Saudi Fellowship Training Program. Final Written Examination of Adult Hematology 2018

Transcription

1 Saudi Fellowship Training Program Final Written Examination of Adult Hematology 2018 Objectives: Determine the quantity and quality of a hematologist s knowledge base ranked as competent, so that the individual can be used as a referral source for Adult hematology. Using theoretical data, determine the candidate s ability to think logically, to solve problems, to apply basic medical science to clinical problems, and to make judgments with valid comparisons. Screen candidates for the purposes of being allowed to take the final clinical examination. Eligibility: Successful completion of the required period of fellowship training. Obtaining a training completion certificate (or equivalent) issued by the local supervisory committee based on a satisfactory Final In- Training Evaluation Report (FITER) and any other related requirements assigned by the scientific board of adult hematology (e.g. research, publication, logbook, etc.). FITER example outlined in Appendix 6 in the exam rules and regulations document on SCFHS website. Any candidate missed a maximum of three (3) months of training of the whole fellowship program are allowed to sit for the exam (written and clinical), and his/her results will be suspended till that missing period is done. Registering for the examination at least one month before the exam date. Rules: The Saudi fellowship specialty final written examination will be held once each year on a date published on the SCFHS website. Examination dates should be provided by the Specialty Examination Committee (SEC) in accordance with the fixed annual schedule submitted by the examination department. There shall be no reset examination. Page 1

2 A candidate would remain eligible for Saudi fellowship final written examination for a period not longer than three years provided they could prove they had been clinically active. If the candidate did not pass within the three years, an exceptional attempt may be granted upon the approval of the scientific council, provided evidence of continuing clinical practice is presented. A candidate who failed to pass Saudi fellowship final written examination including the exceptional attempt has to repeat the final year of training, after which he/she is allowed to sit the final written examination twice after approval by the scientific council. After exhausting all the above attempts (maximum 6 attempts) the candidate will not be permitted to sit the Saudi fellowship final written examination. Examination Format: A. The Saudi fellowship specialty final written examination shall consist of one paper with Single Best Answer (SBA) MCQs (it shall consist of clinical scenarios with SBA from 4 options). Ten unscored items can be added for pretesting purposes. B. The questions may include slide images as well as figures and diagrams of different hematological investigation. Questions are about the work done by physicians in the course of their practice which may include: - Making a diagnosis - Ordering and interpreting results of tests - Recommending treatment or other patient care (patient safety or complications) - Assessing risk, determining prognosis, and applying principles from epidemiologic studies - Understanding the underlying pathophysiology of disease and basic science knowledge applicable to patient care - Patient safety, ethics, professionalism, and research topics will be assessed in the exam. Clinical information presented may include patient photographs, radiographs, photomicrographs, and other media to illustrate relevant patient findings. Exam content is pre-determined by an exam blueprint which is developed by the fellowship exam committee. The blue print is updated annually for accuracy and to keep up to date with current literature. Page 2

3 Examination Conduct and Duration: Exam period shall be between one hour and 40 minutes to two and 1/2 hour for question paper. The exam will be delivered as a computer based test when available, otherwise paper and pencil. Passing Score: A. The passing score is 70%. However, if the percentage of candidates passing the examination is less than 70%, the passing score must be lowered by one mark at a time aiming at achieving 70% passing rate or 65% passing score whichever comes first. Under no circumstances can the passing score be reduced below 65%. B. Alternatively, to set the passing score, a standard setting method that is supported by published scientific evidence can be used, for which the Angoff method is recommended. The process to arrive to the passing score requires prior review and approval. If standard setting is used the above passing score regulation does not apply. See appendix 7 for more details in the exam rules and regulations document on the SCFHS website. C. To set a passing score using a standard setting method (b), the specialty examination committee must obtain approval of the process and passing score from the SCFHS Assistant General Secretary for Postgraduate Studies one month prior to exam administration. Declaration of Result: All score reports shall go through a post-hoc item analysis before being issued and approved by the SCFHS and SEC within two weeks of the examination. Exemption: SCFHS at present has no reciprocal arrangement with respect to this examination or qualification by any other college or board, in any specialty. Page 3

