VAMC Outpatient Clinics
The VAMC clinics focus more generally on Hematology or Oncology respectively and afford the Fellows opportunities for managing patients with a high degree of independence. These clinic experiences have always been highly regarded and enjoyed by Fellows and provide a valuable training experience. Fellows are expected to share responsibility for ongoing management of patients at the VAMC as in a group practice. For instance, when Fellows rotate away from the VAMC to Boston Medical Center they should sign out their panel of patients to incoming Fellows and discuss the changeover with their patients. Fellows have patients scheduled under their name at the VAMC clinics. Prior to clinic sessions a pre-clinic conference occurs in which plans for management are discussed with Attendings supervising the clinic. Attendings are available throughout the clinic to assist in patient evaluation.
Since the merger of the West Roxbury and Jamaica Plain VA Hospitals in Boston, all Hematology/Oncology all outpatients are seen at the Jamaica Plain site. The clinics are housed in a new building and served by a dedicated staff of Hematology/Oncology nurses trained in administration of Chemotherapy and Transfusion. The outpatient rotations provide extensive experience in outpatient management of patients and all aspects of chemotherapy selection, planning and administration. The site provides a very rich experience in Hematology/Oncology for Fellows. The Boston VA Medical Center is a referral center for veterans with Hematology/Oncology-related problems in the New England area. Hence, Fellows are exposed to a wide range of cases. The patients are predominantly male, and many are elderly. Fellows have extensive opportunity and responsibility for management of newly diagnosed solid tumors, hematological malignancies, bone marrow and clotting disorders. The number of new cases seen at the Boston VA overall is comparable to Boston Medical Center. The Boston VA Hospitals have dedicated Radiation Oncology, Pathology and Surgery services. The majority of consults relate to Oncologic problems although non-Oncologic Hematology consultations at also common. Attending Staff associated both with The Boston University School of Medicine and the Harvard University School of Medicine. The VA Hospital system has advanced computer based medical information and ordering systems that the Fellows learn to utilize as part of the rotations.
The goals of this rotation are to learn to manage outpatients with Hematology/Oncology problems, and to learn to perform Consultations on Medical or Surgical Patients with Hematology or Oncology problems. In general terms the goals are similar to those of the Hematology/Oncology clinic rotations at the Boston Medical Center. However, the VA hospitals provide Fellows access to a different population of patients and somewhat different health delivery system. At the VA Hospitals, Fellows also have access to additional superb academic Attending staff as well as having extensive opportunity for independent decision making. The Fellows participate in both Oncology (5 sessions) and Hematology (1 session) Clinics from Monday through Thursday. Monday clinics are supervised by Drs. Michelle Hankins and Valia Boosalis, Tuesdays by Dr. Bauer, Wednesdays are continuity clinic sessions for the Fellows, and Thursdays clinics are supervised by Drs. Fiore and Brophy. The clinic experience at the VA Hospital provides distinct learning opportunities compared to those at Boston Medical Center in that Fellows are able to follow and manage patients with a diversity of Hematology or Oncology problems in one session. This contrasts with clinics at Boston Medical Center that are generally dedicated to specific areas of Oncology (e.g. Breast cancer or Gastrointestinal cancer). The clinic experience at the VA has received consistently high ratings from Fellows in evaluations.