Tuesday, September 4, 2012

Hooked on PHO: Pediatrics Hematology/Oncology (PHO) at Mott

Posted by Beejal at Tuesday, September 04, 2012

Hi everyone,

I’ll begin by noting that words just don’t give justice to how great this rotation is! There is so much that I’d like to say about it, so of course this means that this is another extremely long post! O:-)

I wish that more people knew about PHO!  Dr. Howle is an exceptional preceptor, and you get to interact with Dr. Frame and Dr. Christen a fair amount as well!  You are surrounded by experts in cancer, and while it can be overwhelming, about half way through the light bulb goes off in your head and you say “I get it!”  Dr. Howle describes it well:  We have never been taught anything about PHO in school so our 5 weeks consist of building from the ground-up.   Also, this experience would be very different if I didn’t have the support of my classmates.  I had the rotation with Meenakshi and Tony, and we really worked well together.  We studied together, we motivated each other, and we helped each other with advice about our patients.  

A typical day

We round with the team every morning and attend meetings with them (Tumor Board and Presentations).   For a majority of the day, we work up patients and look up what we don’t know about their medications.  Almost every afternoon, we spend a couple of hours on topic discussions (sometimes with the BMT and Peds Surgery students) and patient presentations.   We discuss chemotherapy agents, children’s cancers, and supportive care.  Below are a list of the topics that we got through (it looks overwhelming… and it was indeed).  In the evenings, we usually check on patient notes and prepare for the next day’s topic discussions.

·         Acute Lymphoblastic Leukemia
·         Acute Myeloid Leukemia
·         Osteosarcoma/ Ewings Sarcoma/ Rhabdomyosarcoma
·         Neuroblastoma
·         PTLD/Burkitt/Hodgkin/Lymphoblastic Lymphomas
·         Brain Tumors
·         Sickle Cell Disease
·         Radiation
·         XLP1/XLP2
·         How cancer arises                                           
·         Neutropenic Fever
·         Chemotherapy-induced Nausea/Vomiting Pain
·         Colony Stimulating Factors
·         Oncological Emergencies
·         Anemia

There are many things great about Dr. Howle.  She does weekly evaluations and is very receptive to our feedback.  We get the opportunity to let her know if we’re overwhelmed, what might help us more, what we don’t feel comfortable with, what works really well, what should and should not change for her future students, and what more we would like to see or do.  A couple of weeks after starting, I asked to see a bone marrow biopsy, a lumbar puncture, and a patient education on chemotherapy.  Dr. Howle made it happen for all three of us within the next two days.  Furthermore, Dr. Howle’s teaching style worked very well for me.  She would quiz us every day about our patients, their chemotherapy, their disease state, and their labs.  Repetition is my friend!  She really made sure we were comfortable and ready to be independent.  She gave us constant feedback and made sure we knew what was expected of us.  Pharmacy aside, Dr. Howle is also such a fun person to be around!  She is dynamic, has much sought-after work-life balance, and really cares about us beyond our abilities to be pharmacy students.  Her main concern was to get enough sleep, and I’ll be the first to admit that sleep was ENTIRELY necessary to stay focused during this rotation.  

The Attending Physicians are excellent teachers, experts in their fields, and very open to pharmacy input.  The team consists of one senior resident, two interns, and two-to-three medical students.  This is a “Sub-Intern” rotation, so not every medical student will circulate through our service; it is selected by only those 4th year students who want to specialize in it. 


Until now, I always said I liked working with geriatrics.  I never thought that I would enjoy kids, but they are all SO cute!  The little ones are so playful!  The older ones have had a tough course so far, but you have respect and admiration for how much they’ve been through.  I have always wanted to have a relationship with my patients, and I really like what I found in PHO.  I ask myself if pediatrics in a different specialty would be as fulfilling, and I don’t think it would be.  I also ask if I’d like Hem/Onc on the adults side, and I am planning on learning that by shadowing.  

Before this rotation, I really loved the patient and inter-professional interactions in the Generalist rotation (Block 1, blogs 1 and 2), but PHO took inpatient pharmacy to another level.  Similar to the Generalist, PHO had patient interactions; however, these patients and their families are fighting chronic disease and you are helping them through their acute problems.  You have a relationship with the patient and their family, you are in a more critical environment, and you are monitoring very sensitive drugs.  I liked the intensity of this unit, and I think I would be great for this type of pharmacist position.

I walked into this rotation having a slight interest in hematology as it relates to anticoagulation.  During my Generalist rotation, I had a very interesting Sickle Cell Disease patient which prompted me to ask, Why not hematology as a career specialty?  I always enjoyed learning about cancer, and even worked in a basic science cancer lab, but I never really considered pursuing pharmacy in the cancer field.

My advice for anyone thinking about taking this rotation  

I really didn’t have a good reason for ranking a rotation like this except that an upperclassman gave it exceptional reviews.   I think I’ve found my niche here, but it is a very specific field and it could be a difficult 5 weeks if you had no interest in cancer.  I worked day and night learning about the cancers and my patients.  Know that it will be your life 18 hours a day (with built in 6 hours of sleep!), 6 days a week (you can have 1 day off!), over 5 weeks.  You also should be mentally prepared both to see the cutest kids ever and the sickest kids ever.

Looking to the future

The other field that I’ve considered is Cardiology.  The Experiential Training gods were looking out for me when formulating my rotation schedule because my next site is Cardiology at the VA hospital in Ann Arbor.  I’ll be able to directly compare my two interests and decide what I’ll be looking for in a career.   

Tune in next time!  If you’ve been keeping up, it seems like every rotation I get a little bit closer to what I want to be when I grow up!

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