Clinical Rotations

Orientation

Starting fellowship is a real transition, and orientation is designed to ease new fellows into the program rather than drop them into it. To that end, July includes scheduled time with faculty and program leadership, reviews of policies and expectations, didactic lectures, hands-on procedural training, and shadowing across the clinical and inpatient services — building familiarity and confidence before fellows take on independent responsibility.

Social events and informal time with the upper-year fellows — who share their own advice from making the same transition — also help new fellows settle in and feel part of the group. The first overnight home call experiences are scheduled toward the end of orientation, with a senior fellow available for backup and same-day feedback to help acclimate new fellows to being on call.

Inpatient hematology/stem cell transplant/cellular therapy service

On this combined service, fellows care for patients with leukemia, lymphoma, and other hematologic malignancies, alongside patients undergoing autologous and allogeneic stem cell transplant and CAR T-cell therapy. Working with a hematology attending and a transplant/cellular therapy attending, fellows lead ward rounds with the residents and gradually take on the teaching role. The rotation builds procedural competence in bone marrow biopsy and intrathecal chemotherapy. 

Through the transplant and cellular therapy experience, fellows gain hands-on exposure to stem cell collection and infusion, high-dose conditioning regimens, and the management of transplant-specific complications, as well as the full arc of CAR T-cell therapy — from cell collection through cytokine release syndrome management.

Inpatient oncology consult service

Fellows provide consultative care for patients with known or suspected solid tumors admitted to Dartmouth Hitchcock Medical Center. Each fellow sees new consults first, develops an assessment and plan, and then reviews each case directly with the oncology consult attending — a one-on-one structure that supports close teaching and increasing independence as fellows progress through training. The rotation offers concentrated experience in the workup of new malignancies, treatment decision-making for hospitalized patients, and management of treatment-related toxicities — such as immune-related adverse events and neutropenic fever.

Inpatient hematology & coagulation consult service

On this service, fellows provide consultative care for hospitalized patients across classical hematology and coagulation at Dartmouth Hitchcock Medical Center, working with a dedicated hematology attending and a dedicated coagulation attending. Common consults include the evaluation of anemias and cytopenias, venous thromboembolism and complex anticoagulation management, heparin-induced thrombocytopenia, thrombotic microangiopathies, and inherited and acquired bleeding disorders. The rotation develops competence in the consultant role and in the interpretation of coagulation studies and peripheral blood smears.

Outpatient disease-group clinic blocks

These month-long clinic blocks provide concentrated outpatient experience in a single major disease area — coagulation, hematology, gastrointestinal, genitourinary, thoracic, breast, or head and neck oncology. Over the month, fellows work with multiple subspecialty attendings within that area in dedicated half-day clinics. Fellows typically have four to five half-day disease-group clinic sessions per week, in addition to their continuity clinics.

A sample weekly schedule for a fellow on a thoracic oncology month:

Outpatient continuity clinics (hematology & oncology)

Throughout the three years, each fellow holds a weekly half-day hematology continuity clinic and a weekly half-day oncology continuity clinic. Fellows work with the same faculty preceptor in each clinic for six-month blocks before rotating to a new preceptor. Because patients on active cancer treatment may have multiple visits per month, fellows see the same patients across multiple encounters within each block — building meaningful continuity during active phases of care and developing autonomy in patient management.

Additional required rotations

Beyond the core inpatient services and continuity clinics, each fellow completes a series of required rotations in adjacent fields across the three years. These experiences round out the training a hematologist-oncologist needs. Required rotations include:

• Gynecologic Oncology
• Neuro-Oncology
• Palliative Care
• Radiation Oncology
• Transfusion Medicine

Call schedule

Call coverage is graduated across the three years — heaviest in Year 1, less through Year 2, and falling to only a few calls per year in Year 3 — protecting Year 3 for scholarly work, electives, and career development.

• No in-house call
• Weeknights: Home call, 5 pm to 8 am
• Weekends:
  • Saturdays: The fellow on the inpatient hematology rotation rounds in-house with the attending and team and holds the pager for 24 hours, 8 am Saturday to 8 am Sunday.
  • Sundays: A different fellow takes home calls and provides consult coverage, 8 am Sunday to 8 am Monday.
• A backup coverage policy is in place for sudden illness, family emergency, or other unanticipated absence. It is designed so that backup responsibilities fall within a clear, equitable rotation.