Utilizing the complete blood count (CBC) and blood smear analysis to improve pediatric residents' skills and knowledge in hematology

Abstract Background: Effective learning in medical education often integrates knowledge with clinical activities, particularly through hands-on, interactive experiences. At Atrium Health Levine Children's Hospital (LCH), pediatric interns undergo only one month of hematology/oncology rotation, which may contribute to a lack of confidence and proficiency in interpreting Complete Blood Count (CBC) and blood smear results, which are key tools in developing differential diagnoses and patient management plans across various specialties. This project aims to develop a pediatric hematology/oncology curriculum that enhances residents' CBC interpretation skills through structured case reviews and expert supervision. Objectives: Assess the feasibility of implementing a hematology curriculum incorporating case reviews, where residents interpret CBC data and blood smears with expert supervision. Evaluate the feasibility of completing the curriculum within a one-month rotation. Measure the impact of this curriculum on residents' hematology knowledge and self-perception of their skills. Methods: This investigation was conducted over a two-year period from July 2023 through June 2025. Twenty-four residents completed pediatric hematology/oncology rotation during this period and participated in all required aspects within the study. Before beginning the one-month rotation, residents complete a 15-question pre-test (Likert scale) to assess self-perception and comfort which specific skills and knowledge within hematology. Residents give ratings on a 5- point scale ranging from strongly disagree (1) to strongly agree (5). Also, residents completed a 10-question board-style (multiple choice) self-assessment to gauge baseline knowledge. They then engage in three pre-recorded PowerPoint lectures covering blood count and smear interpretation. Throughout the rotation, residents independently analyze three patient cases, interpreting CBC data and reviewing blood smears with guidance from hematology and pathology experts. At the end of the rotation, residents complete the same 15-question Likert scale self-assessment of skills and knowledge and 10-question board style multiple choice post-test. Qualitative feedback on the curriculum is also gathered through departmental surveys assessing the pediatric hematology rotation. Results: Thus far, 88% of residents (21 out of 24) have completed all components of the assignment within the rotation. On average, residents demonstrated a slight increase in hematology knowledge (mean score improvement of 8%) based on pre- and post-test assessments. However, substantial improvements in residents' perception of their skills were observed, with the most significant gains in their ability to formulate management plans for conditions like severe neutropenia and recognition of blood smear abnormalities. Qualitative feedback indicates that residents valued one-on-one expert sessions but expressed dissatisfaction with the length of the PowerPoint lectures. They also preferred electronic pre- and post-assessments for convenience. Discussion and Future Directions: Preliminary results suggest that the curriculum is feasible and beneficial in terms of increasing residents' confidence and self-reported knowledge in hematology. Despite limited gains in board-style knowledge tests, the hands-on experience with blood smear interpretation and expert feedback was well received. Future revisions will focus on reducing lecture length, improving the delivery of content (e.g., through one-on-one teaching), and transitioning assessments to electronic formats. This curriculum may serve as a model for implementing impactful learning experiences in short rotations, aligning with ACGME requirements for reduced time in subspecialty rotations. Conclusion: This investigation highlights the potential of a focused, case-based curriculum for enhancing pediatric residents' hematology knowledge and clinical skills. With adjustments based on learner feedback, this model could become an essential component of future hematology training