Clinical Exposure

Our fellowship program offers trainees a dynamic clinical exposure across many sites that result in an unparalleled experience. Not only do our fellows spend time immersed in the tertiary care that occurs at the University of Washington Medical Center and Seattle Cancer Care Alliance, but have added benefit of serving the underserved at Harborview Medical Center, and caring for the veterans at the Seattle Branch of the Puget Sound VA. Furthermore, fellows are exposed to the cutting edge of transfusion medicine and immunohematology at the world-class Bloodworks Northwest.

Harborview Medical Center (HMC)

Training Site Directors
Virginia C. Broudy, MD
Professor, Division of Hematology, Department of Medicine, UWSOM
Chief of Medicine, Harborview Medical Center

John Harlan, MD
Professor, Division of Hematology, Department of Medicine, UWSOM
Adjunct Professor of Pathology
Associate Medical Director for Blood Services
Chief, Section of Hematology/Oncology, Harborview Medical Center

Harborview Medical Center (HMC) is a 413-bed county hospital that serves as the Level I trauma center for a several state area and also provides primary care to indigent patients and patients with HIV-related illnesses. The fellow sees hematology and oncology patients as a consultant on the inpatient ward services and in clinic. There is no inpatient hematology/oncology service, so patients are admitted to a general medical service where the team acts as consultants. There are usually 0-5 new consults per day, and the team generally follows approximately 10 patients. Patients seen on the consult service may also be seen in follow up in the Hematology/Oncology Clinic.

 

Bloodworks Northwest (BWNW)

Training Site Director
Terry Gernsheimer, MD
Professor, Division of Hematology, Department of Medicine, UWSOM

The Bloodworks Northwest rotation, formerly known as Puget Sound Blood Center, provides instruction in the theory and practical application of transfusion medicine, immunohematology and hemostasis/thrombosis toward developing consultative and primary management skills in these subdisciplines of hematology. Located in Seattle, the BWNW is the central transfusion service for all of King County (the densest county in the state of Washington). The BWNW labs provide reference services for testing and provide blood collection and distribution services, including apheresis procedures and transfusion consultation.  Training is provided in donor collection and blood processing, crossmatch and antibody identification, HLA and platelet immunology, donor testing and coagulation. Fellows have the opportunity to provide consultations to referring physicians, particularly in cases involving the management of bleeding, transfusion reactions and antibody-related clinical issues. On Wednesday afternoons fellows attend a BWNW hemophilia clinic.

 

Seattle Cancer Care Alliance (SCCA)

SCCA General Solid Tumor Oncology

Training Site Director
Evan Yu, MD
Attending Physician, Seattle Cancer Care Alliance (GU)
Assistant Professor, Division of Medical Oncology, Department of Medicine, UWSOM

Fellows see a wide variety of oncology patients at the SCCA. Fellows attend multidisciplinary clinics in breast cancer and melanoma tumor clinics where patients are evaluated in conjunction with medical radiation and surgical oncologists. Fellows also participate in general medical oncology clinics where patients are evaluated for a variety of malignancies including GI, GU, lung, gynecologic, and hematologic malignancies. Under the guidance of an attending physician, the fellow may evaluate from two to four new patients per day, order appropriate staging and diagnostic studies, perform bone marrow biopsies and aspirates, and formulate a plan of treatment based on history, physical, and test results. The fellow will evaluate patients for eligibility on clinical research protocols. Fellows will provide an explanation of the study and alternative treatment, enrollment criteria, and coordination of the treatment program. Cases requiring interdisciplinary management may be seen in one of several specialty clinics.

SCCA Malignant/Benign Hematology

Training Site Director
Michael Linenberger, MD, FACP
Medical Director, Apheresis and Cellular Therapy, SCCA
Associate Member, Clinical Research Division, Fred Hutch
Professor, Division of Hematology, Department of Medicine, UWSOM

Fellows learn about the presentation, pathophysiology, clinical manifestations, diagnostic approaches and treatment of a wide variety of benign and malignant hematologic disorders. Fellows attend multidisciplinary clinics in hematology and hematologic malignancies at SCCA.  Fellows participate in a variety of ambulatory care clinics at the SCCA including lymphoma, MDS, myeloma and hematology. This rotation also provides an opportunity to observe in the Apheresis Unit and Cellular Therapy Lab to gain an understanding of the technical and clinical aspects of peripheral blood stem cell mobilization and collection, processing and cryopreservation.  Fellows also participate in consultations for patients who may be candidates for blood and marrow transplantation (BMT), as well as see long-term BMT follow-up patients.

SCCA Blood and Marrow Transplantation (BMT) – Ambulatory Care

Training Site Director
Marco Mielcarek, MD/PhD
Medical Director, Adult Blood and Marrow Transplant Program, SCCA
Associate Member, Clinical Research Division, Fred Hutch
Associate Professor, Division of Medical Oncology, Department of Medicine, UWSOM

The SCCA BMT ambulatory care rotation pairs fellows with foremost experts in the BMT field. The goal of this rotation is to learn the theory, indications, treatment approaches, complications and outcomes of autologous and allogeneic bone and marrow transplantation and to develop confidence and clinical expertise in the care and management of transplant recipients. BMT patients are followed pre- and post-transplant for a period of approximately 100 days, after which they are referred back to their referring physician. Fellows see patients admitted for stem cell infusion in preparation for non-myeloablative transplants and unrelated “mini” transplants.

Fellows have the opportunity to conduct a patient care conference of his/her choosing:

  1. arrival (a summary of the major issues to be addressed during pre-transplant evaluation);
  2. data review (a summary of the pre-transplant evaluation results and upcoming transplant treatment plans, goals, risks and potential adverse events); or
  3. discharge (a summary of post-transplant events and recommendations for further therapy after discharge from the BMT service).

