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King Faisal Specialist Hospital and Research Centre

FELLOWSHIP IN HEMATOPATHOLOGY SUBSPECIALITIES TRAINING PROGRAM

Department of Pathology & Laboratory Medicine

Table of Contents

I Introduction 2

II General Objectives 2

III Specific Objectives 2

IV Admission Requirements 2

V

Structure of Training Program

A. Duration

B. Training Capacity

C. Faculty Qualifications

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VI Program Content 3 -4

VII Evaluation & Promotion 5

VIII Completion 5

IX Duties, Leaves & Holidays 5

Forms and logbook pages 6

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I. Introduction:

The Department of Pathology and Laboratory Medicine offers a fellowship program in Hematopathology and Molecular Genetics for Hematological diseases.

II. General Objectives:

Hematopathology Fellowship Program is a two year program which is designed to provide in depth training and experience in Hematopathology Molecular Genetics and flow cytometry for Hematological diseases for physicians who have completed their hematopathology or hematology training program. The training emphasizes the practical, academic and administrative aspects of Hematopathology in order to produce a fully qualified hematopathologist with broad exposure to various aspects of Hematopathology and related Pathology. The program offers the candidates with an opportunity to learn from rich clinical and pathologic case material routinely dealt by the hematopathologists in this department. In addition to the in house material the department also receives a variety of unusual cases for consultation from several hospitals in the Kingdom of Saudi Arabia, which help to enhance and enrich the experience and exposure of the trainees and expose them to research opportunity. After the completion of the training the fellows are expected to be able to work as independent hematopathologists.

III. Specific Objectives:

1. To provide a broad based and in depth exposure to Hematopathology and related MolecularGenetics and flow cytometry for Hematological diseases including its practical, academic and administrative aspects.

2. Prepare the fellows to ultimately function as competent independent hematopathologists.3. Allow the fellows to enhance their diagnostic skills and knowledge base by handling all

hematology specimens and prepare a complete and concise integrated report. 4. Learn to interpret various hematology specimens and correlate with relevant clinical

information in order to provide meaningful information to clinical colleagues. 5. Develop sufficient knowledge base and experience to be able to discuss the results of the

hematology specimens with consultants, residents and fellows on the clinical side. 6. Present and discuss peripheral blood and bone marrow cases in various clinicopathologic

conferences. 7. Assume responsibility to supervise and teach residents.8. Avail opportunities for collaborative research in Hematopathology and related Molecular

Genetics.

IV. Admission Requirements

Candidates must have completed a resident training in Hematopathology or clinical hematology and/or clinical pathology and must have obtained relevant specialty board certification. Candidates should have above average evaluation during the training.

Candidates will be required to successfully complete a personal interview with the members of the Hematopathology Section and other designated members of the department of pathology.

Three letters of recommendation and a sponsorship letter should be submitted.

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V. Structure of Training Program

A. Duration : Two Years

B. Training Capacity : Fellowship positions = 1 per year

C. Faculty Number : 5

D. Faculty Qualifications:

There are five (5) Hematopathologists in the section who will be participating in the training of the fellows. Their qualifications include one or more of the following:

MD or MBBS, Graduate Bachelor Degree in Medicine

Fellowship of the Royal College of Pathologists of Australasia (FRCPA)

American Board of Pathology or equivalent

King Saud Fellowship in Pathology

King Faisal Fellowship Program

VI. Program Contents:

16 months: HEMATOPATHOLOGY CORE TRAINING

The fellow will rotate on routine and specialized Service and responsibilities in Hematopathology, including signing out with the attending hematopathologist reports on peripheral blood, body fluids, bone marrows, flow cytometry, hemoglobin electrophoresis and hemostatic evaluation. As the fellow progresses in training, he or she will be given the opportunity responsibility for independent signing out of cases with minimal supervision. During this period the fellow is required to complete the log sheet for clinical cases which include full investigations including (flow cytometry, molecular and cytogenetics). The fellow will also be responsible for designing work-up on submitted patient samples and discussing with the technologists and clinical consultants the best strategies of such work-ups. The fellow will be involved in Quality Control (QC) and Quality Assurance (QA) evaluation.

The fellow will be asked to identify an area of interest in the field of Hematopathology for planning, organizing and conducting a research projects. One or more hematopathologists will be assigned to oversee the project and to provide assistance and guidance in its execution. The fellows will be encouraged and guided in documenting their findings in the form of a manuscript for publication. Publication of the data in a peer reviewed journal will be encouraged.

It is required to publish yearly at least one manuscript and will be included in the evaluation.

