Internal Medicine -- Hematology - Rochester

Description:

Students spend the morning hours making rounds on one of Mayo's two hematology hospital services, and spend the afternoons evaluating and managing patients on the hospital service. The Hematology-I Service consists of patients with lymphoma, multiple myeloma and general hematologic problems. The Hematology-II Service consists of patients with acute leukemia and other myeloid diseases.

Students may also be prescheduled on the Hematology Consultation Service depending on scheduling availability. This service sees patients on the other Mayo inpatient services. Students will see patients with anemia and other cytopenic work-ups, coagulation problems, diagnostic and staging work-ups for hematologic malignancies, and evaluation of myeloproliferative diseases.

Specific Goals:

1. Elicit histories, perform physical examinations, and interpret laboratory findings in your evaluation of patients with common hematological disorders. These may include:
   1. Hodgkin's lymphoma
   2. Non-hodgkin's lymphoma
   3. Acute myelogenous leukemia
   4. Non-myelogenous leukemia
   5. Chronic lymphocytic leukemia
   6. Multiple myeloma
   7. Myeloproliferative diseases
   8. Inherited or acquired thrombophilias
   9. Inherited or acquired bleeding disorders
2. Elaborate a differential diagnosis and strategy for evaluation of common hematological abnormalities which may include:
   1. Anemia
   2. Thrombocytopenia
   3. Leukopenia
   4. Polycythemia
   5. Leukocytosis
   6. Thrombocythemia
   7. Pancytopenia
   8. Monoclonal Gammopathy
   9. Lymphadenopathy
   10. Prolonged aPTT, PT, and bleeding time
   11. Acute venous thrombosis
3. Recognize RBC and WBC findings on blood peripheral smears in the following diseases:
   1. Iron deficiency anemia
   2. B-Thalassemia
   3. Anemia of chronic disease
   4. Microangiopathic anemias
   5. B12 or folate deficiency
   6. Liver disease
   7. Acute myelogenous leukemia
   8. Chronic lymphocytic leukemia
   9. Reactive lymphocytosis

Activity Outline:

Students will join the Hematology team for morning rounds on the hospital inpatient service or consult service daily Monday through Friday. Students will be expected to perform comprehensive H&P's on new patients (goal at least one per day) under the supervision of the resident or fellow on the service. The student will be expected to present the case to the consultant on rounds the following day. The student should evaluate their patients daily except on the weekend and also write progress notes on the inpatients. There are Hematology conferences Monday through Thursday including: Monday Clinical Pathologic Conference (CPC), Tuesday Fellows' Core Hematology Curriculum Conference, Wednesday morning Internal Medicine Core Curriculum meetings, and Thursday Divisional Hematology Clinical Conference. In addition, the student will benefit from daily teaching sessions on rounds.

Method of Evaluation:

The consultant and the hospital first assistant evaluate students daily. At the end of each clerkship, an evaluation is completed by the hospital service staff who directly worked with the student. No formal examinations are given at the end of the clerkship. Honors are available.