Oncology Fellow Advisor - Vol. 2, Issue 2 by McMahon Group

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Vol. 2, Issue 2

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

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FELLOWSHIP TRAINING

Medical oncologists assume role of cancer care team leaders.

A DAY IN THE LIFE

We highlight the work of gynecologic oncologist Jamal Rahaman, MD.

Mentor Memos

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Physician Finance

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CAREER PATHS

Hybrid oncology positions combine the best elements of community and academic practices.

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ith a projected increase in demand for oncologists over the next decade, multiphysician hematology and oncology practices will be expanding to meet this rising need.1 As they look to hire, partners in established oncology practices say they are looking for a few key qualities in new associates, and chief among them are the ability to communicate with colleagues and treat a wide variety of disease types. “The most important thing in the community setting is the ability to

Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

communicate,” said Tom Sneed, MD, practice president of Arkansas Oncology Associates in Little Rock. “You cannot do business in the community if you can’t call up another physician and have a pleasant conversation and communicate what you need to communicate.” This ability to converse with colleagues is especially critical in community-based care for 2 primary reasons. First, providing the best patient care often requires working with physicians at a number of different practices. Second, developing long-term relationships with physicians in other specialties creates the referral base that ultimately supports a financially successful community practice. “In terms of personality, generally speaking we would like someone who is very motivated and is interested in making new contacts with referral sources,” said Timothy Byun, MD, a see Community, page 4

Fellows Focus on Handoffs

I For the latest oncology fellow-related information, please visit www.oncologyfellowadvisor.com r.co com m

n the 6 years since the Accreditation Council for Graduate Medical Education instituted work-hour restrictions for residents and fellows,1 continuity of care in general, and the patient “handoff” in particular, has come under increased scrutiny. Although advocates of duty-hour restrictions point to the benefits of better-rested trainees, others worry that

an increase in the number of patient handoffs could increase the incidence of preventable medical errors. Handoffs, of course, are ubiquitous— they occur with every shift change in a hospital, and any time a patient changes locations. “And in teaching hospitals, the most common people involved in handoffs are see Handoffs, page 6

CAREER PATHS

Oncology Fellow Advisor • Vol. 2, Issue 2

Hybrid Oncology Combines Best of Both Worlds

prefer academic centers, where they have access to the new professional model that incorporates the best latest investigational treatments, noted Dr. Cataldo. In elements of both community and academic pracresponse, many community practices either started or tices has recently emerged, creating a so-called hybrid joined research consortiums based at regional academic oncology practice. Although strictly academic and priresearch institutes, which allowed them to enroll patients vate practice positions still constitute the overwhelming in the community in investigational clinical trials. majority of oncology jobs—32% and 57%, respectively1— “Now we are getting the these new hybrid positions best of both worlds,” Dr. are becoming increasingly Cataldo said. “We are able common, experts say. “We are able to provide good-quality to provide good-quality Some believe that deccare with continuity of care reased reimbursements care with continuity of care in the comin the community and offer and a greater emphasis on munity and offer our patients access to our patients access to cliniresearch in the community clinical trials that previously only were cal trials that previously has led to a breakdown only were available in the of the wall between traavailable in the academic setting.” academic setting.” ditional community and —Vince Cataldo, MD Many of these new phyacademic positions, maksicians, however, had ing room for the hybrid been trained in high-level position to form. research techniques, Dr. “I think that hybrid pracMany hybrid oncology positions Cataldo said, and wished to tices have been born out involve unique business partnerships do more than simply enroll of several different things between hospitals, physician practices, patients in other physicians’ that have happened in trials. oncology over the past and academic centers. “What has happened several years,” says Vince over the past 5 years is Cataldo, MD, who is both that these fellows who have an assistant professor at research training from large Louisiana State University academic centers not only Health Sciences Center and are going to communityan attending oncologist at based practices that enroll the Baton Rouge-based patients in new clinical triHematology/Oncology als, but these communityClinic. “One is that a lot of based physicians actually fellows have not been able [are] assuming the role of to find academic positions the primary investigator,” with adequate financial Dr. Cataldo said. “So now reimbursement, forcing a not only are we the sites growing majority of gradfor trials but we now are uating fellows into private developing the clinical tripractice.” als in the community and Financial pressures have they actually are born out virtually eliminated the of the thought processes of the physician who is providsolo medical oncology practice, many of which have since ing the care.” been integrated into multiphysician group practices. At Portland, Oregon-based oncologist Alison Conlin, MD, the same time, access to clinical trials in the community in many ways embodies this kind of physician. Having has increased dramatically. For example, there are now graduated from fellowship at Memorial Sloan-Kettering in more than 50 Community Clinical Oncology Programs in New York City, she was at first conflicted about pursuing the United States—groups of community oncology practhe professional and lifestyle opportunities of commutices that band together to enroll in and perform National nity practice. “You almost feel like if you go into private Cancer Institute-funded clinical trials. practice, or take a hybrid job, you’re cheating a little bit Many fellows have found that in the fast-developing, because you’ve been given such an opportunity to start research-oriented subspecialty of oncology, patients Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

