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Rotation Summaries - Clinical Pathology

Cellular Therapy at University of Minnesota Medical Center, University Campus

The major purpose of the cell therapy rotation is to provide the residents with a working familiarity with current therapeutic options and applications of cellular therapies and insight into future research and development in the field. Although the role of the resident during the rotation is not primarily to provide a service function to the laboratory, residents are expected to take part in daily laboratory activities and didactic-Socratic teaching conferences that allow the residents to concentrate primarily on educational goals rather than service-related concerns.

After the training period, the resident will be knowledgeable and experienced with basic and advanced techniques and future applications of hematopoietic progenitor cell collection, storage, processing, and infusion. The resident should gain a sufficient knowledge base of the cellular therapies so that he/she can intelligently discuss their appropriate applications, advantages and disadvantages. It is also hoped that they may also have creative ideas for improving the techniques and their applications; these will be encouraged and directed.

Supervisory Guidelines For Patient Care

While not the major focus, the resident is involved in some clinical services (regularly scheduled stem cell infusions, decisions regarding deviation from normal procedures, problem-solving, etc) under supervision of the medical director of the Cell Therapy Clinical Laboratory. The resident participates in several individual didactic sessions, covering the range of current and developmental cellular therapies, with the Cell Therapy Clinical Laboratory medical director.

Goals And Learning Objectives

  1. Hematopoietic Progenitor Cell Processing - The resident will:
    1. Understand the current theories and applications of hematopoietic transplantation.
    2. Understand the concepts of engraftment, ways in which it is measured, and use of cytokines to speed marrow engraftment.
    3. Have an introductory knowledge of the regulatory aspects of basic and advanced clinical cell engineering, including the role of the Food and Drug Administration.
    4. Have an introductory knowledge of the quality control aspects of a clinical cell engineering laboratory including cell enumeration, viability, functional evaluation, and detection of microbial contamination.
    5. Understand current theory and applications regarding collection and storage of hematopoietic progenitor cells.
    6. Understand techniques for thawing and transfusing cryopreserved hematopoietic cell grafts, including known adverse reactions. Will participate in these infusions.
    7. Understand the overall theory and methods of T-cell depletion, and related cell engineering methods to control or exploit graft-vs.-host disease.
    8. Understand current clinical methods and rationale underlying positive selection of CD34+ cells.
    9. Have a basic theoretical and practical understanding of selected cell engineering methods involving cell expansion, cell activation, and genetic modification.
  2. Umbilical Cord Blood Banking and Processing - The resident will:
    1. Understand the role of cord blood in hematopoietic cell transplantation.
    2. Understand the structure and operation of a cord blood bank.
    3. Understand the medical evaluation and other criteria used to determine the suitability of cord blood for banking.
    4. Understand the ethical issues involved in cord blood banking including those relating to consent.
    5. Be knowledgeable of the methods used to process and store cord blood.
    6. Be familiar with techniques for thawing and infusing cord blood.

Opportunities To Function As Consultant To Other Physicians

Due to the brevity of the rotation, the lack of experience of the rotating residents and the specialized requirements of the clinicians requesting consultations, there is limited opportunity for the residents to function in the capacity of a consultant while on this rotation. The resident will, however, accompany the Cell Therapy Clinical Laboratory Medical Director during consultations, and will be involved in a primarily educational capacity.

On-Call Duties

The resident is expected to be available to laboratory personnel, either in person or by pager, throughout the working day. No on-call duties outside of regular laboratory working hours are assigned to the resident.

Communication With On-Duty Faculty

Teaching faculty members on service are physically present or available by phone/pager during standard operating hours (8:00 AM - 5:00PM). A supervising faculty member is available on-call at all times for questions.

Education In Management

The resident is invited to attend the Cell Therapy Clinical Laboratory staff meetings and other meetings related to the research and development of new techniques and applications in the laboratory. The resident also becomes involved in management issues, as they arise during the course of the workday. These issues are further discussed in the tutorial sessions with the laboratory director. Transfusion-associated management issues related to planning, organizing, staffing, and economics of the laboratory are discussed at the weekly city-wide blood bank conference that the resident attends.