4 Blueprint outlines No. Sections % 1 Hematopoietic System 19% 2 Coagulation 19% 3 Transfusion Medicine 7% 4 Hematologic Neoplastic Disorders 39% 5 Hematopoietic Cell Transplantation (HCT) 8% 6 Research, Ethics & Professionalism and patient safety 8% Total 100% Note: Blueprint distributions of the examination may differ up to +/-3% in each category Main topics to be assessed under each major discipline are as follows: Hematopoietic System 19% 1. Normal Hematopoiesis 2. RBC Red blood cell production disorders Nutritional deficiencies Anemia of chronic disease Red cell aplasia and hypoplasia Sideroblastic anemia Red blood cell destruction disorders Thalassemias Alpha thalassemia Beta thalassemia Hemoglobin E disorders Sickle cell disorders Sickle cell trait Sickle cell anemia (hemoglobin SS disease) Hemoglobin SC disease and C hemoglobinopathy Sickle cell-β0 and sickle cell-β+-thalassemias Non-sickle hemoglobinopathies Autoimmune hemolytic anemias (AIHA) Warm antibody-mediated autoimmune hemolytic anemia Cold antibody-mediated autoimmune hemolytic anemia Drug-induced hemolysis Page 4

5 Metabolic enzyme deficiency hemolytic anemias Paroxysmal nocturnal hemoglobinuria Red blood cell membrane disorders Microangiopathic hemolytic anemias (other than TTP, HUS, or DIC) Non-autoimmune, acquired hemolytic anemias Erythrocytosis Porphyrias Hemochromatosis 3. WBC Granulocyte dysfunction disorders Granulocytopenia Lymphocytopenia and lymphocyte dysfunction syndromes Leukocytosis Eosinophilia 4. BM failure Aplastic anemia Inherited aplastic anemia Acquired aplastic anemia Pancytopenia Coagulation 19% Platelet and megakaryocyte disorders Inherited disorders of platelet function Acquired disorders of platelet function Drug-induced disorders Non-drug-induced disorders Thrombocytopenia Inherited thrombocytopenia Acquired thrombocytopenia Immune thrombocytopenic purpura (ITP) Drug-induced thrombocytopenia Thrombotic thrombocytopenic purpura (TTP) Hemolytic uremic syndrome (HUS) Thrombocytopenia secondary to liver disease and splenic disorders Thrombocytosis Hemostasis Molecular basis of coagulation and hemostatic agents Normal hemostasis Laboratory evaluation Hemostatic drugs Page 5

6 Inherited bleeding disorders (non-platelet) Von Willebrand disease Types 1, 2A, 2M, 2N, and 3 Type 2B Modifiers of von Willebrand factor levels Hemophilias A and B Hemophilia A Hemophilia B Factor XI deficiency Factor deficiencies other than factor XI Inherited vascular abnormalities Acquired bleeding disorders (non-platelet) Factor inhibitors Disseminated intravascular coagulation (DIC) Acquired vascular abnormalities Secondary acquired factor deficiencies Thrombosis Molecular basis of natural anticoagulants, fibrinolytic Pathway, and anticoagulant therapy Normal anticoagulant and fibrinolytic mechanisms Laboratory evaluation Anticoagulant drugs Thrombotic disorders Inherited thrombotic disorders Factor V Leiden and prothrombin G20210A Deficiencies of natural anticoagulants (antithrombin, proteins C and S) Disorders involving cysteine and homocysteine metabolism Acquired thrombotic disorders Heparin-induced thrombocytopenia (HIT) Anti-phospholipid antibody syndrome (APS) Cancer-related thrombotic disorders Thromboembolism at unusual sites Thrombosis management (non-disease-specific) Complications of thrombotic disorders Transfusion medicine 7% Clinical indications for the use of blood products Red blood cell preparations Platelet preparations Granulocyte preparations Fresh frozen plasma Cryoprecipitate Page 6

7 Risks associated with blood products Risks associated with administration Allergic reactions Nonanaphylactic allergic reactions IgA deficiency Anaphylactic reactions Graft-versus-host disease Electrolyte disturbances Infectious organisms Alloimmunizations Transfusion reactions Hemolytic reactions Febrile reactions Transfusion-related acute lung injury (TRALI) Transfusion-related circulatory overload (TACO) Post-transfusion purpura and other risks associated with dministration Risks associated with therapeutic apheresis procedures Hematologic Neoplastic Disorders 39% Myeloproliferative neoplasms Chronic myeloid leukemia Polycythemia vera and secondary erythrocytosis Primary myelofibrosis Essential thrombocythemia Mastocytosis Chronic neutrophilic leukemia Acute myeloid leukemias (AML) Acute promyelocytic leukemia AML with recurrent genetic abnormalities Therapy-related myeloid neoplasms Myeloid sarcoma AML with myelodysplasia-related changes AML not otherwise specified Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia Myelodysplastic syndromes Chronic myelomonocytic leukemia B-cell neoplasms B-cell acute lymphoblastic leukemia/lymphoma (B-ALL) Lymphoplasmacytic lymphoma Chronic lymphoid leukemias Chronic lymphocytic leukemia/small lymphocytic lymphoma Monoclonal B-cell lymphocytosis Hairy cell leukemia B-cell prolymphocytic leukemia Page 7

