Histocompatibility and Immunogenetics
The examination assesses whether trainees in Histocompatibility and Immunogenetics (H&I) have acquired the requisite highly specialised scientific knowledge, clinical skills, laboratory skills and attitudes required to:
- Advise on donor/recipient compatibility for transplantation
- Provide a risk assessment for transplantation in relation to H&I factors
- Advise on the relevance of HLA type to disease diagnosis and patient management.
- Provide H&I related advice relevant to the treatment of patients with blood products.
- Professionally direct a diagnostic H&I laboratory service.
The purpose of the Part 1 examination is to determine whether a trainee has successfully acquired the core body of knowledge and basic skills that underpin the ability to practise in H&I and continue training to consultant level, encompassing fundamental concepts of Histocompatibility, Immunogenetics and the principles of diagnostic and therapeutic H&I. The standard that the candidates will be expected to achieve in this assessment will be commensurate with having completed 5-6 years in post for science graduates. Most candidates will have gained state registration in H&I, and will have a further 2 years of clinical practice in H&I. For medically qualified candidates, Part 1 will normally be taken after a minimum of 3 years’ training in an H&I laboratory which will include 2 years of higher specialist training.
The training programme will follow in detail the components outlined in the H&I curriculum, with candidates expected to be working through the components of the training log. Training will take place in clinical H&I laboratories supporting organ and haematopoietic stem cell transplantation programmes and blood transfusion services. Practical experience at the bench and experience in clinical liaison must be gained in all aspects of clinical H&I. It may be necessary to receive training in laboratories other than that in which the candidate is employed to receive sufficient breadth of clinical experience.
Format of the examination
The Part 1 examination comprises a written examination.
There are two three-hour written papers: Paper one comprises essay and short notes questions and paper two comprises short answer questions (SAQ). Answers are required for four out of six questions for the first paper, unless otherwise stated and the second paper will cover 20 compulsory strucutred short answer questions. The questions will examine the clinical aspects and effective delivery of diagnostic H&I services across a broad spectrum including solid organ transplantation, haematopoietic stem cell transplantation, blood transfusion and immunogenetics of disease. Candidates will be questioned on their knowledge of scientific principles underpinning the practice of clinical and diagnostic H&I. No special papers will be set for non-medical candidates.
Standards and marking methods
The questions are set and agreed by a Panel of Examiners. Candidates’ answers will be marked against standardised marking plans which specify minimum criteria for achieving a pass grade.
Paper one (essay paper) is marked using a ‘closed’ marking system that uses a limited range of marks as follows.
Mark awarded Category
15 (maximum) Excellent pass
14 Clear pass
12 Borderline fail
11 Clear fail
10 (minimum) Bad fail
Two examiners mark the written papers independently. Their marks for each question are averaged and the average marks for each of the four questions are totalled. Candidates are advised to try to obtain an average mark of about 13 per answer, i.e. to manage their time across all four answers per paper and to try to give relevant, informative and balanced answers to each question attempted.
Paper two (SAQ) is criterion marked against model answers. Marks are only awarded for information required by the question. No marks are available for additional material. If a defined number of facts are requested (e.g state two causes of….), only that number of responses will be marked (e.g. Answer – correct cause, incorrect cause, correct cause, will only receive one out of two marks).
Examiners will be looking for key concepts in these answers and no marks will be awarded for extra information. Candidates should practise writing short, concise ansers, which include only the information requested. Candidates who write unnecessarily long answers are likely to penalise themselves because these answers waste time.
The mark allocation for each part of each question will be stated in brackets within the question paper.
Two examiners also mark the SAQ papers. A standard setting (modified Angoff) procedure is used to determine the notional pass mark and enable appropriate scaling before aggregation with the marks for paper one.
The two papers carry equal weight. The pass mark for each paper is 50 and marks in excess of 50 from one paper can compensate for a slight underperformance on the other paper, provided the score is 48 or above. A total of 47.5 marks or below for one paper results in failure of the examination. If the marks awarded by the pair of examiners result in different outcomes (i.e. pass, fail, borderline) the scripts will be moderated by a further examiner.
The purpose of the Part 2 examination is to provide quality assurance that a trainee who has successfully completed the objective-based curriculum in H&I is able to practise as an independent specialist in H&I.
Part 1 is a pre-requisite for Part 2 and candidates will not normally sit the Part 2 examination until 12 months after passing the Part 1 examination. For medical candidates, the Part 2 examination will normally be taken after a minimum of 5 years’ recognised training including 4 years of higher specialist training. For science graduates, the Part 2 examination will normally be taken after a minimum of 8 years training after gaining the degree entry qualification. State registration (or an equivalent qualification from overseas) is a mandatory requirement..
The training programme will follow in detail the components outlined in the H&I curriculum, with formal assessment of the Training Log. The trainee should extend the knowledge and experience gained during the training period for the Part 1, and thus accumulate advanced clinical, technical, scientific and managerial skills required to direct a diagnostic H&I laboratory. It is usually at this stage that candidates will need to complete the written option required for the Part 2. However, candidates may have started research work earlier in their training, which could provide a topic for the thesis or dissertation. By extension of such research, they may acquire an MD or PhD, which can be presented for the Part 2 examination. This period is also the appropriate time to develop special expertise in a particular area of H&I, e.g. solid organ transplantation, HLA-specific antibody definition, haematopoietic progenitor cell transplantation services etc. Candidates choosing to submit a dissertation, a casebook or a research thesis as part of a professional doctorate as their Part 2 written component are strongly advised to seek advice from the College on their chosen subjects before proceeding. Overseas candidates will have their training programmes assessed individually
Format of the examination
The scope of the examination
To successfully complete the Part 2 examination candidates must demonstrate a level of competence and professional maturity appropriate for independent practice as a consultant.