UWMC Blood and Marrow Transplantation (BMT) – Inpatient Unit

Training Site Director
Marco Mielcarek, MD/PhD
Medical Director, Adult Blood and Marrow Transplant Program, SCCA
Associate Member, Clinical Research Division, Fred Hutch
Associate Professor, Division of Medical Oncology, Department of Medicine, UWSOM

The SCCA BMT inpatient rotation pairs fellows with foremost experts in the BMT field. The goal of this rotation is to learn the theory, indications, treatment approaches, complications and outcomes of autologous and allogeneic stem cell transplantation and to develop confidence and clinical expertise in the care and management of transplant recipients. Fellows provide primary care of patients with the assistance of the attending physician, nursing, pharmacy, social services, transition team, and the outpatient clinic providers. The fellow is responsible for the intake, daily management, diagnostic and therapeutic decision-making, documentation (paper and electronic), and coordination of discharges. Supportive care includes platelet and granulocyte transfusions, reverse-isolation techniques, Hickman catheters, nutrition research, plasma exchanges, ex vivo immunoabsorption, infection prevention and treatment in granulocytopenic and immunosuppressed patients. Basic principles of intensive chemoradiotherapy are emphasized.

Seattle Cancer Care Alliance Clinical Trials

University of Washington-based faculty who have clinics at the SCCA are active participants in SCCA and Southwest Oncology Group (SWOG) protocols in leukemia, lymphoma, lung, breast, GU, brain tumor, and melanoma. Clinical trials are underway using dose dense therapy for breast cancer, high dose therapy for non-Hodgkin’s Lymphoma with marrow-ablative or non-marrow-ablative antibody approaches. As the largest sarcoma and melanoma programs in the Pacific Northwest, clinical investigation is particularly active in these areas. In particular, the use of biologic-response modifiers with IL-2, in renal cell cancer and melanoma is pursued on the inpatient service. Continued expansion of the clinical research protocols is anticipated as programs are integrated in the SCCA.

 

University of Washington Medical Center (UWMC)

UWMC Hematology/Oncology Rotation (also referred to as “Green Medicine”)

Training Site Director
Paul Hendrie, MD, PhD
Clinical Associate Professor, Division of Hematology, Department of Medicine, UWSOM

The fellow works as an active consultant on this inpatient rotation and works directly with the residents, nursing staff, pharmacists, social workers, and the attending physician to assure appropriate workup and care of patients. The fellow supervises the resident who is responsible for primary medical management. The inpatient unit includes patients with new diagnoses of leukemia, lymphoma, aplastic anemia, sickle cell disease, and many solid tumor cancers including renal cell, colorectal, breast and melanoma. The UWMC is a referral center for the five WWAMI states (Washington, Wyoming, Alaska, Montana, Idaho) as well as a local primary care site.

Hematology Consult/Laboratory Medicine

Training Site Director
Janis L. Abkowitz, MD
Clement Finch Professor of Medicine
Head, Division of Hematology, Department of Medicine, UWSOM
Director, Seattle Cancer Care Alliance Hematology Clinic

This rotation provides the opportunity to learn about the work-up, laboratory assessment and treatment of a wide variety of hematologic consultative issues. The focus is benign hematology. Hematology consults often involve evaluation of adenopathy, splenomegaly, and cytopenias, and the management of complex bleeding abnormalities or thrombotic complications, especially in surgical and obstetrical settings. The UWMC is a referral center for the five WWAMI states (Washington, Wyoming, Alaska, Montana, Idaho), and thus, is an active site for both basic medical care and for tertiary referral issues, such as liver transplantation, complex surgery, and high-risk obstetrics. The use of flow cytometry and immunocytochemistry methods are important focuses of this rotation.

 

Veterans Affairs Puget Sound Health Care System

VA Puget Sound is a 428-bed acute care facility that includes all medical and surgical disciplines. On average, 650 new cancer cases are diagnosed annually and 550 new cancer patients receive treatment. Referrals to VA Puget Sound come from other VA institutions nationwide including the system of military hospitals. Three learning experiences occur concurrently at VA Puget Sound.

VAPS Solid Tumor Oncology

Training Site Director
Jon Grim, MD/PhD
Attending Physician, VA Puget Sound Health Care System
Assistant Member, Clinical Research Division, Fred Hutch

The primary goal of this Solid Tumor Oncology rotation is to develop effective consultation skills and enhance medical knowledge about a wide variety of oncologic disorders including lung, genitourinary/prostate, and head and neck cancer. The cancer program is certified as a Teaching Hospital Cancer Program by the Commission on Cancer and as a Comprehensive Cancer Center by the VA. The VA has facilities for all aspects of cancer therapy including radiation therapy, interstitial therapy, subspecialty surgery (orthopedics, neurosurgery, urology, otolaryngology, thoracic surgery, and cardiac surgery) and interventional radiology.

VAPS Hematology Consult

Training Site Director
Robert Richard, MD/PhD
Director, Hematology, VA Puget Sound Health Care System
Associate Professor, Division of Hematology, Department of Medicine, UWSOM

Fellows develop effective consultation skills and enhance medical knowledge by seeing a wide variety of benign and malignant hematologic disorders. The Hematology Service receives on average 8 to 10 consults per week, primarily from the inpatient VAPS services but also from VA facilities throughout the state and Alaska. Most of the outside consult requests can be handled as electronic non-visit consults. The Hematology Consult Service fellow sees all inpatient consults and reviews electronic outpatient consults to determine acuity of the question, respond to the consult, and review their response with the attending physician. The problems encountered as electronic consults are primarily benign hematologic issues such as anemia, cytopenias, and thrombo-embolic disorders.