Goals and objectivesThe Hematopathology Fellowship Program requires fellows to develop competencies in the six areas listed below to the level expected of a new practitioner. Competency in hematopathology will include the acquisition of an appropriate knowledge base to practice this specialty. In addition, the fellow should develop excellent communication skills in order to clearly ascertain the important information of a case, and to report the findings accurately, clearly, and completely. The fellows will also need an understanding of the role of the hematopathologist in the hematology laboratory and health care system in general and should develop a commitment to their professional responsibilities and ethical principles. Finally, there should be awareness of their responsibility and involvement in the patient's care.
Fellows must demonstrate a satisfactory level of competence in diagnostic skill and the ability to provide appropriate and effective consultation in the context of hematopathology services.
Analyzing laboratory results
- molecular studies
- coagulation testing
- automated hematology analyzers and flow cytometry
Prompt and correct handling, work up and interpretation of patient specimens is critical for appropriate clinical care and patient outcomes. In addition, the fellow will be expected to competently perform bone marrow biopsy procedures independently and document all procedures they perform using the ACGME case log system. This care must be compassionate, appropriate and effective for the treatment of health problems and the promotion of health. The fellow is expected to assume increasing responsibility for diagnostic services and also provide resident teaching and mentoring as the fellowship progresses.
The fellow on service will be responsible for
- work up
- reporting of peripheral blood
- bone marrow
- lymph node
- coagulation specimens
The fellow is expected to preview cases, gather essential and accurate information, do differentials on bone marrows when necessary and formulate a report based on their interpretation and impressions. The fellow should not cause unnecessary delays and should ensure ancillary tests are ordered promptly. The fellow will be expected to communicate with other health care providers when required. The fellow will be given more autonomy as they progress through the year.
To gain competency in the bone marrow procedure, the fellow will first observe several bone marrow procedures. Once the fellow is comfortable with the process he/she will perform the procedures under the direction of the nurse practitioner. Once the nurse practitioner feels the fellow is competent and can perform the procedure independently a pathologist will observe the fellow perform one or two bone marrow procedures. If the procedure is performed successfully, an official credentialing document is filled out and signed and the fellow is allowed to perform the procedure independently. However, anytime the fellow should have an issue an attending hematopathologist is available for assistance.
The fellow's diagnostic skill will be assessed by direct observation and oral quizzing at daily sign out and performance at unknown conference, other conferences and tumor board, and evaluated in a global evaluation by all teaching faculty. The fellows will also be expected to complete the FISHE exam. Performance of the bone marrow biopsy procedure will be assessed through a formal credentialing process and using the patient evaluations of their experience during the procedure (360 degree evaluation).
Fellows must demonstrate knowledge about established and evolving biomedical, clinical and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to hematopathology. The fellow will show an understanding of both benign and malignant hematopoietic diseases as well as understand the basic principles of molecular diagnostics and cytogenetics, especially as to how these modalities are applied to hematopathology. Further, the fellow must be able to accurately and efficiently research an unfamiliar area using modern technology. Fellows must demonstrate competence in their knowledge of pathogenesis, including clinical correlation and prognostic significance of hematologic disease.
They must demonstrate competence in
- bone marrow pathology
- lymph node pathology
- peripheral blood and body fluid examination
- red cell disorders
- flow cytometry
- molecular techniques
- automated hematology procedures
- specimen collection
- preparation for routine hematologic testing
They should be able to correlate data from cytological, histopathological and clinical pathology and should demonstrate knowledge of the operation and management of hematology and relevant specialty laboratories including quality control procedures, assay development, quality improvement activities and laboratory regulations.
knowledge is obtained through
- observation of staff
- didactic sessions
- one-on-one teaching
- extensive reading
In addition, the fellow will gain experience through preparation of cases for sign-out, preparation for conferences and presentation at tumor board.
The fellow will be assessed by direct observation and oral quizzing at daily sign out and performance at unknown conference, other conferences and tumor board and evaluated in a global evaluation by teaching faculty. The fellows will also be expected to complete the FISHE exam.
Practice-based learning and improvement
Fellows must be able to systematically analyze their practice using quality improvement methods and implement changes with the goal of practice improvement. They should be able to locate, appraise and assimilate evidence from scientific studies related to their patient's health problems. Competent practice of pathology requires a life long learning and improvement process. The fellows should be able to use evaluation of peers, superiors and other laboratory personnel to improve their practice and incorporate formative evaluation feedback into daily practice. They should use information technology to manage information effectively to optimize learning and improve patient care and facilitate the learning of health care providers. They should participate in quality improvement projects. Scholarly activity is also a requirement of the fellowship.
- must submit at least one abstract for the annual Residents’ and Fellows’ Research Forum
- are also encouraged to submit their projects to national meetings
- attend and present at journal club
- will also be expected to perform literature searches on difficult cases they encounter at sign out
- are expected to review their evaluations and make changes in their practice based on these suggestions
The fellow will be assessed by direct observation and performance of their research project through global evaluation.
Interpersonal and communication skills
Fellows must be able to demonstrate interpersonal and communication skills that result in effective information exchange and collaboration with other health care providers, patients and patients’ families. The fellow is expected to communicate effectively in that they can gather important information and report preliminary results to clinicians when appropriate. They must demonstrate competence in providing appropriate and effective consultations to other physicians and health professionals both intra and inter-departmental. They also must be able to develop reports which are accurate, complete and convey the key diagnostic and therapeutically important parameters of a case in a clear, concise and accurate manner.
The fellow will be expected to contact physicians when working up a case to obtain additional clinical history or report preliminary findings. The fellow is expected to dictate reports which will be critiqued by the attending pathologist for diagnostic accuracy and completeness. The fellow will also be expected to present at conferences and tumor board and educate other members of the health care team.
The fellow will be assessed in a global evaluation by teaching faculty, by direct observation, critique of reports, presentation at conferences and tumor board, and through 360 degree evaluations, including patient bone marrow surveys.
Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. They should demonstrate a responsiveness to the needs of the patient that supersedes self-interest and demonstrate a commitment to excellence and ongoing professional development.
The fellow will be expected to learn by observation of others as well as through critical feedback of others whom they work with. The fellow will be expected to communicate with medical technologists, clinicians, referring pathologists, patients, families and other support staff in a professional manner, demonstrating respect, compassion and integrity. These principles may discussed at the laboratory management seminar or occasionally in journal club using papers that review ethical issues.
The fellow will be assessed by global evaluation and 360 degree evaluation, including patient bone marrow surveys.
Fellows must demonstrate an awareness of and a responsiveness to the larger context and system of health care. They should demonstrate the ability to call effectively on other resources in the system to provide pathology services that are of optimal value. They must demonstrate the ability to work effectively in a variety of health care delivery settings and systems relevant to hematopathology. They must incorporate cost considerations and risk benefit analysis in patient care and population based care. The must participate in identifying system errors and implementing potential systems solutions. They should advocate for quality patient care and optimal patient care systems.
The fellows will attend a monthly management seminar and quality reports meeting. They will be involved in triaging of flow cytometry specimens and make decisions as to what immunoperoxidase stains and other ancillary tests are required.
The fellow will be assessed in a global evaluation by teaching faculty, through direct observation and discussions regarding laboratory utilization and decision making on cases.