Hematology & Medical Oncology Program Goals and Objectives

27 April, 2012

OVERALL

HEMATOLOGY & MEDICAL ONCOLOGY PROGRAM GOALS AND OBJECTIVES

Overview:

The goals of the University of Wisconsin-Madison Hematology & Medical Oncology Fellowship Program are that graduates will attain the professional, attitudinal, cognitive, and technical skills necessary to provide their patients with competent, compassionate, and patient-centered care. Fellows have many opportunities to learn and practice patient communication and shared decision making and to apply current evidence-based knowledge to achieve the best likelihood of the patient's desired outcome. Fellows are given guidance/mentorship and advice to develop their careers, achieve scholarship, and complete the prerequisites needed for the next steps of their careers. Our fellows learn how to problem solve and begin the process of self-directed life-long learning. Fellows are taught to assess patient outcomes in order to improve future decision making and guide practice management. They acquire the ability to organize their workdays, reflect upon and plan for professional-personal balance, manage stress, and maintain personal health. The competencies listed below are achieved through a required set of rotations, a didactic curriculum, and a self-tailored set of electives. Our fellows, faculty, and program are continuously evaluated to ensure success in achieving these competencies, goals and objectives.

Competencies:

In their first year of education, fellows should demonstrate competency in skills relevant to hematology & oncology for patients with common diagnoses and for uncomplicated procedures. In their second year fellows should be able to apply expertise to demonstrate more sophisticated skills with non-routine and complicated patients and under increasingly difficult circumstances, while also demonstrating compassionate, appropriate and effective care. As a third year fellow they should be applying leadership and autonomy in these areas as well as in performing increasingly complex procedures and handling unexpected complications, while demonstrating compassion and sensitivity to patient needs and concerns.

Patient Care:

Fellows will be competent to care for patients in all stages of an illness including those cured who need advice on health promotion and those dying who need compassionate palliation of discomfort. The fellows will learn to develop evidence-based, patient-centered and tailored treatment plans appropriate to the individual goals of the patient.

Medical Knowledge:

Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.

Formal teaching occurs within the didactic curriculum, but most learning takes place within clinical experiences. Thus, competence in medical knowledge is inextricably linked with competence in patient care. In addition to the specialty-specific knowledge content that is assessed with in-training, and certification board exams, it is important that each fellow demonstrates his/her ability to acquire and access new knowledge (i.e., stay up-to-date with the current literature), interpret the information they uncover, and then apply it in the clinical setting. These are learned skills and may be applied to other competency domains, especially Practice-based Learning & Improvement (PBLI) and Systems-based Practice (SBP).

Structured approaches for teaching these skills include journal clubs and critically appraised topics during specific rotations.

Practice-based Learning and Improvement:

Fellows must demonstrate the ability to investigate and evaluate the care of their patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.

Fellows are expected to develop skills and habits to be able to meet the following goals:

·  identify strengths, deficiencies, and limits in one’s knowledge and expertise through reflective exercises;

·  set learning and improvement goals;

·  identify and perform appropriate learning activities;

·  systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement

·  incorporate formative evaluation feedback into daily practice;

·  locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems;

·  use information technology to optimize learning; and,

·  participate in the education of patients, families, students, fellows and other health professionals.

At the core of proficiency in Practice-based Learning & Improvement (PBLI) is lifelong learning and quality improvement. These require skills in and the practice of self evaluation and reflection for quality improvement at the individual practice level, as well as skills and practice using Evidence-based Medicine (EBM). In addition, fellows must learn and practice teaching skills to enable them to effectively educate patients, families, students, fellows and other health professionals.

Interpersonal and Communication Skills:

Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

Fellows are expected to:

·  communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds;

·  communicate effectively with physicians, other health professionals, and health related agencies;

·  work effectively as a member or leader of a health care team or other professional group;

·  act in a consultative role to other physicians and health professionals;

·  maintain comprehensive, timely, and legible medical records.

This competency domain consists of two distinct skill sets, communication skills (used to perform specific tasks such as obtain a history, obtain informed consent, telephone triage, present a case, write a consultation note, inform patients of a diagnosis and therapeutic plan) and interpersonal skills (inherently relational and process oriented, such as acknowledging emotion, relieving anxiety, and establishing trusting relationships). The outcome “communicate effectively with patients, families, and the public…” requires good verbal, non-verbal and written communication skills, but also requires good relationship-building skills.

A structured curriculum may include both didactics and experiential components for addressing verbal, non-verbal, and written communication skills. Interactive teaching methods include structured observed communication sessions followed by feedback, and small group discussion of vignettes during fellowship meetings. A final but important area in this competency domain relates to completing and maintaining comprehensive, timely and legible medical records.

Professionalism:

Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Fellows are expected to demonstrate:

·  compassion, integrity, and respect for others;

·  responsiveness and accountability to patient needs that supersedes self-interest;

·  respect for patient privacy and autonomy;

·  the ability to be on time for required meetings and teaching sessions;

·  accountability to patient care teams, society and the profession; and

·  sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Proficiency in this competency domain is demonstrated through behaviors and attitudes, and is part of all other competency domains. Therefore, teaching and evaluation is most effective when done in the context of patient care and related activities (e.g., conducting QI projects, leading a team, presenting M&M, reflections on practice, conversations with mentors). The major components of professionalism are commitment, adherence, and sensitivity.

Commitment means respect, altruism, integrity, honesty, compassion, empathy, and dependability; accountability to patients and society; and professional commitment to excellence (demonstrated by engaging in activities that foster personal and professional growth as a physician).

