CP training at your program

[levels x3]

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In keeping with man's never ending quest to improve CP training (a Sisyphean task if there ever was one), our program will soon be having a curriculum meeting to discuss possible changes for the coming academic year. As an incoming chief resident for that year, I will need to participate to this end. So I would like to get a feel for how other programs handle CP training, how many months of each service is done, when during residency are they typically done, do you think your training is adequate/excessive/too little, etc. I'll get the ball rolling...

CP at my program:

TMS-3 months as first year, 1 month senior rotation
Micro-3 months somewhere years 2-4
Chemistry-3 months somewhere years 2-4
Heme-3 months in year 2-3, 2 month senior rotation
Cytogenetics/Molecular-3 months somewhere years 2-4
Assorted electives (e.g. Coag, Immunology)-1 month each, typically as senior resident

I think some of these time frames are adequate while others are excessive, though I am aware of the ACGME requirement for 18 months of CP training and our core curriculum hits that mark exactly. So how is it at your program?

 

[josara]

Ours is okay but it is difficult to compare when you're in it.
Transfusion Med 4 months
Hemepath 4 months
Microbiology 3 months
Clinical Chemistry 4 months
Tissue Antigen 1 month
Cytogenetics 1 month
Molecular Diagnostics 1 month
I think chemistry is the hardest to really bring myself to read. (Ugh! Henry's)

 

[yaah]

TMS (with coag) 4 months, 2 as first year, usually one each 2nd and 3rd
Micro 3 months, often with 2 first year
Chem 3 months, often with 2 first year
Heme 5 months, starts in 2nd year
immunopath/molecular/HLA/cytogenetics 3 months, scattered

I think the timeline is fine, although frontloading chem and micro is a little irritating - would rather have them later on in residency so I can get more out of it (better studying, more knowledge, etc, although one month early on is fine to get initial exposure). Frontloading blood bank is good because we need the experience for call.

 

[106174]

Micro - 2 months
Chem - 2 months
Transfusion - 2 months
Coagulation - 2 months
Heme - 4 months
Flow - 1 month
Immunology - 1 month
Molecular - 1 month
Cytogenetics - 1 month
Management - 2 months

 

[SLUsagar]

Stanford CP

3rd year of AP/CP, 1st year of CP only:
3 months transfusion
3 month micro
3 month chemistry
3 month heme (note: for AP/CPers, we also get some heme in AP)
[these are all done in 1yr, in 2+1 month intervals...2+2+2+2+1+1+1+1]

4th year of AP/CP, 2nd year of CP only
2 month VA lab (director, sort of oversee everything)
2 months cytogenetics/molecular/biochemical genetics
1 month coag
1 month cp peds
6 month elective - SUPER flexible, can be electives in AP, CP, or research month
[mandatory 6 months CP can be done at any time among electives...you basically dictate your own 4th (or 2nd) year schedule]

 

[SLUsagar]

Micro - 2 months
Chem - 2 months
Transfusion - 2 months
Coagulation - 2 months
Heme - 4 months
Flow - 1 month
Immunology - 1 month
Molecular - 1 month
Cytogenetics - 1 month
Management - 2 months

what do you do during 2 months of management??

 

[BamaAlum]

All CP rotations can be done at anytime during the 4 years.

Transfusion Med.- 3 months (Seems longer since we do so much apheresis)
Coag- 1 month
Chemistry- 3 months
Microbiology/Immunology- 3 months
Heme- 3 months
Flow- 1 month
Molecular- 1 month
CP Electives- 3 months (can be any CP service or can even be split amongst services)

 

[levels x3]

I appreciate the response. It seems that there is a lot of similarity across programs...too bad because I would love to cut some of these rotations down by a month. In my experience, having been through all of my program's CP rotations, time is not a prime factor influencing what you learn. 3 months in chemistry would be the same as 1 as far as I can tell. I actually enjoy CP, but a few extra months of scope time would serve me better than rejecting yet another urine amino acid quantitation.

 

[big al]

What type of CP conferences does your program have? We have a Clin Path conference once a week. This is split between CP attendings, residents and med techs. The schedule is set up by the chief residents and topics are basically taken right out of Henry's. We also have morning report where any calls from the previous week are reviewed. Do any of you have conferences that are "high yield"? I'm trying to come up with anything that can increase learning in the CP area, especially chemistry.

