Program Overview and Rotation Description

The adult Hematology program fulfills the specialty training requirements in Hematology as defined by the Royal College of Physicians and Surgeons of Canada and is designed to provide residents with training that ensures flexibility in their future career choices in Hematology.

Over forty hematologists and allied health care professionals participate in the two-year residency training program. Trainees move through 4-week block rotations structured to provide exposure to both clinical hematology and laboratory medicine. Rotations are based at Hamilton sites with a major interest and expertise in the content area to be covered. Participating sites include Hamilton Health Sciences (McMaster University Medical Centre, Juravinski Hospital and Cancer Centre, and Hamilton General Hospital sites), and St. Joseph’s Healthcare Hamilton.

The first year of training encompasses laboratory-based rotations including Transfusion Medicine, Hemostasis/Coagulation, Red Cell Disorders (hemoglobinopathies), and Cell Diagnostics 1 (morphology, flow cytometry, molecular testing and surgical hematopathology focusing on examination of lymph nodes, spleen and bone marrow biopsies). The remaining blocks are predominantly clinical and include Acute Leukemia and Allogeneic Stem Cell Transplantation, Community Hematology, Thrombosis 1 and Junior Hematology Attending. Concurrent with these rotations, residents participate in a Longitudinal Clinic experience. In the second year of the program, exposure to inpatient and outpatient malignant hematology is the focus, along with Pediatric Hematology and further exposure to Consultative Hematology, Thrombosis 2, Cell Diagnostics 2 and four elective blocks that allow for focused research or clinical elective experiences.  At least one elective block must be dedicated to research.

 

	1	2	3	4	5	6	7	8	9	10	11	12	13
PGY4	Transfusion Medicine		Red Cell Disorders		Hemostasis/ Coagulation		Cell Diagnostics 1	Community Hematology	Thrombosis 1	Junior Attending		Acute Leukemia & Allogeneic Stem Cell Transplant
	Longitudinal Clinic Experience (PGY4)

 

	1	2	3	4	5		6	7	8	9	10	11	12	13
PGY5	Inpatient Malignant Hematology		Outpatient Malignant Hematology Clinics			Consultative Hematology		Pediatric Hematology	Thrombosis 2	Electives (can be split and scheduled throughout the year)					Cell Diagnostics 2

 

During the two-year training program, residents work closely with hematologists whose interests span diverse areas of clinical hematology, clinical research, and basic research. Basic science teaching is incorporated into all aspects of laboratory and clinical training, as well as during formal (Academic Half-Day) and informal teaching sessions. Biostatistics and critical appraisal are emphasized throughout the teaching program, including in Academic Half-Day sessions and Journal Clubs. The intrinsic CanMEDS roles are addressed within the different rotations and are also areas of focus in McMaster Medicine Subspecialty Resident Combined Academic Half-Days that occur periodically throughout the year. Quality control and quality assurance are covered in both laboratory and clinical rotations, and, in addition to patient safety, during Morbidity and Mortality rounds.

Objectives/Competencies

The goal of our training program is to provide residents with a solid foundation in both clinical and laboratory hematology. The specific objectives are tailored to meet the requirements of the Royal College of Physicians and Surgeons of Canada for certification in Hematology. Upon completion of residency training in Hematology at McMaster University, the resident is expected to be a competent specialist in adult Hematology and to demonstrate the requisite knowledge, skills and attitudes for ethical and effective patient-centred care, as well as management of hematologic laboratories. Additional training may be required to ensure competence in a specialized laboratory or clinical area.

Residents will acquire in-depth knowledge of aspects of biochemistry, genetics, immunology, pathology, pathophysiology, diagnosis, and treatment of hematologic diseases and will learn the hematologic changes that occur with aging and maturation, as well as during pregnancy.  Residents will learn about the psychosocial care of patients with hematologic diseases, including pain management and end-of-life care. Residents will also develop skills required for the performance of diagnostic and therapeutic procedures and interpretation of laboratory tests relevant to the practice of hematology.

The graduating resident is expected to be able to accurately convey relevant information and explanations to patients and their families, colleagues, and other professionals; to effectively collaborate within the healthcare team; to exhibit management skills pertinent to the supervision of hematologic laboratories; to demonstrate a commitment to self-directed learning; to critically evaluate scientific information and facilitate the education of colleagues, students, residents, and other healthcare workers; and to practice ethically and professionally.

