Although there are several books on PTM,21–23
the development of a validated PTM curriculum serves to refine the content for teaching clinical pathology trainees and potentially other target learner groups (e.g., pediatricians, pediatric hematologist-oncologists, other pediatric subspecialists, participants in continuing medical education, and trainees outside the USA). Residency programs may find it easier to include this set of objectives to complement available text resources. In addition, a defined curriculum can be periodically up-dated by interested parties as the field advances through new studies and technologies. Given the limited number of PTM experts, a curriculum would serve as an educational resource to teach the important issues of the field where local PTM expertise is unavailable and/or where there are few pediatric cases in a hospital transfusion service.
Recently, several groups have produced training documents related to transfusion medicine. The Academy of Clinical Laboratory Physicians and Scientists (ACLPS) published a comprehensive clinical pathology residency training document of which transfusion medicine was a subsection.10
Fung et al. further expanded on the objectives from the ACLPS document and assigned the Accreditation Council for Graduate Medical Education (ACGME) general competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice) fulfilled by each objective.11
Wu et al. provided a blueprint on how to design and implement a TM residency and fellowship training program in the context of the ACGME competencies.12
Together, these resources provide a comprehensive scope of all areas of transfusion medicine. However, the content of a PTM curriculum for teaching clinical pathology trainees has received little attention.
This study identified a clear core set of 23 objectives unanimously considered “very relevant”, and a second tier set of 42 “relevant” objectives. The information derived in this study sets a firm foundation for the development of a curriculum of a magnitude that can be incorporated into a demanding residency program. The methodology used provided a clear direction for the next steps in curriculum development, and both narrowed the objectives considered a priority and eliminated those that might otherwise have been debated. Of the “very relevant” objectives, nine are focused on the topic of Pre-transfusion testing, Product selection, and Indications for special patient populations, and six are related to HDFN (). These topics are clearly important and frequently common reasons for consultation of a TM specialist. The second tier of objectives accepted are related to the following topics: Ethical Issues, Hematopoietic Stem Cell Transplantation (HSCT), Neonatal Alloimmune Thrombocytopenia (NAIT), Neonatal Alloimmune Neutropenia (NAIN), Indications and controversies surrounding use of “special” blood products, and Sickle Cell Disease and Thalassemia. Additional topics did not have broad enough consensus among the experts for content validity and hence, we do not have evidence to include these as part of a core curriculum. However, the curriculum is meant to provide a minimum set of PTM topics and should not be used to preclude individual residency program directors from including the rejected topics as part of their Transfusion Medicine training.
Although 26 new objectives related to the topics of Ethical Issues and Hemostasis were presented in the second survey, only one new objective was accepted by content validity criteria. The purpose of this survey was to further refine the content of a PTM curriculum based on expert feedback. An additional column was provided on the survey for the respondent to mark if the objective was “relevant in advanced curriculum”. Twenty-five of the 39 objectives were marked “advanced” by at least one respondent. As a result, some experts did not rate the objective and thereby this had an impact on the quantitative measurements of content validity. To avoid missing data from respondents, the instructions could have been more explicit. A reason none of the Hemostasis objectives were accepted could be related to the wording or content of the objectives. The content may have been oriented for practitioners who most frequently provide direct patient care and considered not relevant for a clinical pathology trainee. In addition, Hemostasis is a topic that is commonly taught during the coagulation core curriculum or rotation. Training programs should consider evaluating the adequacy of pediatric-related hemostasis objectives in the coagulation core curriculum. Finally, experts tend to have biases towards content that they are more familiar with, but the use of ACIs should have minimized the influences of such biases.
There are several potential limitations in this study. The authors of this paper might have created biases in the way the comprehensive review of existing training documents was synthesized in preparing the survey for expert review. While the comprehensive review included documents from pediatrics, clinical pathology, and transfusion medicine, and the wording of the objectives selected for the survey was left unchanged from the original source, members of the PedsTMAA discussed and removed redundant objectives. Although the survey instructions asked reviewers to rate the objective for a clinical pathology trainee, it is possible that expert’s training background (pathology and/or medical specialty) could have influenced their ratings. The relatively small number of recognized experts in the field limited the survey size. Although Hemostasis and Ethical Issues were suggested by the experts as additional topics for a PTM curriculum, the objectives presented were not widely accepted (). The wording of the objectives may have influenced the expert ratings. The objectives were written by members of the PedsTMAA and may have been unnecessarily detailed for a pathology trainee. Despite these limitations, the methodology used in this study has identified a relevant set of objectives to use in further development of a PTM curriculum. The PedsTMAA group will organize the objectives presented here into several levels of training (e.g., residents, transfusion medicine fellows, and other subspecialists) and write them using appropriate language for objectives so that specific medical knowledge needs of target learners are addressed. With a well developed curriculum, more than knowledge can be addressed and the PedsTMAA group will designate the ACGME competencies fulfilled by each objective once they are embedded in learning materials.