Mission

The mission of the SAUSHEC Hematology/Oncology Fellowship Program is to provide the clinical experience, educational resources and mentorship support that produces exceptional Hematology/Oncology physicians who deliver the highest quality of ethical, compassionate, and reliable military medicine. Fellows are prepared to provide the highest level of clinical care with a focus on patient safety and the individual needs of their patients. In addition, SAUSHEC Hematology/Oncology fellowship promotes and mentors scholarly activity and research with the goal of advancing the field of hematology/oncology medicine.

Vision

Our vision is to develop academic and clinical leaders in the community and on the battlefield. We are training the future of oncological care, in all of its forms and in all of its facets. Our program will continue to develop leaders who can independently manage various hematological and malignant conditions. Our graduates will be equipped to embark on novel therapies, including cellular therapies such as Chimeric Antigen Receptor (CAR) T-cell treatments. 

Aims

• Graduates of our program will demonstrate a high level of competence in the recognition, diagnosis and evidence-based management of various hematologic and oncologic conditions.
• Our fellows will demonstrate comfort caring for a diverse patient population. Our fellows will be able to provide comprehensive consultative care in a variety of inpatient and outpatient settings.
• Fellows will learn and feel comfortable with the basics of clinical and/or translational research. They will learn how to collaborate in research with faculty, mentors, and each other to produce mentored research or scholarly work.
• Fellows will be trained in effective, compassionate, and professional communication skills with patients and families as well as with colleagues and various medical specialists.
• Train the next generation of Military Hematologist/Oncologists to become leaders in clinical education and hematology and oncology research.
• Our program will provide exposure to a broad range of hematologic and oncologic diseases.
• Cultivate personal and professional qualities that facilitate teamwork, leadership and balance in the lives of our trainees to maintain longevity in the field.

Our current schedule includes the following:

• Monday morning case conference for one-hour (we discuss weekend admissions, new consults),
• Tuesday one-hour core lecture series,
• Wednesday one-hour core lecture series,
• Thursday one-hour multidisciplinary hematopathology tumor board conference, and
• Friday one-hour core lecture series.

Every fourth Monday we have a combined Journal Club and mortality and morbidity conference. During the fourth Monday conference we also review current clinical trials at our institution and have a focus on research methodology. The additional change this academic year includes the inclusion of a molecular-tumor board to our didactic schedule. This tumor board occurs on the first Monday of the month and includes a one-hour discussion of at least two cases (maximum of four cases) which have molecular implications that have therapeutic consideration and/or clinical trial participation. These are facilitated by me, Program Director, and genetic counselors that assist with counseling for individuals with germ-line mutations.

• Genetics
• Palliative Care Medicine
• Radiation Oncology
• Bone Marrow Transplant – This elective rotation is a two-month elective rotation at a high-volume stem cell transplant center, pre-requisites include 10 months of dedicated Bone Marrow Transplant rotations at this facility. Offered to PGY-6’s in their final six months of training who have elected to pursue credentialing in this particular discipline. 

The call schedule is dictated by inpatient rotations. The required inpatient rotations in this fellowship program include the following: Inpatient Hematology/Oncology Consults, Inpatient Hem/Onc Wards, and Bone Marrow Transplant (BMT). During your PGY-4 year, fellows will have five dedicated inpatient months, PGY-5’s will have four dedicated inpatient months, and PGY-6’s will have three inpatient months. The Inpatient Hem/Onc Ward team is comprised of a senior fellow (PGY-5 or PGY-6), and a junior fellow (PGY-4). Both the BMT rotation and Inpatient Hematology/Oncology Consults will have one fellow, from any PGY year rotating. Our rotation blocks are 4 weeks in duration, as such one fellow will cover the weekend call for the four-week period of time. The weekend call will comprise of management of patients on the Inpatient Hematology/Oncology Wards, and patients on Inpatient Hematology/Oncology Consults. Fellows are expected to take home call after duty hours. The nightly call during the week will be alternated by the fellows that are not planning on providing weekend coverage. Of note, the Inpatient Ward staff is the attending of record after duty hours and on the weekend. During duty hours the Inpatient Hematology/Oncology Consult staff is the attending of record. 

