Pathology and Laboratory Medicine

Hematopathology Fellowship

The Hematopathology Fellowship at Tufts Medical Center offers broad in-depth training in adult and pediatric hematopathology, flow cytometry, cytogenetics and immunopathology. The goal of the 1-year hematopathology fellowship is to prepare the Fellow to independently function as a primary diagnostician and consultant in all areas of hematopathology and clinical laboratory hematology. Fellows should have a strong background in general diagnostic pathology, and acquire skills though the fellowship training to become an independent attending pathologist able to practice in either an academic, community hospital, or commercial laboratory setting, or pursue further subspecialty fellowship training.

Tufts Medical Center presents a rich diversity of cases and the state of the art Clinical Hematology Laboratory has the diagnostic capacity to support the diagnostic needs of patients across various disciplines and to provide subspecialty diagnoses for patients with hematologic disorders. The hematology laboratory performs about one million tests annually and the annual bone marrow volume is up to 800 cases with around 300 additional consultation cases for lymph nodes and other biopsies; approximately 25% of the volume consists of pediatric cases. 

The fellow will be mentored and will assume graduated responsibility for diagnostic sign out of cases with the hematopathology faculty at Tufts Medical Center. The fellow also will participate in conference presentations, tumor boards, pathology laboratory administration, and the education of Pathology and Laboratory Medicine residents.

The Hematopathology Fellowship is ACGME-accredited as of January 2019. The graduating fellow will be eligible for Hematopathology boards with the American Board of Pathology. The fellowship meets the American Board of Pathology criteria for Maintenance of Certification credit and is modeled on hematopathology fellowship programs at other major academic medical centers. Opportunities exist to become involved in ongoing clinical or translational research in the Department of Pathology and Laboratory Medicine, particularly in partnership with other clinical services. Available diagnostic and research techniques include immunohistochemistry, in situ hybridization, cytogenetic techniques, and some molecular applications.

 

The goal of the one-year hematopathology fellowship is to prepare the candidate for advanced practice in hematopathology. The fellowship is based on a model of practice under supervision, rather than a program of didactic and practical exercises.

In general, the practice of hematopathology occurs in one of three major practice settings:  academic practice, community hospital based group practice, or commercial laboratory.  Each of these settings varies in terms of their typical workloads, spectrum of case types, case complexity, and involvement in teaching and scholarly activity. This fellowship takes place in an academic practice setting and will adequately prepare the candidate for practice in any of the major pathology practice models.

At the end of the one-year Hematopathology Fellowship, the successful candidate will be expected to:

1. Provide competent diagnostic interpretation of all hematopathology and hematology material. The Fellow’s expertise will include the following:

  • Intra-operative consultations interpretation of frozen sections and interpretation of touch preparations for immediate evaluation
  • Triaging of material for hematopathology work up based on cytology preparations
  • Interpretation of bone marrow biopsies, lymph nodes, body fluids, other biopsies sent for evaluation of hematopoietic process.
  • Immunophenotyping of leukemias and lymphomas as well as use of flow cytometry in diagnosis of a variety of neoplastic and non-neoplastic conditions.
  • Diagnostic workup and interpretation of coagulopathies.
  • Diagnostic workup and interpretation of hemoglobin and red cell disorders.
  • Body fluid analysis
  • Cytogenetic and molecular genetic work up of neoplastic and non-neoplstic hematologic conditions.
  • Management of Clinical Hematology Laboratory
  • Appropriate  reporting of hematologic neoplasms including required molecular and cytogenetic findings.

2. Develop an analytical approach to diagnoses, which includes the appropriate selection, interpretation, and integration of ancillary techniques such as, immunohistochemistry, flow cytometry cytogenetics and molecular pathology.

3. Recognize own limitations and ask for appropriate consultations.

4. Serve as a consultant to health care providers:

  • Effectively communicate results with clinicians in a concerted effort to improve patient care
  • Discuss cases in pathology and clinical conferences as well as recognize patient care implications.
5. Have demonstrated effective teaching of medical students, residents, pathologists, and clinicians in the following settings:
  • Instructing junior residents in proper handling of hematopathology material and diagnostic process. 
  • Preparing and providing teaching/slide conferences
  • Participation in multidisciplinary conferences and offering consultative services at these conferences with appropriate faculty backup.

6. Have demonstrated effective management of the Clinical Hematology Laboratory

  • Through engagement in the clinical hematology laboratory operation
  • Through participation in inspections, compliance, regulatory and quality related activities. 

7. Professional responsibility for patient care: The fellow will inform the fellowship director and the attending hematopathologist of any planned or unplanned absence and will make arrangements for coverage of their service and cases.

8. Participate in lifelong learning: The fellow is expected to attend:

  • Didactic and teaching conferences related to hematology and hematopathology
  • Resident presentations
  • The residency evaluation meeting to facilitate communication of information related to GME
  • Departmental Quality Assurance meetings (quarterly)

The program is structured to provide all necessary core training over a one year period and to assure that learning the techniques and skills required for excellence in hematopathology practice (adult and pediatric hematopathology, flow cytometry, cytogenetics and immunopathology) is accomplished in a coordinated fashion.
The year is divided a follows:

  • 6 months – hematopathology and flow cytometry 
  • 2 months – clinical hematology and coagulation
  • 2 months – molecular diagnostics and cytogenetics
  • 2 months – research and project work including quality management
  • (1 month   – vacation time is allotted to be carved out of individual rotations)

Days are structured with sign-out every morning with an additional sign-out session in the afternoon.  In addition to their day-to-day service work responsibilities, the Fellow will participate in additional departmental and interdepartmental activities listed below.

