Establishing a combined Immunology/HLA/Coagulation Rotation for Pathology Residents
Authors: Dent Edward A , Duncan Alexander , Sullivan H Cliff , Gebel Howard M , Bray Robert A , Maier Cheryl L , Smith Geoffrey , Guarner Jeannette 
Published: November 2022

Abstract
Given the breath of subspecialties within Clinical Pathology (CP), creating a curriculum with adequate exposure to all areas is challenging. Immunology, coagulation, and HLA rotations have been cited repeatedly by pathology trainees at our institution as targets for improvement. To address these concerns, a combined immunology/ HLA/ coagulation rotation was implemented wherein trainees spend a month exploring testing methods and their interpretations in each of these three different specialized laboratory sections. Herein, we describe the experience of the first 7 trainees (approximately the size of one residency class in our institution) who completed the newly implemented rotation. The rotation combines didactic lectures, assigned reading, time at the bench (to observe procedures), online modules, and case study discussions in each of the areas. The goal was to compare and contrast related concepts/techniques across lab sections. The month is divided so that residents spend the mornings of the first two weeks in HLA, the mornings of the third week in coagulation, and the mornings of the fourth week in immunology. Residents spend afternoons completing assignments and providing narrative interpretations for coagulation tests (such as the Lupus Anticoagulant/Antiphospholipid Antibody test) that they then review with attending physicians. Residents were assessed at the beginning and end of the rotation for their medical knowledge in each area. Additionally, they were provided the opportunity to share their expectations and evaluations of the rotation at its onset and completion, respectively. There was a significant increase in average scores when comparing pre- and post-rotation assessments (46% compared to 78%; p &lt; 0.01) of medical knowledge. Overall, trainees ranked the rotation 4.25 in a Likert scale of 5 and favored the asynchronous eLearning modules (4.7) over discussions in signout (4.29), in person case review (4.43), and assigned reading (4.0). Residents were also asked to rank their comfort in generating reports within each section; they felt more confident with Coagulation profiles (2.86 in a Likert scale out of 3) compared to ANA patterns (2.29) or interpreting HLA results (1.86). Residents described the rotation as “very useful” and “challenging.” Learners cited signing out coagulation cases and exposure to the HLA lab as highlights of the rotation. Coordinating individual schedules across three lab sections was a persistent challenge for trainees. In conclusion, we implemented a new CP rotation combining Coagulation, HLA, and Immunology topics into one month-long rotation. Evaluation of trainees to-date demonstrated an increase in medical knowledge post-rotation compared to pre-rotation, and an overall satisfaction with the rotation based on their feedback. HLA learning modules were restructured in response to limited confidence in HLA report interpretation. Based on the success of the combined rotation, it will become a permanent component of the CP curriculum for all residents.