Impact of Mandatory Classical Hematology Rotation on Internal Medicine Residents' Training Experience

Background: There is an ongoing shortage of classical, or non-malignant, hematologists in the United States. Johns Hopkins Hospital has one of the only mandatory classical hematology rotations for internal medicine residents, and we aimed to evaluate the impact of the classical hematology rotation on internal medicine residents’ training experience and interest in classical hematology as a career path.

Methods: We distributed a 29-question, anonymous online survey via email to 48 residents who had completed the mandatory classical hematology rotation during the 2023-2024 academic year. Survey respondents were asked to rate their educational experience utilizing a scale of 1-5, with 1 and 5 representing very poor and excellent respectively. Respondents were also given the opportunity to give free-text responses on what they enjoyed and what could be improved about the rotation. Residents were also asked how the rotation increased their understanding of classical hematology as a field, medical knowledge of hematology, and interest in pursuing classical hematology as a career.

Results: Sixteen residents (33.3%) completed the survey. Six (37.5%) were in the second year of residency, and 10 (62.5%) residents were in the third. Fourteen (87.5%) residents had chosen their career path, including one resident who had decided on a career in classical and malignant hematology. Two (12.5%) residents were undecided on their careers, with one considering a career in classical hematology.

Three (18.8%) residents were not aware of classical hematology as a career path independent of malignant hematology or medical oncology prior to rotating on the service. Otherwise, residents learned of classical hematology as a career path during residency [8 residents (50%)], during medical school [4 residents (25%)], or prior to medical school [1 resident (6.3%)].

Fifteen (93.8%) residents rated the overall educational experience of the rotation as good or excellent. In addition, 14 (87.5%) residents rated informal and formal education as good or excellent, 14 (87.5%) rated variety of cases as good or excellent, and 15 (93.8%) rated complexity of cases as good or excellent.

Fourteen (87.5%) residents strongly agreed or agreed that the rotation improved their understanding of classical hematology as a field. Furthermore, 15 (93.8%) residents strongly agreed or agreed that increased knowledge of hematology would be useful for their future careers. Eight (50%) residents strongly agreed or agreed that the rotation increased their interest in pursuing a career in classical hematology.

Residents also utilized free text responses to share their experiences on the classical hematology rotation, including 4 residents (25%) sharing that the rotation exposed them to “unique” conditions that residents “do not see elsewhere in the hospital.”

Conclusion: The mandatory classical hematology rotation at Johns Hopkins is well-received by internal medicine residents, and participation led to increased understanding of classical hematology as a field, increased medical knowledge of hematology useful for residents’ future careers, and exposure to conditions not otherwise evaluated in the hospital. Half of the residents surveyed had an increased interest in pursuing a career in classical hematology, suggesting that a mandatory rotation in classical hematology for internal medicine residents may be an important pathway to recruit more physicians into the field.