Hematology

The program is designed so that the residents will acquire the necessary knowledge, skills and attitudes and develop all the required attributes of a competent hematopathologists as defined by the ACGME competencies and the CanMEDS Roles.

Patient Care

1.  Identify, respect, and care about patients' differences, values, preferences, and expressed needs
2.  Listen to, clearly inform, communicate with and educate patients
3.  Share decision making and management with patients
4.  Continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.
5.  Encourage patients and the public to take an interest in their health and to take action to improve and maintain it.
6.  Work in inter-professional teams to enhance patient safety and improve the quality of patient care
7.  Encourage patients and the public to take an interest in their health and to take action to improve and maintain it.
8.  Work in inter-professional teams to enhance patient safety and improve the quality of patient care
9.  Maintain patient safety as a high priority throughout their practice

The residents will be competent in providing optimal Patient Care, as it relates to hematopathology, of the highest standards by:

1.  Gathering essential and accurate information regarding patients being evaluated, including clinical history and previous results of diagnostic tests and biopsies.
2.  Making informed decisions regarding appropriate triaging of patient related samples (peripheral blood films and bone marrow aspirates as well as all other tests performed at the hematology laboratory).
3.  Informing clinicians, pathologists and other trainees of appropriate testing and triaging.
4.  Informing clinicians of diagnostic findings, and educate other residents / trainees, and clinicians of the significance of findings
5.  Efficiently and effectively solving problems with any aspect of the hematopathology service (e.g., requesting additional slides for referred-in cases as necessary, clarifying clinical history, and procuring further samples for Other tests).
6.  Using good judgment as to when to ask for second opinion in the evaluation of blood smears, body fluid reviews, BM and lymph node examinations, flow-cytometry, coagulation studies, hemoglobin variant analyses and other investigations.

