Hematology-Focused Fellowship Training Program Frequently Asked Questions

Although the HFFTP does not intend to discourage the pursuit of careers in malignant hematology or dual board certification in medical oncology, its primary goal is to recruit internal medicine and medicine-pediatrics residency graduates into lifelong subspecialty careers that focus on academic multidisciplinary non-malignant hematology. Consequently, ASH expects that HFFTP-supported fellowship programs will augment their hematology core training with innovative enhanced curricula in multidisciplinary non-malignant hematology designed specifically for the HFFTP fellows.

The earlier APD salary fund date is to ensure that the designated APD has adequate protected time and resources to prepare and fully implement the enhanced and innovative elements of the Hematology-Focused Fellowship track.

In that case, the entering fellow would receive salary support at the appropriate PGY level per standard institutional and fellowship program policy and practice.

Yes. An existing fellowship slot that is specifically reserved for fellows with external funding only can be used for this program.

No. A fellowship slot that is already funded by the institution, even if it is not filled every year, cannot be used for this program. Awarded institutions will be required to develop a new hematology-focused fellowship slot within an existing hematology-oncology program.

Institutions may apply for and be awarded either one (1) or (2) new fellowship slot(s)/year. However, ASH may ultimately decide to award institutions for no more than one fellowship position/year.

Yes. Training in the program must lead to eligibility for initial certification in hematology by the ABIM. The applicant fellowship program will need to have an ACGME accreditation of “Continued Accreditation” at the time of application and throughout the program to be funded.

Institutional graduate medical education (GME) approval is required.

At many institutions, the designated institutional official (DIO) and local GME office must approve the rotation sites, activities, supervision, and funding for the new fellow. This usually requires descriptions and justifications of the patient care duties within the scope of subspecialty requirements; curricular goals and educational objectives; faculty preceptor teaching, supervision, oversight, and evaluation; implications for workforce and reassurance that the new fellow will not detract from existing trainee experiences; approval and completion of any contractual arrangements and agreements by the medical director of a sponsoring hospital or facility. These steps often require many months of planning, review, and approval. Therefore, applying programs should allocate sufficient time to ensure approval for the new fellow.

All fellowship positions must be included within the approved complement number (approved fellowship slots) by the ACGME. If the new fellow slot exceeds the existing approved complement number, a request must be made to the ACGME Review Committee (RC) through the Accreditation Data System (ADS) to increase the approved complement – and this must be done after receiving local institutional approval. Furthermore, the request for ACGME approval must have been made at the time of application submission and must have been received by the time the institutional award is made.

Awarded institutions may also need Accreditation Council for Graduate Medical Education (ACGME) approval to increase the number of approved fellowship slots to accommodate the new fellow(s).

No. Awarded institutions will not be permitted to offer or fill their hematology-focused slot(s) outside of the Match. The selection of fellows must take place within the Medical Specialties Matching Program of the National Resident Matching Program (NRMP) system. Sponsored programs will also be required to list their hematology-focused fellowship slots separately in the Electronic Residency Application Service (ERAS^®). Further details about this process will be provided with the launch of the RFP on February 15, 2021.

ASH’s priority commitment to training a diverse workforce will also be a critical component of the HFFTP. Consequently, the applying program will need to provide evidence of an institutional Disparity, Equity, and Inclusion policy as well as a historical commitment to and performance in attracting disparity candidates to its training program. The recruitment strategy for the Hematology-Focused Fellowship Training Track should similarly demonstrate how individuals from underrepresented racial, ethnic, and gender groups, as well as individuals with disabilities, will be encouraged to apply. The institutional program’s annual progress report will include an assessment of the awardee’s efforts to recruit and retain a diverse workforce.

