Engaging Fellows in Benign Hematology Education
How to Engage Fellows in
Benign Hematology
Alice J. Cohen, M.D., F.A.C.P.
Newark Beth Israel Medical Center
Associate Clinical Professor of Medicine
Rutgers - New Jersey Medical School
Newark, NJ
Disclosures
None
Scope of the Problem
In 2016:
582 individuals sat for the medical oncology boards
98% pass rate
In 2016:
477 individuals sat for the hematology boards
93% pass rate
18% of trainees are not taking the hematology boards
Cost of each exam: $2255 (both exams: $4310)
Pediatrics has 1 hematology/oncology board exam:
ASPHO states that 75% of all members are certified (cost
only $2900)
Hematology/Oncology
Trainees by Match 2017
Hematology: 15
Hematology/Oncology: 544
Pediatric Hematology/Oncology: 163
In clinical practice – job market appears to be
looking for oncology specialists (one disease
expertise and there are more opportunities
than in benign heme) breast cancer specialist
vs. anemia specialist. Salaries also much
higher for oncologists vs hematologist.
Objectives
To review opportunities to expose trainees
to strong benign hematology education
To discuss trainee engagement program with
benign hematologists at own/affiliated
institutions and with ASH
To review examples of benefits of double
boarding in both hematology and oncology
Early Exposure to Benign
Hematology Clinical Experiences
Outpatient experiences in coagulation including
inpatient and outpatient settings for managing
thrombosis
If available, attend a hemophilia treatment center clinic
or allow an off site rotation
If available, attend a comprehensive sickle cell clinic
either on site or at affiliated institution
Rotation in the blood bank/attend a local blood center
education program
For example, NY Blood Center has a 1 week didactic series
for all trainees in the NYC area
Clinic Experience
Allow more time per patient for fellows,
allowing for better learning experience
Remember that fellows are not physician
extenders
Post clinic conference with faculty and all
fellows to discuss cases and receive
feedback on their management
Increase the comfort level of
trainees with diagnosis of
hematologic conditions
Laboratory
Experiences
Work in a special
coagulation clinic – learn
how to select and
interpret diagnostic assays
and manage
anticoagulation
Spend time in a special
coagulation laboratory and
learn how to perform the
assays
Spend time with
hematopathologists
interpreting flow cytometry
and molecular testing
Morphology Conferences
Group review of peripheral smears and bone marrow
aspirations
Required reading of bone marrow aspirations performed
by trainees with faculty
Use of ASH image bank to assist with confidence in
reading slides
Engage hematopathologists to offer morphology sessions
with hematology fellows to review bone marrow
biopsies, lymph node biopsies and immunohistochemical
stains
Benign Hematology
Quality Improvement Project
Transfusion medicine project- appropriate use of
blood products
Monitoring of anticoagulation – compliance with
standardized order sets
Time to treatment in ED for sickle cell patients
with vaso-occlusive crisis
Monitoring for iron overload in chronically
transfused patients and appropriate use of
chelation therapy
Required Presentations for
Hematology Conferences
Fellows should participate actively in didactic
lectures in hematology program
Case presentations at coagulation/benign
hematology conferences, leukemia/lymphoma
conferences
Deliver lectures for medicine/pediatric residents
and students
Journal club: give hematology equal time to
oncology
Hematology Faculty
Advisors/Mentors
Advisors should meet regularly with first year fellows
Identify and make available mentors for research
projects, including clinical specialists who will work
with fellows on short and long term projects
Assist fellows with writing skills
Discuss job experiences and opportunities
Assist with development of a research project that
allows the fellow to build a career in hematology
research
Program Director Meetings
6 month evaluations to include discussion of benign
hematology experiences in the program
Early discussion of career opportunities/goals in
hematology – including academic, research
(clinical/laboratory based) and clinical practice
(group/private/hospital based
Discuss interest in medical education – hematology is
conducive to a teaching career
Review benefits of dual board certification
Discussion about subspeciality fellowships –BMT,
coagulation, transfusion medicine
Association with ASH
All fellows should become a member of ASH the first
month of fellowship (It’s free!).
Support fellows to attend the ASH annual meeting first
or second year of fellowship; Attend trainee program
activities
Encourage trainees to join trainee council.
Encourage fellows to submit abstracts to ASH and
support them to attend if abstract accepted.
Provide information on ASH/and other opportunities for
grant support.
Maintain funding for cocktail reception!
Attendance at
Subspecialty Conferences
Allow trainees to attend other benign hematology
conferences as attendee.
Examples include: ISTH, Miami Sickle Cell
Conference, HTRS
Encourage fellows to submit abstracts to
subspecialty meetings.
Allows fellows opportunity to meet other
hematologists (smaller setting than ASH).
Hematology Knowledge
Essential to a Career in Oncology
Discussion of the benefits of hematology
training/board certification in future
oncology practice: e.g. knowledge and
management of hematologic toxicities of
chemotherapy (anemia, leukopenia,
thrombocytopenia), TTP, cancer-associated
thrombosis and anticoagulation
management
Examples of Benefits of Boarding
in Hematology
Run the coagulation service and your institution
Medical Director of the Special Coagulation Laboratory
Director of a Hemophilia Treatment Center
Director of a Pediatric or Adult Sickle Cell Treatment Center
Director/Member of the bone marrow transplantation service
Medical director of transfusion service
Director of the leukemia/lymphoma/myeloma/MPN service
Hematology Program Director
Discussion and Questions
What have been your biggest challenges in discussion with
fellows about a career in hematology?
Have you found that hematology/oncology fellows do not
have enough exposure to hematology experiences – benign or
malignant hematology?
Do you think partnering with other programs would offer
additional hematology experiences – online teaching/case
discussions/rotations at other institutions?