Medical Knowledge

Residents are expected to establish and maintain clinical knowledge, skills and attitudes appropriate to Hematological Pathology.
1.  Demonstrate mastery of established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social behavioral) sciences related to hematopathology and demonstrate effective the application of knowledge to patient care.
2.  Function effectively as consultants to provide optimal, ethical and patient-centered medical care (providing precise and accurate response to inquiries regarding hematology tests, results, and clinical significance).
3.  Apply knowledge of the clinical, socio-behavioral, and fundamental biomedical sciences relevant to Hematological Pathology
a.  Demonstrate a good knowledge base [including changes related to age from the fetus to the elderly and different physiological states including pregnancy] of:
a.1.  Ontogeny of hematopoietic cells
a.2.  Mechanisms of normal and disordered hematopoiesis
a.3.  Genetics/cytogenetics pertaining to Hematology
a.4.  Immune function
a.5.  Immunohematology
a.6.  Hemostasis
b.  Investigate the following in a timely, cost-effective, logical, step-wise, ethical, and useful manner, integrating information from other investigations:
b.1.  Normal and disordered hematopoiesis, including disorders of hemoglobin synthesis
b.2.  Normal and disordered hemostasis
b.3.  Normal and disordered immune and cellular function
b.4.  Transfusion medicine/immunohematology issues
4.  Demonstrate knowledge, technical, and diagnostic skills relevant to Hematopathology relating to:
a.  Appropriate laboratory specimen collection and identification
b.  Procurement and interpretation of blood films, bone marrow aspirate and biopsy samples in all age groups from neonates to the elderly
c.  Hematology, coagulation and platelet function analyzers, flow cytometers, slide stainers, automation and other technologies related to Hematopathology
d.  Histochemical and immunohistochemical stains, including appropriate indications for use
e.  Molecular genetics/cytogenetic testing
f.  Diagnosis of hemoglobinopathies and gammopathies
g.  Management of a transfusion medicine service including safe transfusion practices from vein-to-vein, audit and utilization reviews
h.  Immunohematologic testing
i.  Procurement of blood donations including selection and screening of donors and apheresis procedures
j.  Therapeutic apheresis, indications and procedure
k.  Preparation, storage, transportation and use of blood components, including the collection and manipulation of stem cells for transplantation
l.  Quality control/monitoring/assessment measures
m.  Potential artifacts related to Hematological Pathology testing
5.  Demonstrate effective clinical problem solving and judgment to address patient problems, including interpreting available data, reporting and communicating investigation results and integrating information to generate differential diagnoses and management plans
a.  Apply interpretive and diagnostic skills effectively, integrating epidemiology, pathophysiology, clinical manifestations and laboratory information, to disorders involving the following:
a.1.  Red cells:
a.1.1  Hypochromic anemias - to include the differentiation of iron   deficiency from other causes of defective hemoglobin synthesis
a.1.2.  Macrocytic anemias - including megaloblastic anemias, congenital anemias, aplastic anemia, hypothyroidism and myelodysplastic syndromes
a1.3.  Hemolytic anemias - congenital and acquired
a.1.4.  Secondary anemias
a.1.5.  Marrow failure syndromes
a.1.6.  Polycythemias - congenital, primary and secondary
a.1.7.  Hemoglobinopathies (sickle cell disease / thalassemia / others)
a.2.  Granulocytes:
a.2.1.  Neutrophil dysfunction - congenital and acquired
a.2.2.  Neutropenia - congenital and acquired
a.2.3.  Neutrophilia
a.2.4.  Leukemias - including transient myeloproliferative disorder
a.2.5.  Myelodysplastic disorders
a.2.6.  Myeloproliferative disorders
a.2.7.  Eosinophilia
a.2.8.  Basophilia
a.3.  Monocytes/histiocytes:
a.3.1.  Monocytosis
a.3.2.  Benign and malignant disorders
a.4.  Lymphocytes:
a.4.1.  Lymphocyte dysfunction - congenital and acquired
a.4.2.  Lymphopenia - congenital and acquired
a.4.3.  Lymphocytosis - benign and malignant
a.4.4.  Leukemias
a.4.5.  Lymphomas - Hodgkin, non-Hodgkin
a.5.  Plasma cells:
a.5.1.  Hyper- and hypo-gammaglobulinemia
a.5.2.  Malignant and benign disorders
a.6.  Lymph nodes, thymus and spleen:
a.6.1.  Normal and disordered architecture and morphology
a.6.2.  Congenital anomalies
a.6.3.  Splenic dysfunction
a.6.4.  Infiltrative and storage diseases
a.7.  Platelets:
a.7.1.  Platelet dysfunction - congenital and acquired
a.7.2.  Thrombocytopenia - congenital and acquired
a.7.3.  Thrombocytosis - benign and malignant
a.8.  Hemostasis/thrombosis:
a.8.1.  Bleeding disorders - congenital and acquired
a.8.2.  Thrombotic disorders - congenital and acquired
a8.3.  Vascular disorders - congenital and acquired
a.9.  Transfusion Medicine:
a.9.1.  Problems involving red cell and platelet compatibility
a.9.2.  Hemolytic disease of the newborn
a.9.3.  Allo-immune and auto-immune cytopenias
a.9.4.  Transfusion reactions
a.10.  Stem cell transplantation:
a.10.1.  Engraftment
a.10.2.  Graft versus host disease
a.10.3.  Other complications
b.  Apply effective forms of reasoning to make complex clinical decisions and to prognosticate and predict risk.
6.  Use preventive and therapeutic interventions effectively
a.  Implement a management plan in collaboration with clinicians, patients and/or their families b.  Demonstrate appropriate and timely application of preventive and therapeutic interventions relevant to Hematopathology using evidence effectively to inform decisions in this regard.
c.  Ensure appropriate informed consent is obtained for therapies
d.  Demonstrate appropriate consultation to ensure patients receive appropriate end-of-life care

7.  Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic
a.  Demonstrate effective, appropriate, and timely performance of diagnostic procedures relevant to Hematopathology ((knowing when to order and how to perform and then interpret the results of diagnostic tests)
a.1  Bone marrow aspiration and biopsy
b.  Demonstrate effective, appropriate, and timely performance of therapeutic procedures relevant to Hematopathology
b.1  Describe principles of treatment [including stem cell transplantation], monitoring and follow-up of primary hematological disorders or diseases affecting the hematological systems, including their potential complications
c.  Ensure appropriate informed consent is obtained for procedures
d.  Document and disseminate information related to procedures performed and their outcomes
e.  Ensure adequate follow-up is arranged for procedures performed

8.  Seek appropriate consultation from other health professionals, recognizing the limits of their expertise
a.  Demonstrate insight into their own limitations of expertise
b.  Demonstrate effective, appropriate, and timely consultation of another health professional as needed for optimal patient care
c.  Arrange appropriate follow-up care services for a patient and their family
d.  Respect the patient’s right to seek a second opinion

Practice-Based Learning and Improvement

Practice based learning and improvement requires the resident/fellow investigate and evaluate their care of patients, appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
Residents/fellows are expected to develop skills and habits to be able to:
 Identify strengths, deficiencies, and limits in one's knowledge and expertise; 
 Set learning and improvement goals;
 Identify and perform appropriate learning activities;
 Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement;
 Incorporate formative evaluation feedback into daily practice;
 Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems;
 Use information technology to optimize learning;
 Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident's teaching abilities by faculty and/or learners.
 Develop individual learning plans
 Participate actively in Quality or Practice Improvement activities (including lectures, seminars, conferences, or a quality improvement project).

