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Learning Objectives

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