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Hemostasis/Thrombosis Fellowship Curriculum:

• Pathophysiology and approach to diagnosis and treatment of congenital and acquired bleeding and clotting disorders

• Comprehensive care approach to hemophilia comprising, but not limited to: nursing, physical therapy, social work, home infusion, patient programs, national data collections, hemophilia treatment center networks

 • Complex and comprehensive management of patients with hemophilia (+/- inhibitors), von Willebrand disease and other rare bleeding disorders including their management in the inpatient and outpatient settings

 • Management of women with bleeding disorders. Participate in monthly combined Heme-Ob/Gyn clinic. Participate in ongoing development of a new focus for “Women with Bleeding Disorders” (care, outreach)

 • Management of hereditary hemorrhagic telangiectasia (HHT). HTTC providers are involved and listed as providers at The HTTC is in the process of certification as a center of excellence.

 • Management of patients with venous thromboembolism and cancer

• Diagnosis and management of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) in collaboration with Pulmonary/Critical Care

 • Differences and indications for anticoagulants including direct oral anticoagulants (DOACs) • Hemostasis and coagulation assays and their appropriate diagnostic use with rotations through the special coagulation laboratory

 • Incorporate point-of-care musculoskeletal ultrasound for rapid bleed detection, synovitis and other common joint abnormalities into clinical decision-making and guided treatments.

 • Incorporate vascular point-of care ultrasound imaging for management deep venous thromboembolism.

 • Acquire competence regarding the pathobiology of hemophilic arthropathy, and current options for interventions, indications, risks and side effects for orthopedic procedures, synovial embolization and (radio)synovectomies

 • Participate in outreach activities involving patient advocacy groups, local Hemophilia Chapters and national and international organizations such as the National Hemophilia Foundation and the World Federation of Hemophilia, Hemophilia Camp

 • Participate in ‘transition of care’ from pediatric centers to adult treatment centers • Exposure to self-infusion trainings and teaching venues for patients with hemophilia and bleeding disorders

• Opportunities for global involvement to advocate for diagnosis and treatment of bleeding disorders in the developing world, especially at the HTTC’ WFH Twinning site in Maputo, Mozambique

• Exposure to the clinical trial program encompassing gene therapy and novel clotting factor preparations.

Educational Resources

• Epidemiology/CREST (funding provided)

• Point-of-care (POC) musculoskeletal ultrasound (MSKUS) program, comprising virtual and hands-on training classes (CME-accredited), with opportunity to directly apply the new knowledge during clinics and rotations in hemophilia clinic. (funding provided)

The Hemophilia &Thrombosis Treatment Center at UCSD is an international leader in the field with several state-of-the-art ultrasound equipment. In addition, interested fellows will be outfitted with a hand-held ButtterflyTM probe that they can use at all times. Annette von Drygalski (APD) is certified in MSKUS by the Alliance for Physician Certification & Advancement (APCA).

• Point-of-care ultrasound (POCUS) - Hematology Focused Program. This program is currently being developed with Annette von Drygalski as the Course Director. The curriculum will focus on POC questions relevant to Hematology, comprising virtual and hands-on components, CME-accredited. Examples of POC applications are deep venous thrombosis imaging, spleen size, lymph node assessments. Participants will be enabled to work towards APCA certification after completion of this program. As with the MSKUS program fellows will be outfitted with a hand-held ButtterflyTM probe that they can use at all times.

• Pre-ASH and pre-HTRS workshops • Hemophilia Academy (applications will be supported)

• Participation in weekly Friday ACGME-curriculum conference from 8-9 am as pertinent to Hemostasis/Thrombosis and non-malignant Hematology.

• Participation in weekly Fellow case conferences from 9-10 am if Heme cases are discussed.

• Participation in weekly clinical Hemostasis/Thrombosis Journal Club (each Wed, 8.30 to 9 am)

• Training in Bioinformatics and large data analysis (RNAseq and Proteomics) through collaborations with the Center for Computational Biology&Bioinformatics UCSD (established collaboration with Hemophilia&Thrombosis Treatment Center – personalized training sessions available).