Haematology

Contact person:

Dr. Caroline Hamm

KEY FEATURES OF HEMATOLOGY FAMILY MEDICINE ROTATION WINDSOR

The Hematology Rotation is both ambulatory care experience as well as inpatient with the resident attending clinics at the Windsor Regional Cancer Program.  A significant benefit of the Windsor Oncology Experience is the one-on-one teaching from dedicated and motivated staff.  The family medicine resident is the often the only resident in the program and so receives a significantly enhanced learning experience.  This is a very well received program from previous trainees.  As well, by offering inpatient training the patient will gain expertise in the developing field of the hospitalist, a new family medicine specialty.

Each half-day the resident is assigned to a clinic where they participate in the management of patients of one member of the Hematology active staff; the resident reviews each patient with the staff doctor and has physical findings checked. Trainees have the opportunity to see consultations, returning patients with hematology-related problems and patients on active treatment. They are expected to dictate notes and letters on all patients seen and write orders (the exceptions are for chemotherapy and immunotherapy).   According to competency based educational initiatives, their attending physician will observe them during both history and physical exam of the patient.

Residents rotate through as many clinics as possible in the 4-week outpatient experience

Our aim is to give them as broad exposure as possible to hematology: both malignant and benign. The resident’s schedule each day is different and during a single week trainees will typically spend every day with a different consultant.  Because the wide spectrum of disease seen by oncologists, there is an opportunity for a broad overview of the care of patients with cancer.

The medical clinics at the WRCP are either multidisciplinary or operate in close proximity with those of other specialities e.g. Radiation Oncology, Oncological Surgery, Hematology, Neurology and Palliative Care permitting the resident to participate in multidisciplinary care.  The residents are expected to participate in the multi-disciplinary rounds, present cases and follow through with recommendations appropriate to their level of training.

At least 80% of the trainees’ time on the Hematology Rotation is spent in supervised direct patient care.

Trainees will gain experience with first hand decision making on a patient population. The trainees work as part of the inpatient team under the supervision of the inpatient attending hematologist.  During this time, trainees may also have the opportunity to assess patients in the Emergency room, and inpatient consultations.  Trainees may follow-up on patients seen by them in the outpatient clinic who require admission to the hematology/oncology inpatient unit. They will spend one of the four weeks of rotation on the inpatient service and have the opportunity of taking first call during their hematology experience in order to gain experience in making independent decisions on patient care.

The residents will also have an opportunity, if desired, to work with an attending in an existing or new research question. We have a close relationship with our development/ basic science research partners at the University of Windsor through the Windsor Cancer Research Group, and research experience is encouraged and facilitated.  The annual International Cancer Research Conference is a great place to present your research. 

GOALS OF THE HEMATOLOGY ROTATION

The goal of the Hematology rotation is to provide the trainee with an overview of the management of patients with a hematological problem that will form a basis for further reading and study. The rotation emphasizes the importance of continuing multidisciplinary care for patients with cancer including the role of family physicians. The goals of the Hematology Elective Rotation are imbedded in the COMPETENCIES of the CanMEDS 2005 Physician Competency Framework. It is recognized that not all elements of the competencies can be taught during such a short 4-week rotation. Specific circumstances may arise where there is opportunity for in-depth experience in some area from time to time. Under Medical Expert are listed some of the areas of knowledge that it is necessary for residents to acquire by the end of the rotation.

EVALUATION OF FAMILY MEDICINE TRAINEES

Evaluation is done electronically, or in paper format, using the One45 program. Each hematologist that has supervised a trainee is asked to complete an electronic or paper evaluation. These are summarized by the Coordinator for Hematology Education and reviewed with the resident before he or she completes the rotation. Trainees are asked to sign-off on their evaluation.

CanMEDS COMPETENCIES AS APPLIED TO ONCOLOGY ROTATION

MEDICAL EXPERT

  1. Demonstrate the skills to do a comprehensive medical consultation including plans for further investigation and treatment, to communicate with referring and consulting doctors and to communicate information to patient and family.
  2. Demonstrate knowledge of the natural history of the commonest forms of hematological problems, both malignant and benign: iron deficiency anemia, B12 and folate deficiency, common hematological malignant disorders such as myelodysplastic syndrome, chronic lymphocytic leukemia and lymphomas . Understand the importance to patient care of collaborative and multidisciplinary treatment plans in the management of these malignancies.
  3. Demonstrate awareness and urgency of the management of the common hematology -related emergencies e.g. spinal cord compression, febrile neutropenia, superior vena caval obstruction, tumour lysis syndrome, hemolytic anemia, etc.

