The impact of training in transfusion medicine

Background Basic training skills and program for all health care providers working in the blood transfusion services is important and essential. All blood transfusion staff should have active participation in a training program that includes teaching all national and international regulations related to blood transfusion administration and guidelines of safe blood and blood products. The blood bank staff (physicians, medical technologists and nurses) should pass proper assessment procedures in order to work in this vita health related services. All staff working in blood transfusion services should receive a proper education and learning skills in this field of medicine. Awareness of blood safety and Good Manufacturing Practice (GMP) in blood transfusion should be greatly increased among them. Methods and Results Sustainable national and international education and training in blood transfusion services are needed and should be considered as a priority. Methods of teaching and training may include courses or workshops consist of a series of lectures, practical sessions, problem based learning and computer based distance learning programs. A proper training and continuous medical education in blood transfusion services have played an important role in minimizing the risk of transfusion related complications in many countries. Conclusions Creating an effective learning and training environment is a real challenge for most developing countries. Transfusion medicine is a branch of medicine which has a great link with almost all medical and surgical specialties. Blood transfusion safety plays an important and significant role in the patient's management. Proper qualified training personnel are the key of delivering safe blood components and the Good Manufacturing Practice (GMP) in blood transfusion services.     

Evaluation of the professional practices of physicians in transfusion technology and medicine]

The evaluation of the professional practices (EPP) is obligatory for all the physicians since July 1, 2005 for a first five-year period. It represents one of the components of the continuous medical training (CMT). The French Society of Blood Transfusion and National Institute of Blood Transfusion are the promoters of the EPP in transfusion technology and medicine. Initially, the programs of EPP will be conceived and controlled by experts and will relate to their basic activities. During a five years cycle, the physician taking part in a program must validate a specific action and take part in a rolling programme. At the end of the programme, the physician will receive a certificate issued by National Institute of Blood Transfusion and will have to submit it to a committee placed under the responsibility of the regional physicians' committee.     

Les bases scientifiques de la formation en médecine transfusionnelle

Transfusion medicine is a medical speciality which deals with all aspects of blood transfusion. The recent evolution of this speciality was marked by an increased collaboration with clinical medicine, the development of alternatives to allotransfusion (autotransfusion, growth factors, molecular genetics), and the technical progress in laboratory techniques. The development of basic science boosted the introduction of new techniques in the detection of virus and blood cell typing. The analysis of clinical trials allowed a better definition of guidelines for the use of blood products. The blood transfusion teaching program is limited during medical training. Specialists in transfusion medicine have to complete a post-graduate course to become certified. Continuous medical training is organised to allow the specialists to keep their accreditation. Transfusion medicine is becoming more and more complex. This complexity should not lead to breaking down transfusion medicine into several activities, but on the contrary to uniting this medical speciality, within which the different actors shall remain open-minded and able to use the same 'language'.     

Laboratory medicine in the compulsory postgraduate clinical training system--newly revised program in Nihon University School of Medicine

In 1999, the 4th report of the discussion group on 21st century medicine and health care proposed that it was necessary to establish in medical education a core curriculum emphasizing carefully selected basic content and to greatly expand the number of subjects that students might take electively. Following this report, a model core curriculum was made by the research and development project committee for medical educational programs in 2001. Similarly, the necessity of establishing a standardized postgraduate training curriculum and system has been discussed for many years. The Departments of Education and Technology and Welfare and Labor proposed a new curriculum named "Objectives in postgraduate clinical training" in order to ensure the quality of the medical doctors licensed to practice medicine in postgraduate clinical training in 2002. Following this new curriculum, Nihon University School of Medicine revised and enlarged its postgraduate program. All graduates are required to enter a full rotation program including general disciplines for two years. In addition to this basic curriculum, an elective curriculum will be added, providing attractive training programs based on medical trainees' needs. The training program in Laboratory Medicine is administered in the 2nd year as an elective program.     

