Basic transfusion medicine curricula should cover good clinical use of blood and blood products and the principles of proper implementation of transfusion services during physicians’ specialist training.
Medical students and residents in internal and surgical specialties should have accurate and comprehensive information on the use of blood and blood products. A study by Flausino et al. revealed that young physicians in particular do not have sufficient information on the indications and complications of the use of blood products [4]. O’Brien and colleagues also evaluated the knowledge level of 116 recently graduated physicians on transfusion medicine with standard patient practices and written examination, and emphasized the lack of sufficient information in this field [15]. Only 17% of the residents knew what “TRALI” was (transfusion-related acute lung injury), while none of the residents assistant knew that irradiating blood products would prevent graft-versus-host disease. Similarly, our study demonstrated that medical students nearing graduation generally did not feel competent in transfusion medicine and did not possess basic knowledge about blood transfusion. In our study, almost half of the medical students who were about to graduate believed that febrile nonhemolytic reactions could be prevented by irradiation, and hardly any of the interns knew the universal donor group for fresh frozen plasma (FFP). The deficiency of basic theoretical and practical knowledge of transfusion medicine among these interns, who will work in emergency departments or enter residency programs after graduation, was a finding that warrants concern. Karp et al. advised awareness of this in disciplines where transfusion is practiced frequently during resident training and said that new graduates should also realize that they are not well-equipped for transfusion. We have reached similar conclusions based on our results, and we believe that providing focused education on blood banking and transfusion practices to first-year residents in departments with frequent transfusion procedures will improve patient care and safety [16].
Panzer et al. evaluated transfusion medicine curricula in 14 countries and determined that the content, training methods, duration, and timing of undergraduate transfusion medicine education vary widely between medical schools [12]. In Australia, while there is theoretical training, there are no training programs available to support students' clinical skills. The curriculum has broader content in Israel and is covered as mandatory courses in France. Since transfusion medicine is regarded as a separate area of expertise in Germany, it is included in a separate training module and practical transfusion training is conducted bedside. In the United States, despite the frequent use of blood components and allocation of funds for transfusion medicine training, a standardized curriculum has not been developed [12].
Although there is substantial variability in transfusion medicine education globally, the coverage of transfusion medicine and blood banking in medical school curricula is typically limited and general [13, 15]. In most medical schools, transfusion medicine is covered as a part of bedside clinical training [4].
Since studies revealed the inadequacy of basic and continuing education on transfusion medicine in Brazil, research has focused on the dissemination of accredited transfusion medicine training programs [13, 17].
In African countries, transfusion medicine training has assumed an important place in the fight against AIDS. However, it was observed that physician training in transfusion medicine in most African countries was limited to only 1- or 2-hour courses. This awareness led to the creation and implementation of training programs appropriate to local conditions [13]. Our study revealed that some medical schools in Turkey still allocate only 1 or 2 teaching hours to transfusion medicine.
In their study on transfusion medicine training in developing countries, Eichbaum et al. reported that each country is trying to determine their current situation and to develop training plans to improve local transfusion medicine practices within the framework of its national health policies. [13].
Our study is the most comprehensive study conducted on this topic in our country. For a physician who has graduated from a Turkish medical school, the learning outcomes of the NCEP state that “they should be aware of blood and blood product transfusion complications at the preliminary diagnosis level and should know enough to refer to the relevant specialist after performing the necessary pre-treatment." and "In an emergency, they should have the ability to practice blood transfusions in accordance with the guidelines." However, the result of our study showed that only 15% of final-year students close to graduation had achieved this learning objective. Considering that transfusion complications are urgent and may require life-saving intervention, the ratio of physicians who think that the learning target has been reached is quite insufficient.
The NCEP educational outcome for blood banking states that a graduate of medical school “recognizes complications of blood and blood product transfusion at prediagnosis level’’. In our study, one-third of medical students near graduation stated that they could not determine the prediagnosis. Considering the urgency of potential transfusion-related complications, it is clear that this educational target is not being adequately met.
Similar studies helped identify deficits in transfusion medicine education in Iran. These studies suggested that 80% of Iranian medical schools did not provide effective theoretical and practical transfusion medicine training. In addition, they pointed out the lack of basic education in transfusion medicine, which is needed not only by medical students and general practitioners but also by medical staff. Taking the example of training programs around the world and targeting different levels of education, a training program was adapted to conditions in Iran and was reported to have had a vital role in improving patient safety and reducing the high cost of treatment with blood products [10, 18]
The students participating in the present study evaluated the education in their medical schools as insufficient. These 6-year medical curricula include a total of 0–4 hours of theoretical courses about blood banking and transfusion medicine, with no standardization in terms of which department is responsible for giving the course or the number of course hours. We have argued that 1 to 4 hours of theoretical training during 6 years of education is grossly insufficient for meeting the educational need in blood banking and transfusion medicine and has essentially no educational value. Our findings support this, as there was no significant relationship between receiving theoretical education and the students’ knowledge level or self-perceived competence.
If the current approach provides no educational benefit, the methods, contents, and objectives of the training should be reevaluated and the programs revised accordingly. For example, centralized education was not effective in China, whereas extremely successful outcomes were obtained with locally structured education [13].
An interesting finding in our study was that students receiving practical training scored lower in questions assessing theoretical knowledge. Assuming that the training they received is mostly based on bedside clinical training and mentor-apprentice relationships, this paradoxical result may be attributable to the transfer of inaccurate information and practice. Evaluating the content and delivery methods of these schools’ programs and interviewing lecturers may help identify failures in practical applications. Holding focus group discussions with the students in these schools may also help identify the problem by analyzing it in its natural environment.
In faculties with blood banks, blood centers procuring their own blood products will provide more encounters with blood banking, apheresis procedures, and donors during students’ education, which can have a positive contribution on the education on blood banking and transfusion medicine.
One of the most common practices physicians encounter during their career is the use of blood products. However, we have demonstrated that medical students nearing graduation do not possess even very basic information about the properties of blood products. Lack of this information can lead to make medical mistakes that may result in serious complications. Therefore, we believe that medical school curricula must be revised in terms of blood banking and the objectives and content of medical education.
A lack of knowledge of transfusion medicine among physicians is common to both underdeveloped areas such as Africa, where there are fewer than 100 physicians trained in transfusion medicine per country, and developed nations such as the USA, which has some of the most advanced transfusion medicine training in the world. This clearly demonstrates the need to improve and disseminate transfusion medicine training globally [13].
The best way to reduce adverse events associated with blood transfusion is to decrease the number of unnecessary and noncompliant transfusions. The current curriculum is somewhat limited in terms of the rational use of blood and its components. Establishing regulations targeting the appropriate use of blood products with theoretical and practical training will create better equipped physicians and prevent many complications and unnecessary transfusions.