Competency Portfolio for the Diploma in Transfusion Medicine Guide for AFC-Diploma Committees/Working Groups, Educators 2012 VERSION 1.0 This portfolio applies to those who begin training on or after July 1 st, 2012. DEFINITION Transfusion Medicine is that domain of laboratory and clinical medicine concerned with all aspects of the collection, testing, preparation, storage, transportation, pretransfusion testing, indications for, infusion and safety of human blood components and products, nonhuman alternatives and alternative products manufactured by recombinant DNA technology. These activities are undertaken in such a way that the rights of blood donors, patients and families are respected. GOALS Upon completion of training, a candidate is expected to function as a competent specialist diplomate in Transfusion Medicine, capable of an enhanced practice in this area of focused competence, within the scope of Internal Medicine, Hematology, Pediatrics, Hematological Pathology, Anesthesiology or General Pathology, The candidate must acquire a working knowledge of the theoretical basis of the discipline, including its foundations in the sciences and research. The discipline of Transfusion Medicine also includes responsibility for: The diagnostic and therapeutic aspects of immunohematology, apheresis, histocompatibility, and related molecular biology and biotechnology Management of the medical laboratory and blood centre, including quality, safety & regulatory aspects Ensuring the appropriate use of blood Ensuring the adequacy of blood for the blood system Supervising the provision of a safe and effective blood supply Supervising the banking and provision of cell therapy products and human tissues for transplantation purposes Engaging governments, other physicians and other health professionals in transfusion medicine The advancement of the discipline through basic scientific and clinically applied research Note: In this document, blood refers to blood, blood components and blood products. Note: All markers must be signed off by supervisor prior to adding to portfolio Note: All submitted cases or clinical material must be deidentified to preserve patient privacy. The Transfusion Medicine diplomate will respect the rights of the individual and family and must This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2012 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Education, attn: Associate Director. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: documents@royalcollege.ca. For questions regarding the use of this document, please contact: credentials@royalcollege.ca. Page 1 of 19
COMPETENCY PTFOLIO F THE DIPLOMA IN TRANSFUSION MEDICINE (2012) demonstrate the requisite knowledge, skills, and attitudes for effective patient-centered care and service to a diverse population. In all aspects of specialist practice, the graduate must be able to address issues of gender, sexual orientation, age, culture, ethnicity and ethics in a professional manner. At the completion of training, the diplomate must demonstrate evidence of acquisition of the competencies described below. INSTRUCTIONS: Complete the table below by indicating in a narrative how each competency was achieved (column A) and providing evidence of achievement of the competency (column B). All required educational activities as laid out in the CTR must be present in the portfolio in column A. To be acceptable for certification for the DRCPSC, all competencies must have been achieved, and there must be evidence for every competency. A single marker may provide evidence for multiple competencies. Append copies of assessment instruments or other exhibits of competence, appropriately labeling them so they are referenced in the portfolio table below. In the view of the AFC Program Committee, this candidate has acquired the competencies of the diploma program as prescribed in the Competency Portfolio and is competent to practice as a diplomate. The following sources of information were used for this evaluation: YES NO written examinations oral examinations clinical observations (e.g. ITERs) from faculty Structured Assessment of a Clinical Encounter (STACER) feedback from health care professionals OSCEs completion of a scholarly project other assessment tools (list): COMMENTS Page 2 of 19
COMPETENCY PTFOLIO F THE DIPLOMA IN TRANSFUSION MEDICINE (2012) 1. The diagnostic and therapeutic aspects of immunohematology, apheresis, histocompatibility, and related molecular biology and biotechnology Key Portfolio Outcomes: Markers: Description 1.1 Manage the transfusion needs of a complex patient Complex transfusion case presentations illustrating a. Complex antibodies b. Autoimmune hemolytic anemia c. Obstetrical complications d. Platelet refractoriness e. Red cell genotyping f. Transfusion support of bone marrow and stem cell transplant g. Pediatric transfusion issues structured oral examination involving a complex transfusion case Submit one clinical case presentation for each of the complex cases presented. Attach supporting materials such as PowerPoint presentations. The structured oral exam that is usually given by the attending physician. Use one of the complex cases developed for the structured oral exam. Provide a list of the questions asked and sign off that the candidate passed. 1.2 Supervise & interpret immunohematology testing Antibody lab reports, signed off by supervisor, including: a. RBC (5) (rare and HDFN) b. HLA (1) c. Platelet-antibodies (1) (NAIT) d. ABO discrepancy (3) e. Rh discrepancy (3) Successful completion of ITER Submit a total of 13 de-identified lab reports or a mock-up of a report. Specified cases and numbers of each are shown in the markers column. Use the Royal College Transfusion Medicine template for lab reports. Supervisor sign off for each Page 3 of 19
