ACGME Initial Application for Hematopathology Fellowship in Hematopathology

SUPPLEMENT 1:  Educational Goals

Learning Objective mileposts:

The monthly learning objectives overlap with the advancement of responsibility.  The learning objectives need to be achieved in order that you can assume independence in each of these various areas. We will meet and go over these learning goals at the end of each month.

This list is to help you make sure that you are staying up with the general trend of gaining experience and knowledge through the course of this year.  This list is NOT a complete list of expectations.  These are just examples.  If you have mastered these, then it is likely that you have mastered many other aspects of the field also.

If after our monthly discussion, you and I do not feel that you have achieved a milepost we will plan an approach and a new date for mastering those particular skills or body of knowledge.

In addition to morphologic based diagnosis, I will try to focus the didactic discussion during the first six months on:

1. Methods (flow, molecular diagnostics, FISH, cytogenetics)
2. Biology of hematopoietic neoplasms

I think it is important for you to be comfortable with these methods/concepts by the halfway mark of the fellowship so that you can reinforce these through the additional cases you will see in the second half of the year.

Mileposts for End of July

Area	Expectation	Achieved/ Plan to achieve
Flow	Basic methods and concepts; Understand and interpret B cell lymphoma panels
Flow Analysis	Able to appropriately gate standard studies, applying negative controls
Surgicals	Use working Formulation approach to diagnose nodal lymphomas
Marrow	FAB and WHO classifications; be able to diagnose acute leukemia using smear and cytochemical stains.
Marrow	Be able to recognize MPD and MDS in peripheral smears
Marrow	Be able to work up anemia
Teaching	Be able to teach residents to count smears

 

Mileposts for End of August:

Area	Expectation	Achieved/ Plan to achieve
Flow	Understand and interpret Acute leukemia panels
Molecular Diagnostics	Understand and interpret Southern and PCR assays for TCR and IgH gene rearrangements
Flow Analysis	Able to perform and teach advanced gating starting from LMD files
Surgicals	Fluently apply WHO classification (know Working and Rappaport translations)
Leukemias	Fluently apply WHO classification of AML and MDS
Management	Demonstrate that you can plan appropriate daily work flow for the 5 FTEs in the Flow cytometry lab

 

Mileposts for End of September:

Area	Expectation	Achieved/ Plan to achieve
Flow	Fluency with gating including “back-gating” procedures
Surgicals	Know appearance of the spleen in hematopoietic neoplasms.
Surgicals	Know the extranodal (non-cutaneous) lymphomas (read Issacson’s textbook).
Molecular Diagnostics	Understand role of and interpret STR analyses
Marrow	Know major cytogenetic subgroups of acute leukemias and prognostic importance
Teaching	Be able to informally teach residents and technologists Flow/morphology correlates
Management	Demonstrate that you understand Pathology-specific billing issues as they relate to ancillary studies in hematopathology

Mileposts for End of October:

Area	Expectation	Achieved/ Plan to achieve
Surgicals	Know the reactive patterns in node biopsies and clinical correlates (read Ioachim&Ratech).
Surgicals	Know the EORTC and WHO classifications of cutaneous lymphomas
Marrows	Demonstrate fluency with clinical scenarios associated with subtypes of leukemia (which are peds? Which are likely to involve tissue? etc.)
Continuing Education	Be able to quickly identify and read current relevant articles in BLOOD and give concise summaries to the hematopathology group

 

Mileposts for End of November:

Area	Expectation	Achieved/ Plan to achieve
Molecular Diagnostics	Fluent ability to apply and interpret molecular diagnostic results in the context of a diagnostic specimen
Continuing Education	Understand the major mechanisms that cause acute leukemias and lymphomas
Marrows	Demonstrate the ability to accurately identify myelodysplastic syndromes by morphology alone

Mileposts for End of December:

Area	Expectation	Achieved/ Plan to achieve
Surgicals	Demonstrate the ability to independently work up difficult diagnostic scenarios such as ALCL vs HL, or LPHL vs TCRBCL.
Surgicals	Be fluent with current prognostic markers in lymphoma and be able to communicate these findings to clinicians
Teaching	Be comfortable leading Flow/morphology correlation conference for residents and technologists
Marrows	Log should be >250 cases
Other Specimens	Log should be >100 cases (Lymph Nodes and other non-marrow specimens)

Mileposts for End of January:

Area	Expectation	Achieved/ Plan to achieve
Marrows	Be fluent with major cytogenetic determinants of outcome for ALL and AML
Marrows	Fluency with non-neoplastic pediatric findings and with addressing small round blue cell tumors

Mileposts for End of February:

Area	Expectation	Achieved/ Plan to achieve
Surgicals	Demonstrate the ability to independently work up post-transplant and immunodeficiency associated lymphoproliferative disorders
Surgicals	Demonstrate the ability to independently work up complex non-B cell malignancies such as AILD-like lymphoma

Mileposts for End of March:

Area	Expectation	Achieved/ Plan to achieve
Continuing Education	Know the common therapeutic protocols for various lymphomas and acute leukemia
Marrows	Log should be ~400
Other Specimens	Log should be ~150

Mileposts for End of April:

Area	Expectation	Achieved/ Plan to achieve
Surgicals	Be fluent with histiocytic and mast cell neoplasms (read Ioachim and WHO)
Continuing Education	Based on your reading of the literature, identify specific focus for your interests within the field of hematopathology; focus your  remaining Journal Club selections on that area

Mileposts for End of May:

Area	Expectation	Achieved/ Plan to achieve
Marrows	independently perform aspirates and core biopsies

Mileposts for End of June:

Area	Expectation	Achieved/ Plan to achieve
Marrows	Log should be ~500 (~50 new acute leukemias)
Other Specimens	Log should be ~200
Continuing Education	Demonstrate the ability to rapidly review current literature on a specific issue in hematopathology and the ability to maintain a command of new developments in the field