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：         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       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       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           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      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      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     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)