Pediatric Hematology/Oncology Elective

Course Overview

The goal of this elective is to provide an intensive experience in clinical Pediatric Hematology/Oncology in which students will acquire an understanding of the diagnosis, pathophysiology, and management of the common hematologic and oncologic diseases of childhood with an appreciation for the effect of these serious diseases on the patients and their families.

Learning Objectives

• Explain the physiology of normal blood formation and destruction
• Accurately diagnose common causes of cytopenias (i.e., neutropenia, anemia, thrombocytopenia) in children. Given history and physical exam, efficiently utilize laboratory tests in the diagnostic work-up and be able to evaluate a blood smear.
• Describe the pathophysiologic mechanisms of the anemia and the different types of crises in sickle cell disease
• Describe in a step-wise manner, the work-up for a prolonged PTT, a prolonged PT, and a prolonged bleeding time. Accurately apply the various bleeding tests in the light of the patient history and physical findings.
• Describe childhood ALL in terms of its incidence, peak age range, common signs and symptoms, and general treatment concepts. Explain how prognostic factors have been used to define tailored therapy for ALL.
• Be familiar with common forms of cancer in children in terms of peak age, clinical presentation, staging, and common sites of metastatic spread. These forms of cancer include Wilms tumor, Non-Hodgkin and Hodgkin Lymphoma, Neuroblastoma, Osteogenic Sarcoma, Ewings sarcoma family of tumors, Rhabdomyosarcoma, Medulloblastoma and other brain tumors.
• Describe a blast cell and be able to differentiate between a blast cell and reactive lymphocyte, and be familiar with the morphology of hematopoietic cells
• Using clinical and laboratory data, differentiate between ALL and ITP, acute mononucleosis and iron deficiency anemia

Schedule of Activities

Students work on the outpatient (AC-6) and inpatient (4th floor SMH) service of the Pediatric Hematology/Oncology. Clinic is currently scheduled Mon., Wed., and Thurs. 8:30 a.m.-5:00 p.m., Tues. and Fri. 8:30 a.m.-1:00 p.m. Students perform initial consultations (history, physical, collect lab data, followed by presentation to attending, including impression and plan. Also may be responsible for dictating patient care notes.) and follow-up evaluations in clinic, with an attending preceptor. They may also attend inpatient rounds each morning, see inpatient consults as appropriate, and may see limited inpatients with the attending.

The elective is primarily outpatient based. Students who desire a more intensive inpatient experience may apply to do a externship on the Pediatric Heme/Onc service. Emphasis is on active participation in all aspects of patient care.

• Inpatient housestaff rounds (Tues.-Fri. 7:30-8:30 a.m.)
• Morning report (Tue., Thurs., Fri. 8:30-9:00 a.m.)
• Attending rounds (scheduled with each housestaff rotation)
• Academic conference (variable Tues. 3:00-4:00 p.m.)
• Sign-in conference (Mon. 8:00-9:00 a.m.)
• Patient conference (Fri., 3:30-5:30 p.m.)

Required Reading

Textbooks can be borrowed from the Peds Hem/Onc Library.

• Principles and Practice of Pediatric Oncology, 2nd ed., by P. Pizzo and D. Poplack (also online)
• Hematology of Infants and Children, 5th ed., by D. Nathan and F. Oski.

Student Evaluations

To receive a grade of pass, students must receive a satisfactory clinical evaluation from their preceptors during the elective. It is preferred that student's also do a short presentation at one of the division clinical conferences or housestaff teaching sessions.