Sites: BIDMC
Director(s): Katharyn Atkins, Jason Freed
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month.
Location: BIDMCE - BI-Deaconess Med Ctr-East (1)
Open to Exclerks: Yes (may be restricted for international students)
Description: The Hematology-Oncology Elective at BIDMC accepts up to 2 students who play an active role on the Hematology-Oncology Consult service. Students work closely with a 2nd-year Hematology-Oncology Fellow, 1 or 2 Attending Physicians and often an internal medicine resident, seeing inpatients in consultation for a variety of hematologic and oncologic concerns that arise on medicine, surgery, obstetrics-gynecology, and intensive care services. Students are expected to present their patients´┐Ż histories, physical examinations, and laboratory findings with preliminary assessment and plans for discussion at daily rounds, where basic science and pathophysiologic concepts are integrated into clinical teaching. Additionally, students attend weekly teaching conferences, where cases are discussed in depth for didactic purposes, again stressing basic science and pathophysiologic concepts that inform evidence-based and insight-based care of patients. Many of the hematology-oncology conferences at BIDMC are multidisciplinary, including the participation of surgeons, radiation oncologists, pathologists, radiologists, transfusion medicine specialists, and laboratory personnel. Multidisciplinary case discussions enrich in-depth understanding of complex aspects of patient care, occasionally resulting in altered patient management plans and highlighting important aspects of systems-based practice and practice-based quality improvement. At one of the weekly Hematology Conferences, students will have an opportunity to give a PowerPoint presentation based on one of their cases from the Consult Service, with a discussion of basic science, pathophysiology, differential diagnoses, and diagnostic and therapeutic considerations relevant to the case chosen for presentation. In addition to serving as an integral member of the consult service, students will also have an opportunity to see patients with attending physicians in outpatient clinics in the BIDMC Shapiro Clinical Center Hematology-Oncology Ambulatory Unit. Outpatient clinics span a variety of subspecialty interests, including benign and malignant hematologic disorders, disorders of hemostasis and thrombosis, breast cancer, gastrointestinal and hepatobiliary malignancies, thoracic oncology, cutaneous oncology, genitourinary oncology, and biological and experimental therapeutics.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Basic science and pathophysiologic concepts are routinely integrated into discussions at Consult Rounds and in didactic conferences, where a strong emphasis is placed on evidence-based and insight-based medicine. While didactic conferences in the Hematology-Oncology Division at BIDMC are structured around a year-long curriculum for hematology-oncology fellows, a broad subset of topics recur frequently, so that students on 4-week elective invariably participate in discussions of tumor biology, molecular mechanisms of disease, mechanisms of hemostasis and thrombosis, the differential diagnostic approach to thrombocytopenia, anemia, leukopenia, leukemia, lymphoma and a host of solid tumor subtypes, most commonly breast, lung, prostate, and gastrointestinal malignancies.
Grade Criteria:
Honors with Distinction: Takes consistently complete, accurate, and efficient history, even on the most complicated patients. Highly organized and poised. Consistently demonstrates superior use of questions. Always responds effectively to patient affect and non-verbal cues. Exam is consistently superior. Uncovers subtle and important findings, incorporating advanced techniques where appropriate. Exceptionally organized and thorough, even on difficult cases. Knowledge base is superior in both breadth and depth. Consistently able to apply sophisticated understanding of pathophysiology to clinical context, even in difficult cases. Differential reflects highly sophisticated reasoning process. Consistently demonstrates well reasoned patient-individualized use of tests/procedures. Generates comprehensive treatment plans, even on difficult cases. Consistently models superior communication skills, and easily engenders trust. Excellent communication skills significantly add to ability to deliver a high level of care. Written and verbal presentations are consistently cogent, efficient and sophisticated. Synthesizes and imparts complex information, and conveys thought processes behind clinical decisions with great clarity and depth. Behavior models the highest standards of integrity, reliability, and collegiality. Consistently seeks out and accepts responsibility. Greatly sensitive to cultural/social/systems factors, and consistently uses this knowledge to provide superior care and find the most appropriate solutions. Demonstrates exceptional intellectual curiosity and initiative; constantly seeks out feedback as a means of self-improvement; reads systematically and in-depth. Honors: Generally accurate and complete enough to identify key problems. Misses less critical information, but only on complicated patients. Generally able to respond to non-verbal cues. Appropriate for level of training. Exam is generally appropriate in scope and technique. Identifies major abnormalities and pertinent normal findings, only occasionally missing elements. Exam linked to history. Appropriate for level of training. Adequate knowledge base. Incorporates basic science information appropriately into clinical decision making. Adequate knowledge of basic pathophysiology of disease. Appropriate for level of training. Differential generally well-reasoned. Understands indications for tests/procedures. Formulates appropriate treatment plans for patient problems. Appropriate for level of training. Generally able to communicate effectively, establish rapport and demonstrate empathy. Appropriate to level of training. Written and/or verbal presentations are most often concise and well organized. Clearly conveys thought processes behind clinical decisions, and tailors presentations to setting. Generally dependable, reliable, responsible, collegial. Able to work well with others. Generally aware of cultural/social/systems factors and attempts to integrate these into patient care. Behavior appropriate for current level of training. Shows interest in improvement and takes initiative in activities that enhance knowledge and skills. Behavior appropriate for current level of training. Satisfactory: Occasionally misses key information. Some deficits with organization and accuracy. Needs improvement in questioning technique and sensitivity to nonverbal cues. Exam occasionally lacks appropriate technique, and shows some deficits in organization and thoroughness. Connection between history and physical is occasionally tenuous, and sometimes misses important findings. Needs improvement. Knowledge base has occasional deficits. Generally able to synthesize basic science and clinical information to identify major problems, but has some gaps in knowledge of basic pathophysiology/disease processes. Able to generate differential, but occasionally lacks depth or detail. Sometimes needs assistance in formulating diagnostic or treatment plan. Shows occasional lack of ability to establish rapp