ROTATION SUMMARY ONCOLOGY WARD

Transcription

1 ROTATION SUMMARY ONCOLOGY WARD Rotation Contacts and Scheduling Details Rotation Director: Clare Twist, M.D Introduction The LPCH Oncology Rotation is designed to increase resident knowledge of the pathophysiology and management of inpatient hematology and oncology conditions including sickle cell disease and common oncologic diagnoses and oncologic complications. As a junior level rotation, the resident will be expected to synthesize clinical and laboratory information then assimilate a management plan. Residents will manage multi-system issues in acutely ill broadly strengthening clinical skills in fluid and electrolyte management, infectious diseases, respiratory support and pain management. Weekly Schedule Time Monday Tuesday Wednesday Thursday Friday Pre-round Pre-round Pre-round Pre-round Pre-round 7:30-8:30 HEME/ONC/BMT SCHOOL for night float Morning Report Morning Report Morning Report Morning Report Grand Rounds Work Rounds Work Rounds Work Rounds Work Rounds (8:00-9:00) Patient Care Patient Care Patient Care Patient Care Work Rounds Conference Conference Conference Conference Conference Patient Care Patient Care Patient Care Patient Care Patient Care 1-3pm Protocol Conference Teaching Session Teaching Session 1700 Sign-out Tumor Board Sign-out Sign-out Sign-out 1800 Sign-out Rotation Specifics Orientation Residents should receive sign-out before beginning the rotation so they are well versed with the on the first day. The resident is expected to arrive at the hospital with enough time to pre-round on their before Morning Report. Residents should ask the Attending on service each week their preference for type of oral presentation and organization of the written note. Residents will receive an Orientation to the expectations of the Oncology Rotation on the 1 st day from the Attending on service at the time. Residents are also expected to review the Hematology and Oncology Manual and Fever and Neutropenia Guidelines available on-line at Rounds Rounds are conducted in 2 phases. Initially sit rounds are held in the conference room at which time the resident patient in a traditional problem-oriented fashion. The Oncology Faculty greatly values the input of our nursing colleagues and all efforts are made to discuss each patient with their nurse present so that she may contribute to and better understand the plan for the day. As a result, the order in which are discussed is frequently driven by nursing availability, except on weekends when the post-call resident will sign his/her out first. During sit rounds, the resident that is not presenting will work the computer showing relevant labs and enter orders as appropriate. Following sit rounds, the team visits each patient and discusses the plan of the day. The resident is expected to lead this discussion with the family.

2 Chemotherapy are covered by a nurse practitioner during the week and residents will cover the chemo on the weekend. When the PNP is not available on weekdays, the chemo will be covered by the Heme/Onc fellow and attending. Pagers The Oncology spectra phone number is Residents should be accessible via pager from 6am until 6pm. Non-urgent pages from nursing staff will be held during morning work rounds and during Tumor Board. Call Schedule Members of the Oncology Inpatient Team will take call on weekends and sign out care to the Night Team at 5 pm each Monday through Friday, thus ensuring continuity of patient care and availability for patient care throughout the work week except for Continuity Clinic afternoons. As the daytime team is intact most days, this provides ample opportunity for teaching. Chemotherapy will be signed out to the Night Float by the chemotherapy PNP each evening and a detailed signout will be communicated to the weekend on-call team on Friday afternoon. The Night Team system limits call to weekends. The night team will arrive at 5 pm to receive sign-out. The Night Team will work all day Sunday and Monday-Thursday evenings (5 pm-7 am). An Evening Report will be led by the hospitalists shortly at 10 pm and Oncology Residents are invited to attend. These Evening Reports will cover acute on-call issues such as management of the patient with seizures or code review. Weekend Rounds On the weekend, residents will cover the on the oncology service as well as the chemotherapy. Sign-out from the Nurse Practitioner covering the chemotherapy will be ed to the residents on service. Rounds will occur as described above however the post-call resident will present his/her first if time constraints from duty hours arise. The post-call resident will not participate in walk rounds on weekends. Night Team Members of the weekday Oncology team will take call on Friday nights and Saturdays for extended call overnight into Sunday morning when they will sign out to the Night Float. The Night Float (+ Heme) resident is expected to arrive on Sunday no later than 7 am to receive sign-out and to pre-round on assigned. The resident participates on inpatient rounds as an integral member of the oncology inpatient team. Weekday morning sign-out will occur promptly at 7:00AM. The Night Float resident will sign-out to the daytime Oncology resident (fellow and attending if available). Overnight admissions and any acute events will be reviewed. Overnight events should still be sent via to all members of the daytime team [DL-HemOnc- Oncall@LPCH.ORG, and put SECURE: Heme/Onc signout in the subject line]. Please see the Heme/Onc Manual for more details. On weekdays, the Night Float resident should arrive promptly at 5:00 PM to receive sign-out from the daytime team except on Tuesday nights when arrival should be at 6pm. Resident Roles and Responsibilities Performs the primary patient care role Discusses overnight events with the Night Team and receives sign-out Pre-rounds on, performs complete physical exam every morning, writes daily progress notes and orders Presents on work rounds and walk rounds, and takes care of daily work associated with patient care Performs dictated history and physicals on new Plans discharges and does paperwork. Supervises subinterns caring for your (PGY 3) Contacts the private pediatricians with an update on their patient Ensures efficiency of walk/work rounds Evaluation and Feedback Residents will receive verbal feedback directly from Attendings in real time as well as feedback of his/her cumulative performance at the culmination of the Attending s service time. Each Attending on service with the resident will be asked to complete a evaluation. Oncology Fellows will also be asked to evaluate the resident through. Resident to resident peer evaluations will be distributed through for the oncology residents on daytime service together as well as for the NF Oncology resident.

