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Section 9: Program Objectives, Goals, and Supervision of Fellows in Hematopathology

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Section 9: Program Objectives, Goals, and Supervision of Fellows in Hematopathology Program Objectives, Goals, and Supervision of Fellows in Hematopathology Page 9 - 1 Section 9: Program Objectives, Goals, and Supervision of Fellows in Hematopathology Updated 06/15/2016 Program Objectives, Goals, and Supervision of Fellows in Hematopathology Page 9 - 2 SECTION 9: PROGRAM OBJECTIVES, GOALS, AND SUPERVISION OF FELLOWS IN HEMATOPATHOLOGY Overview Mission The mission statement of our subspecialty pathology training program is to train Statement outstanding subspecialty pathologists and to provide them with the necessary tools and experience to pursue a scientific approach to the practice of anatomic pathology that will not only enhance their professional lives but will also advance the field of Hematopathology as a whole. Policies The fellows in Hematopathology are subject to the same Policies as applies to the residents in the general pathology residents discussed in Section 1. Specific policies on Duty Hours, Fitness for Duty: Alertness Management and Fatigue Mitigation and Moonlighting follow. Duty Hours The fellows in Hematopathology must comply with the ACGME Duty Hours. o Hematopathology Fellows do not take in-house call. As such, the limit to on- call every third day does not apply. o Hematopathology Fellows cover call from 4:30 p.m. to 8:00 a.m. the next business day. Evening and weekend call is taken for a weeklong duration. o Hematopathology Fellows must have one day free of all hospital duties (day and evening, pager off) in seven days, averaged over 28 days. o If the Hematopathology Fellows moonlight anywhere, the time spent moonlighting counts toward the 80-hour weekly limit. o In a typical workweek, Hematopathology Fellows should not exceed the 80- work hour limit, set by the ACGME. Fellows are responsible for tracking their own work hours on the Verinform system. o In a typical workday, there is no need for a Hematopathology Fellow to work a 24 hour shift. Fellows should be able to complete all of their clinical responsibilities between 8:00 a.m. and 6:00 p.m. o Fellows must not stay later than 10:00 p.m. in order to have 10 hours off between shifts, as required by the ACGME. Fitness for Duty: Hematopathology Fellows must attend the SAFER CD-ROM session at the Alertness beginning of their training, and document their attendance by completing the post- Management and test and signing in on the attendance sheet. Hematopathology Faculty must also Fatigue have documentation of attending the SAFER CD-ROM session at some point. The Mitigation SAFER Program can also be found on the fellows’ Verinform homepage. Documentation of completion of the SAFER Program must be provided. Continued on next page Updated 06/15/2016 Program Objectives, Goals, and Supervision of Fellows in Hematopathology Page 9 - 3 SECTION 9: PROGRAM OBJECTIVES, GOALS, AND SUPERVISION OF FELLOWS IN HEMATOPATHOLOGY Overview, Continued Moonlighting The ACGME and the County of Los Angeles, and Department of Pathology and Activities Laboratory Medicine Moonlighting policies are listed in Section 1. Hematopathology Fellows are subject to these policies. Neither the Hematopathology Fellowship Training Program, its faculty nor the Department of Pathology and Laboratory Medicine require moonlighting activity by its fellows. Hematopathology Fellows must understand that their education is the first priority, and moonlighting activity must not interfere with their education. Hematopathology Fellows must have the approval of the Program Director prior to engaging in moonlighting activity. On Call Hematopathology fellows may only take call if they have Supervisory Fellow Activities Status (see below). Educational The fellows in Hematopathology are encouraged to participate in most of the same Activities educational activities as the general pathology residents, which are listed in Section 3. In addition, fellows are required to lead discussions at weekly “journal club” conferences in hematopathology. These include topics in benign hematology and molecular pathology/cytogenetics, as well as recent journal articles of interest to hematopathologists. A schedule of presentations is prepared by the fellow(s) at the beginning of the year, and some of the presentations can be assigned to the rotating resident in hematopathology. Fellows participate in hematology division Weekly Case Conferences and Grand Rounds. As necessary, the hematopathology fellows prepare and discuss the pathology portions of cases presented at the Case Conferences in concert with the clinical hematology fellow. Finally, hematopathology fellows alternate leading weekly morphology conferences at the mulitheaded microscope for clinical hematology fellows and