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Residents spend five months on the integrated hematopathology service, which incorporates all aspects of hematopathology from the performance of bedside bone marrow aspirations/biopsies to reviewing bone marrow and lymphoma work-ups and issuing comprehensive reports that integrate all of the morphologic and ancillary studies of flow cytometry, immunohistochemistry, cytogenetic, fluorescent in-situ hybridization and molecular assays performed. Additional evaluation of peripheral blood smears, peripheral blood flow cytometry, body fluid smears, body fluid/tissue flow cytometry and DNA ploidy studies are performed on a daily basis. Residents are responsible for obtaining pertinent clinical history from the electronic medical records or through discussions with clinicians, as appropriate, and for communicating the diagnostic findings to clinicians after reviewing the case with an attending hematopathologist. Residents may also be involved in divisional quality assurance, performance improvement or validation of new assays/stains as opportunities arise. These experiences provide residents first hand exposure to the various roles a hematopathologist plays in providing high quality diagnostic, prognostic and therapeutic information. The division also boasts a hematopathology fellowship with enrichment of the residents' experiences by both fello w and faculty guidance and mentoring. This busy service offers a wide variety of hematology cases from both the outpatient community and inpatient population seen by the 40+ Hematologists/Oncologists that are full-time medical staff at Cedars-Sinai Medical Center.
Residents on the hematopathology rotation have a structured day allowing for involvement in all aspects of the practice. All bone marrow and lymphoma work-ups are reviewed at the multiheaded scope, increasing residents' exposure to number and variety of cases. Residents attend a weekly Hemepath Case Review Conference and a monthly Heme/Onc Grand Rounds/Lymphoma Tumor Boards.
Each resident is afforded the opportunity to perform 30-50 supervised bone marrow procedures during their entire residency. There is a numerical limit on the number of bone marrows a housestaff member performs in one day, ensuring this does not interfere with the other aspects of resident education.
Participation in coagulation assay interpretation, protein electrophoresis and hemoglobinopathy evaluation is performed during the separate one-month Coagulation rotation.
|7:30-8:30||Mandatory AP/CP Conference (when occurring)|
|8:30-10:00||Obtain patient histories, preview peripheral smears and bone marrow cases|
|10:00-12:00||Morning sign-out with attending|
|1:00-3:00||Perform bone marrows, Round on hemepath lab benches, Perform lab administrative responsibilities|
|3:00-6:00||Preview and Write-up consults, lymph node and spleen cases, review flow cytometry and molecular tests results, Afternoon sign-out with attending|
Specific Hematopathology Goals and Objectives
- Gather essential and accurate patient information and incorporate it into pathologic interpretations.
- Perform, interpret, and write-up bone marrow aspirate and biopsies including all necessary ancillary testing
- Interpret and write-up peripheral blood smear consults, and lymphoma cases including all necessary ancillary testing.
- Consult on interpretation or follow-up of unusual or unexpected test results.
- Order appropriate special testing when appropriate.
- As a senior resident, direct work-ups of bone marrow cases and lymphoma cases in the absence of the fellow.
- Relate the techniques, use and interpretation of flow cytometry in lymphoproliferative disorders, acute leukemias, myelodysplasia and PNH.
- Recall the techniques for, and interpretation and use of FISH in hematopoietic malignancies.
- Restate the basic principles, methods, and applications of the assays used in molecular hematopathology.
Interpersonal and Communication Skills:
- Participate as an expert in Hematopathology at multidisciplinary conferences.
- Demonstrate the ability to write a comprehensive and coherent report in hematopathology.
- Demonstrate the ability to communicate clear diagnoses to the referring physician or appropriate clinical personnel.
- Educate colleagues and other health care professionals.
- Obtain informed consent and clearly explain the bone marrow procedure to patients.
- 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-identification of 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.
- 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 know how these activities can affect system performance.
- Review the CAP checklist and perform mock inspection for the Hematology section.