Residency training programme curriculum



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LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA (LASUTH) LAGOS

RESIDENCY TRAINING PROGRAMME CURRICULUM

FOR

HAEMATOLOGY AND BLOOD TRANSFUSION

SEPTEMBER 2015

This curriculum is available on LASUTH website



INDEX Page

General Information 3

Aims and Objectives 5

Specific Objectives 6

Rotation Programme 9

Curriculum A. Technical skills 10

B. Clinical Haematology 11

C. Sub-speciality training 12

D General Aspects of Haematology 13

E Research and Dissertation 13

F Attendance at Conferences etc 14

G Outside Postings 14

Seminars in Haematology 14

Weekly Seminars 16

Teaching and learning methods 17

Assessment methods 18

Junior Residency Training 21

Senior Residency Training 30

References 35

General Information

Introduction

Haematology Residency training in the department encompasses both clinical and laboratory aspects of the speciality. Award of the degree FMCPath or FWACP (Laboratory Medicine) by National Postgraduate Medical College and West African College of Physicians respectively require evidence of satisfactory completion of training in both of these aspects.



Entry Requirements

  1. A Medically qualified graduate with a current practicing license of Medical and Dental Council of Nigeria.

  2. Possess evidence of passing Primary examination of either the West African College of Physician or National Postgraduate Medical College.

  3. Possess certificate of National Youth Service Corps (NYSC) or Exemption from NYSC (Nigerian candidates only).

  4. Pass LASUTH residency training entry examination in Haematology

Registration of Associate Fellows of the Colleges

Residents admitted for training are associate fellows of either or both Colleges and must apply to be so registered by the two colleges. Candidates not registered as associate fellows of the colleges will not be allowed to sit for the Part 1 or II Fellowship Examinations.



Examination Requirements

PART 1: Candidates will be qualified to sit for Part 1 examination after the initial two years of training (i.e. Junior residency programme).Only candidates that complete the initial 24 months of training (without interruptions other than the normal annual leave periods) are eligible to write Part 1 examination.

PART II: This is taken at least 2 years post part 1 (senior residency programme)

Duration of Examinations Passed.

A pass in the primary examination stands for 5 years while a pass in the Part 1 Examination will be for four years. Candidates will be required to retake the part 1 fellowship examination after repeating their pre-part 1 postings if they fail to attempt the examinations 4 years after passing.



Temporary Suspension of Training

Candidates intending to take an extended leave or suspend training for any reason must inform the Faculty Secretaries of either or both Colleges in writing, providing details of the anticipated duration of leave or suspension. This exclude period of standard annual leave.

The trainee will be required to undertake additional training time up to the period of additional leave. Where this training suspension exceeds two years and activity during this period is outside Haematology Department, the Period of Training already undertaken shall be deemed to have lapsed. The trainee therefore starts afresh (junior or senior residency postings) provided that no examination already passed has lapsed (primaries -5 years, part 1 ---4 years)

Aim and Objectives

The aim of this curriculum is to provide the trainee the skills and knowledge required for clinical and laboratory haematology service.



  1. General Objectives of the Residency Training in Pathology (NPMCN)

  1. To organise and manage a pathology laboratory, including being conversant with the requisite safety procedures at the laboratory in question

  2. To learn the basic principles underlying all the laboratory, diagnostic techniques as well as practically carrying them out

  3. To prepare laboratory reagents as may be required in the relevant areas of the laboratory

  4. To undertake accurate statistics and periodic clinical audit in the laboratory

  5. To interpret laboratory results and situate them in the appropriate context and sign-out or authorize the reports of these results on the appropriate forms

  6. To make diagnosis or summaries, based on the results of the laboratory tests or procedures, which may impinge on or be contributory to the management of disease processes

