Specimen handling in the laboratories is the direct responsibility of the laboratory technologists. Resident decision making in the laboratory is under the direct supervision of the teaching faculty at their assigned site. The on-service teaching faculty members are physically present during standard operating hours; faculty members not physically present are rapidly available by phone or pager. No diagnosis is communicated to the clinicians before a faculty member has evaluated the case.
For residents who have not performed bone marrows previously, the hematology/oncology staff will perform the initial bone marrows while instructing the resident during the course of the procedure. During subsequent bone marrow procedures, the resident is expected to learn the technique with the assistance of the teaching faculty. In accordance with HCFA regulations, the teaching staff is present during the critical portions of the bone marrow procedure, during the biopsy and aspiration portions. The supervising faculty reviews and co-signs all resident procedure notes.
The resident is expected to review bone marrow, peripheral blood and lymph node morphology slides, as well as corresponding flow cytometry results, formulate an opinion and present that opinion to the assigned staff member during the review and sign-out period. At the initiation of the rotation, the resident and staff should review material together. However, as the resident develops proficiency with the material, the expectation is that the resident will formulate a diagnosis. Both resident and faculty diagnoses are entered into the CoPath system. All resident cases are tracked for concordance with faculty diagnoses.