CAREER PATHS

Vol. 2, Issue 2 • Oncology Fellow Advisor

Editorial Board a good academic career and someone else could have taken your spot,” she said. However, during her job search, Dr. Conlin was put in touch with Craig Nichols, MD, an internationally renowned oncologist who was both joining and expanding a unique practice in Oregon—Providence Cancer Center. “I wanted to live in Portland, but I didn’t want to just full-on see patients 5 days a week,” said Dr. Conlin. “I wanted to have some protected time to work on some interesting projects, do clinical trial development, do new drug development, and even explore some other community-based projects that aren’t necessarily just drug trials.” Dr. Conlin went a step further and specialized in breast cancer, which now makes up almost the entirety of her caseload and is the focus of her protected research time. Many hybrid oncology positions involve unique business partnerships between hospitals, physician practices, and academic centers. For example, the community practice that Dr. Conlin works for was the first oncology practice in the area to be merged with the hospital’s physician group, which up until then was comprised primarily of internists and hospital-based specialists. Thus, Dr. Conlin essentially is an employee of her multiphysician practice, but is paid by the physician division that encompasses both primary care and specialty doctors at the hospital. Dr. Cataldo, who is employed and paid separately by both his private and academic practices, was driven to a hybrid model in part because of an obligation he felt to teach. “I took [my practice] to another level because I wanted to teach and that’s something that’s not traditionally available in community practice. This goes back to the extreme need for oncologists throughout the nation, in all settings, as well as the growing need for oncologic teaching for trainees,” he said. Because the projected shortage of oncologists is so severe, graduating fellows have a unique opportunity to pursue their own goals and to serve the profession as a whole. “It behooves all graduating fellows to look at what the options are because it’s no longer very clear-cut that you either go into academics or you go into community practice,” Dr. Cataldo said. “You can design the type of practice that you want in oncology because there’s such a need.”

References 1. Forecasting the Supply of and Demand for Oncologists: A Report to the American Society of Clinical Oncology (ASCO) from the AAMC Center for Workforce Studies. http:// www.asco.org/ASCO/Downloads/Cancer%20Research/ Oncology%20Workforce%20Report%20FINAL.pdf. Accessed April 13, 2010.

Karin Hahn, MD Associate Program Director, The University of Texas M.D. Anderson Hematology/Oncology Fellowship Chief of Medical Oncology Assistant Professor Lyndon B. Johnson General Hospital Houston, Texas Jamal Rahaman, MD Fellowship Director Division of Gynecologic Oncology Mount Sinai School of Medicine New York, New York

Andrew D. Seidman, MD Attending Physician, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center Professor of Medicine Weill Cornell Medical College New York, New York

Marc Stewart, MD Program Director, Hematology/Oncology Fellowship University of Washington/Fred Hutchinson Cancer Research Center Medical Director, Seattle Cancer Care Alliance Professor of Medicine, University of Washington Seattle, Washington Copyright © 2010

