FCPS syllabus for hematology

FCPS part 1 hematology syllabus 

Introduction

Haematology encompasses both clinical and laboratory aspects of the specialty. Therefore course curriculum in FCPS (Haematology) is designed in such a way that it makes satisfactory completion of training in both of these aspects including adequate knowledge in clinical Medicine.

Purpose and Academic Aim : The FCPS (Haematology) has following academic aims

(i)     Object is to gain experience over a wide field of haematology both clinical & laboratory and General Medicine.

(ii)   Over completion of FCPS degree, candidates acquire appropriate knowledge, training and experience in the specialty.

(iii)  To provide a sound basis for continuing professional development.

FCPS (haematology) course : is divided into two parts. Part-I : To assess knowledge or basic subjects and general medicine. Three written papers of MCQs are used as tools for evaluation.

Part-II : After fulfillment of requisites for FCPS Part-II, eligible candidates can appear in the part-II FCPS (haematology) examination. The final examination comprises written, clinical oral and practical components.

Contents of Part-I examination

The examination consists of three papers (Paper-I, II & III), each consisting of 50 multiple choice questions (MCQ), which are design to test candidate’s knowledge of wide range of topic in General medicine, Haematology and Basic science of clinical practice.

The topics are arbitrarily distributed among the three papers in the following manner.

Paper-I : 50 MCQs

Subjects      Question distribution

2.     Laboratory haematology 20

Paper-II : 50 MCQs

Subject   Questions distribution

2.      Clinical Biochemistry     15

3.      Clinical Pharmacology     10

Paediatrics                 05

Syllabus of FCPS (Haematology) Part-I in detail

Paper –

1. Haematology (General & Clinical) : total 30 MCQs (a) General haematology = 10 MCQ

Items   

1.       Haematopoiesis : origin & development of blood cells (2MCQ)

2.       Erythrocyte : erythropoiesis, structure & function,

nutritional factors in production, destruction.                 (2MCQ)

3.       Granulocytes & Monocytes : structure, morphology,

function,development, variation in pathophysiological             (1MCQ)
conditions, phagocytosis

4.       Lymphocytes & plasma cell : morphology, function,

location lymphoid organs       (1MCQ)

5.       Haemostasis : megakaryocyte & platelets.

structure, function, platelet formation and release,                 (2MCQ)

biodynamic of thrombopoiesis, role of platelet in hemostesis and thrombosis.

6.       Blood coagulation and fibronolysis, coagulation

pathways, procoagulent & anti-coagulant            (2MCQ)
proteins, molecular basis of fibrin formation and stabilization, fibrinolytic system.

(b) Clinical Haematology : 20 MCQ

Items                                                       

Disorders or red cells (MCQ 8)                                     

Anaemia : general consideration and diagnostic strategy Disorders of iron metabolism and Haem synthesis : Iron deficiency anaemia, Anaemia, Anaemia of chronic Disorder, sideroblastic anaemia, Haemosiderosis, Haemochromatosis, Porphyria

Megaloblastic anaemia : Disorder of impaired DNA synthesis, Pernicious anaemia, Folate deficiency, Drug induced megaloblastic anaemia.

Haemolytic anaemia : General consideration, hereditary spherocytosis, hereditary spherocytosis,

hereditary and acquired haemolytic anaemia, Mechanism of immune destruction, Alloimmune &

autoimmune haemolytic anaemia, paroxysmal nocturnal haemoglobinuria, Sickle cell anaemia, thalassaemia, Unstable Hb disease,

Pancytopenia, Aplastic anaemia, & Pure red cell aplasia Anaemia associated with renal, liver, endocrine disease & Pregnancy.

1. Hematologic Malignancy(MCQ-8)    :        

General aspect; complications, Supportive care Acute leukaemia : Classification & differentiation, All, AML, MDS

Myeloproliferative disorder CML, Polycythemia­rubra-vera, Myelofibrosis

Lymphoproliferative disorder : NHL, HD, CLL, Hairy cell leukaemia, Cutenious T-cell Lymphoma. Plasma cell dyscrasias : Multiple myeloma, Waldenstrom’s Macroglobulinaemia, Heavy-

chain-disease, Amyloidosis, Cryoglobulinaemia.

2. Disorder of Haemostasis & coagulation : 

         Diagnostic approach to the bleeding disorder Thrombocytopenia, ITP, TTP, HUS, DIC Bleeding disorder due to vascular abnormalities & platelet function Acquired & inherited coagulation disorders.

3.    Bone Marrow Transplantation : Allogenic, Autologous & Peripheral blood progenitor stem cell transplantation & cord blood transplantation.

2. Laboratory Haematology : 20 MCQ

1.           Examination of blood & bone marrow, specimen

collection, cell count analysis,           20
morphologic analysis of blood cells, staining,

cytogenetic analysis, molecular genetics,

immunodiagnosis, clinical flow cytometry, quality assurance (external & internal), protein & Hb electro-phoresis, blood grouping (direct &

indirect methods) & cross matching, coomb’s test, tests related to coagulation system, uses of radio­active isotopes in haematological practices, etc.

