DEFINITION:Hematology is that branch of medicine which concerns itself with the investigation (clinical and laboratory) and the treatment of diseases of the blood and blood-forming tissues.
intent of a Hematology Training program is to ensure the competence in
treating hematological disorders and in the management of hematological
laboratories. It is anticipated that additional training during or after
the core training period may be required to ensure competence in a
specialized laboratory or clinical area.
Only candidates certified in Internal Medicine or Pediatrics may be eligible for the Certificate of Special Competence in Hematology.
The practice of hematology requires that the candidate be a competent clinician understanding the principles and the interpretation of a wide range of laboratory procedures, based upon a sound knowledge of the basic sciences; the relevant aspects of biochemistry, genetics, immunology, pathology, pharmacology, and pathophysiology of hematologic and neoplastic diseases. The candidate should be aware of the hematologic changes that take place in pregnancy, the neonatal period, childhood, and should possess the technical skills for obtaining tissue and fluid samples for diagnostic purposes.
should be able to provide consultant advice on the diagnosis and
management of patients of all ages. He/she must have an adequate
knowledge of the management of general medical problems, such as the
diagnosis and treatment of infections, and of disorders of the heart,
lungs, liver and kidney. He/she should be skilled in the psychosocial
aspects of the management of patients with malignant disease, the use of
analgesics in the relief of pain, and in the care of the dying patient.
He/she should demonstrate an understanding of biomedical ethics in the
investigation and care of patients. He/she should have experience and
skills in the application of the principles of quality assurance to
clinical care and in the critical appraisal of the medical literature.
He/she should be able to contribute to the education of colleagues,
students, residents and other health workers, and be able to encourage
and sustain a harmonious team approach to patient care.
The candidates seeking to practice either adult hematology or pediatric hematology/oncology must have an adequate knowledge, and the ability to apply this knowledge to:
Knowledge of the physiology and pathophysiology of hematologic and neoplastic cells and diseases.
The principles, interpretation and quality control of laboratory tests, with "hands-on" experience in the general hematology laboratory, the coagulation laboratory and the blood bank, including familiarity with common hematological laboratory skills. Management skills in supervising the laboratory should also be acquired.
The investigation, diagnosis, treatment, and management of patients with hematologic and malignant diseases, including the pharmacology and pharmokinetics of drugs, and the use of blood products, biologic response modifiers, such as growth factors, and chemotherapeutic agents, and the potential response to treatment should be based on consideration of methodologically sound clinical studies, and the rationale and validity of clinical trials in their assessment.
Adult Hematology and/or Pediatric Hematology-Oncology
These three components of the training objectives must be met for the following topics:
Cellular and molecular regulation of growth and differentiation, stem cell biology, cytokines, and the use of in vitro cultures.
The hypoproliferative disorders; congenital and acquired.
The function of the erythropoietin; genetics and the regulation of hemoglobin synthesis and structure, hemoglobin structure and oxygen affinity and stability, erythrocyte metabolism, the structure and function of the erythrocyte membrane. Iron, vitamin B12, and folate metabolism.
Erythrocyte indices and morphology, inherited and acquired disorders of heme and globin synthesis, including the techniques of DNA amplification and analysis in the diagnosis of disorders of erythropoiesis; hemoglobin structure and function; the recognition of intrinsic and extrinsic causes of hemolysis, including disorders of hemoglobin, altered erythrocyte metabolism, and of the structure and function of the erythrocyte membrane, red cell mass and erythrocyte survival; iron, vitamin B12, and folate absorption and metabolism.
The investigation and management of familial and acquired anemia and polysythemia, and the disorders linked to erythropoiesis, such as hemochromatosis and porphyria.
The recognition and function of lymphocyte subsets, lymphocyte differentiation, traffic and distribution. The nature and function of lymphokines. The regulation and modification of gene expression, and the structure and function of the gene products as they effect lymphocytes and immunoglobulins.
The characterization and quantification of lymphocytes and immunoglobulins, including flow cytometry.
Investigation and treatment of Lymphoproliferative disorders, EB virus infections, and familial and acquired immune deficiency states. The use of immunosuppressive and immuno-replacement therapy.
Regulation of growth and differentiation, survival and distribution, cytokines and the responses to bacterial stimuli, and the role of these cells in host resistance.
Structure, function, identification and enumeration of granulocytes and macrophages.
Disorders of granulocyte function, agranulocytosis, and the management of the neutropenic patient, and diseases of granulocytes, and of phagocytic cells.
Platelet formation, platelet structure and function, and inhibitors of platelet function.
Platelet receptors, adhesive molecules, and platelet antigens.
Tests of platelet function and tests needed to classify thrombocytopenic disorders including the measurement of platelet survival.
The investigation and management of thrombocytopenia, thrombocytosis, and congenital and acquired disorders of platelet function.
The coagulation and fibrinolytic pathway, their activation, amplification and inhibition, including the role of adhesive molecules, platelets, endothelial cells and the vessel wall, and the mechanism of fibrinolysis. The inheritance of coagulation disorders. The pathophysiology of hemostatis during pregnancy, and in the neonatal period.
