On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.100 n.6 Cape Town Jun. 2010
Clinical haematology training in South Africa for fellows with the primary specialty of internal medicine - what's in a name?
To the Editor: Clarity with regard to what training in clinical haematology in South Africa involves and aims to achieve can be elusive. Clinical haematology trainees can have primary specialties of Internal Medicine or Paediatrics or Pathology (Haematology). I discuss the situation of those with the primary specialty of Internal Medicine.
In South Africa, clinical haematology combines clinical and laboratory haematology into one subspecialty. Regulation 11(1) of Government Notice No. R.590 of 29 June 2001 (Government Notice)1 states that a clinical haematologist shall have completed 4 years of training as a registrar in Medicine and then 2 years in Pathology (Haematological). In practice, interpretations vary.
The Clinical Haematology regulations of the College of Physicians2 agree with the Government Notice1 on who is a clinical haematologist (CH). However, the regulations stipulate a clinical training component of 1 year and a laboratory training component of a minimum duration of 1 year, which differs from the apparent requirement of 2 years' training in the laboratory component. The regulations state that a CH should restrict himself/herself to treating adults with haematological disorders and can perform laboratory investigations within the scope of his/her training. The word 'restrict' may be interpreted to mean that the CH should restrict himself/ herself to adult patients rather than paediatric patients, or that a CH should restrict himself/herself to the clinical component of haematology. In contrast, the regulations for pathologists3 stick to the Government Notice and stipulate a 2-year clinical training component in either paediatrics or internal medicine. This makes the training and practice of clinical haematology for haematopathologists straightforward.
The regulations of the College of Physicians offer two possible interpretations to the training for clinical haematology, exemplified by the definitions of a haematologist in the USA and the UK. According to the American Society of Hematology (ASH), 'a hematologist is a physician who specializes in the diagnosis, treatment, prevention, and/or investigation of disorders of the hematopoietic, hemostatic, and lymphatic systems, and disorders of the interaction between blood and blood vessel wall'.4 The ASH therefore defines two types of haematologists: doctors who specialise in the clinical and laboratory aspects of haematology, and doctors who specialise in laboratory aspects. The ASH curriculum4 is intended for the former group but does not emphasise practical competency in laboratory haematology, which it presumably leaves to pathologists.5 The European Hematology Association (EHA), while maintaining the ASH definition of haematology, emphasises that a haematologist should have both clinical and technical laboratory competences6 and defines technical competence as the ability to carry out specific laboratory tests independently. However, the EHA acknowledges that European countries vary in terms of the profile and definition of a haematologist, with some countries considering haematopathology as part of haematology and others considering it a different specialisation.6 In the UK haematopathology is part of haematology and is not a separate specialisation.7
Some training institutions in South Africa may interpret clinical haematology according to the ASH and others may interpret it along the UK lines. The former institutions may believe that the 1 year of laboratory training in clinical haematology is not enough for physicians to achieve the competencies of a haematopathologist, while the latter institutions may provide physician clinical haematology trainees with laboratory rotations that provide graduated responsibilities including laboratory medicine calls.
Yohannie Billy Mlombe
College of Medicine
University of Malawi
1. Health Professions Council of South Africa. Medical and dental regulations. http://www.hpcsa.co.za/downloads/medical_dental/Regulations/R.590_of_29_june_2001.pdf (accessed 31 January 2010). [ Links ]
2. College of Physicians: CMSA. http://www.collegemedsa.ac.za/Documents/doc_85.pdf (accessed 31 January 2010). [ Links ]
3. College of Pathologists: CMSA. http://www.collegemedsa.ac.za/Documents/doc_76.pdf (accessed 31 January 2010). [ Links ]
5. Smith BR, Wells A, Alexander CB, et al. Curriculum content and evaluation of resident competency in clinical pathology (Laboratory Medicine): a proposal. Clin Chem 2006; 52: 917-949. [ Links ]
6. European Hematology Association. European Hematology Curriculum/Passport. http://www.ehaweb.org/eha/media/files/education/european_hematology_curriculum_passport (accessed 31 January 2010). [ Links ]
7. A Career in Haematology. BMJ Careers. http://careers.bmj.com/careers/advice/view-article.html?id=20000625 (accessed 31 January 2010). [ Links ]