The goal of our training program is to provide the resident with a solid foundation in both clinical and laboratory hematology. The specific objectives are tailored to meet the requirements of the
Royal College of Physician and Surgeons of Canada for certification in Hematology and to ensure that residents who complete the core training are competent in the diagnosis and management of hematologic disorders and in the management of hematology laboratories.
Over forty hematologists and allied health care professionals participate in the two-year residency training program. Trainees move through twelve
core 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 Hamilton General Hospital sites),
St. Joseph’s Healthcare, and the
Juravinski Cancer Centre.
The first year of training is primarily laboratory based and contains seven blocks. Four of these blocks are two months in duration and provide comprehensive laboratory training in Transfusion Medicine, Hemostasis/Coagulation, Red Cell Disorders, and Cellular Diagnostics. The remaining three blocks are predominantly clinical in nature and include a two month Thromboembolism rotation, a one month Pediatric Hematology Rotation and a one month Junior Hematology Attending Rotation
. Concurrent with these rotations, residents also participate in a Longitudinal Clinic experience. In the second year of the program, there are three blocks that provide comprehensive clinical training including exposure to allogeneic and autologous peripheral stem cell and marrow transplantation, in addition to a four month Elective block and one month Cell Diagnostics Rotation.
| 1st Year |
Transfusion Medicine
(2 months) |
Red Cell Disorders
(2 months) |
Thrombosis
(2 months) |
Pediatric Hematology
(1 month) |
Junior Attending
(1 month) |
Cell Diagnostics 1
(1 months) |
Hemostasis/
Coagulation
(2 months) |
Surgical
Hematopathology
(1 month) |
| Longitudinal Clinic Experience |
| 2nd Year |
Acute Leukemia & Stem Cell
Transplantation
(2 months) |
Inpatient Malignant &
Consultative Hematology
(2 months) |
Elective
(4 months) |
Ambulatory Clinics in Malignant
Hematology
(3 months) |
Cell Diagnostics 2
(1 month) |
At the discretion of the Program Director, and with the specific consent of the residents involved, the Program Director may ask residents to undertake clinical rotations in the PGY-4 year. This will only occur when resident numbers are unbalanced between the PGY-4 and PGY-5 years, resulting in open clinical blocks in one year.
Rotations:
Year One
Cell Diagnostics 1
During this rotation, the resident will acquire diagnostic skills in the interpretation of peripheral blood and bone marrow aspirates and will be introduced to the use of ancillary testing including flow cytometry and molecular/genetic testing. By the end of this rotation, the resident will be able to formulate differential diagnoses of microscope findings and select appropriate ancillary tests. This rotation occurs primarily at the Juravinski site of Hamilton Health Sciences. This is the regional laboratory for Southwest Ontario for flow cytometry and molecular diagnosis of leukemia and lymphoma.
Transfusion Medicine
This rotation develops the resident's expertise in the principles and practices of transfusion medicine, including serology, platelet and white cell immunology, blood product utilization and conservation (including transfusion practices specific to pediatrics, obstetrics, cardiac and vascular surgery, neurosurgery, trauma, critical care, and allogeneic and autologous transplantation), as well as laboratory management and quality assurance. Residents participate in consults and ambulatory clinics in hemophilia and platelet disorders. This rotation occurs primarily at the McMaster site of Hamilton Health Sciences, with some exposure at the Hamilton General site and St. Joseph’s Healthcare.
Hemostasis & Coagulation
This rotation covers the theory and principles of coagulation, platelet disorders, and thrombophilia testing. Residents will develop expertise in the interpretation of coagulation factor assays, protein analyses, platelet investigations and molecular testing in hemostasis and thrombosis. Residents participate in both in and outpatient consultations, focusing on hemostatic and platelet abnormalities. This rotation occurs primarily at the McMaster campus of Hamilton Health Sciences, site of the regional specialized coagulation laboratory and one of the largest reference laboratories for coagulation testing in North America.