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CAREER PATHS

Community

Oncology Fellow Advisor • Vol. 2, Issue 2

more available in the community—because it can be one marker for intelligence and critical thinking skills. “In general, I think it’s a positive thing,” said Dr. Byun. “How much continued from page 1 is it helpful in clinical practice? That’s debatable.” From a business perspective, most fellows have little medical oncologist with Hematology-Oncology Medical understanding of how a community practice actually Group of O.C. in Orange, CA. “And when dealing with runs, and it typically doesn’t play a role in hiring decisions, other physicians, they need to be able to cordially but noted both Drs. Sneed and Byun (Table 1). also intelligently converse, and be able to communicate Decreasing reimbursements across medicine combined effectively.” with higher costs for small businesses have radicalPatient care is at the center of any community oncolly changed the business model of community oncology practice, and the way a physician interacts with ogy practices in recent years. Despite this, very few patients is particularly vital in this setting. young physicians understand “What matters is what kind of Table 1. Tips for a Successful the financial pressures facing person you are, how you comCommunity Oncology Practice multiphysician practices. “If I municate, and how much you made hiring decisions based on care about your patients and • Effectively communicate with colleagues knowledge of the business part are willing to go to bat for them • Make new contacts with referral sources of oncology, I’d never find a and work on their behalf,” said • Treat a wide variety of cancers candidate who is appropriate,” Dr. Sneed. “The whole business • Have research experience said Dr. Sneed. about where [a fellow] trained • Effectively communicate with patients This disconnect can lead to is a little overblown, although • Oversee the total management of patients problems between practices you certainly hear about that • Be business savvy and new associates. “It’s been from a lot of people. The truth my experience recently that felis that you can be an oncologist lows come out into private pracwhether you trained at a small tice and have fairly unrealistic university program or whether expectations about how much you went to Mayo or Sloanmoney they’re going to make Kettering.” and how hard they’re going to Clinically, multiphysician comwork,” Dr. Sneed said. munity practices seek fellows “The economics of running a with the ability to manage a numbusiness is something that you ber of different disease types have to learn,” said Dr. Byun. and clear experience managing “Otherwise you could be a very successful oncologist in patients from diagnosis onward. terms of knowledge base and patient care, but you could “As a community oncologist, you are going to have to go bankrupt. And that’s a reality.” be good at many different cancers and that is just the Generally speaking, however, working hard will ensure reality of being a community oncologist,” said Dr. Byun. the success of new associates as they get up to speed He added that he has developed a focus on gastrointeson the details and eventually attain partnership. “I think tinal cancers; but that any subspecialization as a comthat when fellows graduate, they’ve been working like munity oncologist is a very long-term goal, and that right animals for years to get where they are and [in practice] out of fellowship “a good general knowledge and backsome people rise to the occasion and jump right in, and ground to deal with day-to-day management of cancers” some people sort of say, ‘now I can coast, now I’ve made is prized over specialized knowledge. it,’ which is definitely the wrong attitude,” said Dr. Sneed. That background comes only from experience. “What “When you arrive and are employed by a practice, you you want is someone who’s been at a program where had better expect to work hard or you won’t be around they’ve actually been allowed to be the doctor, not just very long. After all, they’ve hired you for their benefit, not followed around other doctors for years,” said Dr. Sneed, for your benefit.” adding that it’s not uncommon to find fellowship graduates who have little experience overseeing the total manReferences agement of patients, either because they’ve relied too heavily on other colleagues throughout fellowship, or 1. Forecasting the Supply of and Demand for Oncologists: A Report to the American Society of Clinical Oncology (ASCO) spent an inordinate amount of time on the research comfrom the AAMC Center for Workforce Studies. http:// ponent of their fellowship. www.asco.org/ASCO/Downloads/Cancer%20Research/ Both Drs. Sneed and Byun said that research experience Oncology%20Workforce%20Report%20FINAL.pdf. Accessed is valuable, however—particularly as clinical trials become April 13, 2010. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

