HEMATOLOGICAL PATHOLOGY

In order to prepare to undertake such responsibilities the resident will require a sound general knowledge of pathological principles and medical practice. A wide and up-to-date knowledge of all aspects of laboratory hematology is essential. This knowledge must be accompanied by a clear understanding of the basic scientific and technical principles involved, and ability to provide useful consultation to the clinician in the application of the resources of the laboratory to help solve clinical problems, and an appreciation of the principles involved in the management of a large modern laboratory. A successful resident will also show evidence of ability to participate effectively in the education of medical and non-medical associates and students.

Residents in hematological pathology must acquire:

1. adequate knowledge of basic science in relation to hematology;
2. knowledge and experience in the quantitative aspects of routine general hematology;
3. a wide experience in morphological hematology and pathology of the lymphoreticular organs, including the applications of cytochemistry;
4. comprehensive understanding of blood group (red cell, white cell and platelet) systems, immunohematological principles and practice, and component therapy; the collection of blood and preparation of components is included in this section;
5. familiarity with the physiology and pathology of hemostasis and component therapy of its disorders;
6. experience in the use of special hematological techniques such as competitive binding assays, hemoglobin electrophoresis, immunoelectrophoresis, enzyme assays, cell surface markers, tests of leucocyte dysfunction;
7. experience in the use of radioisotopes in vivo and in vitro for the diagnosis and assessment of hematological disease;
8. a sound understanding and practical familiarity with techniques in use in a modern laboratory for the foregoing, together with appreciation of the accuracy, reproducibility, limitations, and clinical usefulness of these techniques, and including knowledge of modifications produced by drugs;
9. understanding of the principles and practice of quality control;
10. a working familiarity with various aspects of management of a hospital or other hematological laboratory service including broad principles of personnel management, staff scheduling, budgeting, structure of hospital management, personnel safety, and equipment evaluation.

The training requirements which follow are the minimum. All residents in hematological pathology, especially those contemplating an academic career, are encouraged to take additional training in their areas of special interest.

A university wishing to have a program in hematological pathology accredited must also sponsor an accredited program in internal medicine. In addition, there must be active teaching services in pediatrics, general surgery, obstetrics and gynecology and anatomical pathology.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in hematological pathology must be consistent with the specialty training requirements.

Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in hematological pathology.

In those cases where a university has sufficient resources to provide most of the training in hematological pathology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to hematological pathology.

1. Teaching Faculty

There must be a sufficient number of qualified teaching staff to supervise residents at all levels and in all aspects of the specialty, and provide teaching in the basic and clinical sciences related to the specialty. The teaching staff should have an appropriate nucleus of full-time teachers.

2. Volume and Variety of Pathological Material

The resources of the program, including volume and variety of materials, laboratory space and equipment, and medical, scientific and technical staff, must be satisfactory to the Specialty Committee in relation to each of the following components:

1. General Morphological Hematology

There must be an adequate volume and variety of material available to provide experience in the investigation and diagnosis of the major types of hematological disorders by analysis of routine blood counts and assessment of blood smear, bone marrow and lymph node morphology. In addition, there must be ample opportunity to select and interpret more specialized tests required to differentiate the more complex disorders, under the supervision of the professional staff.

2. Hemostasis and Thrombosis

There must be adequate facilities available and organized for teaching all aspects of hemostatic and thromboembolic disorders.

3. Blood Banking

Experience must be provided in an active blood bank laboratory and regional transfusion centre. Such training should not be entirely technical in nature, but should include teaching in the investigation and diagnosis of the incompatible crossmatch, hemolytic disease of the newborn, transfusion reactions, and the identification of antibodies. Experience in the areas of component therapy and HLA typing should be provided.

4. Pediatric Hematology

There must be opportunity for training in the hematological pathology of infants and children, supported by an adequate volume and variety of hematological material and all necessary staff and facilities.

5. Special Procedures

Residents must have access for training purposes to equipment and staff concerned with the application of special procedures to hematology, e.g. electrophoresis, enzyme assays, tests of cellular function, competitive binding assays, DNA analysis using molecular biological techniques, immunophenotyping by flow cytometry, immunohistology, electron microscopy, cytogenetics and radioisotope techniques.

