Haematology/Oncology

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information
 

I About The Programme

Name of Programme

Paediatric Haematology/Oncology Service Fellowship Programme

Overview

The Paediatric Haematology / Oncology Service at KK Women’s and Children’s Hospital sees an average of 100 new cases of childhood cancer a year. 70-80% of local cases of childhood cancer receive treatment in KKH. We also receive regional and international referrals. The Service also manages benign haematological conditions including bleeding disorders such as haemophilia, thalassaemia and other forms of anaemia, neutropaenia and thrombocytopenia, as well as bone marrow failure syndromes. The Singapore Children’s Cancer Registry (SCCR) is sited within the hospital. The Children’s Blood and Cancer Centre consists of an inpatient oncology and transplant ward with 23 beds and 4 BMT rooms, as well as a 12-bedded Children’s Day Therapy Centre which caters for outpatient procedures and treatment of children with cancer and blood disorders. The Children’s Blood and Cancer Centre offers a comprehensive programme for the treatment of childhood cancers and hematologic conditions. A multidisciplinary team exists in-house which includes Paediatric Oncology Surgeon, Paediatric Neurosurgeon, Paediatric Ophthalmologist, Paediatric Orthopedic Surgeon, Paediatric Pathologist and Paediatric Radiologist. The full range of Paediatric Medical subspecialties are available in the Children’s Hospital, such as Paediatric Intensive Care, Paediatric Infectious Diseases, Paediatric Immunology, Paediatric Palliative Care.  There is a Blood and Marrow Transplant and Cell Therapy (BMTCT) programme for allogeneic and autologous hematopoietic cell transplants and cellular therapies (CAR-T and NK cell therapy) for malignant and benign conditions, supported by a BMT coordinator and a pheresis and cell collection team. The Haematology Laboratory, Blood Bank and Cell Processing Laboratory provides diagnostic haematology,  transfusion medicine and cell processing services for the hospital.

A holistic approach for the treatment of childhood cancer is supported by allied health and medical social workers from the hospital and the Children’s Cancer Foundation. They provide psychosocial and financial support to patients and parents with a wide range of activities including play therapy, counselling, tutoring and educational activities.

There is also clinical trials and basic science and translational research in paediatric haematology and oncology.

For more information about Paediatric Haematology/Oncology Service, click here.

Aim of Programme

The aim of the programme is to provide a comprehensive course in paediatric haematology/oncology with the primary objective of developing a specialist in paediatric haematology/oncology.

Duration of Programme

6 to 12 months

Number of Training Places

1 to 2 Fellows per year

Learning Outcomes

After completing the programme, Fellows will be able to:

• provide clinical diagnosis, initial opinion and management of referred cases under supervision, including implementation of treatment protocols.
• provide compassionate, cost-effective care for a variety of oncology and haematology disorders that can be translated back to their home country.
• break bad news and communicate in a sensitive manner, and able to communicate with a child patient in an age-appropriate manner.
• perform practical procedures, including access of central lines (e.g. portacath, Hickman lines), bone marrow aspiration, trephine and lumbar punctures.
• manage the symptoms and end-of-life care of patients with terminal or incurable oncology disorders.
• manage bone marrow transplant patients and related complications.
• interpret laboratory results, particularly those regarding benign haematology conditions, including coagulopathies and blood deficiencies.

Content Areas

A significant proportion of the programme will include:

1.     an understanding of the pathophysiology of paediatric benign and malignant haematological and oncological disorders. The type of cases the Fellow is expected to be exposed to would include:

            o   haematological problems such as anaemia, neutropenia, thrombocytopenia and thalassaemia

            o   bleeding disorders such as immune thrombocytopenic purpura and haemophilia

            o   haemolytic disorders such as hereditary spherocytosis and autoimmune haemolytic anaemia

            o   thrombotic disorderso   leukaemia, lymphoma and solid tumours

            o   modalities of cancer treatment, potential toxicities and their management

            o   oncologic emergencies such as hyperleukocytosis, tumour lysis syndrome and anterior mediastinal mass

            o   complications in immunocompromised patients such as febrile neutropenia, pneumonitis, colitis and pancreatitis

            o   end-stage oncology patients on palliative care

   2.     an understanding of the diagnostic and prognostic implications of laboratory tests related to these disorders;

   3.     an understanding of the social and ethical issues in the management of paediatric patients with complex haematological and oncological disorders, incorporating basics of palliative care when appropriate;

Training Methods

The clinical training is through participation in clinical rounds, multidisciplinary discussions and academic teaching. Training is delivered via clinical exposure to patients in the inpatient and outpatient settings. Participation in daily ward rounds, Grand Rounds, Tumour Boards and academic teaching is expected. Opportunities to attend local workshops on childhood cancer will be provided while opportunities for exposure to the haematology or childhood cancer laboratories can be arranged.

