VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
Hematology Pathology Rotation
Description of Rotation or Educational Experience
This rotation in the hematopathology laboratory is designed to help fellows gain a basic understanding of the
preparation and interpretation of the CBC/peripheral blood smear, bone marrow aspirate/biopsy and lymph node,
as well as the cost-effective application of basic and special laboratory data for the diagnosis and treatment of
patients with cytopenias, hemostatic disorders, hematologic neoplasms, and other hematologic disorders. The
rotation is completed in the VCUHS Clinical Laboratories on the second, fifth, and sixth floors of the Clinical Support
Building and will include exposures to the following laboratories:
1)
2)
3)
4)
Laboratory hematology and medical microscopy
Flow cytometry laboratory
Morphologic hematology
Cytogenetics laboratory
Excluding conflicts with the fellow’s hematology-oncology continuity clinic, the fellow should independently examine
the new bone marrow specimens and the peripheral blood smears selected for pathology review each morning.
When reviewing the specimens, the fellow should independently generate a written report of their observations and
interpretation using the morphology atlases and resources in the lab for assistance. These assessments should be
taken to the daily sign-out sessions with the attending pathologist so they can compare their observations and
interpretations to that of the pathologist.
The fellow is expected to independently find the time during the rotation to meet with the laboratory staff in the
hematology, special coagulation, flow cytometry, and cytogenetics laboratories to gain the requisite exposures
necessary to achieve the goals stated below for each section of the rotation’s curriculum.
Location:
Hematopathology Laboratory, Department of Pathology, VCUHS Medical Center
Length of Experience:
2-4 weeks
LABORATORY HEMATOLOGY & MEDICAL MICROSCOPY
The fellow will rotate through the main VCUHS Hematology Laboratory (CSC 6th floor) to familiarize
themselves with laboratory procedures and to gain a basic understanding of laboratory workflow and
management. Technical aspects of the hematology laboratory will be taught via bench rotations and
discussion sessions with technical supervisors. The fellow will also read assigned laboratory procedure
manuals and other material, observe a variety of manual and automated laboratory tests and procedures,
and participate in the interpretation and clinical utilization of laboratory data. The fellow will demonstrate a
competent understanding of the following aspects of essential hematology laboratory assays:
 Clinical utilization and interpretation
 Specimen requirements and stability
 Test method(s) and principle(s)
 Important interferences and contaminants (lipemic, icteric, etc.).
 Physiological variables and pathophysiologic processes that affect results
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 Normal values and ranges, including variations associated with age, gender, and race
 Sensitivity, specificity, and precision (coefficient of variation)
 Technical limitations of the assay in various patient populations, including neonates and children
FLOW CYTOMETRY LABORATORY
This portion of the hematology rotation will occur in the VCUHS Flow Cytometry Laboratory (CSC Building, 5th Floor).
The goal of the two-day rotation is an understanding of the principles of analysis, procedures, and clinical
applications of flow cytometry. At the conclusion of this rotation, the fellows will be expected to understand the
operation of a flow cytometer and flow cytometry laboratory, interpret basic immunophenotypic and other flow
cytometric data, and possess an understanding of how to utilize the services of a flow cytometry laboratory in
routine patient care.
MORPHOLOGIC HEMATOLOGY
This portion of the rotation will occur in the VCUHS Bone Marrow Pathology Laboratory. The goal of this portion of
the rotation is to develop technical proficiency and independence in the preparation of a peripheral blood smear and
bone marrow aspirate slide for morphologic examination. Additionally, the fellow will be introduced to a systematic
approach to the morphologic examination ad interpretation of the peripheral blood smear, bone marrow aspirate,
bone marrow biopsy, and lymph node specimens.
CYTOGENETICS LABORATORY
This portion of the hematology rotation will occur in the VCUHS Molecular Genetics Laboratory. The goal of the twoday rotation is an understanding of the principles of analysis, procedures, and clinical applications of cytogenetics
and molecular genetics. At the conclusion of this rotation, the fellows will be expected to understand the operation
of a molecular genetics laboratory, interpret basic cytogenetic and molecular genetics data, and possess an
understanding of how to utilize the services of a cytogenetics and molecular genetics laboratory in routine patient
care.
