic techniques such as cytogenetics, flow cytometry, and molecular diagnostics. In addition, the rotation offers exposure to essential aspects of specimen handling in Surgical Pathology and in Microbiology (the latter including conventional and molecular methodology).


Electives

Available electives include blood banking, radiation oncology, palliative care, infectious diseases, pediatric oncologic surgery, and intensive care.


Continuity clinic

Weekly. During the first year, fellows are assigned 25-30 new patients for whom they become the primary caregivers. For one-half day per week throughout the fellowship experience, fellows attend a continuity clinic at which they provide direct patient care to these patients under the supervision of the primary attending or clinic attending.


Call

During the week (Monday-Thursday) first year fellows do not take call. This allows the fellow to be an always present supervisor of the service without violating duty hours. First year fellows can take call during the weekends they are rounding if they choose. Call is paid. The fellow remains in-house for call.


Vacation

Fellows have three weeks of vacation time each year. Vacation time can be used during the months the fellow is on Pathology, Hematology Clinic, Neuro-Oncology Clinic, and After Completion of Therapy Clinic.