Clinical training occurs primarily at Barnes-Jewish Hospital as well as Siteman Cancer Center and the Siteman Satellite locations. Barnes-Jewish Hospital serves as a local hospital for the surrounding metropolitan area, with its large socioeconomically diverse patient population, and also functions as a tertiary and quaternary referral center.
Outpatient hematology clinics for fellows are geared towards providing comprehensive and varied exposure to cultivate expertise in work up and management of patients with a variety of common and rare benign hematologic disorders. Diseases seen in clinic include problems such as sickle cell disease, cytopenias, hemophilia, coagulopathies and hemolytic disorders. Most faculty members have an area or interest and expertise within benign hematology that helps create a diverse group of patients for fellows to evaluate and follow. Fellows boarding in hematology are required to maintain a hematology or BMT/Leukemia/Lymphoma continuity clinic throughout the fellowship.
Fellows in clinics with the BMT/Leukemia/Lymphoma faculty will learn about the management of patients with hematologic malignancies including leukemia, lymphoma, multiple myeloma, myeloproliferative diseases and myelodysplastic syndrome. Fellows will also learn the outpatient management of autologous and allogeneic transplant patients as well as patients undergoing cellular therapies such as CAR-T cell treatments. Fellows boarding in hematology are required to maintain a hematology or BMT/Leukemia/Lymphoma continuity clinic throughout the fellowship.
Fellows are able to select from a variety of specialty oncology clinics with a diverse mix of oncology patients. By following individual patients from their initial diagnosis, fellows develop an appreciation for the natural history of the disease process. Fellows learn to evaluate, stage, and treat all major cancer types, write chemotherapy orders, provide supportive care, and manage patients through Home Health and Hospice. Fellows can elect to work with one or more faculty members in oncology who see patients with the fellow and offer suggestions for patient management. On average, fellows will see one to two new patients and 4-8 follow-up patients each half-day of clinic. In addition, patients initially seen by fellows in consultation in the hospital may be referred to a fellow’s oncology clinic.
The Hematopathology rotation was designed to help fellows gain basic understanding of bone marrow biopsy and peripheral blood smear interpretation. Fellows gain an understanding of the hematopathology abnormalities seen in the diagnosis of myeloma, leukemia, lymphoma, and other hematologic disorders under the instructions of a hematopathologist.
BONE MARROW BIOPSY ORIENTATION
The Bone Marrow Biopsy Orientation is designed to help first-year fellows become comfortable with performing bone marrow biopsies. Within the first 2 weeks of fellowship, first-year fellows are scheduled in the outpatient clinic to learn how to perform and become proficient at doing bone marrow biopsies. Fellows conduct at least 5 supervised bone marrow biopsies.
Hematology Inpatient & Consult Service
The Hematology Inpatient rotation is required of all first year fellows by the fellowship program and the ACGME. Fellows will rotate in three non-consecutive 2 week blocks during year one. Fellows lead the team and are expected to triage and delegate consultations as well enhance teaching of house staff through researching and providing literature related to patients on the service. While on the Hematology Service, fellows become adept at identifying and managing the complications of a variety of common and rare hematologic disorders, including sickle cell disease, thrombotic microangiopathy, thrombophilia and bleeding disorders to name a few. All factor products require approval from hematology fellow and they are expected to coordinate patient care with the primary medical/surgical teams, blood bank and laboratory medicine services. Fellows also learn to perform and interpret bone marrow aspirates and peripheral smears. This service also acts as the primary team for hematology inpatient Acute Service Medicine (ASM) service staffed by an ASM nurse practitioner (predominantly patients with sickle cell anemia that are well-known to the hematology clinic). The multidisciplinary rounds in the afternoon include Internal Medicine resident(s), medical student(s), and nurse practitioners and include formal and non-formal didactics from both the staff attending and fellows.
Acute Leukemia/BMT Service
On the Acute Leukemia/Bone Marrow Transplantation Services, fellows learn about the diagnosis and treatment of malignant hematologic diseases, to care for patients undergoing peripheral stem cell/bone marrow transplantation, including haplo-identical transplants, for both hematologic malignancies and solid tumors. Fellows will learn the management and treatment of acute leukemia and complications of stem cell transplants such as graft-versus-host disease and veno-occlusive disease. Fellows will also participate in the care of patients receiving CAR-T and other cellular therapies and will learn the management of cytokine release syndrome.