This academic year we have partnered with our colleagues at Walter Reed National Military Medical Center (WRNMMC) to spearhead a Military Unique Curriculum. This is now included in our regularly scheduled didactics. This curriculum was launched in July of AY 2023 – 2024 and occurs on the 4th Friday of every month from 11:30 a.m. – 12 p.m. Central Time. Our focus includes the following:

Objectives

Leadership 

• Leadership basics: understand various leadership styles including toxic leadership, emotional intelligence, conflict resolution, implementing change
• Understand responsibilities of being Hem/Onc service chief (including how to supervise civilians)

Hematology in critical care 

• Understand principles of massive blood transfusion and management of trauma-induced coagulopathy 

Cancer in service members 

• Understand who to contact and how to create a profile for a service member with cancer, and how to determine world-wide deployability 
• Understand retention criteria for service members with Venous Thromboembolism (VTE), cancer, and germline predisposition to cancer
• Review data on in cancer incidence and survival in service members
• Understand benefits of the Military Health System (MHS) and how healthcare disparities are minimized or eliminated in the MHS

Role of Heme/Onc in combating effects of ionizing radiation

• Review short- and long-term Heme/Onc consequences of high dose radiation exposure

Assessing efficacy of Military Unique Curriculum

• Submission of prospective protocol to Institutional Review Board (IRB) 
• Assess fellow comfort with these topics at baseline and iteratively every 6-12 months using a Likert scale

• Inpatient Hematology/Oncology Consults
• Inpatient Hem/Onc Wards
• Bone Marrow Transplant
• Hematopathology
• Blood Bank/Transfusion Medicine
• Coagulation
• Gynecological Oncology

This is generally utilized during our Monday morning Case Conference lectures. In this capacity we discuss new cancer patients, inpatient consults, and ward admissions for the prior week. The ward attending will get the information from the presenter (usually a PGY-4, but occasionally an upper level PGY-5/6 will present an interesting case), and obtain basics such as age and chief complaint or reason for admission. The fellows will input proper work-up to include pertinent laboratory testing, imaging for staging and other diagnostics that will be useful in the presented case. Once agreed upon proper work-up the faculty will provide expert guidance on how to proceed with the indicated work-up. Once this is accomplished, we will develop and devise a treatment plan based on evidence-based medicine. In this capacity we will then be able to utilize hypothetic scenarios based on the presented case to gauge how the fellows would alter their diagnostic work-up or treatment plan. 

In this capacity we can simulate clinical scenarios that reflect real-world patient presentations. These simulations and presentations mimic clinical experiences that are structured to facilitate learning in a manner that allows fellows to function as part of an effective interprofessional team that works together towards the shared goals of patient safety and quality improvement. This also enforces practice-based learning and improvement, and systems-based practice. 

Another simulation that is also enforced is procedural instruction in a simulated scenario for bone marrow biopsy and aspiration. Our fellows are required to observe staff during this procedure to learn the technical skills employed. Our core faculty give an annual tutorial on the use of a medical drill for bone marrow biopsy and aspiration. This improves upon our accrediting body directed procedures and technical skills. 

Specifically, this academic year we are going to utilize the simulation center for Lumbar Puncture procedure and administration of intrathecal chemotherapy. 

With the initiation of our Military Unique Curriculum, we have focused specifically on leadership objectives. Our curriculum incorporates the fundamental understanding of leadership basics. This is inclusive of the comprehension of various leadership styles (including toxic leadership), emotional intelligence, conflict resolution, and implementing change. We also have curriculum directed at understanding the responsibilities of being Hem/Onc service chief (including how to supervise civilians).

We have great success with research over the last several academic years. Recently, one of our graduating fellows was awarded the SAUSHEC Research Award. Additionally, at any given moment we have 10 clinical trials that are ongoing, most of which are Phase III Randomized Controlled Trials. Last academic year, one of our faculty members, and three fellows were involved with an international phase III clinical trial and our institution was the top accrual center in the country. Requirements for graduation include one publishable manuscript as primary author. This requirement can be met with a case report.

