Educational Goals and Objectives
All PGY levels have the same goals and objectives. However the expectation for the resident’s performance increases as they gain experience and we will monitor this with our statistical program.
The goals and objectives of the LN/BM/Flow experience is to prepare and enable residents to:
- Perform laboratory procedures involved in the diagnosis of neoplastic hematology including the morphology of various leukemias, lymphomas, and reactive processes with correlation with flow cytometry, immunohistochemistry, and cytogenetics in order to practice independently.
- Demonstrate professional behavior regarding patients, other physicians and all clinical laboratory personnel.
- Demonstrate a commitment to reviewing and improving LN/BM/Flow practice patterns and to life-long learning.
- Discuss the scientific basis of LN/BM/Flow, such as detailed knowledge of the various nutritional and other anemias, leukemoid reactions and leukemias on peripheral blood smears, their clinical presentation and morphology and the ability to utilize the medical literature and modern techniques to provide optimal patient care.
- Communicate effectively in verbal and written form with their clinical colleagues, administrative, technical, and clerical personnel.
- Explain the policies and regulations affecting health care (i.e., CAP accreditation, HIPAA, compliance to Medicare and billing regulations, etc.)
The Hematology and Bone Marrow rotation is intended to expose the residents to benign and malignant disorders affecting the hematopoietic system. It will also expose the residents to interpretation of cellular morphology in peripheral blood and body fluids. The rotation will introduce the resident to the performance and interpretation of procedures employed to test and diagnose cellular morphology and hematopoietic disorders. Through participation in daily clinical diagnostic sign out, the resident will learn the importance of clinico-pathologic correlation in evaluating the hematopoietic system. The effect of chemotherapeutic drugs and the monitoring of their effects will also be a focus of the rotation. It is expected that, at the completion of the rotation, the resident will be able to recognize the differences in benign and malignant disorders and be able to render a diagnosis appropriately. Although residents are encouraged to observe and participate in bone marrow collection procedures, this is not a requirement in the rotation.
Training Structure
During the Hematology and Bone marrow rotation, the Resident will:
- Review the biochemistry and anatomy of the hematopoietic system
- Learn about benign and malignant hematopoietic disorders
- Understand the diagnostic testing associated with the above
- Observe the performance of general hematology and bone marrow tests (automated hematology, body fluid analysis, bone marrow preparation and staining and cytochemistry stains)
- Review data on development and implementation of new hematology testing
- Give a lecture to the technologists on some aspect of hematopathology
- Correspond with clinicians about the results of diagnostic testing
- Help in troubleshooting laboratory testing in hematology, as necessary
- Be involved in evaluation of quality assurance projects in the laboratory
- Review CAP hematology and body fluid surveys to understand proficiency testing programs
- Be involved in diagnostic interpretive hematology and body fluid testing
- Review the hematology and bone marrow pending list for diagnostic tests every morning
- Previous laboratory testing results for each of these patients should be printed out with clinical data obtained from Medsite
- Contact the clinical service ordering the test for an update
- When the hematology studies and bone marrow tests are complete, the resident with the attending pathologist will render a diagnostic interpretation
- The resident will contact the clinical service and discuss the interpretation with treatment options
Interpretive Reports
The interpretive reports generated by residents in the Hematology and Bone marrow rotation include the following:
- Peripheral Blood interpretation
- Body fluid interpretation
- Crystal analysis
- Bone marrow aspirate report
- Cytochemistry stains report
- Bone marrow biopsy report
- Immunohistochemistry reports regarding the bone marrows
Graduated Responsibility
The first rotation in Hematology and Bone Marrows is often shared with a senior resident as this service is demanding. During the subsequent rotations, the resident is expected to have the Path Table (peripheral blood, body fluids and crystal analyses) cases reviewed prior to sign out with the pathologist. By the third and fourth years, the resident is expected to have the bone marrows reviewed prior to sign out and during the fourth year, the resident is expected to have a working diagnosis to present to the attending pathologist. The senior resident is also expected to determine which diagnostic tests are necessary for each specific case and have them ordered. The residents will also enter the reports into CoPath and send the report to the attending pathologist for review and sign out.
We currently have no fellows.
The opportunity to observe and perform bone marrow aspiration and biopsies is available to each resident by attending Heme/Onc clinic on Mondays and Thursdays. The resident is paired with the Heme/Onc PA who instructs the resident.