Paper- II

1. General Medicine : total 20 MCQs

Items   MCQ

2.       Gastro-intestinal & biliary diseases       (2MCQ)

3.       Renal diseases     (2MCQ)

4.       Respiratory disease (2MCQ)

5.       Intensive care Medicine(2MCQ)

6.       Diabetes mellitus & Genetics disorders     (2MCQ)

7.       Neurological, Cardiovascular & Rheumatologic diseases            (2MCQ)

8.       General aspect of Medical practices :

clinical examination, history taking.   (4MCQ)

Items              

1. General consideration eg water, electrolytes,PH acid base balance, enzymes, 0xygen dissociation curves etc. (5 MCQ)

2.Metabolism of carbohydrate, lipid & protein and it’s disorder-an overview (5 MCQ)

3. Digestion & absorption, Nutrition, Vitamins & minerals   (5 MCQ)

Child health and common paedrtiatics

haematological disorders.              05

4.                                                                                                 Clinical Pharmacology/Materia Medica : total 10 MCQs

Items

1.         General consideration

2.         Indication, Mechanisms of action, Side effects,

Interaction of common drugs used in clinical             (6MCQ)
Medicine and Haemato-oncology

3.         Principles and pharmacology of chemotherapy

Paper-III

1. Basic pathology : total 15 MCQs

Items   MCQ

1.          Cellular pathology eg cell injury, cell death,

adaptation, intracellular accumulation            (1MCQ)

2.          Acute and Chronic inflammation    (4MCQ)

3.          Tissue repair : Cell growth, fibrosis, wound healing     (1MCQ)

4.          Haemodynamic disorder: thrombosis,      (4MCQ)
embolism and shock

5.          Neoplasia : epidemiology, molecular basis of     (5MCQ)
cancer, tumour progression, carcinogenic agents, grading & staging, laboratory diagnosis of cancer

2. Microbiology : total 10 MC

Items 

1.           Funcdamentals of microbiology : cell structures, classification of bacteria, virus & fungus.

2.           Pathogenesis of bacterial infection, normal microbial flora of human body, infection in immunocompromized patient, diagnosis & clinical correlation of microbiological infection.

3.           An over view of viral, fungal and parasitic infection. 03

3. Basic Immunology & Genetic : total 10 MCQs  Items    MCQ

1.        Immunology : general consideration -immunity &

immune response, host defence, antigen           (6MCQ)
& antibodies, Cytokines, MHC, Compliment system, Immunoglobulin, hypersensitivity, disease of

immune system, primary & secondary

immunodeficiency. Genetic disorders.

2.        Genetic order : mutation, Mendelian disorders,            (4 MCQ)
disorders associated with structural & receptor

proteins, storage protein, Molecular biology of

disease process etc.

4. Transfusion Medicine : Total 10 MCQ

Principle & practice of transfusion medicine, 10 MCQ

Antigen & antibodies in human blood, Blood

group serology.

5. Bio-Statistics : total 05 MCQs

Items   MCQ

1.      Descriptive statistics : e.g. mean, median, mode, (2 MCQ)
standard deviation, standard error, confidence

interval, variance, range, percentile, skew ness,

contingency table, population, missing values, outliers.

2.      Graphical techniques : e.g. histogram, box-plot,  (1 mcq)
scatter gram

Inferential techniques : e.g. null hypothesis,

alternative hypothesis

normal distribution, false positive & false

negative, statistical power,

one & two tailed test, statistical significance-P value, T-test, chi-square test, linear regression, study design.

 FCPS part 2 syllabus 

Training :

1. Training in Medicine :

(a)  Minimum one year training in General Medicine with direct involvement in patients care and offering a wide range of experience in internal medicine.

(b)  It is to be considered as perequisite for Haematological training.

(c) Training in any sub-branches of Medicine e.g. Cardiology, Nephrology, Neurology etc will not be counted.

2. Training in Haematolgy :

(a)    After successful completion of one year training in General Medicine Candidate will get entry for Haematological training which will be of minimum 2 years duration.

(b)   During these 2 years, the trainee will acquire a broad general experience in Clinical & Laboratory haematolgoy under supervision in a recognized haematology Dept/institute 

where both the facilities are available for better correlation       of patient care and understanding.

(a)    A training record (Log book) will be maintained by the trainee. It will be counter-signed by appropriate educational supervisor to confirm the satisfactory fulfillment of the required training experience and the acquisition of the competences that are enumerated in the specialty curriculum. It remains property of the trainee, and must be provided at the final assessment (examinaion).

(b)   2 years training in haematology counted as minimum 6 months training in internal Medicine (as in other disciplines).

FCPS 2nd part course : Trainee will work independently in different field of Haematology and Medicine under supervision for one year. During this period rotational placement in different relevant department are provided.