residents. Definition of The faculty are responsible for the supervision of all activities of the fellows. This “direct” and supervision can be “direct” or “indirect.” (CPR VI.D.3) “indirect” supervision • Under “direct supervision,” the fellow signs out cases at the microscope with the teaching faculty physically present. (CPR VI.D.3.a) • Under “indirect supervision,” the fellow will be given the opportunity to unofficially “signout” cases without concurrent review by the faculty, but with all cases reviewed separately by the faculty prior to official signout. (CPR VI.D.3.b) Continued on next page Updated 06/15/2016 Program Objectives, Goals, and Supervision of Fellows in Hematopathology Page 9 - 4 SECTION 9: PROGRAM OBJECTIVES, GOALS, AND SUPERVISION OF FELLOWS IN HEMATOPATHOLOGY Overview, Continued Definition of • Also, “indirect supervision” allows for hematopathology fellows to process “direct” and lymph nodes to rule out lymphoma and to perform bone marrow aspirations “indirect” and biopsies and process bone marrow biopsies without a faculty member supervision present but with a faculty member available for immediate consultation if continued necessary. • The faculty on service will be available for immediate consultation and “direct supervision” when the fellow under “indirect supervision” encounters a case needing urgent review, including a new diagnosis or leukemia or high grade lymphoma, relapsed leukemia, and/or when a “preliminary diagnosis” will affect any therapeutic or additional diagnostic measures from the clinical service. The fellow will be responsible for knowing the limits of his/her scope of authority and competency level. (CPR VI.D.5). • Hematopathology fellows must have “direct supervision” prior to achieving “Supervisory Fellow Status” described below. Once a Hematopathology Fellow has achieved “Supervisory Fellow Status,” he/she has achieved competency such that he/she can function under “indirect supervision.” (CPR VI.D.4) • To obtain the standing of “Supervisory Fellow,” the fellow must: • Attend the Orientation Lecture on Hematopathology Fellow Duties and Sign-out Protocol • Document “hands-on” experience with a minimum of 20 bone marrow studies that were signed out correctly under the direct supervision of an attending staff physician. • Receive an approval letter signed by the Program Director and placed in the fellow’s file. • The fellow achieving “Supervisory Resident” status may do the following: • Review and communicate to clinicians a “preliminary diagnosis,” without direct attending supervision. Any “preliminary diagnosis” that affects therapeutic and/or additional diagnostic measures will be first reviewed and discussed with the attending hematopathologist prior to independently communicating the “preliminary diagnosis” to the clinical service. • Initiate appropriate workup, order necessary ancillary testing, and prepare reports, at least in preliminary form, no later than the next regular work day, for review by the attending hematopathologist. for release by the attending hematopathologist. • Requests for after hours and weekends consultations will be referred to the supervisory resident on call, whose pager number appears on the monthly call schedule. • Supervisory resident should document consultations performed during fellowship in his/her Log Book. Continued on next page Updated 06/15/2016 Program Objectives, Goals, and Supervision of Fellows in Hematopathology Page 9 - 5 SECTION 9: PROGRAM OBJECTIVES, GOALS, AND SUPERVISION OF FELLOWS IN HEMATOPATHOLOGY Overview, Continued Prerequisite and • The candidate for the Hematopathology Fellowship Training Program must Fellow Selection have completed 3 years of Anatomic Pathology training, 3 years of Clinical Process Pathology training or 4 years of Anatomic and Clinical Pathology training by the beginning of the fellowship training. • The candidate must be a resident in good standing at his/her primary training program. • The candidate must have a valid and unrestricted California Medical License by July 1st of his/her training year. • A letter from the resident’s Program Director must document what rotations the resident has taken, and comment on the completion of these rotations with competence. • Two additional letters from the resident’s Hematopathology faculty are recommended. • Candidates’ dossiers are reviewed for academic achievements, scholarly activities, and personal statements. • Based upon academic achievements, scholarly activities, personal statements, letters of recommendation, and the Program Director’s letter, the candidate is invited for an interview with the Hematopathology faculty and the current fellows. • Selection of the successful candidate is based upon the fellow’s qualifications discussed above and interview outcomes. Final selection is based upon the decision of the Program Director with input from the faculty.
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