From deficiency to competency: Strategies to strengthen classical hematology training across the United States

Abstract INTRODUCTION Classical hematology is a critical yet underemphasized component of hematology/oncology fellowship training. Classical hematology disorders account for a substantial proportion of referrals in both academic and community settings, yet training emphasis is disproportionately weighted toward malignancies, and fellows frequently report limited access to classical hematology resources including mentorship. To address these concerns, we conducted a needs assessment to understand the current landscape of training in the United States. While prior ASH workforce studies have touched on related themes, they did not focus specifically on fellows' experiences. Furthermore, the training environment has evolved considerably in recent years. This study assessed fellows' perceptions, training experiences, and educational needs in classical hematology across the United States. METHODS A 19-item Qualtrics survey was distributed to adult hematology/oncology fellows from April 2025 to July 2025 via program directors and coordinators using publicly available contact information from the Accreditation Council for Graduate Medical Education (ACGME). Participation was voluntary, and responses were anonymous. The survey assessed program characteristics, duration and content of hematology training, perceived readiness for practice, and interest in supplemental resources. Descriptive statistics were used to summarize responses. Programs were categorized according to American Society of Clinical Oncology (ASCO) definitions: small (1-9 fellows), medium (10-19), and large (20 or more). RESULTS Sixty fellows responded: 32% from small programs, 48% medium, 20% large; 68% were trainees at academic institutions. Geographic distribution included the Northeast (38%), South (25%), Midwest (12%), and West (7%). Only 33% identified career interest in classical hematology, yet 45% planned to enter private practice where such cases are commonly encountered. Interestingly, fellows wishing to pursue a career in private practice mostly came from small or medium programs (52% and 44%, respectively). Training duration varied: 22% of fellows reported <3 months of dedicated classical hematology training, and 48% had 3–6 months, despite ACGME requirements of 6 months or greater. While 90% reported frequent clinical exposure, only 61% felt adequately prepared to manage classical hematology cases; preparedness was lowest among those with less than 3 months of dedicated classical hematology training. Key topics (anemia, thrombosis, coagulopathy, and platelet disorders) were widely covered, but hemoglobinopathies and bone marrow failure were less consistently addressed. Depth of training was rated on average 3.8/5.0. Barriers included oncology heavy focus, lack of formal curricula, limited mentorship, and insufficient rotation time. Patient volume and faculty expertise were less frequently limiting. Fellows strongly supported a structured national curriculum (82%) and preferred case-based learning (55%) over online or in-person lectures (37%). Nearly half from small and medium programs identified mentorship and away rotations as key educational needs. Over 80% prioritized skill development in areas of thrombosis management, diagnostic reasoning, specialized test interpretation, and evidence-based practice. CONCLUSIONS The study was limited by sample size and possible selection bias pertaining to which fellows chose to participate. Nevertheless this national survey of hematology/oncology fellows identified substantial variability and deficiencies in classical hematology training, with many fellows feeling underprepared for independent practice despite frequent clinical exposure. Standardized curricula, enhanced mentorship, and expanded educational strategies—particularly in small and medium programs—are urgently needed to ensure workforce readiness and improve patient care.