Required Conferences

  1. Clinical Pathology Conference, weekly, residents and faculty present and discuss interesting clinical pathology cases, recent advancements in clinical pathology, and the interpretation of laboratory values in terms of a clinical setting. This conference provides a weekly forum for trainee and faculty discussion of difficult and unusual cases. The conference is composed of both a 30 minute resident and 30 minute faculty presentation. Residents develop their presentation under the guidance of a faculty member with whom they are currently rotating. This conference provides trainees with the opportunity to correlate and discuss pathologic findings and a regular avenue for trainee peer teaching.
  2. Laboratory Medicine Grand Rounds, weekly, residents attend conferences on a variety of basic science and clinical topics. Conference is held on the University of Minnesota Medical School Campus.
  3. Blood and Marrow Transplantation Conference, weekly, the residents attend this conference to learn and discuss current and future cell and tissue engineering applications, and to participate with BMT clinicians in discussions of clinical studies.
  4. Rosai/Sinard Conference, Friday, weekly, residents present a variety of real cases on a theme related to a recent or up-coming faculty Resident's Conference. This conference provides a regular avenue for trainee peer teaching with feedback given by the Chief Resident's Subcommittee.
  5. Resident's Conference, Friday, weekly, residents attend conferences on a variety of scheduled pathology topics given by the faculty.
  6. AABB/ISHAGE Cell and Tissue Engineering Teleconferences. These are held approximately 2-3 times annually and are attending by the resident.

Optional Conferences

  1. Hematology/Oncology Case Conference, weekly, this is frequently attended by the resident because patients with ongoing transfusion problems and patients undergoing therapeutic apheresis are often discussed. The resident will often be involved in providing data and learning how a clinical decision is made.
  2. City-Wide Blood Bank Conferences, weekly, the resident is expected to attend and participate in case discussions. This conference provides trainees with the opportunity to discuss current issues in transfusion medicine, including cell and tissue engineering.
  3. Periodic Clinical Effectiveness Committee Meetings. The resident is often invited to this management meeting.
  4. Minnesota Association of Blood Banks. The resident is invited to attend this annual scientific two day conference.
  5. National Professional Society Meeting. Periodically (approximately every other year) at least one resident attends the annual American Association of Blood Banks meeting and presents an abstract or poster about a unique transfusion problem.

Scholarly Activities/Research

The resident is expected to regularly review the current medicine literature related to cases in the Cell Therapy Clinical Laboratory, future areas for laboratory growth, and is asked to present a topic for review to the medical director. The resident evaluates and discusses research findings in the literature and receives feedback from faculty. The resident is urged to write and publish interesting or unique cell engineering problems encountered during the rotation. Appropriate faculty members guide the resident through the process leading to a publication. If a resident is interested in a research project and has sufficient time, faculty members will arrange this in one of the associated research laboratories.

Resident Evaluation

If the resident fails to meet expected knowledge goals during the rotation, the lead faculty member meets with the resident to evaluate the problem and develop a corrective action plan. Residents will be evaluated on performance of daily activities (described previously), participation in required meetings and conferences, and presentations to the staff on assigned cases. The residents are provided with continuous feedback on their performance during the rotation. In general, only deficiencies are noted in writing. Residents are evaluated on their demonstrated ability to provide informative consultation to the clinical service teams, their medical knowledge, their application of this knowledge to efficient/quality patient care, and their diagnostic, technical and observational skills. Residents are also evaluated on their interpersonal skills, professional attitudes, reliability, and ethics with members of the teaching faculty, peers, laboratory staff, and clinicians. They are further evaluated on their initiative in fostering quality patient care and use of the medical literature, as it relates to their assigned cases. Their timely completion of assigned interpretive reports is another component of the evaluation. Residents on probation receive a written mid-rotation evaluation.

Educational Resources Available

The Biomedical Library of the University of Minnesota is located on the same campus as the teaching hospital. The resident has full access to borrowing, copying and literature searching at this library. The Cell Therapy Clinical Laboratory medical director provides ready access to cell therapy-related textbooks and journals (Cytotherapy, Journal of Hematotherapy, Blood). The Transfusion Medicine Division maintains a small library of it own, containing pertinent text books and selected journals (Transfusion, Vox Sanguinis). Computer literature searches can be performed in the resident's office. Faculty members also have extensive reprint files readily available to residents.

Computer Information Systems For Education And Service Duties

In addition to the blood bank specific computers, residents have continuous access to the laboratory and hospital clinical information systems, which relate to patient care.

  1. The Phoenix Cell Therapy Clinical Laboratory Information System.
  2. The KDS system for Fairview-University Medical Center laboratories.
  3. The Abaton system (accessed via the Internet) for Fairview-University Medical Center patient information, medical records, radiology, tissue pathology, and laboratory data.

Literature searches can be performed via the network-based system in the Laboratory, via the computers in the residents' room, or via the computers in the University of Minnesota Biomedical Library.