Adherence means accepting responsibility for continuity of care; and practicing patient-centered care that encompasses confidentiality, respect for privacy and autonomy through appropriate informed consent and shared decision-making as relevant to the specialty.

Sensitivity means showing sensitivity to cultural, age, gender and disability issues of patients as well as of colleagues, including appropriate recognition and response to physician impairment.

Professionalism, including medical ethics, will be included as a theme throughout the program curriculum, including both didactic and experiential components and is modeled by the faculty in clinical practice and discussed with the fellow as issues arise during their clinical practice.

Systems-based Practice:

Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, and the ability to call effectively on other resources in the system to provide optimal health care.

Fellows are expected to:

·  work effectively in various health care delivery settings and systems relevant to the practice of hematology and oncology;

·  coordinate patient care within the health care system relevant to hematology and oncology;

·  incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate;

·  always advocate for quality patient care and optimal patient care systems;

·  work in inter-professional teams to enhance patient safety and improve patient care quality; and,

·  participate in identifying system errors and implementing potential systems solutions.

At the heart of systems-based practice (SBP) is a focus on the broader context of patient care within the multiple layers of a healthcare system including purchasers (employers, government), insurers (commercial, Medicare, Medicaid), delivery systems (hospitals, physician networks, drug and technology companies, community resources), work group (local entity providing care such as a group practice, hospital service), providers (physicians, nurses, and others both as individuals and teams that provide direct care), and the users (patients and families). Awareness and effective use of these resources is important to increase patient care quality, reduce errors, and control costs.

This competency domain is closely linked to PBLI because it is often through analysis of one’s practice that system-level opportunities for improvement are revealed. Fellows must develop abilities in this competency domain not only to provide safe and effective care, but also to enable them to act as effective practitioners within a variety of different medical practice/delivery models.

Teamwork skills are important to demonstrating competence in SBP. Participation as members and leaders of interdisciplinary teams will allow fellows experience to learn the effective management of a patient-care team.

27 April 2012

William S. Middleton VA Oncology Clinic Rotation Goals and Objectives

OVERVIEW:

Each fellow will attend one half-day continuity clinic at the William S. Middleton Veteran’s Administration Hospital for six months during each of their three years fellowship training. They may also have elective rotations here during other years of their training in a non-continuity setting. Each patient visit must be staffed by the attending physician in the post-clinic wrap up session, led by Dr. Mark Albertini. During this time, all fellows will present their cases and discuss the plan for care with supporting evidence. The fellow will be present for all cases seen in the VA clinic and therefore can not only learn about their own cases, but have obtain a general sense of care regarding other oncology patients at the VA. All notes need to be signed by the attending.

The VA Oncology faculty all have general outpatient clinics that care for patients with a variety of solid tumors. The clinics are usually organized around an attending MD and a nurse that is usually familiar with the patients seen in the clinic. There is a “triage” service operated by a rotating group of RN’s that will field outside calls regarding laboratory values, follow-up schedules, medication refills and general questions. Calls pertaining to new health issues will be forwarded to the physician or fellow responsible for the patient when clinically indicated in the judgment of the RN.

DEFINITIONS:

Continuity clinics:

The fellows will participate in one half-day oncology clinic per week during their 3-year training program. This clinic will exist in solid 6-month blocks and is deemed the “continuity” clinic. The fellow will attend every week regardless of the other assignments and will have no excused absences due to ward responsibilities. The continuity clinic will preferentially be scheduled in the afternoon to avoid conflict with rounding times on the inpatient service. In this clinic, the fellow must accrue a group of patients that can be identified by the continuity with which the patients return to see the fellow. If the fellow perceives that patients are not returning to their schedule, they should discuss this with the attending or program director. These clinics serve to provide the fellows with a cadre of regular patients with regular follow up to help them learn the “ins-and-outs” of solid tumor patient care, communication and the delivery of health care within various systems at the UW.

Non-Continuity Clinics:

The fellows will participate in 1 to 4 half-day oncology clinics per week. These clinics will exist in 1-2-month blocks and are deemed the “non-continuity” clinics. The fellow will attend every week, but may be excused from these clinics for competing ward responsibilities. While the fellows may establish a cadre of regular follow-up patients during these blocks that is not the focus of these clinics. These clinics serve to further the exposure to different types of solid tumors based on organ system.

GENERAL DESCRIPTION OF RESPONSIBILITIES:

Each fellow will be assigned to an attending physician’s clinic and all patient visits to the fellow in clinic will be staffed by that physician. The attending physicians have clinics organized by their own clinical and research interests. A fellow will find the experiences in different clinics to vary greatly with respect to the types of diagnoses seen. For this reason, all fellows will be rotated through different UW faculty member clinics during their fellowship.

The fellow should assume primary responsibility for all patients they see in their clinic. In addition to patient encounters, the duties include: dictating all physician visits, writing chemotherapy orders, calling patients with lab results, following up on diagnostic tests, discussing issues with family, etc. Essentially, the fellow should assume all responsibilities required to effectively care for the outpatient and facilitate transitions between inpatient and outpatient care. Each patient visit should be staffed by the attending physician. The attending should see all patients in clinic as they are ultimately responsible for their care. All dictations need to be co-signed by the attending. The charge codes are required to be completed by the attending, but the fellow should discuss the various charges and should be aware of the connection between the service provided and the charges applied.

OVERALL GOALS FOR THE ROTATION:

Fellows are expected to achieve the milestones listed below and to show continued growth during each year of training; expected milestones are discussed in more detail in the following section and are broken down by year in training.

·  To become adept at:

o  Forming an organized approach in the diagnosis.