The University of Virginia Health System is a referral center providing primary and tertiary care for large portions of Virginia and West Virginia .  All inpatient and outpatient services in Hem/Onc are provided in Charlottesville .  The Hem/Onc inpatient service consists of 17 ward beds and 8 acute Stem Cell Transplant beds. Two attendings, one hematology and one oncology, are assigned to the inpatient service. The attendings direct a fellow, residents, interns, and medical students and provide primary coverage for the ward service. Outpatient facilities include the Stem Cell Transplant clinic, Cancer Center clinics and Infusion Center , a multi-headed microscope room for review of pathology and bone marrow specimens, and conference rooms.

The University of Virginia is the recipient of a NCI Cancer Center Support Grant with basic research programs in: cell-signaling; endocrinology and cancer; immunology of cancer; metastases, invasion and cell surfaces; and clinical research focusing on drug discovery, including phase I and II clinical trials and phase III trials in cooperation with the ECOG, GOG and NSABP. To learn more please visit the Cancer Center's Research Programs page.

Clinical Experience

A fellow in the combined Hematology / Oncology training program is required by The American Board of Internal Medicine to complete 18 months of full time clinical training with patient care responsibility and 36 months of training at an outpatient continuity clinic. Full time clinical training is defined as at least 80% of the fellow’s professional time during a working week dedicated to clinical (patient care or educational) activities. The 18 months of clinical activity must include 6 months of benign hematology and 12 months of neoplastic diseases including malignant hematology. In addition, the board requires training in a number of associated disciplines and procedures. These requirements are met by rotations on the ward service, hematology consult service, the oncology consult service and selected clinical electives.

• Outpatient Clinics: The continuity clinic provides a major portion of a fellow’s education in the natural history and management of hematologic and oncologic disorders. Continuity clinic is one-half day a week for the entire three years of the fellowship. Each fellow accumulates a panel of patients with various hem/onc disorders for whom they provide continuity care. The fellow is expected to assume the primary hem/onc caretaker role for patients cared for in the continuity clinic. Faculty in hematology and/or oncology staff the fellow’s clinic to fulfill regulatory and billing requirements, but the fellow assumes full responsibility with guidance from faculty for management of the patients. Incoming fellows assume the care of patients from departing fellows.

Fellows attend a second half-day of clinic each week in addition to the continuity clinic. The fellow works directly with one faculty member in a “disease specific” clinic for a period of 4 months. At the end of 4 months, the fellow rotates to another faculty clinic thereby participating in a minimum of 9 different faculty “disease specific” clinics by the end of the fellowship. Disease-specific clinics include breast, prostate, lung, GI, head/neck, sarcoma, malignant hematology, stem cell transplant, and benign hematology and hemostasis. Most cancer clinics are multidisciplinary, thus fostering a team approach inclusive of surgeons, pathologists, medical oncologists and radiation therapists. Additional clinics may be added as electives in the second and third years. Both a variety of attending management styles and a mix of patient disorders will be encountered. While rotating through a specific clinic, the fellow evaluates new patients, reviews progress of established patients, and participates in multidisciplinary aspects of the disease-specific clinic by participating in post-clinic conferences and tumor boards.

• Consultation Services: The Hematology and Oncology consultation services operate separately and independently, providing inpatient consultations as well as emergent outpatient consultations. One fellow is assigned to the Hematology Consult Service and residents or medical students may also participate. The Oncology Consult Service is shared by the two inpatient fellows and consists of only inpatient consultations and emergent outpatient consultations not able to be seen in a faculty clinic or the fellows clinic. The consult fellow coordinates the service’s activities working closely with the consult attending, medical residents and medical students (if present). The on-call ward fellow assumes responsibility for all consultations, hematology and oncology, at night, on weekends and holidays. Consultation in hematology and oncology are provided 24 hours a day, 7 days a week. The consult fellows supervise and teach the residents and students rotating on the consultation service.
  
  
• Inpatient Service: The ward attendings and fellows work closely with residents to provide optimal care to patients with a variety of hematologic or oncologic problems. Two fellows are assigned to the inpatient wards each rotation and split night and weekend on-call responsibilities. The ward fellow’s responsibilities include: overseeing general care of all patients on the service, teaching residents and medical students, participating in morning attending rounds, directing daily check-out rounds, writing chemotherapy orders, administering intrathecal chemotherapy, and performing bone marrow biopsies and interpreting bone marrow aspirates for inpatients on their service.
  
  
• Electives:  Formal electives are required in radiation therapy, blood banking, hematopathology, immunology/flow cytometry, cytogenetics/molecular genetics, coagulation, gynecologic oncology, palliative care, and infusion center with chemotherapy administration. Remaining elective time may be self-designed but requires approval of curriculum, goals and evaluation method by the program director.

Research

Participation in a research project during the fellowship is required. A fellow must chose a basic or clinical research track before the end of the first year of fellowship. The design of the last two years of training differs depending on whether a fellow elects the basic or clinical research track. The basic research track requires completion of all but the continuity clinic portion of the clinical requirements by the end of the second year so that a full year may be spent in the research laboratory with few interruptions for clinical service. Fewer electives are available as the basic research fellow concentrates on the core clinical components only to allow additional time in the research laboratory. Several basic research areas are available through the Cancer Center. The clinical research track begins at the end of the first year. Clinical research requires continued involvement of the fellow for at least two full years although only isolated months will be reserved for research-only activities. Patient accrual into trials and intermittent study activity occur continuously and therefore fellows will frequently be participating simultaneously in research activities and other clinical rotations. Clinical research protocols are available within the context of ECOG and other collaborative groups and as investigator-generated protocols in cancer and hemostasis.

Teaching

Didactic lectures are an on going part of the fellowship and there are a number of conferences available to enhance this aspect of the fellowship. For the first 2 months of each year a series of lectures is given three times per week and covers a broad range of topics in Hematology and Oncology. Conferences including Grand Rounds/Cancer Center Seminars, journal club, bone marrow sign-out, and tumor boards occur several times a week. Fellows are required to teach residents and medical students on rotations and over the course of the 3 years the fellow prepares several grand rounds presentations, journal clubs and various posters and talks for presentation at local and national meetings. A board review lecture series designed and implemented by the fellows is provides an opportunity to teach peers and concentrate on specific topics over the three-year fellowship.