AIMS FELLOWSHIP CURRICULUM HAEMATOLOGY III

Transcription

1 AIMS FELLOWSHIP CURRICULUM HAEMATOLOGY III Module Title: Module Code: Module Convenor: Discipline Committee: Advanced Cellular Haematology HAEM III Haematology Department St Vincent's Hospital Darlinghurst NSW Dr Ross Brown Mr Michael Wheeler Date Module last reviewed: June Date Module last modified: May

2 A. Objectives This module covers advanced aspects of Cellular Haematology. The aim is to ensure that the candidate has a thorough working knowledge of the theoretical and practical aspects of the investigation of haematological cellular disorders. As well as detailed knowledge of laboratory techniques the candidate should understand their application and the interpretation of results. The module is designed to encourage the candidate to study the theoretical and technical aspects of the tests performed in the laboratory. The candidate should ultimately demonstrate a knowledge level equivalent to that required to supervise and direct the activities of a laboratory processing a broad case-mix of patients and maintaining a high standard of work at all times. The module does not assume that the candidate has had any previous formal study of the discipline but does assume that the candidate has a good understanding of basic biological science. An undergraduate level knowledge of Haematology would be beneficial and current or previous employment/experience in a Haematology laboratory is assumed. B. Interrelationship of the Module to Other Modules For this discipline, the compulsory modules cover basic haematology which has been divided into a cellular module and a haemostasis module. These two compulsory modules cover aspects of testing encountered in a medium to large sized routine haematology laboratory. The elective haematology modules comprise an advanced cellular and an advanced haemostasis module. Additional to this, candidates may attempt a Transfusion Medicine compulsory module as an elective. This module extends further in terms of both breadth and depth of knowledge, those areas introduced in the compulsory module, Routine Cellular Haematology. This advanced module expects the candidate to retain knowledge of all/most aspects of the compulsory module plus have an extensive knowledge of specialised testing, physiology, clinical aspects and recent developments in haematology related to the investigation of cellular disorders. The other modules in the Haematology discipline are listed: Compulsory Module HAEM I Routine Cellular Haematology Compulsory Module HAEM II Routine Haemostasis Elective Module HAEM IV Advanced Haemostasis Elective Module HAEM V Transfusion Medicine either compulsory module C. Brief Description This module requires demonstration of an extensive knowledge and understanding of the investigations which are performed in the haematology laboratory for the detection, diagnosis, classification and monitoring of haematological cellular disorders. It also requires a thorough knowledge of normal and abnormal haemopoiesis, clinical aspects of haematological cellular disorders and other technical procedures related to the investigation of cellular disorders.

3 D. Content 1. Haemopoiesis Objective: A thorough understanding of haemopoiesis. 1.1 The development, morphology and function of all normal and abnormal haemopoietic cells found in bone marrow and blood. 1.2 The role of haemopoietic growth factors, especially those in clinical use. 1.3 The role, distribution and physiology of haematinics; specifically iron, vitamin B12 and folic acid in both health and disease. 1.4 The human karyotype including a basic understanding of cytogenetic nomenclature. 1.5 The basics of cellular biology which has implications for understanding haemopoiesis including the cell cycle, apoptosis/cell death, cell differentiation, regulation of receptors and the functions of subcellular bodies. 2. Routine Laboratory Techniques Objective: Demonstration of sustained/ongoing knowledge of the techniques and technology used in cellular investigations which were covered in the compulsory module, Routine Cellular Haematology. 2.1 Automated cell counting 2.3 Staining and microscopy 2.4 Morphology 2.5 Strategies and standards applied to reporting of laboratory results 2.6 Units and reference ranges 2.7 Specimen collection 3. Advanced Laboratory techniques Objective: Demonstration of good working knowledge of the techniques and technology used in the comprehensive investigation of cellular disorders including detection, diagnosis, classification and monitoring of these disorders. This knowledge should include an understanding of the principle and the performance of each technique, limitations of the techniques, common problems and the technical and clinical interpretation of results. 3.1 Special stains 3.2 Flow cytometry 3.3 Cytogenetics including FISH 3.4 Molecular studies 3.5 Immunoassay 3.6 Chromatography 3.7 Miscellaneous techniques including but not restricted to those used for investigation of anaemia and haemolysis 3.8 Recent advances 4. Clinical conditions and situations Objective: To support technical knowledge of laboratory investigations the candidate should demonstrate thorough knowledge of specific cellular based disorders. This should include the initial laboratory presentation of each disorder plus comprehensive subsequent investigations and findings which contribute to diagnosis, classification and disease monitoring. A thorough knowledge of the physiology and clinical aspects of each disorder is necessary with a focus on an understanding of the relationship between clinical presentation, appropriate testing and the interpretation of results. 4.1 Haematological non-malignant conditions Anaemia - macrocytic - microcytic - disorders of iron synthesis