  7. To organise and supervise the primary and secondary health care laboratories

  8. To advise on antibiotic use for communicable diseases based on the results of the appropriate laboratory procedures

  9. Clinical management of infectious, metabolic and haematological disorders

  10. The acquisition of communication skills required for the practice of clinical haematology.

  11. The acquisition of some management skills required in the running of the haematology laboratory.

  12. Understanding of research, audit and team working, which underpin haematology practice.

  1. Specific Objectives

Haematology and Blood Transfusion

  1. Part 1 Level

  1. Technical Skills

  1. Understand basic scientific principles of the techniques used in Haematology laboratory

  2. Be able to carry out basic techniques e.g. estimation of Hb, PCV, WBC (total and differentials), platelet, ESR, Sickling, Solubility tests, Hb electrophoresis, reading of peripheral blood films, coagulation screening tests (prothrombin time, partial thromboplastin time, thrombin time), basic serology tests, e.g. grouping and cross matching, antibody screening and identification

  3. Prepare basic routine reagents.

  4. Understand and master the principles and use of microscope, centrifuges and electrophoretic equipment.

  5. Have knowledge of specimen bottles, anti-coagulants and their uses

  6. Understand the principles and use of automated equipment

  1. Clinical Skills

  1. Be able to describe and investigate simple haematological disorders e.g. anaemia, leukaemia etc. and principles of their management

  1. Donation Drive

  1. Understand the principles of donor recruitment and bleeding and care of donors

  1. Part II

  1. Technical Skills

  1. Understand and be able to take responsibility for organization, management and supervision of the laboratories e.g.

  • Routine haematology laboratory

  • Coagulation laboratory

  • Blood transfusion/serology laboratory

  • Disposal and de coagulation of expires blood, washing up techniques etc.

  • Quality assurance of reagents and techniques

  • Management of staff

  1. Understand and be technically sound in the principles of instrumentation

  2. Be able to carry out special tests e.g. Bone Marrow Aspiration/biopsy preparation and reporting, haemoglobin electrophoresis, L.E> cell preparation and identification

  3. Be able to carry out fine needle aspiration of superficial lymph nodes and masses

  1. Clinical Skills, Responsibility and Decision Making

  1. Be well grounded in the diagnosis and management of haematological diseases e.g. anaemias, leukaemias, lymphomas, bleeding disorders etc.

  2. Be able to handle clinical consultations

  3. Understand and master the principles of oncology



  1. Blood Products

  1. Be able to prepare and preserve blood products



  1. Signing Reports

  1. Must report and sign reports with consultants

  1. Rotation

  1. Must spend at least 3 months each in the Departments of Paediatrics and Internal Medicine

Number of Residents Needed

For each consultant unit,-1 senior resident and 2 junior residents are desirable



Pre-primary Examination

The resident is encouraged to attend the undergraduate lectures in Haematology and Blood Transfusion, Medical microbiology and Parasitology, Morbid anatomy and Chemical Pathology to refresh his memory




  1. Rotation Programme

Within the first 18months, the resident must rotate through the other three sub-specialities of pathology. During the rotation, he will take full part in the residency programme of that department in technical and clinical skills

Rotation Schedule (Table 1)

Year 1

Haematology

Rotation

Rotation

Formal instructions, Lab. Experience, Clin. Management

Year 2

Rotation

Haematology

Above plus Blood Trans. Course, Seminars, Eligible for part 1

Year 3

Haematology, Oncology, Cytology, Paediatric Haematology(3months), Haematology and blood transfusion services, Research project for dissertation

Specific instr. in sub specialities , sound theoretical and practical knowledge

Year 4

Internal Medicine (3months), Haematology

As above plus demonstrator. Eligible for FMC Path Part II exams



  1. Technical Skills

  1. Making and reading of peripheral blood films, Differential counts

  2. Reporting and recognition of malaria parasites, abnormal red blood cell, white blood cells and platelets

  3. Performance of Hb, PCV, WBC and platelet counts. Reticulocyte count

  4. Automated blood counts

  5. Sickle cell tests and electrophoresis

  6. Blood grouping and cross-matching

  7. DAT, IDAT

  8. Antenatal serology

  9. Assessment and counselling of blood donors

  10. Bleeding and care of donors

  11. Collection and preservation of blood inventories

  12. Rapid test for HIV, ELISA tests

  13. CD4 counts, manual and by flow cytometry

  14. PCR participation and knowledge of general principles

  15. Preparation of blood products

  16. Bone marrow aspiration, staining and reports

  17. PT, INR, PTTK, TT and their interpretation

  18. Enumeration of platelets, platelet function tests

  19. Cytochemistry

  20. Immunophenotyping

  21. Molecular tests in haematology

  22. Documentation of tests, registers

  23. Good laboratory practice

  24. Quality control and SOPs

  25. Audit

  1. Clinical Haematology

  1. General haematology

  • Supervised participation in in-patient and out-patient management of haematological disorders

