Coagulation Rotation

Goals and Objectives of Coagulation Rotation

During the Coagulation rotation in the Anatomic and Clinical Pathology Residency Program, the resident will demonstrate the following competencies:

Coagulation Patient Care Components

  • Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families in the pediatric hematology clinic
  • Depending on the tests ordered, contact the ordering physician to determine the reason for the test order and the information the clinicians are seeking and advise on tests ordered
  • Gather essential and accurate information about patients
  • Observe patient counseling/clinic sessions/ history and physical examinations at the pediatric hematology clinic
  • Obtain previous laboratory test results and clinical data from Laboratory Information System (LIS) and Hospital Information System (HIS) respectively
  • Present cases seen in clinic to pathology attending with a focus on relevant coagulation findings
  • Provide prompt consultative support for patients with bleeding and thrombotic disorders
  • Review the specialty coagulation laboratory pending list for specialty coagulation assays at the end and start of each day for each patient for whom coagulation assays are ordered
  • Use information technology to support patient care
  • When the coagulation testing is completed, the resident will render a diagnostic interpretation, which shall be reviewed with the attending pathologist
  • Work with health care professionals, including those from other disciplines, to provide patient-focused care

Coagulation Medical Knowledge

  • Answer questions from clinicians about coagulation testing with attending approval and review prior to answering questions (graded responsibility)
  • Assess technical performance of routine and specialty coagulation assays
  • Be involved in interpretive pathologist reviews of cases
  • Completely read routine and specialty coagulation test procedures
  • Demonstrate an investigatory and analytical thinking approach to clinical situations
  • Know and apply the basic and clinically supportive sciences which are appropriate to their discipline including molecular biochemistry of the hemostatic system, relevant findings in the patient history, congenital and acquired coagulation disorders and diagnostic test strategies
  • Pass three quizzes and one final examination
  • Prepare a 30-minute presentation for coagulation technologists on coagulation testing topic
  • Review data on implementation of new hemostasis assays
  • Understand automated and manual coagulation assays
  • Understand impact of phlebotomy and sample collection for coagulation
  • Understand methods used for routine and specialty coagulation tests
  • Understand normal coagulation and laboratory testing related to coagulation
  • Understand application and interpretation of platelet function testing

Practice-Based Learning and Improvement

  • Analyze practice experience and perform practice-based improvement activities using a systematic methodology
  • Based on the tests ordered, contact (with pathology attending approval) the ordering physician to determine the reason for the test order and the information sought by the clinicians
  • Conclude the correlation of abnormal coagulation results with hematology and chemistry assays
  • Demonstrate mastery of didactic case studies
  • Determine clinical correlation and appropriateness of coagulation testing
  • Explain the indications and interpretation of coagulation test results
  • Facilitate the learning of students and other health care professionals
  • Obtain previous laboratory test results from LIS and clinical data from HIS
  • Participate in current coagulation laboratory operations and assistance with projects such as method validation, implementation of new assays, normal range studies, laboratory assay trouble-shooting, quality assurance and procedure review
  • Present a coagulation clinical case at laboratory rounds
  • Present a lecture to technical staff at the end of the rotation
  • Review the daily quality control results for specialty assays
  • Review the specialty coagulation laboratory pending list for each patient for whom specialty assays are ordered for specialty assays at the start and end of each day
  • Use information technology to manage information, access online medical information and support their own education
  • When the coagulation testing is completed, the resident will render a diagnostic interpretation, which shall be reviewed with the attending pathologist

Interpersonal and Communication Skills

  • Communicate with attending pathologists about patient results
  • Communicate with laboratory technologists about test methods, additional test requests, etc.
  • Communicate test results to clinicians
  • Communicate with clinicians to obtain history for interpretation of test results and/or appropriateness of tests ordered
  • Interact appropriately with technical staff in coagulation laboratories
  • Present clinical cases at lab rounds
  • Present lecture to technical staff at the end of the rotation
  • Present coagulation cases at weekly Jab rounds
  • Present journal articles about coagulation topics at Journal Club if scheduled
  • Use effective listening skills and elicit and provide information using effective verbal and nonverbal, explanatory, questioning and writing skills
  • Work effectively with others as a member or leader of a health care team or other professional groups

