Hematology/Oncology Fellowship

Overview

Three years of training in internal medicine (including internship) are required before a fellow can be accepted into the program. We currently have 12 clinical fellows distributed between the Divisions of Hematology and Oncology over the span of a three-year fellowship. The fellows spend two years in Oncology and one year in Hematology, or they may spend two years in Hematology and one year in Oncology. Fellows will be board-eligible at the end of that period.

The program provides the following major strengths:

  • Exposure to a large faculty of internationally recognized authorities in the area of medical oncology (including specialists in gastrointestinal, genitourinary, thoracic, and breast oncology as well as immunotherapy), general hematology, hematologic neoplasia and HIV disease.
  • Exposure to and ability to learn from the diverse patient population at three hospitals on one campus: LAC+USC Medical Center (the largest teaching hospital in the U.S.), USC Norris Cancer Hospital and Keck Hospital of USC.
  • Ability to work within the multi-disciplinary environment of the USC Norris Comprehensive Cancer Center, one of only 26 such NCI sponsored facilities in the U.S.
  • Ability to work within the academic and research environment of the Division of Hematology, which is known for its excellence in and commitment to teaching.
  • Ability to work within the academic, research, and clinical environment of the Division of Oncology, with its world renowned clinical and translational research expertise and ground-breaking clinical trials.

Fellowship training includes clinical experience through bedside teaching at LAC+USC Medical Center, USC Norris Cancer Hospital, involvement in the design and conduct of clinical trials, a series of multidisciplinary tumor conferences, in-depth fellow discussions and journal clubs, and a series of didactic lectures and conferences. Fellows obtain a wide range of experience on the inpatient chemotherapy ward and consultation services as well as the specialized outpatient clinics.

Objectives

  • To train physicians in the clinical skills necessary for the sub-specialty practices of hematology and/or oncology.
  • To train physicians in the clinical, teaching, and research skills necessary for a full-time faculty position in academic hematology and/or oncology.
  • To provide one year of hematology training for those physicians who are also taking two years of oncology training so that they may be eligible for both the oncology and hematology sub-specialty boards.
  • To provide one year of oncology training for those physicians who are also taking two years of hematology training, so that they may be eligible for both the oncology and hematology sub-specialty boards.
  • To provide basic instruction in clinical hematology and oncology to residents, interns and medical students, including training in techniques of teaching.
  • Special training in the clinical and laboratory work-up of patients with disorders of homeostasis. Because of the section’s interest in these patients, an unusual opportunity exists to develop competence in this area
  • Training in research through undertaking a clinical or laboratory research project, including an intensive course on writing and interpreting clinical trials.
  • An emphasis upon critically reading and discussing the hematologic and oncologic literature.

Functions of the Division of Hematology within the Department of Medicine:

Clinical

  • To provide hematologic consultation and primary hematologic care to inpatients and outpatients of all departments LAC+USC Medical Center, USC Norris Cancer Hospital and Keck Hospital of USC
  • To provide continuing care for all adult outpatients with serious hematologic problems through the operation of the adult Hematology Clinics at LAC+USC Medical Center
  • To operate an 18-bed hematology ward and a day hospital for patients with hematologic disorders at the LAC+USC Medical Center
  • To operate a clinical service coagulation laboratory for the work-up of inpatients and outpatients with suspected hemorrhagic or thrombotic disorders
  • To provide autologous and allogeneic stem cell transplantation services for the patients referred to USC Norris Cancer Hospital

Teaching

  • Graduate teaching
  • To teach the hematology course in the first year (five weeks) of medical school
  • To provide a 6-week clinical elective period for third- and fourth-year medical students, during which time they work with residents and fellows on the hematology consultation service, attend clinics and attend the conferences and rounds of the section.
  • House staff, fellows and other post-graduate teaching

Research

The research interests of the Hematology Section are diverse. They includes basic and clinical research in hemostatic mechanisms and their alterations in disease, sickle cell disease and other hemoglobinopathies, malignant lymphoma and other hematologic neoplasms and hematologic disorders associated with AIDS. Research programs are carried out in various laboratories:

  • The hematology research laboratory that occupies an entire floor of the Raulston Research Building on the campus of the Keck School of Medicine.
  • The clinical coagulation research laboratory that is located in USC Norris Cancer Hospital. This laboratory is used for training in clinical coagulation techniques.
  • A Bone Marrow Transplantation/Hematopoiesis Laboratory at USC Norris Cancer Hospital.
  • An Angiogenesis Disease Laboratory at USC Norris Cancer Hospital.
  • A laboratory, located at the Norris Research Tower, focused on the epigenetics of cancer, studying demethylation as a means of treating various hematologic malignancies.
  • Several Hematology collaborating laboratories are also studying the relationship between viral infections and lymphoma – including HCV, HIV, HHV8, HTLV I, amone others.

