the curriculum project european hematology association eva hellström lindberg, president-elect eha...

The Curriculum Project

European Hematology Association

Eva Hellström Lindberg, president-elect EHA

National Societies Meeting

June 1st, 2005 Stockholm

EUROPEAN HEMATOLOGY ASSOCIATIONBoard and Councilors

EHA EDUCATION COMMITTEEPresent chair: DiDi Jasmin

Chair from June 2005: Tony Green

Pan-European Survey

Pan-European Harmonization (EU project)

•European Hematology CME system

•EHA Curriculum Committee

•Professional issues

Partner Organizations:

• EBMT

• ESH

• National Societies

•European Commission

CME WorkshopsCME Self-learning Tools

EHA EducationOverview

Members and ResponsibilitiesChair:Didi Jasmin

Project Leaders:Eva Hellström-Lindberg (CME Survey) Dimitris Loukopoulos (CME/ECAH) Robin Foà (EHATol) Laurent Degos (EHA Curriculum Committee)

Members:Jane Apperley, Harmut Döhner, Alvaro Urbano

EHA President:Emili Montserrat

Facilitators: Wieslaw Jedrzejczak (UEMS) Adrian Newland (National Recognition of EHA CME)

EHA Education Committee



Project Leader:Eva Hellström-Lindberg

Full results: www.ehaweb.org

“What is a hematologist?” 2002-2003

Pan-European CMESurvey in Hematology



http://www.ehaweb.org/

CME Survey Respondents n =29

1. Sweden2. Denmark3. Iceland4. Finland5. Norway6. Latvia7. Lithuania8. Poland9. Ireland10. United

Kingdom11. The

Netherlands12. Belgium13. Germany14. Switzerland

15. Austria16. France17. Italy18. Spain19. Portugal20. Hungary21. Czech Republic22. Albania23. Bulgaria24. Croatia25. Romania26. Greece27. Israel28. Turkey29. UkraineNational Societies

Meeting


Not recognized as a formal separate specialty 2 countries

Only one (hematology) with different sub-spec. 17 countries

>One (clin. hematology, transfusion medicine, medical oncology, hemato-pathology, clinical immunology, coagulation medicine) 10

Not answered 2

CME Survey Results



CME SurveyLength of specialist training

Specialist inHematology + Internal medicine

Specialist inHematology only

0

1

2

3

4

5

6

7

8

YE

AR

S

1

2

3

4

5

6

7

8

9

YE

AR

S

Years of training in internal medicine

Years of total specialist training period

CME SurveyHematology vs.

Hematology + Internal medicine

,5

1

1,5

2

2,5

3

3,5

4

4,5

5

5,5

Yea

rs o

f h

emat

olo

gy

Hem only Hem + IM-1

0

1

2

3

4

5

6

7

8

Mo

nth

s o

f tr

ansp

lan

tati

on

Hem only Hem + IM

Hematology + internal medicine

Hematology

Hematology training (y) Transplantation training (mo)

CME SurveySpecialist training in different

types of countries

1

2

3

4

5

6

7

8

9YEARS

Internal medicine Total training

EU members

EU candidates

Non-membersNational Societies Meeting


CME SurveyNational systems for CME, etc.

Variable YES NO

Obligatory exam 5 24

Guidelines for CME 11 16

Obligatory CME general 9 20

Obligatory CME hem 8 21

CME point system exist 16 13

OK one point / hour 22 2



CME Survey Summary

Two main types of hematological specialists

Including specialty in internal medicine

Only hematology, but with more lab training

Median total training time 6 years (4 - 8 y)

Median training in IM 2.5 years (0.5 - 6 y)

No clear differences between different types of European countries

Overall positive reactions to European CME credit point system and OK for 1 point / hour



Curriculum ProjectBasic statement

Hematology is a mono-specialty including clinical & laboratory

competences



The Curriculum ProjectHarmonization of Specialist Training

Project Leader: Laurent Degos

Vice-Project Leaders:Eva Hellström-LindbergAlvaro UrbanoMike GreavesDimitris LoukopoulosWolf Dieter Ludwig

EHA OfficeNancy Hamilton



Senior and junior hematologists from various countries + some with other competences

EHA-Curriculum CommitteeSub-Committees:

Leader Subject Overview Alvaro Urbano Clinical

Hematology Including transplantation

Laurent Degos/ Wolf Dieter Ludwig

Diagnosis Includes Bone Marrow Smears

Dimitris Loukopoulos

Cell Manipulation

Gene therapy, apheresis, Transfusion

Mike Greaves Hemostasis /Thrombosis

Clotting both clinical and laboratory

Eva Hellström-Lindberg

General skills Communication skills, methodology for clinical trials, research procedures, ethics



EHA Curriculum Project Update of activities May 2005

Appointment of project leaders April 2004First meeting project leaders May 2004Request to national partners to nominate committee

members - formation of CC June 2004CC meeting (25 junior - senior - lab - clinical

hematologists + others) September 2004First CC draft, approved by EHA board and partners Feb

2005Pan-European CC draft sent our for review by national

societies March - May 1 2005EU report and printing fall 2005



EHA Curriculum Project Basic statements

Hematology is a monospeciality including both clinical and laboratory competences

There is a vast European diversity that needs to be considered and respected

The total recommended training period of 6 years, whereof 2 in internal medicine, equals the European median value