4 - haemolytic; acquired and inherited - hypoplastic. Thalassaemia and haemoglobinopathies. Non-malignant white blood cell disorders - cytophilias and cytopenias - structural and functional variants - storage disorders. 4.2 Haematological malignancies. - where applicable this should include knowledge of cell morphology, cell surface markers, cytogenetic findings and molecular markers used for diagnosis, prognosis and monitoring of disease progression and response to treatment. Acute leukaemia Myeloproliferative disorders Myelodysplastic syndrome Lymphoproliferative disorders Immunoproliferative disorders 5. Miscellaneous Objective: Demonstration of an understanding of miscellaneous laboratory procedures related to haematological activities. 5.1 Stem cell transplantation laboratory 5.2 Cell cycle analysis DNA ploidy and S phase quantitation 5.3 Red cell volume and red cell survival studies 5.4 Prenatal genetic studies sampling methods and analysis 5.5 Point of care testing E. Rationale for content A scientist working in a Haematology laboratory will utilise a range of technical procedures to provide information for the management of patients in a wide variety of clinical settings. This module is designed to ensure an understanding of laboratory techniques, their application and the interpretation of results. F. Examination Under the Fellowship Regulations, a 3-hour written examination will be held at the completion of each Module. Each examination will contain a mixture of short answer questions and essay style questions. In some examinations, clinical and laboratory management case based scenarios will be included in the question mix. The examination in this module will focus on knowledge of technical procedures, technical and clinical interpretation of results and understanding of the rationale for appropriate laboratory investigations. The examination will consist of: Two essay questions, each with a total value of 35 marks; suggested time allocation 30 minutes per essay total 60 minutes. Twenty short answer questions, each worth five marks total value for the short answer questions 100 marks; suggested time allocation five minutes per question total 100 minutes. Twenty minutes for re-reading and review There will be an initial reading time of fifteen minutes, during which no writing will be permitted.

5 G. Texts and Supporting Material The following list of texts is intended as a guide. There is no single text recommended however candidates are encouraged to obtain their own copies or have ready access to at least two texts. Other texts, including new texts which become available, may also be of value. The candidate should peruse current haematology journals for relevant reviews and articles. Texts (Most recent editions) Dacie and Lewis. Practical Haematology (Churchill Livingstone) Hoffbrand and Lewis. Postgraduate Haematology (Butterworth) Chanarin Laboratory Haematology (Churchill Livingstone) Lee G (ed). Wintrobe's Clinical Hematology. (Williams and Wilkins) Beutler, Williams et al. Hematology (McGraw Hill) Bain B. Blood Cells: A Practical Guide (Blackwell) Bain et al. Bone Marrow Pathology. (Blackwell) Jaffe et al. Pathology and Genetics of Tumours of Haemopoietic and Lymphoid Tissue. (World Health Organization Classification of Tumours). IARC Press. Journals Australian Journal of Medical Science Laboratory Hematology Clinical and Laboratory Haematology Blood Blood Reviews British Journal of Haematology Other Essential Reading NATA, ISO and NPAAC guidelines assorted documents NCCLS Standards assorted documents Operating Manuals for instrumentation Other texts with suitable chapters (Most recent editions) Hoffman R. Hematology, Basic Principles and Practices. Nathan et al. Nathan and Oski s Hematology of Infancy and Childhood. (WB Saunders) American Society of Hematology Education Program Booklet Other Journals which should be reviewed American Journal of Clinical Pathology American Journal of Hematology Archives of Pathology and Laboratory Medicine Bailliere s Clinical Haematology Hematology/Oncology Clinics of North America Journal of Clinical Pathology Lancet New England Journal of Medicine Seminars in Hematology CAP Today H. Appointment of a Mentor Each candidate is required to nominate a mentor for the Module at the time of application for entry and into the Fellowship Program. If a candidate is unable to nominate a mentor then the candidate should contact the Module Convenor for assistance. The appointment of a mentor is made by the Examinations Council. I. Module Communications

6 Module Convenor: Discipline Committee: Haematology Department St Vincent s Hospital Darlinghurst NSW rshort@stvincents.com.au Dr Ross Brown Mr. Michael Wheeler J. Candidate Feedback Immediately following notification of the examination result each candidate will be asked to complete a feedback questionnaire on the Module. However, feedback at anytime during the study of the Module is encouraged through the mentor or directly to the Module Convenor.