Clinical Chemistry Training and Competencies

Anatomic and Clinical Pathology Residency Program

Purpose

To assure that clinical pathology residents will attain the general competencies in clinical chemistry expected of a new practitioner as defined by the ACGME.

Definition

The trainer is defined as someone who has been selected to perform the training. The trainer may be the M.D. or Ph.D. laboratory director, the Administrative or Technical Specialist, or a Senior Technologist (Med Tech II).

Procedure

For each item listed on the Clinical Chemistry Training Checklist, the trainer will assure that the general competencies (as defined below) are covered when applicable:

Patient Care: Working under the direction of the medical directors of the chemistry section, the resident will be involved in the interpretation of laboratory tests and in clinical consultation and will also participate in quality control and process improvement processes to ensure the provision of patient-focused and cost-effective care. Specifically, the resident will be expected to:

  • Prepare accurate and concise interpretive reports for relevant tests in the chemistry section (protein electrophoresis, immunoelectrophoresis, PTH profiles, sweat tests, other tests as appropriate)
  • Proactively gather essential and accurate clinical information when a pattern of laboratory test results is in question
  • Provide consultation to clinicians regarding selection of the most clinically appropriate and cost-effective laboratory tests and interpretation of abnormal test results
  • Utilize core scientific and medical knowledge with the help of information technology to make informed recommendations for appropriate follow-up tests in these cases
  • Initiate contact and discussion with the clinicians and other healthcare professionals about specimen problems, appropriateness of STAT and esoteric test requests and other issues requiring clinical input from the laboratory
  • Educate fellow (peer) residents in clinical disciplines about the proper use of laboratory tests by participating in morning report and clinical conferences
Method of evaluation:
  • Informed decision making — oral examination
  • Teamwork — questionnaire completed by superiors, peers, and subordinates
  • Performance of quality control and process improvement reviews — checklist

Medical Knowledge: The resident is expected to have the necessary background education in physiology and the pathogenesis of disease to interact competently with clinicians. The resident will become familiar with the basic biochemistry, endocrinology, toxicology and therapeutic drug tests commonly performed in the clinical chemistry laboratory. This will include: clinical utility of tests, disease correlation, clinical significance of abnormal results, recognizing patterns of test results, reference and critical values, understanding the effects of disease, drugs, preanalytical variables on test results, test methodologies and underlying scientific principles, strengths, and limitations. In addition, the resident is expected to demonstrate the ability to research and answer everyday questions from clinicians regarding laboratory testing.

Method of evaluation:
  • Investigative and analytical thinking — oral exam
  • Knowledge and application of basic sciences — oral exam

Practice-Based Learning and Improvement: The resident will develop a systematic approach to the investigation and evaluation of clinically relevant testing and how to make appropriate decisions resulting in improved patient care. This means integrating individual clinical expertise with the best available external clinical evidence from systematic research. To the attain the above goals, the resident is expected to:

  • Proactively seek examples of abnormal, interesting, and unusual laboratory data and correlates this information with clinical diagnosis and disease state via chart review and contact with clinicians
  • Become familiar and proficient with techniques for performing medical literature searches and demonstrate the effective use of these tools
  • Demonstrate ability to efficiently obtain clinical information and laboratory data on patients via the Hospital and Laboratory Information Systems
  • Prepare and present interesting cases to fellow residents and attending laboratory staff in Interesting Case Conferences
  • Actively participate in quality assurance and improvement activities in the laboratory
Method of evaluation:
  • Analyze own practice for needed improvements — multiple choice questions and review of portfolio with mentor
  • Use of evidence from scientific studies — multiple choice questions
  • Application of research and statistical methods — MCQ and global rating
  • Use of information technology — global rating and portfolio review
  • Presentation of interesting cases — personal log and questionnaire completed by superiors, peers, and subordinates

Interpersonal and Communication Skills: The resident will learn how to be effective when exchanging information with other health care professionals. Specifically, the resident must:

  • Demonstrate ability to communicate clearly, effectively, and efficiently, both orally and in writing
  • Demonstrate ability to interact constructively and negotiate effectively with others on issues requiring resolution
  • Demonstrate appropriate utilization of available communication technologies to communicate effectively with others (e.g., voice mail, electronic mail)
  • Demonstrate ability to prepare and deliver effective presentations utilizing a variety of presentation methods (overheads, slides, presentation graphics, and multimedia)
  • Attend and participate in hospital committee meetings as assigned
Method of evaluation:
  • Listening and communications skills
  • Questionnaire completed by superiors, peers, and subordinates

Professionalism: The resident will be expected to show a commitment to ethical principles when carrying out professional responsibilities. He/she will exhibit behavior appropriate to activities of the clinical chemistry section. Specifically, the resident will be expected to:

  • Maintain strictest patient confidentiality with all clinical and personal information: diagnosis, prognosis, test results, etc.
  • The resident demonstrates compassion and empathy in dealing with patients
  • The resident demonstrates respectful behavior toward other healthcare professionals
  • The resident handles himself/herself appropriately when involved in stressful/emotional situations by maintaining self-control and attempting to defuse the situation
  • The resident responds to pager and telephone calls promptly and courteously
  • The resident regularly and punctually attends conferences, meetings, assigned rotations, and other obligations and comes prepared to contribute
  • The resident demonstrates a commitment to professional and personal development by keeping abreast of developments in the medical literature, participating in research projects
Method of evaluation:
  • Questionnaire completed by superiors, peers and subordinates.

Systems-Based Practice: The resident will be aware of and responsive to the larger context and system of healthcare as it relates to the cases assigned to him/her. Specifically, the resident must:

  • Demonstrate awareness and understanding of the role of the laboratory in the healthcare delivery system and the importance of reliable, cost-effective, and timely laboratory data in clinical decision-making
  • Demonstrate the ability to work effectively with clinicians and other healthcare professionals to achieve high quality and cost-effective care
  • Demonstrate familiarity with different models for healthcare delivery and their impact on laboratory reimbursement
  • Demonstrate knowledge of methods for cost analysis and accounting and cost containment measures
  • Demonstrate understanding of the budget preparation and tracking process
Method of evaluation:
  • Understanding the interaction of their practice with the larger system — questionnaire completed by superiors, peers, and subordinates
  • Knowledge of practice and delivery system — multiple choice questions
  • Practice cost-effective care — checklist
  • Advocates for the patient within the health system — questionnaire completed by superiors, peers, and subordinates

The general competencies will be taught using a combination of the following methods:

  • Direct observation
  • Assigned reading and other learning aids (test procedures, texts, videotapes, computer programs, etc.)
  • Completion of specific learning activities and learning objectives (may be found in description of chemistry rotation)
  • Formal lectures (e.g., School of Medical Technology lectures and Friday conferences)
  • Review of previous interesting cases
  • Attendance at various meetings: chemistry section, chemistry management, Clinical Laboratory Administration Group, Clinical Pathology Quality Assurance and Improvement Committee
  • Management mentorships under the direction of assigned section director

For More Information

Please contact us if you have questions about the Anatomic and Clinical Pathology Residency Program at Danbury Hospital, or would like more information.




close