  • Haematology day clinic management and care of acute cases

  • Comprehensive care of HIV-AIDS patients including use of HAART and treatment of opportunistic infections

  • Counselling activities

  1. Specialist haematology

  • Anaemias—diagnosis and investigations of nutritional and haemolytic anaemias, malaria anaemia, management and prevention strategies

  • Diagnosis of haematology treatment and follow up of patients with haemoglobinopathy particularly HbSS

HbSS antenatal screening methods in conjunction with other laboratories. Counselling activities

  • Acute leukaemias- classification and chemotherapy regimens and their side effects

  • Chronic leukaemia- diagnosis, classification, staging and management. Pathogenesis, molecular biology

  • Myeloma and lymphoma- morphological diagnosis, classification, staging and treatment protocols

  • Haemophilia- diagnosis, management of Haemophilia A and B, Von Willebrand’s disease. Use of coagulation factor concentrates

  • Acquired bleeding disorders. DIC, massive transfusion, renal, hepatic and obstetric complications.

  • Clinical and laboratory aspects of platelet disorders, numerical and functional platelet disorders, mechanism and use of antiplatelet drugs

  • Thrombophilia. Instruction in diagnosis and management of thrombophilic conditions. Anticoagulation and control

  • Bone marrow failure syndromes. Diagnosis and long term management

  • Appropriate use of blood and blood products. Protocols for transfusion and management complications. Alternative strategies to blood transfusion

  1. Sub-speciality Training

  • Blood transfusion

The resident will spend a period of time in blood transfusion centre where active donor recruitment, deferral and retention is taking place. Understand the principles of management of resources in a blood bank. Equipment use and maintenance. Quality assurance in blood banking. Audit

  • Paediatric haematology

In conjunction with the paediatric departments and neonatal unit, instructions while on posting will be given on haematologic problems in children.

    • Neonatal haematology, normal values, anaemias, haematological aspects of sepsis, coagulation

    • Management of haemoglobinopathies in children

    • Congenital bleeding disorders

    • Transfusion in neonates and children

  • Oncology

There will be regular tuition meetings, seminars and practical management with the oncology unit in the department of radiotherapy in order to strengthen knowledge in the use of chemotherapy agents

  • Cytology

Some experience in aspiration biopsy of tumours, staining and interpretation

  • Stem cell transplantation

  • Formal and informal instructions in hematopoietic progenitor cell transplantation

  • Indication, sources, harvesting

  • Problems of allogeneic and autologous transplantation

  1. General aspects of Haematology

  • Communication skills- formal presentation of casesand seminars with the use of IT

Learn the problems of communication of bad news, care of the dying and counselling on the use of chemotherapy

  • Counselling in haemoglobinopathy

  1. Research and Dissertation

An approved research project may be undertaken in the 3rd and 4th years of training and residents will be encouraged to present their finding at conferences and workshops and also publish them in scientific journals

There is ample opportunity for research in the Haematology laboratory at the medical research centre

The resident will work on his dissertation for the FMC Path Part II examination


  1. Attendance at Conferences and Workshops

Continuing education programmes, grand rounds, mortality reviews are ongoing in the hospital once a month

Residents are nominated to attend training programmes of benefit to their course within and outside Lagos. Sponsorship is available for many of these



  1. Outside Postings

Lagos State Blood Transfusion Service (LSBTS)

Nigerian Institute of Medical Research (NIMR)

Lagos University Teaching Hospital, Idi-Araba (LUTH)