COMMUNICATOR

  1. The attending staff will demonstrate to the trainee the development of rapport, trust and ethical therapeutic relationships with patients and their families. Trainee is expected to initially observe this aspect of patient care and then actively participate in discussing issues, plans and problems with patients.
  2. Whenever possible the trainee will be asked to participate with the staff physician in disclosure of adverse results, in the breaking of bad news and in end-of-life discussions.
  3. The trainee is expected to provide concise verbal reports of patient encounters and keep clear and accurate records (electronic). The latter will be monitored and reviewed with the resident from time to time.

COLLABORATOR

  1. Within a multidisciplinary environment the trainee has the opportunity to observe and participate in the process of reaching a consensus regarding patient management.
  2. Nursing care is an essential component of the care provided by hematologists. Trainees must demonstrate they understand the importance of this to patient care and that they respect and work collaboratively with primary care nurses and nurse practitioners.
  3. Demonstrate the ability to work with pharmacists, social workers, community physicians and other health care workers.

MANAGER

  1. Trainees will be expected to demonstrate efficient time management skills to maximize their time with patients and their learning time (this includes time for discussion of facets of the case with the staff physician and others e.g. nurses).

HEALTH ADVOCATE

  1. Trainees will have the opportunity to identify the diversity of physician involvement with individual patients and the fundamental role of the physician in ensuring that the patient navigates successfully through the health care system. They should have an enhanced appreciation of the leadership and organizational skills required of physicians for practice in the modern medical community.

SCHOLAR

  1. Trainees will observe multidisciplinary and collaborative care delivered based on evidence-based medicine. Strong emphasis is placed on evidence-based medicine in all the oncology disciplines but especially hematology where many patients are on clinical trial.
  2. The importance ongoing professional development is emphasized as diagnostic policies and treatments are under frequent revision in keeping with new research and clinical information.
  3. Participation in multidisciplinary rounds is mandatory to demonstrate continuing medical education by interaction with colleagues.

PROFESSIONAL

  1. Trainees will have the opportunity to observe the commitment of physicians to their patients and colleagues through the highest standards of clinical practice.
  2.  

PLEASE NOTE: ELECTIVES MUST BE FOUR WEEKS (1 MONTH) IN DURATION (PART OF A MONTH IS NOT ACCEPTABLE). ALL ELECTIVES LISTED BELOW AND ANY REQUESTS FOR ELECTIVES IN WINDSOR HOSPITALS ARE ARRANGED BY THE WIDNSOR CAMPUS OFFICE..


EVALUATION OF EXPERIENCE

The trainee will be provided with an opportunity to evaluate his / her training experience in the Windsor Hematology/ Oncology  program.  We strongly encourage feedback using the provided paper format but encourage feedback through the primary preceptor or the chair (Dr. Caroline Hamm : caroline. hamm@wrh.on.ca)

Evaluating the staff

We strongly encourage the trainees to evaluate the supervising staff, as well as evaluating the entire rotation.

 

Needs improvement

 

 

Outstanding

 

1

2

3

4

5

6

The supervisor is a skilled clinician.  He/She has a strong command of the principals of his/her specialty.

 

 

 

 

 

 

The supervisor explained him/her self  clearly, is careful and precise in answering questions, and identifies important learning points.

 

 

 

 

 

 

The supervisor encouraged questions and discussion regarding the cases seen.

 

 

 

 

 

 

The instructor showed empathy to patients and modelled a caring physician

 

 

 

 

 

 

The Supervisor provided constructive feedback.

Yes

No

 

I was observed doing a physical exam.

Yes

No

 

I was observed doing a history.

Yes

No

Please comment on strengths or opportunities for improvement.

 

Process:  Currently will be available paper form./ return in a sealed envelope to supervisor after clinic/ rotation or to Oncology Academic office : Karen Reaume