Hematology

We will train you in taking histories, giving physical examinations, and interpreting laboratory data for patients with a wide range of hematologic disorders, including those common to patients with HIV and patients undergoing chemotherapy.

You will conduct microscopic examinations of blood and bone marrow and use morphology to diagnose and treat these patients, seeing new admissions on both inpatient and ambulatory services, and providing follow-up care where appropriate.

In addition, you will gain experience with providing subspecialty consultations under faculty supervision, including patient education, communication with referring physicians and ensuring support for ongoing care of patients’ hematologic conditions.

As part of this rotation, you will participate in the inpatient hematology consultation services at the Erie County Medical Center or the Department of Veterans Affairs Western New York Healthcare System. You will work under the supervision of a hematology faculty member and hematology fellow at each institution.

You will work in conjunction with the hematology consultation team which consists of the faculty attending and the hematology fellow, who are responsible for the performance of inpatient consultations as well as the continued follow up of these patients during their hospitalization. Medical students and other medicine housestaff may comprise the consultation team as well.

Through this experience, you will develop and refine the skills essential for the clinical evaluation of patients with hematologic disorders. These skills include the development of appropriate differential diagnoses, assessment of the need for hospitalization, diagnostic evaluation strategies and treatment plans. You will also become familiar with providing consultation services, including educating patients and communicating with the referring physicians and ensuring support for continuing care of the patients’ hematologic condition. The fellows also participate actively in the teaching activities of the consultation team.

Rounds are conducted daily on weekdays and usually once per weekend with the attending faculty usually evaluating patients directly. Under the direction of the attending physician and hematology fellow, you will provide consultative input to the surgical, rehabilitation, psychiatric and medicine services at the institution as well as coordinate with the housestaff to formulate a diagnostic algorithm and therapeutic interventions.

You will then follow these patients through their clinical course as deemed appropriate by the attending and are expected to perform literature research on topics appropriate to the case at hand and make your findings available to the primary care team. The fellows will teach and supervise trainees on the primary care team and hematology service with regard to specialized techniques.

For inpatient activity, the attendings rotate monthly and evaluate each consultation with the hematology fellow and other trainees on service. Technical procedures are handled by a certification system where an uncertified trainee would be observed by an individual certified in the procedure. Teaching conferences are conducted separate from management rounds, although teaching and patient care decision tend to be conducted at the same time during daily rounds.

Adequate attending staff is present at all ambulatory care sites and are directly involved in discussion and participation in care of the patients. Each patient is discussed at the end of the clinics in a group session and aspects of care and education are raised during these approximately 30-45 minute informal conferences.

At the Erie County Medical Center, you will participate in a weekly hematology clinic and in transfusion medicine programs.

At the Buffalo VA WNY Healthcare System, you will participate in two clinics — a hematology clinic and a clinic of patients with oncology and hematologic malignancies. At this site, you will also be heavily involved in ambulatory chemotherapy in the VA Cancer Center.

At the Buffalo VA Medical Center, there is a combined hematology/oncology service, and subsequently, as part of your rotation, you will evaluate and treat both inpatients and outpatients with diverse hematologic disorders.

In addition, you will care for patients with malignant hematologic disease including lymphomas, myelomas, as well as acute and chronic leukemias. You will review laboratory data, flow cytometry and peripheral smears with fellows and faculty, and may have the opportunity to perform bone marrow biopsies as indicated in the diagnostic work-up under supervision and review pathology specimens on-site with the hematopathologist.

Hematology fellows present at the weekly “Red Cell Rounds” conferences and weekly clinical conferences. In addition, they conduct conferences for internal medicine residents in basic aspects of hematology.

A monthly journal club, clinical research, basic science, multidisciplinary — specific topic format is conducted for all trainees at a common site. Both staff and fellows present at this conference.

This is a case-based teaching conference with active participation from pathology, radiation oncology, surgery and general internal medicine, radiology, as well as hematology and medical oncology.

The hematology fellow is responsible for case selection and arranging for presentations. This conference includes presentation of VA patients as well as presentation of patients seen by community-based physicians.

Approximately once per month the conference has the format of a tumor board with presentations of patients from surgery with a multi-disciplinary discussion of treatment including input from radiation medicine.

This conference also includes discussions of quality assurance issues within hematology and medical oncology.

Both staff and fellows present at this conference.

• PGY-2, PGY-3 or PGY-4

4 weeks