Pediatric Stem Cell Transplant

Department of Pediatrics

Division of Hematology/Oncology

Pediatric Bone Marrow Transplantation Program

Oregon Health & Science University

Doernbecher Children’s Hospital

Pediatric Bone Marrow Transplantation Elective

INTRODUCTION

This one-month elective is designed to educate pediatric residents in the field of blood and bone marrow transplantation for childhood diseases. The rotation will expose the trainee to a variety of diseases, and the acute and late complications of hematopoietic stem cell transplantation therapy. Education will also be provided about the science and technology behind stem cell transplantation. Residents will have the opportunity to work closely with a multidisciplinary team composed of transplant physicians and mid-level health care providers, nurses, pharmacists, nutritionists, social workers and laboratory technicians. By then end of this rotation, the resident will have a better understanding of the complexity of caring for a transplant patient.

ELECTIVE DESIGN

• 1. Sign-up

  2. One resident per month will be accepted for this elective.

• 3. First priority will be given to OHSU Pediatric residents. Visiting residents or students considering training at OHSU are welcome, with permission from their residency program director. However, they will be responsible to arrange Oregon licensing (if necessary), VISA permits (if applicable) and lodging arrangements prior to their arrival.

• 4. Signup will be through the Pediatric Residency Program Office and should occur no later than 4 weeks prior to starting the elective.

• 5. The Pediatric Residency Program Office will notify the Pediatric Hematology-Oncology Office (Jan Naas, ext. 4-0829, naasj@ohsu.edu) at least 4 weeks prior to starting the elective.

• 6. Residents will receive written materials about the rotation including learning objectives and schedule at least 1 week prior to starting the elective.

• 7. Activities

  8. Clinical – Outpatient

     1. • PSCT Clinic is held Monday, Tuesday, Thursday and Friday from 9 am to 4:00 pm in the Hematology/Oncology Clinic Area (10C, DCH)

• 8. 1. • Patients are seen in clinic for:

          • 1. Consultation in consideration for transplantation

            2. Comprehensive evaluation prior to transplant

            3. Follow-up once-to-twice per week during the first 100 days post-transplant

            4. Care of chronic graft-versus-host disease or other chronic transplant complications once-to-twice per month after the first 100 days post-transplant.

            5. Long-term follow-up evaluation once yearly

            6. Evaluation of related donors prior to marrow or blood stem cell donation

            7. Outpatient procedures

• 8. 1. • The resident will be expected to:

          • 1. Perform history and physical examination of transplant patients and precept with the Peds BMT attending to formulate assessments and plans.

            2. Participate in the preparation (record review, data review) of new patients coming for consultation, in collaboration with the transplant team.

            3. Participate in the data review, treatment regimen and study protocol selection of patients being admitted for transplantation.

            4. Perform and/or observe outpatient procedures including bone marrow aspirates/biopsies, bone marrow harvesting, peripheral blood stem cell collection, lumbar punctures with or without administration of chemotherapy, punch skin biopsies, Schirmer’s ocular test, gastrointestinal endoscopies, photopheresis, etc.

• 9. Clinical – Inpatient

     1. 
        

        • Peds BMT Inpatient Rounds are held Monday-Friday at 9 am in the Hematology/Oncology Inpatient Unit (10N, DCH)

• 9. 1. • Patients are admitted for:

  10. The transplant itself for conditioning (chemotherapy + radiation), stem cell infusion and early recovery

  11. After transplant for acute (<100 days) or chronic (> 100 days) including graft-versus-host disease, infections and treatment-related toxicities.

• • • The resident will be expected to:

• 12. Round with the team daily (Mon-Fri) as call and clinic schedule allows.

  13. Participate in the day-to-day management of the transplant patient from admission to discharge.

  14. Perform and/or observe inpatient procedures including stem cell infusion, administration of chemotherapy, etc.

  15. Educational Activities

• 15. 2. • In addition to direct patient care, the resident will have the opportunity to participate in the following activities:

  16. Observe the process of search and selection of donors including HLA-typing and unrelated donor procurement.

• 17. Observe the process of preparation of stem cell products including marrow, peripheral blood and cord blood.

• 18. Observe the process of blood typing post-transplant including patient-to-donor switch and antibody screening.

• 19. Complete National Marrow Donor Program’s BMT on-line curriculum (independent learning). The course is found at: https://bethematchclinical.org/Private/BMT-Curriculum

• 20. Attend 2-3 lectures/conferences per week including:

      2. • • 1. Peds BMT Patient Care Conference (Monday, 1pm)

             2. Peds HemOnc Grand Rounds (Wed, 8am)

             3. SCT Core Lecture series (variable dates/times)

• 21. Schedule Logistics

• 21. 2. • • 2. 1. Residents will be expected to attend the lectures and educational activities of the Pediatric Residency Program. If these activities conflict with rotation-related activities, priority will be given to those activities of the Residency Program.

• 21. 2. • • 2. 2. This elective does not include in-house call or weekend coverage. However, if the resident is taking call for Pediatrics (night float, etc.), we will adhere to the rules and regulations on maximum call-hours, as mandated by the Residency Program.

• 22. Evaluation

  23. Resident Evaluation

      2. • Informal constructive feedback on performance will be given on a daily basis.

• 23. 2. • Formal, written evaluations will be provided at the end of the rotation using the computerized evaluation form available at the Pediatrics Residency Management Web site of OHSU Graduate Medical Education Office (http://www.ohsu.edu/gme). Residents will be evaluated using a categorical scale in the areas of patient care, medical knowledge, interpersonal skills & communication, professionalism, practice-based learning and improvement and systems-based practice. This evaluation will also be discussed during a close meeting between the attending and the resident at the end of the rotation.

• 23. 2. • If there are major concerns about the resident’s performance or conduct, these will be addressed promptly following the policies and procedures established by OHSU and the Pediatric Residency Program.

  24. Attending Evaluation

      2. • Informal constructive feedback on teaching performance or other issues on a daily basis will be encouraged, but not required.

• 24. 2. • Formal, written evaluations will be provided at the end of the rotation using the computerized evaluation form available at the Pediatrics Residency Management Web site of OHSU Graduate Medical Education Office (http://www.ohsu.edu/gme). Attendings will be evaluated using a categorical scale in the areas of clinical skills, teaching and professionalism. Discussion of this evaluation will be encouraged, but not required, during a close meeting between the attending and the resident at the end of the rotation.

• 24. 2. • Major concerns about the attendings performance or conduct will be done following the policies and procedures established by OHSU and the Department of Pediatrics.

  25. Overall Evaluation

      2. • Informal constructive feedback about this elective on a daily basis will be encouraged, but not required.

• 25. 2. • A formal written evaluation will be provided at the end of the rotation using a computerized evaluation that will be e-mailed to the resident. Areas to be evaluated include achievement of teaching objectives, clinical goals and open feedback for suggestions or areas to improve.

• 25. 2. • Major concerns about the elective will be directed to the Pediatric Residency Program Office following the policies and procedures established by OHSU and the Department of Pediatrics.