8 Plasma cell neoplasms Multiple myeloma Plasmacytomas Amyloidosis Castleman disease Monoclonal gammopathy of undetermined significance (MGUS) Non-Hodgkin lymphomas, B-cell Diffuse large B-cell lymphoma Follicular lymphoma Mantle cell lymphoma Marginal zone B-cell and mucosa-associated lymphoid tissue (MALT) lymphomas Burkitt and Burkitt-like lymphomas Primary central nervous system lymphoma General lymphoma issues (not specific to lymphoma type) Immunodeficiency-associated lymphoproliferative disorders Post-transplantation lymphoproliferative disorders Lymphomas associated with HIV infection or primary immune disorders Lymphoproliferative disorders associated with iatrogenic immunodeficiency T-cell and NK-cell neoplasms T-cell acute lymphoblastic leukemia/lymphoma (T-ALL) Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome) T-cell lymphomas Adult T-cell leukemia/lymphoma Large granular lymphocyte leukemia Hodgkin lymphoma Classical Hodgkin lymphoma Nodular lymphocyte-predominant Hodgkin lymphoma Histiocytic and dendritic cell neoplasms Myeloid and lymphoid neoplasms with eosinophilia and abnormalities of PDGFRA, PDGFRB, or FGFR1 Complications of hematologic malignancies Hemophagocytic syndrome Tumor lysis syndrome Spinal cord compression Paraneoplastic disorders Pharmacology Toxicities and complications, including cytopenic complications Drug dosing and dose modifications Clinical trial design and interpretation Page 8

9 Hematopoietic Cell Transplantation (HCT) 7% Stem cell biology and engraftment Biology of hematopoiesis and hematopoietic cell transplantation Tumor immunology Biologic and immunologic relationship between donor and host Hematopoietic cell transplantation in the management of hematologic diseases Autologous transplantation Syngeneic transplantation Allogeneic transplantation Reduced-intensity allogeneic transplantation Haplo-identical transplantation Cord blood transplantation Conditioning regimens Components Toxicities Collecting and handling cells for transplantation Bone marrow Peripheral blood Mobilization Donor complications of cell collection Prophylaxis and supportive care Preventing infectious disease Pharmacologic prevention Environmental prevention Immunosuppressive therapy for graft-versus-host disease (GVHD) Graft-versus-host disease T-cell depletion Complications of immunosuppressive therapy Transfusion and blood product issues related to transplantation Complications after hematopoietic cell transplantation Marrow engraftment failure Graft-versus-host disease, clinical Acute Chronic Opportunistic infections Hepatic sinusoidal obstruction syndrome Management of relapse Late effects Page 9

10 Suggested References: TEXT BOOKS: * Hematology, 7 th Edition, Basic Principles and Practice by Ronald Hoffman * Wintrobe's Clinical Hematology Thirteenth Edition by John P. Greer * Williams Hematology, 9th Edition by Kenneth Kaushansky * ASH SAP American Society of Hematology Self-Assessment Program, 6 th edition * Dacie and Lewis Practical Haematology, 12th Edition, by Barbara Bain, Imelda Bates, Mike Laffan * Bone Marrow Pathology by Kathryn Foucar *WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, WHO Classification of Tumours, Revised 4th Edition. Edited by Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, JOURNALS: * Blood * Blood Review * British Journal of Hematology * Hemophilia * Journal of Thrombosis and Hemostasis * Hematology: ASH Education Program Book * New England Journal of Medicine * Bone Marrow Transplantation * Biology of Blood and Marrow Transplantation * Journal of Clinical Oncology * Leukemia & Lymphoma * Leukemia * The Lancet * Lancet Oncology On-Line RESOURCES: Uptodate.com ASH Image Bank Note: This list is intended for use as a study aid only. SCFHS does not intend the list to imply endorsement of these specific references, nor are the exam questions necessarily taken solely from these sources. Page 10

11 Example Questions EXAMPLES OF K2 QUESTIONS Question 1 A 22-year-old man with sickle cell disease came with acute onset of dizziness, palpitation for one day. Examination reveals pallor and tachycardia. No organomegaly, CNS and other clinical exam is unremarkable. A transfusion of PRBC was ordered in the Emergency Department (see lab results). Test Result Normal Value Hb g/l WBC x 10 9 /L Platelets x 10 9 /L Reticulocytes % Which of the following is the most likely cause? A. Acute hemolytic crises B. Iron deficiency anemia C. Acute sequestration crises D. Aplastic crises from Parvovirus B19 EXAMPLES OF K1 Question 2 At the six months follow up appointment for a patient with CML who is receiving imatinib. What would be the optimal molecular level of BCR-ABL? A. 1 % B. 10 % C. 0.1 % D % Page 11