6. Laboratory Management

Instruction and experience must be provided in the procedures essential to the operation of a hematological laboratory, including quality control, equipment evaluation, laboratory safety, personnel management, hospital administrative structure, budget organization, utilization management, and evaluation and quality control of point of care methodologies.

3. Clinical Services Specific to Hematological Pathology
   1. Consultation

Experience must be provided in the consultative aspects of the use of laboratory data. Residents should have the opportunity to participate in consultations with clinical and laboratory colleagues, both elective and emergency, on a continuing basis during training. This should include consultations received from colleagues external to the teaching institution.

2. Laboratory

The training in hematological pathology must provide experience in all aspects of laboratory investigation currently of importance in the diagnosis and clinical management of patients with hematological disorders. The residents must be provided with increasing responsibility in the interpretive and technical skills that relate to the specialty, as well as in the provision of consultations to clinical colleagues, and in the management of a hematology laboratory. Residents should have exposure to laboratory information systems and the production of timely, clinically relevant data.

4. Supporting Services — Clinical, Diagnostic, Technical
   1. Liaison with Other Specialties and Subspecialties

There must be appropriate liaison with teaching services in pediatrics, general surgery, obstetrics & gynecology and anatomical pathology or general pathology. There must also be well organized services in all branches of laboratory medicine relevant to the work of the institution. Hospitals with a major role in the hematological pathology program should also be engaged in medical undergraduate teaching including pathology.

There must be mechanisms to ensure that the training provided in anatomical pathology, internal medicine and other laboratory and clinical services, meets the needs of residents in hematological pathology. There must be regular contact between residents and clinical colleagues to allow discussion regarding selection and interpretation of tests for the diagnosis and management of patients.

2. Hematologic Oncology

There must be a close association with oncology services, in order that a full range of neoplastic diseases related to hematology is available for teaching. The respective roles of, and pathological changes induced by, radiotherapy, chemotherapy and immunotherapy must be clearly understood by residents.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

1. Organized Scholarly Activities

A coordinated educational program must be provided in hematological pathology and associated fields. The program may include lectures and seminars, which may be interdisciplinary in nature, teaching rounds, special conferences, technical demonstrations, and journal clubs.

2. Basic and Clinical Sciences Relevant to Hematological Pathology

The academic program must include organized teaching in the basic and clinical sciences relevant to hematological pathology including advanced scientific knowledge essential to the practice of the specialty.

3. Biomedical Ethics

The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to hematological pathology.

4. Communication Skills

The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place. Exposure to new communication techniques e.g. telemedicine and telepathology should be provided.

5. Patient Care Team

Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.

6. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

7. Management Skills

Residents must be given opportunities to develop skills in management as applied to hematological pathology such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.

8. Quality Assurance/Improvement

Residents must be provided with opportunities to gain an understanding of the principles and practice of quality assurance/improvement and participate actively in such programs in their hospital departments.

Residents should have instruction and experience such as will ensure competence in quality control procedures and familiarity with the administrative responsibilities involved in directing a comprehensive diagnostic hematology laboratory.

9. Research Opportunities for Residents

There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. Residents should be encouraged to become familiar with all clinical or experimental research being conducted in hematology in the participating institutions and departments. It is desirable that facilities be available to enable a resident, in suitable circumstances and when acceptable to the program director, to engage in research under supervision as part of the residency program in hematological pathology.

10. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

11. Life-Long Learning

All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university.

SPECIALTY REQUIREMENTS:

Approved residency period must include:

1. laboratory residency in hematological pathology, which must include experience in morphological hematology, coagulation work, blood banking and immunohematology;

approved residency in internal medicine, including its specialties, or six months of approved residency in internal medicine and six months of approved residency in general surgery or pediatrics or obstetrics and gynecology; 

PROGRAMS (WITH TRAINING REQUIREMENTS):

Diplomas(Dip):

Six months of approved residency training.

Doctor of Medicine(M.D):

Eighteen months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training.