Haematology

 

Section 1: Information about the writer

Mai Khalifa

ST3 Haematology- Sheffield

Section 2: Scope of practice in the UK

Haematology is an intensive, exciting and rewarding but demanding specialty that encompasses both clinical and laboratory practice.

Clinical care is delivered in both in-patient and out-patient environments and the haematologist frequently contributes to diagnosis and management in other specialties and in the intensive care setting. This holistic approach to clinical care is a highlight of the specialty.

The laboratory practice makes it unique and exciting as you are a core part of the diagnostic process by being involved in interpreting clinical aspects of the various haematological lab tests, including reporting blood films and bone marrows.

The specialty may suit a wide variety of individuals including those who may wish to combine a clinical and academic career. Haematology is developing rapidly with respect to therapeutic advances, and lends itself to research.

Haematologists may work in a variety of settings including district general hospitals, teaching hospitals, blood transfusion services or in highly specialised tertiary referral units such as paediatric or obstetric units.

Procedures

Within the specialty the core procedures include:

1. Performing bone marrow biopsies
2. Performing lumbar punctures for diagnostic purposes and administering intra thecal chemotherapy
3. Removing Hickman lines (in some trusts/ hospitals)

Section 3: Type of Training/ Route to Training

The duration of specialist training is normally five years (note: you are not dual accredited in Internal Medicine when you do Haematology training).

Satisfactory completion of training requires that the trainee acquires the competencies set out in the haematology curriculum and also requires that the trainee obtains FRCPath (Fellow of the Royal College of Pathologists), completing two exams.

One year of specialist training may be approved for research, which is relevant to the specialty and in an area approved by the Specialty Advisory Committee (SAC).

Section 4: Subspecialties

Within haematology there is the opportunity to further develop special interests in a wide variety of clinical and laboratory areas:

1. Haemoglobinopathies/ red cell disorders.
2. Haemostasis and thrombosis.
3. Transfusion medicine.
4. Malignant haematology, transplantation- which can be further subdivided if you choose to work in a tertiary Centre into Myeloid/ Lymphoid/ Myeloma/ Myeloproliferative disorders.

Section 5: Application Process

Entry into Haematology training is possible following successful completion of both a foundation programme and one of three core training programmes:

• Core Medical Training (CMT)
• Acute Care Common Stem – Acute Medicine (ACCS-AM)
• Level 1 Paediatric Training – (For trainees interested in Paediatric Haematology)

Section 6: Requirements To Get Into Training (Person Specification)

For detailed breakdown of the personal specification, please refer to the following link: (http://specialtytraining.hee.nhs.uk/files/2016/02/2016-PS-Haematology-ST3-1.1.pdf)

Understanding shortlisting and some useful tips:

This all depends on your application form score. Please refers to the following link for a detailed breakdown of the scores within each section and to familiarise yourself with the application form: for further breakdown of this please refer to the following link:

(http://specialtytraining.hee.nhs.uk/files/2016/02/2016-PS-Haematology-ST3-1.1.pdf)

1. Undergraduate degrees (Max: 10 points)– which a lot of us will not have unless you have done another degree before or during doing medicine.

2. Post graduate degree (Max: 10 points) – e.g. PhD, Masters, 1 year post- graduate course (this should be at least 8 months), medical education diploma etc.. NOTE: this does not include MRCP

3. Prizes & awards (Max 10 points): if you graduated with a distinction this gives you points 8 points, you can also score some points if you had a prize during medical school or a scholarship.

4. MRCP-UK (Max 14 points): passing the full 3 MRCP exams scores you 14 points.

TIP – if you have not completed your MRCP and have just passed part one written, try doing PACES before part 2 written before the application time as this will score you more points than having Part 1 and part 2 written

5. Presentations: (Max 6 points): This includes oral presentations (power point) or poster presentations at a local, regional or national level.

6. Publications (Max 8 points): This is an area where it is difficult to score high marks unless you have been involved in a research project.

 

7. Teaching (Max 10 points): the scoring for this has recently changed- now it is divided into two sections: Teaching experience and Training in teaching.

For more information go to the following link:https://www.rcplondon.ac.uk/education-practice/course/rcp-educator-accreditation).

8. Quality Improvement – previously called Audit (Max 10 points): to get the highest point make sure you design lead and carry out a quality improvement project and have implemented change as result of it- AND make sure you present it.

 9. Commitment to specialty: This is normally the hardest bit to complete. You basically have to sell yourself and answer three questions.

1. Why you chose to do Haematology?
2. How you are suited for the job?
3. How committed you are to it?

TIPS – try to mention new things you have not covered in the other sections or highlight some specialty related things you have done like e.g.

