VAMC Clinical Rotations
Clinical Rotations at the Boston VA Medical Center
Clinical Fellows at the VAMC rotate for one to two month blocks on the Hematology/Oncology service at the Jamaica Plain and West Roxbury VA hospitals. The goals of this rotation are to learn to manage inpatients 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 Ward and Consult 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.
Since the Boston VA is a referral center for Hematology and Oncology problems among the veterans of New England, there is ample opportunity for Fellows to obtain clinical experience. The rotation at the Jamaica Plain VAMC is primarily focused on outpatient care of Hematology and Oncology patients in daily, busy clinics. The West Roxbury VAMC rotation is focused primarily on inpatient Hematology and Oncology consultations on patients on the Medical or Surgical services. Fellows take one week per month of weekday and weekend call while on service. Being on call at the VAMC mainly consists of being available by beeper. Attendings who are on service are always available as back up for the Fellows who are on call. The bulk of clinical care, including chemotherapy administration, occurs in the outpatient setting at VAMC (see below).
Since the merger of the West Roxbury and Jamaica Plain VA Hospitals in Boston, all Hematology/Oncology inpatients are at the West Roxbury Center site. 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 Fellows see all new Hematology/Oncology consults in the inpatient facility at the West Roxbury VA and also follow established Hematology/Oncology patients who require inpatient admission. During this rotation the Fellows attend one continuity clinic session (1/2 day) at the Jamaica Plain site and attend conferences at the Jamaica Plain site. The Boston VA Hospitals have dedicated Radiation Oncology and Surgery services. The majority of consults relate to Oncologic problems although non-Oncologic Hematology consultations at also common. There is an active medical and surgical service at the Hospital and Attending Staff associated both with The Boston University School of Medicine and the Harvard University School of Medicine. Intern and Resident Staff and Medical Students come from both of these medical schools as well. The VA Hospital system has advanced computer based medical information and ordering systems which the Fellows learn to utilize as part of the rotations.