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During their 36 months of training the fellows have 18 months of clinical rotations and 18 months of research time (clinical or basic science).

The SLVHCS Hospital currently does not admit patients and all SLVHCS patients who require admission are admitted at Tulane Medical Center. However, the SLVHCS still plays a key role in the fellowship program, since it provides a unique experience for interacting with the SLVHCS patients and attendings, and understanding of the SLVHCS.

The TMC (Tulane Medical Center)/ Southeast Louisiana Veterans Healthcare System consult services rotation

The TMC rotation consists of an inpatient service that usually carries between 3-5 patients at a time, and a consultative service at TMC that usually evaluates around 1-2 new consults per day. The team consists of a medical resident, often times a medical student, a fellow and a staff physician. Rounds are held once a day on the inpatient service, and also cover new consults seen the prior day (or the same day depending on the urgency of the consult). All requested consultations must be addressed within 24 hours. The fellow is responsible for interviewing the patient, performing the physical exam, reviewing all pertinent radiological and laboratory data, as well as reviewing the pathology slides with the attending and/or the pathologist. All patients seen on the consultation service should have a clear plan of treatment outlined in the fellow’s note. The fellow must address every consult with a courtesy phone call to the consulting team to pass on the recommendations verbally. This is necessary to establish adequate communication between the services and to ensure patient safety.

When there is a resident scheduled to rotate in this service, he or she may perform the above mentioned tasks with the supervision of the fellow.

In addition, the fellows rotate through the Hemophilia or the Sickle cell clinic once per week while on this rotation. The fellow assigned to this rotation also covers the SLVHCS, for emergencies, until an inpatient unit is re-established for SLVHCS patients.


MCLNO (University Hospital) Consult Service

The University rotation offers an experience of providing consultative services for patients admitted to the General Medicine Teams, as well as surgical teams, including subspecialties. Patients are admitted to their primary team, and the Hematology/Oncology service is consulted for opinion and recommendations. The service carries an average of 3-5 active inpatients.

The University Hospital Consult service rotation consists of an inpatient consult service that is usually composed of an internal medicine resident, a hematology and oncology fellow and a faculty member. An average of 1-2 new consults a day are seen during a typical month, with both hematologic as well as oncologic problems. Fellows have the opportunity to master the learning experience in providing consultative services. The patient population is diverse, and well balanced in terms of different pathologies. Rounds are held once a day on the inpatient service, and also cover new consults seen the prior day (or the same day depending on the urgency of the consult).

All requested consultations must be addressed within 24 hours. The fellow is responsible for interviewing the patient, performing the physical exam, reviewing all pertinent radiological and laboratory data, as well as reviewing the pathology slides with the attending and/or the pathologist. All patients seen on the consultation service should have a clear plan of treatment outlined in the fellow’s note. The fellow must address every consult with a courtesy phone call to the consulting team to pass on the recommendations verbally. This is necessary to establish adequate communication between the services and to ensure patient safety.

When there is a resident scheduled to rotate in this service, he or she may perform the above mentioned tasks with the supervision of the fellow.


Tulane Bone Marrow Transplant Unit & Leukemia and Lymphoma Services

The BMT/Leukemia rotation consists of an inpatient transplant service that usually carries between 7-15 patients at a time, and an outpatient clinic that usually evaluates around 4-6 new candidates per week, and follows post-transplant patients at various stages of follow-up. Allogeneic and autologous transplants are performed using both bone marrow and peripheral blood as sources of progenitors. The majority of the patients are enrolled on Clinical Trials approved by the IRB (Institutional Review Board). These protocols are in-house and Group Investigational Studies. The fellows learn how to enroll patients on clinical trials. The fellows learn indications of SCT (Stem Cell Transplant), management of the complications of SCT and provide post transplant care. The team consists of a fellow, a physician’s assistant, and a staff physician. Rounds are held once a day on the inpatient service. Dr. Hana Safah is the key faculty member.


Continuity Clinic

MCLNO Hematology/Oncology Continuity Clinic

The MCLNO Hematology and Oncology continuity clinic is the rotation in which fellows meet the criteria for a continuity care clinic. Throughout their years of fellowship, they are exposed to various specific clinics in other rotations, but it is in the MCLNO clinic that the fellows establish a continuity of care and see the patients over a continuum of three years, depending on the patient outcome.

