Coagulation Rotation

The one month coagulation rotation allows the resident to develop competency in diagnostic Coagulation/Special Electrophoresis at the general pathologist level, and to gain experience in interpreting laboratory tests as well as in integrating the results in conjunction with the patient's history into the coagulation consult report. The service is very active, with the current volume of testing the resident sees including 300 coagulation consults, 50 -100 thromboelastograms ( TEG's), 100 hemoglobin evaluations by HPLC  and 350  protein electrophoresis per month. 

Rotation Structure

During the first week of the one month coagulation rotation, the resident will be given a pre-test to help the director evaluate the resident's preliminary knowledge of coagulation. The major method of instruction is by test result interpretations. At the rotation beginning, the resident observes the laboratory director evaluating the interpretative test results. Within one week, the resident is expected to do interpretations and present them to the faculty. The resident is expected to review all interpretive tests done in the laboratory and prepare the initial interpretative report within one day, for review with the laboratory director. Specifically, the resident is responsible for:

  • Reviewing assigned coagulation cases before rounds, obtaining clinical data, and providing preliminary interpretation.
  • Handling questions from Clinical Laboratory Scientists regarding cases.
  • Calling positive results to clinicians and explaining HIT diagnosis and management.
  • Ordering as necessary any additional reflexive testing for Consult Panels.
  • Discussing reading assignment topics.
  • Writing brief updates on Coagulation topics.
Residents carry out a mock inspection using the CAP Laboratory checklists, which are extremely valuable for learning CLIA and other regulatory requirements relative to Coagulation. Additionally, CAP and other surveys (or Proficiency Evaluations) should be reviewed by the resident as they are required by regulatory agencies for laboratory Quality Assurance. At the end of the rotation the resident is expected to successfully complete the post-test indicating a sound understanding of coagulation.

DAILY SCHEDULE
7.30-8.30Mandatory AP/CP Conference
8.30-10.00Write up preliminary Interpretations of Hemoglobin Electrophoresis, Platelet Aggregometry , Protein Electrophoresis
10.00-12.00Sign out, Patient Rounds if necessary
12.00-1.00Lunch/conference
1.00-4.00Read assignments (scheduled topics), Write up Coagulation cases
4.00-6.00Coagulation cases sign out, Reading assignment discussion

Specific Coagulation Goals and Objectives

Patient Care:

  • Gather essential and accurate patient information and incorporate it into pathologic interpretations
  • Effectively analyze and interpret coagulation testing.
  • Successfully consult with clinicians in developing an appropriate diagnostic plan.
  • Consult on interpretation or follow-up of unusual or unexpected test results.
  • Order appropriate special tests when appropriate.

Medical Knowledge:

  • Recognize the impact of point-of-care testing (POCT) on clinical care.
  • Identify reasonable and complete differential diagnoses for peripheral smears, protein disorders, hemoglobin disorders and coagulation cases based on the available clinical information, laboratory tests, and current published information.
  • Explain the basic principles, methods, and applications of the assays used in coagulation, hemoglobin and protein disorders evaluation.
  • Define the principles and practices of automated coagulation testing.

Interpersonal and Communication Skills:

  • Participate as an expert in laboratory coagulation at multidisciplinary conferences.
  • Demonstrate the ability to write a comprehensive and coherent coagulation consultation report and an articulate comprehensive consultation note.
  • Demonstrate the ability to communicate clear diagnoses to the referring physician or appropriate clinical personnel.
  • Ability to educate colleagues and other health care professionals.
  • Demonstrate the ability to educate non-pathology clinicians and other health care workers about fundamental principles of pathophysiology underlying test design/interpretation and the approach to choosing and coagulation.

Professionalism:

  • Demonstrate compassion, understanding of and respect for patients, their families, and the staff and physicians caring for them.
  • Model positive work habits, including punctuality, dependability, and professional appearance.
  • Self-identify the resident as the case physician, taking initiative to advance cases.
  • Demonstrate principles of confidentiality with all information transmitted both during and outside a patient encounter.

Systems-Based Practice and Practice-Based Learning:

  • Demonstrate the ability to work with other health care personnel to develop clinically advantageous and cost-effective care-delivery strategies.
  • Explain how coagulation and hematology diagnoses affect health care decisions for patients and the health care system.
  • Practice cost-effective health care and resource allocation that does not compromise quality of care, understanding the need for and cost of special studies, extended testing, and send-out testing.
  • As senior residents, attend the CP QA committee meetings to be able to explain how to partner with the administrative and technical staff to assess, coordinate, and improve health care and identify how these activities can affect system performance.
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