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, Specific instr. in sub specialities ,
Cytology, Paediatric sound theoretical and practical
Haematology(3months), knowledge
Haematology and blood
transfusion services, Research
project for dissertation
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

10
 23. Good laboratory practice

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

- Anaemiasdiagnosis 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

11
 - Haemophilia- diagnosis, management of Haemophilia A and B, Von

Willebrands disease. Use of coagulation factor concentrates

- 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

12
 o Transfusion in neonates and children

- Oncology

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

13
 The resident will work on his dissertation for the FMC Path Part II examination

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

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13. Management of aplastic anaemia

14. Cryoprecipitate: composition, preparation, preservation and utilization

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

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Weekly Activities of the Department OF Haematology and Blood Transfusion

Weekly clinical programme of activities (Table 2)

Day 8.00am-5.00pm BLOOD

Monday Clinic Unit Day care/ward call BANK
ward CALLS
round IN THE
Tuesday Clinic Unit Day care/ward call 1ST
ward WEEK
round OF
Wednesday Case presentation, Slide review/ Day EACH
presentation of short Special care/ward MONTH
topics in haematology investigation/ call
Bench work
Thursday Clinic Unit Day care/ward call
ward
round
Friday Seminar/dept. Consultant Day
meeting/journal review/ ward round care/ward
call
Saturday Ward Calls
Sunday Ward Calls

16
Teaching and Learning Methods

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

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Assessment Methods

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

18
Assessment of Residents Performance

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

19
 Preparation and staining
Reports on BM
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

20
 platelets
15. Lymph node histology and
classification of lymphomas
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

21
The trainee will be instructed in methods for obtaining bone marrow by aspiration and trephine,
making slides from the aspirate and touch or roll preparations from the trephine. Resident must
be conversant with preparation of basic stains.

Trainee will be exposed to fine needle aspiration biopsy techniques.

Clinical training during this induction period will include supervised participation in in-patient
and out-patient management of haematological disorders including clinical on-call as
appropriate

There will be an assessment at the end of the 3-month rotation

Following the introduction period, the trainee will receive instruction and practical experience
in further aspects of haematology and rotate through other specialities in pathology, for the rest
of the 1st year of training and through the 2nd. Part 1 FMCPath examination will be written after
the 1st two years of posting (Table 2).

Junior residents will also start formal academic and clinical components of the training, as
indicated in the tables

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Table 4: Schedules for junior resident postings, first 24 months

Module Programme Duration Contact Contact Contact Total

in months academic bench clinical credit
Hrs/wks work rounds units/
Hrs/wks Hrs/wks module
earned
1 Haematopoiesis, 1 4 12 16 4
blood cells and
functions;
introduction to clin.
Haemato
2 Non-haemolytic 2 4 12 16 8
anaemias
(nutritional
deficiencies,
marrow failure,
others)
3 Transfusion 2 4 12 16 8
medicine and
haemolytic disease
of the new born
4 Haemolytic 2 4 12 16 8
anaemias (acquired
&inherited)
5 Haemostasis and 2 4 12 16 8
bleeding disorders,
AIDS
6 Haematologic 3 4 12 16 12
malignancies:
lymphoproliferative
&myeloproliferative
disorders, plasma
cell neoplasm
Chemical pathology 3 Outside postings
Histopathology 3
Medical 3
microbiology
&parasitology
Leave period 3
Total for the 4 24 192 576 960 48
semesters of
3months each

23
Note:

Academic work includes lectures, seminars and journal clubs

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

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Further details on the programme (Tables 5)

Table 5: Basic haematology: haematopoiesis, blood cells and functions, and introductory
clinical haematology

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: fanconis anaemia, pure red cell aplasia

25
Table 7

Transfusion medicine and haemolytic disease of the new born

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

26
Table 8

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), Schumms test

27
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
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

28
Table 10

Haematologic malignancies: lymphoproliferative, myeloproliferative &plasma cell disorders

S/N Topics
1 Aetiopathogenesis
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

29
Second year of training

During the second year of RTH, the trainee will externally rotate through other specialities in
pathology namely, clinical pathology, microbiology and parasitology and morbid anatomy
(histopathology). The trainee is expected to spend at least three months in each posting and is
required to participate in all the activities of each department. The trainee must be proficient in
all the routine laboratory procedures of each department, give seminars that will be graded and
provide clinical service where appropriate (e.g. STI, infectious disease, endocrine and
metabolic clinics). In morbid anatomy, the trainee must conduct post-mortems during the
posting under supervision and later independently and attend clinic-pathological conferences
and grand rounds.