Experience with tests of hemostasis, including coagulation factor assays, using functional assays, immunoassays, chromogenic substrates and allied techniques.
The investigation and treatment of congenital and acquired disorders of coagulation. The detection and treatment of venous thrombosis and pulmonary embolism. The use of anticoagulants, antiplatelet drugs, and fibrinolytic agents in venous and arterial thrombosis.
The structure and function of cellular antigens and their relevance to immunity and transplantation (including HLA). The clinically relevant blood group antigens. The mechanism of immune clearance of cells. The components of the complement pathway, their activation and function.
The detection and identification of blood group and HLA antigens and antibodies. Techniques for screening for transfusion of transmitted diseases, and their limitations. The preparation of preservation of blood and blood components for transfusion.
The procurement and utilization of blood and blood products. The investigation and treatment of patients requiring blood transfusion and blood component therapy, and of transfusion reactions. The principles and indications for apheresis. The role of iron-chelation therapy in prevention and treatment of iron overload.
Transplantation immunology, immunosuppression, graft-versus host disease (GVHD), and gene therapy.
The indications, performance and complications of BMT, and the treatment of GVHD.
The molecular genetic and cytogenetic alterations in hematopoietic malignancies. Oncogenes and factors regulating cell growth. The pharmacology of chemotherapeutic drugs. The fundamentals of radiobiology.
Morphology, cytochemistry, cell-surface markers, and cytogenetics in determination of cell lineage. The histopathology of lymph nodes, the reticuloendothelial system, and bone marrow.
The investigation and treatment of hematological malignancies, including chemotherapy and radiotherapy. The prevention and treatment of complications, including infections, immunosuppression, and hormone suppression. The use of biological response modifiers.
Supportive care, including nutrition, pain control, psychiosocial counselling. The late effects on growth, development and intellectual function. The benefits of the team approach to the management of malignancy.
Oncogenes, cytokinesis, biology of metastasis, principles of drug resistance, the principles governing surgical, radiation and chemotherapeutic treatments, including pharmacology and radiobiology.
Electron microscopy, surface markers and cytochemical methods in histological diagnosis and staging.
Design, conduct and interpretation of clinical trials, multi-modality treatment strategies, principles of clinical staging, supportive care and rehabilitation, assessment of performance status, management of the adverse effects of therapy (including the late effects in children) and palliative care.
The anatomy and physiology of the RE system including the spleen.
The investigation of splenic function. The histology of the RE system and its diseases.
The diagnosis and management of disorders of the spleen, metabolic storage diseases and proliferation of histiocytes.
Maternal-fetal relationships and the function of the placenta as it applies to the hematologic system. Developmental hematology in the fetus. The biology and physiology of the full term and premature infant in terms of hemopoiesis and hemostasis. Bilirubin metabolism in the newborn.
Knowledge of normal values for cellular elements of the blood and coagulation tests in terms of hematopoiesis and hemostatis. The intepretation of abnormal values.
The diagnosis and management of disorders of red cells, white cells, platelets and coagulation in the newborn, including the consequences of maternal-fetal incompatibility.
practice in the newborn. Prenatal diagnosis and genetic counselling for
The resident must be provided with a graduated increase in personal responsibility, appropriate to the level of competence, in both the clinical and laboratory aspects of the specialty. The equivalent of at least one year must be spent in clinical work, during which the resident has supervised responsibility for the care of patients with hematological disease and experience in the laboratory procedures required to manage these patients. There must be at least two qualified hematologists to supervise the residents and provide teaching in the basic and clinical sciences related to hematological diseases.
Through the facilities of the university and the participating institutions, the overall training program must satisfy the following requirements:
1. CLINICAL PROGRAM
Clinical training must be based on adequate resources to ensure full training for each resident in all areas of hematology. The description of the integrated program should specify how the responsibility for each of the components of the program is shared by the participating institutions. The number and variety of patients available for teaching under each of the following headings must be satisfactory:
2. LABORATORY TRAINING PROGRAM
There must be adequate clinical laboratory facilities, adequately staffed and under qualified medical supervision. The hematological laboratory facilities must be of high standard and capable of providing well supervised studies in those procedures usually associated with a major hematology laboratory. The technical staff and the volume and variety of work must be considered to be adequate for training by the specialty committee. In hospitals in which clinical and laboratory hematology are not supervised by a single person, the Committee must be satisfied that there is the degree of cooperation and liaison between clinical and laboratory hematology that will permit the resources of both divisions to be utilized effectively in the training of residents. Residents must also receive training in the diagnostic applications of radioisotope procedures to hematology, including techniques and interpretation, and become familiar with the principles of and indications for radiotherapy.
3. EDUCATIONAL PROGRAM
A coordinated educational program must be provided in hematology and associated fields. This should include definitive teaching in the basic sciences, and also advanced scientific and clinical knowledge essential to the practice of hematology in those areas outlined in the preceding sections. The program may include didactic lectures and seminars, which may be interdisciplinary in nature, teaching rounds and special conferences, technical demonstrations, and journal clubs.
PROGRAMS (WITH TRAINING REQUIREMENTS):
Eighteen months of approved residency training.
Forty eight months(four years)of approved residency training.