Vol. 2, Issue 2 • Oncology Fellow Advisor

FELLOWSHIP TRAINING

Medical Oncologist As Cancer Care Team Leader

life,” said Dr. Philip, who also is the team leader of gastrohe treatment of resectable cancers has undergone intestinal oncology at Karmanos Cancer Center. many changes over the past 15 years. Cancer patients “Sometimes I think oncologists may just jump to the no longer necessarily undergo a standardized, linear conclusion that more testing, and more sophisticated course of treatments; instead a course of therapy is attempted tests, are better for them to make a decision,” now often individually tailored and based on input from said Dr. Cristofanilli. Positron emission tomography (PET) a number of specialties, including medical oncologists, scans, for example, may be of limited use, or may need to radiation oncologists, and surgeons.1 be repeated, which may not be covered by insurance. The rise of the multidisciplinary approach raises a quesThe issue of ordering tests, and in particular highly tion: Who oversees the management of a cancer patient’s expensive, sometimes questionable tests like PET scans, care? Although it may seem intuitive that the medical gets to the heart of one unfortunate aspect of multidiscioncologist would always fill this role, it is not an estabplinary care in America: money. lished fact, experts say. The best way for the medical oncologist to overcome “It’s an important question and I don’t think it’s comthese obstacles and establish a coordinated treatment pletely established yet,” said Massimo Cristofanilli, MD, plan is a thorough understanding not chairman of medical oncology and just of medical oncology, but also of the leader of the Breast Service all the different specialties involved. Line at Fox Chase Cancer Center in “I hope that medical “First and foremost, you have to Philadelphia. know your specialty very well and A cure for cancer, particularoncology fellows try to you have to also know the other ly for stage I tumors, traditionexpand their view bespecialties well,” said Dr. Philip. This ally has been seen as surgical, but cause more and more, knowledge allows an oncologist to the increasing role of nonsurgical interact with every member of the treatments has resulted in a subthey’ll be required to be team, from pathology to surgery, he tle, but noticeable, shift toward a leaders, to be in charge noted, and “that’s what is required multidisciplinary team approach of of the team.” to be a leader.” which surgery is only one part. When differences of opinion arise “The complexity of emerging —Massimo Cristofanilli, MD between specialists about how a treatment modalities has made it patient should be managed, the best a little bit more difficult for surcourse, he said, is “to keep personalgeons to represent the leaders of ity differences at a minimum” and rely on national guidethe management team,” said Dr. Cristofanilli. lines to establish a course of treatment, said Dr. Philip. Systemic therapy is becoming the most important He added that the best way to avoid problems is to component of the treatment plan, which requires spenddiscuss the case as early as possible and communicate ing more time with patients as well as coordinating with with each team member before approaching the patient a pathologist, radiologists, and sometimes laboratory with a definitive treatment plan. Otherwise, conflicting and medicine, Dr. Cristofanilli noted. independent views from different physicians may leave the Typically, the medical oncologist will assume the role of patient and family unhappy and confused. coordinator as soon as a cancer diagnosis is established. “If you’re the team leader, have the case discussed and The medical oncologist verifies the diagnosis, stages the a consensus opinion formulated before anyone makes a patient, and begins discussing the treatment plan with recommendation to the patient,” Dr. Philip said. subspecialists, said Philip Agop Philip, MD, PhD, professor It is likely that advances in cancer care will make mediof medicine and oncology at Karmanos Cancer Institute cal oncologists play even more of a leadership role in in Detroit, MI. the future. “There have been a lot of changes in the last Although a stepwise process might be ideal in cancer 12 to 15 years and I hope that medical oncology fellows care, in practice it may not always proceed that way. try to expand their view because more and more, they’ll A patient might first be referred to a different cancer be required to be leaders, to be in charge of the team,” specialist, who may then recommend, or even begin, a concluded Dr. Cristofanilli. course of treatment before a medical oncologist has been consulted. Reference “Then the medical oncologist has to pick up the pieces and determine the best treatments. Although we talk 1. Wagman LD, Byun TE. Managing colorectal cancer liver metastases. Oncology. 2009;23(12):1063-1071. about a ‘coordinator’, it doesn’t always work that way in Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

