Clinical Pathology Program

Histocompatibility (HLA) Laboratory Rotation for Clinical Pathology Residents

Rotation Directors:
Medical Director:  Ronald E. Domen, MD
Associate Medical Director:  Hiroko Shike, MD

Goals and Objectives:

General Objectives

The rotation in Histocompatibility (HLA) and Clinical Immunology should equip the Pathology Resident with a complete overview of the role of this laboratory and the testing it performs, in the workup of the various types of patients and donors it serves. The resident will learn the basic administrative, laboratory, and clinical aspects of solid organ and bone marrow transplantation, and platelet transfusion support of the refractory patient.

The resident/fellow will observe serological and molecular testing done in this laboratory, and will have the opportunity to perform test procedures. Meetings with the Medical Director, Associate Medical Director, and/or the Technical Supervisor are encouraged in order to assist in correlating laboratory procedures with clinical considerations.

The length of this rotation is two weeks. Additional elective rotations are encouraged and can be arranged with the Medical Director and the Program Director.

ACGME Core Competencies

The ACGME Core Competencies will be incorporated into these goals and objectives and will also be the basis for resident evaluation during this rotation. The following summarizes the core competencies.

Patient Care (PC):

  • Resident demonstrates a satisfactory level of diagnostic competence and the ability to provide appropriate and effective consultation in the context of pathology services (specifically, Histocompatibility services).
  • Resident provides patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
  • Resident works with health care professionals, including those from other disciplines, to provide patient-focused care.

Medical Knowledge (MK):

  • Resident demonstrates knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care and to pathology (specifically, Histocompatibility).
  • Resident demonstrates an investigatory and analytic thinking approach to clinical and pathological situations (specifically, Histocompatibility).
  • Resident knows and applies the basic and clinically supportive sciences appropriate to pathology (specifically, Histocompatibility).

Practice-Based Learning and Improvement (PBLI):

  • Resident demonstrates the ability to investigate and evaluate their diagnostic and consultative practices, appraise and assimilate scientific evidence and improve their patient care practices.
  • Resident locates, appraises, uses, and assimilates evidence and information from scientific studies related to their patients' health problems.
  • Resident applies knowledge of study designs and statistical methods to the appraisal of clinical studies.
  • Resident uses information technology to manage information and support their own education.
  • Resident facilitates the learning of students and other health care professionals.

Interpersonal and Communication Skills (ICS):

  • 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, nurses, and laboratory staff).

Professionalism (P):

  • Resident demonstrates a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
  • Resident demonstrates respect, compassion, and integrity; responsiveness to the needs of patients that supersedes self-interest; accountability to patients, colleagues, and the profession; and, a commitment to excellence and on-going professional development.
  • Resident demonstrates a commitment to ethical principles pertaining to confidentiality of patient information, informed consent, and business practices.
  • Resident demonstrates sensitivity and responsiveness to patients' culture, age, gender, and disabilities.

Systems-Based Practice (SBP):

Resident demonstrates an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care and pathology services (specifically, Histocompatibility services) that are of optimal value. Resident understands how their pathology services (specifically, Histocompatibility services) and professional practices affect other health care professionals and organizations. Resident understands principles underlying the practice of cost-effective health care and resource allocation that does not compromise quality of service or patient care.

Goals for Cognitive Improvement

The following is a specific list of goals and objectives for this rotation. The resident should have achieved competency in these areas by the end of the rotation. Rotations beyond the basic two weeks will address these goals and objectives in more depth or will be structured to fit the needs of the resident. The abbreviation of each ACGME Core Competency specific to each goal is noted in parenthesis at the end of each statement.

  • Understand the basic concepts and nomenclature of Histocompatibility (HLA). (MK)
  • Understand basic concepts and techniques of HLA typing and histocompatibility testing, and their role in organ and bone marrow/HSC transplantation. (MK, PC)
  • Understand the association of HLA typing in the context of disease association (e.g., HLA-B27). (MK, PC)
  • Understand the HLA test procedures and protocols used for platelet transfusion support. (MK, PC)
  • Understand the basics of platelet antibody testing and its use in evaluating patients who are refractory to platelet transfusion as well in the evaluation of the thrombocytopenic patient. (MK, PC)
  • Understand the role of HLA as it relates to Transfusion-Related Acute Lung Injury (TRALI) and blood donor screening for HLA antibodies. (MK, PC)
  • Understand the role of HLA in Transfusion-Associated Graft-versus-Host Disease (TA-GVHD). (MK, PC)

Recommended Reading:

  • Henry's Clinical Diagnosis and Management by Laboratory Methods
  • HLA Rotations Hand-Outs
  • Selected journal and chapter readings

Technical Instruction:

Resident technical instruction consists of training sessions with the HLA Laboratory staff at the bench. The resident is expected to observe all of the following tests. The resident should schedule these sessions with the HLA Laboratory Chief Technologist. The resident is not expected to become expert in all of these procedures, but is expected to learn principles, uses and applications. Resident exercises are intended solely for the education of the resident, and any bench work performed by the resident or fellow will not be used for patient care under any circumstances.

Requirements:

  • Level of training: PGY-1-5
Duration and Timing of the Rotation:
  • Two weeks
Teaching Staff:
  • Medical Director:  Ronald E. Domen, MD
  • Associate Medical Director:  Hiroko Shike, MD
Components:
  • Didactic lectures
  • Procedure observations at bench
  • Personal reading
Method(s) of Evaluation:
  • Global evaluation
  • Procedure check-list
  • Residents will be evaluated based on direct observation by faculty
  • After each rotation, residents will be evaluated by faculty in New Innovations