Division of Clinical Chemistry

Education and Residency Program of the Clinical Chemistry Division

General Description

The goal of the rotation is to introduce the resident to the main technologies of clinical chemistry and to function as a clinical pathologist solving technical, clinical, and administrative problems.

Specific objectives are:

To achieve an understanding of the technology involved
To understand the use and clinical significance of test results
To evaluate quality control results and resolve technical problems indicated by same
To be able to search the literature and resolve both clinical and technical problems that arise during the rotation
To know how to determine the need for a new laboratory test and to set up and evaluate the test for clinical use

Duties and Responsibilities

Daily hands-on professional supervision of different laboratory sections
Deal with all requests from clinicians for laboratory information and interpretations
Participation in on-call schedule in Clinical Pathology
Presentation at staff seminar, technologist in-service seminar, and weekly Clinical Pathology case conference
Participate in morning rounds with a senior staff attending

Teaching Staff

Mohamed A. Virji, M.D., Ph.D.

Description of Rotation

A description of the rotation is presented and explained to the resident on the first day of the rotation (see section 6 below). Briefly, the rotation includes:

A 10-day highly structured rotation that also serves to introduce the resident to each staff person and the basic laboratory technology used in Clinical Chemistry
A 6-l0 week rotation during which the resident takes responsibility for managing one or more laboratory sections (testing, QC, personnel, etc.). All problems involving patient care are first referred to the resident. During this part of the rotation, the resident may take a number of elective periods that cover specialty areas (both technical and clinical interpretation) that were not covered in the initial rotation. An elective covering a new test evaluation is highly recommended.

Resident Supervision and Evaluation

On initial rotation the material covered each day is evaluated at the end of the day with the professional staff person involved. Elective rotations are similarly evaluated. The resident has a daily conference with the senior staff person responsible for the section which the resident is currently taking. Deficiencies are handled in these daily conferences. No written evaluation is done until the resident has completed his/her rotation.

Instructions and Guidelines for Residents in Clinical Chemistry

Technical Procedures

The resident will have approximately 10 working days to rotate through most of the sections of the Clinical Chemistry laboratory. During this time, the major technologies used in clinical chemistry will be presented. For each block you will have a study outline and a recommended reading list. The reading includes material from selected texts, material in the lab manuals, and important references. You should contact the listed professional staff at the beginning and end of each day, to assure that all the material is properly covered.

Laboratory Project (Elective)

A large part of the work of the clinical pathologist in this area relates to planning, evaluation, and implementation of new methods and equipment. While a clinical laboratory project is not mandatory for all residents, it is highly recommended that you select this elective if you expect to be responsible for a hospital clinical laboratory service. The main objective of this experience is to learn how to solve laboratory problems in this field. During initial rotation (see above), the professional staff will present to you some possible projects that will form the basis of this elective. The project that you select can be either clinical or experimental. Once you have identified a project, you will be assigned to work with a member of the professional staff, who will help guide you through the project.

Service

Supervision of a Section: You will be responsible for supervising a section of the laboratory, interposing yourself between the section supervisor and the responsible professional. All routine operations in the section will be your responsibility; the professional staff person will be your attending and review dally activities with you.
Clinical Consultation: The laboratory supervisors will forward all clinical problems to you and other residents or fellows on the service. You will have an opportunity to resolve the problem yourself, or consult with appropriate professional staff. The purpose of this duty is to provide you with experience in handling the usual kinds of questions that arise from physicians and nurses on the clinical units.
Morning Rounds: Morning rounds occur between 8:30 - 9:30 a.m., covering problems that have occurred in the previous 24 hours. Normally fellows and the on-call pathologist will round with you.
Selectives: A list of selected laboratory analyses will be given to you, covering various types of experience in Clinical Chemistry. Since it is impossible to cover all of Clinical Chemistry in 2-3 months and do a project, you will have to select topics that best fit your goals and background. These should be selected with the help and concurrence of your advisor, and should be scheduled to fit in with the work you are doing on your project. Contact the staff person for the selective to schedule time for it. As with the technical procedures, you should contact the listed professional staff at the beginning and end of each day's work. Any adjustments in the teaching material, recommended reading, etc. can be made at these daily conferences.
On-call: You will be on call during your Clinical Pathology rotation, covering any clinical or laboratory problems that arise on the evening and night shifts. Supervisors are instructed to contact the on-call person when problems arise that are not covered by routine laboratory policies. A clinical call notebook has been assembled to summarize most of the problems and suggested solutions. One particular problem that may arise is short staffing. The clinical consequences of this may be either increased turnaround times or possible errors from technical staff being pushed beyond a reasonable workload. The supervisor usually can make some recommendations on how to handle the situation, based upon prior planning and shifting of workload and work assignments. You must realize that by approving a particular solution, you are accepting the responsibility for that solution. So be aware of the clinical consequences of any approved course of action.

Conferences

Morning Rounds: Morning rounds take place daily, from 8:30 - 9:00 a.m. covering Laboratory problems of the previous 24 hours. Check with either the fellow or on-call pathologist for starting time and location.
Clinical Pathology Case Conference: There is a weekly clinical pathology case conference on Tuesday at 3:00 p.m. This is a resident conference. Residents are required to present a brief case or lab problem that has occurred in the past week. Five to 10 minutes are sufficient.
Clinical Pathology Lecture Series: There is a weekly clinical pathology lecture, covering most topics in clinical pathology over a two-year cycle. The Chemistry staff will present basic material in this field at these lectures and will not expect to repeat this again during the resident's rotation in Clinical Chemistry. You are advised to attend this lecture series.
Clinical Chemistry Scientific Conference: The professional staff has a weekly scientific conference on Thursday at 2:00 p.m. The format for this is open, using cases, research, literature, etc. Each resident will be expected to present at one conference during the rotation.
In-service Education: Education of technologists is an important part of running a laboratory. These conferences are give one to two times a month. Residents will be expected to present once during their rotation. We have available (see secretaries) some readings and- slides that cover a number of topics useful for in-service education.
Project Report: If you work on a laboratory project, the last Thursday scientific conference during your rotation will be used for presentation of your work.

Competency and Evaluation

The Chemistry staff is responsible for evaluating your knowledge and performance in clinical chemistry, in particular your knowledge about analytic methods and instrumentation (analyses), your knowledge on the clinical and your knowledge of laboratory management. Enclosed is a specific list defining in detail each of these knowledge areas and the professional staff person responsible for evaluating your knowledge in each topic. Sometime before the end of your rotation you should plan on meeting with each of the listed staff who will then evaluate your knowledge in the listed areas. When you have demonstrated your competency in a specific area, the box will be checked off as completed by the evaluator.

Any areas not checked off will be listed as incomplete in your final evaluation and forwarded to the residency director's office, with the recommendation that you should return to Clinical Chemistry at some future time to finish your Clinical Chemistry rotation. Your Chemistry rotation will be considered incomplete until competency has been demonstrated in all listed topics. The Chemistry staff is fully aware that this is a large amount of material to cover in the time allotted for this rotation. Your objective, however, should be to develop competency in as many areas as possible during your rotation to minimize the amount of material that has to be covered in a follow-up Chemistry rotation.

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