  1. Seminars in Haematology and Blood Transfusion

Weekly Topics

  1. Multiple myeloma

  2. Markers of lymphoma and their classification

  3. Iron metabolism

  4. Investigation of autoimmune haemolytic anaemias

  5. Diagnosis and treatment of acute lymphoblastic leukaemias

  6. Platelet structure and functions

  7. Normal and abnormal haemoglobins

  8. Chronic myeloid leukaemias: prognosis and treatment

  9. Red cell enzymopathy: pathology and investigation

  10. Platelet concentrate: preparation, storage and utilization

  11. Spherocytic haemolytic anaemias

  12. Red cell in-vitro preservation and utilization

  13. Management of aplastic anaemia

  14. Cryoprecipitate: composition, preparation, preservation and utilization

  15. Thrombosis, antithrombotic agents and their monitors

  16. Myelo dysplastic syndrome

  17. Inherited bleeding disorders: platelet and vascular disorders

  18. Inherited bleeding disorders: coagulation disorders and vWD

  19. Stem cells and boneu marrow transplantation

  20. Acquired bleeding disorders

  21. Polycythaemia

  22. Management of lymphomas

  23. Management of acute leukaemias

  24. Management of chronic leukaemias

  25. Inherited immune deficiencies

  26. Syndromic management of HIV/AIDS

  27. Antiretroviral therapy: guidelines and side effects

  28. Quality control and organisation of blood transfusion service

  29. Quality assurance in haematology

  30. Exchange blood transfusion and plasmapheresis: modalities and indications

Weekly Activities of the Department OF Haematology and Blood Transfusion

Weekly clinical programme of activities (Table 2)



Day

8.00am-5.00pm

BLOOD BANK CALLS IN THE 1ST WEEK OF EACH MONTH

Monday

Clinic

Unit ward round

Day care/ward call

Tuesday

Clinic

Unit ward round

Day care/ward call

Wednesday

Case presentation, presentation of short topics in haematology

Slide review/ Special investigation/ Bench work

Day care/ward call




Thursday

Clinic

Unit ward round

Day care/ward call

Friday

Seminar/dept. meeting/journal review/

Consultant ward round

Day care/ward call




Saturday

Ward Calls

Sunday

Ward Calls

Teaching and Learning Methods

  1. Observation of assisting and discussing with consultants

  2. Task specific on the job training

  3. Observation of laboratory methods

  4. Practical bench work

  5. Personal study

  6. Postgraduate education courses

  7. Clinical experience

  8. Laboratory meetings

  9. Clinical team meetings


Assessment Methods

  1. Continuous assessment

  1. Mini tests

  2. Case presentation

  3. Slide reviews

  4. Seminar presentation

  1. Annual review

  1. Detailed and reliable history taking and clinical examination

  2. Accurate and timely diagnosis and formulation of a treatment plan

  3. Good follow up notes

  4. Sound knowledge of laboratory methods, limitations and interpretation of results

  5. Ability to present and discuss cases


Assessment of Resident’s Performance

Laboratory and Practical Haematology

Objective: to understand basic scientific principles of the techniques used in haematology and carry out basic techniques and apply the laboratory results to patient care.

(Table 3)



Activity

Assessment

Signature of consultant

  1. Preparation:

Reagents

Buffers


Dilution fluids

Stains








  1. Making and staining of

Peripheral films

Leishman


Supravital stains







  1. Manual tests

Haemoglobin

PCV


Rbc count

Rbc indices









  1. WBC COUNT

Differential count

Absolute count









  1. Use of automated machines







  1. Perform bone marrow

Aspiration

Biopsy


Preparation and staining

Reports on BM









  1. Blood transfusion techniques

Blood grouping

Cross-matching methods

Investigation of transfusion reactions








  1. Coagulation tests

PT

INR


PTTK

Thrombin time

Fibrinogen assay FDPs

Automated methods









  1. Platelets

Counts

Function tests









  1. LE preparation







  1. ESR







  1. Cytochemical staining

Immunophenotyping

Cytogenetics









  1. Haemoglobinopathy

Sickling test

Solubility test

Hb electrophoresis

Kleihauer technique









  1. Blood products

Preparation of red cell conc.