Format of the examination
Candidates must undertake one of the written options and a practical and oral examination. These examinations may be taken in any order.
Candidates who have passed the Part 1 practical examination will not be required to sit the Part 2 practical examination. Candidates who have passed the Part 1 written examination only will proceed to the Part 2 practical and oral examination.
For candidates who passed the Part 1 practical examination, the option of taking the Part 2 oral only will be available until 2020.
The written component of Part 2 will be one of the following options
1. a PhD/MD thesis, normally completed during the training period
2. a series of refereed, published papers (or in press)
3. a dissertation, which must extensively cover an aspect of histocompatibility and immunogenetics at an advanced level. This option should be applicable to candidates whose PhD thesis subject does not fall within specific areas of Histocompatibility and Immunogenetics. Candidates choosing this option are strongly advised to seek advice on their chosen subject before proceeding.
4. a casebook, which must be a comprehensive work to an advanced level. The casebook should consist of 7-8 cases with a total length, excluding references, in the range of 14,000-20,000 words. The reports should be of a quality fit for peer-reviewed publication. Cases should be selected to cover the main areas of clinical practice, including solid organ transplantation (renal, cardiothoracic, pancreas, pancreatic islet cells, liver), haematopoietic stem cell transplantation, blood transfusion and immunogenetic testing (including HLA typing as an aid to disease diagnosis). A clinical audit should also be included as one case. Candidates choosing this option are strongly advised to seek advice on their chosen subjects before proceeding.
5. A research thesis completed during study for a professional doctorate. The subject and content of the research project must be approved as relevant to H&I and candidates are strongly advised to seek advice on their project proposal before proceeding if they intend to submit the thesis as a Part 2 written option.
Instructions for the written component of the Part 2 examination
Candidates who wish to present written work (published papers, dissertations, doctorate theses, casebooks) should read carefully the generic guidelines published by the college under the heading Guidelines for candidates undertaking written options for the Part 2 examination in the Regulations and Guidelines on the Exams section of the college website (www.rcpath.org/exams). Candidates submitting publications should note that the quality of the publications and the candidate’s contributions to the research work will be the determining factors. As a guideline, a minimum of three publications (not unrelated case reports) with the candidate as the first author would be required. With multi-author publications, proportionately more publications would be required, the number depending upon the extent and significance of the contributions made by the candidate. Although candidates may wish to undertake project work relevant to the Part 2 before passing the Part 1 examination, the finished project may not be submitted as an option for the Part 2 until after success in the Part 1. Candidates do not need to have passed the written option before proceeding to the Part 2 practical and oral examination but are strongly encourage to have had their proposal approved.
The practical examination is held over 1 day and will concentrate on analytical and interpretive skills along with basic clinical interpretation of H&I data. The practical examination is designed to assess all aspects of clinical H&I laboratory practice including interpretation of HLA typing and HLA antibody identification data, donor selection and assessment of donor compatibility. Case studies and interpretation of laboratory data, together with statistical manipulation, will usually be provided.
Standards and marking
The questions will be designed to test laboratory, interpretative and clinical competencies commensurate with completion of the training requirements for the Part 2examination. The papers will be agreed by a Panel of Examiners and an outline marking plan prepared for determining the standard required for a passing grade. The pass mark in the practical examination is 50% of the total marks assigned to all the questions. Parts of questions may be allotted different marks according to time expected to complete the answer. The candidate’s answers will be marked by two examiners.
Communications skills are essential for Consultant Clinical Scientists in H&I and it is important that trainees develop their clinical liaison skills to enable them to offer appropriate clinical advice to their colleagues and to think through the consequences of their advice for patient management. The oral examination will assess these skills, in addition to the candidates’ knowledge of laboratory management and management structures, budgetary control, audit, health and safety at work, quality assurance and training. Examiners will also require candidates to show that they are aware of recent developments and scientific advances in the field, as well as new technologies. The oral examination in H&I will last for 60 minutes. It will be immediately preceded by a 30 minute period, during which the candidate will have the opportunity to examine material relevant to the practice of H&I. This material may include clinical case histories, laboratory reports and quality assurance data. During the first part of the oral examination, the candidate will be asked to discuss this material in order to assess his/her ability to deal with specific problems and provide practical advice to colleagues. The rest of the oral examination will be used to assess the candidate’s knowledge of basic and applied aspects of H&I, including laboratory management, audit, accreditation, training and clinical governance. Candidates will need to demonstrate a level of competence appropriate for independent practice at consultant level and to show familiarity with current scientific advances in the specialty and cognate disciplines. The oral examination lasts 60 minutes and is conducted by two examiners. It is structured and predefined under following categories:
Segment one: three seen clinical case scenarios; assessing clinical liaison, ethical issues, therapy and complications.
Segment two: questions relating to: quality assurance, laboratory safety /accreditation /audit / management and questions relating to fundamental H&I and recent advances.
50% pass marks must be achieved in both segments of the viva.