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Hematology/Oncology Fellowship Program

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Letter from the Program Director

Thank you for your interest in the fellowship training program in Hematology/Medical Oncology at Georgetown University Medical Center and the Lombardi Cancer Center.  We are proud of our fellowship program, and the current and past fellows who have trained here.

This is an exciting time in the worlds of hematology and medical oncology, as the “War on Cancer” has started to bear fruit.  The knowledge about the mechanisms that underlie the development and progression of malignant processes has led to new therapies that have started to revolutionize the treatment of cancer.  At the Lombardi Comprehensive Cancer Center, active research is ongoing in all aspects of the study of cancer and its treatment, from basic research to new drug development to clinical trials, as well as the translational studies that help us understand the linkages between “the bench and bedside.”  Our fellows have the opportunity to participate in all phases of this research.  Our expectation is that the tools that fellows learn and hone during their training will serve them throughout their careers in patient care, or research.

Georgetown’s Lombardi Comprehensive Cancer Center is one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers, and is widely recognized for both research and clinical excellence, with national leaders in many fields in both medical oncology and hematology.  The entire range of human cancers is treated at the Lombardi Comprehensive Cancer Center.  Thus, fellows may experience and interact with specialists in pediatric oncology, radiation oncology, and gynecologic oncology.  Moreover, patients and their cases are evaluated in multidisciplinary conferences in most oncologic disease types with surgeons, radiation oncologists, pathologists, and radiologists, allowing fellows to understand the entire range of treatments.   

Our fellows flourish in an atmosphere of excellence in both clinical care and cutting edge clinical and basic research.  Fellows spend about half of their clinical time during fellowships in disease-specific clinic setting, and are expected to present frequently on topics of interest.  In this setting, with an understanding of the mechanisms that underlie cancer development and drug activity, fellows acquire a solid foundation for patient care as well as for the integration of future developments in patient care.  The graduates of our program have entered all areas of hematology and medical oncology.  About half of our fellows enter private practice, and half pursue an academic career.  Some graduates have also entered government or industry.  The division has also developed the career of some of its fellows by appointment to the Georgetown faculty.  Six of our current faculty members graduated from our fellowship program.

As faculty members, my colleagues and I continue to be excited by what our training and educational programs offer us, our patients, and our fellows.  We hope you will join us.

Jimmy J. Hwang, MD
Assistant Professor of Medicine
Hematology/Medical Oncology Fellowship Program Director

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Introduction to the Fellowship Program

The mission of the fellowship program of Georgetown University Medical Center's Division of Hematology/Oncology is to provide a balanced program of clinical training and research experience in order to develop the best clinicians and investigators in the country. Our full-time and attending faculty are dedicated to directly supervising each fellow's training experience. Our faculty's patient and research load is structured so that fellows and faculty have extensive one-on-one contact. Significant emphasis also is placed on ongoing educational opportunities in which faculty and fellows work together to explore and resolve clinical problems.

Faculty members in the Division of Hematology/Oncology are responsible for care of all hematology/oncology patients at the Medical Center. Faculty members are dedicated to oncology, hematology and bone marrow transplantation. All faculty members who participate in the training program are full-time Georgetown University faculty.

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About Georgetown and the Washington DC Area

As the nation's capital, Washington is an important health care center. Here, crucial health policy decisions are debated every day in many arenas. In addition to the Department of Health and Human Services, the area's health institutions, among them the National Institutes of Health, the National Library of Medicine, and the World Health Organization, contribute to Washington's international reputation as a biomedical center.

Georgetown University Medical Center is a growing interdisciplinary medical center with about 1,100 physicians. Its components are: the 609-bed University Hospital, the School of Medicine, the School of Nursing, the Lombardi Comprehensive Cancer Center, the Georgetown Institute for Health Care Research and Policy, and the Georgetown Center for Bioethics.

Georgetown University Medical Center has long prided itself on the strength of its programs for clinical education and patient care. With the aim of building new strength in biomedical science, Georgetown has, in more recent years, established several centers for specialized research and scholarship. The oldest of these is the Lombardi Comprehensive Cancer Center.

