Competence Based Postgraduate Education of Clinical Pathologists and Laboratory Physicians in Taiwan

Competence Based Postgraduate Education of Clinical Pathologists and Laboratory Physicians in Taiwan

Competence Based Postgraduate Education of
Clinical Pathologists and Laboratory
Physicians in Taiwan
Chien-Feng Sun, MD, FCAP
Director, Department of Laboratory Medicine
Linkou Chang Gung Memorial Hospital
Taiwan
Practicing Clinical Pathology/Laboratory
Medicine in Taiwan

Taiwan Society of Clinical Pathology and Laboratory Medicine
(TSCPaLM) plays the central role in certification/recertification and
continuing education of the Clinical pathologists/laboratory physicians in
Taiwan.
 CP/LM as one of the 19 major medical specialties
 TSCPaLM board examination in CP/LM
 Certificates good for 6 years
--173 Clinical Pathologists certified
 Re-certification requires 180 credit hours in continuous education
 Certification/recertification of hospital for CP/LM training, 3 years
--22-24 hospitals certified for 20~24 trainees
 Continuing education program
Clinical Pathologists/
Physicians in Laboratory Medicine




In 1991, 21 CP (1/4285 beds)
In 2002, 103 (1/1295 beds)
In 2010, 173 (1/919 beds)
In 2014, 179 (1/899 beds)
Resident Training Program in CP/LM in
Taiwan


Three year program
Minimal requirement in various fields in LM：
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Clinical chemistry,
Clinical microscopy,
Hemato-pathology,
Clinical microbiology/Virology,
Clinical serology/Immunology,
Immunohematology/Blood banking,
Molecular biology and
Laboratory administration and management
Comparison of CP vs MT responsibilities
Responsibilities
Chemical Pathologist
/Clinical Chemist
Medical
Technologist
CLIA ‘’88 Director
Yes
No
Lab Consultant for Physicians
Yes
No
Directs Resident training
Yes
No
Directs New Technology Acquisition
Yes
No
Establishes New Clinical Testing & QA/QC Programs
Yes
No
Performs Routine Clinical Testing
No
Yes
Development & Validation of New Tests & Protocols
Yes
Yes
Participates in Resident Education
Yes
Yes
Kiang-Teck J. Yeo (姚建德教授), Professor of Pathology,Director, Clinical
Chemistry & UCMedLabs
Competence Based Training in Laboratory Medicine
--Scope
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Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
System-based practice
ACGME: Accreditation Council for Graduate Medical Education
BR Smith et al. Curriculum Content and Evaluation of Resident Competency in
Clinical Pathology (Laboratory Medicine). Clinical Chemistry 2006:52(6):917-949.
Laboratory Medicine Training
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Serve as a consultant to physicians on cost-effective test
strategies and interpretation of results
Interpretation and reporting of laboratory test results
Select, evaluate, and apply laboratory instruments and
procedures appropriate to the screening, diagnostic, and
monitoring needs of clinical decision making
Plan, organize, staff, and direct laboratory resources
Use the techniques of medical informatics to acquire and manage
data, translate data to clinically useful information, and
communicate that information in support of patient care and
educational programs
Play an influential role in medical staff and healthcare delivery
activities that reach beyond the confines of the laboratory
BR Smith et al. Curriculum Content and Evaluation of Resident Competency in
Clinical Pathology (Laboratory Medicine). Clinical Chemistry 2006:52(6):917-949.
Training of Physicians in Laboratory Medicine
-- Patient care