Fellows attend the BMT Patient Review Conference every week where patients undergoing treatment or being considered for transplantation are discussed. While on either the Acute Leukemia or Bone Marrow Transplantation Services, fellows may be asked to present at the BMT Morbidity and Mortality Conference. Fellows interested in research and careers in stem cell transplantation and cellular therapy can participate in this service as an elective rotation.
Oncology Consult Service
The Oncology Consult rotation is required of all first year fellows by the fellowship program and the ACGME. Fellows will rotate in three non-consecutive half-month blocks during year one. On this rotation, fellows will become proficient in the work-up, diagnosis, and management of patients with lymphomas and solid tumors. Fellows are expected to learn how to function as a cancer-specific consultant to primary physician inpatient services in the care of patients with cancer or suspected cancer. They will review all pathology, recommend diagnostic and staging work up, and make treatment recommendations for all new consults. The fellow will staff all new consults with an Oncology faculty member. The fellow will work as a team with the primary inpatient consult attending physician to coordinate patient care with the primary medical/surgical team, surgical subspecialties, and radiation oncology. Fellows work in an interdisciplinary team consisting of Internal Medicine residents, nurse practitioners, nurse coordinators and pharmacists. The Oncology rotation is staffed by the Oncology fellow Monday – Friday (8 AM-5 PM).
During this rotation, the fellows lead a multidisciplinary team (nurses, nurse practitioners, pharmacists). Fellows receive didactics provided by our oncology clinical pharmacists regarding administration, side effects, etc of chemotherapeutic agents/regimens. They then have the opportunity to complete chemotherapy regimens in EPIC playground including dose adjustments based on such variables as renal function as well as hematologic and non-hematologic toxicities.
Tranfusion Medicine Rotation
:The Transfusion Medicine Rotation is a two week rotation which focuses on providing fellows with training in the basic principles of blood banking, transfusion medicine, and apheresis. Fellows will maintain a half day continuity clinic during this rotation, but otherwise are expected to be present for daily Monday – Friday rounds and didactics with the Transfusion Medicine team.
Fellows have the option of participating in several 2-week elective rotations including transfusion medicine, sickle cell elective, radiation oncology, cardio-oncology, gynecologic oncology, palliative care, pediatric oncology, pediatric hematology, research and senior BMT.
- First and second year fellows take call, while third and fourth year fellows do not take call. Most calls are done in the first year.
- Our fellows do not take direct patient calls from oncology patients. Those calls are covered by nurses or nurse practitioners. The fellow serves as a “back-up” if the nurse has a question regarding a patient call.
- During the week, the call shift is from 5pm to 8am the following morning and is home call.
- During the weekend, the call is divided into 2 shifts; from Friday at 5 pm until Saturday at 3 pm and from Saturday at 3 pm until Monday at 8 am. Call on the weekend days is in-house, meaning that in addition to taking home call overnight, the fellow does come in to the hospital during the day to round as the primary provider on the inpatient sickle-cell disease service and staff new Heme/Onc consults.
Fellows are allowed to moonlight during their second through fourth years of Fellowship.
- Fellows typically moonlight on the Inpatient BMT and Inpatient Medical Oncology services, which allows for opportunities to learn relevant Heme/Onc subject matter while also earning extra income.
- There are overnight shifts and weekend day time shifts available.
- Fellows must monitor and report clinical work hours, with those moonlighting hours counting toward the ACGME mandated duty hour limits.
Stipends & Benefits
Trainee stipends are equivalent to Barnes-Jewish house staff stipends for comparable years of experience. The possibility of research fellowship support for additional research training for well qualified applicants can be arranged on an individual basis.
Additional benefits include:
- Paid personal time off (4 weeks, 7 days per week)
- Paid sick leave (14 days)
- Allowance for annual trips to scientific meetings
- Online journal access and access to Becker Medical Library
- Access to ASH-SAP and ASCO-SEP training materials
- Meals at reduced rates in the hospital
- Two lab coats annually with embroidery
- Free parking and/or Metrolink passes
- On- and off-site computer and library access
- Paid medical liability insurance
- Participation in group health and dental plans
- Life, accidental death and dismemberment, and long-term disability insurance are available
Fellows are allowed to moonlight during their second and third years of fellowship.