Fellow responsibilities

  1. Case Editing, preparation and sign-out
  2. Sign-out of outside consultation cases 
  3. Consultant for junior residents on grossing, cytology and hematopathology.
  4. On call responsibilities include a backup for the residents who take primary responsibility for handling of the after hours inquiries. A faculty member is available always available for back up, if needed. 

The fellow has administrative responsibilities as part of the program structure; this affords an opportunity to learn skills that are required for academic and private practice and are critical to master. Administrative Quality Assurance activities include:

  • Review (under supervision) of monthly quality management data generated by clinical hematology laboratory
  • Review of amended reports for discrepancies
  • Correlation of inter-institutional review case diagnoses
 

During the year, the Hematopathology Fellow's mandatory conferences include:

  • Pediatric Hematology/Oncology (weekly)
  • Pathology and Lab Medicine Core Lecture Series (weekly)
  • Hematologic Malignancy (weekly)
  • Plasma Cell (weekly)
  • Pediatric Bone Marrow Transplant (monthly)
  • Coagulation Stewardship (monthly) 
  • Departmental Journal Club (monthly)
  • Surgical pathology weekly conference (occasionally and time permitting)

The fellow is expected to prepare for and be present at the above conferences. Cases with questions should be discussed with the appropriate faculty member prior to the conference.  Fellows may attend other departmental and interdepartmental conferences and educational opportunities to maintain competence in general pathology.

Teaching responsibilities

Tufts Medical Center has an anatomic and clinical pathology residency program with 10 residents. The fellow is expected to take an active role in resident education. The fellow teaching activities are:

  1. Consultation/supervision of junior residents in grossing room
  2. Unknown slide conferences for residents

The fellow is expected to initiate or participate in one or more research projects related to any area of hematopathology, to present the research data at national meetings, and to publish the data in pathology/biomedical journals.

The department provides funds for purchasing books and attendance at a national meeting. If an abstract is presented at a meeting, additional funds and time off are provided.
 

Our department thrives through the efforts of a dedicated and caring faculty working in close collaboration with our residents. Our faculty consists of experienced and nationally recognized general and sub-specialty pathologists who are committed to guiding and mentoring the residents through their training.

Pathologist-in-Chief
Barbarajean Magnani, PhD, MD

Anatomic Pathology
Elizabeth M. Genega, MD, Chief, Anatomic Pathology
Knarik Arkun, MD, Director of Autopsy and Neuropathology
Jeffrey Arnold, MD, Cytopathologist and Surgical Pathologist
Natalie Ciomek, MD, Surgical Pathologist, Hematopathologist
Janet M. Cowan, PhD, Medical Director, Cytogenetics
Stephen P. Naber, PhD, MD, Senior Pathologist, Medical Director, Biorepository
Monika Roychowdhury, MD, Acting Medical Director, Cytology, Surgical Pathologist
Daniel Rust, MD, Surgical Pathologist, Pediatric Pathology
Arthur S. Tischler, MD, Senior Surgical Pathologist (Endocrine Pathology)
Julie Y. Tse, MD, Dermatopathologist
Ying Wang, MD, PhD Surgical Pathologist, Cytopathologist

Clinical Pathology
Barbarajean Magnani, PhD, MD, Chief, Clinical Pathology
Steven A. Bogen, PhD, MD, Medical Director, Clinical Chemistry
Raymond L. Comenzo, MD, Medical Director, Blood Bank and Transfusion Medicine
Nicholas Heger, PhD, Assistant Director Clinical Chemistry
Gary Horowitz, MD, Medical Director, Informatics and Point of Care
Monika Pilichowska, MD, PhD, Medical Director of Hematology
Arthur R. Rabson, MD, Medical Director of Immunology & Microbiology, Tissue Typing, Andrology, and Molecular Laboratories
John J. Xin, MD, PhD Associate Director, HLA Lab

Fellowship Program Administration
Monika Pilichowska, MD, PhD, Program Director, Hematopathology Fellowship
Rouette Hunter, Manager, Clinical Hematology Laboratory
Coby Horowitz, Academic Program Coordinator

Tufts Medical Center is a world-class academic medical center located in Boston and the principal teaching hospital for Tufts University School of Medicine. It also sponsors nineteen specialty ACGME-accredited clinical training programs.

Tufts Medical Center is a 415-bed robust organization, providing everything from routine medical care to treating the most complex diseases affecting adults and children. Tufts Medical Center is also home to the Floating Hospital for Children, a full-service children's hospital dedicated exclusively to all levels of pediatric care.

Tufts Medical Center provides heart, kidney and bone marrow transplants, is a level I trauma center, provides comprehensive neurological and neurosurgical care, and offers cutting-edge cancer treatments.

Tufts Medical Center is also home to The Boston Gamma Knife Center, the first and only Gamma Knife Center in Massachusetts and northern New England.

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Applicants must be board eligible in AP/CP and licensed to practice medicine in the State of Massachusetts by the time their fellowship begins. We encourage those interested to apply 18 months in advance. To apply, download the CAP Standardized Application for Pathology Fellowships. Letters of recommendation should be addressed to: 

Monika Pilichowska, MD, PhD
Hematopathology Fellowship Director
Department of Pathology and Laboratory Medicine
Tufts Medical Center
800 Washington Street
Boston, MA 02111

All application material should be submitted to Coby Horowitz.
 

To learn more, contact:

Coby Horowitz
Academic Program Coordinator
Department of Pathology & Laboratory Medicine
Tufts Medical Center, Box 115
800 Washington Street
Boston, Massachusetts 02111

Telephone: 617-636-1112
Fax: 617-636-7128
E-mail: chorowitz@tuftsmedicalcenter.org