Specific Standards of Accreditation for Residency Programs in Hematology

2009 EDITORIAL REVISION – MARCH 2015 VERSION 1.3 INTRODUCTION A university wishing to have an accredited program in Hematology must also sponsor an accredited program in Internal Medicine. The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in Hematology. This document should be read in conjunction with the General Standards of Accreditation and the Objectives of Training and Specialty Training Requirements in Hematology. STANDARD B.1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B.1 in the General Standards of Accreditation for the interpretation of this standard. The program director must be certified by the Royal College in Hematology. STANDARD B.2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for Hematology are outlined in the Objectives of Training and Specialty Training Requirements in Hematology. Based upon these general objectives each program is expected to develop rotation specific objectives suitable for that particular program, as noted in Standard B.2 of the General Standards of Accreditation. STANDARD B.3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in Hematology.

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SPECIFIC STANDARDS OF ACCREDITATION FOR HEMATOLOGY (2009)

The structure and organization of each accredited program in Hematology must be consistent with the specialty requirements as outlined in the Objectives of Training and Subspecialty Training Requirements in Hematology. In addition to offering the components noted in the subspecialty training requirements all accredited programs in Hematology should offer community-based learning experiences. Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to the level of training, ability and experience, in both the clinical and laboratory aspects of the subspecialty. Please refer to the Subspecialty Training Requirements for a detailed description. STANDARD B.4: RESOURCES There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in Hematology. In those cases where a university has sufficient resources to provide most of the training in Hematology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, sexual orientation, gender, culture, ethnicity and ethics appropriate to Hematology. 1. Teaching Faculty There must be a sufficient number of qualified teaching faculty to supervise residents at all levels and in all aspects of Hematology and provide teaching in the basic and clinical sciences and the laboratory component related to hematological diseases. 2. Number and Variety of Patients There must be a sufficient number and variety of patients available on a consistent basis to meet the educational needs of the residents in the program. 3. Clinical Services Specific to Hematology a) In-Patient There must be adequate numbers of patients available to provide opportunities for training and experience in the clinical evaluation and treatment of known and suspected diseases relevant to the subspecialty of Hematology including acute leukemia, lymphoproliferative disorders and bone marrow failure states.

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SPECIFIC STANDARDS OF ACCREDITATION FOR HEMATOLOGY (2009)

b) Consultation The program must provide residents experience in the provision of an in-patient and out-patient general hematology consultative service to primary care physicians and other disciplines. It is desirable that residents participate with faculty in the provision of expert advice to community organizations and government institutions such as transfusion services and the Canadian Hemophilia Society. c) Ambulatory In-patient and out-patient teaching services should be integrated as much as possible, in order to provide continuity of care and observation of patients both in and out of hospital. Programs must offer an experience in a longitudinal clinic. Opportunity for collaborative practice in clinics must be available to provide opportunities for investigation and follow-up of hematology patients. Special clinics, for example bleeding disorders, thrombosis and pediatric hematology clinics, provide an important component of the training. There must be out-patient facilities for the administration of chemotherapy and the performance of diagnostic and therapeutic procedures. d) Laboratory Components of the Program Clinical laboratory facilities must be adequately staffed with qualified medical supervision and provide a full range of hematological tests. The volume and variety of work must be considered adequate for training by the specialty committee of the Royal College. In hospitals where clinical and laboratory hematology are separately administered, there must be a high degree of cooperation and liaison between clinical and laboratory hematology so that the resources of both divisions are utilized effectively in the education of residents. The program must provide opportunities for residents to gain experience in: • • • • • • • • • • •

General laboratory hematology Coagulation Transfusion medicine Peripheral blood morphology, bone marrow aspirates and biopsies The histopathology of the lymph nodes and spleen Interpretation of flow cytometry Interpretation of cytogenetic analysis, Interpretation of molecular testing and diagnostics Interpretation of histocompatibility testing Interpretation of hemoglobinopathy testing Laboratory quality assurance

e) Thrombosis/hemostasis There must be adequate numbers of patients available to provide opportunities for training and experience in the clinical evaluation and treatment of thromboembolic disease and bleeding disorders

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SPECIFIC STANDARDS OF ACCREDITATION FOR HEMATOLOGY (2009)

f)

Stem Cell Transplantation

Residents must have exposure to allogeneic and autologous stem cell transplantation including initial patient assessment, donor selection, stem cell collection and infusion, inpatient management and management of graft-versus-host disease and other complications. g) Community Health Care Systems There must providee access to community health care systems or institutions that serve the hematology patient such as palliative care units (hospice), home care, visiting nurse surveillance and care, and community physicians. Residents must have the opportunity to interact directly with these providers to marshal community resources for the continuing care of patients. h) Pediatric Hematology There must be adequate numbers of patients available to provide opportunities for training and experience in the clinical evaluation and treatment of known and suspected diseases relevant to pediatric hematology in both in-patient and out-patient settings. i)

Intensive Care Units

The program must provide the opportunity for residents to gain consultation experience for critically ill patients with primary or secondary hematological problems. j)

Emergency Departments

There must be opportunities for residents to manage acute hematological problems in the emergency setting. k) Liaison with other Specialties and Subspecialties There must be appropriate liaison with teaching services in Hematological Pathology, Medical Oncology, Radiation Oncology, Palliative Medicine and General or Anatomical Pathology. STANDARD B.5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENT OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfil all of the CanMEDS Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside and in clinics, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B.5 in the General Standards of Accreditation, the Objectives of Training, the Specialty Training Requirements in Hematology and the CanMEDS Framework

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SPECIFIC STANDARDS OF ACCREDITATION FOR HEMATOLOGY (2009)

for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert The General Standards of Accreditation apply to this section. 2. Communicator In addition to the General Standards of Accreditation, the following requirements apply: -

The resident must be provided with opportunities to develop skills in communication with the patient and family and in providing continuing care for the patient with progressive illness and end of life care.

3. Collaborator The General Standards of Accreditation apply to this section. 4. Manager In addition to the General Standards of Accreditation, the program must provide exposure to laboratory quality assurance 5. Health Advocate In addition to the General Standards of Accreditation, the program must provide opportunities for the resident to understand the mechanisms available for funding of expensive medications and to advocate for such agents for their patients as well as to understand the critical importance of sufficiency and safety of the blood supply. 6. Scholar In addition to the General Standards of Accreditation, the following requirements apply: -

The program must provide residents with appropriate resources, time, and supervision to participate in a scholarly research, quality assurance, or educational project.

7. Professional The General Standards of Accreditation apply to this section.

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SPECIFIC STANDARDS OF ACCREDITATION FOR HEMATOLOGY (2009)

STANDARD B.6: EVALUATION OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of evaluation data on each resident enrolled in the program. Please refer to Standard B.6 in the General Standards of Accreditation for the interpretation of this standard. APPROVED BY COUNCIL – September 1990 REVISED – Education Committee –March 2006 REVISED – Education Committee – May 2007 REVISED – Specialty Standards Review Committee – June 2009 EDITORIAL REVISION – April 2011 EDITORIAL REVISION – June 2013 EDITORIAL REVISION – March 2015

© 2015 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

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