Hematopathology Fellowship Program
The Hematopathology Fellowship at Cedars-Sinai offers comprehensive training in diagnostic hematopathology including bone marrows, peripheral smears, lymphomas, coagulation, special testing, cytogenetics and molecular hematopathology. Fellows are expected to enter the year with a strong background in clinical or clinical and anatomic pathology, and to emerge from it as polished attending pathologists who can quickly adapt to the role of and competently perform as junior staff in either a community or academic setting. This busy service offers a wide range of hematology experience and cases, brought in to Cedars-Sinai by the 40 plus full time and attending Hematology/Oncology specialists. The large volume of bone marrow, lymph node and flow procedures at Cedars-Sinai ensures the resident is exposed to a wide variety of hematopathologic entities. In addition, there is an active lymphoma consultation service. There also are in excess of 50,000 surgical pathology specimens annually, including extra-nodal lymphomas. The CSMC Hematopathology fellowship is highly competitive. Therefore, interested applicants should strongly consider concurrent application for the Surgical Pathology Fellowship, as qualified candidates may be offered Surgical and Subspecialty Fellowship positions in consecutive years.
The fellow will be provided with and given graduated responsibility for signing out cases including consultation cases with incorporation of all ancillary studies. The fellow is expected to become involved in ongoing clinical or translational research in the Department of Pathology and Laboratory Medicine, including initiation and completion of at least one research project during the course of the year. Available diagnostic and research techniques include immunohistochemistry, in situ hybridization and other contemporary molecular techniques. The fellow also will participate in conference presentations, clinical pathology administration, and education of Pathology residents.
The program is structured to provide all needed core training over a one-year period and to assure that learning of the techniques and skills needed for excellence in the practice of hematopathology (morphology, immunohistochemistry, molecular diagnostics, laboratory management administration and informatics) is accomplished in a coordinated fashion. The fellowship encompasses experiences in bone marrow biopsy and aspirate performance and interpretation, peripheral smear, lymph node, extra-nodal lymphoma and spleen specimen interpretation; and interpretation of appropriate ancillary studies.
Rotations are generally done in one month blocks. While on the bone marrow rotation, fellows are the primary pathologists responsible for interpreting, preparing reports for, and discussing cases with clinicians including bone marrow, peripheral blood smears, flow cytometry, DNA ploidy, cytochemistry and hemoglobinopathies. In addition, while on the bone marrow rotations, the fellow gains experience in special testing, flow cytometry, and protein and immunofixation electrophoresis. On the lymph node rotations, the fellow performs the pathologist functions for lymph node, molecular hematopathology, and FISH cases. There are rotations through the immunohistochemistry, coagulation, cytogenetics and molecular pathology sections, including laboratory bench experience in these areas.
|Sample Schedule on Bone Marrow Rotation|
|7.30-10.00||Conferences, Case preview, Resident case teaching|
|1.00-6.00||Perform bone marrows, Round on hemepath, coagulation, cytogenetics or molecular hemepath areas including benches Perform laboratory administrative responsibilities|
The bone marrow service is busy; therefore the 2 residents and 2 fellows on hematopathology rotate performance of bone marrows. There is a numerical limit on the number of bone marrows a housestaff member performs in one day, ensuring this does not interfere with the other aspects of resident education.
On call responsibilities are on an every other week basis. The on call hematopath fellow is available to provide consultations for the CP resident who is taking 1st call, and the fellow also may get questions from the AP resident about handling a surgical specimen related to hematopathology. The fellow may have to perform and/or review a bone marrow on the week-end. The fellow additionally is responsible for giving preliminary results on flow cytometry panels, e.g. on acute leukemia cases, performed on Saturday morning.
The fellow has administrative responsibilities as part of the program structure; this affords an opportunity to learn skills that are required for
academic and private practice and are critical to master. Administrative Quality Assurance activities in which the fellow participates include:
- Attending and participating in the weekly hematopathology administrative meeting.
- Attending the laboratory management and administrative group meetings.
- Participating in the CP performance improvement committee meetings
- Reviewing hematopathology reports for CAP required elements
During the year, the Hematopathology Fellow mandatory conferences include:
- CP Journal Club (monthly)
- Molecular Pathology Journal Club (monthly)
- Leukemia/Lymphoma Tumor Board (monthly)
- Oncology Tumor Board (hematopathology cases) (weekly)
- CP Resident Conference (monthly)
- Coagulation Conference (monthly)
- Spleen Meeting (quarterly)
The fellow is expected to prepare for and present at most of the above conferences. Cases with questions should be discussed with the appropriate faculty member prior to the conference. Fellows are encouraged to attend other departmental and interdepartmental conferences and educational endeavors to maintain competence in general pathology.
Cedars-Sinai Medical Center has an anatomic and clinical pathology residency program with 20 residents. The fellow is expected to take an active role in resident education, honing teaching skills during the year. The fellow teaching activites include:
- Supervising and assisting junior residents in learning to perform bone marrow aspirates and biopsies.
- Reviewing slides with residents prior to sign-out.
- Present one CP Didactic resident lecture.
The fellow is expected to initiate or participate in one or more research projects related to any area of hematopathology, to present the research data at national meetings, and to publish the data in pathology/biomedical journals. In addition, there are a number of local research competitions and awards for which the fellow can compete. More information about research opportunities may be found at our housestaff research website . The department provides funds for purchasing books and attendance at a national meeting. If an abstract is presented at a meeting, additional funds and time off are provided.
Goals and Objectives
The overall goals are for the fellow to acquire necessary medical knowledge, diagnostic skills and experience to practice as an outstanding hematopathologist, to gain research experience and skills with the option of developing a successful academic career, and to an outstanding educator for pathology colleagues and clinicians.
Specifically, goals and objectives include:
- Patient Care - Be able to competently perform bone marrows without supervision, independently work-up and complete the majority of cases including ordering and interpreting ancillary studies, present cases at conferences, and function as a consultant to clinical physicians.
- Medical Knowledge - Have an extensive knowledge of disorders in hematopathology including the clinical aspects of these disorders, and understand the techniques, use and interpretation of flow, FISH, and molecular hematopathology.
- Interpersonal and Communication Skills - Be comfortable discussing problem cases and sensitive issues with clinicians, design and deliver effective presentations/instructions for residents, co-fellows and faculty, and create cogent correct and timely reports for hematopathology specimens.
- Professionalism - Effectively communicate regarding cases, display and promote ethical and respectful behavior to all, model positive work habits, and be sensitive to issues of diversity.
- Systems-based Practice - Learn about and become able to manage administrative and technical functions involved in the operation of a pathology department and its interactions with the medical center.
- Practice-based Learning - Be involved in quality assurance/quality improvement and independently engage in furthering life-long learning.
All Pathology Department Faculty
Prior Fellow Placements
Applicants must be board eligible in AP or AP/CP and licensed to practice medicine in the State of California by the time their fellowship begins. We encourage those interested to apply 20 months in advance. For application information, please visit our Fellowship General Information page.