Providing consultation to physicians on cost-effective
laboratory tests
Interpretation and reporting of laboratory test results
Medical direction of a transfusion service or blood donor
center, and
Direct patient care during the collection of autologous
blood and the provision of apheresis services (donor and
therapeutic)
Wu YY , Tormey C, Stack G. Resident and Fellow Training in Transfusion Medicine.
Clinics in Lab Med 2007;27:293-342
Transfusion Medicine Training
-- Patient care
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Review and interpretation of unusual blood typing or blood group aby ID
Clinical investigation of newly discovered blood group aby’s,
Investigation, evaluation, and reporting of Tx Rx,
Evaluation of PLT refractoriness,
Eligibility determination of preoperative autologous blood donors
Coordination of therapeutic apheresis and PBSC collections
Obtaining informed consent, and writing procedure and progress notes for
therapeutic apheresis and PBCS collections
Utilization review of blood component and plasma derivative requests,
especially for unusual or frequently abused requests
Evaluation of the need for Rh immune globulin and communication of
recommendations to clinicians
Any other transfusion issue that requires coordination or communication
with clinicians
Wu YY , Tormey C, Stack G. Resident and Fellow Training in Transfusion Medicine. Clinics in Lab
Med 2007;27:293-342
Laboratory Medicine Training
-- Practice-based learning and improvement

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Acquire the skills and habits of remaining up-to-date regarding new
developments, trends, and regulatory requirements.
Learn to distinguish technologies and practices that are proven in terms of
safety and efficacy from those that would be premature to implement.
Create a culture that inculcates in trainees a lifelong commitment to
continuing education through reading of the latest medical literature and
attendance at relevant lectures, seminars, conferences, and regional and
national meetings.
Establishment of a journal club or a speaker series reinforces the program’s
commitment to continuous learning.
Assigning to the residents and fellows responsibility for developing and
implementing new policies, procedures, techniques, or instruments is
valuable in helping them acquire this competency.
Wu YY , Tormey C, Stack G. Resident and Fellow Training in Transfusion Medicine. Clinics in Lab
Med 2007;27:293-342
Transfusion Medicine Training
-- Interpersonal and communication skills
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develop or improve communication skills as first-line consultants
 gain extensive experience in communicating with other physicians, with
technical staff members in the transfusion service, with apheresis nurses,
and with other caregivers.
the residents and fellows gain experience in communicating but also
with patients and families.
 be courteous and respectful at all times,.
show compassion and patience to patients and their families.
learn how to communicate efficiently, coherently, and understandably,
and to demonstrate a balanced personality.
learn how to organize and present complex information to their
colleagues,
Wu YY , Tormey C, Stack G. Resident and Fellow Training in Transfusion Medicine. Clinics in Lab
Med 2007;27:293-342
CP Resident Expectations & Responsibilities
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DAILY ROUNDS
 Review the state of the lab
 QC/QA Issues
 Interesting Patient/Case from Call/Critical Values
 Follow-up on Patient Case
ON-CALL:
 Blood bank section
PRACTICAL LABORATORY EXCERCISES/PROJECTS:
 Bench Rotations
 Interpretation and make comments on selected tests
 Consultation to clinical physicians
 Troubleshooting Abnormal Assay Results on Clinical Cases
 Active participation in method validation/evaluation
 Perform internal audits according to CAP checklists
OTHERS
 Involve in procedure review and seminars
 Present Continuing Education topics for each disciplines
Transfusion Medicine Resident Training
Items
Time
Tutors
1
Introduction of blood bank
2 hr
Leaders
2
Preparation of components for transfusion
(physician order, tests, key-in, validation)
2 hr
Leaders
3
Issuance of components
2 hr
Leaders
4
Blood bank information system
8 hr
MTs
5
Resissuance of components
2 hr
MTs
6
LPR、LPP、WRB
8 hr
MTs
7
Irradiation of components
2 hr
MTs
8
Newborn transfusion
1 hr
MTs
9
Autologous transfusion
2 hr
MTs
10 Phlebotomy (donaitons)
1 hr
MTs
11 Components: dosage and indication
4 hr
Director
12 Adverse transfusion reactions: lab investigation
2 hr
Supervisors
3 months
Directors
8 hr
Directors
In 3 months
Supervisors
13 Adverse transfusion reactions: reports
14 Transfusion related topics
15 Cases studies
Signature
Health Examination Interpretation
IFE & PEP
APT & Chart Review
Parentage Testing
Chimerism Testing
Antibodies Screening & ID
Investigation of Transfusion Reaction
Investigation of Transfusion Reaction
Resident Training in Laboratory Medicine
--Interpretation and reporting of laboratory test results