‘’ ‘’ ‘’cryoprecipitate

‘’ ‘’ ‘’ FFP

‘’ ‘’ ‘’ platelets









  1. Lymph node histology and classification of lymphomas







  1. Performance of lumber puncture

Interpretation of CSF cytology







  1. Interpret peripheral blood films and relate to the clinical picture







  1. Principles of laboratory management

  2. Q.C.

  3. Staff performance and appraisal

  4. Laboratory statistics







Junior Residency Training (Table 4)

A formal introduction to laboratory haematology is required during the first three months of residency training programme, this will be followed by rotation through the major laboratories, in and out-patient managements of patients, emergency bench calls from 4pm to 8pm; and all day during the week ends and public holidays. Clinical calls are also compulsory for all residents during the call periods as for emergency bench calls, except that they are not run concurrently by the same individual. Laboratory haematology will include instruction and hands on experience in routine haematology/heamato-oncology, blood transfusion medicine, haemostasis and coagulation and special tests, laboratories.

The trainee in haematology will spend the first 3 months as introduction to laboratory and clinical haematology. He/she will spend a minimum of 2 weeks in blood transfusion, four weeks in general haematology (for stain preparation, diagnostic blood counting, peripheral blood film and bone marrow slides reporting) and one week in coagulation. The remaining five weeks will be for clinical exposure

The trainee will be instructed in methods for obtaining bone marrow by aspiration and trephine, making slides from the aspirate and touch or roll preparations from the trephine. Resident must be conversant with preparation of basic stains.

Trainee will be exposed to fine needle aspiration biopsy techniques.

Clinical training during this induction period will include supervised participation in in-patient and out-patient management of haematological disorders including clinical on-call as appropriate

There will be an assessment at the end of the 3-month rotation

Following the introduction period, the trainee will receive instruction and practical experience in further aspects of haematology and rotate through other specialities in pathology, for the rest of the 1st year of training and through the 2nd. Part 1 FMCPath examination will be written after the 1st two years of posting (Table 2).

Junior residents will also start formal academic and clinical components of the training, as indicated in the tables

Table 4: Schedules for junior resident postings, first 24 months



Module

Programme

Duration in months

Contact academic Hrs/wks

Contact bench work Hrs/wks

Contact clinical rounds Hrs/wks

Total credit units/ module earned

1

Haematopoiesis, blood cells and functions; introduction to clin. Haemato

1

4

12

16

4

2

Non-haemolytic anaemias (nutritional deficiencies, marrow failure, others)

2

4

12

16

8

3

Transfusion medicine and haemolytic disease of the new born

2

4

12

16

8

4

Haemolytic anaemias (acquired &inherited)

2

4

12

16

8

5

Haemostasis and bleeding disorders, AIDS

2

4

12

16

8

6

Haematologic malignancies: lymphoproliferative &myeloproliferative disorders, plasma cell neoplasm

3

4

12

16

12




Chemical pathology

3

Outside postings




Histopathology

3




Medical microbiology ¶sitology

3




Leave period

3
















Total for the 4 semesters of 3months each

24

192

576

960

48

Note:

Academic work includes lectures, seminars and journal clubs

Lab/bench work includes analytical procedures, bone marrow aspiration and PB and BM slide reviews. Contact clinical work includes ward rounds, clinics and teaching rounds

Lab/bench work and clinical work should necessarily follow the academic schedule

1 hour of contact work/week for 3 month= 1 unit

2-4 hours of contact bench/Lab work per week for 3 months=1 unit

2-4 hours of contact clinical rounds per week for 3 months=1 unit

Trainees in JRT programme will be ELIGIBLE TO SIT FOR PART 1 FMCPath examination only after he/she MUST HAVE COMPLETED A MINIMUM OF 24MONTHS OF POSTINGS AS FOLLOWS:

12 months (48 weeks) of haematology postings

09 months (36 weeks) of outside postings

03 months (12 weeks) of leave

Credit units earned during outside postings are determined by individual departments

To be eligible to sit for part 1 examination, the trainee must have accumulated a total minimum credit points of 48 units for haematology postings and he/she should have completed rotations in the 3 sister departments of chemical pathology, histopathology and medical microbiology and parasitology

All contacts must be entered in the appropriate section of the log book and signed by the supervising consultant or appropriate person in all cases before the candidate is allowed to sit for the part 1 FMCPath examination

