Haematology clinical science

The examinations for fellowship of the Royal College of Pathologists in haematology are designed to assess a trainee’s knowledge, skills and behaviour in the fields detailed in the Higher Specialist Scientific Training (HSST) curriculum for clinical scientists in haematology. Possession of FRCPath in haematology is increasingly a requirement for appointment to a consultant clinical scientist post in haematology.

‘Clinical scientist’ is a title protected by statute, and can only be used by individuals registered with the Health and Care Professions Council (HCPC). Candidates for the FRCPath examinations for haematology clinical scientists should be HCPC registered.

Clinical scientist training is now structured through the Scientist Training Programme (STP). Entry to this programme in England and Wales is managed through the National School of Healthcare Science (NSHCS), and can either be directly as an external candidate through the NSHCS recruitment process, or through the in-service route, where applicants (usually biomedical scientists) are sponsored by their employer. In Scotland and Northern Ireland, candidates follow very similar programmes towards an equivalence process (see below).

Learning is delivered through 3 years of approved and accredited workplace-based training, with the first year in a range of settings before specialisation in the last 2 years of training. Scientist trainees are also required to undertake a specifically commissioned master's degree in their chosen area.

There are a number of other routes to HCPC registration as a clinical scientist. The Association of Clinical Scientists assesses candidates who have gone through non-standard training in the UK and have worked in laboratory medicine for a minimum of 6 years. Similarly, the Academy for Healthcare Science (AHCS) has developed an equivalence assessment process for scientists who have undertaken training, hold qualifications and/or have considerable professional experience, and who wish to show that these are equivalent to the STP programme.

Individuals who have trained outside the UK can make direct application to the HCPC for registration.

Part 1

Introduction and format

This comprises 2 written papers evaluating candidates’ knowledge and clinical scientific judgement in important areas within the HSST curriculum for clinical scientists in haematology. The Part 1 examination is used to determine whether a candidate has attained an acceptable level of knowledge and reached an acceptable level of competence based on the objectives of the training programme.

Candidates must achieve a pass mark in both papers at a single sitting to pass the Part 1 examination.

Paper 1: essay questions

This examination lasts 3 hours and comprises 4 essay questions. Candidates must answer all 4 questions.

This examination addresses important areas of clinical scientific practice, and can include questions in the following 4 areas:

general and red cell haematology (including laboratory management)
haematological oncology
haemostasis and thrombosis
blood transfusion.

The aim of this essay examination is to determine a candidate’s ability to demonstrate the following skills:

present a clear and cogent written answer to the question
select, organise and communicate relevant information or knowledge
structure an essay that communicates relevant facts clearly without irrelevant information
display an appropriate knowledge of disease pathogenesis, diagnostic investigation, interpretation of results and new developments and relate this to clinical and laboratory practice
select an appropriate course of action and, in so doing, to display good clinical scientific judgement
critically evaluate investigational strategies or recent advances.

In addition to evaluating topics from the main areas of haematology, questions within each paper may include the following areas to provide a balanced assessment of basic knowledge, laboratory practice, and clinical scientific knowledge, judgement and skills:

focused tasks, e.g. preparation of a letter to a GP/referring consultant, a business case for new equipment/test, an information sheet for patients or a standard operating procedure
focused problems, e.g. describing investigation of a particular clinical or laboratory problem of a common or important nature
basic knowledge of disease pathophysiology in the context of its application to clinical laboratory practice
critical evaluation of investigational strategies with a requirement to demonstrate clinical scientific judgement through selection of an appropriate approach to a specific case.

Essay questions explore a candidate’s abilities to communicate effectively in writing in a structured and clear manner, to critically evaluate investigational strategies and to demonstrate an ability to combine knowledge derived from different sources and experience gained from clinical and laboratory practice to make a considered judgement or recommendation.

Paper 2: short answer questions

Paper 2 of the Part 1 written examination for haematology clinical scientists consists of 20 compulsory short answer questions (SAQs), to be answered in 3 hours. SAQs are designed to test factual knowledge and understanding across the range of the curriculum. Each question comprises a stem and usually 5 or 6 sub-questions. The stem defines the topic of the question and may include a short scenario or vignette. Each sub-question is designed to elicit a specific piece of information, or demonstrate understanding of the topic and its context. Unless stated otherwise, the answer required will relate specifically to the material provided in the stem and not to the topic in general.

Points to note:

SAQs are criterion marked against an explicit model answer
marks are only awarded for information required by the question – no marks are available for additional material
if a defined number of facts are requested (e.g. State two causes of…..), only the first 2 responses will be marked (e.g. answer – correct cause, incorrect cause, correct cause, will only receive 1 out of 2 marks)
answers requiring more than single word or phrase responses will be answerable in a single sentence or a small number of sentences.

Examiners will be looking for key concepts in these answers and no marks will awarded for extra information. Candidates should practise writing short, concise answers, which include only the information requested. Good use of English, avoidance of abbreviations and clear handwriting are essential. Candidates who write unnecessarily long answers are likely to penalise themselves because these answers waste time.

