How to become a haematologist
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m240 (Published 31 January 2020) Cite this as: BMJ 2020;368:m240
Haematologists diagnose and manage disorders of the blood and bone marrow. The specialty uniquely combines both clinical and laboratory practice. This dual role provides an opportunity to combine clinical skills with cutting edge science in order to make a diagnosis, choose the best treatment plan, and monitor a patient’s progress.
Entry requirements
The first step to becoming a haematologist is to complete a medical degree followed by two years of foundation training. The next step is a core training programme, and here there are three options: internal medicine training (IMT) stage 1 (which replaced core medical training from 2019)1; acute care common stem—acute medicine (ACCS-AM)2; and level 1 paediatric training.
Trainees on the IMT pathway can apply to enter specialty training in haematology after completing two years and passing the Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP (UK)) examination. The ACCS-AM pathway takes three years and trainees must also pass the MRCP (UK) examination. The paediatric pathway also takes three years and trainees will then have to pass the membership examination for the Royal College of Paediatrics and Child Health.3
All applications for haematology training go through South West Severn deanery.4 Specialist training in haematology normally takes five years if training full time. There are a few training programmes with a paediatric haematology focus which may be particularly suitable for those who have come through paediatric training.
In the first year of specialist training, trainees are given an introduction to laboratory aspects of haematology and the presentation and management of haematological disorders. After this, trainees gain practical experience in blood transfusion, paediatric haematology, and general haematology, such as the investigation of anaemia, haematological malignancy, haemostasis, and thrombosis. When on call, trainees may be asked to respond to a haematological problem in any aspect of the subject—transfusion and coagulation problems are particularly common out of hours.
A new curriculum for haematology is to be implemented in 2020, subject to General Medical Council approval. The consultation has now closed but the draft curriculum is available from the Joint Royal Colleges of Physicians Training Board website.5
In order to complete training, the doctor will have to demonstrate they are capable of unsupervised practice in seven specialty capabilities in practice (CiPs, see box 1) as well as the six general CiPs common to all physician specialties (see box 2). The trainee can then be recommended to the GMC for the award of certificate of completion of training.
Speciality capabilities in practice
Providing a comprehensive haematology laboratory service, including investigation, reporting, and blood transfusion
Providing safe clinical advice to colleagues on interpretation of haematology laboratory results, blood transfusion practice, and haematological disorders
Managing patients with suspected or known haematological disorders in the outpatient setting
Managing patients in an ambulatory or day unit environment including specialist haematological treatments
Managing inpatients with haematological conditions and providing continuity of care to haematological inpatients
Managing acute haematological emergencies in all environments
Managing end of life and palliative care skills
Generic capabilities in practice
Able to function successfully within NHS organisational and management systems
Able to deal with ethical and legal matters related to clinical practice
Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour, and professional judgement
Is focused on patient safety and delivers effective quality improvement in patient care
Carrying out research and managing data appropriately
Acting as a clinical teacher and clinical supervisor
Examinations
Trainees need to pass parts 1 and 2 of the Fellow of the Royal College of Pathologists (FRCPath) in haematology. FRCPath part 1 in haematology aims to determine whether you have successfully acquired a core body of knowledge that will underpin your ability to practise in haematology. FRCPath part 2 in haematology is designed to test your practical skills and understanding, and show that you can apply your expertise appropriately and safely.
The part 1 examination will usually be taken after three years of specialist training. Part 2 is usually taken by the end of ST7. More information on the exams can be found on the Royal College of Pathologists website.6
Flexibility of training
It may be possible to transfer into haematology from other specialties. The level of transferable experience will be judged on a case by case basis. Transferring out of haematology is also possible as there will be many transferable skills. Specialties that share competencies with haematology include clinical and medical oncology, immunology, internal medicine, paediatrics, and palliative care. Trainees may also choose less than full time training programmes.
Getting in
In order to demonstrate an interest and develop practical skills in haematology, medical students should try to attend relevant conferences, undertake a placement in haematology, or undertake a student selected module or project in haematology. Foundation trainees should make contact with a local haematology department and aim to get a rotation in haematology. Specialist trainees should try to undertake a relevant research project and try to get some work published and present at conferences.
Medical students, foundation trainees, and core medical trainees can join the British Society for Haematology for free as associate members.7 Specialist trainees can join through a discounted membership. Medical students and trainee doctors can also apply for membership of the Royal College of Pathologists.8