Washington is one of the world's great cities, exciting for its intellectual, political, and cultural richness. The John F. Kennedy Center for the Performing Arts is within minutes of Georgetown. The Smithsonian Institution, the National Gallery of Art, the Holocaust Museum, the National Air and Space Museum, and of course, the White House and Capitol, lead the list of cultural and historical attractions.

Washington also is rich in diverse outdoor recreation with expansive parks and trails, not to mention the Potomac River and the C&O Canal. Washington's location between the Blue Ridge Mountains and the Chesapeake Bay offers both sailing and white water rafting within a few hours travel. The Washington Redskins (football), Wizards (basketball), and Capitols (hockey), as well as the Washington Nationals (baseball) and the Georgetown Hoyas basketball team, provide merely a few of the spectator sports opportunities in the area.

Georgetown University and its Medical Center are located in Georgetown, one of the oldest sections of Washington, D.C., in a historic neighborhood of row houses, gardens, shops, and restaurants, within walking distance of the Potomac River.

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Application Requirements

We are pleased you are considering fellowship training in the Division of Hematology/Oncology at Georgetown University Hospital and the Lombardi Cancer Center. Our educational mission is to provide a balanced program of clinical training and research experience in order to develop the best clinicians and investigators in the country.

The Application Process (Deadline: March 1st)

You should apply for the Hematology-Oncology Fellowship Program at Georgetown University Hospital through ERAS (Electronic Residency Application Service). ERAS is an internet-based applications process developed by the Association of American Medical Colleges to transmit fellowship applications, letters of recommendation, Program Director letters, medical transcripts and other supporting credentials from applicants, residency programs and medical schools to fellowship program directors using the Internet. For information about the process or to register for ERAS on the web, please go to www.aamc.org/eras.

Upon receiving the applications through ERAS, the fellowship program will contact candidates about the possibility of an interview. Interviews will be scheduled in the late winter, early spring months.

Matching with the Hematology/Oncology Fellowship Program

The Hematology/Oncology program participates in the National Residency Match program's Medical Specialties Matching Program (MSMP) in Hematology/Oncology.  This is a computerized venue for matching an applicants preferences for fellowship programs with the program directors' preferences for applicants.  For information about NRMP or to register on the web to participate in NRMP, please go to www.nrmp.org.

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The Clinical Training Program

Georgetown's fellowship training program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) for subspecialty training and offers a clinical training track to prepare fellows for certification in a three-year program leading to eligibility for the hematology-oncology subspecialty certifying examination.

The first year of clinical training for medical oncology and hematology Fellows is focused on an in-depth clinical experience that integrates the Fellows into the primary care of the division's patients. The faculty member shares in caring for each patient and provides year-to-year continuity in managing the patient.

The weekly outpatient schedule is divided into disease-specific clinics, which are attended by faculty with expertise in these diseases. The outpatient clinics are a major focus for clinical teaching. During patient visits, faculty members and Fellows review patient management, disease response, and treatment selection. An integrated approach to patient management is stressed, including coordination of care with research nurses, nurse practitioners, social workers, and the psychiatry liaison service.

Combined Hematology and Oncology Program: Year 1 is medical oncology, year 2 is hematology, year 3 is research projects and outpatient continuity clinics

Clinical Responsibilities

All 1st and 2nd year Fellows spend 2 to 3 months each year on the Georgetown University Hospital hematology/oncology inpatient unit. The Fellows supervise the house staff and take responsibility for ordering and overseeing chemotherapy administration on the inpatient service. Fellows participate daily in formal teaching rounds with the attending physician of the month. The oncology consult service is covered by the Oncology Fellow on the inpatient service while the hematology consult service is assigned to a hematology Fellow separate from the hematology inpatient service. The 2nd year hematology Fellows continue to have 3 half days clinic while on consult.