Educational Goals
LABORATORY HEMATOLOGY & MEDICAL MICROSCOPY
The rotation will include practical teaching meetings with laboratory supervisors, observation of procedures at the
benches, informal and formal didactic sessions with hematopathology fellows and faculty, case-based learning,
conferences, online training modules, and recommended reading. By the conclusion of the rotation, the fellow is
expected to achieve the following:
 Possess a basic knowledge of the assays performed in the hematology and coagulation laboratory, including
specimen requirements and stability, analytic method(s) and principle(s), important interferences and
contaminants, physiological variations, normal values, clinical utilization and interpretation, best time for
analysis, technical skill level needed, cost, and methods of quality assurance and quality control.
 Possess a detailed knowledge of the common diseases involving the peripheral blood, bone marrow, and
lymph nodes, including anemias, acute/chronic leukemias, myeloproliferative/myelodysplastic diseases,
reactive and malignant diseases involving the lymph nodes, plasma cell neoplasms, and
bleeding/thrombotic diseases. This knowledge will include the clinical characteristics, pathophysiology,
laboratory features, diagnostic evaluation, and basic treatment aspects of each disease.
 Efficiency and safely obtain bone marrow aspirates and biopsies, and prepare high quality marrow
aspirate and peripheral blood smears for examination.
 Understand the handling, processing, and staining of bone marrow and lymphoid tissue for
pathologic review.
 Efficiently examine peripheral blood smears, bone marrow specimens, lymph nodes, and other
hematologic specimens and render an accurate diagnosis.
 Understand the role of immunophenotypic analysis by flow cytometry and immunohistochemical
staining in the diagnosis of hematologic diseases, how these procedures are performed and
interpreted, and the reactivity of the important monoclonal antibodies used for hematologic
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diagnosis.
FLOW CYTOMETRY LABORATORY
During the rotation, the fellows will work in the flow cytometry laboratory to become familiar with the technical
aspects of flow cytometry (i.e., specimen preparation, staining procedures, instrumentation, reagents, instrumental
analysis, and data display and analysis), as well as the specific protocols used for immunophenotyping of
hematopoietic cells. The resident will attend the daily hematopathology case signout and present relevant case flow
cytometry data in the context of other laboratory, histology, molecular and clinical information available.
MORPHOLOGIC HEMATOLOGY
This portion of the Hematology rotation will occur in the VCUHS Main Hematology and Bone Marrow Laboratory
(CSC Building, 6th Floor). The objectives of this unit are to provide fellows with an understanding of the routine and
special procedures and methodologies used in the general hematology and bone marrow laboratory. During this
fourteen day period, the fellows will:
• Learn the indications for, and methods of obtaining, preparing, staining, and examining peripheral
blood and bone marrow and specimens.
• Learn to recognize all normal and many pathologic cell types in the peripheral blood and bone
marrow; learn to perform a differential count.
• Learn the indications and procedure for performing a bone marrow aspirate and biopsy; observe
several bone marrow procedures performed by the fellows and faculty; and assist in the
performance of bone marrow aspirates and biopsies.
• Assist the senior residents, hematopathology fellows, and faculty in the interpretation of bone
marrow aspirates and biopsies.
• Learn the appropriate utilization of ancillary techniques (i.e., flow cytometry,
immunohistochemical, cytogenetic, molecular, microbiological, etc.) in hematologic diagnosis.
• Learn the basics of lymph node interpretation.
CYTOGENETICS LABORATORY
This portion of the hematology rotation will occur in the VCUHS Molecular Genetics Laboratory. The goal of the twoday rotation is an understanding of the principles of analysis, procedures, and clinical applications of cytogenetics
and molecular genetics. At the conclusion of this rotation, the fellows will be expected to understand the operation
of a molecular genetics laboratory, interpret basic cytogenetic and molecular genetics data, and possess an
understanding of how to utilize the services of a cytogenetics and molecular genetics laboratory in routine patient
care.
 Understand the role of karyotypic analysis in the evaluation of hematologic malignancies. This will
include the specimen requirements for karyotypic analysis, the technical aspects of performing and
interpreting karyotypic analysis (including tissue culture, cell harvest, slide preparations, banding,
special staining, microscopy, and computer assisted karyotyping), and the diagnostic and
prognostic significance of the most common translocations, deletions, inversions, etc. identified by
karyotypic analysis.
 Understand the role of basic molecular procedures (FISH and PCR) in the evaluation of hematologic
malignancies. This will include specimen requirements, basic technical aspects of performing and
interpreting FISH and PCR, and the diagnostic and prognostic significance of the most common
molecular abnormalities found in hematologic diseases.
