Hematology / Oncology Rotation Guidelines



Stony Brook Pediatrics

Hematology / Oncology Rotation Guidelines

Welcome to your Hematology/ Oncology Rotation. We hope to make this a great learning opportunity for you. To this end, we have written a brief description of our schedule and rotation requirements.

Important phone numbers

Eva- (division administrative assistant) 444-7720

NP number- 444-2542

Cancer Center- front desk- 638-0965, Infusion room- 638-0970/71

Cancer Center appointment line- 638-0965/80966

Daily routine

Hem/Onc rotation is similar to the rotation in general pediatrics on 11N in terms of patient flow.

Dress is business casual.

Come in to get sign out from the night team no later than 6:30 am, then pre-round on all the patients and examine them before morning report. Alert your senior resident of any problems or questions. Complete your notes in Power chart before morning report. This is a general guideline- check with your Attending to see if he/she prefers that you complete the assessment/plan on your notes after morning rounds

Attend morning report and be prepared to give a brief description of H/O admits or pertinent films if we “run the list.”

IHI rounds are held between 9.15 and 9.30 AM on Monday, Wednesday and Friday. These are multi- disciplinary rounds to help facilitate communication between various members of the team and assist in making a patient plan for the day

Morning Rounds with the attending usually occur at around 9:30 am. We round on each patient individually. You are expected to provide a concise presentation on your patient which includes pertinent history, physical exam, lab data assessment and plan. Whenever pertinent, we encourage you to come up with a differential diagnosis. We also strongly encourage you to formulate a plan even if it ends up being changed during rounds.

Admissions require an Admission H&P just as on 11N. Please make sure that your patient has an appointment made upon discharge by calling the cancer center at 80965

Use H/O sign-out (medicine physician’s work list) sheets to keep track of your patients. Update the master list on the H/O computer throughout the day

Anticipated patient admissions are listed on the board the week before to help you anticipate and prepare for the admissions. Their chemotherapy orders are placed in the chemo protocol binders (also a great resource) and chemo drug binders.

Wednesday Morning Lectures –The intern and senior resident take turns stay on the floor and round with the attending and manage patient issues.

Afternoon Rounds with the attending will occur in the late afternoon/early evening. On days that your attending is in clinic in the afternoon, he/she may chose to go over the patient list over the phone at the end of clinic

Schedule

Tumor Board is held on the 2nd and 4th Monday of the month. You may be asked to present a patient if he/she was diagnosed during your rotation

Interdisciplinary Meeting is held every Tuesday at 11.00 AM, you are expected to make a brief presentation of each case under your care

Radiology rounds are held every Thursday at 11.00 AM

Clinic Schedule: There is an afternoon clinic every day except Friday from 1-5.00 PM. There also 2 half clinic sessions on Monday and Friday mornings. The morning clinics are the best time for you to learn how to access mediports.

Patient Care Issues

Patients on our service can often have complex medical problems. Make sure that you obtain interval history and perform a thorough physical exam daily or with any change in the patient’s medical status and follow up on lab results in a timely fashion. Make sure you let the attending know at once if a patient has a change in medical status.

H/O nurse practitioners are a great resource and often round with the team in the morning. They write the chemo orders before patients are admitted; review all their orders and ask them if you have any questions. The chemo protocols are very specific; if you think something needs to be changed with fluids, labs, etc. please check with the NPs or the attending before making changes.

Don’t forget to get consent for blood/blood product transfusions upon admission if appropriate for your patient. Most patients on chemotherapy receive blood products that are irradiated and CMV safe- check with your attending

In case of a patient with febrile neutropenia, make sure that blood cultures are drawn from all lumens of the central line and antibiotics are divided between lumens. Do not D/C IV fluids between medications but make sure that fluids run at KVO between administrations of antibiotics to minimize risk of line infections.

Patients should receive antibiotics within an hour of being noted to be febrile.

Expectations during the rotation:

You are expected to familiarize yourself with the side effects of chemotherapeutic agents your patient is receiving. It is helpful to note side effects of current chemo meds on the sign out sheet for easy access during night float and attending rounds.

Our out- patient clinic is held in the Cancer Center, which is the building across the parking lot. Our clinic is located on the second floor. You are expected to identify one afternoon to attend clinic every week during your rotation based on your CCC schedule and your senior’s schedule

You must learn how to access mediports in the H/O clinic. Be proactive and ask the clinic nurses the best time for you to learn.

We encourage you to observe procedures (bone marrows and spinal taps) being performed on your patient, they are usually performed In the PICU

We encourage you to try and see peripheral and bone marrow smears with your Attending whenever possible.

If asked to see a consult, come up with a differential diagnosis and plan on your own before you present the case to your attending

Please try and review the curricular requirement for this rotation. Relevant articles have been posted on the residency curriculum website. We encourage you to try and do PREP questions relevant to hem/onc during this rotation

You will be asked to make 2 presentations during your rotation, each of about half hour duration, one on a hematology and one on an oncology topic of your choosing. You will present your talks on Tuesday morning after the interdisciplinary team meeting.

We will make every effort to provide you with feedback both during and upon completion of your rotation. Please do not be shy about seeking feedback.

Please do not hesitate to ask questions whenever you are not sure about something. We welcome feedback from you about the rotation as we are always striving to improve.

Good luck!

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Rotation Requirements

▪ Reading Materials on curriculum website- you are expected to read these during your rotation

▪ Must attend at least one clinic per week

▪ Must achieve Mediport procedure credentialing

▪ Two short prepared presentations, one in hematology and one in oncology

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