Pediatrics Hematology Oncology

About the Program

Welcome to the Pediatric Hematology and Oncology Fellowship program at the King Hussein Cancer Center. I am excited to introduce you to what our program can offer and invite you to learn more.

As Program Director, I am thrilled to announce that our PHO program has recently achieved accreditation from both the Jordan Medical Council (JMC) and the Arab Board of Health Specializations. This recognition reflects our unwavering dedication to maintaining the highest standards in healthcare delivery.

At the heart of our program is a commitment to excellence in both patient care and medical education. Our dedicated team of healthcare professionals works tirelessly to provide compassionate and comprehensive care to children facing hematologic and oncologic challenges. We take pride in our collaborative approach, ensuring that each patient receives personalized attention and the latest advancements in treatment. Over the three-year journey, our fellows will gain exposure to various hematological and oncological malignancies, acquiring the skills to diagnose, investigate, and treat diverse diseases in the field.

The entire department faculty supports our clinical mission; each faculty member has a specialized area of excellence within the field of Pediatric Hematology and Oncology. Within the Department, we have specialty clinics) in Leukemia, Lymphoma, Solid Tumors, Neuro-oncology, pain and palliative and Childhood Cancer Survivorship. Additionally, we boast an advanced unit in bone marrow transplant with leading experts.

We are continually striving to enhance our program through research initiatives, educational opportunities, and community outreach. It is our goal to not only treat pediatric hematologic and oncologic conditions but also contribute to advancements in the field.

We appreciate your interest in the Pediatric Hematology and Oncology Fellowship at the King Hussein Cancer Center. For further information, please explore our website.

Sincerely,

Faiha Bazzeh, MD

Pediatric Hematology Oncology Fellowship Program Director

Pediatrics Hematology/Oncology Fellowship Program

A formal Jordan Medical Council accredited fellowship program was established in January 2003. This is the first Pediatric Hematology /Oncology training in the country; it introduces the opportunity for young pediatricians to specialize here at home.

In addition this program is open to pediatricians from neighbouring countries seeking to specialize in Pediatric Hematology /Oncology. The program is a three-year Fellowship. It offers certification in the subspecialty of Pediatric Hematology/Oncology upon successful completion of the certification examination given by the Hematology/Oncology Committee at the Jordan Medical Council and the Arab Board of Health Specializations.

Objectives

It is the intent of this training program to develop physicians clinically competent in the field of Pediatric Hematology/Oncology with sufficient knowledge. Physicians completing this training program will be eligible for certification in Pediatric Hematology/Oncology.

Fellows will develop the skills needed of a subspecialty consultant; they will learn the skills of history taking, physical examination, data interpretation, problem synthesis, and proper use of diagnostic and therapeutic procedures. The full spectrum of procedures applicable to the practice of Pediatric Hematology/Oncology will be learned by the fellow, and will include training in the technical and psychomotor skills required.

Clinical skills

The performance of a directed but thorough history and physical examination.
The ability to serially measure palpable tumor masses.
The ability to interpret clinical data, including laboratory data, imaging studies, pathologic specimens, and the microscopic interpretation of blood smears and marrow aspirates and biopsies.
The ability to formulate an appropriate differential diagnosis and diagnostic plan based upon the clinical, laboratory, and radiological findings.
The ability to communicate clinical data in an organized, succinct, and intelligible fashion.
The ability to select appropriate, safe, and cost-effective laboratory and diagnostic studies.
The ability to formulate and carry out an appropriate therapeutic plan for Pediatric Hematology/Oncology disorders.
The ability to work effectively as part of a multi-disciplinary team.
The ability to provide appropriate humanistic, ethical, and conscientious care to the patient.

Technical and Procedural Skills

The Fellow will know the indications, contraindications, complications, potential benefits, alternatives, and limitations of the following diagnostic and therapeutic techniques and procedures and will be able to appropriately, safely and expeditiously perform or recommend and, where applicable, interpret these procedures based upon knowledge of the history and clinical findings. The Fellow will receive training in each of these areas to accomplish this goal.

Accurately calculate doses, order, administer or supervise the administration of cytotoxic chemotherapeutic agents and biologic response modifiers. Specifically, instruction in the careful, concise, and accurate ordering of these agents will be emphasized.
Ordering and administration of blood products, including factor replacement. This will include instruction in the indications for specific preparation of blood products—filtered, irradiated, and washed.
Recommend and assess tumor imaging studies, including plain films, CT scans, ultrasound (dynamic or static), MRI, and metabolic scanning.
Recommend surgical procedures.
Recommend appropriate insertion of central venous access, including PICC lines, broviac or portacath catheters.
Perform bone marrow aspiration and biopsy, including preparation, staining, examination, and interpretation of blood smears, bone marrow aspirates, and touch preparations. Perform lumbar puncture.
Recommend apheresis procedures, including therapeutic plasmapheresis or peripheral stem cell harvest for transplantation.
Perform and interpret partial thromboplastin time, prothrombin time, platelet aggregation, bleeding time and other standard coagulation assays.

