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Transfusion Medicine Fellowship
Transfusion Medicine Fellowship
The Transfusion Medicine Fellowship at Cedars-Sinai offers comprehensive training in all aspects of transfusion medicine and provides the graduating fellow with the expertise necessary to work in either a hospital or blood center setting. The teaching program relies heavily on direct patient and medical staff interaction via daily patient rounds, and clinical consultation for all matters related to transfusion support of the complex medical and surgical patients in our tertiary care center. Both inpatients and outpatients are cared for in our full service therapeutic apheresis center, and fellows gain experience with standard apheresis therapies as well as LDL apheresis and peripheral blood stem cell collection and processing. Recent implementation of molecular genotyping of both blood donors and patients for determination of extended red cell phenotype provides the fellow with numerous research opportunities as well as exposure to state of the art laboratory testing methods. The Rita and Taft Schreiber Blood Donor Services collects approximately 25,000 blood components annually utilizing fixed site and mobile blood collecting facilities and provides invaluable experience in donor center operations.
The fellow will be provided with and given graduated responsibility for performing apheresis consults, managing donor and patient care issues, and consulting with clinicians regarding appropriate blood component utilization. The fellow is expected to become involved in ongoing clinical or translational research in the Department of Pathology and Laboratory Medicine, including initiation and completion of at least one research project during the course of the year. The institution has a full HLA Laboratory, and the Pathology Department has an active coagulation division in which the fellow may participate. The fellow also will participate in conference presentations, clinical pathology and laboratory administration, and education of Pathology residents.
The program is structured to provide the fellow with experience in all aspects of Transfusion Medicine over a one-year period to prepare the trainee for a successful career in Blood Banking/Transfusion Medicine. Cedars-Sinai Medical Center serves as the primary fellowship teaching institution, and during the year the fellow gains experience in blood donor operations, blood component processing, blood utilization and management as well as therapeutic apheresis including peripheral blood stem cell collection and processing. Throughout the year, the fellow works closely with the attending physicians in transfusion medicine to learn the role of the medical director. Teaching is primarily through clinical case material and daily rounds with the teaching faculty, and fellows learn to provide the clinical consultations required of a hospital based transfusion medicine specialist. Laboratory experience in immunohematology is provided and, if the fellow needs supplemental training in HLA or coagulation, those rotations are made available on site. For blood donor testing and community blood center experience, the fellow spends up to one week at a regional blood center.
Review and follow up of the daily blood utilization report
Coordinate activities of rotating residents
Provide written consultations for therapeutic apheresis patients
Write daily progress notes for on-going therapeutic apheresis patients
Review immunohematology work-ups and provide consultation reports
Review transfusion reaction work-ups and provide consultation reports
Coordinate donor notification letters
Attend Divisional QA and management meetings
On call responsibilities for the transfusion medicine fellow include taking call on a rotational basis with attendings. Attendings are always available for consultation and coverage whenever necessary, and the fellow should call the designated attending when needed for back-up. Call is assigned a week at a time, beginning Wednesday at 5 PM and ending the following Wednesday at 8 AM, and the call schedule is made on an annual basis. Any specific requests for time off pertaining to the call schedule should be made by June 1 prior to the start of the academic year. An attempt will be made to accommodate all requests. Any change in call weeks once the final schedule is distributed, will become the responsibility of the fellow making the request.
The fellow has administrative responsibilities as part of the program structure; this affords an opportunity to learn skills that are required for academic and private practice and are critical to master. Administrative Quality Assurance activities in which the fellow participates include
Perform and review transfusion and tissue audits
Assist with new method assessment and validation as needed
Participate in periodic CAP checklist assessment and review proficiency testing reports
Attend QA meetings for Division as well as stem cell transplant program
The clinical responsibilities the fellow assumes during the year of training include:
During the year, the Transfusion Medicine Fellow mandatory conferences include:
CP Journal Club (monthly)
CP Resident conference (monthly)
CP teaching conference (weekly)
Bone Marrow Transplant conference (weekly)
Transfusion Committee (quarterly)
The fellow is expected to prepare for and present at several of the above conferences. Cases with questions should be discussed with the appropriate faculty member prior to the conference. Fellows may want to attend other departmental and interdepartmental conferences and educational endeavors to maintain competence in general pathology.
Cedars-Sinai Medical Center has an anatomic and clinical pathology residency program with 20 residents. The fellow is expected to take an active role in resident education, honing teaching skills during the year. The fellow teaching activities are:
Provide supervision of junior residents for transfusion reaction evaluation, immunohematology consultations and therapeutic apheresis consultations.
Oversee orders written for apheresis by rotating residents
Provide consultation for questions regarding donor suitability and deferrals
Provide assistance for questions regarding appropriate blood component utilization
The fellow is expected to initiate or participate in one or more research projects
related to Transfusion Medicine, to present the research data at national meetings, and to publish the data in pathology/biomedical journals. The department provides funds for purchasing books and attendance at a national meeting. If an abstract is presented at a meeting, additional funds and time off are provided.
Goals and Objectives
The overall goals are for the fellow to acquiring necessary medical knowledge, diagnostic skills and experience to practice as a subspecialty expert in Transfusion Medicine, to gain research experience and skills to develop a successful academic career, and to become an outstanding educator for fellow pathologists, clinicians and researchers in the field. Specifically, goals and objectives include:
Patient Care - Be able to investigate and interpret adverse reactions to blood transfusions, interpret unexpected red cell antibody findings, evaluate the need for special transfusion products, and provide clinical consultation for therapeutic apheresis and cellular therapies
Medical Knowledge - Have an extensive knowledge of appropriate transfusion therapy to function as a clinical consultant in transfusion medicine, to evaluate blood donor suitability and to understand the theory and practice of therapeutic apheresis.
Interpersonal and Communication Skills � Be comfortable discussing problem cases and sensitive issues with clinicians, design and deliver effective presentations/instructions for residents, co-fellows and faculty at daily rounds and at clinical conferences, and create cogent correct and timely reports for transfusion reactions. Effectively communicate with technical and medical staff regarding appropriate transfusion therapy, and provide consultation and coordination of care for therapeutic apheresis patients.
Professionalism - Provide prompt, timely and appropriate communication with clinical and technical colleagues regarding transfusion requirements or possible delays. Inform blood donors of abnormal test results, and display and promote ethical and respectful behavior to all, being sensitive to issues of diversity.
Systems-based Practice - Learn about and become able to manage administrative and technical functions involved in the operation of a pathology department and its interactions with the medical center. Learn the role Transfusion Medicine plays in the totality of medical care in today's complex delivery system, and appreciate the role of information management in patient care.
Practice-based Learning - Be involved in quality assurance/quality improvement and independently engage in furthering life-long learning. Participate in development and implementation of new policies and procedures as guided by quality improvement initiatives and regulatory requirements.
Faculty in Transfusion Medicine
Ellen B. Klapper, MD, Program Director
Information regarding stipends, benefits, contracts, etc. may be found at the Cedars-Sinai GME website.
Applicants must be board eligible in AP or AP/CP and licensed to practice medicine in the State of California by the time their fellowship begins. We encourage those interested to apply 20 months in advance. For application information, please visit our Fellowship General Information page.