Typical Day on CP

The CP rotations tend to be a bit more variable. You start out with a "trial month" where you rotate through the various rotations each for one week to get an introduction to what each service is like. This also prepares you for taking night and weekend call. Then, you spend more in-depth time on each rotation. On CP rotations, morning conferences typically start at 8:30 AM. The rest of the day varies based on what service you are on.

Pipetting

Rotations in CP

Chemistry/Immunology/Molecular

Responsible for three different labs. Serum protein electrophoresis (SPEPs), your main job in chemistry, is the most time-consuming (looking at the gels for serum and urine specimens and determining whether you see an abnormal band, usually part of a screening for monoclonal gammopathy). Quick-texts available to help "figure out what to say" but not to worry-- it will become second-nature by the end of the rotation. Also a few times a week you review the urine toxicology GCMS runs. Chemistry 11 AM teaching session (Tuesdays and Fridays) is basically a time for you to get feedback on the SPEPs, learn about lab management issues, or anything else that you might want to know. Dr. McClaskey has a loose schedule/curriculum for these meetings although you can give him input to align the topics with your interests.

Immunofixation electrophoresis (IFE), your main job for immunology, tells you what specific immunoglobulin components comprise the bands you previously identified by SPEP. It can also help confirm an SPEP that was weak or indeterminate. Same as for SPEP, you look at the gels, write up the interpretation, and do the billing.

Molecular is basically entering a straightforward interpretation into the computer and doing billing. Examples of tests: chimerism to determine if a bone marrow graft was successful, assessing for mutations as part of a hypercoagulability workup, monitoring leukemic disease progression by measuring abnormal fusion gene products over time, determining EBV infection by measuring gene products of the virus, and assisting in the diagnosis of various hematologic disorders by identifying characteristic mutations. Lots of variability with which tests are done each day (they are usually batched).

Smears

Blood Bank

BThe most clinically oriented rotation in CP. You will write notes on the patients you round on (don't need a stethoscope!). The clinic in Smilow does therapeutic apheresis (hematologic malignancies, multiple sclerosis, sickle cell), as well as harvest stem cells for bone marrow transplants. Occasionally there is an urgent need for pheresis, which may result in having to come into the clinic if you are on home-call, but this is pretty rare.

You are also the blood product police and you have to approve and oversee usage. Diplomacy skills help. Also need to work up transfusion reactions (which have a way of always happening in the middle of the night) and positive antibody screens. Less daunting than it seems due to lots of back-up (2 fellows, senior resident at first). Rounds are in the late mornings after lecture. You may be asked to "look into something", sometimes to foresee future usage needs other times it is for quality control or curiosity.

Pheresis rounds at 4 to report stem cell collection yields and goals, treatment plans, and any problems there were with the pheresis or gaining peripheral access.

VA-1

The Veterans Hospital is close to Yale and there's a shuttle. It's practice for how small community labs work and it's very hands-on. Attending are mostly Yale attendings and very teachy. Main duties: cover VA pager (answer clinicians' questions, approve products, handle management issues) and approve "send-out" tests (tests not performed at the VA are sent to Quest for a fee). On Friday, you will give a CME-accredited presentation to the VA attendings called "Test of the Week" about one of your cases that week with a focus on a particular test and its utility and indications.

VA-2

Rotate through various labs (TB, HIV) and do a project. You choose the project and attendings can help. Good time to get a poster in for a meeting.

Microbiology/Virology/Parasitology

Time to read and work on projects. These labs are very self-sufficient and the techs are incredibly knowledgeable and eager to teach you about plating or any of the assays they do. Microbiology fellow leads plate rounds (twice per week with ID). Main responsibility: get cases ready for rounds, carry pager for "issues." There's a worksheet to direct your reading and attendings go over it at the end.

Flow lab

Hematology/Flow Cytometry

By far the busiest and closest to AP. Get smears before lecture and check with techs about any issues. Write up smear interpretations in morning, go through flows and then attending comes and signs out in early evening. You stay until 6-8 pm usually. Also must do coags and hemoglobin gels. Toward end of month you give Heme Rounds and present interesting cases.