• Choosing to do a Haematology rotation as part of you previous training.
• Going to Haematology clinics in you spare time.
• Attending any Haematology conferences or courses
• Participating in Haematology teaching/ choosing Haematology papers for journal club presentations during previous rotations.
• Joining the British Society of Haematology.
• Practicing to look at blood films, or do bone marrows
• Attending Haematology MDTs

Section 7: Important CV/Portfolio Perks (How To Achieve Them)

Always tailor what you write to the personal specifications below by giving examples:

• Shows initiative/drive/enthusiasm (self-starter, motivated, shows curiosity, initiative)- e.g. being in charge of the Rota, or the mess committee
• Demonstrable interest in, and understanding of, the specialty
• Commitment to personal and professional development
• Evidence of self-reflective practice
• Extracurricular activities / achievements relevant to the specialty
• Evidence of participation at meetings and activities relevant to the specialty
• Evidence of attendance at organised teaching and training programme(s)

More tips are found in the section 6.

Section 8: The Interview

The recruitment process for Haematology is National, which means everyone applying for the job goes to the same place for the interview. It has been held in Bristol for the 3 rounds.

Folders

For the interview you need to do prepare two folders (always refer to the recruitment website for up to date folder requirements):

1. Eligibility folder

This must contain original and copies of:

• Primary medical Qualification.
• GMC certificate.
• MRCP diploma (or letter of passing the exams if you have not completed full MRCP).
• Passport.
• Other ID – e.g. driving License.
• Proof of Address (e.g. bills).
• Visa (biometrics card).
• Core training competencies (ARCP documents).
• Proof of English language – if needed.

2. Evidence folder

This must be divided into sections matching those of the application form and containing the evidence of the all the claims you have stated on your application form.

REMEMBER: if there is no certificate or letter to proof something you scored yourself for on the application from you will be deemed non appointable. HAVE PROOF FOR EVERYTHING TO SECURE YOUR SCORE!

 

 

Interview: format and how to prepare

The interview is made of three stations (each 10 minutes); total duration time is 40-45 minutes. You will have two interviewers in each stations and each will be scoring you. They will take turns to ask you.

 

1. Clinical/ professionalism & governance

The scenario details will be relatively brief (two/three sentences), areas to consider when reviewing the scenario are:

• What steps you would take?
• Any potential treatments possible?
• Any further information you would gather?
• How you would go about communicating with any people (e.g. patients, family members, colleagues) involved in the scenario.

 

For your answer follow the natural sequence of history, examination, investigations and management. Or ABCDE assessment if the patient was acutely unwell.

e.g. you are the junior haematology registrar on call and you have been contacted by the lab about a 19 year old boy FBC done by GP showing pancytopenia and a blood film showing blasts. How would you proceed?

 

Important points to cover:

• Re examining the film and confirming the findings (ask a consultant to look as well).
• Contacting the GP regarding the child and checking the clinical aspects of why the test was done?
• Arranging urgent admission- you are suspecting acute Leukaemia.
• Going through the important history/ examination points.
• Investigations- make sure you read about the different bone marrow samples and what each is tested for.

Other e.g. of clinical scenarios: Neutropenic sepsis, Haemolytic Anaemia (metallic valve related haemolysis), myeloma, anaemia.

 

To prepare: use Oxford handbook of clinical Haematology.  

Remember they ask you basic haematology questions at the stage.

 

Professionalism/ Governance

Following the clinical scenario will be discussion of professionalism and governance. This discussion will be prompted by a short question (often a single sentence) provided by interviewers. This will not be given to you before arriving at the station. This section of the interview is designed to assess your demonstration and understanding of professionalism and governance in a given situation.

 

To prepare for this station familiarise yourself with Good Medical Practice. Also use ISC medical interviews book.

 e.g. you are the registrar on the ward and you discover that a patient with DVT has been given a sub – therapeutic dose of LMWH for the last 7 days. How will you handle this situation?

 

Important points to cover

• Checking the patient first – make sure no harm has occurred.
• Correcting the error and prescribing the right dose.
• Explaining this to the patient and apologizing for the mistake.
• Speaking to whoever prescribed the dose and the nurses to explain the error.
• Mention that it is a team responsibility.
• Completing Datix form of this incident (make sure you know who receives a copy of the Incident/ Datix form)

 

2. Portfolio station

This is where your application form and training to date will be reviewed. This will include checking the documentation you have brought along to ensure all content on your application form is correct.

There may be a third interviewer present here, who is brought in to assist with reviewing of this documentation, allowing the other two clinicians to concentrate on questioning.

This third interviewer will not award a score, although they can bring items to the attention of the other two interviewers who will be awarding scores.

The two main aspects of discussion here, on which you will be assessed, will be your suitability for and commitment to ST3 training in the specialty, and your achievements to date.

• Make sure your answers are structured and to the point.
• For every category of the folder, prepare something you will talk about if you get asked. For e.g. if you are asked about an audit talk about the one which scored you most points, if they ask you about presentations talk about national ones, then regional, then local etc..
• Try and show your commitment in your answers by incorporating Haematology specificthings toy did.

To prepare for this refer to ISC medical interview book

 

3. Presentation

At this station you will be asked to give a presentation, which you are expected to prepare in advance on a given subject (see below). Your communication skills will also be assessed at this station.