Educational activities

Program-Wide Educational Activities

Academic Half-Day

Residents are excused from their clinical duties on Friday morning to attend an academic half-day every week. Attendance at Academic Half-Day is compulsory for all residents. The curriculum is organized by the resident-chaired Academic Half-Day Subcommittee, composed of resident representatives and faculty, with oversight by the Program Director. Faculty are invited to present at Academic Half-Day in their area of expertise. In addition to the core hematology topics, morphology and specific sessions addressing the intrinsic CanMEDS roles (Collaborator, Communicator, Health Advocate, Manager, Scholar, and Professional) are also included.

Division of Hematology and Thromboembolism Grand Rounds

Regional Hematology and Thromboembolism Grand Rounds occur biweekly and typically follow the Academic Half-Day. Rounds are videocast to all hospital sites.

Medicine Subspecialty Academic Half Days

The subspecialty medicine programs combine efforts to provide half-days addressing the intrinsic CanMEDS roles that are common among all specialties, with specialty-specific content addressed within each program. Separate subspecialty half-days are organized for the PGY-4 and PGY-5 residents with some common sessions. A committee with resident representation from all the medicine subspecialties allows for topics that are selected by the residents to ensure relevance and interest. Topics may include financial planning, career planning, resident stress, and harassment.

CanHaem Hemoglobinopathy Video Conferences

These are held four to five times per year and typically involve a review of an interesting hemoglobinopathy case, followed by a discussion. Residents on their Red Cell Disorders rotation will be required to attend these sessions.

Hematology Journal Club

Journal Club is organized by a resident representative with guidance from a faculty member (Journal Club Supervisor). Administrative support is provided by the Program Assistant and the Journal Club Supervisor. Journal clubs occur approximately five times per year. Topics span the breadth of hematology and are chosen by the residents in consultation with the Journal Club Supervisor and Program Director. Residents are expected to be active participants in the presentation and interpretation of papers

Morbidity and Mortality (M&M) Rounds M&M rounds are organized by a resident representative with guidance from a faculty supervisor and administrative support provided by the Program Assistant.  M&M rounds occur approximately 5 times per year and focus on issues related to quality improvement and patient safety.  These important rounds aim to identify problems and initiate changes to improve the safe delivery of high-quality care within complex health care systems.

Academic Rounds

• Leukemia, Lymphoma and Stem Cell Transplantation Rounds attended during Malignant Hematology rotations and Cell Diagnostics Rotations, weekly)
• Medical Grand Rounds (weekly)
• Pediatric Hematology-Oncology Rounds (Pediatric Hematology Rotation, weekly)
• Residents also participate in rotation-specific rounds, seminars, educational sessions and seminars

Practice Hematology Exams

Three practice examinations are held annually. Each winter, the Hematology Residency Program conducts an Objective Structured Clinical Examination (OSCE) and morphology exam for all hematology residents. The OSCE consists of several stations that test history taking, physical examination, slide interpretation, interpretation of test results, and clinical management of hematologic problems. The McMaster Hematology Residency Program also participates in the annual National Practice Examination and Resident Retreat held each summer. All hematology residents participate in the written and morphology components of this test; residents at the PGY5 level and above also complete a mock oral examination. The Hematology Residency Program pays for PGY5 residents to participate in the American Society of Hematology (ASH) online written In-Training Examination each spring. This test is mandatory for PGY5 residents. The results of these tests are reviewed and used to as a tool to guide the setting of future individual and program learning objectives; they are not used by the Residency Program for evaluative purposes.

Annual Department of Medicine Resident Research Day

Residents are required to attend this event each year and are excused from clinical and laboratory duties to do so. Hematology residents are required to submit at least one abstract to the Department of Medicine’s Annual Resident Research Day during their training.

Scientific Conferences

Residents are fully funded to attend the annual meeting of the American Society of Hematology (ASH) or an alternate conference approved by the Program Director. For example, residents have been funded in past to attend the American Society of Clinical Oncology (ASCO) meeting and the Royal College International Conference on Residency Education (ICRE). If available, additional funding is provided for residents presenting research at other conferences.

