If you had a chance to spend one day with a group of fourth year medical students who had already been accepted into residency programs, and you had the goal of providing them with the information any beginning doctor needs to know about the laboratory, where would you begin and what would you teach them?
I had this opportunity recently. The director of a medical school boot camp for Fourth-year medical students (MS4) who would start residency in two months approached me, wanting to know if I’d like this opportunity. Of course, I jumped at the chance. The hardest thing was deciding what information to leave out, to essentially focus the short course on the minimum information related to the lab that a doctor should know when they begin their career. I can honestly say that the opportunity was educational for me also – it showed me exactly how little a graduating doctor knows about the lab! Now in its third iteration, we learn and add and subtract as we go.
We do a brief introduction and overview of general lab structure and then start with phlebotomy. Most doctors (and I’m going to exclude everyone who entered medical school after being a medical technologist) have no idea that the tube top color indicates the type of anticoagulant, and for instance that every purple top tube everywhere in the world has EDTA anticoagulant in it. We also covered basic phlebotomy technique. Then we rotated them in groups through the various sections of the lab, allowing each section to educate the group on the some of the items they considered the most important features of that section. Some of the topics that were covered include:
Client services/accessioning: some tests utilize a whole blood sample (CBC, blood gases), many, many samples require spinning and aliquotting while maintaining sample identity. Hemolyis, lipemia and icterus interfere with tests.
Chemistry: batch vs random access testing, main chemistry analyzer vs manual testing, pre-analytical affects on test results; reference intervals
Hematology: why clotted tubes can’t be used, how white cell differentials are performed (mostly manual in pediatric institutions)
Microbiology: blood culture bottles in the instrument vs plating and identification; how susceptibility testing works; likelihood of a false positive on a positive flu test run in the summer
Blood banking: what a type and crossmatch includes; how various blood products should be transported; uncrossmatched blood availability
Each section is also instructed to encourage questions and interaction with the MS4s as they tick off main points.
This is an educational opportunity I wish I were granted for all MS4s everywhere. Each year we run this program we refine it as we learn what they most need to know, as well as what they don’t know and what we don’t know. It’s a wonderful learning process.
-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.