The Clinical Chemistry and Toxicology rotation is designed to develop a pathologist who is capable of:
- Communicating and advocating on behalf of the laboratory to the clinical service and the patient to the laboratory
- Ensuring the quality, clinical appropriateness/usefulness of data produced by the laboratory
- Directing and managing a clinical laboratory enterprise
In addition, the rotation will instill an understanding of the medical decision-making role that pathologists bring to the clinical laboratory and to the broader system of healthcare. The goal is to produce a pathologist who understands and consults on:
- The development and validation of diagnostic tests for enabling the emerging practice of Personalized/Precision Medicine.
- Test utilization in context of general application and patient specific settings
- Assay interpretation in acute/chronic clinical management
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
- Gather essential and accurate information about patients using all relevant available modalities and integrate it with the Clinical Chemistry/Toxicology laboratory test results to contribute to the differential diagnosis of the patient.
- Act as a skilled consultant to other clinicians to develop a diagnostic plan based on specific clinical questions and relevant clinical and pathological information.
- Review and provide interpretation on unusual or unexpected test results. Where appropriate, suggest follow-up testing, and evaluate the clinical utility of the tests ordered.
Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.
Investigate unusual laboratory results and report back to the section direction/manager the results of their investigation.
- Demonstrate the knowledge to determine the clinically optimal yet cost-effective testing and laboratory strategies including issues of test menu construction, turn-around-time, and in-house vs. POCT vs. reference lab (send-out) tests.
- Demonstrate awareness and understanding of general and test-specific standards for method development and validation as defined by CLIA.
- Perform method validation including determination of reference intervals, accuracy, precision, notification of medical staff, and understand all the tasks necessary for introducing a new test into the lab.
- Explain the principles of the basic methodologies used in the Clinical Chemistry/Toxicology laboratory including: spectrophotometry, densitometry, turbidimetry, nephelometry, chemiluminescence, atomic absorption spectrophotometry, amperometry, potentiometry, capillary and gel electophoresis, and HPLC/Tandem mass spectometry.
Practice-Based Learning and Improvement
Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.
- Employ mathematics and statistics as appropriate to laboratory testing
- Understand and implement quality control and quality assurance programs as required; review and sign-off on laboratory QC, calibration, and calibration verification.
- Demonstrate awareness and understanding of proficiency programs, such as those provided by CAP and similar organizations.
- Trouble-shoot laboratory results including interfering substances, mechanical failures, reagent issues, and issues related to biological matrices.
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Prepare a laboratory budget, perform cost-accounting for laboratory testing, and understand the business methods and management involved in evaluating the purchasing of laboratory equipment.
- Understand the operation and role of commercial and hospital laboratories along with the overall role of the clinical laboratory in the healthcare system.
- Design and implement policies to continually improve patient safety as they relate to the clinical laboratory testing at all levels.
Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
- Ensure all clinical pages received are completed in a timely fashion.
- Demonstrate positive work habits, including punctuality, dependability, and preparedness for each clinical session.
- Interact with others without discriminating on the basis of religious, ethnic, sexual, or educational differences.
Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.
- Critically review journal articles on laboratory issues/tests and summarize the findings to the group.
- Demonstrate the ability to contribute to the in-service education of the medical and laboratory staff.
- Demonstrate the ability to write an articulate, legible, comprehensive and concise consultation note, report, or update to other physicians/clients.
- Demonstrate the ability to verbally communicate critical results and answer physicians/clients questions.
- Burtis C, Ashwood E, and Bruns D. (2006) Tietz Textbook of Clinical Chemistry andMolecular Diagnostics. Elsevier Saunders, St. Louis, 4th Edition.
- Tietz, N.W. (1997) Clinical Guide to Laboratory Tests. Saunders, Philadelphia.
- Wong SHY, Sunshine I (eds), (1997) Handbook of Analytical Therapeutic Drug Monitoring and Toxicology. CRC Press, Inc., Boca Raton. 354pp.
- Wong SHY, Linder M, Valdes R Jr.,(2006). Pharmacogenomics and Proteomics: Enabling the Practice of Personalized Medicine. AACC Press. 386pp.
- Hallworth M, Watson I. (Authors) Holt D, Tett S, Wong SH. (eds), (2010). Therapeutic Drug Monitoring Clinical Guide, 3rd edition. Abbott Laboratories, Chicago, IL. 131 pp.
- Kaplan, L., Pesce, A. (2009) Clinical Chemistry, Mosby, St. Louis
- Scott M, Gronowski A, and Eby C. (2007) Tietz’s Applied Laboratory Medicine. Wiley, New Jersey. 2nd Edition
- Smith BR, Wells A, Alexander CB, et al. Curriculum Content and Evaluation of Resident Competency in Clinical Pathology (Laboratory Medicine): A Proposal. Clinical Chemistry 2006;52(6):917-949.
Required conferences include: Clinical Pathology conferences
An initial assessment which is completed after 2 weeks during the 2-month block rotation is completed with each resident to provide the resident with information on their individual progress and address any noted deficiencies. The final overall assessment is then recorded on the standard ACGME evaluation form (MedHub) at the end of each rotation by the course director based on input from the entire faculty. In addition, the following strategies are also used to assess competency throughout the entire rotation:
- Case logbook
- Oral exam
- Simulations/Mock CAP inspection
- Global rating
- Written exams/quizzes