Training Curriculum of Haematology : Three Years

The trainee will be required to be instructed in the major aspects of laboratory and clinical haematology as follows :

1.     Laboratory (Haematology) Training : One years General Consideration :

a.    The programme will include instruction in automated blood counting; making & staining peripheral blood film and reporting of the same, including recognition of the malignant diseases, malarial parasites and abnormal red cell forms (sickle cell, spherocytes, schistocytes etc).

b.    The trainee will be instructed in methods for obtaining bone marrow by aspiration and trephine, making slides from the aspirate and touch or roll preparation from the trephine and basic staining methods used.

1.     Reporting of blood films.

2.     Supervised reporting of bone marrow aspirates; introduction to cytochemical and immunophenotypic characterization of blood films

3.   Examination of CSE cytology by cytospin preparations.

4.    Methods for identification of abnormal haemoglobins and their interpretation

5.    Detection of anti-D antibodies and prevention of haemolytic disease of newborn;

6.   Anticoagulation and it’s control.

7.  Test for coagulation disorders such as; Techniques for coagulation screening tests(PT, APTT, TT, fibrinogen assay, FDPs, the use of automated techniques in blood coagulaion); interpreatation of coagulation screening results; measurement of the INR and anticoagulation dosing; tests for thrombotic risk factors.

8.   Flow cytometry and other advanced in haematology.

9.    An understanding of quality control through national and local basis.

Clinical (Haematology) Training : Two years

The remaining two years will involve formal instruction in clinical haematology. The trainee will receive instruction in common clinical problems and as well as able to manage all shorts of haematological dicorders (non-malignant & malignant) : such as

1 Diagnosis and treatment of acute leukaemias with particular emphasis on classification and the use of chemotherapy regimens. The trainee should receive formal training in the hazards, handling, administration and toxicity of chemo­therapeutic drugs used in haematology. The trainee should become familiar with common trial protocols used for the treatment of acute leukaemia.

2.     Chronic leukaemias : the natural history, molecular biology of the disease, diagnosis, classification and staging of chronic leukaemias with modern management.

3.     Myeloma : diagnosis, classification and treatment protocols, follow-up.

4.     Lymphoma : diagnosis , classification, staging and treatment protocols, follow-up, complication, prognosis,

5.     Haemophilia : diagnosis, and management of common inherited disorders of coagulation, particularly hemophilia (A

and B) and von Willebrand’s disease. Use of molecular biological techniques to identify genetic defects. Instruction in the preparation, safety and use of coagulation factor concentrates.

6. Haemoglobinopathies: management of a-thalassaemia and sickle cell disease with an understanding of other haemoglobin abnormalities. Anttenatal screening methods, counseling and advice to parents.

 7. Acquired bleeding disorders: diagnosis and management of acquired hemorrhagic states, particularly those associated with DIC, massive transfusion, renal and hepatic disease and obstetric complications.

8. Bone marrow failure syndrome: diagnosis and long term management of the pancytopenic patients including myelodysplastic syndromes and aplastic anaemia Iron chelation regimens.

 9. Myeloproliferative disorders including nolycythemia rub vera. Use and technique of therapeutic venesections.

 10. Thrombophilia: diagnosis and management of thrombophilic conditions. Indication for anticoagulation and control. Management of over-anticoagulation.

11. Anaemia: the diagnosis, investigation and management of common anaernias including iron deficiency, megaloblastosis plus the other deficiency states and the congenital and acquired haemolytic anaemia of immune and non-immune cause.

Method of Training:

a. The trainee will require dedicated periods of training with a trainer Professor/Assoc Professor.

 b. There should be appropriate placement in out-patient clinic (out-door), ward-care of patients (indoor) and haematological laboratory practices.

c. The trainee will also develop skills in direct but self motivated learning (text book, journals, videos etc). Adequate time must be provided for such learning. d. Library facilities, journal-clubs, slide-session, scientific and clinical seminars should be provided.

FCPS (Hematology) 2nd part course:

The trainee entering this part of course programme, will have a sound theoretical and practical knowledge of haematological practice, this developed to acquiring self sufficiency in the speciality. There should be rotation placement in relevant departments during the final year.

(a) During this year the trainee will continue to broaden experience and understanding of various blood diseases and their management. This should include both laboratory and clinical aspect.

(b) In addition there should be further formal training in Blood transfusion Medicine, paedriatric haematology, Nuclear Medicine relating to haematology (i.e use of radio-isotopes in haematology) and Radiotherapy dept. for familiarity with radiation techniques.

(c) Trainee should attend in regular up-date discussion of academic and practical aspect of haematology, relevant national and international meeting (seminars & symposiums).

 Final Examination of FCPS of Haematolgy Part-II There should be no limitations for FCPS Haematology Part-II Course. The candidate should have proficiency in all aspects of Haematology & relevant subjects, which is based on written, practical and oral examination by examiners appointed by the Bangladesh college of Physicians and Surgeons.

1. Written : Paper-I & Paper-II

 2. Practical : Laboratory :

a) Slide sessions (long and connecting slides);

 b) Coagulation tests,

c) Blood transfusion Clinical :

 a) Short cases

b) Long cases

3. Oral /Viva :