The primary goal of the HFFTP is to train a new generation of junior faculty in subspecialty careers focused on academic multidisciplinary non-malignant hematology who will themselves sustain and grow these efforts nationally. This will require deeper academic training in expanded content areas and new skills (e.g. combined hematology-transfusion; systems-based hematology; medical education). It is anticipated that 2 years of dedicated time in research training or scholarly (in addition to required fulltime rotations and continuity clinic) will be required to accomplish these goals.

Training in the HFFT tracks must lead to eligibility for American Board of Internal Medicine (ABIM) hematology certification and thus must provide the traditional core curriculum elements and competencies with an equal balance of clinical non-malignant and malignant hematology. The traditional curriculum elements for hematology training are included in section IV of the ACGME Common Program Requirements for Hematology and cross all core competency domains. The disease and ancillary content areas span the practice of hematology, with a focus on patient care and medical knowledge, but with attention to all other competencies. The trainees’ developmental trajectories in each of the core competencies are articulated through the Hematology and Medical Oncology Milestones 2.0.

Optimal training experiences in traditional and/or enhanced curriculum domains may require external (away) rotations that utilize the unique strengths of partner institutions to provide specialized training activities and/or to accommodate innovative learning opportunities. These rotations are intended to provide a rich educational experience in a particular disease, subspecialty skill set and/or patient populations (e.g. sickle cell disease) and/or access to outstanding faculty mentorship (e.g. comparative effectiveness research) that is not available at the home sponsoring institution. External rotations may involve inpatient or outpatient clinical settings or specialized research opportunities. A letter of agreement (PLA) between the host and partner programs will be required to: (a) identify the faculty members who will assume educational and supervisory responsibility for fellows; (b) specify the responsibilities for teaching, supervision, and formal evaluation of fellows; and (c) specify the duration and content of the educational experience. ASH will provide up to $5,000/year per fellow to support expenses for travel, lodging, meals, and incidentals incurred during a month-long externship rotation.

The primary goal of the HFFTP is to address significant gaps in the current and future hematology workforce by recruiting internal medicine and medicine-pediatrics residency graduates into sustainable subspecialty careers in academic non-malignant hematology. This RFP explores the multidisciplinary approach to non-malignant training as a key element of enhanced career viability , sustainability, productivity and ,importantly, long term satisfaction. The HFFTP defines multidisciplinary hematology as traditional clinical hematology paired with either enhanced career expertise in a subdiscipline of non-malignant hematology (e.g., transfusion medicine, vascular medicine), or a complimentary discipline (e.g., medical education, systems-based hematology) . See the Program Description-Program Curriculum section in the RFP for examples of innovative multidisciplinary training with the potential to enhance an ACGME traditional curriculum in hematology.

Applying programs will therefore be expected to create and/or incorporate existing novel educational activities and learning experiences that align with one or more of the suggested enhanced curriculum focus areas. Enhanced activities are expected to include experiential learning and innovative instruction as well as collaborative opportunities that may involve externship rotations at partner institutions.

These novel and focused activities will require dedicated faculty and may require specialized facilities and/or clinical resources (e.g. specialized clinics, advanced laboratory expertise, patient populations). The enhanced curriculum training areas must also be provided necessary administrative oversight, monitoring and evaluations of the learners. Implicit in this process is an understanding that these activities will represent complex interventions and therefore will likely require modification as the pilot projects evolve.

Applicant programs should be mindful that enhanced curriculum activities should not jeopardize trainee ABIM certification eligibility or the learning environment. If an enhanced program activity is meant to displace a traditional activity, the applicant program may need to contact the ACGME Review Committee prior to submitting a proposal to ensure that graduates will be ABIM-eligible. Programs are also encouraged to consider applying to the “Advancing Innovation in Residency Education (AIRE)” ACGME pilot program if their proposal includes focused training in the quality and safety of patients with hematologic disorders.

Yes, applicant programs may be able to justify a two-year fellowship that still fulfills the commitment to innovative academic multidisciplinary training in non-malignant hematology. For example, this situation could be the result of innovative ACGME-approved strategies applied to combined med-peds hematology training with overlapping requirements. However, there is no current mechanism through which funds allocated for the third year of PGY-level fellowship salary and benefits can be redirected.

