Progressive responsibility in our hematopathology fellowship program at MCC is designed and followed based on the following three principles:
- For fellows that show extraordinary progress, moving through the different stages of progressive responsibility at an accelerated rate is possible.
- For fellows that fail to progress as projected, he/she will need to demonstrate adequate skill level prior to advancing to the next stage.
- Program director/educational committee will decide if the fellow should move on to an advanced level training after gathering all feedbacks from the attendings’ evaluation.
- Fellows are expected to learn how to triage in house bone marrows with direct attending supervision.
- Refresh their recognition of hematopoietic cell morphology and normal bone marrow histology.
- Learn basic hematopathology report writing techniques.
- Be able to research clinical histories and incorporate appropriate portions into an accurate clinical history.
- Become familiar with dictation, PathNet and Power Chart system for signing out.
- Observe the attending during rendering of preliminary diagnosis to clinical teams.
- Present to frozen room and prepare history and slides for the attending. Observe the attending on how to generate a frozen section diagnosis and order accessory tests.
- Present hematology related cytology case to attending and take notes about attending’s decision.
- Become familiar with peripheral blood smear sign out system and corresponding testing.
2nd and 3rd month:
- Fellows are expected to be able to more independently triage in-house bone marrow under supervision, write full reports with minimal to moderate correction by attending.
- Diagnostic level should be improving with ability to diagnose simple cases with supervision by attending.
- Learn basic treatment modalities and be able to recognize their affect on the bone marrow.
- The fellow will start to learn how to prepare a preliminary diagnosis and communicate a preliminary to the clinician, based on what has been discussed with the hematopathology attending.
- Become more actively involved in frozen sections, hematology-related cytology service and provide own opinion to pathology attending on triage of cases and prepare related documents.
- Start to take care of simple bone marrow and lymph node consultation based on the attending’s instruction and sign out under supervision.
- Review and sign out peripheral blood smear and flow cytometry under the attending’s supervision.
- Review in-house surgical case, intradepartmental surgical or cytologic consultation cases with attending.
- Learn to appropriately order flow and immunohistochemical staining panel.
4th through 6th month:
- Fellows are expected to be able to triage most cases independently, requiring attending input on a minority of cases.
- Be able to write full reports with minimal correction by attending.
- Diagnostic level on bone marrow case should continue to improve with ability to diagnose of typical hematologic neoplasms e.g., MPN, MDS/MPN and lymphoma and leukemia, with little or no input from attending.
- At the beginning of the fourth month – the fellow should be able to provide accurate blast and plasma cell counts to clinical teams as requested for preliminary interpretation. By end of 6th month the fellow should be able to develop preliminary diagnosis with direct attending supervision.
- Review peripheral blood smear and flow cytometry with mild correction except for complicated case scenarios.
- Be able to provide frozen section diagnosis by incorporating with the attending’s input.
- Develop skills to independently take care of intradepartmental cytology and surgical case consultation by providing own interpretation to hematopathology attendings and releasing consented diagnosis to surgical pathologist/cytologist.
- Participate in sign out of designated in-house surgical pathology cases and lymph node review cases from every attending under supervision.
7th and 9th month:
- Fellows are expected to be able to triage nearly every case independently.
- Be able to write full bone marrow reports with only minor correction by the attending.
- Diagnostic level should continue to improve to the point where able to diagnose vast majority of cases with little or no attending input.
- Be able to render most preliminary diagnoses with little input from attending.
- Be expected to independently communicate some preliminary diagnosis to clinicians, using good clinical judgment in determining which cases need attending input prior to releasing preliminary diagnosis.
- Know how to deal with diagnostic discrepancies and diagnostically challenging cases and seek additional materials, documents or outside consultation to render a correct diagnosis under guidance of an attending.
- At 9th month be able to act as a “pre-attending” facing daily work load nearly even to that of an attending including providing complete bone marrow, surgical, cytology, flow cytometry, lymph node and consultation reports.
- Diagnostic level should be at or near attending level.
- Confidently provide nearly all preliminary diagnoses independently.*
* For all fellow rendered preliminary diagnoses, the fellow will provide the slides to the attending in the same business day for review to confirm accuracy of fellow’s interpretation.