Unusual results, to review clinical history
Review and interpretation of laboratory results,
in drug tests,
in panel tests,
in PEPs/IFEs,
in abnormal smears,
in Flow cytometry reports for Leukemia/Lymphoma,
in STRs for chimerism,
in parentage tests,
in DNA ploidy,
in Western blot interpretation,
in Proficiency testing
Transfusion Medicine Resident Training
Items
Time
Tutors
1
Preparation of Cell suspension and hemagglutination
2 hr
MTs
2
Blood systems
2 hr
Supervisors
3
ABO grouping and Rh typing
8 hr
MTs
4
ABO subgroups
16 hr
MTs
5
Antibody screening
16 hr
MTs
6
Cross-matching test
4 hr
MTs
7
Manual Polybrene test
1 hr
MTs
8
LISS
1 hr
MTs
9
Conventional test
1 hr
MTs
10
DAT & IAT
4 hr
MTs
11
Du Test
4 hr
MTs
13
Blood antigen tests other than ABO
4 hr
MTs
14
Antibody identificaiton
16 hr
MTs
Signature
Transfusion Medicine Resident Training
Items
Time
Tutors
15
Adsorption-Elution Test
8 hr
MTs
16
Saliva Test
8 hr
MTs
17
Preparation of Reagents (MP etc)
1 hr
MTs
18
AutoVue tests (ABO, Rh, Aby screening and ID)
2 hr
Leaders
19
Gel-tube method and Automation
4 hr
Directors
20
Stem cell collection
16 hr
MTs
21
BM transplant related tests and QC
4 hr
MTs
22
HLA serology test
4 hr
Directors
23
HLA antibody screening
4 hr
Directors
24
Platelet antibody screening
4 hr
Directors
25
HLA crossmatching
4 hr
Directors
26
CAP Checklist- Transfusion Medicine
16 hr
Directors
27
CAP Checklist- Histocompatiblity
16 hr
Directors
Signature
Training Facilities for Clinical
Pathology/Laboratory Medicine

Standards for training hospitals




Two board certified Clinical Pathologists
Training program director must be board certified clinical pathologist
Accredited program for three years
Annual review of the training program
Continuing Education Programs in CP/LM

TSCPaLM scientific and educational programs
 At least two symposia/seminars a year
 Continuing education topics
1. Annual Meeting of Taiwan Society of Clinical Pathologists
2009/11/01 W7 08:30-17:00 TVGH (Taipei)
2. Training Programs for Clinical Pathology/Laboratory Medicine
2010/06/26 W6 8:30-17:00, TVGH (Taipei)
3. Quality assurance programs and accreditation systems in Laboratory
medicine
2010/07/10（W6）09:00–17:00 (CKUH, Tainan)
4. Setting standards for HER2 testing in gastric cancer
2010/09/11 (W6) Taipei
Practicing Clinical Pathology/Laboratory
Medicine in Taiwan

Taiwan Society of Clinical Pathology and Laboratory Medicine
(TSCPaLM) plays the central role in certification/recertification and
continuing education of the Clinical pathologists/laboratory physicians in
Taiwan.
 CP/LM as one of the 19 major medical specialties
 TSCPaLM board examination in CP/LM
 Certificates good for 6 years
--179 Clinical Pathologists certified
 Re-certification requires 180 credit hours in continuous education
 Certification/recertification of hospital for CP/LM training, 3 years
--22 hospitals certified for 12 trainees
 Continuing education program
Clinical Pathologists/
Physicians in Laboratory Medicine




In 1991, 21 CP (1/4285 beds)
In 2002, 103 (1/1295 beds)
In 2010, 173 (1/919 beds)
In 2014, 179 (1/899 beds)