Goals and Objectives
During this rotation, the resident will demonstrate the following competencies:
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Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:
Work with health care professionals, including those from other disciplines, to provide patient-focused care
Observe patient counseling/clinic sessions/ history and physical examinations at the pediatric hematology clinic.
Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families in pediatric hematology clinic
Gather essential and accurate information about patients
Present cases seen in clinic to pathology attending with a focus on relevant coagulation findings
Provide prompt consultative support for patients with bleeding and thrombotic disorders.
Use information technology to support patient care
Review the specialty coagulation laboratory pending list for specialty coagulation assays at the end and start of each day. For each patient for whom coagulation assays are ordered
Obtain previous laboratory test results and clinical data from LIS and HIS respectively
Depending on the tests order, the ordering physician may be contacted to determine the reason for the test order and the information the clinicians are seeking and advise on tests ordered
When the coagulation testing is completed, the resident will render a diagnostic interpretation, which shall be reviewed with the attending pathologist
Demonstrate an investigatory and analytic thinking approach to clinical situations
Answering questions from clinicians about coagulation testing with attending approval and review prior to answering questions (graded responsibility)
Review data on implementation of new hemostasis assays
Be involved in interpretive pathologist reviews of cases
Know and apply the basic and clinically supportive sciences which are appropriate to their discipline including:
Molecular biochemistry of the hemostatic system, relevant findings in the patient history, congenital and acquired coagulation disorders, diagnostic test strategies
Preparation of 1/2 presentation to coagulation technologists on coagulation testing topic
Understanding of normal coagulation and laboratory testing related to coagulation.
Understanding of application and interpretation of platelet function testing
Understanding of methods used for routine and specialty coagulation tests
Pass 3 quizzes and 1 final examination
Complete reading of routine and specialty coagulation test procedures
Understand impact of phlebotomy and sample collection for coagulation
Understanding of automated and manual coagulation assays
Practice-Based Learning and Improvement
Analyze practice experience and perform practice-based improvement activities using a systematic methodology
Participation in current coagulation laboratory operations and assistance with projects such as: method validation, implementation of new assays, normal range studies, laboratory assay trouble- shooting, quality assurance, procedure review
Review daily quality control results for specialty assays
Review the specialty coagulation laboratory pending list for specialty assays at the start and end of each day. For each patient for whom specialty assays are ordered
Obtain previous laboratory test results from LIS and clinical data from HIS
Based on the tests ordered contact (with pathology attending approval) the ordering physician to determine the reason for the test order and the information sought by the clinicians
When the coagulation testing is completed, the resident will render a diagnostic interpretation, which shall be reviewed with the attending pathologist
Use information technology to manage information, access on-line medical information; and support their own education
Interpretation of coagulation and special coagulation test results
Clinical correlation and appropriateness of coagulation testing
Indications and interpretation of coagulation test results
Correlation of abnormal coagulation results with hematology and chemistry assays
Facilitate the learning of students and other health care professionals
Present a coagulation clinical case at laboratory rounds
Demonstrate mastery of didactic case studies
Present lecture to technical staff at the end of the rotation
Interpersonal and Communication Skills
Use effective listening skills and elicit and provide information using effective verbal and nonverbal, explanatory, questioning, and writing skills
Communication with Laboratory technologists about test methods, additional test requests, etc.
Communication with attending pathologists about patient results
Work effectively with others as a member or leader of a health care team or other professional group
Present clinical cases at lab rounds
Interact appropriately with technical staff in coagulation laboratories
Present lecture to technical staff at the end of the rotation
Communication of test results to clinicians
Communication with clinicians to obtain history for interpretation of test results and/or appropriateness of tests ordered.
