Inpatient experiences are consultative and conducted on the Gundersen Health System La Crosse Campus. All patients are admitted to the internal medicine or hospitalist service. In conjunction with hematology or medical oncology staff, the fellow is responsible for making daily rounds, performing clinical evaluations, ordering chemotherapy and managing treatment complications. During this rotation, fellows also take referral phone calls from providers within and outside the institution for all issues regarding hematology and medical oncology.
Fellows are assigned to rotate through general and subspecialty clinics at the Center for Cancer and Blood Disorders at Gundersen Health System. With staff supervision, fellows independently evaluate and treat new and returning patients. Rotations include general hematology and oncology clinics, as well as multidisciplinary specialty clinics such as breast, gastrointestinal, gynecologic, head and neck and lung.
This required one-month rotation takes place at the University of Wisconsin Carbone Cancer Center in Madison, Wis. The Stem Cell Transplant program started in 1981 and performs approximately 110 transplants annually, including allogeneic (related and unrelated), autologous and cord blood transplants, and CAR-T infusions. Fellows stay at an apartment near the hospital, free of charge.
All fellows spend a week with our two dedicated hematopathologists during the first "bootcamp" month of fellowship, learning the basics of reviewing and interpreting peripheral smears and marrows. Later in the first year, fellows expand on their "bootcamp" experiences by gaining expertise in the preparation and interpretation of bone marrow aspirates and biopsies and flow cytometry. They also become familiar with operations of the clinical laboratory and pathology processing (histology, etc.) and gain insight into lymphoma diagnoses by being introduced to lymph node biopsy interpretation. At the end of the month, competency is assessed.
In this rotation, fellows spend time in different clinical laboratories to learn about the principles, mechanics and interpretation of common tests used in hematology and oncology. The different areas include blood bank, coagulation, general hematology and immunology. Fellows provide consultative expertise to providers needing blood-banking assistance, which offers an opportunity to learn about principles and mechanics of plasma and cellular aphaeresis.
This one-month rotation is divided between inpatient and outpatient experiences. During the rotation, fellows learn how to manage pain and other common symptoms afflicting patients with cancer, including those in early stages of the disease and at the end of life. Fellows also lead patient and family conferences and have faculty-observed patient interactions to allow them to work on end-of-life discussions, delivery of difficult news and other communication techniques.
Fellows have the opportunity—but are not required—to travel to outreach locations to learn more about how cancer and blood disorders are managed in rural and potentially low-resource areas. This is a great experience for a fellow who is interested in a career in rural hematology/oncology.
Each fellow is expected to complete at least one academic project during their fellowship training. However, many fellows take advantage of our excellent research infrastructure and finish several projects. We also have support through our designation as an NCI Community Oncology Research Program (NCORP) to carry out cooperative group trials and attend cooperative group meetings. We are affiliated with ECOG, Alliance, SWOG, COG, GOG and RTOG. Through the Wisconsin Oncology Network, opportunities exist to write clinical trials that can be carried out in several sites. As such, fellows interested in an academic career start to build their research portfolio early, while fellows interested in community practice may chose to focus on quality improvement or cancer care delivery research.
Research: Poster Presentations
Real World Application of Thromboprophylaxis in Patients with Malignancy. Nicole Mischler, Nancy Fisher, MBA, Susan Frankki, BS, Attila J Kovacs, PhD, Lori Rosenstein, MD. Presented at the 61st American Society of Hematology Annual Meeting, Orlando Florida, December 7-10, 2019
Academic Day 2020