Red Cell Disorders
This rotation covers the special laboratory investigations for disorders of hemoglobin, iron metabolism, and hemolytic anemias, with emphasis on protein analyses and molecular biologic techniques. The Red Cell Disorders Laboratory at McMaster University is the major reference laboratory for red cell disorders in this region. The Ontario Reference Laboratory for DNA investigation of hemoglobinopathies is located at McMaster University Medical Centre. In addition to the laboratory component of this rotation, residents also participate in two half-day general hematology clinics per week and a hemoglobinopathy clinic. This rotation occurs at both St. Joseph’s Healthcare (clinical component) and the McMaster campus of Hamilton Health Sciences (laboratory component).
Thromboembolism
This rotation is primarily clinical and involves inpatient and outpatient exposure, as well as weekly one-on-one seminars with leading experts in the field. Teaching is centered on the diagnosis and treatment of thromboembolic disorders, the management of thrombophilias and on issues related to the use of antithrombotic therapy. There is one half-day clinic per week with a focus on thrombosis issues unique to women. The most recent clinical trials related to thromboembolic disease and research topics in thrombosis and fibrinolysis are reviewed, as are the fundamentals of hemostasis and coagulation. Hamilton is a major referral centre for thromboembolic disease and the Hamilton Regional Thromboembolism Group has an international reputation for clinical trials and basic science research. This rotation occurs primarily at the Juravinski and Hamilton General sites of Hamilton Health Sciences.
Pediatric Hematology
In-depth training is providing in both in-patient and out-patient pediatric hematology. The general care of neonatal and pediatric hematology disorders and the team approach to patient care are emphasized. This rotation occurs at the McMaster campus of Hamilton Health Sciences.
Junior Hematology Attending
The goals of this rotation are to develop consultancy and time management skills, as well as to allow the hematology resident experience in the supervision and education of junior residents and medical students. This rotation occurs at St. Joseph’s Healthcare and includes both inpatient (primarily consultative) and outpatient exposure. The patients seen on this rotation will have primarily benign and low-grade malignant disorders.
Surgical Hematopathology
This is a one month laboratory-based rotation focused on the basic science and laboratory aspects of the diagnosis of hematologic disorders, with an emphasis on hematologic oncology. The intent of this rotation is to ensure that hematology residents have appropriate knowledge with respect to the investigation, diagnosis, and monitoring of disorders of the blood, bone marrow, lymph nodes and spleen. During this rotation, residents will be exposed to bone marrow core biopsies, as well as diagnostic hematopathology involving lymph nodes, spleen and other hematopoietic and extranodal sites. There will also be exposure to molecular studies, immunohistochemistry, and flow cytometry as it relates to diagnosis in hematopathology. This rotation occurs primarily at the Juravinski site of Hamilton Health Sciences. This is the regional laboratory for Southwest Ontario for flow cytometry and molecular diagnosis of leukemia and lymphoma.
Longitudinal Clinics
Concurrent with their first year rotations, residents participate in a half-day per week ambulatory clinic block.
Year Two
Cell Diagnostics 2
During this rotation, the resident will build on the skills acquired during Cell Diagnostics 1, while developing a basic understanding of the principles of flow cytometry and the characteristic immunophenotypes of common hematologic disorders. At the end of this rotation, residents will have expertise in microscopic diagnosis and be able to amalgamate clinical knowledge of hematologic disorders, as well as knowledge of molecular diagnosis, cytogenetics and flow cytometry to make an accurate diagnosis. This rotation occurs primarily at the Juravinski site of Hamilton Health Sciences. This is the regional laboratory for Southwest Ontario for flow cytometry and molecular diagnosis of leukemia and lymphoma.
Clinical Hematology
Three rotations based at the Henderson General Hospital cover both general and malignant inpatient and outpatient hematology practices.
Acute Leukemia and Stem Cell Transplantation: This two month rotation focuses on the care of patients with acute leukemia and those undergoing autologous and allogeneic stem cell transplantation. In addition to managing inpatients on the Acute Leukemia and Transplant Service, residents will see patients presenting for ongoing acute care in Oncology Day Services, attend one or two transplant focused out-patient clinics per week (including a Chronic Graft versus Host Disease follow-up clinic), participate in consultation and assessment of patients referred for stem cell transplantation, and be involved in Family Meetings held before patients undergo stem cell transplantation. Residents will participate in regularly scheduled teaching sessions reviewing topics relevant to this rotation, in addition to Regional Lymphoma, Leukemia and Stem Cell Rounds.
