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 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 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?