The fellow is required to submit a log sheet with the required number of diagnosed cases in each disease category and evaluation will be based on the log sheet.

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8 months: SUBSPECIALITIES TRAINING

During this period which will be distributed during the 2 years , the candidate will be assigned to:

1- Cytogenetics/FISH Laboratory for a period of one (1) month. The fellow will have technical training in during this period; the fellow will be exposed to all Cytogenetics and FISH studies related to Hematooncology( FORM 1).

2- Molecular Genetics for hematological diseases for a period of (2) month. The fellow will have technical training in the field and will be exposed to all available molecular techniques and will be involved in all aspects of the sign-out of cases under the supervision of a staff pathologist and will be fully responsible for interacting with the clinical and other staff for clinicopathologic correlations (FORM 2).

3- Flow cytometry for hematological diseases for a period of 1 month. The fellow will have

technical training in the field and will be exposed to all available techniques,

interpretation and will be involved in all aspects of the sign-out of cases under the

supervision of a staff pathologist and will be fully responsible for interacting with the

clinical and other staff for clinicopathologic correlations (FORM 3).

4- Laboratory management for a period of (1) month. The fellow will be exposed to quality control and learn all administrative issue related to hematology and laboratory medicine and get involved in accreditation process (FORM 4).

5- Lymphoma pathology rotation for a period of (1) month. The fellow will spend with pathologist , during this time he/she will expose to diagnostic approach to lymphoma from receiving lymph node to evaluating different materials for diagnosis of lymphoma

6- There will be 2 months elective and which can be utilized in research or area of interest, he/ she can coordinate with the section and get approval from program director. This period will be distributed one month / year.

ALL THESE ROTATIONS WILL BE ARRANGED ACCORDING TO AVAILABILITY OF TRAINING SLOTS WITH PROSPECTIVE SECTION AND NOT TO BE BACK TO BACK AND OVER THE TWO TRAINING YEARS.

EACH FELLOW WILL HAVE HIS/HER ROTATIONS ARRANGED WITH THE START OF THE ACADEMIC YEAR

Fellows will also be given responsibility for teaching the residents in pathology as well as those rotating from the other clinical specialties. Fellows will actively participate in the weekly departmental and sectional conferences by own presentations and attendance at those of others. These include:

1. Hematopathology Section Journal Club every Saturday2. Pathology Grand Rounds every Sunday3. Hemostasis Educational activities every other Sunday4. Pediatric Clinico-pathologic conference every other Monday5. Adult clinico-pathologic conference every Monday

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6. Pathology Residents Case Presentation every Monday7. Lymphoma Morphology Meeting every Tuesday8. Adult Hematology Grand Rounds every Wednesday

VII. Evaluation

The fellow level of competence and performance will be evaluated at a frequency by the Post Graduate education committee and in the manner detailed in the Policy for Fellowship Training Program. The fellow is required to complete a LOG SHEET (FORM 5 & 6) with required number of Clinical cases in each area of Hematopathology and submit it yearly with the technical training sheets and the published or accepted paper.

VIII. Completion

A certificate of Fellowship training at KFSH&RC will be awarded upon satisfactory completion of the requirements of the program.

IX. Duties Leaves and Holidays

Regulations governing duties, leaves and holidays are as stipulated in the Policy for FellowshipTraining Program.

HEMATOPATHOLOGY FELLOWSHIP TRAINING PROGRAM

Recommended: Recommended:

________________________________________ _________________________________ Tarek Owaidah, MD,FRCPA, FACP Fouad Al Dayel, MD,FRCPA, FRCPath Program Director Acting Chairman Pathology & Laboratory Medicine Pathology & Laboratory Medicine

Recommended: Approved:

_____________________________ ______________________________ Saud Al Shanafey, MD Abdulrahman Alrajhi, MD, MPH Deputy Executive Director Executive Director Academic & Training Affairs Academic & Training Affairs

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Forms and logbook pages:

Form # 1: CYTOGENETICS ROTATION

Form # 2: MOLECULAR GENETICS ROTATION

Form # 3: FLOW CYTOMETRY ROTATION

Form # 4: LABORATORY SAFETY PROGRAM

Form # 5: TEACHING SESSION LOGBOOK

Form # 6: LOGSHEET FOR CLINICAL CASES

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FORM 1

Cytogenetic and FISH Syllabus during 1 month

Trainee Name: ____________________

During this period the candidate will get one case of each of the 6 diseases and follow it from

sample collection to report

OBJECTIVES Fanconi MM AML MDS ALL MPN

Specimen collection, storage and processing (pre/post natal blood and hematological specimens)

Cytogenetis

Cell culture

Harvesting

Slide preparation and staining

ASI

FISH

Cell culture

Harvesting

Slide preparation and staining

Slide treating (Types of probes)

Clinical interpretation

Define the term karyotype.

