Clinical Pathology Residency Program

 

Introduction

Most hospitals in the Middle East are secondary care medical centers and their laboratories performed routine non-complex testing. Such laboratories do not require a highly qualified specialist in each field of laboratory medicine. A general clinical pathologist can manage these laboratories with no difficulty.

Most of these laboratories are located in large cities such as Riyadh, making it easy to consult with pathologists at tertiary care medical centers. Based on the above, we strongly believe that there is a bad need for a general clinical pathology training program to support hospital needs in the Kingdom and the Middle East including the Gulf region.

The department of pathology at King Saud University College of medicine has designed a clinical pathology training program for the residents. The program is run by 16 full time faculty members. It has a capacity to train up to 52 residents and fellows in all aspects of laboratory medicine including; clinical chemistry, microbiology, hematopathology, cytopathology, immunology and blood bank.

The main laboratories are located at King Khalid and king Abdulaziz University Hospitals.   The central laboratory, King Khalid University Hospital, is located on the 1^st floor of the main building. In addition to their basic training in the central laboratories, the residents are expected to rotate in three additional large hospitals in Riyadh area.  These include King Faisal Specialist Hospital and Research Center, Riyadh/Kharj Military Hospital and King Fahad National Guard Hospital.  

In addition to providing excellent laboratory services to the medical centers, the department of pathology at King Saud University is committed to strong  training and research in different aspects of clinical pathology and teaching undergraduate students of the first and second years medical students. The department also conducts, on annual bases, three major courses in basic pathology, microbiology and immunology for the second year dental students.

 

Name of the program:

KSU Fellowship in Clinical Pathology

General Objectives (Goals):

This program aims at graduating a well-trained Clinical Pathologists to be able to drive the advancement of laboratory medicine for improvement and submission of high standard medical services to the patients.

In general, the graduates of the program are expected to lead all technical, clinical and administrative functions of a clinical laboratory.

Specific Objectives:

By completion of this program, the candidates will be able to:

1. Acquire the up-to-date knowledge and training in the field of laboratory medicine.
2. Recognize the needs for new clinical laboratory tests through introducing state of the art technology in the laboratories.
3. Provide patient care - related consultations to treating physicians and assist physicians in the interpretation of Laboratory tests.
4. Educate physicians and health care workers on significant scientific issues in laboratory medicine.
5. Represent the laboratory as an active role in the advancement of the health care system.
6. Participate - with hospital administration - in designing clinical /laboratory practice guidelines and manage different sections of the laboratory. 

Degree Requirements:

The training in the program will be conducted at King Khalid University Hospital and other tertiary care hospitals which recognized to have enough number of samples, space and teaching staff to assure all the trainees at different levels will have the opportunity to come across all clinical cases during the years of the training .

Resources and Facilities:

The main venue for teaching and training the candidates will be at the  King Khalid University Hospital that having very well equipped laboratories and well trained technical staff in different sub-specialties of laboratory medicine including the following CAP accredited laboratories; Clinical Chemistry, Histopathology Hematopathology, Microbiology, Immunology and Blood Bank. In addition, the candidates in this program will rotate in different major hospitals in Riyadh that having, at least, similar laboratory facilities under supervision of highly qualified staff.

The staff members assigned to supervise the teaching and training in this program from King Khalid University Hospital and other participating hospitals include the following:

Teaching staff	Specialty	Qualification	Name of the hospital	% of week in the lab
Prof. A. M. Kambal	Microbiology (Bacteriology)	MD, MRCPath, FRCPath	College of Medicine & KKUH	Full time
Prof. Ahmed A. Adeel	Microbiology (Parasitology)	MBBS, PhD. (USA)	College of Medicine & KKUH	Full time
Prof. Zahid Shakoor	Microbiology (Immunology)	MBBS, PhD. UK	College of Medicine & KKUH	Full time
Dr. Ali Somily	Microbiology (Bacteriology)	MBBS, FRCP (C)	College of Medicine & KKUH	Full time
Dr. Fawzia Al-Otaibi	Microbiology (Bacteriology)	MBBS, KSU Fellowship	College of Medicine & KKUH	Full time
Dr. Malak El-Hazmi	Microbiology (Virology)	MBBS, KSU Fellowship	College of Medicine & KKUH	Full time
Dr. Mona Badr	Microbiology (Virology)	MBBS, KSU Fellowship	College of Medicine & KKUH	Full time
Dr. Noura El-Khizzi	Microbiology	KSUF Micro FRCPath	RKMH	Full time
Dr. Samira Al-Johani	Microbiology	MBBS, FRCPC	NGH	Full time
Dr. Sahar Al-Thawadi	Microbiology	MD, ABMM	KFSH&RC	Full time
Dr. Sadia Bakhashween	Microbiology	KSU Fellowship Micro	RKMH	Full time
Dr. Rana Hasanato	Biochemistry	MD., KSU Fellowship	College of Medicine & KKUH	Full time
Dr. Waleed Al Tamimi	Biochemistry	Ph.D.	NGH	Full time at KAMCNG
Dr. Samia Subki	Biochemistry	MD., KSU Fellowship	RKMH	Full time at RKMH
Dr. Shihab Al-Mashhadani	Haematology	MBBS, DCP, FRCPA, IFCAP (USA),	College of Medicine & KKUH	Full time
Dr. Fatma Al-Qahtani	Haematology	MBBS,KSU Fellowship Haematology	College of Medicine & KKUH	Full time