Each fellow is assigned with a half-day continuity care clinic weekly throughout their training. The clinic provides exposure to an array of patients with hematologic and oncologic disorders. On average, the fellows are assigned 6 patients during a half-day clinic, including one or 2 new referrals.  Each case is presented and discussed with the faculty. Dr. Marianne Barnhill is the key faculty member.
 
The clinic is located at 136 S. Roman Street, 3rd Floor, New Orleans, LA 70112.  

The clinic can provide the following services:

  • Evaluation and management of patients diagnosed with a malignant disorder (pathology diagnosis is required) 
  • Evaluation and management, if indicated,  of benign hematological disorders 
  • Systemic conventional chemotherapy or targeted therapy in the outpatient setting. This is discussed and planned during the patient’s clinic visit and the chemotherapy is administered at the Chemotherapy infusion area, at University Hospital, located on the 8th floor East 
  • Admissions, inpatient chemo, etc. This is planned during the patient’s visit and when indicated, all admitting procedures start at the clinic.

There are monthly meetings that take place including administration, all attending physicians involved (Tulane and LSU), as well as nursing personnel in the clinic. These meetings occur on every third Friday of the month, from 8:30 AM to 9:30 AM. This is an opportunity for all of those involved in the functioning of the clinic to discuss current operational issues as well as potential problems and possible solutions; that is, for strategic planning to take place.

Patients can be referred to Hematology/Oncology clinic in 2 ways:

  • the hematology/oncology consultation service will see and refer appropriate inpatients for follow up in clinic
  • a patient can be referred from another service or another facility. This service should fax a consult form to 504-903-0217. This fax will be located in a secure area in order to comply with HIPPA laws and insure patient privacy. Once the referral arrives in the clinic, it is then reviewed for completeness by the clinic coordinator (RN Georgette Lang-Mims), and placed on a folder for review.

Each consultation will be reviewed for completeness by an attending. The consult will either be accepted or rejected. If accepted, the patient can be scheduled for an appointment by the clinic staff. If rejected, the attending will put a written note on each consult detailing what needs to be completed before an appointment can be scheduled. This is necessary to optimize the use of medical and ancillary personnel in the clinic. The clinic coordinator will contact referring services for additional information, as long as contact information is provided on the referral (email, pager, phone number, etc).

The appointment will be scheduled by the clinic staff. The clinic staff will then contact the patient via phone call (either voicemail generated or personally, depending which one is feasible) AND through a letter to remind them of their appointment. The notification will include information about time of appointment, location of appointment and any instructions regarding insurance issues or tardiness. This message should be scripted in order to insure completeness and reproducibility.


Extra Clinics

SLVHCS Hematology/Oncology Clinic

The Southeast Louisiana Veterans Health Care System outpatient clinic is a 4-month block rotation assigned to second and third year fellows where they have the opportunity to provide care for the unique SLVHCS patient population. The clinic is composed of an internal medicine resident,a fellow, an ARNP and the attending. The key faculty member here is Dr. Nancy VanderVelde.

Hemophilia Clinic Rotation

This rotation provides trainees the opportunity to learn about the diagnosis and management of disorders of coagulation by attending clinics and multidisciplinary staffings at the Louisiana Comprehensive Hemophilia Care Center (LCHCC). The LCHCC serves all patients in Louisiana with congenital coagulation disorders, having an active census of over 250 patients. The LCHCC is a comprehensive diagnostic, evaluation and treatment center that provides care for patients of all ages with support services for their families. The fellow rotating in this clinic functions as a member of a multidisciplinary team which consists of adult and pediatric hematologists, hemophilia nurse specialist and nurse educator, social worker, physical therapist, orthopedist, dentist and dental hygienists. The fellow will also gain experience from the numerous clinical research trials available to the center's patients, including studies of new clotting factor concentrates as well as ongoing epidemiologic studies. The fellow is expected to attend the weekly Thursday morning clinic where an average of 5-6 patients are seen. A syllabus is provided to all fellows. The key faculty member is Dr. Cindy Leissinger.