At the end of the training program, hematopathology residents will able to:

1.  Use appropriate resources and information technology to support clinical consultations and diagnostic decision making in hematopathology
2.  Critically evaluate medical information and its sources, and apply this appropriately to practice decisions
3.  Understand the use and limitations in hematopathology of ancillary diagnostic tools
4.  Identify clinical and laboratory medicine consultants who can provide assistance with questions in hematopathology
5.  Demonstrate graduate expertise in the performance and evaluation of studies related to hematopathology
6.  Show a gradual increase in the fund of knowledge in hematopathology, and show improvement in competence, efficiency, and confidence in all areas of hematopathology
7.  Manage their practice and career effectively
o  Set priorities and manage time to balance patient care, practice requirements, outside activities and personal life
o  Implement processes to ensure personal practice improvement
o  Maintain and enhance professional activities through ongoing learning
o  Take part in regular and systematic audits and in systems of quality assurance and quality improvement
o  Work with colleagues and patients to maintain and improve the quality of their work and promote patient safety
8.  Employ information technology appropriately for patient care
9.  Manage a practice including finances and human resources
o  Direct and manage a Hematology laboratory including addressing issues pertaining to quality management, staffing and reporting
o  Plan, budget, and evaluate new or expanded patient programs that impact Hematology laboratories
o  Apply efficient methods of indexing specimens and reports, for providing a useful patient-based filing system, for rapid reporting of results and for convenient data retrieval
10. Facilitate the learning of patients, families, students, residents, other health professionals, the public and others, as appropriate
11. Advocate for and maintain their own health

Systems Based Practice

Systems-Based Practice requires residents/fellows to demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents/fellows are expected to: 

Work effectively in various health care delivery settings and systems relevant to their specialty
 Coordinate patient care within the health care system
 Incorporate considerations of cost awareness and risk benefit analysis in patient care
 Advocate for quality patient care and optimal patient care systems
 Work in inter-professional teams to enhance patient safety and improve patient care quality
 Participate in identifying system errors and in implementing potential systems solutions

7.  Actively participate in activities (including clinical teaching, audit projects, Mortality & morbidity rounds, workshops and carrier nights) so to acquire  the necessary knowledge, skills and attitudes for system based learning
8.  Demonstrate knowledge of:
o  different types of medical practice and delivery systems
o  system resources
o  systems issues and the reduction of error, including root cause analysis
o  tools and techniques for controlling costs and allocating resources
o  understanding financing and insurance structures
o  evaluating risk and benefit costly prescribing

At the end of the training program, residents will able to:

Promote the health of individual patients, communities, and populations

Identify the determinants of health for the populations that they serve

a.  Adopt a population health approach to the prevention of illness, promotion of health and control of disease
b.  Identify the most important determinants of health of the populations, including barriers to access to care and resources
c.  Work with related organizations to identify vulnerable or marginalized populations within those served and respond appropriately

Respond to the health needs of the communities that they serve

Participate in activities that contribute to the effectiveness of their healthcare organizations and systems

b.  Demonstrate the ability to use evidence to inform quality improvement
c.  Participate in systemic quality process evaluation and improvement, such as patient safety initiatives
d.  Demonstrate efficiency in identifying, preventing and Managing Potential Harm
e.  Describe the structure and function of the healthcare system as it relates to Hematological Pathology, including the roles of physicians 
f.  Describe principles of healthcare financing, including physician remuneration, budgeting and organizational funding

Apply evidence and management processes for cost-appropriate care.

