Haematology Watch, Vol.6, Issue 1.
HAEMATOLOGY TRAINING
Haematology Training in Pakistan: An Overview
Mehmood
The specialty of Haematology in Pakistan encompasses diagnostic laboratory practice, although physicians and surgeons often seek advice from haematologists about therapeutics.
The haematologists are trained in Pakistan under supervision of College of Physicians and Surgeons, while a secondary body Pakistan Society of Haematology gives guidance to students and supervisors.
Background:
In the United Kingdom the specialty of haematology encompasses both clinical and laboratory
practice, hence haematologists are both pathologists and physicians.1
Disappointingly, feedback
from FRCPath examinations has repeatedly
highlighted poor performance in areas of laboratory medicine and the 2012 GMC survey demonstrates the majority of trainees spend less than
20% of their total time in the laboratory, despite
haematologists being regularly called upon to
give laboratory-related advice.2
The recent centralisation of pathology services has removed
both source (training) material and the need for
pathology reporting from many hospitals training haematologists, so the question is: what can
we do to improve laboratory training and maintain patient safety if our dual role as clinician
and pathologist is to continue?
Using qualitative research methodology,3
focus groups and inter-trainee debates entitled
‘How do we improve our laboratory training?’
were held across the UK in a bid to create nationally relevant recommendations to improve
laboratory training in haematology. Themes for
discussion were generated by a preceding anonymous questionnaire and direct quotes from trainees were used in regional reports to illustrate
opinions. Focus groups were held in London
(n=30), the North Western Deanery (n=16), Scotland (n=11) and Wales (n=12). This document
summarises the findings of these reports. The
findings are grouped into the emergent themes
arising from this work, with striking similarities
in different regions. There were several examples
of excellent laboratory training in busy clinical
haematology departments. These examples of
best practice were used to help construct recommendations. The research aims to address the
relationship between training and service provision; when, where, who and how laboratory
training can best be delivered and assessed; the
role of the FRCPath examination and the impact
of pathology centralisation. From this the authors hope that positive steps towards improved
laboratory training for haematologists can be
successfully implemented across the UK.
1. Impact of service commitments
“The biggest problem is that lab training is always given
a lower priority than clinical service.”
“Service commitments mean that different jobs have
varying exposure to laboratory haematology. It’s easy to
get deskilled and lose your confidence (and competence)
in the lab.”
“It feels as though other clinical staff think you
are going for a break if you say you are going to the
laboratory.”
Trainees acknowledge that service commitment and training are closely interwoven, with
trainees learning in a service context. However,
the major barrier to effective laboratory training
was felt to be conflicting pressure to provide clinical service, with laboratory training and experience most readily sacrificed due to pressures of
service requirements.
2. Role of laboratory induction
“I did get lab induction – but it was very informal.”
“I was overwhelmed by morphology teaching sessions which I attended as a new ST3 – they seemed to be
geared towards more senior trainees.”
“On paper we had a laboratory induction but there
were insufficient staff to cover the ward – so I never got
to attend.”
There were recurrent concerns regarding the
lab skills demanded of new ST3s. The JRCPTB
2010 haematology curriculum1
attempts to put
increased focus on early laboratory training, although trainees and trainers alike appear to under-appreciate this. Laboratory expertise cannot
be assumed with new ST3s and there was agreement across the UK that a period of formal induction should be provided for all new haematology
trainees. At present, this happens with varying
success in certain training regions, although is
How can we improve laboratory
training? Views from Uk haematology
trainees
T
he Trainee Leads for the British Society for Haematology (BSH) and Intercollegiate
Committee on Haematology (ICH) have carried out qualitative research into how to
improve laboratory training in haematology. This is a particularly important issue at
present because recent feedback from FRCPath exams has highlighted poor performance
in areas of laboratory medicine and there appears to be a drive to separate the clinical and
laboratory practice of UK haematologists. The research covers all areas of the UK through the
use of focus groups and has had positive feedback from all who have seen the findings.
Dr Jane Graham
Dr Kirstin Lund
Dr Charles Percy
Dr Tom Butler
Some useful links:
http://www.ehaweb.org/assets/documents/CV-PASSPORT-2012.pdf
http://www.gmc-uk.org/Haematology_Curriculum_2010.pdf_32485915.pdf