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Patient Care
LABORATORY HEMATOLOGY & MEDICAL MICROSCOPY
Goal
Fellows must provide patient care that is compassionate, appropriate, and effective for the treatment of
health problems and the promotion of health. In the laboratory, the fellow must demonstrate a satisfactory
level of diagnostic competence and effective consultation in duties assigned by the senior technologists or
attending faculty.
Competencies
Fellows are expected to:
 Assisting in the interpretation and appropriate clinical utilization of laboratory data.
 Gathering essential and accurate information from other health care providers.
 Assisting in quality control and quality assurance procedures, and the evaluation of the results of
such procedures.
FLOW CYTOMETRY LABORATORY
Fellows must provide patient care that is compassionate, appropriate, and effective for the treatment of
health problems and the promotion of health. In the laboratory, the fellow must demonstrate a satisfactory
level of diagnostic competence and effective consultation in duties assigned by the senior technologists or
attending faculty.
Competencies
Fellows are expected to:
 Participate in the analysis of patient specimens using flow cytometry.
 Understand the value of flow cytometry as a patient care diagnostic tool.
 Learn how to interpret flow cytometry results and correlate those findings with morphology and with other
clinical and laboratory data.
 Understand the criteria for the selection of cell markers based on clinical indications.
MORPHOLOGIC HEMATOLOGY
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the
treatment of health problems and the promotion of health. In the laboratory, the fellow must demonstrate
a satisfactory level of diagnostic competence and effective consultation in diagnostic hematology.
Competencies
Fellows are expected to:
 Assist the laboratory faculty, fellows, and staff in the performance and interpretation of blood
smears, body fluids, bone marrow aspirates/biopsies, and other hematologic specimens.
 Evaluate all abnormal slides referred to the pathologist throughout the rotation. Slides for
pathologist review are placed in the slide consultation basket in bone marrow laboratory by the
laboratory staff. When slides are present, the fellow should obtain clinical information about the
patient, including prior pathologic evaluations, and perform a microscopic review of the slide. If a
differential count is not available, or the available differential count appears incorrect, the fellow
should perform a 100-200 cell differential. The fellow should formulate a differential diagnosis and
then review the case with the attending hematopathologist. This review is an essential part of the
laboratory’s function since the slide reviews are often the first place where an abnormality is
detected.
 Attend and assist in the performance of bone marrow aspirates and biopsies in selected cases. For
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cases assigned to the fellow by the fellows or attending pathologist, they will:
Obtain sufficient history from computer or physician’s office to understand the reason for the bone
marrow request and to identify any coexistent disease process, such as coagulation diseases, drug
administration (especially anticoagulants!), extreme obesity, allergies (especially lidocaine and
latex) that might effect bone marrow interpretation or pose a risk during specimen procurement.
The fellow should obtain appropriate laboratory data, including the CBC, folate, B 12, and iron in
anemias or macrocytosis. If available, the fellow should available peripheral blood smears. These
findings should be discussed with fellows or attending pathologist prior to attending/performing
the bone marrow procedure.
 Assist and/or perform the patient interview, written consent, time-out, and procurement of the
bone marrow aspirate and biopsy.
 Observe bone marrow the processing and staining of the bone marrow specimens with the bone
marrow laboratory staff, and will assist the fellow or attending hematopathologist in requesting
appropriate ancillary studies such as flow cytometry, cytogenetics, FISH, molecular diagnostics, or
immunohistochemical/special stains.
 Evaluate the assigned two bone marrow cases per day. In these cases, the fellow will:
 Review prior bone marrow and surgical pathology reports in each assigned case, and
obtain prior relevant microscope slides (especially the original diagnostic and most
recent slides), if available.
 Microscopically evaluate the peripheral blood smear, bone marrow aspirate smears
and biopsies.
 Gather and interpret any ancillary studies that have been performed, such as flow
cytometry, immunohistochemical stains, molecular diagnostic studies, etc.
 Assist the hematopathology fellow in the completion of the written report form and
review case with the hematopathology fellow or attending hematopathologist.
 Attend the weekly Hematopathology Consensus Conference (Wednesday, 1330, Bone Marrow
Laboratory), and if possible, the weekly Morphology Conference (Thursday, 1400, Bone Marrow
Laboratory), and any special events related to hematology (i.e., guest lectures, ASCP
teleconferences, etc.).
• Understand gross processing and triaging of fresh lymph nodes and spleens and other specimens
with possible hematopoietic/lymphoid disorders.