Allocate finite healthcare resources based on sound judgment that is supported by evidence–based information.

a.  Employ processes to ensure standardization, policy adherence, adverse event and incident reporting
b.  Conduct audits, utilization reviews, and cost-benefit ratio analysis of diagnostic interventions, to achieve efficiencies and cost containment
c.  Plan and implement quality management programs and laboratory information systems
d.  Minimize hazards of the laboratory workplace to create and maintain a safe working environment
e.  Participate in effective multi-disciplinary patient safety initiatives
f.  Explain resource utilization issues of the laboratory as they apply to the conduct of research

Serve in administration and leadership roles, as appropriate

a.  Demonstrate ability to provide leadership and effectively manage others
b.  Chair or participate effectively in committees and meetings
c.  Lead or implement change in health care
d.  Plan relevant elements of health care delivery (e.g., work schedules)

Professionalism

Professionalism requires residents/fellows to demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Presidents are expected to demonstrate: larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents/fellows are expected to demonstrate:

Compassion, integrity, and respect for others;
 Responsiveness to patient needs that supersedes self-interest;
 Respect for patient privacy and autonomy;
 Accountability to patients, society and the profession;
 Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Residents should:

1.  Demonstrate a commitment to their patients, profession, and society through ethical practice.
2.  Exhibit appropriate professional behaviors in practice, including honesty, integrity, commitment, compassion, respect and altruism.
3.  Respect patient confidentiality, privacy and autonomy as per patient privacy legislations Recognize the principles and limits of patient confidentiality as defined by professional practice standards and the law.
4.  Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict.
5.  Demonstrate a respectful attitude towards other colleagues and members of an interprofessional team.
6.  Demonstrate a knowledge of and commitment to the ethical principles pertaining to patient care and the conduct of clinical research in hematology and medicine in general.
7.  Demonstrate proper respect for technologists, clinicians, medical students, nurses and all other staff.
8.  Protect patients from risk of harm posed by another colleague’s conduct, performance or health through appropriate actions as guided by the local rules and regulations.
9.  Demonstrate cultural competency by showing an understanding and respect of patients' cultural backgrounds and traditions.
10. Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation 

Interpersonal and Communication Skills

Interpersonal Skills and Communication requires the resident/fellow to skills that are effective in the exchange of information and collaboration with patients, their families, and health professionals. Residents/fellows are expected to develop skills and habits to be able to:
 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds;
 Communicate effectively with physicians, other health professionals, and health related agencies;
 Work effectively as a member or leader of a health care team or other professional group;
 Act in a consultative role to other physicians and health professions, and health related agencies;
 Maintain comprehensive, timely and legible medical records, if applicable.

At the end of the training program, residents will able to:

1.  Develop rapport, trust, and ethical therapeutic relationships with patients and families
2.  Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues, and other professionals
3.  Convey relevant information and explanations accurately to patients and families, colleagues and other professionals
4.  Develop a common understanding on issues, problems and plans with patients, families, and other professionals to develop a shared plan of care
5.  Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
6.  Communicate effectively with other health professionals, support organizations, administrative bodies, governments and others in the wider community
7.  Convey effective oral and written information about a medical encounter
a.  Maintain clear, accurate, and appropriate records (e.g., written or electronic) of clinical encounters and plans
b.  Present verbal reports of clinical encounters and plans
c.  Present medical information to the public or media about a medical issue
8.  Participate effectively and appropriately in an interprofessional healthcare team
9.  Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict.

Chairman and Program Director

Chairman:  Dr. Khalil Saleh Abdullah Al Farsi
Program Director:  Dr. Sulayma Nasser Mohammed Al Lamki

Duration of the Residency Training Program

  The duration of the program is 5 years.  The first year is composed of rotations in internal medicine and other major specialties.  The residents will then spend 4 years rotating through the different areas of hematopathology.  They will also have rotations in in-patient, out-patient and community-based clinical hematology.

Required Rotations

o  Residents will acquire knowledge, skills and attitudes in all major sections of hematology/hematopathology that will enable them to practice as independent consultants in the field of hematolpathology. These sections/areas include:

  General Hematopathology

  Transfusion Medicine / Blood banking and apheresis

  Thrombosis and hemostasis

  Hemoglobinopathies

  Flowytometry

  Cytogenetics and molecular hematology

o  In addition, the residents will be exposed to clinical hematology including adult hematology (in-patient, out-patient, consultative and community hematology) and pediatric hematology & immunology, thalassemia and bone marrow transplantation.

  Outline of Rotations

YEAR 1 (R-1)

YEAR 2 (R-2)

YEAR 3 (R-3)

YEAR 4 (R-4)

YEAR 5 (R-5)

Training Centers

Main Training Centers

1)  Sultan Qaboos University Hospital
2)  Royal Hospital

Regional Hospital for other Rotations and/or Electives

1)  Armed Forces Hospital
2)  MOH Department of Blood Services (Central Blood Bank Section)

Minimum Requirements for Admission

1)  Successful completion of undergraduate medicine (MD or equivalent)
2)  Completion of internship
3)  Passing a written entrance exam if deemed necessary by the Education Committee
4)  Passing an interview