The Veterans’ Administration Palo Alto Health Care Service provides medical care for a wide range of cancers. First-year fellows rotate to the facility.

Program Timeline

Year One

The timeline is different for fellows in combined hematology/oncology training (18 months of clinical training) or in hematology (12 months clinical training) or oncology (12 months clinical training).

The clinical training programs have as their goals:

  • Acquisition of basic hematology and/or oncology skills.
  • Development of the range of skills needed to practice superb academic medicine in hematology and/or oncology.
  • Learning the principles of clinical research and applying them in trials.


Fellows receive a diverse clinical training experience during their first year, which provides them with the broad experience necessary to ensure a comprehensive and sound knowledge base in oncology/hematology and gain the tools needed to pass subspecialty Board certification. A strong educational program is a key component of the training structure throughout the years of fellowship.

 

Oncology Rotations:

Outpatient service:
 Fellows have the opportunity to interact with all oncology faculty members and to treat patients with a wide variety of cancers during 6 month blocks of disease specific continuity clinic rotations. In addition, fellows will attend disease-specific clinics across the spectrum of solid tumors on a monthly rotation basis and will have constant exposure to academic practice in disease specific multidisciplinary tumor boards.

During the first 18 months, double-boarding fellows undertake 3 one-half day continuity clinics:  2 in oncology and 1 in hematology.  During the latter half of the second year, fellows undertake 1 one-half day oncology continuity clinic and 1 one-half day hematology clinic.  Single-boarding fellows undertake 3 one-half day continuity clinics in the first year followed by 2 one-half day continuity clinics in the second year and 1 one-half day continuity clinic in the third year.

Each fellow is assigned 2 months in the Hospital Oncology Service. While the Hospital Oncology Fellow has the primary role of providing consultation to oncology patients on other inpatient services, he/she will be a critical resource for the inpatient oncology team (MED 10). This inpatient team consists of two medicine interns, a medicine resident, medical students, and an attending medical oncology faculty member.

VA Oncology: Fellows gain additional clinical experience at the Veterans’ Affairs Palo Alto Health Care System (VAPAHCS). Each fellow rotates to this service for 2 months and with a faculty attending, the VA fellow will provides consultation to the inpatient VA services and attend oncology clinics, in addition to participation in the weekly oncology conferences and tumor board.

 

Hematology Rotations:

Outpatient service:
Fellows interact with all of the hematology faculty members and see patients with both benign and malignant hematologic diseases during the outpatient rotations. They are also assigned to continuity clinics for all years of their hematology fellowship.

Inpatient service (Med 8): 
Each fellow spends 2 months on the Hematology Inpatient Service (Med 8). The fellow supervises a team of two residents, an intern, and medical students. A hematology faculty member attends on the service at all times. The Med 8 service is primarily comprised of patients with hematologic malignancies, especially acute leukemia.

Hematology Consult service:
The fellows spend 2 months each at Stanford Hospital and the Veterans Affairs Palo Alto Heath System on the hematology consult service and they are responsible for consults at each location indepedently. They work closely with the consult attending at each site and see a wide variety of hematologic diseases. The fellows also participate in the weekly hematology clinic at the VAPAHCS and the monthly Tumor Board.

Coagulation/Transfusion:
The fellows rotate through the coagulation and transfusion laboratories and learn how common assays are performed, how to interpret the results, and the clinical significance of these results. They will also learn about therapeutic pheresis during this rotation.  Increasing exposure to molecular diagnostics and flow cytometry is also incorporated.

 

Blood and Marrow Transplantation (BMT) Rotations:

Fellows spend 1 month on the BMT service and learn the principles of stem cell transplantation in the autologous and allogeneic settings. The BMT team consists of an attending, BMT fellows, and medical residents.