• Review lymph node, spleen and extranodal specimens with possible hematopoietic/lymphoid
disorders with the fellows and/or attending hematopathologist.
• Keep a list of cases that you have worked on and return it to the hematopathology residency
coordinator at the completion of the rotation.

CYTOGENETICS AND MOLECULAR GENETICS LABORATORY
Fellows must provide patient care that is compassionate, appropriate, and effective for the treatment of
health problems and the promotion of health. In the laboratory, the fellow must demonstrate a satisfactory
level of diagnostic competence and effective consultation in duties assigned by the senior technologists or
attending faculty.
Competencies
Fellows are expected to:
 Describe the principles of analysis, procedures, and clinical applications of cytogenetics and molecular
genetics.
 Describe the operation of a molecular genetics laboratory,
 Interpret basic cytogenetic and molecular genetics data, and possess an understanding of how to utilize the
services of a cytogenetics and molecular genetics laboratory in routine patient care.
Medical Knowledge
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LABORATORY HEMATOLOGY & MEDICAL MICROSCOPY
Goal
The fellow must acquire and demonstrate appropriate knowledge about established and evolving biomedical
techniques and procedures and their practical application to the analysis of blood and other body fluids and develop
an investigative and analytic thinking approach to problems arising in the hematology laboratory.
Objectives
Fellows are expected to:
 Understand the technical principles of operation instrumentation, quality assurance/quality control, and
limitations of the automated multiparametric hematology analyzers used to determine blood counts. To
achieve this goal, the fellow will acquire experience in multiparametric instrument analysis and data
interpretation.
 Learn the essential facts (method(s) and principle(s) (outlined above) of each major parameter determined
and reported with the automated hematology analyzer, including the white blood count (WBC), red blood
cell count (RBC), hemoglobin (Hgb), hematocrit (Hct), MCV, MCH, MCHC, platelet count, mean platelet
volume (MPV), and reticulocyte count.
 Understand the importance of age and gender-specific reference ranges, especially the variation between
adult and pediatric values.
 Understand the flagging criteria reported for abnormal blood specimens, and the criteria for further
investigation of these specimens, including the preparation and review of peripheral blood smears by the
technologist and/or pathologist.
 Understand whole blood and commercial product calibration for automated hematology assays and the
interpretation of quality control data (i.e., moving averages, commercial controls, Levy-Jenning QC points,
etc.).
 Understand important manual assays performed in the hematology laboratory, including including the
erythrocyte sedimentation rate (ESR), reticulocyte count, sickle cell preparation, and WBC/platelet counts
estimated from the peripheral blood smear or determined by manual methodology.
 Develop the skills to examine and interpret a peripheral blood smear, estimate the white blood cell and
platelet count, and identify significant findings, including variations in erythrocytic, leukocytic, and platelet
morphology, blasts, parasites, and intraleukocytic inclusions.
FLOW CYTOMETRY LABORATORY
Goal
Fellows are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences
and the application of their knowledge to patient care and the education of others.
Objectives
All fellows are expected to:
 Acquire a core knowledge of flow cytometric principles and practice
 Understand the specimen requirements for immunophenotypic analysis and other types of flow cytometric
analysis, and the importance and technique of cell viability determination.
 Understand the principles of operation of the multi-color flow cytometer, including the specimen delivery
system/flow cell, lasers, optics and electronics for data collection.
 Understand basic hematopoiesis and the principles and stages of hematopoietic cell maturation and
development.
 Understand the importance of immunophenotypic characterization of normal and aberrant hematopoietic
cell populations as a clinical and research tool.
 Understand the use of flow cytometry as a diagnostic tool
 Understand the importance of immunophenotypic analysis in detecting abnormal cell subsets in patients
with hematopoietic malignancies.
 Learn the normal pattern of cell marker expression in the peripheral blood, bone marrow, and lymph node,
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and the abnormalities most commonly detected in patients with acute and chronic leukemia, lymphoma,
plasma cell neoplasms, and other hematopoietic malignancies.
Understand special circumstances in immunophenotypic analysis and data interpretation, including the
effects of drugs such as Rituximab, Campath, and Myelotarg, and the application of flow cytometry to
monitor the efficacy of those drugs.
Understand the importance of multicolor flow cytometry as a highly sensitive technique in the detection of
minimal residual disease.
Understand the importance and practice application of flow cytometry in the quantitation of CD34+ cells in
donor cell stem cell collections for bone marrow transplantation.