The trainee will be assessed at the end of each posting and a report of performances is
forwarded to the trainer in haematology

Assessment of junior residency training

At the end of the first two years, the trainee will be qualified to sit for the part II FMCPath
examination majoring in Haematology

Senior residency training (SRT)

The senior residency training (SRT) programme starts in the third year of enrolment, but only
after the trainee must have passed the part 1 FMCPath examination. It includes both laboratory
and clinical programmes. Residents undergoing this phase of training will take part in all
departmental activities as set out in tables 4-11 but at a more advanced level and acquire
additional competences in the following:

Investigation and management of haematological conditions without supervision. Involvement

in on-going clinical and laboratory research in the department.

Laboratory proficiency in the following:

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

30
 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.

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 Haemat Haemat Internal med Haemat/dissertatio Leave
yea n
r
4th Paediatric Haemat/dissertatio Haemat/dissertatio Haemat/dissertatio Leave
yea s n n n
r
5th Haemat --------- ---------- ------------ -------
yea -
r

31
Using 12 units/3 months, excluding the 6 months of outside postings (internal medicine and
paediatrics) and 3 months of leave periods leaving half time in fourth year for dissertation, the
maximum units for 3rd and 4th years should be 4. Dissertation carries 6 units, the total units for
part II candidates should be 70

Curriculum for senior residency training

Candidates undergoing senior resident postings are expected to have a sound theoretical and
practical knowledge of haematological practice but will not have had a great deal of
unsupervised experience in applying that knowledge. The second phase of training is thus
devoted to acquiring this self-sufficiency in the speciality. There will also be exposure to
management issues and the trainee should be involved in the teaching of medical and
paramedical students, as well as supervision of junior residents.

This phase will also be used by the trainee to expand interested in particular aspects of
haematology and to develop a wider expertise in these aspects e.g. haemato-oncology,
haemostasis and transfusion medicine.

If possible, and if desired by the trainee, more extended time can be spent in sub-speciality
training. In addition part of this time (12-24) should be used for a relevant clinical and
laboratory based research project approved by the NPMC that will be presented in part
fulfilment of the FMCPath part II examination

Required facilities for senior resident training

Specified out-patient duties with the opportunity to see new patients, determine the
diagnostic approach and therapy appropriate to their condition. There will be close
collaboration with consultant colleagues and referring medical colleagues. Such
expertise is essential
Increasing opportunity to oversee the care of in-patients. There must be regular,
structured strategic discussion over management policy between consultants, trainee,
nursing and paramedical staff so that the trainee acquires the skills needed for effective
team work
The opportunity to be actively involved in the daily management of the haematology
laboratory with full participation in management discussions. Trainees should be

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 encouraged to attend appropriate management courses. Such management instruction
should include laboratory computer systems, quality control, audit, potential of
automation and near patient testing
Familiarity with radiation techniques and use of radioisotopes where possible
Regular update discussions of discussions of academic and practical aspects of
haematology including the availability of appropriate journals
Rotations at this level of training shall include blood transfusion, paediatric
haematology and haemostasis foe=r which secondment to other centres may be
necessary. The actual details and duration of exposure to each specialty should be a
minimum of three months

Additional formal/ informal training

Blood transfusion practice including the identification of antibodies; methods for

preparing leukocyte depleted blood products and their use; identification and
management of auto-antibody diseases, both warm and cold; methods of HLA typing.
There should be instructions in methods for preparing blood components and in
available techniques for rendering blood products safer from virus contamination and
transmission. A formal blood transfusion course of four weeks would be appropriate
Formal and informal instruction in indication, techniques and problems of allogeneic
and autologous haematopoietic progenitor cell transfusions. Trainees should have
experience in a transplant unit during this year
More detailed instruction in clinical and laboratory aspects of coagulation including
specific factor assays, identification of inhibitors, techniques for measuring protein C,
S, antithrombin III, lupus anticoagulant and such additional factors as from time to time
become important. This practical experience should be linked to instruction in the
theory of coagulation and fibrinolysis
Clinical and laboratory aspects of platelet disorders including numerical and functional
abnormalities and the use and limitation of platelet function studies. Such practical
experience needs to be linked to an understanding of platelet function and interaction
with vessel wall. Mechanisms and the use of antiplatelet drugs
Clinical and theoretical instruction in radioisotope methods inhaematology. Clinical
experience means knowledge of the usefulness of isotopes in clinical practice and
interpretation of results. It is not necessary at this stage to have hands-on experience

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 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

Acknowledgement:

The Department is grateful to Dr Bodunrin Osikomaiya for her secretarial assistance.

Dr Akinsegun Akinbami

HOD

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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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