Key Portfolio Outcomes: Markers: Description documenting achievement of competence in the medical direction of the Transfusion Service (must document both adult and pediatric exposure, as one or two separate ITERs) report. Submit one ITER for the Transfusion Service. If pediatric and adult experiences are separate, two ITERS are required. Use the Royal College ITER template. 1.3 Prescribe and supervise apheresis appropriately Collection of three therapeutic apheresis case reports, including deidentified or simulated consultations, orders, reflection on each case, and supervisor comment. blood centre structured examination (oral, and/or written) with content related to donor apheresis Submit three case reports using the Royal College Transfusion Medicine template. Sign off by the supervisor. The structured examination completed at the blood center comprised of both written (take home exam) and oral components. One to two questions will relate to donor apheresis. Sign off by the blood center manager on successful completion of the structured examination. Page 4 of 19
2. Management of the medical laboratory and blood centre, including quality, safety & regulatory aspects Key Portfolio Outcomes: Markers: Description 2.1 Develop a transfusion-related standard operating procedure (SOP) Satisfactory completion of one transfusion-related SOP, signed off by a supervisor Write a standard operating, technical or nursing procedure relevant to blood transfusion 2.2 Evaluate a laboratory s compliance with accreditation standards and develop a strategy to ensure a laboratory is compliant with accreditation standards & regulations Satisfactory completion of one internal laboratory audit report relating to an external standard, signed off by a supervisor Satisfactory completion of one report detailing a gap analysis and strategy to ensure compliance with an external laboratory standard, signed off by a supervisor Using a lab audit template or checklist, submit one lab audit; only one section of a lab is required. Lab audit can be completed at the hospital or blood center. Using a template or checklist, submit a gap analysis. Write a report in response to the gap analysis providing a strategy to ensure compliance. Only one section of a lab is required. The gap analysis can be completed at the hospital or blood center and must be signed off by a supervisor. 2.3 Manage the administrative and technical aspects of effective laboratory function Satisfactory completion of a report describing the validation of a new laboratory procedure or instrument multisource feedback assessment of Write a report describing validation of a procedure or instrument. Sign off by a supervisor. Using a multisource feedback Page 5 of 19
Key Portfolio Outcomes: Markers: Description supervisory competencies related to the transfusion laboratory, including input from technologists, attending physician, and management team structured examination related to administrative aspects of laboratory function tool, collect feedback from technologists, managers, attending physicians and management team of supervisory skills of the transfusion laboratory. The structured examination completed at the blood center comprised of both written (take home exam) and oral components will relate to technical aspects of laboratory management. Sign off by the blood center manager on successful completion of the structured examination. 2.4 Evaluate a laboratory s quality management system Successful completion of one case report related to a quality issue, including a strategy to address the quality issues arising Successful completion of one report related to external proficiency testing, including a strategy to deal with any discrepancies Submit one case report related to a quality issue. Submit one report dealing with an external proficiency testing case. The written report includes the testing, reporting and addressing of any issues on receipt of the report. Successful completion of one root cause analysis and corrective action preventative action (CAPA) of a real or simulated case related to blood Submit one root cause analysis and CAPA The structured examination Page 6 of 19
Key Portfolio Outcomes: Markers: Description safety (such as wrong blood to wrong patient) Successful completion of one structured examination relating to quality control issues completed at the blood center comprised of both written (take home exam) and oral components will include issues related to quality control issues within the laboratory. Sign off by the blood center manager on successful completion of the structured examination. Page 7 of 19