MORPHOLOGIC HEMATOLOGY
Goal
The fellow must acquire and demonstrate appropriate knowledge about established and evolving
biomedical techniques and procedures and their practical application to the analysis of blood and other
body fluids and develop an investigative and analytic thinking approach to problems arising in the
hematology laboratory.
Objectives
All fellows are expected to:
• Identify and troubleshoot potential problems in the acquisition and laboratory analysis of
peripheral blood, bone marrow, urine, and body fluid specimens.
• Accurately interpret a peripheral blood smear and provide a differential diagnosis based on CBC
data.
• Accurately identify changes in red blood cells and white blood cells on a peripheral smear, and
offer possible pathophysiologic causes (e.g. GM-CSF effect).
• Know the medical indications for performing a bone marrow procedures, how to obtain patient
consent, and possible procedural complications. Be able to perform a bone marrow aspirate and
biopsy.
• Recognize all normal hematopoietic cell types at all stages of maturation in the bone marrow and
how normal pediatric blood and bone marrow differ from those of adults.
• Know how bone marrow specimens are processed and stained (Wright-Giemsa stain, Prussian blue
stain, decalcification, etc.).
• Understand how bone marrow specimens are collected for ancillary studies such as cytogenetics,
FISH, molecular diagnostic studies, cultures, etc.
• Know the reactivity of all essential antibodies used in routine flow cytometry and
immunohistochemical panels to assess hematopoietic/lymphoid disorders in lymph node, spleen,
and other extranodal sites.
• Know immunophenotype of normal hematopoietic elements, and confidently interpret flow
cytometry data including histograms/dot plots in cases of acute and chronic leukemia and other
diseases.
• Know role of cytogenetics and molecular diagnostic studies in evaluation hematopoietic/lymphoid
disorders in bone marrow and blood.
• Know normal architecture and immunoarchitecture of lymph node, spleen, and Peyer’s Patch.
• Understand how clinical hematology is practiced including, patient concerns and what information
clinicians need from pathologists.
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CYTOGENETICS AND MOLECULAR GENETICS LABORATORY
Goal
Fellows are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences
and the application of their knowledge to patient care and the education of others.
Objectives
All fellows are expected to:
 Acquire a core knowledge of cytogenetics and molecular genetics principles and practice
 Understand the specimen requirements for cytogenetics and molecular genetics
 Understand the importance of cytogenetics and molecular genetics characterization of normal and aberrant
hematopoietic cell populations as a clinical and research tool.
 Understand the use of cytogenetics and molecular genetics as a diagnostic tool
 Understand the importance and limits of cytogenetics and molecular genetics analysis in detecting
abnormal cell subsets in patients with hematopoietic malignancies.
 Learn the cytogenetics and molecular genetic abnormalities most commonly detected in patients with acute
and chronic leukemia, lymphoma, plasma cell neoplasms, and other hematopoietic malignancies.
 Understand the impact of cytogenetics and molecular genetics in selecting a patient-centered individual
treatment plan in the management of hematologic malignancies
 Understand the importance and limits of cytogenetics and molecular genetics as technique in the detection
of minimal residual disease
Practice- Based Learning and Improvement
Goal
Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate
scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.
The fellow is expected to present primary scientific and medical evidence to support their conclusions and care plans
in the diagnosis, prognosis, management, and monitoring of the patients on the service. The fellow is expected to
recognize their areas of deficiency. Depending upon the acuity of the care situation, the fellow is expected to be
able to effectively utilize their resources to arrive at necessary information and to apply the information to their
patient care. Moreover, the fellow is expected to recognize conditions and circumstances requiring escalation.
The fellow is expected during this rotation to develop skills and habits to be able to:
 Identify and remediate gaps in personal medical knowledge of hematology assays, morphology, and
ancillary techniques and develop a personal strategy to maintain and update medical knowledge regularly.
 Understand the principles of quality control and quality assurance in the hematology laboratory, and the
practical ability to recognize and apply these principles in laboratory analysis.
 Develop the ability to collect and evaluate medical evidence regarding laboratory assays in terms of their
analytical performance, clinical utility, and cost-effectiveness.
 Develop the ability to use laboratory resources and other information to investigate clinical questions.
 Develop the skills to locate, appraise, and assimilate patient medical information, scientific evidence, and
laboratory resources into diagnostic practice using a systemic methodology.
 Demonstrate an investigative and analytic thinking approach to clinical and pathologic problems.
 Develop the ability to use laboratory problems and clinical inquiries to identify process improvements that
may minimize opportunities for medical errors.