 

[levels x3]

We have a similar system of CP conferences to you, with one morning conference per week devoted to CP (the other days are all AP) and a weekly CP call conference. That "CP call" is really just a forum to have residents present short, case-based presentations. Only at the end of that conference do we discuss any interesting calls from the past week.

Most of our lecture topics come straight out of Henry as well, though our lecture format will be changing dramatically in the near future. We used to have attendings do your typical hour long didactic thing, but since it's been shown many times that something like 5% or less of this type of teaching is actually retained, we've been trying some new things. Some of our lectures now are based on some type of review article that we all have to read. The attending then guides a discussion based on the article to highlight the key points. There are a lot of review articles out there in places like The Mayo Clinic Proceedings and The New England Journal that could serve as the starting point for these sessions. For whatever reason, a lot of these articles are heme/coag related. We also get a ton of TMS training through service work and call, so nobody really has a problem learning it.

Micro and Chemistry are more difficult. We've been trying to do more question and answer based sessions. Typically either a topic is assigned in advance and each resident finds or creates a few board style questions or the attending will give us a set of questions/cases from a review text. We then go over these questions during the conferences. I don't really know if we learn more this way, but it's far less painful than sitting through an hour long chemistry lecture. I also suppose you could consider them to be more "high yield" than most lectures.

 

[big al]

I was thinking of something along the lines of a journal club. In your example, who chooses the articles? Our attendings are open to whatever suggestions we have. However, the problem is that the attendings want the conferences to be primarily resident led. We also have some residents who want to do as little extra work as possible. They would rather continue our current arrangement than attempt something new that might possibly lead to more work or pain. Any suggestions on how to approach a situation such as this? How do you motivate attendings and residents to do more than the minimum? Other thoughts I had were to have a monthly hemepath conference where interesting cases from the month are reviewed, an interesting "case" conference where topics such as micro - plates, interesting smears, etc., chemistry - recent problems that have been encountered and how they were resolved, are reviewed. Anyone else have suggestions from their program?

 

[levels x3]

The articles for the few times we have done this so far have been chosen by the attending as being a good review of the topic at hand. In one case the article was a review in the NEJM about using hydroxyurea to treat sickle cell. We used that as a jumping off point to talk about various hemoglobinopathies. I think it was quite successful. I suppose it sort of ran like a journal club, but it was more focused on the topic behind the article. We didn't critique it or anything like in a traditional journal club. This particular attending wants to keep trying this, though it won't always be a journal article as a reading assignment. It might just be a chapter in Henry (or part of a chapter).

As for who leads, I think it's important for a department to have both attending led and resident led conferences. I don't think it's productive or fair for a department to tell it's residents to lead every conference while they sit in the back and once in awhile chime in with some obscurity. Residents don't have the level of knowledge needed to do that. We're still residents...still in training. There needs to be some number of basic didactic lectures to attempt to instill that core knowledge base. Resident led conferences should, in my opinion, be focused on case-based learning where we can apply what we hopefully have learned.

We haven't had a huge amount of trouble getting people to prepare for these new style conferences. Sure we complain while in the middle of preparing some questions, but everybody does it. One way we've motivated people is by making these question and answer conferences "board focused". We're all anxious about boards and if people think it's going to help them, they are more likely to put some effort into it.

 

[big al]

Everyone has listed what rotations they have with CP but what are the responsibilities on each rotation. For example, at our program heme is very busy, TMS we work up any transfusion reactions, coagulation is very busy and chemistry and micro is pretty much just reading. Are there any educational sessions you have with the med techs? Any additional ideas?

 

[yaah]

We have a lot of educational stuff with the techs in micro - spend time at every station (fungus, urines, bloods, etc) learning what they do and how they work stuff up, etc. Chemistry is kind of user dependent - we have time where we learn about mass spec as it relates to toxicology/drug screening. Other chem stuff is sort of up to us.

We do a lot in immuno with SPEPs and ANCAs. Molecular we sit in on signout and usually have topics to look into.