3. Ensure the appropriate use of blood Key Portfolio Outcomes: Markers: Description 3.1 Serve as an effective consultant for clinical services requiring blood management for individual patients Collection of at least one deidentified case summary related to each of the following, including details of the blood used, relevant investigations, conclusions, recommendations, and reflection on the case: a. Massive transfusion b. Sickle cell c. Inherited bleeding disorders d. Transfusion support of bone marrow or solid organ transplant e. Reversal of anticoagulant f. Urgent consultation relating to bleeding g. Inappropriate blood order Submit one case summary or consult for each of the complex cases presented. The structured exam can either be an oral exam administered by the attending physician or a written/take home exam. Provide a list of the questions asked and sign off that the candidate passed. structured examination related to blood management for individual patients 3.2 Serve as an effective consultant on behalf of the blood centre for hospital clinical services At least one de-identified case summary related to a complex consultation to a blood centre (such as rare RBC request, unexpected antibody in transfusion recipient, special access request), including Submit one de-identified case summary related to a complex consultation for a blood center. Signed off by the supervisor. The structured examination Page 8 of 19
Key Portfolio Outcomes: Markers: Description details of any blood used, relevant investigations, conclusions, recommendations, and reflection on the case structured oral assessment related to consultation for a blood centre completed at the blood center comprised of both written (take home exam) and oral components will include issues related to complex consultation for a blood center. (Boundary issues will be explored with how to deal with issues about providing a consult when you don t have privileges at the institution.) Sign off by the blood center physician on successful completion of the structured examination. 3.3 Supervise the process of obtaining informed consent for the provision of blood products for patients structured oral assessment related to informed consent for the provision of blood A structured oral exam administered by the attending physician. Use a challenge case such as a Jehovah s Witness or underage person who doesn t want to be transfused. Provide a list of the questions asked and sign off that the candidate passed. 3.4 Manage the appropriate utilization of blood products An audit of blood utilization in a given context, including an analysis of any variance with current clinical practice guidelines, Submit one audit or report related to use or adaptation of a clinical practice guideline related to utilization of blood for a hospital or a certain patient group. Page 9 of 19
Key Portfolio Outcomes: Markers: Description An updated clinical practice guideline related to utilization of blood to address the findings of an audit A report for a Transfusion Committee related to an issue of appropriate utilization of blood in a hospital, indicating when it was presented to the Committee 3.5 Develop and implement blood conservation strategies At least one de-identified preoperative consultation simulated case involving blood conservation techniques, including details of the blood used, relevant investigations, conclusions, recommendations, and reflection on the case Completion of a structured oral examination related to blood conservation strategies Submit one pre-operative consultation or simulated case report involving blood conservation techniques. A structured oral exam administered by the attending physician relating to blood conservation strategies. Provide a list of the questions asked and sign off that the candidate passed. Page 10 of 19
4. Ensure the adequacy of blood for the blood system Key Portfolio Outcomes: Markers: Description 4.1 Manage the supply of blood structured examination related to inventory management, outdating and wastage The structured exam can either be an oral exam administered by the attending physician or a written/take home exam. Provide a list of the questions asked and sign off that the candidate passed. An audit related to inventory management, outdating and wastage Submit one audit related to inventory management, outdating and wastage. 4.2 Develop a strategy to implement blood shortage management protocols structured examination related to blood shortage management Report and written reflection on a simulated blood shortage The structured exam can either be an oral exam administered by the attending physician or a written/take home exam. Provide a list of the questions asked and sign off that the candidate passed. Case report and written reflection of a blood shortage event Simulate a blood shortage event and submit one report and written reflection. Page 11 of 19
Key Portfolio Outcomes: Markers: Description Submit one written reflection case report and written reflection of a blood shortage event. 4.3 Advise on donor recruitment strategies structured examination related to donor recruitment in special populations The structured examination completed at the blood center comprised of both written (take home exam) and oral components will relate to donor recruitment strategies. Page 12 of 19
5. Supervise the provision of a safe and effective blood supply Key Portfolio Outcomes: Markers: Description 5.1 Manage the appropriate selection and testing of blood donors structured examination with content related to donor issues The structured examination completed at the blood center comprised of both written (take home exam) and oral components will relate to a complex consultation to a blood center. Sign off by the blood center manager on successful completion of the structured examination. scholarly presentation related to donor testing, that must include transfusion transmissible disease n ITER documenting achievement of competence in donor testing Submit one scholarly presentation related to donor testing, acceptable formats include: 1) Power point presentation that was delivered by the candidate; 2) written critical review of donor testing including test requirements and rationale; or 3) written, in-depth analysis of one or more donor test including details of testing, sensitivity/specificity, implications etc. Submit one ITER documenting achievement of competence in Page 13 of 19
