Specific Standards of Accreditation for Residency Programs in Pediatric Hematology/Oncology

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1 Specific Standards of Accreditation for Residency Programs in Pediatric Hematology/Oncology INTRODUCTION 2009 A university wishing to have an accredited program in Pediatric Hematology/Oncology must also sponsor an accredited program in Pediatrics. The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in Pediatric Hematology/Oncology. This document should be read in conjunction with the General Standards of Accreditation, the Objectives of Training and the Specialty Training Requirements in Pediatric Hematology/Oncology. STANDARD B1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. STANDARD B2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for Pediatric Hematology/Oncology are outlined in the Objectives of Training and the Specialty Training Requirements in Pediatric Hematology/Oncology. Based upon these general objectives each program must develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. STANDARD B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in the subspecialty. The structure and organization of each accredited program in Pediatric Hematology/Oncology must be consistent with the specialty training requirements as outlined in the Objectives of Training and the Specialty Training Requirements in Pediatric Hematology/Oncology. This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2009 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: For questions regarding the use of this document, please contact: Page 1 of 6

2 Residents must be provided with increasing individual responsibility, under appropriate supervision, according to their level of training, ability and experience. In addition to offering the components noted in the specialty training requirements, all accredited programs in Pediatric Hematology/Oncology should offer community-based learning experiences. STANDARD B4: RESOURCES There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Royal College specialty training requirements. In those cases where a University has sufficient resources to provide the training in Pediatric Hematology/Oncology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited Pediatric Hematology/Oncology residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to Pediatric Hematology/Oncology. 1. Teaching Faculty The teaching staff must include a sufficient number of Pediatric Hematologists/Oncologists, with acceptable qualifications, based at the primary teaching site. These individuals must devote sufficient time to the program to ensure adequate teaching and to provide critical evaluation of the progress and competence of the subspecialty residents. The spectrum of expertise must include pediatric hematology, pediatric oncology, and pediatric hematopoietic stem cell transplantation. There must be at least one Pediatric Hematologist/Oncologist who is familiar with the management of infants, children and adolescents with cancer, including use of relevant chemotherapy drugs and their toxicities. In addition to pediatric subspecialists (including Cardiology, Critical Care, Emergency Medicine, Endocrinology, Gastroenterology, Infectious Diseases, Nephrology, Neurology and Respirology), appropriate consultants must be available in Anesthesiology, Dermatology, Diagnostic Radiology, Pain and symptom management, palliative care, pathology, pediatric surgical specialties, Physical Medicine and Rehabilitation, and Radiation Oncology. Residency education must take place in the context of multidisciplinary teams made up of pediatric nurses, social workers, psychologists, pharmacists and other allied health professionals committed to the care of the child and adolescent with cancer or nonmalignant hematologic disorders. The Pediatric Hematology/Oncology service should be under the direction of a recognized specialist in Pediatric Hematology/Oncology. Page 2 of 6

3 2. Number and Variety of Patients The number and variety of patients available to the program on a consistent basis must be sufficient to meet the educational needs of the residents. The clinical experience must involve patients who have a broad variety of hematology and oncology problems that should include but not be limited to the following categories: hematologic and oncologic disorders of the newborn hemoglobinopathies including sickle cell and thalassemia syndromes inherited and acquired disorders of the red blood cell membrane and of red blood cell metabolism and other anemias inherited and acquired disorders of white blood cells hemophilia, von Willebrand disease, and other inherited and acquired coagulopathies platelet disorders, including idiopathic thrombocytopenic purpura (ITP) and acquired and inherited platelet function defects congenital and acquired thrombotic disorders congenital and acquired immunodeficiencies leukemias, both acute and chronic lymphomas bone tumors organ and soft tissue tumors central, peripheral and sympathetic nervous system tumors bone marrow failure syndromes long-term transfusion therapy bone marrow reconstitution including use of allogeneic peripheral blood stem cells and umbilical cord blood graft-versus-host disease dying patients patients in pain 3. Clinical Services Specific to Pediatric Hematology/Oncology There must be integrated involvement with multi-institutional clinical trials and regularly scheduled multidisciplinary pediatric tumour board meetings. Pediatric Hematology/Oncology services must have active participation by designated individuals providing such services as nutritional counselling and psycho-social support. 3.1 Patient Services Space in an ambulatory setting must be provided for optimal evaluation and care of patients, including facilities for outpatient chemotherapy and transfusions. There must also be an inpatient area with a full spectrum of pediatric and related services staffed by some combination of pediatric residents/clinical assistants (associates)/clinical nurse specialists (nurse practitioners) and faculty. The program must be able to provide sufficient isolation of patients from airborne pathogens. The program must have a mechanism for ensuring long-term follow-up of successfully treated patients, either at the original treatment center, or by a specialist who is familiar with the potential long term adverse effects of treatment for childhood cancer. Page 3 of 6