Please refer to overview of the fellowship curriculum for competencies/objectives for practice based learning and
improvement.
Systems Based Practice
Goal
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as
well as the ability to call effectively on other resources in the system to provide optimal health care. Fellows will
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work within a multidisciplinary team of health professionals including physicians, PhD professionals, laboratory
technicians, and administrative personnel. This will provide the fellow experience and feedback in effectively
working within a multi-disciplinary team of health professionals. Additionally, working with the context of a broader
health system includes the importance and necessity to recognize conditions and circumstances requiring
consultation and/or escalation for the effective and safe delivery of patient-centered medical care.
During the rotation, the fellow will focus on the following topics:
• Understanding the role of the laboratory in the health care system, and the importance of reliable, costeffective and timely laboratory results in clinical decision-making.
• Learn the working structure of the various hematology laboratories as well as the types of personnelincluding educational and certification requirements involved in providing hematology services.
• Develop a basic understanding of national regulatory requirements (CLIA, CAP and JCAHO) for clinical
laboratories, especially regulations unique to the hematology laboratory. At times, they will also perform
inspections of the Hematology Laboratory using the CAP Hematology Inspection check list and will discuss
their finding with a staff pathologist.
 Effectively using the Laboratory Information System (LIS) and entry/retrieval of laboratory results and
familiarity with the Hospital Information System (HIS) for retrieval of clinical information on patients.
 Understanding the steps in specimen handling and processing through the triage department and the
criteria for sample rejection (observation and procedure review), recommend changes in laboratory
procedures/policies.
• Enhance patient outcomes by collaborating with other laboratorians, clinicians, and administrators, and
others to generate ideas for improving hematology laboratory services.
• Understand the need for cost effective laboratory utilization and resource allocation.
Please refer to overview of the fellowship curriculum for competencies/objectives for systems based practice.
Professionalism
Goal
Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical
principles. The fellow is expected to model professional and courteous behavior in the treatment of the patient and
in working with the entire health care team. The fellow is expected to complete documentation of their patient care,
of their communications with the patient and health care providers, and of their procedures in a timely fashion
within the medical record. The fellow is also expected to recognize the critical importance of their own education
and the importance of life-long learning as part of their professional responsibility. As such, it is the obligation of the
fellow to themselves, their profession, and their patients to attend and complete in a timely fashion all of fellowship
training program’s expected educational activities.
During this rotation, the fellow will demonstrate:
• Knowledge and understanding of ethical issues affecting the clinical laboratory.
• Maintenance of confidentiality of patient information.
• Respectful behavior towards all patients and medical personnel.
• A prompt and courteous response to all pager and telephone calls.
• Regular, punctual attendance and participation in rounds, conferences, meetings and rotation
responsibilities.
Reliably
completing each assigned task and thoroughly completing all case analyses.

Being
available
and visible in the laboratory as required.

Please refer to overview of the fellowship curriculum for competencies/objectives for professionalism.
Interpersonal and Communication Skills
9
Goal
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of
information and collaboration with patients, their families, and health professionals.
During this rotation, the fellow is expected to:
• Demonstrate effective verbal and written communication skills, especially the ability to communicate
clearly and effectively with clinicians, other housestaff, medical technologists and other medical personnel.
• Develop the ability to prepare and deliver effective oral presentations, to other health care professionals,
especially the presentation of laboratory data at interdisciplinary clinical conferences such as the VCUHS
Hematopathology Conference.
• Demonstrate a caring attitude and respectful behavior with everyone they contact.
• Demonstrate the efficient and appropriate use of information technology and other means of
communication (direct, telephone, e-mail, written) to obtain, investigate, and communicate accurate
medical information.
• Work effectively with other health care professionals to provide patient focused care.
Please refer to overview of the fellowship curriculum for competencies/objectives for interpersonal and
communication skills.
Teaching Methods
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Observation of laboratory procedures and techniques
Hands-on preparation of specimens
Independent interpretation of pathology specimens under the supervision of an attending
pathologist
Didactics
Performance feedback
Self-directed readings
Assessment of Fellow Performance
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
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Daily feedback on accuracy and quality of specimen interpretation and pathology consultation reports
(morphology days of rotation)
End-of-rotation evaluation of the fellow by the supervising attending physicians
Semi-annual self-assessment by the fellow
Assessment of Rotation
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End-of-rotation evaluation of the supervising attending physicians by the fellow
Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision
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Direct supervision by the pathology department faculty during the morphology portions of the rotation.