Key Portfolio Outcomes: Markers: Description donor testing achieved on the Blood Centre Rotation. 5.2 Advise on the quality of manufactured blood products and components Successful completion of current Good Manufacturing Practice (cgmp) training cgmp training will be conducted at the blood center. The blood center manager will sign off on completion of the training. n ITER documenting achievement of competence in component suitability Submit one ITER documenting achievement of competence in component suitability achieved on the Blood Centre Rotation. 5.3 Manage the safety and surveillance systems for a given blood system Collection of at least one case summary or simulated case related to each of the following severe transfusion reactions, including details of the blood used, relevant investigations, conclusions, recommendations, and reflection on the case, at least one of which is reported using the relevant hemovigilance system: a. transfusion related acute lung injury (TRALI) b. severe allergic transfusion reaction Submit one case presentation for each of the complex cases presented. The structured exam can either be an oral exam administered by the attending physician or a written/take home exam. Provide a list of the questions asked and sign off that the candidate passed. Page 14 of 19
Key Portfolio Outcomes: Markers: Description c. bacterial contamination d. acute intravascular hemolysis e. acute severe hypotension f. transfusion related graft versus host disease g. delayed hemolysis h. post-transfusion purpura structured examination related to transfusion reactions and reporting as well as error reporting Page 15 of 19
6. Supervise the banking and provision of cell therapy products and human tissues for transplantation purposes Key Portfolio Outcomes: Markers: Description 6.1 Advise on the recruiting, assessing, maintaining, and selection of appropriate stem cell donors Submission of one consultation related to stem cell donor assessment Submit one consultation related to stem cell donor assessment. 6.2 Supervise the collection, processing, and storage of stem cells Submission of at least two case summaries including the collection, storage and infusion of stem cells Submit at least two case summaries. 6.3 Describe screening procedures and quality control processes for tissue donors structured examination related to screening procedures and quality control processes for tissue donors The structured exam can either be an oral exam administered by the attending physician or a written/take home exam. Provide a list of the questions asked and sign off that the candidate passed. Page 16 of 19
7. Engages governments, other physicians and other health professionals in transfusion medicine Key Portfolio Outcomes: Markers: Description 7.1 Contribute to the effective functioning of an inter-professional committee related to transfusion medicine Satisfactory completion of a multisource feedback assessment of contributions to an interprofessional committee related to transfusion medicine reflective report describing interactions with governmental or regulatory officials Satisfactory completion of a multisource feedback assessment of contributions to a committee which includes governmental or regulatory officials Using a multi-source feedback tool, submit assessment of contributions to an interprofessional committee to a committee which includes governmental or regulatory officials Submit one ITER documenting effective contribution to a governmental or regulatory committee. n ITER documenting effective contribution to a governmental or regulatory committee related to transfusion medicine Page 17 of 19
Key Portfolio Outcomes: Markers: Description 7.2 Educate other physicians, other health professionals, members of the public, and government officials about aspects of transfusion medicine Submission of a teaching dossier demonstrating at least two effective presentations (as evidenced by formal participant evaluation) related to transfusion medicine for at least two of the preceding groups Submit a teaching dossier for at least two effective presentations for at least two of the following groups (physicians, other health professionals, members of the public and government officials). Page 18 of 19
8. The advancement of the discipline through basic scientific and clinically applied research Key Portfolio Outcomes: Markers: Description 8.1 Conduct or contribute to a research project related to transfusion medicine Submission of an abstract or completed manuscript Submit an abstract or manuscript Submission of a research proposal or grant application Submit a research proposal or grant application Submission of a progress report of their research project Submit a progress report of a research project. Satisfactory completion of an ITER documenting their achievement of competence in conducting or contributing to a research project related to transfusion medicine Submit one ITER documenting achievement of competence in conducting or contributing to a research project. Submission of an satisfactory evaluation of a presentation of one critically appraised article presented at a transfusion medicine related journal club Submit an evaluation of a presentation or critically appraised article presented at a journal club. REVISED - (2012) Page 19 of 19