1. 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

2. Disclosures
None

3. 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)

4. 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.

5. 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

6. 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

7. 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

8. Increase the comfort level of trainees with diagnosis of hematologic conditions

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. Maintain funding for cocktail reception!

17. 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).

18. 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

19. 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

20. 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?