Direct supervision by the pathology department faculty, fellows, and/or laboratory professionals during the
laboratory hematology, flow cytometry, and cytogenetics/molecular genetics portions of the rotation.
Educational Resources
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LABORATORY HEMATOLOGY & MEDICAL MICROSCOPY
Reading Assignments (* = Required)
Journal Articles
*Barnes PW et al. The International Consensus Group for Hematology review: Suggested criteria for action following
automated CBC and WBC differential analysis. Lab. Hematol. 11:83-90, 2005.
*Buttarello M and Plebani M. Automated blood cell counts: State of the art. Am. J. Clin. Pathol. 130:104-116, 2008.
*Tefferi A. et al. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin. Proc. 80(7):923-936, 2005.
Zandecki M et al. Spurious counts and spurious results on haematology analysers: a review. Part I: Platelets. Int. Jnl.
Lab. Hem. 29:4–20, 2007.
Zandecki M. et al. Spurious counts and spurious results on haematology analysers: a review. Part II: White blood
cells, red blood cells, haemoglobin, red cell indices and reticulocytes. Int. Jnl. Lab. Hem. 29:21–41, 2007.
Book Chapters
Read and understand the following:
Henry, John Bernard (ed.), Clinical Diagnosis and Management by Laboratory Methods, 21st Edition.
Philadelphia: WB Saunders, 2007:
o
Chapter #27. Basic Examination of Urine
o
Chapter #28. Cerebrospinal, Synovial, and Serous Body Fluids
Hippel TG. Routine testing in hematology (Chapter #14). In: Rodak BF, Fritsma GA, and Doig K. Hematology: Clinical
Principles and Applications, 2007, pp. 160-174. (Complete quiz at end of chapter)
Color Atlas of Body Fluids. An Illustrated Field Guide Based on Proficiency Testing. Katherine A. Galagan, David
Blomberg, P. Joanne Cornbleet, and Eric F. Glassy, Editors, 2006.
Burns S. Quality assurance (Chapter #5). In: Rodak BF, Fritsma GA, and Doig K. Hematology: Clinical Principles and
Applications, 2007, pp. 39-49. (Complete quiz at end of chapter)
Longanbach SA et al. Automated cell counting instrumentation and point of care testing. In: Rodak BF, Fritsma GA,
and Doig K. Hematology: Clinical Principles and Applications, 2007, pp. 541-570. (Complete quiz at end of chapter).
DVDs/CDs
Laboratory Medicine: Urinalysis, Pesce Kaplan Publishers, Version 5.1.
Wood B. et al. Serous fluid, Medical Training Solutions, Inc. (DVD must be signed out from Kathy Corker)(Complete
exams 1 and 2).
Wood B. et al. Cerebrospinal fluid, Medical Training Solutions, Inc. (DVD must be signed out from Kathy Corker).
FLOW CYTOMETRY LABORATORY
Videos/Courses
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
Fluorescence tutorials (5 flash videos) at http://www.invitrogen.com/ site/us/en/home/support
Tutorials.html (Introduction, Spectra, Light filters and sources, Introduction to flow cytometry, Data
analysis).
BD Biosciences. Introduction to Flow Cytometry: A Learning Guide, 2000.
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Books
Flow Cytometry in Clinical Diagnosis by Carey, JL et al. ASCP Press, Fourth Edition, 2007.
Flow Cytometry in Hematopathology: A Visual Approach to Data Analysis and Interpretation (Current Clinical
Pathology) by Nguyen, DT, Diamond, LW, and Braylan, RC. Humana Press, Second Edition, 2007.
Flow Cytometry and Immunohistochemistry for Hematologic Neoplasms by Sun, T. Lippincott Williams & Wilkins,
First Edition, 2007.
Clinical Applications of Flow Cytometry by Riley, R.S. et al. Igaku Shoin, First Edition, 1993.
Journal Articles
Al-Mawali A, To LB, Gillis D, Hissaria P, Mundy J, Lewis I. The presence of leukaemia-associated phenotypes is an
independent predictor of induction failure in acute myeloid leukaemia. Int. J. Lab. Hematol. 31:61-68, 2009.
Al-Mawali A, Gillis D, Lewis I. The role of multiparameter flow cytometry for detection of minimal residual disease in
acute myeloid leukemia. Am. J. Clin. Pathol. 131:16-26, 2009.
Kern, W. et al. The role of multiparameter flow cytometry for disease monitoring in AML Best Pract. Res. Clin.