Further details on the programme (Tables 5)

Table 5: Basic haematology: haematopoiesis, blood cells and functions, and introductory clinical haematology

S/N

Topic

1

Haematopoiesis, stem cell and blood cells &growth factors

2

Erythropoiesis, red cell metabolism and benign disorders or erythropoiesis

3

Haemoglobin structure, function and metabolism

4

Bone marrow structure and functions

5

Lymphatic structure and function

6

Innate and adaptive immunity

7

Leucocytes structure &function; benign disorders of leucocytes

8

The platelet structure &function

9

History taking, physical examination of common haematological disorders

Table 6

Non haemolytic anaemia



S/N

Topic

1

Iron deficiency anaemia: iron metabolism; aetiopathogenesis; clinical features; laboratory features; differential diagnosis; management and prevention

2

Megaloblastic anaemia: vitamin B12 metabolism, folate metabolism; causes and pathogenesis of megaloblastic anaemia, clinical features, laboratory features, differential diagnosis, management and prevention

3

Iron overload: aetiology, pathogenesis, laboratory diagnosis, clinical features and management. Chelating agents in iron overload

4

Bone marrow failure: aplastic anaemias, causes, laboratory and clinical features

5

Bone marrow failure: fanconi’s anaemia, pure red cell aplasia

Table 7

Transfusion medicine and haemolytic disease of the new born



S/N

Topic

1

The blood bank: organisation, infrastructure &basic equipment, counselling room, bleeding room, donor resting room

2

Blood donor organisation: donor organisers, phlebotomists, types of blood donors, donor care

3

Donor blood screening for transmissible infections, HBV, HCV, HIV, syphilis etc.

4

Medical screening of blood donors; bleeding room procedures

5

Grouping anti-sera: sources; avidity, antigen/antibody reaction enhancing agents

6

Laboratory procedures: ABO and rhesus blood grouping (tile and tube techniques), antibody screening, direct and indirect anti human globulin tests, cross matching

7

Laboratory procedure: component preparation, red cell concentrates, fresh frozen plasma (FFP), frozen plasma (FP), platelet concentrates, cryoprecipitate etc.; indication for component use

8

Clinical transfusion practice; checking of donor/recipient data at bed side; hazards of blood transfusion , investigation and management of transfusion reactions

9

Red cell substitutes

10

Parentage dispute and blood group serology

11

Haemolytic disease of the new born (ABO, Rhesus, others); diagnosis and management

12

Laboratory safety and quality assurance in transfusion practice

Table 8

Haemolytic anaemia (acquired and inherited)



S/N

Topic

1

Haemoglobinopathies: Classification, laboratory and clinical features

2

Haemoglobinopathies: sickle cell disorders aetiopathogenesis, incidence, diagnosis, management

3

Haemoglobinopathies: thalassaemic syndromes, aetiopathogenesis, incidence, diagnosis, management

4

Inherited Haemolytic anaemias: G6PD deficiencies, hereditary spherocytosis, hereditary elliptocytosis, diagnosis and management

5

Acquired Haemolytic anaemias: malaria, septicaemia and other infections

6

Acquired Haemolytic anaemias: paroxysmal nocturnal haemoglobinuria (PNH)

7

Immune Haemolytic anaemias: autoimmune Haemolytic anaemias

8

Laboratory methods other than haemoglobin electrophoresis: direct and indirect anti-human globulin tests, osmotic fragility tests, acidified serum lysis test (Hams test), Schumm’s test


Table 9

Haemostasis and bleeding disorders, acquired immune deficiency syndrome



S/N

Topic

1

Physiology of haemostasis, coagulation and fibrinolysis

2

Platelet structure and functions

3

Aetiopathogenesis of bleeding and thrombotic disorders

4

Thrombophilia: congenital and acquired. Causes, investigations and treatment

5

Inherited bleeding disorders

6

Acquired bleeding disorders, anticoagulant therapy, other methods of management of bleeding &thrombotic disorders

7

Laboratory techniques: PT, INR, APTT, PT, fibrinogen assay

8

Laboratory techniques: platelet function studies (bleeding time, aggregation tests etc.)

