Clinical Pathology Program
Clinical Hematology Elective
Keri Donaldson, MD
Goals and Objectives:
The general goal of the Clinical Hematology Elective rotation is to develop competence and expertise that will enhance the resident's ability to function as a pathology consultant for hematologic diseases. By the end of the rotation the resident should be proficient in: (1) the clinicopathologic correlation of peripheral blood smear, bone marrow biopsy/aspirate, and coagulation test results in common diseases; (2) the interpretation of hematology and coagulation tests; (3) appropriate selection of hematology and coagulation tests; and, (4) collecting bone marrow biopsies and aspirates.
The objectives of the rotation are encompassed by the six core competencies as defined by the ACGME and residents will be evaluated during their training in each of these areas:
- Provide patient care that is compassionate, appropriate, and effective for the treatment and restoration of health
- Gather essential and accurate information about patients using all relevant available modalities including direct patient consultation and incorporate into pathologic interpretations.
- Effectively examine and interpret peripheral blood smears and body fluid slides, bone marrow biopsies and aspirates, incorporating flow cytometry and molecular/cytogenetic information.
- Effectively analyze and interpret coagulation testing.
- Understand procedural aspects of bone marrow aspiration and biopsy.
- Effectively consult to other clinicians in developing a diagnostic plan, when appropriate, based on specific clinical questions and relevant clinical and pathological information.
- Effectively consult on interpretation or follow-up of unusual or unexpected hematologic test results.
- Effectively participate as expert in Laboratory Hematology and Hematopathology at multidisciplinary conferences.
- Use all relevant information resources to acquire and evaluate evidence-based information.
- Develop and maintain a knowledge base in the basic and clinical sciences necessary for effective consultation in Laboratory Hematology and Hematopathology that includes automated hematology testing, peripheral blood and body fluid analysis, flow cytometry analysis, bone marrow biopsy and aspirate analysis, and lymph node specimen analysis as it relates to RBC disorders, platelet disorders, leukemias, lymphoproliferative disorders, inflammatory disorders and coagulation disorders.
- Understand the various levels of evidence in medicine and their translation into evidence-based practice.
Practice-based Learning and Improvement:
- Demonstrate the ability to critically assess the scientific literature.
- Demonstrate knowledge of evidence-based medicine and apply its principles in practice.
- Use multiple sources, including information technology, to optimize life-long learning and support patient care decisions.
- Develop personally effective strategies for the identification and remediation of gaps in medical knowledge needed for effective practice.
- Use laboratory problems and clinical inquiries to identify process improvements to increase patient safety.
Interpersonal and Communication Skills:
- Resident demonstrates interpersonal and communication skills that result in effective information exchange and teaming with other health care professionals, patients, and their families.
- Resident creates and sustains a therapeutic and ethically sound relationship with patients, colleagues, and other health care professionals.
- Resident uses effective listening skills.
- Resident works effectively with others (including faculty, other residents, and laboratory staff).
- Demonstrate compassion: be understanding and respectful of patients, their families, and the staff and physicians caring for them.
- Interact with others without discriminating based on religious, ethnic, sexual, or educational differences.
- Demonstrate positive work habits, including punctuality, dependability, and professional appearance.
- Demonstrate responsiveness to the needs of patients and society that supersedes self-interest.
- Demonstrate principles of confidentiality with all information transmitted both during and outside a patient encounter.
- Demonstrate a commitment to excellence and ongoing professional development.
- Demonstrate interpersonal skills in functioning as a member of a multidisciplinary health care team.
- Demonstrate understanding of the role of the clinical laboratory in the health care system.
- Demonstrate the ability to design resource-effective diagnostic plans based on knowledge of best practices in collaboration with other clinicians.
- Demonstrate knowledge of basic health care reimbursement methods.
- This elective is available for residents in years three or four after they have developed a foundation in hematopathology and coagulation.
Duration and Timing of the Rotation:
- This elective is 4 weeks long and the timing must be coordinated through the Hematology/Oncology Division of the Department of Medicine.
Clinical Pathology Faculty:
- Michael H. Creer, MD
- Keri J. Donaldson, MD
- Melissa R. George, DO
- Hamid Al-Mondhiry, MD
- David Claxton, MD
- W. Christopher Ehmann, MD
- M. Elaine Eyster, MD
- Witold Rybka, MD
- Han-Mou Tsai, MD
- Victoria Smalls, MT(ASCP)
- Diane Richwine, MT(ASCP)
- Jeffrey Sanders, MS
The resident will join the Hematology Consulting Service (Department of Medicine) during this rotation and will be supervised by Hematology Faculty during appropriately selected patient consults primarily for anemia, thrombocytopenia, and bleeding and thrombotic disorders. The resident is expected to review peripheral blood smears, bone marrow biopsies/aspirates, and laboratory data on patients. In select cases the resident should "follow" samples through any specialized hematology testing. Since all pertinent information and the patients themselves should be available, this represents a unique opportunity for developing skills in clinical-pathologic correlation. The resident may be called upon to assist in teaching basic blood cell morphology and laboratory hematology/coagulation to medical students during clinic hours.
Since the testing necessary to diagnose these patients will cross sectional lines in pathology, the resident will also participate in selected activities of both the divisions of Clinical and Anatomic Pathology. During this month the resident is relieved of the service responsibilities of "Usual" Hematology/ Coagulation rotations, except for possible coverage of an absence per Departmental Policies.
During this elective residents should be able to perform between five and ten bone marrow aspirate and trephine biopsies on adult patients under appropriate clinical supervision to establish competency. A basic Illustrated Guide to Performing Bone Marrow Aspiration and Biopsy is available for review. The resident learning experience consists of a combination of service responsibilities, self-instruction, technical instruction, conferences and informal teaching during rounds with the faculty.
Conferences and Case Material:
Residents on the Clinical Hematology elective rotation are strongly encouraged to attend:
- Hematology/Oncology Grand Rounds, each Thursday at 7:45 AM (T2500)
- Lymphoma/Leukemia Conference, each Wednesday at 5:00 PM (T4007)
- Lymphoma Case Review, last Tuesday of each month at 2:00 PM (C7702)
Residents may be asked to present at these conferences.
Method(s) of Evaluation:
- Residents will be evaluated based on direct observation by faculty
- After each rotation, residents will be evaluated by faculty in New Innovations