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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
1
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
2
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.
3
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)
4
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.
5
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.
2. Specific Objectives
Haematology and Blood Transfusion
A. Part 1 Level
i. 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
ii. Clinical Skills
7. Be able to describe and investigate simple haematological disorders e.g.
anaemia, leukaemia etc. and principles of their management
iii. Donation Drive
6
8. Understand the principles of donor recruitment and bleeding and care of
donors
B. Part II
i. 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
2. Understand and be technically sound in the principles of instrumentation
3. Be able to carry out special tests e.g. Bone Marrow Aspiration/biopsy
preparation and reporting, haemoglobin electrophoresis, L.E> cell
preparation and identification
4. Be able to carry out fine needle aspiration of superficial lymph nodes and
masses
ii. Clinical Skills, Responsibility and Decision Making
5. Be well grounded in the diagnosis and management of haematological
diseases e.g. anaemias, leukaemias, lymphomas, bleeding disorders etc.
6. Be able to handle clinical consultations
7. Understand and master the principles of oncology
7
iii. Blood Products
8. Be able to prepare and preserve blood products
iv. Signing Reports
9. Must report and sign reports with consultants
v. Rotation
10. 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
8
3. 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
9
A. 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
10
24. Quality control and SOPs
25. Audit
B. 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
2. 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
11
- 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
C. 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.
o Neonatal haematology, normal values, anaemias,
haematological aspects of sepsis, coagulation
o Management of haemoglobinopathies in children
o Congenital bleeding disorders
o Transfusion in neonates and children
- Oncology
12
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
o Formal and informal instructions in hematopoietic progenitor
cell transplantation
o Indication, sources, harvesting
o Problems of allogeneic and autologous transplantation
D. General aspects of Haematology
o 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
o Counselling in haemoglobinopathy
E. 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
13
F. 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
G. Outside Postings
Lagos State Blood Transfusion Service (LSBTS)
Nigerian Institute of Medical Research (NIMR)
Lagos University Teaching Hospital, Idi-Araba (LUTH)
4. 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
14
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
15
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
Wednesda
y
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
16
a. Observation of assisting and discussing with consultants
b. Task specific on the job training
c. Observation of laboratory methods
d. Practical bench work
e. Personal study
f. Postgraduate education courses
g. Clinical experience
h. Laboratory meetings
i. Clinical team meetings
Assessment Methods
17
1. Continuous assessment
1. Mini tests
2. Case presentation
3. Slide reviews
4. Seminar presentation
2. 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
18
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
2. Making and staining of
Peripheral films
Leishman
Supravital stains
3. Manual tests
Haemoglobin
PCV
Rbc count
Rbc indices
4. WBC COUNT
Differential count
Absolute count
5. Use of automated machines
6. Perform bone marrow
Aspiration
Biopsy
Preparation and staining
Reports on BM
19
7. Blood transfusion techniques
Blood grouping
Cross-matching methods
Investigation of transfusion
reactions
8. Coagulation tests
PT
INR
PTTK
Thrombin time
Fibrinogen assay FDPs
Automated methods
9. Platelets
Counts
Function tests
10. LE preparation
11. ESR
12. Cytochemical staining
Immunophenotyping
Cytogenetics
13. Haemoglobinopathy
Sickling test
Solubility test
Hb electrophoresis
Kleihauer technique
14. Blood products
Preparation of red cell conc.
‘’ ‘’
‘’cryoprecipitate
‘’ ‘’ ‘’ FFP
‘’ ‘’ ‘’ platelets
15. Lymph node histology and
classification of lymphomas
20
16. Performance of lumber
puncture
Interpretation of CSF
cytology
17. Interpret peripheral blood
films and relate to the
clinical picture
18. Principles of laboratory
management
19. Q.C.
20. Staff performance and
appraisal
21. 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.
21
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
Contact clinical rounds
Total credit units/
22
Hrs/wks Hrs/wks 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 postingsHistopathology 3Medical microbiology ¶sitology
3
Leave period 3Total for the 4 semesters of 3months each
24 192 576 960 48
Note:
Academic work includes lectures, seminars and journal clubs
23
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
24
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
25
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
26
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
27
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
28
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
29
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.
30
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
mont
h
3rd
yea
r
Haemat Haemat Internal med Haemat/
dissertation
Leave
4th
yea
r
Paediatric
s
Haemat/
dissertation
Haemat/
dissertation
Haemat/
dissertation
Leave
5th
yea
r
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
31
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
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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
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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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