Studies on recruitment and retention within hematology have consistently identified the exceedingly strong positive influence of mentors and faculty preceptors who role model successful life-long careers in hematology. This will be particularly critical for successful innovative training in multidisciplinary non-malignant hematology.

Applicant institutions and/or partnerships must therefore provide evidence of rich and abundant clinical and research capacities, environments, and opportunities; patient populations; ancillary support; and highly qualified core faculty supervision and mentorship to support the enhanced multidisciplinary clinical curriculum and the companion research/scholarly activity component of the HFFTP. Institutional resources must be sufficient to accommodate the training requirements of the additional complement of HFFTP fellows without diluting the experiences and opportunities for fellows recruited to the established fellowship program. Core faculty must have productive scholarly activities, specific areas of expertise and/or resources needed to support HFFTP fellow projects and activities. Clinical and research faculty qualifications must meet or exceed ACGME requirements. Proficiency in creating and implementing innovative training experiences, educational activities and research opportunities is expected.

A major intent of this RFP is that applicant institutions apply a substantial body of experience in malignant and non-malignant hematology fellowship training to the design of a novel and innovative career development track in multidisciplinary non-malignant hematology. Programs that have traditionally focused on medical oncology should not use this RFP to fund an initial effort to expand training opportunities into hematological disciplines. However, ASH acknowledges that some institutions with critical skillsets in hematology training may not yet have established substantial track records in training non-malignant hematologists due to insufficient institutional support , and that the funds provided through this RFP might overcome these barriers and realize institutional potential for innovative multidisciplinary non-malignant hematology training. This section of the RFP outlines a non-inclusive set of institutional resources as well as faculty experience and expertise that would define a robust track record in hematology training and/or the strong potential to innovate training in multidisciplinary non-malignant hematology.

ASH recognizes that innovative career development in multidisciplinary non-malignant hematology could necessitate approaches to training in academic inquiry that go beyond education in traditional laboratory or clinical research methods. This would particularly be the case when multidisciplinary training involves complimentary disciplines such as systems hematology or medical education. Consequently, the RFP requires that applicant institutions demonstrate the capacity to foster and support scholarly activity that complements their proposed innovative core curricular education and clinical training in complementary disciplines.

The HFFTP is an ASH-sponsored pilot that will undergo a rigorous outcomes evaluation for success based on well-defined indices outlined in the RFP. As part of the evaluation process, HFFTP APD’s will submit yearly reports on both their progress and challenges in meeting the HFFTP’s goals and objectives. APD’s will also be expected to respond to questionnaires and surveys in a timely manner. Additionally, HFFTP fellows will also be required to respond to annual questionnaires and follow-up tracking reports.

The HFFTP-mandated reports are intended to complement the existing fellowship reviews, evaluations, assessments, and reporting, as well as the existing competency or promotions committee reviews, and annual assessments of program compliance and performance with faculty including the ACGME Annual Program Evaluation (APE) and the Program Evaluation Committee (PEC) reports.

Both PD and Assistant Program Director (APD) applicant qualifications should include a strong record in hematology fellowship training, and well as the expertise to lead innovative educational activities in non-malignant and multidisciplinary hematology, including clinical training, research skills development, scholarly projects, and career preparedness. More specifically, the PD must also serve as an academic role model while fulfilling the administrative and technical aspects of the role. The PD must be familiar with the institution’s infrastructure, operations, policies and procedures; must know the ACGME requirements for training programs; should have experience in successfully leading initiatives involving faculty members, support personnel, and fellows; and should be capable of creating an environment of collaboration and respectful discussion, with the goal of continued improvement of the educational experience.

