Bone Marrow Transplantation

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH, DFCI
Directors: Antin, Joseph Harry
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time every month. Closed April 2016
Open to Exclerks: Yes (may be restricted for international students)
Students will become members of the transplant team, participating in rounds and discussions with patients and families, and becoming involved with management decisions and all other aspects of inpatient care. They will see outpatients with a staff member, participate in donor evaluation and
screening, and become involved with interpretation of HLA typing and with post-transplant care. Students will participate in the procurement of bone marrow, and will observe marrow cryopreservation,monoclonal antibody treatments of marrow, and other research activities of the transplant team. Students
are expected to understand the use of bone marrow transplantation in the treatment of malignancies, marrow failure, and congenital disorders. They will develop a practical understanding of hematopoiesis, transplant immunology, graft versus host disease, infections in immunocompromised hosts, support of
patients with pancytopenia, and issues of social importance regarding the adaptation and coping of patients and families to complex and life threatening illnesses.
Learning Goals:
To understand what patients and diseases are considered appropriate for autologous and allogeneic stem cell transplantation. This will be accomplished through didactic discussions, literature assessment, in the context of patient management.
To understand the immunologic issues involving stem cell transplantation from HLA typing to immunologic reconstitution to graft versus host disease. These principles will be taught in a patient based setting focusing on patient care with appropriate reading and lectures.
To become familiar with the management of severely immunocompromized patients. In the setting of a transplantation unit, students will assist the transplant team in assessing the degree of immuno- and myelosuppression, establishing a plan for infection prophylaxis based on the clinical context, and initiation of therapy for infection in compromised hosts.
To become familiar with the social and psychological stresses and disruptions that are intrinsic to stem cell transplantation, and to work with the transplant team in identifying and alleviating psychosocial problems.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Clinical stem cell transplantation incorporates aspects of cellular immunology, humoral immunology, pharmacology, genetics, stem cell biology, and microbiology in a dynamic way that is unique for this discipline. The transplant team uses evidence based principles as much as possible in the management of the patients. Students will see the clear juxtaposition of evidence based medicine, clinical experience and skill, and judgement where no evidence exits. There will be an opportunity to participate actively in clinical trials. This teaching will take place at the bedside as well as in formal lectures and didactic discussions.
Students will be evaluated on their grasp of transplant-related issues, their ability to function well in the transplant-team setting, and in their interactions with patients and families.
Grade Criteria:
High Honors:
Demonstration of an in-depth understanding of disease pathophysiology, immunological complications of transplantation, management of complications of transplantation, and skillful integration into the transplant team. In depth review of a relevant topic that arises during patient management is expected.
Demonstration of a good working knowledge of the underlying reasons for applying transplantation to particular patients as well as the complications of transplantation. There should be an excellent working relationship with all of the members of the transplant team. There should be a presentation or review of a relevant topic demonstrating a strong grasp of the concepts and background involved.
Basic understanding of the indications for transplantation, principle complications of transplantation, and management of transplant related complications and issues. There should be evidence of outside reading and participation in teaching exercises.
Poor attendence, failure to grasp the basic issues involving patient assessement for transplantation, inability to work with the team, failure to acquire new knowledge through the literature.
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