Hematology and Hematopathology Rotation

Goals and Objectives

At the end of the rotation, the resident will have demonstrated competency in the following skills.

Patient Care

Performance of bone marrow aspirates and biopsies in clinical setting (by arrangement with Division of Hematology and Oncology)
Timely completion of bone marrow reports
Peripheral blood and body fluid reviews
Hemoglobinopathy interpretation (HPLC and electrophoresis including correlation with CBC)
Urinalysis including automated and microscopic exams
Joint fluid crystal exams

Medical Knowledge

Morphological interpretation of peripheral blood smears and correlation with clinical information
Evaluation of Wright-stained body fluids for inflammation and malignancy
Morphological examination of joint fluids for crystals
Chemical and microscopic urinalysis
Automated hematology, including complete blood counts, histogram interpretations and reticulocyte analysis
Familiarity with automated hematology analyzer and information system
Be able to recognize mature and immature hematopoietic cells in order to perform a differential count on either peripheral blood or bone marrow specimens.
Form a meaningful differential diagnosis for commonly seen hematopoietic diseases.
Have an appreciation and working knowledge of the utility and interpretation of ancillary studies such as flow cytometry, immunohistochemistry and cytochemical stains.
Approach the diagnosis of anemias, cytopenias, leukemias, lymphomas, myeloproliferative syndromes, and myelodysplastic syndromes by combining the available morphological and historical information

Practice-Based Learning and Improvement

Indications and interpretation of special hematology tests, including hemoglobin electrophoresis, glucose-6-phosphate dehydrogenase screens, osmotic fragility tests, etc.
Correlation of Wright-stained body fluids with Cytopathology results
Correlation of abnormal blood smear findings and bone marrow findings with flow cytometry results
Be able to compare current and previous pathology results to understand treatment effects on disease processes.
Correlate bone marrow results with other pathology on patients
Understand the limitations of sub-optimal or inadequate bone marrow specimens.
Be able to order appropriate ancillary testing, including flow cytometry markers, FISH/genetic testing, and molecular testing.

Interpersonal and Communication Skills

Communication of test results to clinicians
Communication with clinicians to obtain history for interpretation of test results and/or appropriateness of tests ordered.
Communication with Laboratory technologists about test methods, additional test requests, etc.
Presentation of cases at weekly hematology lab rounds
Presentation of journal articles on hematopathology/laboratory hematology topics at Journal Club
Presentation of pathology at clinical conferences
Communication with attending pathologists about patient material
Effectively communicate bone marrow findings to clinicians
Write bone marrow reports that provide appropriate descriptions and synthesize findings into a comprehensive diagnosis.
Ask appropriate questions of attendings and clinicians to improve understanding of clinical significance of pathologic findings

Professionalism

Be available in hematology laboratory and sign-out area as required
Demonstrate self-motivation in pursuit of hematology rotation requirements
Demonstrate courteous and coll egial behavior with peers and laboratory staff
Be responsible for obtaining bone marrow smears from Cancer Center lab
Follow up on all special stains and studies on assigned cases until the case is completely signed-out.
Read independently on cases and search primary sources.

Systems-Based Practice

Be familiar with Laboratory Information System and entry/retrieval of laboratory results, including hematology information system
Be familiar with Hospital Information System for retrieval of clinical information on patients
Be familiar with anatomic pathology information system (COPATH), including retrieval of pathology reports, ordering special stains, etc.
Understand how bone marrow examinations fit into the overall care and management of patients with hematological and malignant conditions.
Understand cost-effective laboratory utilization in the evaluation of hematologic disorders
Understand basic triage and work flow of hematology specimens in ancillary lab areas, such as flow cytometry and genetics/molecular.

Duration

The total requirement is six months.

Duties and Responsibilities of Residents by Year

Arrange and attend bench instruction with the technologists in each of the component laboratories.
Daily, review and sign out the "Review queue" of abnormal smears with the Attending Pathologist.
Enter Review queue results into LIS.
Review and sign out hemoglobin electrophoresis results with Attending Pathologist.
Attend clinical pathology conferences, coagulation conference, leukemia/lymphoma conference and lymphoma conference.
Obtain pertinent clinical information about every bone marrow case
Gather peripheral blood smears, clot specimens and core biopsies when available.
Perform the 100 cell differential count on the peripheral smear using the bone marrow evaluation form as a guide.
Order or gather additional studies, such as histochemical stains and immunophenotyping studies and bone marrow or lymph node biopsies.
Attend daily sign-out sessions, reviewing cases seen by all Residents on the rotation.
Be available in the hematopathology laboratory area to show cases to clinicians.
Senior residents orient junior residents to the duties and responsibilities and review basic morphology with junior residents.
Senior residents may be assigned consult cases from outside institutions for evaluation and sign-out.
Senior residents may sign-out Review queue cases independently, at discretion of the Attending pathologist.
Senior resident should take responsibility for more cases than junior resident on busy days.

Teaching Staff

Howard Meyerson, MD - Rotation Director
Rose Beck MD, PhD
Ramya Gadde, MD
Kwadwo Oduro, MD, PhD
Chris Ryder, MD, PhD
Christine Dillman MT ASCP

Supervision and Evaluation

Residents meet on a regular basis with the Director of the rotation and with the lead technologists for supervision. Evaluations are based on daily interaction with residents over multi-headed microscope and other "sign-out" activities. In this way, residents receive daily feedback on their interpretations of case material. Residents are assisted by attending staff in preparation of conferences, and receive feedback on their presentations.

Residents are evaluated on a monthly basis with regard to competency areas. Evaluations are forwarded to the Residency Program Director, where they are available for review.