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LM Chem Rotation

LM Chem Rotation

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Published by Jamshaid Iqbal

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Published by: Jamshaid Iqbal on Jul 22, 2012
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07/22/2012

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Chemical PathologySupervision:
Shirley Welch, Ph.D.Steven Kazmierczak, Ph.D.
Location:
OHSU and Kaiser Permanente
Duration:
3 months
Organization:
Chemical pathology is comprised of a 12
-
week rotation. S
ix
weeks of the rotation areperformed at the OHSU Hospital and clinical laboratories. The remaining
six
weeks arespent at the Kaiser Clinical Laboratory. The first two weeks of the rotation at OHSU arefocused on laboratory instrumentation and test methodology, general laboratoryoperations and procedures including quality control and quality assurance, regulatoryrequirements (CAP/CLIA), and safety (OSHA). The remaining
four
weeks of the OHSUrotation are comprised of correlation of laboratory test results with pathophysiology. Thisincludes a review of the basic biochemistry and physiology of the human body andbiochemical and morphological manifestations of disease states. Following the
six
weeks atOHSU, residents complete
six
additional weeks of training at the Kaiser Regional ClinicalLaboratory. During this time, residents gain addition experience in therapeutic drugmonitoring and toxicology, endocrine function testing, and other esoteric testing notoffered in the OHSU clinical laboratory.
Goals of the rotation:
The overall goal of the Clinical Chemistry rotation is to provide the resident with a set of tools that will enable the resident to develop and maintain a level of expertise in clinicalchemistry that is appropriate to the professional responsibilities undertaken as apracticing pathologist. This includes understanding the role of analytical and qualityprinciples that underlie laboratory techniques employed in the clinical chemistrylaboratory. These tools will include basic principles of medical microscopy andurinalysis, analytical chemistry, quality control, quality assurance and laboratorymanagement, correlation of laboratory test data with pathophysiology, development of effective personal reference tools (textbooks, journals, handouts, files), and developmentof a set of personal educational objectives for the rotation and the residency.Opportunities will be provided so that the resident can become proficient in these areasby the application of these tools in the laboratory setting.
 
Objectives:
Core competencies that the resident will have learned following completion of thisrotation are summarized below:
Patient Care
The resident will demonstrate the ability to provide effective clinical consultation byshowing proficiency in the following:
 
Gather appropriate and accurate clinical information.
 
Interpret laboratory test results within the clinical context.
 
Develop a diagnosis or differential diagnosis, based on laboratory results andclinical information.
 
Use of information technology to support patient care decisions and educate
practitioner.
 
 
Use evidence-based medicine and clinical decision-making concepts to interpretresults and make informed decisions.
 
Advise clinicians on the use of clinically appropriate and cost-effective tests.
 
Advise clinicians on appropriate follow-up for unexpected test results.
 
Understand the limitations of point-of-care testing, and how to interpret theseresults in the appropriate context.
Medical Knowledge
The resident will demonstrate the following:
 
Show knowledge of common clinical chemistry tests and their medicalapplication and correlation to pathophysiologic processes.
 
Show knowledge of the effects of disease, and preanalytical, analytical, andpostanalytical variables on clinical laboratory test results.
 
Show general knowledge in the basic and clinical sciences necessary for effectiveconsultation in laboratory medicine.
 
Ability to collect and evaluate medical evidence regarding the utility of laboratorytests.
 
Show an analytical approach to laboratory and clinical questions.
 
Show an understanding of laboratory work-flow and how this impacts theselection of laboratory instrumentation and personnel needs.
 
Show an understanding of how to effectively meet regulatory guidelinesgoverning clinical laboratory operations.
 
Show an understanding of point-of-care testing and how it relates to testingperformed within the main clinical laboratory setting.
 
Development of a personal strategy to maintain and update medical knowledgerequired for understanding the clinical chemistry laboratory.
 
Understand clinical indications for body fluid analysis.
 
Understand manual hemocytometer cell counting.
 
Understand cytocentrifuge sample preparation and slide staining.
 
Identify blood and body fluid cell morphology.
 
 
Interpret results of body fluid analyses in the appropriate clinical context.
 
Recognize malignant cells and recommend appropriate confirmatory tests.
 
Correlate abnormal body fluid cell morphology with cytology, flow cytometry,and other relevant diagnostic test results.
 
Identify body fluid crystals.
o
 
Distinguish between urate and calcium pyrophosphate crystals, usingpolarized light.
Practice-Based Learning and Improvement
The resident will demonstrate:
 
Ability to find and evaluate evidence from scientific studies.
 
Application of appropriate statistical and study design principles in the evaluationof scientific evidence.
 
Ongoing identification of deficiencies in personal medical knowledge andattempts at remediation.
 
An understanding of, and the ability to, apply principles of quality assurance andquality control.
 
Ability to evaluate current and proposed testing methods for analyticalperformance, clinical utility, and cost effectiveness.
 
Use and evaluation of proficiency testing results to improve laboratory practice.
 
Ability to use laboratory problems and clinical inquiries to identify processimprovements that lead to increases in patient safety and outcome, and minimizeopportunities for medical errors.
Interpersonal and Communication Skills
The resident will demonstrate:
 
Ability to effectively work with others as part of the health care team.
 
Ability to communicate clearly and effectively with clinicians, laboratorytechnologists, and other medical personnel.
 
Ability to use appropriate modes of communication in a timely manner.
 
Ability to choose and use appropriate mechanisms for communication (telephone,face-to-face, email).
 
Ability to express ideas and positions clearly and effectively, both verbally and inwritten form.
 
Ability to prepare and deliver effective presentations.
Professionalism
The resident will demonstrate:
 
Compassion, respect, and integrity.
 
Responsiveness to the needs of the patient and society the supersedes self-interest.
 
Knowledge and understanding of ethical and privacy issues affecting the clinicallaboratory.

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