Program Structure
The goal of our Hematology and Oncology Fellowship Program is to train our fellows to be highly skilled specialists who are competent to practice independently and provide excellent care for patients with cancer and/or hematologic disorders. We also strive to teach necessary research and critical thinking skills to ensure their success as clinical investigators and provide a foundation for an academic career in Hematology and Medical Oncology.
Teaching of Hematology
The teaching of Hematology has largely been integrated with the teaching and training in Oncology and there has been no attempt to isolate the two disciplines. Fellows are encouraged during their training to use elective time to pursue specific rotations in the hematologic field. The Blood Bank, under the direction of Dr. Emmanuel Fadeyi, has established a fellowship rotation which exposes individuals to all facets of blood banking and immunohematology. Similar rotations are available through hematology laboratory and the coagulation laboratory. Dr. John Owen is the Director of the Coagulation Laboratory and is the Associate Director of the Hematology Laboratory.
The major forum for teaching in this area is a weekly case based Hematology Conference which is led by Dr. Owen. The principle intent of this conference is to expose fellows to the rational and logical application of hematologic knowledge. Each meeting typically begins with an evaluation of a blood smear together with minimal clinical information. Information, constructs, and hypotheses are then generated based upon this, and they are tested against the reality which is usually known for that specific patient. The content of this conference runs the gamut from direct patient care through all levels of basic science. This conference has been particularly well received by the fellows and has in the large part been responsible for the growing interest in nonmalignant hematology amongst our fellowship candidates.
Teaching of Oncology
The subspecialty program in Oncology is organized to provide training and experience over three years that will allow the trainee to become a competent oncologist. Clinical experience consists of observation and management of patients with a variety of oncologic problems including both solid tumors and hematologic malignancies. The clinical experience is accomplished in both the inpatient and outpatient settings. Experiences include inpatient rotations in solid tumor, leukemia, bone marrow transplantation, and consults. Outpatient rotations include the Hematology and Oncology outpatient clinic and the continuity clinic. In addition, second and third year fellows rotate at the W.G. (Bill) Hefner VA Medical Center in Salisbury, North Carolina. For more information on this rotation, scroll down to "VA Rotation Information".
The joint Hematology and Oncology Fellowship program is a three year program leading to ABIM Board eligibility in Medical Oncology and Hematology.
The following selective areas, approved by the Fellowship Committee, provide for 6 months of additional rotations:
| Radiation Oncology | Laboratory Coagulation |
| Gynecologic Oncology | Palliative Care |
| Blood Bank | Hematopathology |
| Additional Clinical Rotations listed below | Research, both clinical and basic science |
Additional clinical rotations in breast, lung, GI/GU, CNS, sarcoma, malignant hematology, BMT, geriatric oncology, and head and neck cancers are available for fellows as selectives.
The trainee is given the opportunity to assume continuing responsibility for acute and chronically ill patients by following their own patients in the fellow's clinic and by seeing new patients on consult service and caring for patients on in-patient services.
An attending physician is assigned for supervision and is available at all times to serve as a resource to the fellow. This includes a clinic supervisor, an attending supervisor for all inpatient and consult services, and an attending on call to discuss and see new and acutely ill patients.
VA Rotation Information
The University is affiliated with the W.G. (Bill) Heffner Veterans Affairs (VA) Medical Center. Fellows in their third year of training spend two months at the VA. Second year Fellows are assigned a one-month block. Fellows spend four days a week at the VA. The other day is spent at Wake Forest for their half-day continuity clinic and independent study.
Fellows receive a broad range of clinical experiences on the rotation. They provide care to veterans in the Hematology and Oncology Clinic and Inpatient Consultative Service. The consultative service provides care to veterans admitted to the 45 bed general medicine and surgery VA hospital. The Hematology and Oncology Clinic is a newly renovated clinic with 24 chemotherapy infusion chairs and 10 patient rooms. It has access to emergency services, multidisciplinary consultants, imaging, and support services. It is a major referral center to a catchment population coming from over 20 surrounding North Carolina Counties. Clinics are held Monday through Friday.
Our VA physician faculty members have joint appointments at Wake Forest (WF) and the VA. They see patients at both institutions, supervise students and residents, and conduct research. This rotation is currently supervised by three Hematology and Oncology physicians, Dr. Michael Goodman, Dr. Antonius Miller, and Dr. Jimmy Ruiz.
The rotation provides junior and senior fellows an opportunity to work with a comprehensive electronic medical record while working in a close partnership with multidisciplinary oncology teams. They will also learn to achieve competence using a formulary to guide pharmacotherapy. Fellows are expected to attend relevant daily conferences that include tumor boards and journal clubs. Overall, the experience at the VA will serve to develop and perfect general care skills in the care of cancer and hematology patients in the outpatient setting as well as in the inpatient/consult environment.
