Table 5.

Hematopathology Entrustable Professional Activity 4: Complete Workup and Diagnostic Reporting of a Complex or Rare Hematolymphoid Diagnosis.

Skills

Ordering appropriate initial and, if indicated, next round ancillary studies based on clinical setting and differential diagnosis. Integrating ancillary studies including immunohistochemistry, flow cytometry immunophenotyping, cytogenetics, fluorescence in situ hybridization, targeted molecular studies

Providing a preliminary report to the patient-facing team

Writing succinct and complete final report including any indicated synoptic reporting

Integrating relevant literature/references and/or expert consultation

Recognizing areas of diagnostic challenge where a definitive diagnosis cannot be reached with the given material and communicating effectively to the clinician

Knowledge areas

Pathogenesis, clinical correlation, and prognostic significance; diagnostic and relevant clinical practice guidelines for hematolymphoid neoplasia, congenital, infectious, and other specific nonneoplastic entities

Flow cytometry immunophenotyping panels, immunohistochemical stains, cytogenetic analysis, including karyotyping and fluorescence in situ hybridization and molecular ancillary testing

Indications for and interpretation of next-generation sequencing panel testing, fluorescence in situ hybridization testing, and esoteric/sendout testing; techniques and technical limitations of ancillary studies

Example scenarios

Perform complete diagnostic workup of myelodysplastic syndromes, myelodysplastic/myeloproliferative neoplasms, T/NK cell lymphomas, gray zone lymphomas, histiocytic and dendritic cell neoplasms, and nodular lymphocyte predominant Hodgkin lymphoma

ACGME Hematopathology Milestones version 2.0

Patient Care 1 and 2 (levels 3-5): Interdisciplinary consultation, reporting

Medical Knowledge 4, 5 and 6 (levels 3-5): Morphologic interpretation and diagnosis, selection of molecular and cytogenetics testing and interpretation of reports, clinical reasoning in hematopathology and hematology

Systems-Based Practice 3 and 5: Physician role in health care system, utilization (levels 3-5)

Practice-Based Learning and Improvement 1 and 2: Evidence-based practice and scholarship (levels 3-5), reflective practice and commitment to personal growth

Professionalism 1, 2, and 3: Professional behavior and ethical principles, accountability and conscientiousness, self-awareness and help-seeking

Interpersonal and Communication Skills 2 and 3: Interprofessional and team communication, communication within health care systems

Abbreviation: ACGME, Accreditation Council for Graduate Medical Education.