General Training Environment
The Hematology/Medical Oncology Fellowship is a small (total of 6 Fellows, 2 per year) collegial program with a wide variety of clinical, educational, and scholarly opportunities. Because of the small size of the program, all 6 Fellows and all faculty attending physicians have frequent opportunities to work closely with each other and become familiar with each other's interests and expertise.
A responsible attending physician is readily available at all times to support a Fellow during rotations, and when on call duty which is taken from home.
The curricular goals of the Fellowship are accomplished through a variety of inpatient and outpatient experiences
- A core lecture series including an orientation series and supplemental institution-wide lectures
- Participation in various teaching and research conferences including tumor boards
- Participation in team meetings for quality assurance and interdisciplinary care planning
- Designing a research project
- Presentation of seminars
- Membership in ASCO Education Essentials for Oncology Fellows(EEOF)and ASH Fundamentals for Hematology Fellows Program FHF)
- Faculty guided review of EEOF and FHF modules
- One-on-one teaching and supervision
Structured assimilation of the competencies and procedures pertinent to Hematology and Medical Oncology. In addition, many lectures are given on campus by both visiting speakers and University of Vermont faculty on topics related to Hematology or Medical Oncology in the Departments of Pathology, Biochemistry, Microbiology, Surgery, Molecular Genetics, and Pharmacology.
Each Fellow sees at least 200 hematology and 200 oncology consultations annually covering a broad array of diseases and presentations. Fellows attend two half day continuity clinics weekly in Hematology and Medical Oncology respectively during the entire 3 years of training.
Continuity is assured by working with the same faculty Attending physician in the same clinic, for a minimum period of 6months evaluating and managing a particular set of conditions seen in the specialized practice of that Attending physician. The outpatient experience is supplemented by a specific outpatient clinic elective which allows a Fellow to learn about other disorders that they have not been exposed to during the continuity clinics.
Rotations, Electives and Specialized Training Tracks The principal rotations are:
- Dedicated inpatient Hematology/Oncology and Oncology consultations
- Hematology consultations (hospital-based)
- Outpatient clinic
More time is available for research in the second and third years. Month-long electives:
- Transfusion medicine
- Radiation oncology
- Gynecologic oncology
- High-dose chemotherapy/peripheral blood stem cell transplant
- Pediatric oncology
- Palliative care and outpatient clinics.
A one-month allogeneic bone marrow transplant rotation is usually taken at another center and is supported with extra funds to defray additional costs. The educational experience is further enhanced by mentored participation in one of three structured senior year specialized training tracks in, hemostasis and thrombosis research, cancer genetics, and breast oncology.
In addition to a high level of scholarship, Fellows gain proficiency in the modern ACGME competencies including:
- Practice-based learning case-based presentations)
- Systems-based practice (quality assurance and discharge planning team rounds)
- Professionalism (committee participation and attendance at national professional society meetings)
- Communication skills (Schwartz Center Rounds)
Fellows also develop competence and technical expertise in relevant procedures such as:
- Bone marrow biopsy
- Interpretation of bone marrows and peripheral smears
- Therapeutic pheresis
- Management and care of indwelling central venous catheters
- Administration of chemotherapeutic and biologic agents via all therapeutic routes
As the major tertiary care hospital serving Vermont and northeastern New York and the primary teaching hospital for the College of Medicine, UVM Medical Center provides access to a range of patients with rare and complicated diseases as well as those with conditions that are prevalent in any community, although disorders specific to ethnic minorities (e.g.,sickle cell anemia) and HIV-related malignancies are under-represented.
However, because there is no county or veteran's hospital in the area, Fellows sees patients from the full socio-economic spectrum. In addition, the vast majority of patients admitted to UVM Medical Center are available for teaching. The outpatient services are located in the University of Vermont Cancer Center clinics on the 2nd floor of the Ambulatory Care Center immediately adjacent to the Breast Care Center, Radiation Oncology and clinical laboratories.
Faculty Practice Resources
The clinical faculty practice comprising the UVM Medical Center Hematology-Oncology Division consists of 11 board-certified sub specialists with specific disease site expertise or fields of interests. All clinical faculty physicians are also members of the University of Vermont Cancer Center, and serve on a variety of UVM Medical Center committees pertaining to clinical practice, teaching and research such as the Cancer, Pharmacy and Therapeutics, and Education committees, thus providing many opportunities for Fellows to gain professional experiences or freely access research resources such as statistical consulting or the Cancer Registry which publishes the annual UVM Medical Center Cancer Program Annual Report on its Web site.
Fellows, like faculty, are supported by clinical research nurses and associates, a nutritionist, social worker, massage therapist, and licensed doctorate clinical psychologists (from the Cancer Patient Support Program) who are available on site to provide free services including participation in clinical trials. Fellows also get limited but valuable exposure to private practice oncology Attending physicians on weekends and during inpatient teaching rounds for several weeks each year.