There is no nightly or weekend call specific to this rotation. Mileage will be paid to compensate for the round trip drive.
Research
All Fellows spend at least three months doing laboratory research. The purpose is to ensure that all Fellows have a basis for making career choices. This mandated rotation occurs in year one and can form the basis for an ongoing involvement in "wet" research during the whole of the fellowship. Taking a leadership role in other research areas, particularly clinical trials, is strongly encouraged. As a member of the Section, fellows are expected to support the research efforts of all Section members.
Vacation and Statutory Holidays
Each fellow is allowed 3 weeks vacation to be taken at the fellow’s convenience, subject to certain limitations. The limitations derive from professional responsibility and all absences require adequate and approved coverage for responsibilities. It is recognized that under certain circumstances this may not be possible, in which case the request will be considered on its merits. Requests for vacation must be submitted in writing to the Program Director as early as possible. The request for vacation must include a vacation form detailing the cross coverage for the fellow’s responsibilities. Cross-covering fellows or faculty must signify their acceptance of these responsibilities by their signature.
Fellows in their last year in the institution are required to be on site during the last two weeks of June of their final year.
Additionally, each fellow will have five consecutive days off spanning either the Christmas or New Year Holiday.
Statutory holidays will be taken in accordance with the general practice of the institution. Coverage of service functions will be arranged as for weekend coverage.
The ABIM sets the acceptable duration of training. For combined Hematology and Medical Oncology the duration is 36 months. At least 18 of the 36 months must be clinical training. The ABIM also dictates that time away from the program, vacation plus personal time plus sick time, cannot exceed one month per year of training. There is room for some interpretation and we have taken the stance that provided total time off does not exceed three months over three years then graduation can occur on schedule. If the total time away exceeds three months, graduation will need to be delayed to meet the 33 month requirement.
Since few leaves of absence are taken in whole months, three months is considered to be 13 weeks or 65 working days.
Academic Requirements
Formal Conferences: (Attendance of all fellows is required)
- Internal Medicine Grand Rounds, Thursday 8:00-9:00 a.m.
- Hematology and Oncology Grand Rounds, Monday 5:00-6:00pm
- Fellows Core Conferences - To be held daily noon to 1 p.m.
- Monday: Oncology Core Curriculum
- Tuesday: Hematology Case Conference
- Wednesday: Hematopathology alternating with BLOOD Journal Club
- Thursday: Board Review Conference on different Hematology and/or Oncology topics
- Friday: Surgical Oncology / Tumor Board conference
Fellows are also invited to attend the Research Protocol Meeting the last Tuesday of every month at 5:00 pm and are expected to be primary reviewer and presenter at protocol meeting as assigned.
Fellows are invited to attend the GU Case Conference each Wednesday, 5:00-6:00 pm as well as other subspecialty tumor boards including breast, BMT, head and neck, and CNS.
Reading
Fellows should read each issue of Blood and The Journal of Clinical Oncology. They are also expected to read one of the standard textbooks of Hematology and one textbook of Oncology.
Attendance at Scientific Meetings
Attending and participating in scientific meetings is an important part of training. A limited amount of money is available to cover expenses. Any fellow is free to attend any meeting of his choice on his own time and at his own expense provided all service responsibilities have been covered. The Hematology and Oncology Section provides $1,000 per year to offset the cost of attending meetings. In general, Fellows are expected to share a hotel room and use the lowest reasonable advance purchase air-fare. Should a fellow choose not to share a room, then the reimbursement would still be limited to the amount paid if a room was shared.
Second year fellows are encouraged to attend the American Society of Clinical Oncology Meeting and reimbursement will be provided with expenses kept to a reasonable amount as stated above. Coverage will be provided for them by the first year fellows.
Third year fellows are encouraged to attend the American Society of Hematology Meeting and reimbursement will be provided with expenses kept to a reasonable amount as stated above. Coverage will be provided for them by the second year fellows.
Additional meeting attendance during any year of fellowship will be allowed if the fellow is presenting research. Travel reimbursement will be provided if at all possible. These meetings will be approved individually upon request.
Local Meetings
Fellows are allowed to attend the meetings of the Piedmont Oncology Association. The fellow on call for that day will remain at WFBMC until the end of the working day in order to be available for phone calls, emergency consults and back-up for oncology housestaff.First year fellows are encouraged to attend the Fall Piedmont Oncology Association Meeting and coverage will be provided for them to take this time off. Any other fellow who is not covering an in-patient service will also be allowed to attend if they are interested. All fellows not covering an in-patient service are encouraged to attend the Spring Piedmont Oncology Association Meeting. Expenses for both of these meetings are covered by the Section within certain guidelines.