Haematol. 23(3):379, 2010.
Tung, J.W. et al. Modern flow cytometry: A practical approach. Clin. Lab. Med. 27(3):453, 2007.
Craig FE, Foon KA. Flow cytometric immunophenotyping for hematologic neoplasms. Blood. 111:3941-3967, 2008.
Perkel, J.M. Cytometry For The Next Generation. Science. 330 (6005:853, 2010.
Wood BL, Arroz M, Barnett D et al. 2006 Bethesda International Consensus recommendations on the
immunophenotypic analysis of hematolymphoid neoplasia by flow cytometry: optimal reagents and
reporting for the flow cytometric diagnosis of hematopoietic neoplasia. Cytometry B Clin. Cytom. 72(Suppl
1):S14-22, 2007.
Kroft, S.H. Role of flow cytometry in pediatric hematopathology. Am. J. Clin. Pathol. 122 (Suppl 1):S19-S32, 2004.
Oldaker TA. Quality control in clinical flow cytometry. Clin. Lab. Med. 27:671-85, 2007.
Henel G, Schmitz J. Basic theory and clinical applications of flow cytometry. Lab. Med. 36:428-436, 2007.
Craig FE. Flow cytometric evaluation of B-cell lymphoid neoplasms. Clin. Lab. Med. 27:487-512, 2007.
Cady FM, Morice WG. Flow cytometric assessment of T-cell chronic lymphoproliferative disorders. Clin. Lab. Med.
27:513-32, 2007.
Qadir M, Barcos M, Stewart CC, Sait SN, Ford LA, Baer MR. Routine immunophenotyping in acute leukemia: Role in
lineage assignment and reassignment. Cytometry B Clin Cytom. 70:329-334, 2006.
Herzenberg LA, Tung J, Moore WA, Herzenberg LA, Parks DR. Interpreting flow cytometry data: a guide for the
perplexed. Nat Immunol. 7:681-685, 2006.
Herzenberg LA and Herzenberg LA. Genetics, FACS, Immunology, and Redox: A Tale of Two Lives Intertwined. Annu.
Rev. Immunol. 22:1–31, 2004.
Oliveira JB et al. Applications of flow cytometry for the study of primary immune deficiencies. Curr. Opin. Allergy Clin.
Immunol. 8(6):499-509, 2008.
Lamb LS, Jr. Hematopoietic cellular therapy: implications for the flow cytometry laboratory. Hematol. Oncol. Clin.
North Am. 16(2):455-476, 2002.
MORPHOLOGIC HEMATOLOGY
Reading Assignments (* = Required)
12
Books and Book Chapters
*Henry, John Bernard (ed.), Clinical Diagnosis and Management by Laboratory Methods, 21st Edition.
Philadelphia: WB Saunders, 2007:
* Chapter 30 Hematopoiesis
*Chapter 31 Erythrocytic Disorders
*Chapter 32 Leukocytic Disorders
Color Atlas of Hematology. An Illustrated Field Guide Based on Proficiency Testing. Eric F. Glassy, Editor, 1998.
Jaffe, E.S. et al. Hematopathology: Expert Consult. Saunders, 2010.
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Steven H. Swerdlow, et al, Editors, 2008.
Gulati, G. and Caro, J. Blood Cells: An Atlas of Morphology with Clinical Relevance. ASCP, 2007.
Kjeldsberg, C.R. (ed.) Practical Diagnosis of Hematologic Disorders, ASCP, 4th edition., 2006.
Foucar, K. et al. Bone Marrow Pathology, 3rd ed., ASCP, 2010.
Orkin, SH, et al. and Nathan, D.G. Nathan and Oski’s Hematology of Infancy and Childhood, Saunders, 7 th Edition,
2008.
Penchansky L. Pediatric Bone Marrow, Springer, 2004.
Ioachim, H.L. and Medeiros, L.J. Ioachim’s Lymph Node Pathology, Lippincott Williams & Wilkin, 4 th edition. 2008.
O’Malley, D.P. et al. Benign and Reactive Conditions of Lymph Node and Spleen. American Registry of Pathology,
2009.
Foucar, K. et al. Non-Neoplastic Disorders of Bone Marrow (Atlas of Nontumor Pathology). American Registry of
Pathology, 2009.
Dunphy, C.H. Integrated Hematopathology: Morphology and FCI with IHC. ASCP, 2009.
Last revised July 26, 2014 -- JCB
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