Duration: Three months
Rotation Director(s): Julie Qualtieri, MD
Jun Mo, MD
Richard McMasters, MD
Fred Lucas, MD
Description of Rotation
The hematopathology rotation consists of workup of lymph nodes and related organs and, in addition, bone marrow, blood, and body fluids evaluation. The learning experience during this rotation is to include not only patient problems but also administrative and technical issues. In addition, participation in research projects is strongly encouraged. This should result in posters and publications. At the end of the rotation, or when the director assessed an adequate resident's exposure to the material, a slide-based open book exam is given. For details of the hematopathology rotation, refer to the Clinical Pathology Residency Training Manual. For details of each type specimen, spleen etc., consult the Surgical Pathology Specimen Protocol Manual or the hematopathologist.
- Perform proper handling of lymphoid tissue (skin, spleen, lymph node, extranodal tissue etc.) for lymphoma and leukemia work-up according to LYMPH NODE PROTOCOL.
- Learn to differentiate benign from malignant conditions.
- Understand the basis of the WHO classification of lymphomas, leukemia’s and myelodysplastic disorders, with emphasis on understanding distinct hematopathologic entities.
- Know main lymph node pathologic patterns and key features of specific benign entities.
- Relate the results of ancillary studies to the diagnosis (flow cytometry, cytochemistry, cytogenetics, immuno-histochemistry and gene rearrangement results).
Level of Training
Throughout the three-month rotation, the resident must learn to process, evaluate and diagnose all hematopathology-related specimens, including but not limited to fresh or fixed lymph nodes, skin, spleen, thymus, soft tissue, extranodal lesions suspected of lymphoma etc., under the rotation director’s supervision.
The resident is responsible for getting the sign-out materials including the paperwork, slides, flow cytometry results and other pertinent information to the sign-out area. If flow cytometry results are ordered, the resident has to evaluate the data with the flow cytometry attending. The resident is required to evaluate the materials and study the cases. In cases of suspected myeloma, the resident will obtain the results of serum protein studies.
The resident usually starts the day with any pending tasks left over from the previous day: review and dictate any pending immunohistochemical stains and dictate any pending reports and follow up urgently needed cases, especially the outside consults. The slides become available between 10:30 and noon; the resident should review the slides and consult with the attending if any special stains can be ordered for the afternoon sign-out. Sign-outs take place at 2 p.m. at the hematopathology microscope. Around 3:30 to 4 pm when the immunohistochemistry and/or flow cytometry results are available, the resident will gather them and notify the hematopathology attending that they are ready for sign-out. The resident and the attending, at sign-out, will evaluate the cases, discuss the diagnosis and differential diagnoses and draw a panel necessary to resolve the differential diagnosis.
The resident will be evaluated by the director on the basis of the resident's knowledge, skills and professional growth. Other factors include review of dictated reports, oral presentations, eagerness to learn and interpersonal relation and attitude. An end-of-rotation slide-based open book exam will be given. Results will be discussed with the resident, and will determine if the resident has satisfactorily obtained the knowledge and skills outlined in the objectives above.