9

Laboratory techniques: specific factor assays (VIII &IX); identification of inhibitors; assays of protein C7S, antithrombin III and lupus anticoagulant. Heparin assay

10

Acquired immunodeficiency syndrome

11

Laboratory procedures: HIV screening techniques, CD4 counting techniques, PCR techniques and viral load in infants and adults living with AIDS


Table 10

Haematologic malignancies: lymphoproliferative, myeloproliferative &plasma cell disorders



S/N

Topics

1

Aetiopathogenesis

2

Classification, staging and prognosis

3

Clinical presentation, investigation, complication

4

Laboratory diagnostic methods: fine needle aspiration (FNA) and histologic biopsy of tissues; cytochemistry and immunophenotyping of tumour cells; cytogenetic characterisation of tumour cells

5

General investigations of haematologic cancers: FBC, ESR, serum biochemistry, LFT, viral screening (HBV, HCV &HIV), radiology (Chest X-ray, ultrasonography, computed tomography, magnetic resonance imaging (MRI) etc

6

Cancer chemotherapy

7

Targeted therapy in haematologic cancers

8

Treatment of haematologic cancer

9

Common childhood tumours

Methods of training

All trainees will participate actively in all academic, practical and clinical programmes including seminars, tutorials, patient management and out of hour clinical and laboratory services

The trainee will require dedicated periods of training with a trainer consultant. This will be especially important where skills are developed from pattern recognition, especially morphology but also clinical examination. The trainee will develop skills in directed but self-motivated training (text books, journals videos etc.). Adequate time must be provided for such learning (minimum half day per week). Library facilities, journal clubs, scientific and clinical seminars should be provided.

Throughout the training period per year, there will be an increasing use of in service experience for training purposes. At no time should this service load become such that the trainee fails to benefit from clinical and laboratory service work

Second year of training

During the second year of RTH, the trainee will externally rotate through other specialities in pathology namely, clinical pathology, microbiology and parasitology and morbid anatomy (histopathology). The trainee is expected to spend at least three months in each posting and is required to participate in all the activities of each department. The trainee must be proficient in all the routine laboratory procedures of each department, give seminars that will be graded and provide clinical service where appropriate (e.g. STI, infectious disease, endocrine and metabolic clinics). In morbid anatomy, the trainee must conduct post-mortems during the posting under supervision and later independently and attend clinic-pathological conferences and grand rounds.

The trainee will be assessed at the end of each posting and a report of performances is forwarded to the trainer in haematology

Assessment of junior residency training

At the end of the first two years, the trainee will be qualified to sit for the part II FMCPath examination majoring in Haematology

Senior residency training (SRT)

The senior residency training (SRT) programme starts in the third year of enrolment, but only after the trainee must have passed the part 1 FMCPath examination. It includes both laboratory and clinical programmes. Residents undergoing this phase of training will take part in all departmental activities as set out in tables 4-11 but at a more advanced level and acquire additional competences in the following:

Investigation and management of haematological conditions without supervision. Involvement in on-going clinical and laboratory research in the department.

Laboratory proficiency in the following:


  1. Kleihauer technique for foetal haemoglobin (HbF)

  2. Detection of anti D antibodies

  3. Cytogenetic procedures

  4. Coagulation factor assays

  5. Resolution of parental disputes

  6. Details of techniques of bone marrow/stem cell transplantation

He/she would also spend three months each in the department of internal medicine and paediatrics for further clinical exposure.

He/she would undertake a clinical and laboratory based research that will be presented as a dissertation for part II final FMCPath examination (Table 11).a senior resident is deemed to have completed his/her training if he/she has completed 24months of rotations:



  • 16 months (64weeks) in haematology

  • 6 months for internal medicine and paediatrics

  • And cumulative 3 months of annual leave

  • Has completed the dissertation

  • Has a cumulative credit units of 70 (including 6 unit for thesis)

Table 11:

Senior resident training rotation.












