The field of pediatric hemostasis and thrombosis is rapidly growing, especially in light of the increasing incidence of thrombosis in children’s hospitals and recent development of novel therapies to treat hemophilia and other rare bleeding and clotting disorders. In recognition of the unique knowledge base required, along with the limited devotion specific to hemostasis and thrombosis within general pediatric hematology/oncology fellowship programs nationwide, there is a need for advanced training programs that can develop expertise for those seeking a career in pediatric hemostasis and thrombosis.
As the largest pediatric hospital in the country providing quaternary care to patients from around the world, Texas Children’s Hospital is uniquely suited to provide exceptional training in pediatric hemostasis and thrombosis for a fellow who has completed training in pediatric hematology/oncology.
Goals and Objectives
Overall Goal: To develop clinical expertise, translational research, and leadership skills in pediatric hemostasis and thrombosis.
Clinical Objectives: Upon completion of advanced training in the care of pediatric patients with disorders of hemostasis and thrombosis, the fellow will be competent in the following objectives.
Hemostasis
Diagnose and manage Hemophilia A and B, including acute bleeding events, prophylactic regimens, and immune tolerance induction
Use of plasma-derived and recombinant factor products
Use of non-factor products
Use of bypassing agents
Diagnose and manage von Willebrand Disease
Develop an approach to adolescent with heavy menstrual bleeding
Diagnose and manage inherited platelet disorders
Diagnose and manage rare bleeding disorders (including congenital factor deficiencies, e.g. FXIII)
Develop a laboratory hemostatic evaluation in the setting of trauma
Develop a peri-operative hemostatic plan in bleeding disorders patients
Understand methodology and indications for coagulation laboratory testing (Coagulation laboratory)
Thrombosis
Diagnose and manage venous thrombosis and pulmonary embolism
Hemostatic evaluation and peri-operative planning for children with portal vein thrombosis (PVT institute)
Diagnose and manage arterial thrombosis
Evaluate and manage stroke in neonates, children, and adolescents
Manage anticoagulation in the cardiac population
Indications for and appropriate evaluation of thrombophilia
Evaluate and treat Post Thrombotic Syndrome (PTS Clinic)
Manage transfusion and anticoagulation in pediatric patients on extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD), (Transfusion Medicine Team)
Interpret coagulation assays as tools for anticoagulation management (Special Coagulation Laboratory)
Manage anticoagulation in patients with vascular anomalies (Vascular Anomalies Multi-Disciplinary Clinic)
Understand the role of interventional therapy for venous and arterial thrombosis
Research Objectives. Receive mentorship and support to complete a clinical research project during fellowship including abstract submission to a national meeting (ASH, ISTH, HTRS/THSNA)
Conduct a hypothesis-driven research project
Obtain clinical research skills through specialized training at Baylor College of Medicine and Texas Children’s Hospital
Disseminate and present clinical and research findings
Program Eligibility
Candidates should be board eligible, per the American Board of Pediatrics, for pediatric hematology-oncology or should have received equivalent training as judged by the program director(s). Only individuals who have successfully completed an ACGME-accredited fellowship in pediatric hematology-oncology or equivalent training are eligible for this advanced training opportunity.
Candidates will be asked to provide their curriculum vitae and a statement of career goals. Suitable candidates will interview with HAT program directors and clinical faculty, including the Section Chief of Hematology. Selection of candidates will be made by the program director, clinical program directors, Section Chief of Hematology, and Division Director of Hematology/Oncology.
Foreign medical graduates and visa holders
At this time, we are only able to accept applicants with J-1 training visas, but not those with H1B visas.
Program Duration
One year
Program Dates
July - June
Curriculum
The overall curriculum includes outpatient and inpatient hemostasis/thrombosis clinical experience as well as time in the coagulation laboratory, experience with the transfusion medicine service and ancillary services (interventional radiology, pharmacy).
The schedule for the 12-month training program is:
12 weeks of Outpatient Hematology clinic
General hemostasis and thrombosis
Focused hemostasis clinics: hemostasis and thrombosis and gynecology combined clinic, hemophilia treatment center
Focused thrombosis clinics: post thrombotic syndrome, vascular anomalies
12 weeks of Inpatient Hematology Consults
ICU hemostasis and thrombosis consults (8 weeks)
Non-ICU hemostasis and thrombosis consults (4 weeks)
*Up to a total of 2 weeks of Night Float covering the pediatric hematology/oncology/BMT inpatient services may be included in the curriculum to help with maintaining general clinical skills.
8 weeks of rotation within the hemostasis special coagulation laboratory, with transfusion medicine colleagues, and with the ECMO/VAD team
2 weeks rotation with our interventional radiology colleagues
1 week with pharmacy
10 weeks of research/scholarly activity or elective time
4 weeks of clinical elective
3 weeks of vacation
**All rotations will be done at Texas Children’s Hospital
Scholarly Activity and Research Training
A specific requirement of the fellowship is the successful completion of a guided scholarly research project. Fellows will have 20% protected time to complete this project. The project idea should be developed during the application process and after acceptance, so that research can begin at the start of the fellowship and encompass the entire training year. This project must be different from that which the fellow completed during their pediatric hematology/oncology subspecialty training program. A clinical mentor from among the faculty will guide the research and monitor progress. The fellow is expected to have regularly scheduled meetings with the mentor and scholarship oversight committee to ensure appropriate progress in the project. The conduct of the research project will include the generation of a hypothesis, study design, data evaluation and if applicable, a grant application. The expected deliverable is abstract submission to a national conference and manuscript publication. Fellows will also be expected to participate in the updating and creating of clinical practice standards as relevant to ensure high-quality patient care at Texas Children’s Hospital Hematology Center.
Supervisory and Patient Care Responsibilities
Under the direct supervision of an attending physician, fellows will learn to diagnose and manage the spectrum of Hemostasis and Thrombosis-related issues seen in infants, children, and adolescents on the inpatient and outpatient services.
All fellows will independently perform the initial evaluation and management planning for patients of all levels of acuity, including ordering of laboratory and imaging studies as indicated.
Fellows will have a direct one-to-one relationship with their attending faculty and work closely to formulate differential diagnoses and management plans for each patient.
Fellows will meet formally with the attending to establish competencies, set goals for the rotation, and review their performance regarding progression of skills and attainment of objectives, as well as future goals, which will be communicated in writing to the coordinator of the training program who can then pass on this information to the subsequent attendings.
On-call fellows will triage calls after hours for the service and consult their attendings when needed for appropriate disposition.
Fellows will work with a junior fellow and assume a teaching role for that individual in addition to providing direct patient care. Both will be under the immediate supervision of an attending as well as with all inpatient rotations.
The fellow will prepare and give presentations related to specific patient problems or topics on rounds or at a variety of multidisciplinary conferences, which commonly form the basis for subsequent treatment recommendations.
Didactic/Educational Meetings
Hemophilia Treatment Center weekly meeting
Inpatient Hemostasis and Thrombosis weekly meeting
Hematology and Coagulation CME weekly conferences
340b weekly meeting
Portal Vein Thrombosis Institute bi-weekly meeting
Great Plains Regional Hemophilia Network ECHO weekly meeting
Other: grand rounds; Problem Case Conference; fellow training seminars
