Host Institutions

The University of Manitoba is affiliated with two teaching hospitals:

• Health Sciences Centre Winnipeg (HSC)
• St. Boniface General Hospital (SBGH)

The program is also affiliated with CancerCare Manitoba (CCMB) which is adjacent to HSC and within SBGH.

Although the Section of Haematology/Oncology is a combined section within the Department of Internal Medicine, clinical activities are separate between the two services. The close administrative relationship makes it easy to offer an integrated program in both Haematology and Medical Oncology for candidates wishing to seek dual certification from the Royal College of Physicians and Surgeons of Canada. If candidates are interested in pursuing a third year of fellowship, the program would undertake to ensure funding.

The Haematology program is in a building phase. Enthusiastic new recruits and active recruitment of faculty is underway.

Clinical training in adult haematology is obtained on the inpatient and outpatient services of our institutions. CancerCare Manitoba is unique among provincial cancer agencies in that its mandate encompasses all blood disorders. Accordingly, all haematology outpatient clinics for both benign and malignant disorders take place in CCMB facilities.

CancerCare Manitoba (CCMB) is the organization which oversees cancer care in Manitoba. CancerCare Manitoba is charged by an act of the legislature of Manitoba with responsibility for:

• cancer prevention
• detection
• care
• research
• education for the people of Manitoba

As a centre of choice, CCMB is dedicated to enhancing the quality of life for those living with cancer and blood disorders, and to improving control of cancer for all Manitobans.

Clinical Rotations

General Haematology: Rotations will be undertaken on the clinical hematology services at SBGH and HSC. During these periods, residents will attend outpatient clinics and see in-hospital consults at the respective hospitals.

HSC and SBGH are full service tertiary care hospitals. Together they provide all tertiary care services for a population of over one million through the following facilities:

• medical wards
• surgical specialties
• intensive care units
• HSC has 797 beds
• SBGH has 555 beds

Additionally, HSC has a busy high-risk obstetrics unit and SBGH has a family practice unit.

These wards generate diverse consultations encompassing the entire spectrum of consultive hematology. Outpatient experience in benign hematology is available in the clinics of:

• SBGH
  
  • Dr. Catherine Moltzan
  • Dr. Majid Shojania
• HSC
  • Dr. Donald Houston
  • Dr. Rajat Kumar
  • Dr. David Szwajcer

Longitudinal Clinic: Residents have a half-day longitudinal outpatient clinic throughout the two years of their training, under supervision of one of the above faculty. As the primary consultant in this clinic, the resident will experience:

• the natural history of haematological disorders
• develop personal relationships with patients and their families
• gain skills in the independent management of patients

Pediatrics: Experience in Pediatric Hematology/Oncology is provided under the supervision of Dr. Sara Israels, Head of the Section of Pediatric Hematology/Oncology, with participation of:

• Dr. Bonnie Cham
• Dr. Geoff Cuvelier
• Dr. David Eisenstat
• Dr. Marlis Schroeder
• Dr. Jayson Stoffman
• Dr. Donna Wall
• Dr. Rochelle Yanofsky

Inpatient services are provided in the provincial Children's Hospital, part of the HSC complex. Outpatient activities take place in a unique children's clinic facility at CCMB. The University of Manitoba has a Royal College program in Pediatric Hematology/Oncology.

Leukemia/BMT: Experience in acute leukemia and blood and marrow transplant is provided by the inpatient and outpatient Leukemia/Bone Marrow Transplantation service, amalgamation of the Leukemia Program under the direction of Dr. Eric Bow and the Manitoba Blood and Marrow Transplant Program under the direction of Dr. Donna Wall, with participation of:

• Dr. Eric Bow
• Dr. Morel Rubinger
• Dr. Brent Schacter
• Dr. Matthew Seftel
• Dr. David Szwajcer

This service is an academic investigative unit which represents the major referral service for all adult patients with acute leukemia in the province of Manitoba, with inpatient services provided on a specialized closed unit at HSC.