Both the Program Director (PD) and APD applicant qualifications should include a strong record in hematology fellowship training, and well as the expertise to lead innovative educational activities in non-malignant and multidisciplinary hematology, including clinical training, research skills development, scholarly projects, and career preparedness. Additionally ,the designated APD should be a board-certified hematologist and have documented additional institutional support for a total 10% commitment to a primary role in the design, development and oversight of the Hematology-Focused Fellowship Track. The APD should have the appropriate administrative experience and academic expertise to work closely with the PD and other core faculty to optimize the hematology-focused educational and training experiences of Hematology-Focused Training Track fellows. This includes the seamless integration their clinical, scholarly, and research activities and training into the existing hematology-oncology program. The APD is therefore expected to be an active member of the Clinical Competency Committee and Program Evaluation Committee of the fellowship program. The APD should also demonstrate the competency to assume responsibility for program reporting as outlined in the RFP, as well as the authority to represent the institution to the Sponsor as an active member of the Program Network Working Group (PNWG).

The Hematology or Hematology/Oncology Fellowship Program Director (PD) and the designated Assistant Program Director (APD) for development and oversight of the Hematology-Focused Fellowship Track within the Fellowship Program will jointly submit a multiple principal investigator (multi-PI) application on behalf of their institution. The multi-PI application is meant to emphasize the joint PD and APD responsibility and authority for leading and directing the innovative Hematology-Focused Fellowship Track. The application will therefore describe a Leadership Plan delineating the PD's and APD's roles, as well as their administrative and scientific responsibilities for the innovative program. The application will also address the organizational structure and governance of the training partnership including a communication strategy, the process for making decisions on scientific and administrative direction, and procedures for resolving conflicts.

If an institution has an ACGME accredited combined hematology/oncology fellowship program that does not currently include a single-board option, a responsive application to this RFP would require the creation of a novel innovative hematology-focused fellowship training track within the combined program that incorporates both traditional and enhanced clinical curricula and related research experiences (see additional FAQs on the Hematology-Focused Fellowship Curriculum).

ASH’s multiyear longitudinal workforce study that started in 2018 was limited to the US adult hematology-oncology workforce. The strategy behind the RFP is based on the findings from the workforce study. Consequently, for the ASH HFFTP, the deliberations on the implications of adding hematology focused tracks to established hematology-oncology fellowship programs only considered US-based ACGME accreditation and the ABIM requirements for Single Boarding in Hematology. ASH anticipates that the lessons learned through this program about innovative career development in non-malignant hematology will inform models that will be adapted beyond the US adult hematology training paradigm.

With regards to US pediatric hematology-oncology fellowship programs, US adult hematology-oncology programs are encouraged to partner with pediatric hematology-oncology programs to develop multidisciplinary and innovative fellowship training programs, particularly related to joint subspecialty training that would address non-malignant hematological disorders across the lifespan. It is important to note that the Program Director and the Assistant/Associate Program Director will need to be housed within the US hematology-oncology program in order to apply.

No. However, adult hematology-oncology programs are encouraged to partner with pediatric hematology-oncology programs to develop multidisciplinary and innovative fellowship training programs, particularly related to joint subspecialty training that would address non-malignant hematological disorders across the lifespan. In addition, the Program Director and the Assistant/Associate Program Director will need to be housed in the adult hematology-oncology program in order to apply.

No. ASH’s multiyear longitudinal workforce study that started in 2018 was limited to the US adult hematology-oncology workforce. The strategy behind the RFP is based on the findings from the workforce study. Consequently, for the ASH HFFTP, the deliberations on the implications of adding hematology focused tracks to established hematology-oncology fellowship programs only considered US-based ACGME accreditation and the ABIM requirements for Single Boarding in Hematology.

However, US hematology-oncology programs can partner with Canadian or any other international programs to develop multidisciplinary and innovative fellowship training programs, particularly related to joint subspecialty training that would address non-malignant hematological disorders. It is important to note that the Program Director and the Assistant/Associate Program Director will need to be housed within the US hematology-oncology program in order to apply.