Research

The Division of Hematology and Thromboembolism is very productive in terms of both clinical and basic science research. Research projects are encouraged and supported in the first year, and during the second year, there is a 16-week elective. At least 4 weeks of the elective must be devoted to research, although the entire block can be used for that purpose if desired. Research projects can include quality improvement projects, systematic reviews, clinical research, or basic science projects. To facilitate resident research, the program has designated a Resident Research Advisor. The Resident Research Advisor assists residents in identifying a research supervisor among the McMaster faculty, can advise residents regarding potential research projects and assists with navigating residents through the process of research (e.g., ethics submissions, methodologic questions, abstract and manuscript preparation, poster and oral presentation). Faculty members are also very willing to discuss potential opportunities with individual residents.

Mentorship

Strong mentorship from the faculty (formal and informal) is provided to assist with issues about the training program, career guidance, and research. Resource information regarding potential mentors is provided to the residents.

Residency Mentorship Coordinator

The role of the Residency Mentorship Coordinator exists outside of the evaluative framework of the Hematology Residency Training Program. The Mentorship Coordinator develops relationships with each of the residents and serves as a resource and advocate for them within the Residency Training Program. The Mentorship Coordinator is available to assist with any personal or professional difficulties that the residents may have and can offer confidential and independent information and advice, as well as help them access appropriate resources. This role is currently filled by Dr. Donald M. Arnold (link to contact bio).

Resident Research Advisor

The Division of Hematology and Thromboembolism is very productive in terms of both clinical and basic science research. Research projects are encouraged and supported in the first year and during the second year, there is a 16-week elective that can be used for research if the resident chooses so. These projects can include quality assurance projects, systematic reviews, clinical research, or basic science projects. All residents participate in research projects and many have presented their results at national and international meetings (e.g. American Society of Hematology, International Society on Thrombosis and Hemostasis, American Society of Clinical Oncology, Royal College of Physicians and Surgeons of Canada).

To facilitate resident research, the program has designated a Resident Research Advisor. The Resident Research Advisor assists the residents in identifying a research supervisor among the McMaster faculty, can advise residents regarding potential research projects and assists with navigating residents through the process of research (e.g., ethics submissions, methodologic questions, abstract and manuscript preparation, poster and oral presentation). The Resident Research Advisor meets with the residents at least twice a year and reports to the Residency Training Committee yearly on resident progress. This role is currently filled by Dr. Deborah Siegal (link to contact bio).

Career Counseling

Residents meet individually with the Residency Program Director at least every six months to review their goals, academic performance, and any ongoing research. Career planning is a required component of this meeting. Hematology residents also meet with the Division Director to discuss career plans. Depending on the interests of the resident, career guidance may also involve additional meetings with appropriate faculty members and mentors (including the Residency Mentorship Coordinator).

Preparation for the Hematology Royal College Examination

In preparation for the Royal College of Physicians and Surgeons Examination in Hematology, three practice examinations are held annually (Program Mock Exam, National Mock Exam, and ASH In-Service Exam). Most residents form study groups in preparation for the Royal College Examinations. Faculty members participate in organized review sessions for these study groups, including morphology review sessions. In addition, informal “oral examinations” are integrated into seminar sessions to provide feedback on the resident’s knowledge base.

Associated Fellowships

On completion of their residency training, the Division of Hematology and Thromboembolism encourages residents to consider obtaining additional training. Residents wishing to pursue an academic career should anticipate that another two to five years of training in a focused area of hematology and research will be required to ensure success in their future careers. Every effort is made by the program to provide guidance and mentorship to residents making career decisions. Excellence in post-residency training is emphasized. Some residents have elected to remain in Hamilton to pursue further academic training (e.g., Master in Health Research Methodology, Masters of Education) or clinical training (e.g., Clinical Thromboembolism, Transfusion Medicine, and Platelet Immunology). Funding for clinical and research fellowships is available from several different sources. Although there are no guaranteed funding positions for additional training after completion of the Residency program, residents have traditionally been successful in obtaining independent funding for further training. During their post-residency fellowship, many trainees enroll in the McMaster Clinician Investigator Program. This Royal College Certified program provides advanced training as a platform for Clinician-Researchers while they are completing their research training at McMaster.