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.
A Medically qualified graduate with a current practicing license of Medical and Dental Council of Nigeria.
Possess evidence of passing Primary examination of either the West African College of Physician or National Postgraduate Medical College.
Possess certificate of National Youth Service Corps (NYSC) or Exemption from NYSC (Nigerian candidates only).
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.
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.
General Objectives of the Residency Training in Pathology (NPMCN)
To organise and manage a pathology laboratory, including being conversant with the requisite safety procedures at the laboratory in question
To learn the basic principles underlying all the laboratory, diagnostic techniques as well as practically carrying them out
To prepare laboratory reagents as may be required in the relevant areas of the laboratory
To undertake accurate statistics and periodic clinical audit in the laboratory
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
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
To organise and supervise the primary and secondary health care laboratories
To advise on antibiotic use for communicable diseases based on the results of the appropriate laboratory procedures
Clinical management of infectious, metabolic and haematological disorders
The acquisition of communication skills required for the practice of clinical haematology.
The acquisition of some management skills required in the running of the haematology laboratory.
Understanding of research, audit and team working, which underpin haematology practice.
Haematology and Blood Transfusion
Part 1 Level
Understand basic scientific principles of the techniques used in Haematology laboratory
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
Prepare basic routine reagents.
Understand and master the principles and use of microscope, centrifuges and electrophoretic equipment.
Have knowledge of specimen bottles, anti-coagulants and their uses
Understand the principles and use of automated equipment
Be able to describe and investigate simple haematological disorders e.g. anaemia, leukaemia etc. and principles of their management
Understand the principles of donor recruitment and bleeding and care of donors
Understand and be able to take responsibility for organization, management and supervision of the laboratories e.g.
Routine haematology 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
Understand and be technically sound in the principles of instrumentation
Be able to carry out special tests e.g. Bone Marrow Aspiration/biopsy preparation and reporting, haemoglobin electrophoresis, L.E> cell preparation and identification
Be able to carry out fine needle aspiration of superficial lymph nodes and masses
Clinical Skills, Responsibility and Decision Making
Be well grounded in the diagnosis and management of haematological diseases e.g. anaemias, leukaemias, lymphomas, bleeding disorders etc.
Be able to handle clinical consultations
Understand and master the principles of oncology
Be able to prepare and preserve blood products
Must report and sign reports with consultants
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
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
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
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
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
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
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
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
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
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
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
Lagos State Blood Transfusion Service (LSBTS)
Nigerian Institute of Medical Research (NIMR)
Lagos University Teaching Hospital, Idi-Araba (LUTH)
Seminars in Haematology and Blood Transfusion
Markers of lymphoma and their classification
Investigation of autoimmune haemolytic anaemias
Diagnosis and treatment of acute lymphoblastic leukaemias
Platelet structure and functions
Normal and abnormal haemoglobins
Chronic myeloid leukaemias: prognosis and treatment
Red cell enzymopathy: pathology and investigation
Platelet concentrate: preparation, storage and utilization
Lymph node histology and classification of lymphomas
Performance of lumber puncture
Interpretation of CSF cytology
Interpret peripheral blood films and relate to the clinical picture
Principles of laboratory management
Staff performance and appraisal
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
Duration in months
Contact academic Hrs/wks
Contact bench work Hrs/wks
Contact clinical rounds Hrs/wks
Total credit units/ module earned
Haematopoiesis, blood cells and functions; introduction to clin. Haemato
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
Haematopoiesis, stem cell and blood cells &growth factors
Erythropoiesis, red cell metabolism and benign disorders or erythropoiesis
Haemoglobin structure, function and metabolism
Bone marrow structure and functions
Lymphatic structure and function
Innate and adaptive immunity
Leucocytes structure &function; benign disorders of leucocytes
The platelet structure &function
History taking, physical examination of common haematological disorders
Non haemolytic anaemia
Iron deficiency anaemia: iron metabolism; aetiopathogenesis; clinical features; laboratory features; differential diagnosis; management and prevention
Megaloblastic anaemia: vitamin B12 metabolism, folate metabolism; causes and pathogenesis of megaloblastic anaemia, clinical features, laboratory features, differential diagnosis, management and prevention
Iron overload: aetiology, pathogenesis, laboratory diagnosis, clinical features and management. Chelating agents in iron overload
Bone marrow failure: aplastic anaemias, causes, laboratory and clinical features
Bone marrow failure: fanconi’s anaemia, pure red cell aplasia
Transfusion medicine and haemolytic disease of the new born
Laboratory diagnostic methods: fine needle aspiration (FNA) and histologic biopsy of tissues; cytochemistry and immunophenotyping of tumour cells; cytogenetic characterisation of tumour cells
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
Targeted therapy in haematologic cancers
Treatment of haematologic cancer
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:
Kleihauer technique for foetal haemoglobin (HbF)
Detection of anti D antibodies
Coagulation factor assays
Resolution of parental disputes
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:
Has a cumulative credit units of 70 (including 6 unit for thesis)
Senior resident training rotation.
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
The Department is grateful to Dr Bodunrin Osikomaiya for her secretarial assistance.
Dr Akinsegun Akinbami
Higher Medical Training. Curriculum for Haematology.Jan.2005.http//www.jchmt.org.uk
National Postgraduate Medical College, Residency Training Manual and Handbook.|