Hematology Ward Experience

The hematology ward (7B in the LAC+USC Medical Center) has 18 beds on our own medical specialties ward, reserved for patients with hematologic malignancy. Admissions are controlled by the fellow. The ward is a fully equipped wing of the newly built LAC+USC Medical Center, providing state-of-the-art laminar air flow and other facilities.

Training purposes of the ward service

During this period the fellow is expected to acquire the clinical competence that can only come from close contact with, and responsibility for, a group of seriously ill patients with hematologic malignancy.

Training provided by the Hematology Clinics

The general hematology clinic is attended by all fellows, as well as residents in medicine rotating through our service. Three full-time staff attend clinic each week. Between 40-50 patients may be seen, and the fellows are responsible for knowing about the clinical problems of each.

The full-time staff reviews all cases with the medical residents and fellows.

Organization of the Lymphoma-Leukemia Clinic

The fellow is directly responsible for the care of patients with hematologic malignancies. These patients usually are on combination chemotherapy and are followed at frequent intervals. Each fellow sees about 5-6 patients per week.

Four full-time staff review all cases with the fellows. Full-time chemotherapy nurses and research nurses are available to facilitate the administration of chemotherapy and to administer all required aspects of research protocols.

The clinic has been organized to provide the fellow with a group of “personal patients” to follow throughout the two years. This enables the fellow to have direct responsibility for the continuous care of patients with hematologic malignancies receiving chemotherapy.

Training purposes of the Kaposi’s sarcoma Clinic/AIDS-Lymphoma Clinic

These two clinics are organized so that fellows have some experience in managing patients with AIDS, and with AIDS-related malignancies. This frequent complication of AIDS requires significant background knowledge and good clinical judgment, and this rotation provides an experience that fulfills those requirements, working with faculty who are recognized internationally in this field

Training purposes of the Hematology clinics

By providing the fellow with a group of patients to follow throughout the two years, the fellow learns firsthand the responsibilities of the ambulatory care of patients with hematologic disorders.

By giving the fellow supervisory responsibilities for this large group of patients, the fellow also acquires experience in teaching. He or she is responsible not only for bedside teaching but also for teaching hematology and hematologic morphology to the house-staff.

By making the fellow responsible for reviewing and approving the decisions of medical residents, the fellow is challenged to know more hematology and internal medicine than these residents and is stimulated to read and organize his knowledge so that he/she can teach his/her contemporaries.

By providing adequate full-time faculty coverage in clinics, the trainee can review difficult problems with a more experienced physician immediately after he/she has made an independent assessment of the problem.

Fellows

Current and past fellows

Fellows within the USC hematology/oncology training program are a diverse group. Over the past several years our fellows have come from the following internal medicine programs:

  • University of Southern California
  • University of California, Davis
  • Mount Sinai School of Medicine, New York
  • University of California, Los Angeles
  • UCLA/West L.A. VA
  • Santa Barbara Cottage Hospital

Fellows graduating from one of the training programs of the Divisions of Hematology and/or Oncology are known for their solid clinical knowledge and ability to successfully embark on careers in the fields of both hematology and oncology from the moment of graduation. Over the past 5 years, we have placed 4 fellows into academic positions and 11 have gone into clinical practice.

The faculty are responsible for the education of approximately 84 interns and 120 residents each year.

Hematology and Blood Diseases Fellows

Grace Chang, MD
Anishka D’Souza, MD
Umair Ghani, MD
Irene Kang, MD
Charlene Lee, MD
Ming Li, MD
Xin Li, MD
Derrick Su, MD
Steven Yu, MD

Post-Doctoral Fellows and Graduate Students  

Giridharan Ramsingh, MD
Devi Thiagarajan, PhD
Kwasi Connor, PhD

Preet M. Chaudhary, MD, PhD
Ram Gopalakrishnan, PhD
Tim Triche, PhD

Akil A. Merchant, MD
Parvesh Chaudhry, PhD

Fellows – Research and Future Careers

Fellows graduating from Hematology/Oncology training programs are known for their solid clinical knowledge and ability to successfully embark on careers in the fields of both hematology and oncology from the moment of graduation. Our fellows have progressed on to academic positions as well as clinical practice in Southern California and throughout the United States.

Fellows within both the dedicated as well as combined training programs are encouraged to participate in clinical as well as laboratory-based translational research. Over the past 5 years fellows have routinely presented abstracts at several major annual conferences, including the American Society of Hematology (ASH) and the American Society of Clinical Oncology (ASCO), and have published multiple papers in peer-reviewed journals. Fellows receive training in writing clinical trials and most have become principal investigators on various protocols.