The station will be divided into two parts

• Five minutes for your presentation, followed by
• Five minutes for discussion of it and some broader issues relating to general research.

 

You should prepare a presentation on either:

‘An interesting case I have been involved in’

OR:

‘An interesting recent development / research finding in haematology’

You should only present on ONE of these topics, not both.

 

When preparing your presentation, please bear in mind the points below:

• Clarity & relevance most important – Select a topic that is relevant to haematology, and which you can present with clarity. This is more important than trying to impress by choosing a subject that is esoteric or complex. It should be relevant to your application where possible.

• No aids/resources – There will be no projectors or laptops for PowerPoint, no OHPs, flip-charts, etc. You are welcome to use prompts on small cards, but these should be for your own use only, and should not be given out as hand-outs. Don’t read off your presentation, PRESENT IT!

 

Please note that you will be stopped after five minutes so as to allow further discussion to take place, so try and get your main points across before then. At the same time, bear in mind that interviewers will be assessing the level, depth and content of your presentation, as well as expecting some structure.Interview nerves will be taken into consideration.

 

Post-presentation discussion

Once your presentation is finished (interviewers will stop you at the five minute-mark), interviewers will discuss it with you and ask further questions relating to the items you raise and any further points.This discussion will take place for approximately another five minutes.

You will be asked questions based on your presentation i.e on the topic and then research related questions.

The first area for which you will receive a score will be your presentation and its accompanying discussion; essentially, this mark will reflect your understanding of the subject matter, as displayed via your presentation and the accompanying discussion.

The second mark will be on the communication skills you display.

 

Interview scoring

Each interviewer scores you out of 5 for following 6 different aspects:

1. Clinical & governance

1. Suggestions and responses to clinical scenario
2. Professionalism and governance discussion

2. Portfolio

1. Suitability/ commitment
2. Achievements up to date

3. Presentation

1. Presentation skills
2. Communication

 

Appointable – automatic

If you are awarded a score of at least 3/5, for all marks given to you at your interview, then you will automatically be classed as appointable.

 

Not appointable – automatic

If any of the 12 scores awarded to you at interview are 1/5, this will reflect poor performance and an area of major concern.

If three or more of your 12 interview scores are of 2/5, this will reflect several areas of concern across your whole interview.

Should your interview assessment falls under either category above, the level of concern over your potential progression to ST3 will see your application classed automatically as not appointable .

 

Appointability subject to panel decision

In the event that your 12 interview scores contain one or two marks of 2/5 (and the rest 3/5 or above), your appointability status will be subject to discussion in the post-interview ‘wash-up’ meeting.

The clinicians who have interviewed you will discuss your general performance during the interview and any concerns or otherwise they have about your application as a whole.

Should they deem it appropriate, your application will be classed as appointable, and you can then be considered for post offers; whereas if they feel their concerns are too substantial for this outcome, they must class your application as not appointable, and it will progress no further in the current recruitment round.

Section 9: Competition Ratio

For full details of competition ration, average scores for application forms and interviews check the following link: http://www.st3recruitment.org.uk/specialties/haematology

Section 10: Offers and Visa Issues and HEE

Section 11: Speciality Exams

FRCPath exams

There are two, generally tough exams which need a lot of preparation.

Part 1: written, contains MCQs/EMQs and essay questions. Usually done in ST4/ST5 (Fee: £610 in UK, £830 outside UK)

Part 2: three day exam, contains morphology short and long questions, written exam covering transfusion, coagulation and as well as oral examination (VIVA). Usually done in ST6-7. (Fee: £1282).

Section 12: Speciality Courses

Always refer to the BSH website (British society of Haematology) for up to date courses dates, conferences and guidelines which you will use for you everyday job as a registrar. http://www.b-s-h.org.uk/

 

For haemostasis and thrombosis a very useful website is: http://www.practical-haemostasis.com/

Always familiarise yourself with the local trust Haematology guidelines for you everyday job.

 

Examples of useful courses

• Barbra Bain- one day Morphology course (useful to do early in training)- imperial college website
• There are two transfusion courses which are mandatory to attend- details of dates are on the NHSBT website (NHS blood and transplant)
• Essential transfusion Medicine (1 week course)
• Intermediate transfusion Medicine (3 weeks course)
• Theoretical and practical aspects of Haemoglobinopathy testing- imperial college website.

Section 13: Rotations

The framework, duration division as well as order of rotation obviously will differ from one deanery to the other. Broadly speaking you will rotate between a Tertiary transplant Centre and district hospitals to cover Haem-oncology, coagulation & thrombosis, lab/ morphology and transfusion competencies. You also have 4-6 months in Paediatric Haematology.

You do not do general medical on calls during you training (although some trusts are starting to introduce this- check this before applying to a specific deanery).

Section 14: Ranking of Deaneries

Section 15: Wages / Take Home Cash

Section 16: MTI

Section 17: Experience of Sudanese Doctors (Personal Experience)

Section 18: Important Links and Websites