Service

During the inpatient rotation 1st year oncology Fellows are excused from outpatient assignments except the continuity clinic. The inpatient medical team also integrates services with research nurses, social workers, and members of the pain control and psychiatry service staffs.

Fellows participate in follow-up outpatient clinics daily. The clinics are divided into disease-specific sessions. Fellows are responsible for the evaluation and work-up of all new patients, as well as seeing established patients for chemotherapy and follow-up.

On Call Rotation

First and second year Fellows are responsible to take first call during evening hours and weekends. The faculty member who is the month's ward attending provides backup. Fellows take calls from home. When Fellows are not on call at night or over the weekend, they have no responsibilities for patient coverage. Third year Fellows will have to cover the VAH three to four weekends/year.

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Combined Hematology and Oncology Program:

Hematology Program: 2 years

 

On Call Responsibilities

Year 1 Fellows join the combined program call schedule. Year 2 Fellows who are not in the combined program share on call responsibilities through the date of the American Board of Internal Medicine certifying examination. Also year 2 Fellows will have to cover the BMT calls while at that rotation.

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Special Training Opportunities in the Medical Oncology Fellowship

Year 1 Oncology Fellows rotate at the Washington VA Medical Center, a general oncology service both at the inpatient and outpatient services. Hematology Fellows rotate at Washington Hospital Center for 1-2 months.

Electives

Year 2 elective rotations are available in such services as radiation medicine, gynecologic oncology, pediatric hematology/oncology, hematology electives (pheresis, blood banking, coagulations) and pathology.

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Special Training Opportunities in the Hematology Fellowship

Clinical Coagulations Rotation

Hematology Fellows participate in clinical rotations in coagulation, blood banking and heresies. Fellows training in coagulation laboratory is oriented toward clinical problem solving of a full range of coagulation disorders.

Hematology Fellows will have two months of experience in the Bone Marrow Transplantation program in years I and 2. This rotation entails extensive training in both allogenic and autologous bone marrow transplantation for hematologic malignancies as well as for solid tumors.

Blood Services Interaction

Hematology Fellows rotate through the University Hospital's Blood Bank Blood Donor Service, and Hemapheresis Unit. The Blood Bank is accredited by the American Association of Blood Banks and performs a full range of services, including irradiation of compounds on-site, antibody identification, and red cell washing using a fully computerized system. The Blood Donor Service is the only full-service American Red Cross blood collection site in the country operating within a medical center. It offers autologous-and directed donor collection, as well as platelets, pheresis, and special collections. The hemapheresis Unit collects stem cells for transplant and provides therapeutic plasmapheresis for a wide range of diseases.

Electives

Rotations are available in molecular hematology, pediatric hematology, hematology clinical laboratory, blood bank/pheresis and coagulation.

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Research Training

Clinical Research

The division offers a series of specialized senior fellowships that provide for Fellows who demonstrate-research promise and accomplishment with support beyond the period required for board certification. The division has major clinical research programs in breast cancer, prostate cancer, developmental therapeutics, hematologic malignancies. The division participants in cooperative studies with Cancer and Leukemia Group B (CALGB) and the National Surgical Adjuvant Bowel and Breast Program (NSABP), among other groups.

Developmental Therapeutics Fellowship

Georgetown offers one to two-year Developmental Therapeutics Fellowship Program designed to train hematologists and oncologists for careers in academic clinical research, the pharmaceutical industry, or regulatory agencies.

The fellowship focuses on the early clinical trials of novel anti-cancer agents with an emphasis on clinical pharmacology and the regulatory requirements associated with new drug development. At the start of the program, Fellows are given primary responsibility for one or two early clinical trials and are expected to complete, analyze, and publish the study during their fellowship. Training is coordinated with the Division of Clinical Pharmacology in the Department of Pharmacology and includes clinical trials methodology, research ethics, biostatistics, analytical drug assays, pharmacology, and pharmacokinetics, Course work at Georgetown or at the Food and Drug Administration (FDA) Staff College is encouraged. Fellows complete a three-month rotation at the FDA.