4 3.2 Laboratories The program must have a hematopathology laboratory able to perform current testing for accurate diagnosis and monitoring, including: general hematology testing blood and bone marrow examination thrombosis and hemostasis testing a blood bank with the capability to perform red blood cell antigen typing, antibody screening and provision of blood components and coagulation concentrates, and to provide appropriate testing of blood and blood products including irradiated, safe (e.g. leukodepleted, CMV antibody negative) blood components. The program must have access to specialized laboratories capable of assaying redblood-cell enzymes, identifying unusual hemoglobins, performing human lymphocyte antigen typing, immunophenotyping of leukemia blast cells, performing flow cytometry, performing cytogenetic analysis, and identifying complex congenital and/or acquired hemostatic abnormalities. The principal training institution should have available the diagnostic services of a clinical chemistry laboratory with the capability to monitor patients, including timely access to antibiotic and antineoplastic drug levels; microbiology, immunology, cytogenetics, and molecular genetics. 3.3 Diagnostic imaging There must be radiologists with specific expertise in the diagnostic imaging of infants, children and adolescents. The program must have ready access to diagnostic imaging equipment including that required to perform computed axial tomography, magnetic resonance imaging, ultrasonography, radionuclide imaging, and angiography. 3.4 Consultation The program must provide residents with the opportunity to obtain experience in the provision of a consultant service in pediatric hematology/oncology to primary care physicians and other specialists. 3.5 Pain control There must be meaningful access to health professionals experienced in pediatric pain control. 3.6 Resources for Community Learning Experiences There must be an appropriate experience in communicating with primary care physicians of children/adolescents with cancer and serious blood diseases, and with health care professionals in satellite pediatric oncology centres. 3.7 Radiation Oncology There must be a radiation oncologist familiar with the treatment of infants, children and adolescents. The program must have radiation therapy equipment able to deliver current treatments for infants, children and adolescents. 3.8 Surgery There must be surgeons with expertise in Pediatric General Surgery and in Page 4 of 6

5 Neurosurgery, Urology, Ophthalmology, Otolaryngology, Plastic Surgery, Gynecologic Surgery, Cardiac Surgery and Orthopedic Surgery. 3.9 Pathology There must be an experienced pediatric pathologist with special training in the pathology of the tumors of infants, children and adolescents and who is a member of the multidisciplinary team at the pediatric cancer center Pharmacy The program must have a pharmacy capable of accurate and well-monitored preparation and dispensing of antineoplastic agents and investigational agents Hematopoietic Stem Cell Transplantation Programs must either have a hematopoietic stem cell transplantation program or have an inter-university agreement for this component of the program Genetic Counselling The program must have access to expert genetic counselling Research Adequate resources must be available for proper mentoring and encouragement of research endeavors on behalf of the resident. Adequate space and facilities for data analysis and statistical analysis must be available to both faculty and residents. 4. Supporting Services Clinical, Diagnostic, Technical The program must have expertise in and facilities capable of timely preparation of parenteral and other supplemental nutrition for infants, children and adolescents. STANDARD B5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENTS OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfill all of the CanMEDS Roles of the specialist. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside, in clinics or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B5 in the General Standards of Accreditation, the Objectives of Training, the Subspecialty Training Requirements in Pediatric Hematology/Oncology and the CanMEDS Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS Roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert Page 5 of 6

6 2. Communicator 3. Collaborator 4. Manager In addition to the General Standards of Accreditation, the following requirements apply. The program must provide the opportunity for residents to complete ongoing horizontal activity in critical practice evaluation relevant to the objectives of Pediatric Hematology/Oncology. The resident must be progressively entrusted with the management of in-patients and ambulatory patients, including the most complex problems in Pediatric Hematology/Oncology. 5. Health Advocate 6. Scholar In addition to the General Standards of Accreditation, the following requirements apply. A formal program providing instruction in research methodology, statistics and epidemiology must be offered through the affiliated university or equivalent. 7. Professional STANDARD B6: EVALUATION OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of evaluation data on each resident enrolled in the program. Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard. Adopted - Education Committee - February 2003 Revised SSRC June 2009 Page 6 of 6

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