How we approach: Training pediatric coagulationists

Abstract

Unique expertise is required for the care of children, adolescents, and young adults with bleeding and clotting disorders. A number of Hemophilia Treatment Centers have developed pediatric hemostasis and thrombosis fellowship programs to facilitate subspecialty training and recruitment and retention in this field. This manuscript reviews an approach to training pediatric coagulationists including a description of current programs, sample curriculum, funding sources, and expected outcomes.

Practical considerations and consensus opinion for children’s hospital–based inpatient hemostasis and thrombosis (HAT) consultative services: Communication from the ISTH SSC Subcommittee on Pediatric/Neonatal Thrombosis and Hemostasis

“…practices in pediatric HAT disorders, to foster ongoing competency, 24 and should also provide regular "in-service" education to stakeholder divisions/departments (e.g., hematology, critical care medicine, hospital medicine, neonatology, pharmacy). Patient education is a key component in achieving better patient outcomes.…”

“…Position 4: Leaders of children’s hospital–based inpatient HAT consultative services should offer to their multidisciplinary team members continuous education and training opportunities on evidence‐based best practices in pediatric HAT disorders, to foster ongoing competency, 24 and should also provide regular “in‐service” education to stakeholder divisions/departments (e.g., hematology, critical care medicine, hospital medicine, neonatology, pharmacy) 28 …”

“…Despite these findings, the number of providers trained specifically in pediatric HAT has been recognized as deficient since the mid-2000s. [22][23][24] The required expertise to manage all aspects of pediatric HAT is not readily obtained in a standard pediatric hematology/oncology fellowship. Even with the development of numerous pediatric HAT training programs predominantly in the United States, Canada, and Australia, additional mentored experience is required during the early years of practice in order to independently manage complex HAT disorders in inpatient settings, including among critically ill and postoperative children.…”

“…Even with the development of numerous pediatric HAT training programs predominantly in the United States, Canada, and Australia, additional mentored experience is required during the early years of practice in order to independently manage complex HAT disorders in inpatient settings, including among critically ill and postoperative children. 24 The institution of a standardized and protocol-driven pediatric inpatient HAT service, especially at tertiary care referral centers, could potentially alleviate many of these issues, but there are limited pediatric data to support such protocols. Many patient populations would benefit from a standardized inpatient HAT service approach, which could decrease time to diagnosis; minimize HAT management complications; optimize resource utilization; and limit inter-provider variability in the approach to radiographic imaging, laboratory evaluation, medical management, education, and transition of care to the outpatient setting for patients with HAT complications.…”

“…Despite these findings, the number of providers trained specifically in pediatric HAT has been recognized as deficient since the mid‐2000s 22–24 . The required expertise to manage all aspects of pediatric HAT is not readily obtained in a standard pediatric hematology/oncology fellowship.…”