Olive View-UCLA Medical Center
Outpatient Continuity Clinics
A unique aspect of our fellowship training program is the longitudinal outpatient experience provided to our fellows. From the first week of their fellowship to final week of training, fellows see their own panel of outpatients during twice weekly clinics at Olive View-UCLA Medical Center. This regular continuity experience establishes a strong physician-patient relationship, and allows the fellow to closely follow and care for a patient through initial diagnosis and treatment and into surveillance and survivorship. While on the Olive View-UCLA inpatient services this continuity experience will be a 1.5 days per week; while on the Cedars-Sinai inpatient services, Kaiser Permanente inpatient services, and certain electives, the continuity experience will be approximately 1 day per week.
Inpatient Hematology and Oncology Wards
The inpatient ward service at Olive View-UCLA provides directed care to patients hospitalized due to acute leukemia, lymphomas, and other oncologic diseases that require intensive inpatient treatment. The ward service provides a strong clinical experience, in which fellows will learn to diagnose and manage a wide variety of aggressive hematologic and oncologic illnesses such as acute myeloid/lymphoblastic leukemias, aggressive lymphoproliferative disorders, blast crises, tumor lysis syndrome, DIC, coagulopathies, and other bleeding orders. In additions fellows are exposed to hematologic conditions requiring urgent and aggressive pheresis techniques such as hyperleukostasis, TTP, aggressive hemolytic anemias, and hyperviscosity syndrome.
This rotation consistently receives high marks by fellows’ evaluations for the depth and breadth of cases seen and for the autonomy provided to the fellow in management decisions. Fellows will participate in this dynamic service one to two months every year throughout their fellowship. The inpatient team consists of a fellow, two housestaff and a dedicated attending. The fellow is responsible for coordinating all inpatient treatment plans, managing chemotherapy-related and oncologic side effects, and supervising the intern and resident. Attending rounds are held daily. Call responsibilities include sharing evening pager call with other fellows assigned to Olive View Consult Service; and rounding one weekend (out of four weekends) on both the ward and consult service with the assistance of a housestaff resident or intern. There is no in-house overnight call. While on this rotation, fellows will attend their continuity clinics: hematology (half-day Monday afternoon); oncology continuity clinic on Wednesday reduced to a half-day (afternoon) –to allow for daily morning rounds.
While on the consultative services, fellows’ responsibilities include performing all consultations and formulating diagnostic and treatment plans; participating in weekly tumor boards, educational conferences and outpatient clinics; and teaching and supervising housestaff. First and second year fellows are assigned six to seven months of consultation between Olive View-UCLA and Cedars-Sinai; while third year fellows are assigned two to three months of consultation. The consult service at Olive View-UCLA consists of a team of three fellows, housestaff and one attending. Attending rounds are held daily, Monday through Friday. Fellows are responsible to round one weekend (out of four weekends) on the consult service and ward service, with the assistance of housestaff. Call during the work week is divided evenly by the fellows assigned to consult services. There is no in-house overnight call.
Special Treatment Center
The special treatment center rotation provides strong clinical experience in the management of a chemotherapy infusion center. In this outpatient setting, fellows become skilled at various procedures including bone marrow biopsies and administration of intrathecal chemotherapy. In addition, fellows are exposed to management of infusion reactions, management of chemotherapy related toxicities, and triage and management of oncologic patients in a sub-acute setting. Fellows work with a dedicated attending and chemotherapy nurses. This rotation is from Monday-Friday for 1-2 months during each year of training. There is no call during this rotation.
Cedars-Sinai Medical Center
Stem Cell Transplantation Service
The stem cell transplantation program at Cedars-Sinai runs a robust, active inpatient transplant service that provides extensive exposure to autologous and allogeneic transplantations. The Blood and Marrow Transplant Program, one of the largest in the Los Angeles region, has completed more than 1,500 stem cell and bone marrow transplant procedures since it was established two decades ago and now performs about 140 transplants a year. The Blood and Marrow Transplant Program performs autologous, allogeneic-related and unrelated, and allogeneic cord blood transplants, using HEPA-filtered, positive pressure rooms to ensure the safety and comfort of patients. The program is one of only two in the country offering bloodless bone marrow transplant to Jehovah’s Witnesses with lymphoma, multiple myeloma and other blood cancers. The Blood and Marrow Transplant Program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) and the National Marrow Donor Program (NMDP).