Professionalism

  • Answer pages promptly
  • Attend all didactic sessions, conferences and bench sessions with technologists
  • Be available and visible in the coagulation laboratory area as required
  • Be punctual
  • Convey information to laboratory staff in a timely manner
  • Demonstrate a commitment to excellence and on-going professional development
  • Demonstrate courteous and collegial behavior with laboratory staff (laboratory supervisor will evaluate resident based on input from laboratory personnel)
  • Demonstrate respect, compassion and integrity with patients and accountability to the profession by observation of patient evaluations in the pediatric hematology clinic and present findings to pathology attending
  • Demonstrate self-motivation and organization in pursuit of coagulation rotation requirements (reading and clinical service time)
  • Follow up on all assigned coagulation cases until the case is completely signed-out with the attending pathologist
  • Read independently on topics related to patient case material and search primary sources

Coagulation System-Based Practice

  • Design a change control packet for a mock new test including elements required for bringing up a new test
  • Generate via the LIS a list of special coagulation tests ordered ("Queue") on a daily basis and then review each case for appropriateness of the specialty coagulation tests ordered; after discussion with the pathology attending, the pathology resident may contact the ordering physician to discuss the tests ordered and see if tests are recommended.
  • Have a working knowledge of and familiarity with the LIS and entry/retrieval of laboratory results and familiarity with the HIS for retrieval of clinical information on patients
  • Perform a "mock" CAP inspection of the coagulation laboratories
  • Practice cost-effective health care and resource allocation that does not compromise quality of care
  • Prepare a report of the "mock" inspection findings
  • Present "mock" inspection findings and report to the coagulation supervisor and pathology attending
  • Review recent CAP proficiency testing programs results for coagulation for UH Cleveland Medical Center
  • Understand the fundamentals of laboratory accreditation and regulatory requirements and how the College of American Pathologists Laboratory Accreditation Program affects the health care organization and their own practice
  • Understand cost-effective laboratory evaluation of coagulation disorders
  • Understand the steps in specimen handling and processing through the triage department and the criteria for sample rejection (observation and procedure review)

Coagulation Rotation Duration

The coagulation rotation is taught as a one-month rotation.


Duties and Responsibilities by Year

  • Answer questions/follow up cases for Specialty Coagulation Assays
  • Arrange and attend bench instruction with the coagulation technical coordinator for bench time and observation of each of the routine and special coagulation tests performed
  • Attend clinical pathology conferences, hematology conference and laboratory rounds
  • Attend monthly quality control review meeting
  • Call clinicians and or chart review to obtain additional information when necessary with attending approval
  • Complete special coagulation form for each patient case with written preliminary diagnosis on each form prior to attending review
  • Coordinate a mutually convenient sign-out time with pathology attending on coagulation
  • Coordinate with pediatric hematology clinical service observation of patient evaluations in hematology clinic
  • Create a single page written contribution to coagulation resident's manual on a topic of the resident's choice
  • Discuss with Hematology fellow before weekly Hematology conference (re: cases that will be presented and review results prior to the conference with attending)
  • Enter review queue diagnosis/billing codes into LIS after sign-out
  • Evaluate "ST AT" requests for specialty coagulation testing
  • Participate in current coagulation laboratory operations and assistance with projects such as method validation, implementation of new assays, normal range studies, laboratory assay trouble-shooting, quality assurance and procedure review
  • Prepare a 30-minute presentation to laboratory technologists on coagulation topic for all three shifts
  • Prepare a daily review and sign-out of "Review queue" special coagulation cases with the attending pathologist
  • Preview cases and complete path interpretation in LIS prior to attending sign-out
  • Review all procedures in coagulation and special coagulation laboratories
  • Review daily quality control results for special coagulation assays
  • Review pending coagulation folder and review queue in morning and afternoon daily

Coagulation Teaching Staff

Katharine A. Downes, MD, Rotation Director
Robert Maitta, MD, PhD
Hollie Reeves, DO
Molly Klima, MT (ASCP)


Coagulation Rotation Supervision and Evaluation

Faculty attendings supervise all aspects of the Coagulation rotation. The pathologist with significant resident contact during the rotation evaluates the rotating residents, addressing the six competency areas.

Evaluations are based on daily interaction with residents and "sign-out" activities. In this way, residents receive daily feedback on their interpretations of case material. Residents are assisted by attending staff in preparation of coagulation presentations for laboratory rounds and for the technical staff and receive feedback on their presentations.

Residents are evaluated on a monthly basis with regard to competency areas. Evaluations are reviewed with the resident and then forwarded to the Anatomic and Clinical Pathology Residency Program Director, where they are available for review.

Back to Top