 

The candidates will have a unique opportunity to be exposed to a quite enough clinical cases through the huge number of patients’ samples performed in the laboratories of the assigned hospitals. An example of this is the annual investigations performed in the different laboratories of King Khalid University Hospital during the year 2011/2012 as follows:

KKUH  Laboratory division	No. of tests/year
Clinical Chemistry	3243142
Microbiology: Bacteriology Molecular Biology Mycology Parasitology Virology	366558 3539 20843 6853 182475
Hematology	733580
Anatomic Pathology : Cytology Electron Microscopy Histology	22033 9203 87951
Cytogenetics	764
Immunology	135797
Lab Receiving (sent out test)	1148
Phlebotomy: (extracted & miscellaneous) Male Female Academic	56348 108213 17021
Grand total	4,995,468

 

Number of positions: 

2-3 residents will be accepted initially.  The acceptance number could be increased or decreased dependent on the requirements of the program.  Stand by residents 2-3.

 

Admission Requirements:

The applicant has to submit the following documents

1. All the requirement of the postgraduate medical education of the Saudi Universities.

• Completed application form provided at the residency office.
• Curriculum Vitae (C.V.).
• Transcript of records (copy)
• Original letters of recommendation.
• Letter of no objection from the sponsor to be a full time resident for the program period of 4 years.
• Post graduate certificates (copy) (if any).
• Saudi ID/Passport OF Iqama for Non-Saudi (Copy).
• Six passport size pictures (Not applicable for female).

1. A proof of basic qualification such as MBBS or equivalent degree, which is acceptable by King Saud University.
2. Successfully pass an admission examination and an interview.
3. Passed Saudi Council of health specialties examination.
4. Successfully completed one year of rotating clinical appointments (internship).

Evaluation:

The annual evaluation competencies include:

• Basic scientific knowledge
• Clinical skills and consultation ability
• Practical skills
• Interpersonal and communication skill
• Professionalism
• Resource utilizing practice

• This examination and evaluation of the residents at the end of each year will abide with the KSU examination regulations 
• External examiner will be invited to supervise the final examination.  The practical and oral examination will cover all the materials learned throughout the training. 

Progress monitoring and Graduation Requirement:

• To ensure that the resident acquires adequate knowledge, technical skills, and research ability. The progress of resident will be monitored as follows:
• The resident will be evaluated by his supervising faculty member in each rotation during the program. This evaluation will be discussed and signed with the resident before sending it to the program director. The program director will meet with the resident to review the evaluations.
• Annual evaluation of the faculty by the residents to ensure their adherence to the program objectives and the learning needs of the trainee.

Examinations:

Dates of examinations for all disciplines at all levels of the program:

*   R1-R4

All exams will be held during the month of September each year.

 

*   The details and regulations of the Annual Examination in the various subspecialties of Pathology at various levels of the Program from R1-R4.

• The R1, R2 examinations will be assessed as following:

1. Continuous Assessment 40%

The continuous assessment should involve the evaluation of the practical training, seminars, tutorials, journal clubs, case discussion / presentation as well as attendance and punctuality besides the attendance and participation in relevant extra-curricular specialty activities.

