Haematology

This comprises 2 written papers evaluating candidates’ knowledge and clinical judgement in important areas within the haematology curriculum. 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.

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

The questions address an important area of laboratory or clinical practice in each of the following 4 areas:

1. blood transfusion
2. general haematology (including laboratory management)
3. haematological oncology
4. haemostasis and thrombosis.

The aim of this essay examination is to determine a trainee’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, established therapies 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 judgement
• critically evaluate investigational strategies, treatment options or recent advances.

In addition to evaluating topics from the 4 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 knowledge, judgement and skills:

• focused tasks, e.g. preparation of a letter to a GP/referring consultant, a business case for new drug/equipment/test, an information sheet for patients or a standard operating procedure
• focused problems, e.g. describing the management or 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 or laboratory practice
• critical evaluation of investigational or clinical strategies with a requirement to demonstrate clinical 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 or therapeutic 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. 

This paper lasts 3 hours and contains 125 multiple choice questions (MCQs) examining a candidate’s knowledge and ability to apply this knowledge over a wide range of content areas. The questions assess the pathogenesis, investigation and management of haematological disease, the use of therapeutic modalities, and aspects of laboratory and clinical practice.

50 questions are ‘best from five’ format; 75 questions are ‘extended matching’ format. Details and examples are provided below. No marks are deducted for an incorrect answer. An answer sheet is provided for you to record your answer to each question.

Blood transfusion, general haematology (including laboratory management), haematological oncology, and haemostasis and thrombosis each comprise approximately 25% of this examination. A small number of questions may evaluate trainee knowledge of management topics, research methodology, ethics or statistics.

Most questions are structured around clinical or laboratory vignettes and are designed to assess a trainee’s clinical judgement and ability to apply their knowledge rather than simple recall or recognition of facts.

The questions map to the haematology training curriculum and the ‘blueprint’ from which questions have been developed is detailed below. Each question examines a focus within a theme. Examples listed under each theme are not exclusive.

The pass mark for Paper 2 is determined by an Angoff procedure undertaken by members of the Panel of Examiners in Haematology. This is a validated method of determining minimal acceptable competence.

General and laboratory haematology themes

• Bone marrow failure syndromes
• Iron metabolism abnormalities
• Underproduction anaemias
• Haemolytic anaemias
• Obstetric haematology
• Paediatric haematology
• Infective problems in 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

Therapeutics themes

• Chemotherapeutic agents
• Haemopoietc growth factors
• Stem cell transplantation
• Anti-thrombotic agents
• Anti-platelet agents
• Thromboprophylaxis
• Pro-thrombotic agents

Other themes

• Laboratory practice
• Laboratory management
• Infective 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. Clearly, the theme of laboratory management has focus areas such as health and safety, quality assurance and clinical governance.

• Aetiology and pathogenesis
• Epidemiology
• Clinical features at presentation
• Clinical investigations
• ‘Routine’ laboratory investigation
• Morphological features of blood or marrow
• Special techniques for diagnosis
• Cytogenetics
• Molecular diagnostics
• Differential diagnosis
• Prognostic factors
• Staging
• Complications
• Natural history
• Indications for therapy
• Therapeutic options
• Therapy-related complications
• Transfusion issues
• Issues related to diagnosis in pregnancy
• Issues related to a paediatric patient

This examination assesses the core skills required of a consultant haematologist. It comprises 3 written papers and an oral examination, which evaluate candidates’ knowledge, skills and clinical judgement in important areas within the haematology training curriculum. 

The Part 2 examination is held simultaneously over 3 days at a number of  examination centres in the UK using identical question papers and clinical material. 

Candidates must achieve a pass mark in all 3 papers and demonstrate competence in the oral examination at a single sitting to pass the Part 2 examination.

• Up to 12 questions to be answered in 1 hour and 30 minutes.
• Each question requires the candidate to examine 1 or 2 microscope slides and/or flow cytometry plots or additional laboratory data or quality assurance.

The questions in the written papers adopt a ‘short answer’ format, which requires a candidate to provide a focused response to the question. These questions can be answered in a few short words or phrases. Typically, they contain words such as ‘list’, ‘name’ or ‘outline’, suggesting that a series of short responses are required.

Short answer questions can vary in their level of complexity from questions that simply require recall of factual knowledge to more complex questions that require application of knowledge or clinical reasoning. A series of questions may relate to a ‘clinical vignette’, building on case information.

• 3 questions to be answered in 1 hour and 30 minutes.
• Each 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 clinical investigations and interventions.

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

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

• 8 topic areas to be answered in 60 minutes.
• Each candidate has two 30-minute oral examinations with 2 pairs of examiners.
• 1 oral examination covers 2 topics in coagulation and 2 topics in transfusion medicine; the other covers 2 topics in general and laboratory haematology and 2 topics in haematological oncology.
• 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 problem. 
• Examiners select questions from a pre-agreed bank of questions. All candidates receive the same 8 structured questions.
• 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 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.

There will be the option of a paediatric viva for candidates undergoing paediatric training.