Presentation of coagulation cases at weekly lab rounds
Presentation of journal articles about coagulation topics at Journal Club if scheduled
Professionalism
Demonstrate respect, compassion, and integrity with patients and accountability to the profession by:
Observation of patient evaluations in Pediatric Hematology Clinic and presenting findings to pathology attending
Attendance at all didactic sessions, conferences, and bench sessions with technologists
Being punctual
Being available and visible in coagulation laboratory area as required
Answering pages promptly
Conveying information to laboratory staff in a timely manner
Reading independently on topics related to patient case material and search primary sources
Demonstrating courteous and collegial behavior with laboratory staff (laboratory supervisor will evaluate resident based on input from laboratory personnel)
Following up on all assigned coagulation cases until the case is completely signed-out with the Attending pathologist
Systems-Based Practice
Understand the fundamentals of laboratory accreditation and regulatory requirements and how the College of American Pathologists Laboratory Accreditation Program affects the health care organization, and their own practice by:
Review recent CAP proficiency testing programs results for coagulation for UHCMC
Performing a "mock" CAP inspection of the coagulation laboratories
Preparation of a report of the "mock" inspection findings
Presentation of the "mock" inspection findings and report to the coagulation supervisor and pathology attending
Having a working knowledge of and familiarity with the Laboratory Information System (LIS) and entry/retrieval of laboratory results and familiarity with Hospital Information System (HIS) for retrieval of clinical information on patients
Generating via the LIS on daily basis a list of special coagulation tests ordered ("Queue") and then reviewing each case for appropriateness of specialty coagulation tests ordered. After discussion with the pathology attending, with approval of the pathology attending the pathology resident may contact the ordering physician to discuss the tests ordered and if tests are recommended
Designing a change control packet for a mock new test including elements required for bringing up a new test
Understanding cost-effective laboratory evaluation of coagulation disorders.
Duration
The Coagulation rotation is taught as a one-month rotation.
Duties and Responsibilities by Year
Review all procedures in coagulation and special coagulation laboratories
Arrange and attend bench instruction with the coagulation technical coordinator for bench time & observation of each of the routine and special coagulation tests performed
Daily review of Quality Control results for special coagulation assays
Attendance at monthly Quality Control review meeting
Daily preparation, review and sign out of "Review queue" special coagulation cases with the Attending Pathologist.
Coordinating a mutually convenient sign-out time with pathology attending on coagulation
Answering questions/following up cases for Specialty Coagulation Assays
Reviewing pending coagulation folder and review queue in morning and afternoon daily
Calling clinicians and or chart review to obtain additional information when necessary with attending approval
Complete special coagulation form for each patient case with written preliminary diagnosis on each form prior to attending review
Preview cases and complete path interpretation in LIS prior to attending sign-out
Entering review queue diagnosis/billing codes into LIS after sign-out
Evaluation of "STAT" requests for specialty coagulation testing.
Attendance at clinical pathology conferences, hematology conference, laboratory rounds
Discuss with Hematology fellow before weekly Hematology conference re: cases that will be presented and review results prior to conference with attending
Participation in current coagulation laboratory operations and assistance with projects such as: method validation, implementation of new assays, normal range studies, laboratory assay trouble- shooting, quality assurance, procedure review
Coordinate with pediatric hematology clinical service observation of patient evaluations in hematology clinic
Single page written contribution to coagulation resident's manual on a topic of the resident's choice
Preparation of 1/2 hr presentation to laboratory technologists on coagulation topic - for all three shifts
Teaching Staff
Katharine A. Downes, M.D., Director of Coagulation Laboratories
Harry Taylor, MD, Director of Blood Banking/Transfusion Medicine
Lan Zhou, M.D., Ph.D.
Leah Rainey, MT (ASCP), Technical Coordinator of Coagulation Testing
Sarah Alexander, MD, Division of Pediatric Hematology/Oncology
Brian Berman, MD, Division of Pediatric Hematology/Oncology
Anthony Villella, MD, Division of Pediatric Hematology/Oncology
Supervision and Evaluation
Faculty attendings supervise all aspects of the Coagulation rotation. The pathologist with significant resident contact during the rotation evaluates the rotating residents addressing the above six competency areas. Evaluations are based on daily interaction with residents and "sign-out" activities. In this way, residents receive daily feedback on their interpretations of case material. Residents are assisted by attending staff in preparation of coagulation presentations for laboratory rounds and for the technical staff and receive feedback on their presentations. Residents are evaluated on a monthly basis with regard to competency areas. Evaluations are reviewed with the resident and then forwarded to the Residency Program Director, where they are available for review.