FELLOWSHIP TRAINING

Handoffs

Oncology Fellow Advisor • Vol. 2, Issue 2

patient should provide guidance about potential scenarios and how to handle them, as well as list critical tasks that need to be completed. continued from page 1 Overall, the handoff should be interactive, with the receiver “reading back” key information and tasks. trainees,” said Vineet Arora, MD, assistant professor of An effective, written sign-out includes all pertinent medicine at the Pritzker School of Medicine in Chicago, patient information—code status, active and anticipated who has studied patient handoffs and developed ways to problems, and pending tests or consults—and is, most improve them. importantly, up to date. Indeed, studies demonstrate that problematic handoffs Following the Joint Commission’s 2006 mandate that among house staff not only are common, but may lead accredited hospitals implement a standardized handdirectly to patient harm. In a 2008 survey of more than off protocol, many institutions 150 medical and surgical house have adopted published framestaff at Massachusetts General works like the SBAR (SituaHospital in Boston, 59% of resi“Probably the biggest handoff tion, Background, Assessment, dents reported that one or more is when you’re post-call. Those Recommendation) technique or patients had been harmed during are the most active patients other generic written protocols their most recent clinical rotation for sign-off. Although this reprebecause of problematic handoffs, and the time period when it’s sents a step toward a standardand 12% reported that this harm most likely to cause problems.” ized, institution-wide approach had been major. Nearly one-third —Nicholas Campbell, MD to quality improvement, they reported that the overall quality don’t always reflect the needs of handoffs at the institution was of a specific medical specialty or fair or poor.2 institution (Table 2). The effect of a preventable seriOncology, in particular, can ous adverse event on a trainee can present difficulties during handbe particularly intense, experts say. offs because of the severity of “By the time someone is an disease in many inpatients. oncology fellow, it is very likely “Checklists are just a guidethat they will have participated, or post,” said Dr. Arora. “If you’re been aware of, handoffs that have passing off a cancer patient being resulted in an error,” Dr. Arora said. treated for acute leukemia, there “And when that happens, it can be is going to have to be a very difreally demoralizing. You can spend ferent ‘background’ section than a lot of time blaming yourself.” Table 2. Proper Handoff Etiquette if you were passing off a healthy Nevertheless, a study of more • Conduct verbal handoffs if possible postpartum female who has just than 200 internal medicine resi• Allow time for questions delivered.” dency programs found that 60% • Written handoffs should be up to date For fellows, often the most of the programs did not provide and comprehensive difficult patient handoffs come any lectures or workshops on • Communicate effectively after taking call. “Probably the sign-out skills.3 • Customize the SBAR technique to your biggest handoff is when you’re “My impression is that most institution post-call. Those are the most fellows are probably learning on active patients and the time the job,” said Dr. Arora, who also SBAR, Situation Background Assessment period when it’s most likely to lectures at institutions trying to Recommendation cause problems,” said Nicholas improve their handoff process. Campbell, MD, a hematology “[Fellows] are operating in a high and oncology fellow at the University of Chicago. degree of uncertainty and the handoff poses an extra At his institution, fellows also run the bone marrow layer of uncertainty. Whether you are the sender or the transplant service, Dr. Campbell said, and occasionreceiver, it’s going to be difficult and that’s when it’s very ally a physician “moonlighting” the night shift will helpful to have a standard protocol,” she added. require extra time when handing off an abnormally sick For trainees, the most important aspect of the handoff patient. to understand, Dr. Arora noted, is that it is a transfer not Adding to this complexity, Dr. Arora explained that just of patient information, but of responsibility. oncology fellows also take a lot of home calls for the Ideally, verbal handoffs should be face to face with ample time for questions. The physician handing off the see Handoffs, page 8 Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

Vol. 2, Issue 2 • Oncology Fellow Advisor

A Day in the Life of Jamal Rahaman, MD …

MENTOR MEMOS

Gynecologic gist oncolo Academia d Hospital base

ncology Fellow Advisor presents our Day in the Life

ment and palliative care. Within the surgical arena alone, “it’s one of the few specialties where you do everything series. In each segment, we interview a prominent yourself,” he said. “The same surgeon does the urologic thought leader about how he or she got into the field of surgery, bowel surgery, and vascular surgery, as well oncology and his or her typical workday. as the cancer surgery and gynecologic surgery. So it’s In this issue, we interview Jamal very appealing if you’re looking for a comprehensive and Rahaman, MD, DGO, FACS, FACOG, broad discipline.” fellowship director in the Division of With only 500 to 600 board-certified specialists, OB-GYN oncology also is a very small and highly comGynecologic Oncology at Mount Sinai petitive field. “At this point, there are only 42 fellowship School of Medicine, and director, programs in the United States, and we have about 1,200 Gynecologic Oncology Chemotherapy residents graduating every year,” Dr. Rahaman said. “If Service at Mount Sinai Medical Center, you are planning on getting into the field, you have to New York, NY. Dr. Rahaman serves as start early to make your application competitive.” an editorial board member of Oncology Fellow Advisor. Because so few fellowship slots are available, some candidates do not get matched for a program at the end Meeting the challenges of today’s evolving medical of their residency and have to do another 1 to 3 years of landscape often requires creative skills far beyond clinical research to gain a competitive edge. “It’s a long haul,” Dr. expertise. Some individuals seem uniquely suited to this Rahaman said. “Medical school, 4 years of residency, and task. Jamal Rahaman, MD, is one of them. if you’re lucky you go straight to fellowship—it is still a “My path in medicine? Medicine picked me,” said Dr. minimum of 11 years.” Rahaman. The length of the fellowship is a minimum of 3 years—2 Dr. Rahaman was planning to pursue engineering when years of clinical and 1 year of research—but some prohe received a scholarship to go directly from high school grams have a longer research component. The path into medical school. That unorthodox beginning proved to board certification is simia bit of a harbinger. In addition larly arduous. “You do a writto being trained in obstetrics ten examination, which is given and gynecologic oncology, Dr. “Gynecologic [oncology] is every 2 years; and then you Rahaman also is a trained carhave to collect your cases and diothoracic and vascular survery unique in that it is the only present [a] research thesis for geon. “So I have a very broad oncology specialty—and one your oral exam, 2 to 4 years background,” he said. of the few specialties in all of after you finish your fellowDr. Rahaman feels lucky to ship,” Dr. Rahaman said. have trained when he did, being medicine—that is truly “I think that you have to be exposed to new approaches comprehensive.” very clear about whether you while laying down a foundation —Jamal Rahaman, MD want to pursue it. And because of traditional techniques. “In my it’s so competitive, you have to career, I’ve been able to masposition yourself early.” ter open surgery, laparoscopic Dr. Rahaman’s practice today runs broad. “I have a surgery, and now robotics,” Dr. Rahaman said. “I am very very busy surgical practice, a very busy chemotherapy fortunate that I have been able to span all 3 elements of practice, and I’m the director of the fellowship training surgery.” program, so I have a lot of academic responsibilities,” he His inclination toward diversification in surgical techsaid. Add to that directing the chemotherapy infusion niques offers insight into Dr. Rahaman’s choice of specialunit at Mount Sinai, directing clinical trials, and running a ty. “Gynecologic [oncology] is very unique in that it is the robotic surgical training program. “There are a lot of difonly oncology specialty—and one of the few specialties in ferent elements with a lot of moving parts,” he said. all of medicine—that is truly comprehensive,” he said. “Fortunately, we structured the chemotherapy infusion Gynecologic oncologists manage all aspects of patient center within the office practice, which is in the same care from precancer diagnoses, surgery, chemotherapy, and radiation therapy coordination to pain managesee Day in the Life, page 8 Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