Cancer Control and Prevention Fellowship

The Lombardi Cancer Prevention and Control Research Program Provides training in (1) molecular epidemiology research, where biological markers of risk and prognostic significance are identified and tested; (2) bio-behavioral research that aims to translate advances in molecular biology and epidemiology into state-of-the-art cancer prevention and control interventions; and (3) cancer geriatrics research that encompasses molecular epidemiology, health behavior, and health services research issues for the majority of most cancer patients who are elderly.

This program also provides opportunities for training through participation in multi-institutional research projects focusing on the prevention and control needs of low-income and medically underserved populations. For example, Lombardi is collaborating with Johns Hopkins University to promote cancer screening and tobacco control among East Baltimore community organizations that already provide their low-income, black and white members an opportunity to buy food through a national food and community-service program. Lombardi also is collaborating with the Washington Hospital Center to promote cancer screening and dietary modification to-District of Columbia participants of the same program. Another national study based at the Lombardi Center is looking at the cost-effectiveness of breast-conserving surgery, with and without radiation therapy, versus modified radical mastectomy for early stage breast cancer among black anti white women age 65 and above.

Breast Cancer Fellowship

The Lombardi Cancer Center is home to a Specialized Program of Research Excellence (SPORE) in breast cancer. This SPORE grant recognizes and supports multidisciplinary translational research in breast cancer that has a high likelihood of influencing clinical care. The SPORE can support fellowship training research in one of the many Lombardi laboratories that focus on molecular biology, cell biology, and drug development in breast cancer.

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Fellows' Teaching and Career Development

Conferences

In addition to the standard course of research and clinical experience, a distinctive feature of Georgetown's fellowship program is an integrated program of lectures-and teaching opportunities. The conferences are an important teaching venue, and Fellows actively participate.

The Division of Hematology/Oncology has several weekly conferences focused on both patient care and research interactions. Fellows actively participate in these conferences, which are one of the major activities of the teaching program:

1. Morning Report: Every Monday morning the entire group of faculty and Fellows attend a 40 minute case presentation or literature review provided by one of the Fellows. The last 15 minutes are for Board Review of multiple choice questions.
2. Hematologic Oncology Conference: The Hematologic Oncology faculty and the Hematopathology faculty gather once a week on Tuesday’s to review the status of complex patients including their pathology, treatment plans and entry to research studies.
3. Breast Cancer Conference: The Multidisciplinary Breast Cancer Conference follows the weekly Breast Clinic. The Breast Cancer Conference focuses on patient management issues and includes discussion of relevant literature and ongoing research. The conference is attended by representatives from medical oncology, radiation medicine, radiology (mammography), surgery, pathology, and psychiatry. Patient presentations and literature review are done by Fellows.
4. Gastrointestinal Oncology Conference: This is a weekly conference with members of the Departments of Radiology and Surgery and the Division of Gastroenterology to review management of patients who are beginning their therapy at Georgetown.
5. Pathology Conference: The Department of Pathology conducts a weekly slide review for the division. This conference is also attended by faculty from the Department of Radiation Medicine. The conference is designed to familiarize Fellows with histologic patterns typical of malignant diseases and to prepare them for the pathology section of the board examination in medical oncology.
6. Pulmonary Conference: weekly the Divisions of Pulmonary Medicine and Hematology/Oncology meet to discuss management issues of common interest. This is a conference that reviews many of the patients with lung cancer.
7. Cancer Center Research Conference: The Cancer Center sponsors a weekly research seminar usually given by a speaker from another institution on a topic relevant to research at the cancer center.
8. Brain Tumor Conference: A weekly multidisciplinary brain tumor conference held Friday and attended by members of Oncology, Neurosurgery, Radiation Oncology and Radiology departments.
9. Oncology Journal Club: held once weekly on Wednesdays at 12:30 pm. Presentations include clinical and basic science topics from recent publications.
10. Hematology Journal Club: held once weekly on Mondays at 12 noon.
11. Coagulation Teleconference: held once monthly between GUH, GWH, NCI, and WHC.
12. Lymphoma Teleconference: Held once monthly between GUH, WHC, GWH, and NCI.
13. Hematology research Conference: Held weekly on Thursdays at 12:30 pm. Review of current protocols and patients accrual. Also lectures on hematology topics are provided frequently by members of the division.
14. Lombardi Grand Ground: Held last Wednesday of each month. Prominent speakers from different centers are invited.
15. Tuesday Core lecture Series: Core lectures that cover the whole curriculum are provided by members of the cancer center.
16. Tumor Biology Seminar Series: Held weekly on Fridays at 2:00 pm at the research building. Covers basic science topics as: angiogenesis, invasion, and metastasis, radiation biology, growth regulation, cancer control, cancer genetics and epidemiology, developmental therapeutics.
    