Each faculty physician's clinical and research specialization covers the areas of:
- Breast cancer
- Gastrointestinal cancer
- Lung and head/neck malignancies
- Genitourinary/urologic cancer
- Brain tumors/melanoma
- Hematologic malignancies
- Cancer genetics and counseling
- Cancer in the elderly
- Supportive care
- Lymphedema service and survivorship
- Coagulation disorders
- Benign hematologic disorders
- Basic laboratory investigation
- Thrombosis and epidemiology
In concert with interested and specifically skilled members of other Departments such as Surgery Radiation Oncology, and Pathology, faculty lead or participate in multidisciplinary services or programs for breast cancer, lymphoma, high-dose chemotherapy/stem cell transplant program, thrombosis and hemostasis, gastrointestinal cancers, pancreatic cancer, genitourinary/urologic cancer, and familial cancers. Some of these activities are manifested in the wide variety of teaching and research conferences.
The principal monthly rotations are:
- Hematology consultation (hospital-based)
- Outpatient clinic
- Inpatient Hematology/Oncology service and Oncology consultation (hospital-based)
There are substantially fewer hospital-based rotations in the second and third Fellowship years when electives and research months predominate. Beyond an ACGME mandated 18 months of clinical rotations, Fellows have the opportunity to tailor their second and third year experiences with the assistance of their mentor towards an individualized training track. Specialized Training Tracks are also available. Throughout the 3 years of training, regardless of rotation, Fellows maintain responsibility to their continuity clinics.
Fellow Presentations and Rounds
Fellows present a half-hour seminar twice a year, on a current topic of interest. Fellows also present at University of Vermont Cancer Center Grand Rounds once in the second and third years, and lead journal club discussion twice a year. A weekly meeting led by the hospital-based Fellows, and attended by faculty, inpatient and outpatient nurses, and pathology and research personnel optimizes communication between inpatient and outpatient caregivers and serves as a quality assurance forum for all hospitalized hematology and oncology patients.
The inpatient service Fellow also leads the inpatient unit weekly multidisciplinary discharge planning meeting attended by internal medicine residents, a case manager, social worker, nutritionist, nurse manager, palliative care nurse, chaplain and other ancillary personnel.
The individual Fellow's progress though a graded set of educational, professional and scholarly experiences commensurate with arising level of responsibility assigned to each year of training, is evaluated and guided by the Program Director every 6 months. Examples of advanced activities include:
- Design and conduct of a research project
- Greater autonomy in patient care
- Presentation at Vermont Cancer Center Grand Rounds and leading Communication Rounds(a forum for improving the relationship between patients and clinical caregivers)
- Chief Fellow service
- Participation on hospital or scientific committees
- Choice of a specialized training track
Fellows maintain a portfolio binder (or online) that documents a personal program of self-study and professional growth, and supports achievement of the standard competencies necessary for graduation. The Chief Fellow is a third-year fellow who serves on the Division's Education Committee, manages rotations, call, back-up and vacation schedules, assists in developing a core lecture series and board review schedule, and assists the Program Director at the Fellow's monthly curriculum review meeting.
Fellows are strongly urged and supported to go to at least one major national professional meeting (American Society of Clinical Oncology or American Society of Hematology) their second and third year but often also attend updates or research conferences and join special courses.
Hematology and Oncology faculty pursue basic, epidemiologic, and clinical research. Areas of active clinical investigation on the local and national levels include breast cancer, lung cancer, genitourinary cancer, symptom management, cancer genetics, and developmental therapeutics. A research training program in hemostasis and thrombosis is available which can include a wide variety of topic areas including study of the epidemiology of venous and arterial thrombosis in large U.S. populations, translational studies of hemostatic function in relation to myeloproliferative disease, cancer and vascular disease, and basic biochemistry of blood coagulation.
Mechanisms of carcinogenesis (leukemogenesis) and determination of individual and familial risk are studied in ongoing translational programs in Hematology and gastrointestinal malignancy. Collaborations with researchers in other departments including Pathology, Biochemistry, and Health Promotion are available and increase the available clinical and basic science projects.
As a member of The Alliance for Clinical Trials in Oncology the National Surgical Adjuvant Breast and Bowel Project (NSABP), Gynecologic Oncology Group (GOG), Radiation Therapy Oncology Group (RTOG), the Hematology/Oncology Division actively participates in the design and implementation of treatment trials in all phases, employing a variety of immunologic, anti-angiogenic, receptor targeting and other investigational agents. Fellows are exposed to clinical trials as an integral part of high quality, modern cancer care.
