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General Competencies in Clinical Microscopy

Anatomic and Clinical Pathology Residency Program

Purpose

To assure residents will obtain the general competencies necessary to the level expected of a new practitioner as defined by ACGME requirements.

Definition

The trainer is defined as someone who has been specifically selected to perform the training. The trainer In the section of Clinical Microscopy is the Assistant Medical Director with the help of the Medical Director, Administrative Specialist, Technical Specialist, or Senior Technologist (Med Tech II).

Procedure

For each objective listed on the Clinical Microscopy Residency Training Checklist, the trainer will ensure that the general competencies (as defined below) are covered and evaluated during the training period when applicable:

  • Patient Care: Working under the direction of the pathologist, the resident will be:
    • Involved in the interpretation of tests, quality control and process improvement to ensure the provision of patient-focused care. This includes gathering essential and accurate clinical information when a testing pattern is in question. The resident will utilize medical knowledge with the help of information technology to make informed decisions regarding outcomes, including recommendation for appropriate test follow-up when indicated
    • Involved with the process of obtaining Bone Marrow samples for evaluation at the request of the ordering physician. This includes but is not limited to obtaining patient history, performing patient assessment and collecting and processing the bone marrow aspirates and biopsies. The Resident will interact with other healthcare professionals to provide compassionate, appropriate, and effective patient care for each situation
  • Medical Knowledge: The resident will be given a working background on critical steps of tasks assigned and be made aware of established policies, procedures, and the evolving sciences Residents will be expected to demonstrate an investigatory approach and apply analytical thinking to the cases assigned
  • Practice-Based Learning and Improvement: The resident will learn a systematic approach to the investigation and evaluation of clinical events 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
  • Interpersonal and Communication Skills: The resident will learn how to be effective when exchanging information with patients, patient's families, and other healthcare professionals
  • Professionalism: The resident will be expected to show a commitment to ethical principles when carrying out professional responsibilities. The importance of recognizing critical events and the proper triage and management of these situations will be stressed
  • Systems-Based Practice: The resident will be aware of and responsive to the larger context and system of healthcare as it relates to the responsibilities assigned and demonstrate the ability to effectively integrate with system resources to provide optimal patient care

Objectives for the Clinical Microscopy Rotation

The field of Clinical Microscopy (Hematology) is diverse in that it integrates well established benchmark science, microscopy, Coulter technology from the 1960s, imaging technology, immunohistochemistry, cytochemistry, cytogenetics, and molecular methods to help arrive at a diagnosis.

Even with modern technology the keystone of clinical microscopy remains morphology of the blood smear and bone marrow preparation. The changes identified and the clinical information obtained will direct the specimen to the next level of investigation.'

The broad objectives to be covered during this rotation include:

  • Preparation and interpretation of the blood smear
  • Specimen handing, the Coulter principle and data interpretation
  • "Esoteric" hematology testing
  • Coagulation specimen handling and test protocols
  • Semen analysis
  • Observation and performance of bone marrow aspirates and biopsies and interpretation of these specimens

Duties and Responsibilities of the Resident

Residents are assigned to Clinical Microscopy for clinical interpretive services. These include but are not limited to smear review of blood and body fluids, histogram review, lupus anticoagulant interpretation, coagulation consults, and/or any unusual or unexpected findings as outlined in the Clinical Microscopy Procedure manuals. This exposure will aid the resident in the development of skills necessary for proficiency in diagnosis and problem solving ability.

  • The resident will make available to the section a beeper number and will be called as needed. The Medical Director must be notified of any coverage issues from the assigned schedule so that proper coverage is assured
  • The resident must participate in one research activity during each year. This activity can relate to method evaluation, basic research, or other task delegated and/or as approved by the Medical Director
  • Upon completion of each objective, the resident will complete a comprehensive assessment activity. Assessments will be a part of the overall evaluation of the resident and must be completed by the end of the rotation
  • Each resident must participate in the management and direction of the laboratory, which includes inspections, safety, quality improvement, and data processing
  • Each resident must participate in the teaching activity as part as the Medical Technology program. The number and frequency of the lectures to be determined at the discretion of the Clinical Pathology Resident Coordinator
  • The general competencies will be taught utilizing a combination of the following methods:
    • Direct observation (smear review, etc.)
    • Assigned reading including section procedures and reference material (see bibliography)
    • Formal lectures
    • Review of cases
    • Occasional participation in morning report with Internal Medicine residents
    • Oral and written examination and interpretation
    • Management of Mentorship (attending section meetings, reviewing summaries of event reports, proficiency testing results)

Mode of Assessment

Upon completion of training the resident's performance for each of the objectives listed under heading 2 will be documented and measured on the credentialing log defined for each task. A minimum number of cases will be established and each will be reviewed and signed off by the covering pathologist who will offer suggestions as appropriate for the resident's continued growth as a laboratorian.

Final Evaluation of General Competencies, Clinical Microscopy Section

  • Modes of Assessment — 30%
  • Credentialing Logs — 30%
  • Performance of Bone Marrow aspirates and biopsies — 20%
  • Interpersonal and Communication Skills — 10%
  • Professionalism — 10%

Clinical Microscopy Bibliography

  1. Hematology-2nd Edition
    William J. Williams et al.; McGraw-Hill Book Company, Copyright 1977
  2. Wintrobes Clinical Hematology-9th Edition Volumes 1 & 2
    G. Richard Lee, MD, et al.; Lea & Febiger, Copyright 1993.
  3. Practical Hematology-8th Edition
    Sir John Dacie; Churchill Livingstone
    S. M. Lewis, Copyright 1995.
  4. Hematology of Infancy and Childhood-Volumes 1 & 2
    3rd Edition, David G. Nathan, MD, Frank A. Oski, MD:
    W. B. Saunders Company, Copyright 1987.
  5. Hematology-Basic Principles and Practice-2nd Edition
    Ronald Hoffman, MD, et al.; Churchill Livingstone, Copyright 1995.
  6. Body Fluids-2nd Edition
    Carol R. Kieldsberg and Joseph A. Knight
    American Society of Clinical Pathologists Press-Chicago, Copyright 1986.
  7. Laboratory Medicine/Urinalysis and Medical Microscopy-2nd Edition
    James A. Freeman and Myrton F. Beeler; Lea & Fibiger, Copyright 1983.
  8. Clinical Diagnosis and Management by Laboratory Methods-19th Edition
    John Bernard Henry, MD; W. B. Saunders Company, Copyright 1991.
  9. Atlas of Synovial Fluid Analysis and Crystal Identification
    H. Ralph Schumacher, Jr. and Antonio J. Reginato; Lea & Febiger, Copyright 1991.
  10. Bone Marrow Pathology
    Kathryn Foucar, MD; ASCP Press, Copyright 1995.

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.
 




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