We encourage second-year Fellows to attend scientific and medical conferences in the Washington/Baltimore metropolitan area. In addition, the division supports travel to one national meeting during the second and third fellowship years. Most Fellows chose to attend one of the annual meetings of a major national society, such as the American Society of Clinical Oncology or the American Society of Hematology.

Teaching Opportunities

Fellows provide supervision and instruction to residents and medical students who rotate through the outpatient clinic. Fourth year medical students are assigned to the outpatient department throughout the year. Each student is assigned to a Fellow for clinical supervision and teaching.

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Nursing Services

Nurses are an integral part of patient care in a variety of roles and settings-in the division:

• Inpatient Unit Nurse: a large staff of specialty certified oncology nurses who serve on the oncology inpatient units.
• Primary Chemotherapy Nurse: specially trained nurses assigned to each Fellow. Specific responsibilities include chemotherapy, blood product administration, patient education, symptom management, and discharge planning.
• Nurse Practitioners: nurses with extensive medical preparation who work in collaboration with attending physicians and Fellows to deliver care to selected, groups of patients. They obtain medical history, perform physical exams and order tests and treatments.
• Clinical Research Nurses: nurses who manage patients in clinical trials.
• Case Managers: nurses who follow patients with specific diagnoses.

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Facilities

Inpatient units. The division has two dedicated inpatient wards at Georgetown University Hospital: a 20-bed solid tumor ward, and an 18-bed BMT/hematologic malignancies ward.

Outpatient Clinic. The outpatient department Of the Division of Hematology/Oncology is tile Lombardi Comprehensive Cancer Center, tile site for a wide range of multidisciplinary clinics and the primary location for outpatient cancer activities at Georgetown.

Oncology Infusion Center. Chemotherapy and blood component therapy is administered in Georgetown University Hospital's dedicated oncology infusion center, which has 14 infusion chairs and a six-bed day hospital. The infusion center also is equipped with a laboratory to facilitate pharmacokinetics studies that require repeated blood sampling.

Basic Science Research Center. With the completion of the Medical Center's new research building in the fall of 1994, the Lombardi Comprehensive Cancer Center occupies three floors of the six-story research building, adjacent to the Medical Center. The Research building contains laboratories, cancer center administrative offices, lecture halls, and meeting rooms.

Computer Facilities. In addition to the Hospital Information System, the cancer center has a dedicated internal' computer network maintained by three full-time staff members. The network also accesses the medical library information system, which has client access through Internet to other academic institutions and databases.

Dahlgren Medical Library. The Dahlgren Medical Library, a state-of-the-art facility with computer access to international medical bibliographic services and databases, serves Georgetown University Medical Center. The library's collection is composed of approximately 170,000 books and bound journals, more than 1,800 journal subscriptions, and more than 13,000 audiovisual programs and microcomputer software programs.

Campus Services. Adjacent to the cancer center is the Leavey Center which houses a conference center, hotel, cafeteria, restaurants, and the University bookstore. The University's Yates Field House also is adjacent to the cancer center and has indoor tennis, squash, and racquetball courts, as well as a pool and exercise facilities. Yates is available for use by all members of the University community for an annual fee.

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