Postgraduate training program in laboratory medicine at a clinical teaching hospital

The Tenri Hospital resident system was introduced in 1976 and the training program for laboratory medicine began in 1982. Thus, the author proposes goals for the the future on the basis of experience. It is appropriate that trainees study emergency tests, blood transfusion and microbiology(particularly Gram's stain and sputum culture) as practical matters, and in addition to these, learn how to reply to consultations from physicians, learn the laboratory flow(so-called laboratory system), and announce interpretations of laboratory data at reversed clinical pathological conference(R-CPC). The objectives of these training programs are to gain skills for appropriate laboratory utilization and interpretation, and develop communications and consultations with clinical pathologists and medical technologists. The key points of success in the training are close cooperation of the laboratory and teaching divisions. Particularly, cooperation with medical technologists is necessary, and it is essential medical practice for trainees because they will have to work with them in future. Finally it should be emphasized that there training has a limited effect because of the short duration. It is thus important to communicate and discuss clinical matters regularly in medicine.     

Postgraduate trainings program in pathology and laboratory medicine at teaching hospitals of Japan

It is meaningful to propose a postgraduate training program in pathology and laboratory medicine to select the course after graduation and promote recognition of the roles of pathologists(AP) and laboratory physicians(CP). It is desirable that the training program be common to both AP and CP, although this would be difficult in practice. So author proposes a practical training program that should involve making rounds with AP and CP. The desirable period of training is 3 or 4 years. In the program of laboratory medicine for AP, conferences and CPC are essential and other courses are elective. In the selective program, laboratory management is very important because it will be useful when the graduate becomes a laboratory manager. In the pathology program for CP, autopsy and CPC(as a pathologist) are essential. Training in surgical pathology and cytology are desirable to set limits in materials, for example, liver, kidney, bone marrow, and other tissues. Key points of successful training are good relationships chiefs of AP and CP, high level performance and give-and-take in routine work. It is very difficult to study and maintain the knowledge and technique necessary in all fields of pathology and laboratory medicine. So the author emphasizes that the training program should be constructed to focus on useful issues in routine work and management of laboratory.     

The integrative family medicine program: an innovation in residency education.

The Integrative Family Medicine (IFM) Program is a four-year combined family medicine residency program and integrative medicine fellowship. It was created in 2003 to address the needs of four constituencies: patients who desire care from well trained integrative physicians, physicians who seek such training, the health care system which lacks a conventional integrative medicine training route, and educational leaders in family medicine who are seeking new strategies to reverse the declining interest in family medicine amongst U.S. graduates. The program was designed jointly by the University of Arizona Program in Integrative Medicine (PIM) and family medicine residency programs at Beth Israel/Albert Einstein College of Medicine (AECOM), Maine Medical Center, Middlesex Hospital, Oregon Health & Science University, and the Universities of Arizona and Wisconsin. One or two residents from each of these institutions may apply, and when selected, commit to extending their training by a fourth year. They complete their family medicine residencies at their home sites, enroll in the distributed learning associate fellowship at PIM, and are mentored by local faculty members who have training in integrative medicine. To date three classes totaling twenty residents have entered the program. Evaluation is performed jointly: PIM evaluates the residents during residential weeks and through online modules and residency faculty members perform direct observation of care and review treatment plans. Preliminary data suggest that the program enhances interest amongst graduating medical students in family medicine training. The Accreditation Council of Graduate Medical Education Family Medicine residency review committee has awarded the pilot experimental status.     

Postgraduate medical training in laboratory medicine and clinical genetics in Chiba University Hospital

Compulsory postgraduate clinical training in laboratory medicine will start on a national basis in April 2004. It remains to be discussed how departments of laboratory medicine and/or divisions of clinical laboratory should contribute to the training program. I here summarize what we are planning to do in Chiba University Hospital together with my personal views on this topic. Two points are of note in our program. First, one-week training in the division of clinical laboratory is essential as a part of the 6-month training of internal medicine. The items in the program include Gram staining, white blood cell differential counting, urinary sediment study, and representative point-of-care testing. A program to follow the entire flow of laboratory tests(from withdrawal of blood to reporting of the test results) is also included to highlight a variety of pre-analytical errors. Furthermore, trainees are encouraged to learn how to work and co-operate with co-medical personnel. Second, our program aims at training postgraduate medical students to be clinical geneticists competent at genetic counseling. Genetic counseling is the process by which patients or relatives at risk of a disorder that may be hereditary are advised of the consequences of the disorder, the probability of developing or transmitting it and of the ways to test them. Thus, our final goal is to foster genetically oriented experts in laboratory medicine and clinical geneticists with a wide knowledge of laboratory medicine.     

