The Hematopathology program at the MGH seeks to train individuals who will become leaders in the field of hematopathology. Leadership can involve generation of new knowledge in the form of basic or clinical research, dissemination of knowledge through teaching of medical students, trainees, or practitioners of either pathology or clinical medicine, and the provision of high-quality, state-of-the-art patient care. The philosophy of post-graduate Pathology training in our department is based on the premise that trainees learn best by being exposed to a wide variety and large volume of clinical material and by having a level of responsibility appropriate to their level of experience.
Training in both the Anatomic and Clinical Laboratories involves consistent exposure to and responsibility for clinical specimens, with supervision and backup from faculty. The trainee’s involvement with challenging consultation cases from pathologists around the world gives him/her insight into some of the most difficult issues in hematopathology diagnosis as well as the role academic institutions play in making their expertise available to other institutions within the health care delivery system. Communication with clinical colleagues in the course of patient care is an important part of this experience. Fellows are given enough responsibility to test their knowledge and decision-making capacities. Every case and every decision is reviewed by a senior pathologist, who corrects and gives feedback on the fellow’s judgments and performance. In this way, the interests of patient care are served and the fellow's communication skills and overall professional development are monitored.
Fellows must also learn to critically evaluate the literature, practice evidence-based medicine, and present laboratory and other data at conferences; these activities are incorporated into the daily responsibilities of our trainees. Fellows are expected to design and carry out at least one independent clinical or basic research project, thereby teaching them the use of scientific evidence and application of research methods to advance the field.
Types and Numbers of Appointments
There are two Hematopathology fellowship positions each year.
Through the individual components of the fellowship over the course of the year, the fellow is expected to develop competency in (and is continually evaluated in) the following:
- Patient care (case ownership, responsibility, and teamwork)
- Medical knowledge in all aspects of hematopathology
- Ability to continually learn and improve his/her practice (by analyzing his/her own clinical and research experiences, incorporating information from didactic lectures, conferences, and evaluations, and practicing evidence-based medicine)
- Interpersonal and communication skills (teaching, learning, clear diagnosis, and effective interaction with patients and members of the health care system)
- Professionalism (ethical behavior, maturity, and respect for patients and members of the health care system)
- Systems-based practice (using hospital and pathology information systems, practicing cost-effective care, and understanding the role of hematopathology in the hospital and overall health care system).
Applicants must be Board-certified or eligible for certification in AP or AP/CP, and if a graduate of an international medical school, have a valid ECFMG certificate and visa and have a Massachusetts license prior to starting the fellowship.
Applicants for fellowships in Hematopathology must 1) have completed residency training in Anatomic or in Anatomic and Clinical Pathology acceptable to the American Board of Pathology, and be eligible for 2) employment and 3) medical licensure in Massachusetts.
Graduates of an international medical school must have a valid ECFMG certificate and visa and a Massachusetts medical license prior to starting the fellowship.
Goals and Objectives
The goals and objectives of this fellowship are:
To develop medical knowledge in the techniques of bone marrow aspiration and biopsy and their interpretation, lymph node interpretation, coagulation testing, cell analysis systems, peripheral smear and body fluid morphology interpretation, and the applications of advanced technology (including in-situ hybridization, immunocytochemistry, cytogenetics, and molecular diagnosis), to hematologic problems of both adults and children.
To become proficient in the diagnosis and classification of hematologic malignancies, and of non-neoplastic diseases of hematopoietic and lymphoid tissues and peripheral blood.
To be able to effectively and in a timely fashion communicate hematopathologic diagnoses by formulating an interpretive report that will provide, in a clear, concise, and complete form, the information needed by clinicians to proceed in the management of the patient.
To learn the appropriate, cost-effective performance and interpretation of techniques utilized in the diagnosis of hematologic diseases, including cytochemistry, flow cytometry, immunohistochemistry, cytogenetics, fluorescence in-situ hybridization (FISH), molecular diagnostics, automated cell counting, hemoglobin electrophoresis, and coagulation testing, and to understand the role of these tests in the overall health care delivery system.
To be able to use effectively hospital information technology systems to construct and communicate hematopathologic diagnoses, including integrating laboratory studies and clinical information with morphologic findings and proficiently using pathology information systems.
To become a proficient communicator in the presentation of information at clinical conferences and scientific meetings.