3 Competency-based Goals and Objectives Goal 1. Understand the rationale and strategy of multi-modality therapy in the care of children with cancer. Collect and report daily subjective, PC - Gather essential and accurate information about objective, laboratory findings on inpatient their oncology. PC - Perform complete and accurate physical examinations Generate and communicate a comprehensive plan of care for oncology. PC - Make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment Review consultative notes from the initial diagnosis and work-up of your ; explain the rationale for treatment plan currently being followed. Protocol conference Tumor Board Self evaluation and reflection PC - Make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment Identify major therapies (chemotherapy, radiation therapy, surgery) involved in the care of children with cancer and explain their potential short and long-term side effects. State how cooperative group clinical trial research has increased survival rates for children with cancer. Advocate for quality patient care and assist in dealing with system complexities Tumor board Attending discussion Tumor board Self evaluation and reflection PC - Provide family-centered patient care that is culturally effective and developmentally and ageappropriate SBP - Advocate for quality patient care and assist in dealing with system complexities Coordinate and communicate with consulting services for in. Self evaluation and reflection ICS - Communicate effectively with physicians, other health professionals, and health related agencies Goal 2. Understand the pathophysiology of vaso-occlusive crises in children with sickle cell disease. Identify the risk factors for vaso-occlusive

4 crises in children with sickle cell disease. Describe the natural history of vasoocclusive crises. Identify the relevant laboratory and radiographic studies in the evaluation of a patient with vaso-occlusive crisis. Explain the supportive care and therapeutic interventions in the management of vaso-occlusive crisis (including hydration, pain management, PRBC transfusion strategies, monitoring of Hbg/Retic count, monitoring for fever and/or hypoxemia). Post-assessment test on teaching module Post-assessment test on teaching module Post-assessment test on teaching module Post-assessment test on teaching module Goal 3. Develop competence in communicating to parents of children with life-threatening illnesses. Participate in patient care conferences. Observe communication PC - Communicate effectively and demonstrate caring and respectful behaviors when interacting with and their families P - Demonstrate sensitivity and responsiveness to culture, age, gender and disabilities Participate in psycho/social rounds Observe communication PC - Interview /families about the particulars of the medical condition for which they seek care, with specific attention to behavioral, psychosocial, environmental and family unit correlates of disease Observe either initial diagnosis conference, consent conference, or end of life discussion. Observe communication P - Respect for patient privacy and autonomy ICS - Create and sustain a therapeutic and ethically sound relationship with ICS - Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills Demonstrate communication strategies during bedside rounds. Observe communication ICS - Communicate effectively with, families, and the public as appropriate, across a broad range of socioeconomic and cultural backgrounds;

5 PC - Counsel and educate and their families Goal 4. Understand the common presentations and comprehensive management of childhood leukemia. Identify the common signs and symptoms of marrow failure. Recognize some of the more unusual presentations of childhood leukemia. Describe the possible CBC-d results in children with marrow failure. Generate 3-5 main differential diagnosis in children with marrow failure syndromes. Explain the pathophysiology and management of chemotherapy-induced mucositis. Explain the pathophysiology and management of Tumor Lysis Syndrome. Teaching Module MK - Demonstrate an investigatory and analytic thinking approach to clinical situations Apply transfusion guidelines to properly order blood products for oncology. Describe the potential risks and side effects of blood products and

6 management of transfusion reactions. PC - Counsel and educate and their families Goal 5. Understand the approach to a child with an abdominal mass. Generate a differential diagnosis for an infant and child with an abdominal mass. Define the laboratory and imaging workup involved in a child with an abdominal mass. Describe the physical findings in a child with an abdominal malignancy. Didactic lectures Didactic lectures Didactic lectures Written history and physical exam on new Completion of teaching module Post-assessment Written history and physical exam on new Completion of teaching module Post-assessment Written history and physical exam on new Completion of teaching module Post-assessment PC - Perform complete and accurate physical examinations PBLI = practice based learning and improvement ICS = interpersonal and communication skills P= professionalism MK= medical knowledge PC= patient care SBP = systems based practice