Postgraduates' training as laboratory physicians/clinical pathologists in Japan--board certification of JSLM as a mandatory requirement for chairpersons of laboratory medicine

The educational committee of the Japanese Society of Laboratory Medicine(JSLM) proposed a revised laboratory medicine residency curriculum in 1999 and again in 2001. The committee believes that present undergraduate clinical training is insufficient and that Japanese medical graduates need clinical training for two years after graduation. This two years training should be a precondition for further postgraduate training in laboratory medicine and should include fundamental clinical skills(communication skills, physical examination and common laboratory procedures such as Gram's stain, Wright-Giemsa stain and urinalysis). After the two years training, the minimal training period of laboratory medicine should be three years, and should include: 1) Principles, instrumentation and techniques of each discipline including clinical chemistry, clinical hematology, clinical microbiology, clinical immunology, blood banking and other specific areas. 2) The use of laboratory information in a medical setting. 3) Interaction of the laboratory physician with laboratory staff, physicians and patients. With good on-the-job training and 24 hours on-call duties, laboratory physicians are expected to perform their tasks, including laboratory management, effectively. They should have appropriate educational background and should be well motivated. The background and duties of the laboratory physicians often reflect the institutional needs and personal philosophy of the chairperson of their department. At the moment, few senior physicians in Japan have qualifications in laboratory medicine and are unable, therefore, to provide the necessary guidance to help the laboratory physicians in their work. I therefore believe that the board certification of JSLM should be regarded as mandatory for chairpersons of laboratory medicine. Our on-call service system can enhance the training in laboratory medicine, and improve not only laboratory quality assurance but patients' care as well.     

Outline of a medical genetics curriculum for internal medicine residency training programs.

To keep pace with the rapid advances in medical genetics, internal medicine residency training programs need to train internists to develop new attitudes, knowledge bases, and skill sets. Currently, such programs have no medical genetics curriculum. Thus, to set a minimum standard for genetics education in the context of training in internal medicine, the Internal Medicine Residency Training Program Genetics Curriculum Committee was formed, with members representing professional organizations of medical geneticists, internists, genetic counselors, internal medicine and genetics residency program directors, and internal medicine residents. The committee's task was to develop a concise outline of a medical genetics curriculum for residents in internal medicine in accordance with requirements of the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education. The curriculum outline was drafted and circulated for comment. Before publication, the final document was approved by those member organizations that had a policy of approving curricula. Key learning objectives of the curriculum include appreciation of the rapid advances in genetics, the need for lifelong learning, the need for referral, and the role of genetic counselors and medical geneticists, as well as developing the ability to construct and analyze a three-generation pedigree. A wide variety of teaching methods can be useful in these regards, including didactic lectures, multimedia CD- ROMs, and clinical experience. Teaching should be related to clinical experiences whenever possible. The curriculum developed by the committee and presented in this article will assist in teaching residents the attitudes, knowledge, and skills they will require.     

Laboratory medicine in the obligatory postgraduate clinical training system--common clinical training program in the department of laboratory medicine in our prefectural medical university hospital

I propose a postgraduate common clinical training program to be provided by the department of laboratory medicine in our prefectural medical university hospital. The program has three purposes: first, mastering basic laboratory tests; second, developing the skills necessary to accurately interpret laboratory data; third, learning specific techniques in the field of laboratory medicine. For the first purpose, it is important that medical trainees perform testing of their own patients at bedside or in the central clinical laboratory. When testing at the central clinical laboratory, instruction by expert laboratory technicians is helpful. The teaching doctors in the department of laboratory medicine are asked to advise the trainees on the interpretation of data. Consultation will be received via interview or e-mail. In addition, the trainees can participate in various conferences, seminars, and meetings held at the central clinical laboratory. Finally, in order to learn specific techniques in the field of laboratory medicine, several special courses lasting a few months will be prepared. I think this program should be closely linked to the training program in internal medicine.     