Identify the six chromosome groups (A-G).

Distinguish between constitutional and acquired karyotype.

Define and describe a clinical example of the following

chromosome abnormalities

Outline the application of FISH testing

FISH interpretation under microscope

Outline different probe for different hematological disease

Quality Management

Total allocated days for training

Signed by: ________________________ Section head: __________________________

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FORM 2

Trainee Name: _______________________

Molecular Syllabus during 2 months

OBJECTIVES

Day Technical signature

Specimen collection, storage and processing (pre/post natal blood and hematological specimens)

2

DNA/RNA extraction from blood, bone marrow and other specimens 7

Polymerase chain reaction, including quantitative estimation 7

Real time PCR 7

NGS 7

Gene sequencing

Other relevant techniques as applied to diagnosis

Thrombophilia studies Molecular testing, (eg. Factor V Leiden, prothrombin G20101A gene mutation, methyl tetrahydrofolate reductase

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Acute leukemia studies 7

Myeloprolifrative studies 7

Others 2

Quality Management 3

Signed by: ______________________ Section: ___________________________

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FORM 3

Trainee Name: ________________________

Flow Cytometry Syllabus during 1 month period

OBJECTIVES DAY SIGN

Instrumentation 3 days

Introduction, lasesrs, flurochromes,

filter

1

Basic elements of flow cytometry operation principles

1

Compensation 1-2

CD classification 1

Panels design 1

Unit establishment 1

Data analysis 15 days

CD45 and light scatter 2

Gating strategy 2

Benign vs. malignant populations 4

Leukemia 4

Lymphoma 4

Multiple myloma 2

DNA Analysis 2

CD34 enumeration 1

Quality Management 1

Total allocated days for training 30

Signed by: ____________________ Section: ______________________

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FORM 4

Trainee Name: __________________________

Laboratory Safety Program Form

This form is designed to confirm that trainees have understood and are able to apply laboratory safety instruction provided by the employer as it relates to the RCPA curriculum. It covers the essentials for new trainees and is the basis for subsequent learning that will be assessed and eventually leads to the ability to function in a laboratory management role as a pathologist.

I have participated in a laboratory safety induction program or educational session.

I have reviewed the laboratory safety manual

I know where to find the laboratory safety equipment and how to use it

I have known immunity to hepatitis B (natural or vaccine)

I have been vaccinated and/or screened for other infectious diseases as required by my laboratory

I know how and when to wash my hands and carry this out

I wear enclosed shoes in the laboratory and tie back long hair if applicable

I wear appropriate protective clothing (gown, gloves, goggles, mask as needed) and always remove it before leaving the laboratory

I cover any cuts or wounds before working in the laboratory

I never eat or put anything in my mouth whilst in the laboratory

I know how to handle blood and other body substances and tissues to avoid transmission of infection to myself and others

I know how to prevent sharps injury

I am aware of electrical, chemical, radiation and biological hazards and how to prevent them

I know what to do in an emergency

I know the procedure for reporting safety-related incidents

I know where to find information about legislative requirements for laboratory safety

I know where to find detailed information about laboratory hazards such as dangerous chemicals

I always clean up after myself I set up my workspace and ensure correct posture and lifting technique so as to avoid strain and injury

Trainee name (print) .................................................................... Signature.............................

Witness (supervisor or other senior member of staff):

Name (print) .................................................................................. Signature.............................

Date: ……………

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FORM 5

Teaching Sessions Log Trainee Name: ____________________

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FORM 6

Log Sheet for Clinical Cases

Trainee Name: _____________________

OBJECTIVES Minimum # Sample # signature

Hematological malignancies

Acute myeloid leukemia with normal cytogenetics 5

Acute myeloid leukemia with abnormal cytogenetics 5

Acute lymphoblastic leukemia with abnormalities 15

Myelodysplastic syndrome 5

Myeloproliferative neoplasm 10

Multiple myeloma 5

Lymphoma Tissue and BM involvement 10

BM Failure syndromes 2

Abnormal Hemoglobin electrophoresis 50

Coagulation

Case with bleeding history for investigation 3

Case of thrombosis for investigation 5

Platelet disorders 2

Hemophilia with complications 3

vWD different types 2

Anemia for investigation 5

Research 2