The Fellow will be expected to be able to concisely outline the nature and utility of each procedure, along with its potential complications and benefits to the patient for the purpose of obtaining informed consent. The Fellow will appropriately document the indications, performance and results of all procedures in the patient chart. The Fellow will be expected to learn to identify his/her own limitations, and identify when to terminate procedures or seek assistance.

Program Requirements

The Pediatrics Hematology Oncology Fellowship candidates must be graduates of an accredited medical school, have completed an accredited paediatrics residency, and be Jordanian/Arab board certified or eligible. The total number of new applicants differs from year to year based on the department needs. However, we try to keep at least the same number of fellows of the previous years by hiring new ones instead of those who left.
For the selection criteria, please refer to the trainee selection policy.

Scientific Curriculum

The Fellow will receive formal instruction, clinical experience, and opportunities to acquire comprehensive knowledge in the following areas:

Morphology, physiology, and biochemistry of blood, marrow, lymphatic tissue, and the spleen.
Basic molecular and pathophysiologic mechanisms, diagnosis, and therapy of diseases of the blood, including anemias, diseases of white cells, and disorders of hemostasis and thrombosis.
Etiology, epidemiology, natural history, diagnosis, pathology, staging, and management of neoplastic disorders.
Measurement of the complete blood count, including platelets and white cell differential, using automated or manual techniques with appropriate quality control.
Immune markers, immunophenotyping, cytochemical studies, and cytogenetic and DNA analysis of neoplastic disorders.
Molecular mechanisms of neoplasia, including the nature of oncogenes and their products.
Systemic chemotherapeutic drugs, biological and immunological response modifiers, and growth factors and their mechanisms of action, pharmacokinetics, clinical indications, routes of administration, and limitations, including their effects, toxicity, and interactions. The use of multiagent chemotherapy protocols and combined modality therapy in the treatment of neoplastic disorders.
Management and care of indwelling venous access catheters.
Principles and application of surgery and radiation therapy in the treatment of neoplastic disorders. In particular, a basic understanding of the physics involved in the administration of radiation therapy and the complications arising from its use, as well as a comprehensive understanding of potential interactions between systemic therapy and radiation therapy.
Management of the neutropenic and/or the immunocompromised patient.
Rapid identification and treatment of hematologic and oncologic emergencies, including spinal cord compression, hypercalcemia, disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenia purpura (TTP), & heparin induced thrombocytopenia (HIT).
Effects of systemic disorder, infections, solid tumors, and drugs on the blood, blood-forming organs, and lymphatic tissues.
Allogeneic and autologous bone marrow transplantation and the nature and management of post-transplant complications.
Indications and application of imaging techniques in patients with blood and neoplastic disorders.
Pathophysiology and patterns of solid tumor metastases.
Pain management in the cancer patient.
Nutrition management for the cancer patient.
Rehabilitation and psycho-social management of patients with hematologic and neoplastic disorders.
Hospice and home care for the cancer patient.
Recognition and management of paraneoplastic disorders.
The etiology of cancer, including predisposing causal factors leading to neoplasia.
Current cancer prevention and screening recommendations, including competency in genetic testing and counseling as they relate to hereditary cancers and hematologic disorders for high- risk individuals.
Tests of hemostasis and thrombosis for both congenital and acquired disorders and regulation of anti-thrombotic therapy.
Treatment of patients with disorders of hemostasis and the biochemistry and pharmacology of coagulation factor replacement.
Transfusion medicine, including the evaluation of antibodies, blood compatibility, and the use of blood component therapy and apheresis procedures.
Understand the late effects of cancer therapy.