1. Final examination 60%

• R3 Examination

At the end of the 3^rd year of the program and will consist of the following:

1. Written examination      (40% of the total marks)

• Essay
• MCQ’s

1. Practical Examination    (40% of the total marks)
2. Oral Examination          (20% of the total marks)

• R4 Examination:

At the end of the fifth year of the program and will consist of the following:

1. Written Examination          (40% of the total marks)

Two essay type papers       (each for 3 hours)

 (Major component should be short account type)

1. Practical Examination       (40% of the total marks)
2. Oral examination               (20% of the total marks)

      Clinical Examination (if applicable)

Program Structure:

Description:

This is a four year program.  Pathology residents in the straight Clinical Pathology (CP) or Anatomical Pathology (AP) programs or in the combined APCP Program are eligible to enroll.

 

A 36-month core curriculum in CP will be offered to ensure familiarity with all basic aspects of laboratory medicine. In addition, the program will offer elective rotations in the laboratories to allow for sub specialization, flexibility and personal interests.

• Residents in the straight CP program will require a total of 48- months of training.
• For residents in the four year CP program who wish to pursue additional training in laboratory medicine we offer research opportunity and or subspecialty training during the fourth year.

 

Responsibilities:

One of the most important responsibility of the residents is  taking On-call, which is done rotation among all residents, once every 3-4 nights and weekends for emergency consultations and problem-solving . Backup is available at all times from the Chief Resident and the laboratory medical directors.

Program structure academic activities:

A half day didactic lectures, designed by the program director of clinical pathology and chief resident to cover all aspects of Laboratory Medicine. Attendance of these lectures is expected in addition to the daily interaction with the faculty during laboratory rotations.

Academic activities:

• Morning report conference: In this conference the trainee is expected to present and discuss the challenging cases encountered during the preceding week.
• Clinical Case presentation conference: This is a formal presentation by the residents of cases selected to highlight the practical application of laboratory data in patient diagnosis and management.
• Journal club: The residents are expected to present critical analysis of recently published literature "hot papers” at the monthly Journal Club.

Clinical activities:

All rotating residents in different specialty of laboratory medicine should participate in the ongoing activities of their sections. In addition they are expected to attend or participate in the following conferences:

• Grand round:  Presented by the department junior academic staff and associated faculty.  This is an important teaching activity to prepare residents for the pathology board examinations.

·        Research Seminar: state-of-the-art topics under investigation are presented by senior departmental staff or faculty members from the School of Medicine

Advanced Training in Clinical Pathology:

Opportunities for additional subspecialty and/or research training are available during the third year of residency in the clinical pathology program. The resident should ensure that this training is in line with their career goals and fulfills the requirements for  King Saud pathology fellowship program.

Learning objectives:

At the end of their training, the residents are expected to acquire deep knowledge in different disciplines of laboratory medicine as follows:

Microbiology:

Learn general microbiology techniques and the interpretation of cultures from blood, CSF, the respiratory tract, genital areas, wounds and stools. Develop skills in mycobacteriology (tuberculosis), mycology, parasitology, molecular diagnostic methods and the interpretation of antibiotic susceptibility profiles. Take advantage of rotations through various benches of microbiology and participate in daily rounds throughout the laboratory to correlate microbiological and clinical findings.

Biochemistry:

Fellows are expected to learn the basic principles of laboratory management, laboratory automation, quality control, serum protein and isoenzyme electrophoresis, clinical enzymology and laboratory endocrinology. They are also expected to become familiar with pharmacokinetics, the clinical interpretation of therapeutic, toxic drug levels, and the interpretation of cardiac markers.

Hematology and Transfusion medicine:

Learn general hematology techniques and special procedures such as coagulation, bone marrow interpretation, flow cytometric analysis and interpretation of abnormal differential cell counts.

Screen body fluid smears for atypical or neoplastic  cells. Analyze bone marrow aspiration smears and interpret results of platelet function tests, hemoglobin electrophoreses and special hematology cytochemistries analysis.

Learn the fundamentals of blood typing and screening, antibody identification and cross matching. Resolve serology related problems and transfusion reactions.  Analyze transfusion reactions, and perform apheresis procedures. Become familiar with the indications for various blood products utilization, and learn how to screen for transfusion transmitted diseases.

Immunology/Flowcytometry:

Develop deep understanding of the integration of immunologic analysis with serum protein electrophoresis and other chemical analyses. Learn the interpretation of bacterial and parasitic serological assays.

Interpret lab results for autoimmune diseases, and tests for immunodeficiency assays and HLA typing using morphological, cytogenetic, molecular, and flowcytometric diagnostic assessments. 