The mark allocation for each sub-question will be stated in brackets in each instance.

The pass mark for the Part 1 SAQ examination is determined by an Angoff procedure undertaken by members of the College’s Haematology Clinical Scientist Examiners Panel. This is a validated method of determining minimal acceptable competence.

Short answer question blueprint

General and laboratory haematology themes

Bone marrow failure syndromes
Iron metabolism abnormalities
Underproduction anaemias
Haemolytic anaemias
Obstetric haematology
Paediatric haematology
Laboratory haematology
Laboratory management

Haematological oncology themes

Myeloproliferative disorders
Myelodysplastic syndromes
Acute leukaemias
Lymphoproliferative disorders
Plasma cell dyscrasias
Lymphomas

Haemostasis and thrombosis themes

Platelet disorders
Inherited haemorrhagic disorders
Acquired haemorrhagic disorders
Inherited thrombotic disorders
Acquired thrombotic disorders

Transfusion medicine themes

Indications for blood and blood product transfusion
Complications of blood and blood product transfusion
Donor selection
Blood product production
Blood product selection
Blood bank techniques

Other themes

Laboratory practice
Laboratory management
Infectious disease in haematology
Haematological problems of systemic disease

Each question examines a single focus within a theme. For example, within the theme of lymphoma, a question may address topics within any of the areas listed below. Many, but not all, areas of focus listed apply to most of the themes listed above. The focus areas within laboratory management include health and safety, quality assurance and clinical governance.

Aetiology & pathogenesis
Epidemiology
‘Routine’ laboratory investigation
Morphological features of blood or marrow
Special techniques for diagnosis
Cytogenetics
Molecular diagnostics
Differential diagnosis
Prognostic factors
Staging
Complications
Natural history
Issues related to diagnosis in pregnancy
Issues related to a paediatric patient

Part 2

Introduction and format

The Part 2 FRCPath examination is the core assessment of clinical scientific and laboratory skills and may be taken once a candidate has successfully completed the Part 1 examination and acquired additional significant experience of practice as an HCPC-registered clinical scientist.

The standard required to pass this examination is the standard that would be expected of a consultant clinical scientist in haematology.

All written papers in the Part 2 examination are marked by members of the Haematology Clinical Scientist Examiners Panel. The final marks awarded by the examiners must be approved by the College's Examination Committee before a final pass/fail decision is made.

Feedback on areas where a candidate failed to demonstrate an adequate standard is sent to candidates who fail the examination.

The Part 2 examination consists of 2 components:

written project
practical and oral examination.

Written project

Submission of either:

a dissertation on a specific area of haematology clinical science
a PhD thesis
a portfolio of papers
a case book (10 cases) subject to the College regulations for Part 2 written submissions.

Practical and oral examination

The candidate chooses one of the following modules covering laboratory practice.

Interpretation paper – general and oncological haematology and red cell haematology

Includes 8 SAQs and 2 long case questions to be answered in 2 hours.
Each SAQ requires the candidate to examine 1 or 2 microscope slides and/or flow cytometry plots and/or genetics data and/or quality assurance (NEQAS) reports. Questions will be asked based on the interpretation of the morphology of the case and/or other information provided.
Each long case question provides a case history and contains several parts, each of which require the candidate to interpret microscope slides, laboratory results or other clinical investigations and provide a report, make a diagnosis and/or recommend further investigations.

Interpretation paper – haemostasis and thrombosis

Includes 8 questions to be answered in 2 hours.
Each question provides a case history or laboratory results, which requires the candidate to interpret data, make a diagnosis and recommend further investigations.

Interpretation paper – transfusion medicine

Includes 10 questions to be answered in 2 hours.
Each question provides a case history or laboratory results, which requires the candidate to interpret data, make a diagnosis and recommend further investigations.

This examination is closely analogous to that taken by medically qualified haematologists. The candidate will be expected to demonstrate clinical scientific knowledge and understanding of how the selected module relates to other areas of haematological practice (for example, a candidate undertaking the haemostasis and thrombosis module would require knowledge of the pathogenesis of acquired disorders of haemostasis associated with haematological malignancy).

This paper is followed by a structured viva voce:

each candidate has an approximate 60-minute oral examination with a pair of examiners
4 topic areas will be examined in 60 minutes, including 3 topics in the candidate’s specialist area of knowledge and 1 topic on broader haematology issues
questions are structured to evaluate both basic knowledge of the topic examined and the candidate’s ability to apply their knowledge of the topic in making a judgement in a clinical scientific problem
candidates are marked using a predetermined set of marking descriptors.

The oral examination is used to explore a candidate’s ability to evaluate problems and demonstrate good clinical scientific judgement. It is also an assessment of a candidate’s ability to communicate clearly and effectively. It provides a further assessment of a candidate’s knowledge in areas of the specialty to complement their score in that area in the written examination.

An egregious error in the oral examination will result in a candidate’s performance in the entire examination being reviewed as a borderline candidate. If this error is deemed sufficiently serious by the Examination Board, it may cause the candidate to fail the examination overall.