Do the people making the decisions on transfusion have enough education and training to be able to do so efficiently and well? If not, how do we fix it? Dr. Rich Haspel is here to help us answer both questions!
It’s 2 am. A patient with a GI bleed needs a red blood cell transfusion, but is confused by some of the scary-sounding language on the transfusion consent form about possible complications. The charge nurse calls the internal medicine resident on duty, who feels a lump in her throat as she walks into the patient’s room. “I hope that I know how to answer this question,” she thinks…
The next day, while an 80 year old male with acute leukemia is getting a platelet transfusion, he begins to feel short of breath. The nurse overseeing the transfusion asks the hematology fellow, “What do you want me to do next, doctor?” The fellow feels his pulse quicken, and he prepares to give his best answer…
Situations like this are real and occur every single day in hospitals around the world. Many studies have shown a significant lack of basic transfusion medicine training for clinical physicians, and a not-too-surprising accompanying knowledge gap (side note: This issue is one of the main reasons I keep this web site going! I want to help everyone learn the basics of transfusion medicine.). Of course there are exceptions, but generally, clinical physicians don’t know all we wish they did.
Today’s guest, Dr. Rich Haspel, worked with the BEST Collaborative to try to formally define the issue using the first validated transfusion medicine exam and survey, and he is here to share details on what he found. The results won’t surprise you (there’s a gap), but the thing I like most is that Dr. Haspel is passionate about changing the situation, and he will give us tips on how to use the exam to make things better in your hospital or in your own clinical practice. Please check out the references below, and write to Dr. Haspel to get a copy of the exam yourself!
I admit, I am a little worried about how this episode will be received by my clinical friends. No one likes some pathologist suggesting they don’t know enough! I hope the message here is clear, though: We share this data respectfully, and we understand that you can’t know what you’ve never really been taught! Through targeted early education and interaction with transfusion medicine professionals who care, I believe we can improve this situation, and quickly!
Dr. Haspel received his Bachelor of Science degree from Stanford University, his PhD in Molecular Cell Biology from Rockefeller University, and his MD from Cornell University. He completed an internship in medicine and a residency in clinical pathology at Brigham and Women’s Hospital in Boston. He received his fellowship training in transfusion medicine at Massachusetts General Hospital. He is currently a transfusion medicine physician, Medical Director of the Stem Cell Processing Laboratory, and the Director of Medical Education in the Department of Pathology at Beth Israel Deaconess Medical Center, and an Associate Professor of Pathology at Harvard Medical School. Dr. Haspel’s academic focus is on medical education. He has received NIH funding to facilitate the work of a national committee in developing a genomics curriculum for pathology residents. He has also led international studies to evaluate internal medicine resident and hematology fellow transfusion medicine knowledge using a validated survey and exam.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Haspel nor I have any relevant financial disclosures.
Note: You can (and should) email Dr. Haspel to get your very own copy of the exam we discuss in this episode. His email address is published in the first three articles listed below, but for privacy purposes, I’m not putting it directly on the page.
- Article describing development of the validated exam and survey: Haspel RL et al. Development of a validated exam to assess physician transfusion medicine knowledge. Transfusion 2014;54:1225-1230. Also see a video about this article on TransfusionNews.com.
- First use of the exam (medicine residents): Haspel RL et al. Internal medicine resident knowledge of transfusion medicine: results from the BEST-TEST international education needs assessment. Transfusion 2015;55:1355–1361.
- Second use of the exam (hematology trainees): Lin Y et al. BEST-TEST2: Assessment of hematology trainee knowledge of transfusion medicine. Transfusion 2016;56;304–310.
- Article describing the state of transfusion medicine education in US medical schools: Karp JK et al. Transfusion medicine in American undergraduate medical education. Transfusion 2011;51:2470-2479.
- Report of use of the BEST-TEST to evaluate educational curriculum: Lin Y et al. Evaluation of “Transfusion Camp,” a postgraduate transfusion medicine education program using the BEST-TEST knowledge assessment tool. Transfusion 2015;55:2049-2051.