Research activities carried out within the program by the unit faculty are supported by grants from the National Cancer Institute, the Department of Defense, the American Cancer Society, the American Health Association, the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, the University of Vermont Cancer Center/Lake Champlain Cancer Research Organization, and pharmaceutical sources. Research opportunities for fellows also are offered by faculty with adjunct appointments in the Department of Medicine. Biostatistical support is available through the Vermont Cancer Center and the Department of Medical Biostatistics of the University of Vermont. The philanthropically supported DeGroot Fund is available to trainees interested in Hematology projects.
Fellow Research Projects
Fellows are offered 12 to 18 months of research time and may participate in basic or clinical research with faculty mentoring. Fellows are expected to participate in at least one research project during the fellowship and a Fellow's initially assigned general mentor is often helpful in matching a Fellow's interest to the general categories of research opportunities available. A research project is typically embedded in any one of the specialized training tracks in:
- Hemostasis and thrombosis research
- Supportive care
- Cancer genetics
- Breast oncology
Throughout the first year, the fellow should become familiar with the research interests of the faculty through conferences and individual exploration and discussions leading to the choice of a research mentor and begin project planning and design. The project should be initiated early in the second year and completed in the third year. Under the supervision of a research mentor, Fellows are expected to write grant proposals for ASCO, ASH, or CALGB and other locally available grants as well as to make the principal effort in conducting and analyzing the research.
Lives of our Fellows
Our Fellows play an important and integral role in the life of the Hematology/Oncology Division and enrich the clinical, educational and research missions by their individual contributions and participation in divisional activities.
Although run by a Program Director and Associate Program Director, all faculty are closely involved with Fellowship training. The program is in full compliance with ACGME duty hour policies and aspires to strike a healthy balance between career development and personal freedom in the lives of our Fellows. Fellows are given a great deal of flexibility in tailoring their supervised program experiences, developing a mentored strategy of professional growth, and optimizing their readiness for successful placement.
All Fellows are required to undertake a research project. Fellows can easily advocate, either individually or collectively, through a senior Chief Fellow, their assigned mentor, the training program director or an ombudsman in the Graduate Medical Education office. In recent years, Fellows have typically become dual board-certified and taken positions in academic institutions, private practice, or community hospital cancer centers. The Fellowship receives philanthropic support to enable unique unfunded educational opportunities specific to an individual training pathway such as special courses, project materials, or conference attendance.
Fellows have considerable resources available to support their educational goals and to facilitate functioning as physicians, trainees and researchers. Fellows receive laptop access and LCD projector use, free parking permits, business cards, white coats with embossed name, free cell phone when on call, and access to electronic journal articles through the Dana Medical Library. They have access to Division secretarial resources for academic and educational activities as well as primary nurse support in the clinic for assistance with patient care issues.
The fellow's office is in the main hospital with convenient access to all clinical areas, the medical library, classrooms, auditoriums and research laboratories. It is equipped with networked personal computers work stations, and textbooks as well as personal filing and desk space.
Fellows from a wide variety of demographic (age, gender, marital status) and educational (MD, MD/PhD, DO, IMG) and ethnic backgrounds, co-exist very comfortably in this program embedded in a university campus within a college town. We adhere in letter and spirit to the policy of UVM Medical Center to "provide employment, training, compensation, promotion, and other conditions of employment without regard to race, color, sex, age, religion, national origin, sexual orientation, ancestry, place of birth, or disability" both in our recruitment process and during the training program.
Each fellow is able to find a satisfying balance between professional and personal life that suits her or his specific needs. Additionally, there is an enviable degree of camaraderie among the Fellows in both social and work place settings which helps reduce stress and burnout.
Our Fellows always meet with applicants during the interview process for lunch to offer a candid assessment of their experiences, and they enthusiastically participate in the recruitment process including final ranking. Fellows are backed up by another Fellow in the event of fatigue, illness or family emergency. Fellows can take 3 weeks of vacation a year. Depending on the year of training (i.e., experience of the Fellow) and type of rotation, average weekly duty hours range from 50 to 70 hours including weekend call which is taken from home. Many of our Fellows are parents and some of our recent Fellows have become parents during Fellowship.
Social and Family Life
The greater Burlington area offers many fine opportunities for children, families and individuals with respect to residential options, education, all-season recreation, community fellowship, and entertainment. An annual Fellows' Welcome party, Holiday Season party, and Farewell celebration are important social hallmarks of the life of the Hematology/Oncology unit. Faculty, Fellows and alumni routinely meet for dinner annually at the American Society of Clinical Oncology meeting and the American Society of Hematology meeting.
Additional information regarding the Hematology/Oncology Fellowship Training Program may be obtained from the program coordinator Linda [dot] Nortonuvmhealth [dot] org (Linda Norton) (802-656-5465) or the program director.