PEDU-4053 - Acting Internship in Pediatric Hematology/Oncology

PEDU-4053 - Acting Internship in Pediatric Hematology/Oncology

Elective Title: Acting Internship in Pediatric Hematology/Oncology
Course Number: PEDU-4053
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: Successful completion of Pediatrics clerkship.
Responsible Faculty Director: Barkat Hooda, M.D. Periods Offered: 4-11 including holiday period 8 
Coordinator: Other Faculty: Akila Muthukumar
Location to Report on First Day:
2.210 Research Building 6/J10A at 9:00am

1. Students will broaden their knowledge and understanding of common Pediatric cancers and blood disorders by participating in the care of such patients in the hospital and clinics, attending conferences/lectures, and utilizing self-teaching aids

2. Students will gain experience in the comprehensive management of patients with hematological or oncological disorders under the direct supervision of faculty

1. Obtain history and perform a physical examination that is appropriately specific and complete for patients with hematological and/or oncological disorders

2. Organize a reasonable list of differential diagnoses for patients who present with a suspected hematological or oncological disorder

3. Select and attempt to interpret the laboratory and radiological studies that are necessary to diagnose and treat hematological and oncological disorders, including complete blood counts, peripheral blood smears, and bone marrow smears and biopsies

4. Understand the broad principles of the management of hematological and oncological disorders

5. Appreciate and address the emotional and psychological impact of significant hematological and oncological disorders on patients and their families

6. Assume clinical responsibility for the complete care of patients with hematological or oncological disorders at a level expected from a PL1 intern. Please note that PL2/3 have the primary responsibilities for High-risk Hematology Oncology patients; PL1 and AI work under the supervision of PL2/3 performing at the same level (both have secondary responsibilities)

Description of course activities
1. Outpatient Activities: Students are expected to actively participate in the pediatric hematology/oncology clinics under active supervision of faculty as per the attached schedule in this document; PL3 residents have the primary responsibility for the patients - AI work under their direct supervision.

2. Inpatient Activities: Students are expected to actively participate in the care of pediatric hematology/oncology floor at J10A as a member of the multidisciplinary care team under active supervision of faculty; PL3 residents have the primary responsibility for the patients AI work under their direct supervision.

3. Consultations and Referrals: Students are expected to assist in the consultations and referrals of patients with suspected or known hematological or oncological disorders under the direct supervision of the attending faculty.

4. Conferences: Students are expected to attend the conferences and lectures that have particular relevance to General Pediatrics and Pediatric Hematology/Oncology when scheduled. These include, but are not limited to, the Pediatric Hematology/Oncology Multidisciplinary Divisional Conference(s), Pediatric Oncology Tumor Board, Hematology/Hematopathology Conferences, Neuro oncology Multidisciplinary Tumor Board, Residents Morning Reports, Noon Conference and Friday Grand Rounds.

Daily Routines: The day starts with Morning Report at 8:00am with the Pediatric Resident team in RB6, 3.300A, followed immediately by rounds at J10A , with the Pediatric Hematology/Oncology team on service See weekly schedule below.

Pediatric Hematology Oncology Out-patient Clinic Schedule: Monday: AM - No Clinic & PM - BH & AMK; Tuesday: AM - Faculty & PM - BH & AMK; Wednesday: AM - Faculty & PM - BH & AMK; Thursday: AM - No Clinic & PM - Faculty; Friday: AM - Faculty-PCP & PM - Faculty.

Type of students who would benefit from the course
This course is available and valuable for students interested in Pediatrics, Internal Medicine, Family Medicine, Radiation Oncology, and Pathology. The rotation is particularly designed to stimulate sufficient interest for Pediatric learners interested in future fellowship training in Hematology/Oncology

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8:00-12:00 1:00-5:00
Tuesday 8:00-12:00 1:00-5:00
Wednesday 8:00-12:00 1:00-5:00
Thursday 8:00-12:00 1:00-5:00
Friday 8:00-12:00 1:00-5:00
Saturday NA NA
Sunday NA NA

 Average number of patients seen per week: 25
 Call Schedule: NA

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time N/A
Self-Directed Study N/A
Data-Collection/Analysis N/A
Other The day starts with Morning Report at 8:00am with the Pediatric Resident team in RB6 3.300A followed immediately by, rounds at J10A, with the Pediatric Hematology/Oncology team on service

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Every day.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Attending physicians, resident physicians, and students.
  B. Frequency / Duration of Presentation(s)?
    Every day or as per the assignment given by the attending faculty
  C. Format - What guidelines are set for the student's presentation?
    Presentation of patients in the hospital/clinics and PBL discussions on assigned topics
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Every day.
  B. Format - What guidelines are set for the student's written work?
    Epic notes and other documentation of patients in the hospital and clinics
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    As per attending physician/supervising resident (PL2/3) instructions
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Advance skills include observing the faculty write chemotherapy orders, learning quality assurance procedures (including patient check list on J10A before sending patients to PACU/OR to minimize surgical complications), assisting faculty in the procedures as requested, Learning care of Central Venous Access Device including access(s) de-access procedures Advance from chemo certified staff, etc.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    The final evaluation will be based on input from all who have interacted with the student, with special consideration of the following criteria:
study and work habits; application of acquired knowledge; interaction with the patients and their families, attending and resident physicians, and other members of the
multidisciplinary care team; degree of initiative and enthusiasm; and degree of initiative, enthusiasm and professionalism

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    Halfway through the rotation, students struggling in the rotation will be provided verbal feedback in an attempt to address the problem

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    Pediatric oncology practice requires oncology certified staff as standard of care. As such, there will be very limited opportunities in performing procedures (intrathecal chemotherapy/Bone marrow aspiration/Biopsy) or chemotherapy ordering skills

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    All learners will be encouraged to participate as observers with limited hands-on experience during procedures (intrathecal chemotherapy/Bone marrow aspiration/Biopsy or chemotherapy ordering skills

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    We do not have PGY1 rotating in our division; AI will work directly under supervision of PGY3 level resident at the level similar to that of a PGY 1

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    Principles and practice of Pediatric Hematology Oncology learnt during the rotation will generate sufficient enthusiasm for those wishing to pursue a future career in this field as patient population is high risk in general and management is complex compared to patients on General Pediatric service

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Half way through the rotation, students struggling in the rotation will be provided verbal feedback in an attempt to address the problem

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There are two Faculty members in the division (Dr Barkat Hooda & Dr Akila Muthukumar) who work on schedule that will roughly provide students equal exposure to either faculty. All learners are constantly supervised by the faculty and Letters of recommendations are provided upon request to AI post completion of their rotation when requested based upon their observed performance by the faculty

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    There are two faculty members in our division, Dr. Muthukumar and Dr. Barkat Hooda, who write written evaluations. They have direct contact with their students and that is why they are very familiar with their abilities and performance. While residents work in tandem, medical students present their H&P and differential directly to us in the clinic and discuss management plan with us.