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 &parasitology

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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