Cytogenetics:

The training in clinical cytogenetics and molecular pathology laboratories will include cytogenetic and molecular genetic testing for congenital and acquired disorders. The trainee will exposed to testing samples from various body sites include amniotic fluid, chorionic villi, products of conception, peripheral blood, and tissue samples, including prenatal and neonatal samples as well as cancer studies include bone marrow, bone core biopsies, solid tumors, paraffin embedded slides, effusions, lymph nodes, and peripheral blood sample.

The Program structure:

The fellowship program will be conducted at King Khalid University Hospital (KKUH), King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh Military Hospital (RMH) and King Fahad National Guard Hospital (KFNGH) as follows:

First Core Year (Residents should attend R1 lectures)

Microbiology

Biochemistry

Hematology/transfusion

Immunology/Flowcytometry

Holidays

3 months

3 months

3 months

2 months

1 month

Second Core Year (Residents can attend R1 lectures)

Molecular

Cytogenetics

Microbiology

Biochemistry

Hematology/ transfusion

Immunology/ Flowcytometry

Holidays

2 months

2 months

2 months

2 months

2 months

1 month

1 month

Third Core Year (Residents can attend R1 lectures)

Molecular

Cytogenetic

Micro

Biochem

Hematology/ transfusion

Immuno/ Flowmetry

Elective

Holidays

1 month

1 month

1 month

1 month

1 month

1 month

5 months

1 month

Fourth Year Complete 12-24 months (12 months  dedicated to subspecialty of clinical pathology i.e. microbiology or hematology)

 

Clinical Fellowship (senior fellow can rotate in area of interest i.e. subspecialty)	Elective laboratory training
5-6 months	5-6 months
It is optional for the fellow to select either one of clinical fellowship or research project or both

 

Core Three Years CP program requirement

Topic	Period
Microbiology	6 months
Biochemistry	6 months
Hematology/Transfusion and blood bank	12 months
Immunology/Flowcytometry	4 months
Molecular / Cytogenetics	3 months
Elective	2 months
Holidays	3 months
Total	36 months

Equivalence of the Program to other degrees

• The program has an objective of training residents that can cope with international standards. The degree that a resident will obtain is equivalent to the Clinical pathology (USA and this program is recognized by American College of Clinical Pathology.
• Other equivalent or similar programs includes: Clinical pathology program (UK, Ireland, , Italy), Laboratory Medicine program (Germany, Romania, Poland, Eastern Europe), Clinical analysis program (Spain) or Clinical/Medical Biology program  (France, Belgium, Netherlands, Austria, North and West Africa...)

Program Certification:

 The candidate will be granted KSU Fellowship in Clinical Pathology  upon satisfying the following:

- Passing the Fellowship exam.

- Satisfactory scores at the final overall evaluation.

- Satisfactory attendance and active participation in the academic activities of the   department.

- Completion of  research publications.

 Withdrawal :

A valid reason for withdrawal must be given in writing to the Clinical Pathology Program Director.  Submission of withdrawal should be made 3 months before the end of the training year to the Departmental Residency Committee (DRC) which will refer the request to the Postgraduate Training Board (PGTB) with recommendations.  The final decision will be made by the PGTB who will give their final reasons in writing.  In case the withdrawal was rejected by the PGTB and the resident left the program without permission, he will not be allowed to join any other programs for one year.

  Disciplinary actions:

Disciplinary actions will be in accordance with the KSU Residency Training Programs Policies and Procedures.  The residents must perform their duties in a manner consistent with the institutional and departmental regulations concerning patient care, interpersonal relationships, and legal and ethical conduct.

Any fellow exhibiting poor performance or misconduct will be thoroughly discussed in the Department Residency Committee before any disciplinary action is initiated.  In case of dismissal from the program, the program director has to refer the matter to the PGTB for appropriate decision.  The PGTB will then forward the matter to the Vice Dean of the Postgraduate and Continuing Medical Education. (Refer to appendix 1 - for KSU Policies and Procedures for Residency and Fellowship)

 Vacations:

• Must be according to the postgraduate guidelines, please refer to the KSU Residency Training Programs Policies and Procedures.
• The fellow is entitled to a four (4) weeks vacation per year and should be approved by the program director.
• The fellow will have both of the Eid Holidays.
• Justified absence from the program such as sick and maternity/paternity leave should be compensated if more than 1 week/year.
• Educational leave will be granted to attend one hands-on course a year and one international conference a year.