To learn to professionally interact with and effectively teach residents, medical students, clinical colleagues, and ancillary laboratory staff and to respect the input and effectively learn from other members of the health care system.
To be able to effectively access pertinent scientific literature, analyze the literature critically, integrate new information in an ongoing fashion into diagnostic decision-making, and use systems-based resources to improve one's practice.
To have an understanding of the principles of clinical investigation, including the ability to design, carry out and publish studies using patient-related information to advance knowledge or to disseminate existing knowledge in the specialty.
To develop an understanding of issues involved with managing a diagnostic hematopathology service, a flow cytometry laboratory, and a hematology/coagulation laboratory and to understand the function of these services in the hospital and overall health care delivery system.
Structure of the Hematopathology Program
The most difficult area of hematopathology is the diagnosis and classification of hematologic malignancies and their precursors in bone marrow, lymph nodes and other tissue biopsy specimens. To acquire proficiency in this area requires consistent supervised exposure to diagnostic specimens over as long a period as possible. For this reason, the largest amount of time in the 1-year program is spent on the Hematopathology Service. This service is responsible for all bone marrow, lymph node, spleen, and thymus specimens, as well as blood and body fluid specimens requiring pathologist interpretation and specimens from other services with extranodal lymphoid infiltrates and lymphomas. The fellow is assigned to this service for 28 weeks, spread throughout the 12-month fellowship. The remaining weeks include assigned time to be spent in the other laboratories (Hematology, Coagulation, Flow Cytometry, Immunopathology, Molecular Diagnostics and Cytogenetics), at Children's Hospital Boston to acquire additional experience in pediatric hematopathology, and on a clinical service (Leukemia, Lymphoma, Bone Marrow Transplant, and/or Hematology Consult), as well as unscheduled weeks that can be used for in-depth involvement in ongoing research projects, rotations at other institutions or laboratories of interest to the trainee (to be set up in consultation with the Program Director), and/or additional experience on Hematopathology or another service.
The fellowship Core Curriculum encompasses 43 weeks for fellows with AP/CP background (45 weeks for fellows with AP only background) in the following rotations:
Hematopathology (28 weeks)
Flow cytometry (2 weeks)
Laboratory Hematology (1 week)
Coagulation Laboratory (4 weeks)
Immunopathology (1 week)
Leukemia/Lymphoma/Hematology Clinical Rotation (2 weeks)
Molecular Diagnostics and Cytogenetics (2 weeks)
Pediatric Hematopathology (2 weeks)
Exclusive of four weeks of vacation, the remaining six weeks are devoted to elective time on research projects, review of hematopathology consultation cases, and/or additional elective time in one of the core areas.
As the year progresses, the fellow is encouraged to write complete reports and to communicate preliminary results to clinicians. The fellow will provide backup and supervision for the residents on the service in gross and microscopic interpretation, in handling calls regarding specimens, and in presenting at clinicopathologic conferences. In the final 6 months of the fellowship, each fellow spends two weeks performing independent Hematopathology signout, showing cases to the attending only when problems are encountered. This responsibility includes teaching individuals at various levels (medical students, junior residents, senior residents on electives, and visiting pathologists) who may participate in hematopathology signout. All cases are reviewed subsequently by the attending and countersigned, but the expectation is that no changes should be necessary to specimens that the fellow thinks are straightforward; major changes are reviewed together with the fellow and supervising attending. In this way, the fellow and the faculty will be able to assess the fellow’s ability to function independently, while maintaining an adequate level of supervision.
Robert P. Hasserjian, MD
Hematopathology Fellowship Program Director
Judith Ferry, MD
Director of Hematopathology
All fellowship positions for academic year 2019 – 2020 have been filled.
We will begin accepting applications for academic year 2020 – 2021 in October 2018.
Interested applicants should send a completed CAP standardized Application for Pathology Fellowships, a current CV, a copy of their USMLE transcript, a one-page personal statement concerning their interest in hematopathology, and three letters of reference (including one from their residency program director or department chief) to BOTH Dr. Robert Hasserjian and Linda Arini:
Robert P. Hasserjian, MD
Director, Hematopathology Fellowship Program
Massachusetts General Hospital
55 Fruit Street, Warren 244
Boston, MA 02114