The advanced laboratory coagulation and hemostasis fellowship is a 1 or 2 year training program at McMaster University, designed to provide a trained laboratory-based physician (hematopathologist, general pathologist, clinical pathologist, anatomical pathologist or laboratory medicine physician) with more advanced coagulation/hemostasis laboratory training. The program is specifically designed for laboratory physicians that will oversee a coagulation/hemostasis laboratory as a major focus of their practice. The three primary objectives of the fellowship are to develop competence in:

1. coagulation laboratory practice and test interpretation for the full spectrum of coagulation laboratory investigations, across the lifespan
2. laboratory assessment of congenital and acquired bleeding disorders (including disorders of platelet number and function), thrombotic problems and abnormalities detected by screening tests of coagulation
3. quality improvement in laboratory coagulation/hemostasis practice

The special competency in advanced laboratory coagulation/hemostasis will be achieved by the following:

1. Performance of test interpretation for the full range of coagulation/hemostasis assays performed by the HRLMP Core and Special Coagulation Laboratories, including whole mount electron microscopy assessments for dense granule deficiency and molecular tests for bleeding and thrombotic disorders
2. Review of standardized interpretation comments, with a focus on quality improvement to improve the communication of test finding and their significance
3. Undertake quality review of select methods and assays to solidify knowledge about procedures required for test implementation and their ongoing quality monitoring and improvement
4. Preparation of a portfolio (anonymized information) to record experiences with scoring schemes
5. Preparation of presentations, using anonymized information, to lead case-based teaching sessions with junior trainees on relevant laboratory coagulation/hemostasis problems, with clinical and/or laboratory implications. These should include laboratory diagnostic strategies, as relevant
6. Participate in ongoing external quality assurance exercises, such as NASCOLA and ECAT case interpretation for external quality assurance of coagulation problems, with additional practice using historical exercise materials to further advance these skills
7. Participate in patient advocacy initiatives, and develop a portfolio of recent literature on issues laboratories should consider to improve patient advocacy
8. Lead a research or quality improvement (QI) project. For the two-year fellowship, the project will be of greater scope (see Scholar objectives) than QI projects undertaken during a one year fellowship.
9. Participate in coagulation/hemostasis laboratory activities, such as requests for proposal for new instruments, new procedure and/or reagent lot validation and implementation, as appropriate

The fellowship program is 12 or 24 months in duration and includes experiential and structured educational components.

Experiential components (70%)

The weekly schedule will be as follows:

• 2-3 days/week in the laboratory. If there are two fellows in the program (e.g., one doing a one-year fellowship and a second, doing a two-year fellowship), the schedule may be adjusted to allow for more academic time to do quality improvement and research project work
• Daily activities related to the HRLMP test interpretation and reporting
• 2-3 days academic time
• There is the option to include some elective time (up to 20% of the fellowship time) to gain exposure to other aspects of laboratory hematopathology.

Structured educational components (30%)

• Participate in daily teaching related to discussions on test interpretation (flexible timing)
• Participate in weekly meetings related to the coagulation laboratory services (e.g., Continuous Quality Improvement Huddles)
• Design and conduct a research or QI project
• Regional hematology grand rounds
• Pathology and Molecular Medicine Grand Rounds
• Attend relevant hematopathology, hematology and laboratory hematology conferences
• Attend relevant laboratory meetings (formal and informal)

To be eligible, applicants should be certified in Hematopathology, General Pathology, Clinical Pathology, Anatomical Pathology or Laboratory Medicine by the Royal College of Physicians and Surgeons or equivalent organizations. International applicants will need to successfully complete a Pre-entry Assessment Program (PEAP). They must also have verified sponsorship support for their fellowship that meets or exceeds the minimum funding requirement of Postgraduate Medical Education at McMaster University (currently: minimum of 50K per annum). Applicants must submit a letter of interest, a detailed CV, written verification of amount and duration of fellowship financial support from their sponsor (which should detail how the financial support will be paid, i.e., directly to the fellow or via transfer of funds to McMaster), in addition to a minimum of two letters of reference that includes one from their hematopathology residency program director.