Hematology Clinical Services and Rotations

There is one general hematology clinic each week and one lymphoma-leukemia clinic each week. The general hematology clinic is attended by all fellows, as well as residents in medicine rotating through our service. Three full-time staff attend clinic each week as well as additional volunteer faculty. Between 50-70 patients may be seen, and the fellows are responsible for knowing about the clinical problems of each. In the lymphoma-leukemia clinic, the fellow is directly responsible for the care of patients with hematologic malignancies. These patients usually are on combination chemotherapy and are followed at frequent intervals. Each fellow sees about 7-10 patients per week. Six full-time staff review all cases with the fellows. Full-time chemotherapy nurses and research nurses are available to facilitate the administration of chemotherapy and to administer all required aspects of research protocols. The clinic has been organized to provide the fellow with a group of “personal patients” to follow throughout the two years. This enables the fellow to have direct responsibility for the continuous care of patients with hematologic malignancies receiving chemotherapy. In addition, fellows rotate through the Kaposi’s Sarcoma clinic and AIDS/Lymphoma Clinic. These two clinics are organized so that fellows have some experience in managing patients with AIDS, and with AIDS-related malignancies. This frequent complication of AIDS requires significant background knowledge and good clinical judgment, and this rotation provides an experience that fulfills those requirements, working with faculty who are recognized internationally in this field.

The fellow spends 2-3 months per year on the Hematology Ward at LAC+USC Medical Center where he/she receives intensive training in the diagnosis and management of seriously ill patients with acute or chronic leukemia, lymphoma, Hodgkin’s disease, multiple myeloma and other disorders. During this period the fellow is expected to acquire the clinical competence that can only come from close contact with, and responsibility for, a group of seriously ill patients with hematologic malignancy. The specialized ward has been completely renovated, providing state-of-the-art laminar air flow and other facilities.

The fellow spends 2-3 months each year in the USC/Norris Cancer Hospital and Research Institute, which where he/she is responsible for the diagnosis and management of patients referred for investigative protocols and for patients on the Bone Marrow Transplantation (BMT) Unit. The service is staffed by two residents, one physician-assistant, and one fellow. Rounds are made twice daily by full-time faculty. The BMT Unit is a state of the art self-contained six-bed unit is located in the USC/Norris Cancer Hospital. The fellow obtains experience with high-dose chemoradiotherapy and autologous peripheral blood progenitor or marrow rescue in patients with refractory or relapsed hematologic malignancies and selected patients with solid tumors. The allogeneic BMT program provides additional experience with matched sibling stem cell transplants.

Approximately six months during the two years are spent on the Consultation Service, which is responsible for answering the requests for consultation on adult inpatients at the Los Angeles County+USC Medical Center and the USC/University Hospital. The LAC+USC Medical Center Consultation Service is staffed by three medical residents and one-to-two medical students. The USC/University Hospital Consultation Service consists of a fellow and senior faculty member. During this period the fellow continues to see a wide variety of patients with hematologic disorders, with their morphologic material, but also has some free time to pursue other aspects of his/her training as described below.

The Fellow is also provided time for the following added training experiences:

  • Participation in a clinical and/or laboratory research project.
  • Evaluation of referred private patients with complex clinical hematologic problems.

Each fellow is entitled to a one-month vacation each year.

In addition to the above, there are opportunities to spend elective time in Hematopathology, Oncology, Blood bank, Venous Thrombosis laboratory, Radiation Oncology, and others.

Hematology Conferences and Lectures

Fellow Specific Seminars in Hematology are advanced seminars where pertinent literature on the speaker topic of the week is discussed, with mentoring and education provided at the fellow level by all faculty throughout the year.

Hematology Grand Rounds Conference is held weekly. A specific topic is discussed in depth by invited expert discussants from USC and from throughout the country and world.

Each year the Hematology section hosts an internationally recognized hematologist for the Donald I. Feinstein Lectureship, an endowed lectureship named in honor of the former Chief of the Division of Hematology at USC.

The weekly Hematology Patient Care Conference is attended by clinical hematologists, hematopathologists, radiologists and radiotherapists, as well as house officers, fellows and medical students. Members of the Hematology section provide a brief clinical review of the patient’s problem, which is followed by a display of the patient’s morphologic material, scans and radiographs. Further diagnostic and therapeutic recommendations are then discussed by the multidisciplinary team.

Cancer Center Grand Rounds is a weekly multidisciplinary conference that includes all of the departments and divisions involved in the care of patients with various types of cancer at the Keck School of Medicine of USC. This conference is mandatory for all combined Hematology/Oncology fellows.

Didactic Hematology Seminars are two one-hour didactic seminars held each week. During the first six months of the year, the topics are regularly assigned to faculty. During the second six months of the year, the fellow is expected to select four different topics for presentation at these seminars.

Fellow Weekly Mentor Sessions/Journal Clubs begin in October of each year. Faculty meet with fellows on a weekly basis to discuss various topics in benign and malignant hematology. Literature on the topic is carefully reviewed, in a format designed specifically for the level of our fellows.