Transfusion safety and haemovigilance committees]

Transfusion safety and haemovigilance committees (TSHC) were initially created in the public health care sector. Nowadays, they are also a mandatory committee of private health care institutions. The members of the TSHC, as well as the way the committee is driven and organized, are defined by law. The aim of the committee is focused on the management of transfusion safety and haemovigilance. The TSHC takes part in the improvement of the safety of transfused patients, and monitors the applying of haemovigilance rules. It also handles the training of all staff members involved in the blood transfusion process.     

Une formation à la recherche en médecine transfusionnelle dans le monde francophone

A two-week, French language, clinical research course in transfusion medicine has recently been created at the Pasteur Institute in Paris under the joint leadership of faculty members from the University of California San Francisco (UCSF), the Blood Systems Research Institute (BSRI) and the National Institute of Transfusion of Paris. The goal is to train transfusion professionals from the developing world to conduct clinical research that will contribute to improving the quality of care and safety in transfusion practices in their respective countries. The course provides training on clinical and epidemiological research methods and their potential applications in transfusion medicine. As part of the course, each student develops a study protocol that can be implemented in his/her blood center of hospital.     

Status of the clinical laboratory in the mandatory postgraduate medical training system from the standpoint of the community hospital

In city hospitals, it is difficult to develop an appropriate program for laboratory medicine. The ideal goal for the future on the basis of experience is that trainees study emergency tests, blood transfusion and microbiology as practical matters. In addition, it is effective to learn how to reply to consultations from physicians, to learn the laboratory flow, and to present interpretations of laboratory data with the laboratory physician at each case conference. The objectives of these training programs are to gain skills for appropriate laboratory utilization and interpretation, and develop communication and consultation with laboratory physician and medical technologists. The key points of success in training are that teaching divisions have confidence in the laboratory. Particularly, cooperation with medical technologists is necessary, and is essential medical practice for trainees because they will have to work together in the future. In addition, working with trainees increases the pride and dignity of medical technologists.     

Education in transfusion medicine,Part III – The importance of haemovigilance education

According to the literature, there are significant differences in the availability of education and training in transfusion medicine worldwide, with significant heterogeneity in the existing curricula. Recognising the need for education with the aim of achieving globally standardised competencies in transfusion medicine, a group of experts collaborating in the European and Mediterranean Initiative in Transfusion medicine (EMITm) proposed a process of incremental training and education. Subsequent to two previous papers published by this group on general education in transfusion medicine, this paper specifically refers to the field of education in haemovigilance. This topic is of particular importance when one considers the role of haemovigilance in improving the safety of transfusion practice, and the fact that this role can only be realised through the cooperation of all participants in the transfusion chain. In addition to promoting the importance of education in haemovigilance, this paper provides an overview of the available literature on this topic and proposes an education programme on haemovigilance for medical students and residents.     

Evaluation of a one-year Masters of Public Health program for medical students between their third and fourth years.

For physicians to better treat and advise their patients on the roles of behavioral and social factors in health and disease, greater levels of competency in social and behavioral sciences are needed. Physicians should also understand the structure, financing, and administration of the health care delivery system, so that they will be able to practice medicine effectively and participate in planning and managing the delivery of care. And, improving overall public health requires that physicians understand the basic tenets of population-based medicine. One way to achieve these goals is to develop education and training programs for integrating formal public health training with formal medical training.There are many models by which a medical student or practitioner can obtain a master of public health (MPH) degree. In this article, the authors describe an accelerated one-year MPH program for competitively selected New York City medical students who have completed their third year of training and enroll at the Mailman School of Public Health, Columbia University. The Macy Scholars Program, offered between 1999 and 2007 to 12 students per year, is completed between the third and fourth years of medical school. Under full-tuition scholarships, students complete a practicum experience, attend seminars, and write a master-level paper or thesis, among other requirements. Data from an evaluation of this program demonstrate participant satisfaction and support of the program, outstanding academic performance, and the effect of public health training on their residency and career choices.     

