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Hematopathology Rotation

Residents spend five months in the hematopathology rotation, which incorporates all aspects of hematopathology including performance of bone marrow biopsies and aspirates; peripheral smear, bone marrow, lymph node spleen specimen interpretation; and interpretation of appropriate ancillary immunohistochemistry, flow cytometry, and molecular hematopathology including fluorescence in-situ hybridization (FISH), southern blot and PCR. (Electophoresis interpretation is learned during the coagulation rotation.) New stains and procedures are added as clinically indicated, and residents may be involved in the testing and implementation of new antibody staining or other procedures which provide additional diagnostic, prognostic or therapeutic information. Incorporating these aspects of hematopathology prepares resident for the roles a hematopathologist performs during practice. This busy service offers a wide range of hematology experience and cases, brought in to Cedars-Sinai by the 40 plus full time and attending Hematology/Oncology specialists. The large volume of bone marrow, lymph node and flow procedures at Cedars-Sinai ensures the resident is exposed to a wide variety of hematopathologic entities. Additionally, there are two Hematopathology fellows who actively participate in resident teaching along with the faculty, offering guidance and mentoring in this area.

Rotation Structure

The resident has a structured day on the hematopathology rotation to allow for involvement in all aspects of the practice.

The bone marrow service is busy with each resident performing in excess of 100 bone marrow procedures during their residency; therefore the 2 residents and 2 fellows on hematopathology rotate performance of bone marrows. 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.

Specific Hematopathology Goals and Objectives

Patient Care:

• 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.

Medical Knowledge:

• 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.

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-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.