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Creating a Benign Hematology Curriculum

Creating a Benign Hematology Curriculum. Susan Claster MD Division of Hematology Oncology UCI Medical Center. Thank you. What is Benign Hematology?. Clotting/thrombophilia Bleeding disorders Hemoglobinopathies Non malignant disorders of RBCs,WBCs and plts Autoimmune disorders. Case.

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Creating a Benign Hematology Curriculum

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  1. Creating a Benign Hematology Curriculum Susan Claster MD Division of Hematology Oncology UCI Medical Center

  2. Thank you

  3. What is Benign Hematology? • Clotting/thrombophilia • Bleeding disorders • Hemoglobinopathies • Non malignant disorders of RBCs,WBCs and plts • Autoimmune disorders

  4. Case • 25 y/o female • Jaundiced since childhood • Hgb 9, MCV 65, WBC 13, plts normal • Bili 5, mostly indirect • s/p chole as a teenager • Had been seen by several community H/O MDs who were unable to make a dx • Failed iron,vitamins • FHx positive

  5. Diagnosis • Smear: thal intermedia • Globin gene mapping confirms heterozygous dominant beta thal with severe mutation • Started on HU low dose • Doing well

  6. Workforce Issues • Most HemeOncpractioners are oriented towards liquid or solid malignancies • The average age of BH according to a recent survey by ASH was between 50-60 y/o • Example: only 4 adult hematologists in California and 15 in the US who specialize in hemoglobinopathies

  7. Decline in Benign Heme funding

  8. Clinical focus of trainee graduates who pursue private practice or academic careers

  9. Workforce Issues- NIH 2012 • Career opportunities are limited to academic positions • Current NIH funding issues take physician-scientists out of clinic- lack of exposure to these individuals for current trainees • Concept of a “systems hematologist”- inpatient specialist • “Enriching the Hematology Research Workforce through Short-term Educational Experiences in Emerging Science Research Education Program Grant (R25) “

  10. Background UCI • Prior structure: one fellow covering both Heme and Onc consults- allowed no time for teaching • Clinical Lab rotation for fellows started 7/12 • Previously Team O attending saw all Heme consults • Monthly heme case conference started 3/13 but transitioned to weekly meeting starting early 2014 which allowed us to review data in real time

  11. Goals of Rotation • Increase trainee’s fund of knowledge regarding benign hematology • Allow for trainee to have more time for reading, learning by splitting Heme and Onc consult servies • Engage trainees to become interested in this field

  12. Collaborators • KanwarKahlon- HemeOnc • DeepaJeyakumar- HemeOnc • Minh ha Tran- Transfusion Medicine • Irina Maramica- Transfusion Medicine • Diane Nugent -CIBD • Amit Soni- CIBD • Jason Zell- HemeOnc • SherifRezk- Pathology • Sheila Zhao- Pathology

  13. Who do we interact with most often? • Lab Med/Pathology • Transfusion Med • Maternal-Fetal • ICU • Medicine • Surgery

  14. Hematology IP/OP Rotation • Started July 1 • Dedicated fellow • Attendings: Kahlon and Claster • Residents and students welcome • Rounds on consults 5 days a week • Clinic at UCI Mon/Thurs pm • Clinic at CIBD either Wed pm or Friday am • Heme conference Tues 1 pm • Transfusion Medicine involvement- TBD • Monthly didactic presentation at the end of the rotation

  15. Center for Inherited Blood Disorders • HTC- Hemophlia, VWD • Hemoglobinopathies • Thrombosis • Rare Bleeding Disorders- FXIII, PAI-1 inhibitor • Platelet disorders- genetic and acquired

  16. Services/Team at CIBD • All pts seen by RN, MSW, PT, psychologist • Medical home • FQHC look alike • Member of community clinic consortium • Funding for uninsured pts • Navigators for covered Ca • Grants pending-CMS innovation grant, HRSA for SCD regional care • Dr Nugent/CIBD coordinating center for Western states Hemophilia region IX

  17. In Progress • Involvement of Transfusion Medicine • Having more residents and students on the service • More formal didactic sessions with trainees presenting articles,talks

  18. Metrics • Survey monkey • ASH site exam results- fellows • Numbers of students/residents who take rotation

  19. Pretest • On a scale of 1-5( 1 being completely uncomfortable and needing a consult and 5 being very comfortable with the workup and don’t need additional help ) please rate your comfort level managing patients with the following diagnoses: • Microcytic anemia • Macrocytic anemia • thrombocytopenia • ITP • Sickle cell disease • HIT • Coagulopathicpt • Thrombosis • TTP • Pregnant pt w/clot • AIHA • Delayed tx reaction • Leukopenia

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