Hematology/Oncology Fellowship Program
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 also rotate with the Hematology and Transplantation Service, NCI/NHLBI/NIH Clinical Research Center as well as have the option for additional research training and program electives at the NIH.
GW School of Medicine and Health Sciences and 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 Hospital houses the 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.
The GW Outpatient Hematology/Oncology Clinic sees almost 2000 new patients per year with about 1,500-1,600 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. Fellows spend one month with the palliative care program for experience in inpatient and outpatient palliative care and pain management. There are one month rotations with the cancer genetics and prevention service as well as the GWUH laboratory medicine and blood bank.
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.
GW Inpatient Hematology/Oncology Consult Service
Fellows spend 6 months on the inpatient hematology consult service and 6 months on the inpatient oncology consult service. During this time they evaluate hospitalized patients for common hematologic disorders and newly diagnosed oncologic conditions. The consult service is overseen by an attending hematologist or oncologist who rounds with the fellows on a daily basis. During rounds the team discusses the pathophysiology, clinical presentation, and evidence-based therapy. Active patients are followed by the team daily. The fellow is responsible for communication of the treatment plan and recommendations to the primary treating team.
GW Inpatient Red Team Service
Fellows spend 6 months on the inpatient Red Team service which admits and follows patients with acute leukemia, patients requiring inpatient chemotherapy for malignant hematologic and solid tumor oncologic diseases, and cancer patients with complications from their disease and/or treatment. The Red Team is overseen by an attending oncologist who rounds with the fellows and residents and is responsible for the primary care of the patients. During rounds, the team discusses the pathophysiology, clinical presentation, and evidence based therapy. The fellow takes an active role in teaching the resident house staff.
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. VA faculty maintains active grant supported research activities in which fellows actively participate.
National Institutes of Health
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.
All fellows rotate with the Hematology and Transplantation Service, NCI/NHLBI/NIH Clinical Research Center. A broad spectrum of diseases are represented including aplastic anemia, autoimmune thrombocytopenias and hemolytic anemias, sickle cell anemia, myelodysplastic syndromes, mastocytosis, multiple myeloma, chronic myelogenous leukemia, acute leukemias and congenital bone marrow failure states.
Topics include cancer screening, cancer risk assessment, cancer prevention and genetics, initial diagnosis and treatment of common and uncommon malignancies, disease pathogenesis and supportive oncology to include pain management, clinical trial design and conduct including the basis of Phase I, II and III trials and the legal and ethical implications of clinical research.
George Washington University Hematology/Medical Oncology Best Practices Course
Fellows attend the annual comprehensive review of clinical best practices presented by the nation’s leading clinicians and educators in the field with lectures designed to reflect the prevailing standards of care in Hematology and Medical Oncology.
Case Conferences and Tumor Boards
Multidisciplinary case conferences focusing on presentation, diagnosis and management are held on alternate Fridays and at special designated disease-oriented times to accommodate surgical, pathology and radiation oncology input. Cases are presented by fellows and faculty.
Tumor Boards are held weekly or biweekly for all disease sites. Fellows are expected to attend these conferences and present their active clinic patients for multidisciplinary discussion regarding management.
Cancer Center Distinguished Lecture Series (Alternating Fridays)
Guest lectures by GW Faculty as well as nationally and internationally recognized experts in cancer related topics.
Challenging Cases in Oncology
Fellows conduct a series of particularly challenging oncologic cases encountered in the clinic or hospital and conduct a discussion using the literature to support content.
Weekly Journal Club
Fellows discuss new and landmark articles that shape our current understanding of cancer biology and serve to provide evidence for clinical decision making. Attendings moderate the discussion to put the new data into context.
Quarterly Morbidity and Mortality Conference
A review of unexpected occurrences, ICU admissions, unexpected outcomes to include deaths are presented for discussion.
Quarterly Clinical Research Review
Fellows and Faculty present upcoming clinical research for an academic discussion of trial feasibility, design, and scientific merit.