Internal medicine resident perceptions of optimal training duration.

PURPOSE: To describe internal medicine residents' opinions regarding the optimal duration of internal medicine residency training, and to assess whether these opinions are associated with specific career interests. METHOD: A national cohort study was conducted during the 2005 Internal Medicine In-Training Examination (IM-ITE), which involved 382 of 388 (98.5%) U.S. internal medicine programs. A sample of 14,579 residents enrolled in three-year categorical or primary care training programs in the United States reported their opinions regarding optimal residency training duration on the IM-ITE 2005 Residents Questionnaire. Reported optimal training duration was assessed by postgraduate training year, sex, medical school location, program type, and reported career plan. RESULTS: Among the residents surveyed, 78.1% reported a three-year optimal length of internal medicine residency training, 15.3% preferred a two-year training duration, and 6.7% preferred a four-year duration. Residents planning careers in general medicine, hospital medicine, and subspecialty fields all preferred a three-year training duration (83.8%, 82.6%, and 75.9%, respectively). Residents planning subspecialty careers were more likely than those planning general or hospital medicine careers to prefer a two-year program (18.7% versus 7.4% and 8.3%). Residents planning generalist or hospitalist careers were more likely to favor a four-year program (8.9% and 9.1%, respectively) compared with residents planning subspecialty careers (5.4%). CONCLUSIONS: Most internal medicine residents endorse a three-year optimal duration of internal medicine residency training. This perspective should be considered in further national discussions regarding the optimal duration of internal medicine training.     

Training and education--with a view of the involvement in Germany.

The replies of 15 countries to the questionnaires-training and education-have shown that transfusion medicine teaching and education regarded as a definitely clearly defined specialty with different tones and degrees, is to be considered at different levels relating to teaching basic knowledge of transfusion medicine during the education as well as in the postgraduate training. The reported results may serve as an incentive or impulse to suitable regulations and a common consensus of transfusion medicine curriculum although each European Country has its peculiarities.     

Training, skill and competences' follow-up]

Blood transfusion safety is a public health requirement, which is claimed by public health authorities and blood users too. In order to comply with transfusion safety, available national regulatory requirements must be strictly followed (or applied) by blood transfusion workers, caring nurses and physicians. Transfusion's good practices are based on knowledge of the process and the skill in blood transfusion fields. Quality systems, risks management, audits, inspections and certification programs implemented by blood establishments and patients' care services should lead to efficiency. All professionals involved in blood banking and transfusion processes (blood donation, preparation and storage of blood products, transfusion therapy...) must be qualified. They have to follow a program of continued training education. Their competence or ability must also be periodically assessed and documented to let continue and perform tasks safely.     

Roles and perspectives of the clinical laboratory in the new compulsory program for postgraduate clinical training: a report from Kobe University Hospital

After the induction of the new compulsory program for postgraduate clinical training in 2004, Kobe University Hospital has changed dramatically, far more than expected. The reform of incorporating national universities also started in the same year. Accordingly, doctors and medical technologists (MT) working in the clinical laboratory have been looking for ways to contribute to the new clinical training program and hospital reforms. There are three big issues: Firstly, the hospital systems have been changing qualitatively due to the decreased numbers of residents. The clinical activities in the university hospital had largely depended on residents for various work in the old program. The numbers of residents, however, has fallen to less than half in the new program. In addition, there has been a growing consensus that university hospitals should refrain from loading excessive work and responsibilities on residents. These changes directly resulted in transferring the burden of residents onto senior doctors and faculty staff. Secondly, the roles of the clinical laboratory and the intensity of activity have been changing with the need of cooperating with hospital reforms caused by the new clinical training program and incorporating process. To improve or support the clinical activities and economical efficiency of the university hospital as an independent corporation, MT and other co-medical staff have been encouraged to help with various jobs which had been done by residents in the old system. Thirdly, how should we present updated and attractive training programs to medical students and postgraduates who are interested in becoming CPs? In this report, I introduce our new department of evidence-based laboratory medicine, and propose a few novel pathways for CPs, which I hope will show the new direction for the future of CPs.