The combined hematology and medical oncology fellowship training program of the George Washington University School of Medicine and Health Sciences (GW SMHS) and the Washington Veterans Administration Medical Center (VAMC) developed an ongoing research training affiliation with the National Institutes of Health (NIH) more than 10 years ago. GW SMHS and the VAMC are the sites of clinical training for both hematology and medical oncology, and fellows have the option for research training and program electives at the NIH. Fellows are not expected or required to generate any portion of their salaries.
GW School of Medicine and Health Sciences and the GW Hospital
The fellowship program is through the GW School of Medicine and Health Sciences, which consists of educational programs and extensive clinical and basic science research, along with the GW Hospital and its large ambulatory care facility. The GW Hosital houses a 24-bed oncology unit. Patients undergoing bone marrow transplantation are housed in the four-bed bone marrow transplant unit. The hospital has an active inner-city emergency service, and full primary-, secondary-, and tertiary-care services in all medical specialties, except for pediatrics. High quality support services include diagnostic and therapeutic radiology and clinical laboratories. All clinical departments have a fully accredited residency and/or fellowship training program.
Veterans Administration Medical Center
The Veterans Administration Medical Center (VAMC) is the major teaching affiliate of GW, with internal medicine and fellowship training rotations in all subspecialties. Most other departments (surgery, pathology, urology, etc.) also share combined training programs with the GW. Since 1974, the Division of Hematology and Oncology at GW SMHS and the VAMC have had an integrated training program with equal time rotations of fellows in years one and two of hematology and oncology training.
Four full-time hematology faculty are located at VAMC. The principal activity of fellows at VAMC is the care of patients with hematologic disorders and malignancies on the VA wards. The VAMC is a central referral hospital for VA patients with hematologic malignancies and, therefore, experience with leukemia, lymphoma, and myeloma is particularly rich. In addition, regular hematologic consultations for patients with red cell disorders and coagulation/thrombosis problems are also seen. Solid tumor oncology is a separate division. GW fellows may rotate on that service on an elective basis. The VAMC also has a regular hematology outpatient clinic one half-day per week and at all other times for urgent patients. One or two fellows in the combined program may have longitudinal ambulatory care experience at the VA hospital on Thursday afternoons. VA faculty maintains active grant supported research activities in which fellows actively participate.
National Institutes of Health (NIH)
The GW-VAMC program has an affiliation agreement for hematology/oncology fellowship research training with NIH. This program is based in the NIDDK, but also involves specific laboratories in NHLBI and NCI. For areas of research not available at GW or VAMC, fellows are offered the opportunity to work with specific NIH investigators and may elect to do their research year(s) at the NIH. While at the NIH, fellows maintain their longitudinal ambulatory experience at GW or VAMC at least one half-day per week. In addition, fellows in research year(s) return to GW-VAMC for one or two months of further clinical/ward experience in oncology or hematology.
Ambulatory Care Experience
The ambulatory care facility for hematology and oncology sees more than 1000 new patients per year with 500-600 new oncology patients and 300-400 new hematology patients.
Each fellow has a longitudinal ambulatory clinic, and short-term clinics working with the various faculty members.
In the ambulatory care setting, the fellow is under the direct supervision of a designated faculty member. The fellow is given gradually increasing responsibility in the care of his/her patients to maximum independence by the end of year one. In most cases, the fellow makes the primary contact with the patient, conducts the evaluation, and devises a treatment plan.
All fellows have half-day-per-week longitudinal clinic at GW for the duration of their fellowship training. The fellow's longitudinal clinic takes priority overall other activities. Therefore, if a fellow is rotating at another hospital or the NIH, he/she is required to return for his/her half-day clinic on a weekly basis.