The Fellow will achieve a high level of cognitive knowledge of the following specific disorders, including their risk factors, molecular basis, appropriate treatment options, and prevention strategies, where applicable:

Leukemias, both acute and chronic
Solid tumors of organs, soft tissue, bone, and central nervous system
Lymphomas
Bone marrow failure
Hemoglobinopathies, including the thalassemia syndromes
Inherited and acquired disorders of the red-cell membrane and of red-cell metabolism
Autoimmune hemolytic anemia
Nutritional anemia
Inherited and acquired disorders of white blood cells
Platelet disorders, including ITP and acquired and inherited platelet function defects
Hemophilia, von Willebrand's disease, and other inherited and acquired coagulopathies
Hematologic disorders of the newborn
Transfusion medicine and use of blood products
Congenital and acquired immunodeficiencies

In addition to specific hematologic and malignant disorders, the Fellow must develop competency in all aspects of chemotherapy, including treatment protocols and management of complications, diagnosis and treatment of infections in the compromised host, appropriate use of transfusion of blood products, plasma pheresis and bone marrow transplantation. The Fellow is also expected to learn methods of physiologic support of the cancer patient including parenteral nutrition, control of nausea and pain, staging and classifications of tumors, complete knowledge and application of multimodality therapy, learning to function as a member of an oncology team, and learning the epidemiology of childhood cancer.

Work Duties

The following are the duties of the trainees during their rotation:

Inpatient rotation: patient clinical care which includes daily rounds and examination of all patients, rounding with the consultants and supervising the residents, meeting with the head nurse to discuss any concerns, daily progress note is expected to be written on all patients.
Outpatient clinic attendance with the consultant.
Multidisciplinary clinic attendance and presentation of cases.
Participation of departmental activities.
Communication with other hospitals for patients referral.
After hours and weekend coverage as per monthly schedule.

Scientific Activities

Throughout their fellowship, fellows will attend the following departmental activities:

Tumor board: This is held weekly.
Bone Marrow Club: monthly.
Journal Club: monthly.
Topic of the Month: monthly.
Grand Round: monthly.
Mortality& morbidity: monthly.
St Jude, Leukemia- Lymphoma teleconference: weekly.
Service meetings: weekly to Biweekly.
St Jude Hospital/Hospital of Sick children Horizon Live Meetings: monthly.
Patient Management Round: weekly.
Morning report: daily
Multidisciplinary clinics and meetings according to the rotation:
- Leukemia/Lymphoma monthly meeting
- Ocular Oncology MDC
- Solid Tumors MDC
- Sarcoma MDC
- Neurooncology MDC

The marked activities are usually prepared by the fellow who will present the pertinent information of an interesting case and conduct an in-depth discussion of that case or he/she will prepare some newly released articles with the help of attending physician to be discussed.

In addition to the above activities, our fellows also attend the following Hospital activities:

Grand Round: weekly.
Mortality& morbidity: monthly.
Clinico pathology Conference: monthly.

Our fellows will be sponsored to attend regional and international meetings, and they are encouraged to present an oral or poster presentation in these conferences. Also our fellows are offered a wide range of research opportunities in many areas, some of which include retrospective reviews, interesting cases and prospective randomized studies.

Rotations

Typically the fellows are supposed to have the following rotations during the 3 years of training:

Pediatric Hematology
In Patient Service ( Leukemia/ Lymphoma)	6 months	First year/early second year
Outpatient Service	5 months	Second year/third year
Hematopathology Lab(KHCC)	1 month	Third year
Pediatric Oncology
In Patient Service ( Solid Tumor/Neuro oncology)	6 months	First year/early second year
Outpatient Solid tumor Service	3 months	Second year/third year
Outpatient Neuro oncology Service	3 months	Second year/third year
External/international Rotation	4 months	Third year
Blood Bank	2 weeks
Hematopatholgy /Flowcytometry Lab	2 weeks
Coagulation Lab	2 weeks
Cytogenetics	2 weeks
HLA Lab	2 weeks
Radiation Oncology	2 weeks
Benign Hematology	1 month
BMT program	4 months	End of second year/early third year
Pain and Hospice	1 months	Third year
Procedures( Bone Marrow and Intrathecal)	1 months	Second year

Research

Fellows in Pediatric Hematology/Oncology will receive instruction in the principles and techniques involved in basic science and clinical research, and will be expected to participate in at least one research project during their program preferably after the first year of training.

They will be encouraged to seek the advice of Faculty members when deciding on a potential research project, and will receive whatever assistance they require. It is hoped that the exposure our Fellows receive to research during their program will foster an interest that will last throughout their career.

Fellows will be expected to identify a scientific mentor and an area of research interest, and communicate this to the Program Director.

Evaluation

To ensure the acquisition of adequate knowledge and good technical skill development, performance of all fellows will be monitored carefully during the course of their Paediatrics Hematology-Oncology fellowship. Therefore they will be evaluated formally by the supervising faculty members after each clinical rotation; in addition all the educational activity presented by the fellow will be also evaluated by the audience in a special evaluation form. The number of activities attended by the fellow will be counted as part of their evaluation. These evaluations are usually discussed with each fellow. A yearly examination to assess the progress in the fellow's knowledge will be held, the score of the exam will be discussed with each fellow individually.