Division of Hematology and Hematologic Malignancies and Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA.
Division of Hematology and Hematologic Malignancies, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Blood Adv. 2023 Jul 11;7(13):3244-3252. doi: 10.1182/bloodadvances.2023009843.
Graduate medical education training in hematology in North America is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Trainees routinely review peripheral blood smears (PBS) in providing clinical care. Competency in PBS review at graduation is required by the ACGME. However, there are no consensus guidelines on best practices surrounding PBS review, education, or competency. We describe the generation of proposed theory and the consensus recommendations developed through a multi-institutional focus group, developed using constructivist grounded theory and a modified nominal group technique. Eight academic hematologists, spanning classical and malignant hematology, enrolled and participated in 2 one-hour focus groups. All routinely worked with fellows and half had formally instructed trainees on PBS interpretation. Focus group data were analyzed using mixed-methods techniques. Tenets of emerging theory were identified through inductive coding. Consensus recommendations (CR) were generated. Participants reviewed CR in an iterative fashion until consensus was reached. Strong consensus was reached on multiple aspects of PBS education. All agreed that trainees should learn PBS review through a systematic approach. Group discussion focused on disorders of red and white blood cells. The diagnoses of acute leukemia and thrombotic microangiopathies were most commonly discussed, with specific emphasis on disorders in which prompt recognition was required to avert significant patient morbidity. These CR offer external validity to future research and curricular development for both PBS review and other visuospatial tasks in medical education.
北美血液学的研究生医学教育培训由研究生医学教育认证委员会 (ACGME) 认证。培训生在提供临床护理时通常会检查外周血涂片 (PBS)。ACGME 要求培训生在毕业时具备 PBS 审查的能力。然而，目前围绕 PBS 审查、教育或能力，没有共识指南。我们描述了通过多机构焦点小组生成的拟议理论和共识建议的产生过程，该小组使用建构主义扎根理论和修改后的名义群体技术开发。八位学术血液学家，涵盖了经典血液病和恶性血液病，参加并参与了两个为期一小时的焦点小组。所有人都经常与研究员一起工作，其中一半人曾正式指导过 PBS 解释方面的培训生。使用混合方法技术对焦点小组数据进行了分析。通过归纳编码确定了新兴理论的原则。生成了共识建议 (CR)。参与者以迭代的方式审查 CR，直到达成共识。在 PBS 教育的多个方面都达成了强烈的共识。所有人都同意，培训生应该通过系统的方法学习 PBS 审查。小组讨论集中在红血球和白血球的疾病上。急性白血病和血栓性微血管病的诊断最常被讨论，特别强调了需要迅速识别以避免患者严重发病的疾病。这些 CR 为未来研究和医学教育中 PBS 审查和其他视觉空间任务的课程发展提供了外部有效性。