3 months

3 months

3 months

2 months

1 month

3rd year

Haemat

Haemat

Internal med

Haemat/dissertation

Leave

4th year

Paediatrics

Haemat/dissertation

Haemat/dissertation

Haemat/dissertation

Leave

5th year

Haemat

---------

----------

------------

--------

Using 12 units/3 months, excluding the 6 months of outside postings (internal medicine and paediatrics) and 3 months of leave periods leaving half time in fourth year for dissertation, the maximum units for 3rd and 4th years should be 4. Dissertation carries 6 units, the total units for part II candidates should be 70

Curriculum for senior residency training

Candidates undergoing senior resident postings are expected to have a sound theoretical and practical knowledge of haematological practice but will not have had a great deal of unsupervised experience in applying that knowledge. The second phase of training is thus devoted to acquiring this self-sufficiency in the speciality. There will also be exposure to management issues and the trainee should be involved in the teaching of medical and paramedical students, as well as supervision of junior residents.

This phase will also be used by the trainee to expand interested in particular aspects of haematology and to develop a wider expertise in these aspects e.g. haemato-oncology, haemostasis and transfusion medicine.

If possible, and if desired by the trainee, more extended time can be spent in sub-speciality training. In addition part of this time (12-24) should be used for a relevant clinical and laboratory based research project approved by the NPMC that will be presented in part fulfilment of the FMCPath part II examination

Required facilities for senior resident training



  • Specified out-patient duties with the opportunity to see new patients, determine the diagnostic approach and therapy appropriate to their condition. There will be close collaboration with consultant colleagues and referring medical colleagues. Such expertise is essential

  • Increasing opportunity to oversee the care of in-patients. There must be regular, structured strategic discussion over management policy between consultants, trainee, nursing and paramedical staff so that the trainee acquires the skills needed for effective team work

  • The opportunity to be actively involved in the daily management of the haematology laboratory with full participation in management discussions. Trainees should be encouraged to attend appropriate management courses. Such management instruction should include laboratory computer systems, quality control, audit, potential of automation and near patient testing

  • Familiarity with radiation techniques and use of radioisotopes where possible

  • Regular update discussions of discussions of academic and practical aspects of haematology including the availability of appropriate journals

  • Rotations at this level of training shall include blood transfusion, paediatric haematology and haemostasis foe=r which secondment to other centres may be necessary. The actual details and duration of exposure to each specialty should be a minimum of three months

Additional formal/ informal training

  • Blood transfusion practice including the identification of antibodies; methods for preparing leukocyte depleted blood products and their use; identification and management of auto-antibody diseases, both warm and cold; methods of HLA typing. There should be instructions in methods for preparing blood components and in available techniques for rendering blood products safer from virus contamination and transmission. A formal blood transfusion course of four weeks would be appropriate

  • Formal and informal instruction in indication, techniques and problems of allogeneic and autologous haematopoietic progenitor cell transfusions. Trainees should have experience in a transplant unit during this year

  • More detailed instruction in clinical and laboratory aspects of coagulation including specific factor assays, identification of inhibitors, techniques for measuring protein C, S, antithrombin III, lupus anticoagulant and such additional factors as from time to time become important. This practical experience should be linked to instruction in the theory of coagulation and fibrinolysis

  • Clinical and laboratory aspects of platelet disorders including numerical and functional abnormalities and the use and limitation of platelet function studies. Such practical experience needs to be linked to an understanding of platelet function and interaction with vessel wall. Mechanisms and the use of antiplatelet drugs

  • Clinical and theoretical instruction in radioisotope methods inhaematology. Clinical experience means knowledge of the usefulness of isotopes in clinical practice and interpretation of results. It is not necessary at this stage to have “hands-on” experience

Basic theoretical and interpretative knowledge of radioisotope tests is desirable during the training and trainees who wish to obtain more experience are encouraged to do so

Before signing trainees for examinations, trainers may use reasonable procedure to determine the readiness of otherwise of the candidate for the said examination



Acknowledgement:

The Department is grateful to Dr Bodunrin Osikomaiya for her secretarial assistance.



Dr Akinsegun Akinbami

HOD

References

  1. Higher Medical Training. Curriculum for Haematology.Jan.2005.http//www.jchmt.org.uk

  2. National Postgraduate Medical College, Residency Training Manual and Handbook.|



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