All Fellows will have a named supervisor/mentor, who will regularly assess the performance of each Fellow during the entire duration of programme.

Tentative monthly schedule:

1. Daily ward rounds and consults
2. Grand rounds: Weekly, every Wednesday, 10.30am - 12.30 am
   
3. Blood/Marrow Transplant and Cellular Therapy Grand Round: Weekly, every Friday, 1.00 - 2.00pm
4. Tumour Board Meeting: Monthly, every 2nd Wednesday, 1.00 - 2.00pm
5. Psycho-social round: Monthly, every 1st Wednesday, 2.00 - 3.00pm
6. Leukaemia/Lymphoma board: Monthly, every last Thursday, 2.00 - 3.00pm
7. Academic Afternoon: Weekly, every Monday, 2.00 - 3.00pm
8. Paediatric Palliative Care Meeting: Weekly, every Tuesday, 10.30am - 12.30pm
9. Childhood Cancer Survivorship Meeting: Bi-monthly, every 1st and 3rd Tuesday. 1.30 - 2.30pm
10. Molecular Tumour Board: Monthly, every 2nd Wednesday, 7.45 - 9.00am
11. Genetics-Oncology Meeting: Quarterly / Ad-hoc
12. Attachment to haematology laboratory for reporting of blood films, bone marrows, flow cytometry and blood bank can be arranged.
13. General paediatrics departmental teaching – Fellows have the opportunity to attend morbidity, mortality and CICU rounds, journal clubs and hospital conferences.

Past and Present Fellows

Some of our past fellows are:

Team of Experts

The Paediatric Haematology/Oncology Fellowship Programme is managed by the following experts:

II Assessment and Evaluation

Aims of Assessment

Fellows will need to demonstrate their proficiency level based on the following competencies:

(A) Patient Care

• Fellows must provide compassionate, appropriate and effective patient care for the treatment of paediatric haematology oncology conditions.

(B) Medical Knowledge

• Fellows must demonstrate up-to-date knowledge about established and evolving biomedical, clinical and epidemiological sciences pertaining to paediatric haematology/oncology, as well as its application to patient care.

(C) Practice-Based Learning and Improvement

• Fellows must demonstrate ability to investigate and evaluate patient care practices, critically assess scientific evidence to continuously improve patient care based on constant self-evaluation and life-long learning.

(D) Interpersonal and Communication Skills

• Fellows must demonstrates interpersonal and communication skills that result in effective information exchange and collaboration with patients and their families, as well as the healthcare team.

(E) Professionalism

• Fellows must demonstrate a commitment to carrying out professional responsibilities, and adherence to ethical principles.

(F) Systems-Based Practice

• Fellows must demonstrate awareness of, and responsiveness to, the larger context and local system of care including challenges and limitations in order to provide optimal healthcare within current constraints.

Assessment Approaches

All Fellows are expected to undergo 3-monthly formative work-based assessments and meet with their supervisors with their portfolios on a 3-monthly basis at least. Fellows must demonstrate to the Programme Director or designated supervisor that they have satisfactorily met their training objectives and will be awarded a letter of satisfactory completion at the end of their training period once they have done so.

There is no summative assessment.

Evaluation Process

General overall grading system

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competencies based knowledge, skills and performance that Fellows must demonstrate throughout the programme.

*The hospital/department reserves the right to terminate the training programme in the event of unsatisfactory performance of the temporarily registered doctor (as reflected in the assessment reports to the SMC).

III Target Audience and Eligibility Requirements

Target Audience

Qualified paediatricians who have gone through postgraduate training in paediatrics. Experience working in a paediatric haematology/oncology unit is an advantage.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

• Fulfill all Singapore Medical Council (SMC) criteria for temporary registration for training (for SMC criteria, click here).
• Have a minimum 36 months experience in paediatrics post-housemanship / internship. Applicants with less experience may be considered on a case-by-case basis.
• Prior experience in Paediatric Haematology/Oncology is preferred.

IV Other Information

Course Fees

$3,000.00 per month

Funding

Preferrably self-funded or funded by external sources (e.g. scholarships, if available)

Certification

Letter of satisfactory completion will be awarded upon completion of fellowship.