The first fellowship year provides comprehensive clinical training in multiple specialty areas, along with initial exposure to clinical investigations and research methods. Fellows work in multidisciplinary teams to provide outstanding care and develop subspecialty expertise in a variety of inpatient and outpatient settings.
Inpatient Leukemia-Lymphoma (2 months)
We see about 125 new patients with leukemia or lymphoma each year. Fellows supervise all inpatients on the Leukemia-Lymphoma service and become proficient at diagnosing leukemia and lymphoma, enrolling patients on treatment protocols, ordering chemotherapy and providing supportive care. Fellows learn how to manage complications of therapy, including infectious complications in the immunocompromised host and complications of chemotherapy. Fellows also develop expertise performing bone marrow aspirates and administering intrathecal chemotherapy.
Inpatient Stem Cell Transplant (2 months)
About 150 stem cell transplants are performed each year in our specialized 16-bed BMT unit. During this rotation, you will care for children and adolescents undergoing transplantation, allowing you to gain 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.
Solid Tumor/Neuro-Oncology (2 inpatient months and 1 clinic month)
We see about 175 patients with solid tumors each year and another 175 patients with newly-diagnosed brain tumors. Fellows supervise all inpatients on the Solid Tumor/Neuro-Oncology service and become 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. Fellows are also exposed to the details of Phase I clinical trial protocols, methodologies and ethical considerations. The clinic month focuses on providing education in the diagnosis and management of CNS tumors.
Hematology Service and Clinics (2 inpatient months and 1 clinic month)
During this rotation, fellows care for children and adolescents with nonmalignant hematologic disorders at LeBonheur Children's Hospital and St. Jude. Fellows participate in an active Hematology Consultation service at LeBonheur and occasionally in the Newborn Nursery. Each fellow spends one month in the Hematology Clinics at St. Jude, including the general hematology, sickle cell, bone marrow failure, hemophilia and thrombosis clinics. These clinical experiences allow fellows to participate 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)
This rotation gives fellows experience with the long-term effects of treatment. You will contribute to ongoing studies of late effects of therapy on the skeleton, aid in evaluations of neurotoxic and cardiotoxic effects of therapy, and aid in investigations of risk factors for second malignancies.
Hematopathology (1 month)
During this rotation, fellows develop expertise in reading peripheral blood and bone marrow smears and become 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 Microbiology, including conventional and molecular methods.
Available electives include blood banking, radiation oncology, palliative care, infectious diseases, pediatric oncologic surgery and intensive care.
Continuity Clinic (weekly)
During the first year, you will be assigned 25-30 new patients for whom you will act as primary caregiver. You will spend one half day per week throughout your fellowship experience providing direct patient care to these patients in the continuity clinic under the supervision of the attending physician.
Scheduling and Call
Weekend coverage is provided primarily by the first-year fellows (on an every-other-weekend basis), although fellows in subsequent years are asked to provide weekend coverage for 4-8 weekends per year.
First-year fellows do not take call Monday-Thursday in order to allow the fellow to be an always-present supervisor of the service without violating duty hours. During your first year, you can take call during the weekends you are rounding if you choose. Call is paid and done in-house.
Fellows have three weeks of vacation time each year. Vacation time can be used during the months you are on Pathology, Hematology Clinic, Neuro-Oncology Clinic and After Completion of Therapy Clinic.