What can ASH do to further assist making fellows/faculty
aware of job opportunities in hematology?
Opportunities and strategies to engage trainees in benign hematology education, focusing on the importance of early exposure, clinical experiences, and fostering engagement with benign hematologists. Discusses challenges in the field and the benefits of double boarding in hematology and oncology.
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Presentation Transcript
How to Engage Fellows in Benign Hematology Alice J. Cohen, M.D., F.A.C.P. Newark Beth Israel Medical Center Associate Clinical Professor of Medicine Rutgers - New Jersey Medical School Newark, NJ
Disclosures None
Scope of the Problem In 2016: 582 individuals sat for the medical oncology boards 98% pass rate In 2016: 477 individuals sat for the hematology boards 93% pass rate 18% of trainees are not taking the hematology boards Cost of each exam: $2255 (both exams: $4310) Pediatrics has 1 hematology/oncology board exam: ASPHO states that 75% of all members are certified (cost only $2900)
Hematology/Oncology Trainees by Match 2017 Hematology: 15 Hematology/Oncology: 544 Pediatric Hematology/Oncology: 163 In clinical practice job market appears to be looking for oncology specialists (one disease expertise and there are more opportunities than in benign heme) breast cancer specialist vs. anemia specialist. Salaries also much higher for oncologists vs hematologist.
Objectives To review opportunities to expose trainees to strong benign hematology education To discuss trainee engagement program with benign hematologists at own/affiliated institutions and with ASH To review examples of benefits of double boarding in both hematology and oncology
Early Exposure to Benign Hematology Clinical Experiences Outpatient experiences in coagulation including inpatient and outpatient settings for managing thrombosis If available, attend a hemophilia treatment center clinic or allow an off site rotation If available, attend a comprehensive sickle cell clinic either on site or at affiliated institution Rotation in the blood bank/attend a local blood center education program For example, NY Blood Center has a 1 week didactic series for all trainees in the NYC area
Clinic Experience Allow more time per patient for fellows, allowing for better learning experience Remember that fellows are not physician extenders Post clinic conference with faculty and all fellows to discuss cases and receive feedback on their management
Increase the comfort level of trainees with diagnosis of hematologic conditions
Laboratory Experiences Work in a special coagulation clinic learn how to select and interpret diagnostic assays and manage anticoagulation Spend time in a special coagulation laboratory and learn how to perform the assays Spend time with hematopathologists interpreting flow cytometry and molecular testing
Morphology Conferences Group review of peripheral smears and bone marrow aspirations Required reading of bone marrow aspirations performed by trainees with faculty Use of ASH image bank to assist with confidence in reading slides Engage hematopathologists to offer morphology sessions with hematology fellows to review bone marrow biopsies, lymph node biopsies and immunohistochemical stains
Benign Hematology Quality Improvement Project Transfusion medicine project- appropriate use of blood products Monitoring of anticoagulation compliance with standardized order sets Time to treatment in ED for sickle cell patients with vaso-occlusive crisis Monitoring for iron overload in chronically transfused patients and appropriate use of chelation therapy
Required Presentations for Hematology Conferences Fellows should participate actively in didactic lectures in hematology program Case presentations at coagulation/benign hematology conferences, leukemia/lymphoma conferences Deliver lectures for medicine/pediatric residents and students Journal club: give hematology equal time to oncology
Hematology Faculty Advisors/Mentors Advisors should meet regularly with first year fellows Identify and make available mentors for research projects, including clinical specialists who will work with fellows on short and long term projects Assist fellows with writing skills Discuss job experiences and opportunities Assist with development of a research project that allows the fellow to build a career in hematology research
Program Director Meetings 6 month evaluations to include discussion of benign hematology experiences in the program Early discussion of career opportunities/goals in hematology including academic, research (clinical/laboratory based) and clinical practice (group/private/hospital based Discuss interest in medical education hematology is conducive to a teaching career Review benefits of dual board certification Discussion about subspeciality fellowships BMT, coagulation, transfusion medicine
Association with ASH All fellows should become a member of ASH the first month of fellowship (It s free!). Support fellows to attend the ASH annual meeting first or second year of fellowship; Attend trainee program activities Encourage trainees to join trainee council. Encourage fellows to submit abstracts to ASH and support them to attend if abstract accepted. Provide information on ASH/and other opportunities for grant support.
Attendance at Subspecialty Conferences Allow trainees to attend other benign hematology conferences as attendee. Examples include: ISTH, Miami Sickle Cell Conference, HTRS Encourage fellows to submit abstracts to subspecialty meetings. Allows fellows opportunity to meet other hematologists (smaller setting than ASH).
Hematology Knowledge Essential to a Career in Oncology Discussion of the benefits of hematology training/board certification in future oncology practice: e.g. knowledge and management of hematologic toxicities of chemotherapy (anemia, leukopenia, thrombocytopenia), TTP, cancer-associated thrombosis and anticoagulation management
Examples of Benefits of Boarding in Hematology Run the coagulation service and your institution Medical Director of the Special Coagulation Laboratory Director of a Hemophilia Treatment Center Director of a Pediatric or Adult Sickle Cell Treatment Center Director/Member of the bone marrow transplantation service Medical director of transfusion service Director of the leukemia/lymphoma/myeloma/MPN service Hematology Program Director
Discussion and Questions What have been your biggest challenges in discussion with fellows about a career in hematology? Have you found that hematology/oncology fellows do not have enough exposure to hematology experiences benign or malignant hematology? Do you think partnering with other programs would offer additional hematology experiences online teaching/case discussions/rotations at other institutions? What can ASH do to further assist making fellows/faculty aware of job opportunities in hematology?