Sickle Cell Disease Comprehensive Clinic Rotation

This rotation takes place at the Comprehensive Sickle Cell Clinic at the Tulane Cancer Center under the supervision and direction of Dr. Rebecca Kruse-Jarres. It is attended by an adult sickle cell nurse as well as as the social worker from the Sickle Cell Center. The clinic meet son every fourth Monday of the month. An average of 9 patients is scheduled per clinic for a comprehensive visit. About two or three of these are new patients. The clinic visit entails a comprehensive history and physical and focuses on routine care of the chronic aspects of patients with Sickle Cell Disease. Special attention is given to prophylaxis and to early detection of complications such as retinopathies, aseptic necrosis of bone, iron overload, pulmonary hypertension, etc.


Electives

Radiation Oncology Elective Rotation

This will be a one-month rotation. During this rotation, the fellow will have a commitment to the Hematology/Oncology Service in the form of two clinics per week. One of these is the MCLNO Continuity care clinic. These clinics will require on half-day each. The remaining time should be fully spent in this rotation. Dr. Stephen Kraus is the key faculty member.

Hematopathology Elective Rotation

This will be a one-month rotation. During this rotation, the fellow will have a commitment to the Hematology/Oncology Service in the form of two clinics/week. These clinics will usually require one half-day each. The remaining time should be fully spent in this rotation. Dr. Meredith Lakey is the key faculty member.

Palliative Care Elective Rotation

This rotation takes place under the auspices of St. Jospeh Hospice and Palliative Care, 824 Elmwood Park Boulevard, Suite 155, New Orleans, LA 70123. The site contacts are Laurence Durante, MD., Cookie Sweene, RN, Nursing Director.

Urologic Oncology Elective Rotation

The goals of this rotation are to provide the fellow in training with the experience of evaluating and managing oncological problems that are present in patients diagnosed with malignancies of the genitor-urinary (GU) tract. This rotation will involve both clinical and non-clinical responsibilities focusing on prostate, renal and bladder cancers with an emphasis on prostate cancer. Clinical responsibilities will be in the Tulane Cancer Center and the Multi-disciplinary GU clinic. Clinics are held twice weekly. Non-clinical time and responsibilities will involve structured reading of key manuscripts, discussion with the attending, reviewing and writing articles for the peer-reviewed literature, and possibly protocol and translational research activities. Dr. Oliver Sartor is the key faculty member.

Gynecologic Oncology Elective Rotation

This rotation can vary in length from two to four weeks. During that rotation the fellows will attend clinic with the attending and evaluate patients with various gynecologic malignancies including ovarian cancer, cervical cancer or uterine cancer. The fellows will also be exposed to various modalities of treatment including surgery, radiation therapy with interstitial implants for cervical cancer as well as chemotherpy for ovarian cancer. Dr. William Robinson is the key faculty member.

ENT Oncology Elective Rotation

This rotation may vary in length from two to four weeks. During that rotation fellows will be expected evaluate patients in the clinic with the attending and become familiar with performing endoscopic oropharyngeal and nasopharyngeal examinations to evaluate tumors. They will also become familiar with methods of examination of head and neck cancers in addition to tumor measurements. They will also have the opportunity to attend several surgeries for the treatment of head and neck cancer. They will also be involved in the multimodality discussions for treatment of this disease.

Pediatric Hematology/Oncology Elective Rotation

This rotation can vary in length from two to four weeks. During this rotation, fellows are expected to make daily inpatient rounds with pediatric teams and evaluate pediatric malignancies and learn about their treatment. That rotation may include bone marrow transplantation for pediatric malignancies. They will also have the opportunity to attend clinic and participate in the discussion of treatment plans with patients and their families. Dr. Tammuella Singleton is the key faculty member.

Louisiana Coagulation Laboratory Rotation

The Louisiana Coagulation Laboratory Rotation consists of a 2-week outpatient rotation at the laboratory of Dr. Gloria Coker.

Ochsner Blood Bank

This rotation can vary in length from two to four weeks. During this rotation the fellow will work at Ochsner Clinic, Department of Pathology under the direct supervision of Dr. F. Rodwig or his designee and gain experience in the following areas: 1) operation and testing of blood bank donation center, 2) pheresis and other procedures pertinent to Transfusion Medicine, and 3) general concepts in Transfusion Medicine and function of a Blood Bank. The key faculty member for this rotation is F. Rodwig, MD.

 

 

1430 Tulane Ave, New Orleans, LA 70112 504-988-5263 medsch@tulane.edu