The BMT program offers experience in:

• adult marrow and peripheral blood stem cell transplantation
• cord blood transplantation
• reduced intensity allografting
• marrow autografting

The major research interests include infectious complications in leukemia and BMT patients.

Medical Oncology: Experience in Medical Oncology is available through the hospital consult services at both HSC and SBGH, as well as in the disease site specific outpatient clinics of CCMB.

The Medical Oncology program has been revitalized under the direction of Dr. Piotr Czaykowski, Director, Medical Oncology Subspecialty.

Laboratory Training

The extensive laboratory training includes:

• four months in Haematopathology rotations in:
  • Haematopathology Laboratory, HSC with:
    • Dr. Thomas Fourie
    • Dr. Carmen Morales
    • Dr. Charles Musuka
    • Dr. Kristine Roland
    • Dr. Gaynor Williams
  • clinical Haematology Laboratory, SBGH with:
    • Dr. Catherine Moltzan
    • and the above haematopathologists
  • Cytogenetics Laboratory with:
    • Dr. Gaynor Williams
    • Dr. Angelika Dawson
  • Flow Cytometry and Immunoprotein Laboratories with:
    • Dr. Carmen Morales
• One month is spent with Dr. Debra Lane in Transfusion Medicine at the Canadian Blood Services Transfusion Service
• One month with Dr. Sara Israels in the Hemostasis Laboratory (the provincial referral laboratory for special coagulation testing).
• Additional time on any of these services can be arranged as suits the interests of our trainees.

Academic Activities

Academic activities trainees are expected to participate in include:

• weekly Medical Grand Rounds
• weekly Section of Haematology/Medical Oncology Grand Rounds
• an informal weekly case presentation-based Walk Rounds
• biweekly Lymphoma Rounds
• a monthly joint Haematology Disease Site Group/Hemostasis Disorders Care Team meeting

Fellows are expected to present cases frequently at the Walk Rounds and Lymphoma Rounds, and give formal presentations at least twice per year to the Section Grand Rounds. A journal club is held monthly in conjunction with the Medical Oncology program.

A weekly academic half-day will cover the breadth of the curriculum in Haematology set out by the Royal College's objectives of training. The format of these sessions is dependent on the number of fellows in the program; when numbers allow, they will primarily be resident-led, but with faculty-supervised formal small group learning activities; if only a single fellow is involved, they will take the form of one-on-one tutorials with assigned faculty members. Topics of common interest are held in conjunction with the trainees in Medical Oncology.

To address the Royal College's CanMEDS competencies of Health Advocate, Manager, Collaborator, and Communicator, an Administrative Project Block of one month has been developed. Trainees are expected to prepare:

1. a submission to the Pharmacy and Therapeutics Committee at CCMB or one of the host hospitals, and
2. develop or adapt for local use a clinical practice guideline for a relevant Disease Site Group at CCMB

Research

During the course of the two years of training, trainees are expected to become involved with research projects either at the clinical or basic science level. An asset of the program is the close interaction between clinicians and basic scientists in the Manitoba Institute of Cell Biology (MICB), a joint institute of CCMB and the U of M, which is located within CCMB.

Many of the attending physicians in the Section have laboratory research programs of their own in the MICB, or collaborative projects with MICB scientists. Areas of major interest include:

• identification of molecular markers of prognostic significance
• mechanisms of gene amplification and genomic instability in tumours
• regulation of apoptosis
• platelet granule proteins
• molecular mechanisms of thrombosis

Participation in the CancerCare Manitoba Research Day and U of M Internal Medicine Resident Research Day are encouraged, with the hope that the strong prize-winning record of our trainees will continue.

Many trainees become involved in their own projects under the supervision of one or more of the attending faculty. Initially trainees become involved with some of the ongoing projects under the supervision of one of the faculty but later develop projects according to their own interests with the support of their supervisor. A third year allows development of greater skills in basic research can be arranged for interested trainees.