Fellows will participate in this service for a 6 to 8 week rotation block during their second and/or third year for a minimum of 3 months. The inpatient team is composed of a fellow, nurse practioners, and an attending. The fellow is responsible for assisting and coordinating all inpatient treatment plans for their assigned patients, managing chemotherapy and related side effects, and participating in weekly stem cell transplant conferences and lectures. Attending rounds are held daily, seven days a week. Evening and weekend call duty is shared with the fellow assigned to Cedars-Sinai Consultation service. The fellow will round one in every two weekends, and will participate in formal attending rounds on all stem cell transplant patients during the weekends with the attending and nurse practioner. There is no in-house overnight call. While on this rotation, fellows will also attend an outpatient stem cell transplant clinic on a weekly basis at Cedars-Sinai and will also continue their outpatient continuity clinic one half-day per week at Olive View-UCLA.
Consultation Service / Subspeciality Clinics
While on the consultative services, fellows’ responsibilities include performing all consultations and formulating diagnostic and treatment plans while teaching and supervising housestaff. The consult service at Cedars-Sinai consists of a fellow, housestaff and one attending. Attending rounds are held daily, Monday through Friday. In addition every afternoon, fellows attend subspecialty clinics at the Samuel Oschin Comprehensive Cancer Institute. These clinics include Dr. Robert Figlin’s Urologic Oncology Clinic, Dr. Ronald Natale’s Lung Cancer Clinic, and Dr. Jeremy Rudnick’s Neuro-oncology Clinic. Additional subspecialty clinics are available as well. Evening and weekend call duty is shared with the fellow assigned to Cedars-Sinai Stem Cell Transplant Ward. The fellow will round one in every two weekends, and will participate in formal attending rounds on all stem cell transplant patients during the weekends with the nurse practioner. There is no in-house overnight call. While on this rotation, fellows will maintain their continuity clinic one half-day per week at Olive View-UCLA on Wednesday.
Clinical Trials/ Phase I Research Rotation
In their third year, fellows work with Dr. Alain Mita and Dr. Monica Mita at the Experimental Therapeutics Program. During this two-week rotation, fellows are exposed to phase I research in the Clinical Trials Unit—where new anti-cancer drugs and ground breaking treatment strategies are tested.
Kaiser Permanente Los Angeles Medical Center
During their second and third year, senior fellows will have the unique ability to experience and work at a Kaiser Permanente Los Angeles Medical Center, performing rotations in both the Hematology and Oncology inpatient ward service and in outpatient clinics. Kaiser Permanente Los Angeles is the flagship hospital of the southern California HMO network, and serves as a tertiary referral center for complex hematologic and oncologic disease. The fellow will provides direct care to patients hospitalized due to acute leukemia, lymphoma and other hematologic and oncologic diseases that require intensive inpatient treatment. The inpatient team consists of a fellow, housestaff and one attending. The fellow is responsible for coordinating all inpatient treatment plans, managing chemotherapy-related and oncologic side effects, and supervising the housestaff. Attending rounds are held daily Monday through Friday. Integrated throughout the day will be rotations through outpatient clinics. There is no in-house overnight call. Weekend coverage is minimal. While on this rotation, fellows will attend their Wednesday continuity clinic at Olive View-UCLA Medical Center.
Dedicated elective rotations through radiation oncology and palliative care are incorporated into the first and second year schedule. Radiation oncology rotations take place at Cedars-Sinai and at local private offices of referrals partners throughout the San Fernando Valley. Palliative Care/Hospice Rotations occur at the UCLA West Los Angeles VA Program.
Fellows may participate in other electives offered at:
- General Hematopathology
- Transfusion Medicine
- Diagnostic Imaging
- Palliative Care/Hospice
- Palliative Care/Hospice
- These may include and other subspecialty clinics within hematology and oncology.