Inpatient Malignant and Consultative Hematology: During this two month block, residents will have primary responsibility for inpatients on the Malignant Hematology Service. Although these predominantly consist of patients with malignant hematologic disorders (including those with Hodgkins and non-Hodgkins Lymphoma, multiple myeloma and related disorders, myeloproliferative disorders, the chronic leukemias and myelodysplasia); patients with more general hematologic disorders will also be seen. Residents on this rotation will also be responsible for performing inpatient hematology consults requested by other services within the Henderson Hospital. Residents will participate in regularly scheduled teaching sessions reviewing topics relevant to this rotation, in addition to Regional Lymphoma, Leukemia and Stem Cell Rounds.
Ambulatory Malignant Hematology Clinics: During this three month ambulatory care block, the resident will participate in eight half-day clinics per week focusing on the outpatient care of patients with myeloid and lymphoid malignancies, those who have been referred for or have undergone stem cell transplantation, those being treated with curative intent and those with palliative care needs. The resident will also attend a limited number of additional clinics with specialists who interact frequently with hematology patients, including radiation oncologists. Residents will be involved in procedures carried out in the outpatient clinics including bone marrows, lumbar punctures with intrathecal chemotherapy and the administration of chemotherapy. Residents will participate in regularly scheduled teaching sessions reviewing topics relevant to this rotation, in addition to Regional Lymphoma, Leukemia and Stem Cell Rounds.
Elective
This four month period is used either to gain exposure to hematology-related research, establish interest in hematologic subspecialties, or to receive additional clinical training in a specialized area of hematology or in community-based hematology. The site and supervisor for the elective blocks are chosen by the resident, in consultation with the faculty and Program Director. A research focus is encouraged as a fundamental component of clinical experiences (e.g. chart review, systematic review or continuous quality improvement project) and a minimum of one month of research experience is required. All residents are expected to at least submit an abstract to the Annual Department of Medicine Research Day in order to satisfy the requirements of this rotation.
Program-Wide Educational Activities:
Academic Half-Day in Hematology (each Friday morning)
Residents are excused from their clinical duties to attend a morning devoted to education. Attendance at Academic Half-Day is compulsory for all residents. The curriculum is organized by the residents 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, several sessions designed to satisfy the requirement for teaching of the Collaborator, Communicator, Health Advocate, Manager, Scholar, and Professional domains are also included.
Hematology and Thromboembolism Grand Rounds (twice per month)
Postgraduate Medical Education Multidisciplinary Academic Half Days
Canadian National Hemoglobinopathy Video Conferences
These are held four to five times per year and typically involve review of an interesting hemoglobinopathy case, followed by discussion.
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.
Other Academic Rounds
Academic Rounds include Leukemia. Lymphoma and Stem Cell Transplantation Rounds (Clinical Hematology Rotations and Cell Diagnostics Rotation, weekly), Medical Grand Rounds (weekly), Pediatric Hematology-Oncology Rounds (Pediatric Hematology Rotation, weekly), and Platelet Function Case Rounds (weekly, after Medical Grand Rounds at the McMaster site). Residents also participate in rotation-specific rounds, seminars, educational sessions and seminars.
Annual Department of Medicine 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.
Annual National Hematology Residents Retreat
On Call:
Hematology residents are expected to attain proficiency in the recognition and management of emergent, urgent and elective problems in hematology. As part of this training, residents participate in out of hospital adult hematology on-call duties. Although residents have similar on-call as faculty members, there is graded responsibility, commensurate to the knowledge, ability and experience of the residents. Residents are on-call with a faculty member, who provides support, advice and education. The frequency of the call is designed to provide optimal and adequate exposure to urgent problems. In both years of the program, the resident is on-call approximately three weeknights and one weekend per month. Outside calls will be covered by the resident except on Friday and Saturday evenings after 11:00 pm. The following post-call workday will be adjusted as per PAIRO guidelines.
There are no on-call duties during the Elective Rotation.