On average, every fellow will have four ambulatory blocks per year (each block 4 weeks total).  Two of these blocks will include protected time for a total research allotment of 4-weeks.

Two of our core-faculty will champion the Research Conference. This conference serves as a sole didactic session that will be performed on the fourth Monday of the month. Our focus will be to discuss the 10 clinical trials that we have open at our institution. Our research coordinators are present and available to discuss new clinical trials opening soon. We will then discuss Process Improvement projects, Quality Improvement projects, QI/PS participation, and pertinent case reports within our field. Also, the fellow on “Ambulatory/research” will discuss ongoing projects and proposed research protocols that they are involved with. Lastly, we will discuss research methodology and will include Institutional Review Board (IRB) protocols. 

Fellows participate in helping to improve the health care system for our patients. Fellows will be educated in quality improvement and patient safety (QIPS) principles through the completion of the SAUSHEC Hem/Onc QIPS core curriculum.

While developing excellent clinical skills as it relates to hematology and oncology, the SAUSHEC Hem/Onc Fellowship program also focuses on developing future military leaders through mentoring, modeling, and are Military Unique Curriculum. 

Funding for fellows to attend at least one professional conference during fellowship when presenting a scholarly activity. Fellows from our Institution have given national lectures, research podium presentations, held national leadership board positions, and presented research at our annual American Society for Hematology (ASH), American Society of Clinical Oncology (ASCO), and Transplantation and Cellular Therapy (TCT).

• Adult Blood Cancer and Stem Cell Transplant Clinic, Methodist Hospital, San Antonio, Texas.
• Seattle Cancer Care Alliance, Fred Hutch Cancer Center, Seattle, Washington. 

Our program offers rotations to fourth-year medical students interested in applying to Hem/Onc Fellowship. Rotations are typically four weeks (one block) long and the Inpatient Hematology/Oncology Ward Rotation and the Bone Marrow Transplant Rotation are the two rotations offered. This experience will be inclusive of didactic opportunities, simulation experiences, and catered time for learning about the values and culture of the program. 

Students interested in rotating with our program should contact dha.jbsa.brooke-amc.list.saushec-hemonc@health.mil and follow guidance through SAUSHEC Graduate Medical Education regarding rotation logistics. 

If you would like to schedule an interview with our program, please contact dha.jbsa.brooke-amc.list.saushec-hemonc@health.mil.  

Program graduates take both the American Board of Internal Medicine Hematology, and the American Board of Internal Medicine Medical Oncology exams. These exams are offered annually.  To become fully board certified, applicants are eligible to take board certification exam 6 months following graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the American Board of Internal Medicine by June 30th, at the latest September 30th.

Fellows are expected to assume increasing levels of responsibility as teachers to their peers in the department throughout their time. They are required to give four lectures each fellowship year; two are core lectures pertinent to the field, one Journal Club and one Morbidity and Mortality conference.

Fellows are offered opportunities to teach courses and local, regional, national, and international conferences.

• All faculty are board certified in Internal Medicine
• All faculty are board certified in Hematology
• All faculty are board certified in Medical Oncology
• Five of our faculty are credentialed in Bone Marrow Transplant (No board certification required for this)
• One Faculty credentialed in Cancer Specific Medical Genetics

Our PGY-4 fellows are paired with a mentor under direct supervision for the first 6 months of training. Following completion of proper ACGME milestones for PGY-4 fellows, the fellow will progress to indirect supervision. Regardless, every six months the fellow will be under supervision with a staff hematologist/oncologist. All cases, documents, patients, and orders will be supervised by the attending mentor. 

We have instituted a revised formal well-being curriculum, led by one of our core faculty, and fellows. The curriculum focus is on lectures pertaining to well-being. We also utilize the Maslach Burnout Inventory and Mayo Well-Being Index twice annually (August and December). We have also instituted a “Fifth Friday” for our fellows.