The curriculum could be used as a support for national development



EHA Curriculum Basic Principles

Tick-box systemDescriptive rather than evaluatingFocused to give information that facilitates mobilityAcceptance of European differencesThree skill levels (Competence, Knowledge, Awareness)Written with the background knowledge of the US curriculum



EHA Curriculum CV Skill Levels

1A: RED CELL DISORDERS Awareness Knowledge Competence Anemias due to deficiency or chronic disease

X

Each item in the Curriculum is assigned a skill level:

1.Awareness

2.Knowledge

3.Competence



EHA Curriculum CVDefinitions of Skill Levels

1. Awareness (A): Basic notions2. Knowledge (K): Updated concepts on patho-physiology, epidemiology,

diagnosis, prognosis, different therapeutic approaches.3. Competence (C): Adequate understanding and practical integration of

knowledge and skills for optimal diagnosis and treatment of patients at any phase of their disease. (T - Technical knowledge of the procedure, I - Interpretation of the results)

4. Technical Competence (TC): Ability to carry out independently specific laboratory tests. In the Diagnosis and Transfusion Medicine sections, the competence is subdivided in technical competence (T - knowledge of the procedure and ability to carry out independently specific laboratory tests) and interpretation competence (I – interpretation of the results).

1A: RED CELL DISORDERS Awareness Knowledge Competence Anemias due to deficiency or chronic disease

X

EHA Curriculum CVClinical Section

1B: BONE MARROW FAILURE Awareness Knowledge Competence Fanconi’s anemia X Acquired aplastic anemia X Paroxysmal Nocturnal Hemoglobinuria X 1C:NON MALIGNANT WHITE BLOOD CELL DISORDERS

Awareness Knowledge Competence

Granulocyte dysfunction disorders X Granulocytopenia X Lymphopenia and lymphocyte dysfunction syndromes

X

EHA Curriculum CVDiagnosis Section

2B: RED BLOOD CELL LABORATORY TECHNIQUES


Hemoglobin electrophoresis X Sickling process X Oxygen affinity X Examination of blood and bone marrow smears for RBC parasites

T/I

Osmotic fragility X Red blood cell enzyme assays X Parameters of iron metabolism (e.g., iron, transferrin, transferrin saturation, soluble transferrin receptors, and ferritin)

I

Laboratory approach to the diagnosis of nutritional deficiencies (e.g., vitamin B12, folic acid)

I

Laboratory approach to the diagnosis of primary hemochromatosis (e.g., HFE mutations)

I

EHA Curriculum CVThrombosis and Hemostasis Section

3C: CONGENITAL BLEEDING DISORDERS


Coagulation factors and current understanding of coagulation mechanisms

X

Natural history, presentation and complications of congenital coagulation disorders including hemophilia A & B and von Willebrand’s disease and subtypes

X

Taking a relevant history, including previous challenges and family history, and conducting a focused clinical examination to assess for abnormal bleeding

X

Ability to formulate a comprehensive differential diagnosis and management plan

X

Less prevalent factor deficiencies such as XI, X, VII, V and II and a/dysfibrinogenaemia

X

Rare, easily overlooked deficiencies: factor XIII, antiplasmin X Diagnostic methods including, screening tests, specific factor and inhibitor assays

X

Interpret laboratory results accurately, and in the light of the clinical background

X

Use of molecular biological techniques to identify genetic disorders

X

Advise on use of molecular biological techniques in diagnosis

X

Use of molecular biological techniques in prenatal and family testing

X

EHA Curriculum CVTransfusion Section

4F: GUIDELINES AND NATIONAL LAWS FOR THE USE OF SPECIALLY PROCESSED BLOOD COMPONENTS AND DERIVATIVES


Cryoprecipitate X Factors VII, VIII and IX; Fibrinogen X Immunoglobulins X 4G: ADMINISTRATION OF THE TRANSFUSION


Information for the patient; X Routine vs. emergency transfusions X Proper identification of the recipient X Rate and conditions of administration and monitoring

X

EHA Curriculum CVGeneral Skills

5D: PSYCHOSOCIAL ISSUES General recommendations: The trainee should be offered opportunities to experience and integrate the psychosocial aspects of hematology. This may include specific training courses.


Impact of hematological disorders in patients and their families and consequently ability to deal with normal psychological reactions to these diseases

X

Recognizing and management of psychological distress and appropriate counseling of patients

X

Available resources for psychosocial and psychiatric support and treatment

X

Practical experience to appropriately address social and economic needs and resources

X

Patients rights according to national legislation X Appropriate response to specific needs of patients of different cultural origins, and their families

X

The EHA - Leonardo da Vinci project has finalized a draft for a European curriculum for

hematological training

Hematology is a clinical and biological mono-specialty

The individual cv should be based on a sum of defined knowledge

The validity of the CV has to be tested and updated regularly.

EHA Curriculum Project Conclusions



EHA Curriculum ProjectQuestions for the future

1. How should the printed version be circulated / disseminated?

2. Better definition of basic pediatric training.

3. How to become a super specialist?

4. What is the role of the mentor?

5. How often should the curriculum be updated?

6. How should training centers be accredited?National Societies Meeting


the curriculum project european hematology association eva hellström lindberg, president-elect eha...

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