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Oncology Fellow Advisor • Vol. 2, Issue 2

Day in the Life

Handoffs continued from page 7

continued from page 6

facility as the OR [operating room],” Dr. Rahaman said. “So you can run from the OR to the office to the chemotherapy suite, and the academic offices and patient practice offices are all within the same campus. We do everything simultaneously.” Team efficiency also is aided by their reliance on a Web-based electronic platform. “It integrates everything,” Dr. Rahaman said. “We can write chemotherapy orders and access patient records from anywhere in the world. It’s a very efficient system.” The ability to conduct portions of their work anywhere the Internet is available allows Dr. Rahaman and his colleagues to have a bit of flexibility in their personal lives. “You can backlog a lot of work and catch up with it nights and weekends,” he said. “That way, you’re not stuck in the office late at night. It’s the same volume of work, but you can shift it around to accommodate other aspects of your life.” The electronic platform also helps Dr. Rahaman and his colleagues to be compliant with the ever-evolving regulations and mandates. “Every year, there are different regulations, different fiscal constraints, and different challenges,” he said. Meeting those challenges sometimes requires the recruitment of experts outside of medicine who can propose alternative models for problem solving. “We do that a lot,” Dr. Rahaman said. “We’ve been very lucky and successful in our creative teams. When you look for synergy, it gives you efficiency. And that’s how you survive.”

first time in their careers, providing consults over the phone for emergent cases and then passing on all of the relevant information over the phone at the end of their call shift. Despite the sheer volume of handoffs and unique patient situations, a few oversights appear time and time again in communication-related adverse events, Dr. Arora said. Out-of-date patient information and vague language are among the most common mistakes made during sign-out. “Sometimes bad things are going to happen, the question is what’s preventable,” said Dr. Arora. “Because there is a preventable component to this, we can do a better job teaching communication and then making sure a proper handoff actually occurred.”

Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

References 1. Accreditation Council for Graduate Medical Education duty hours standard fact sheet. http://www.acgme.org/acWebsite/newsRoom/newsRm_dutyHours.asp. Accessed April 1, 2010. 2. Kitch BT, Cooper JB, Zapol, et al. Handoffs causing patient harm: a survey of medical and surgical house staff. Jt Comm J Qual Patient Saf. 34(10):563-570. 3. Horwitz LI, Krumholz HM, Green ML, Huo SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med. 166(11):1173-1177. 4. Institute for Healthcare Improvement situation background assessment recommendation. http://www.ihi.org/IHI/Topics/ PatientSafety/SafetyGeneral/Tools/SBARTechniqueforCom municationASituationalBriefingModel.htm. Accessed April 1, 2010.