Myers-Briggs Type Indicator

Let me be honest and straightforward: this was not my favorite model when I first learned about it. Until, that is, I went through the certification to become a trainer and I fell head over heels in love, despite it being more complicated and intricate than the other models used and discussed in the Leadership Institute. The MBTI provides a deep understanding of your personality traits, natural skills, and tendencies while highlighting skills you have learned along the way. As an added bonus, this understanding isn’t tied to any life role (work, parent, child, friend, etc.). I, for instance, have a slight preference for extraversion with a lot of introversion tendencies. However, I usually come across as highly extraverted, as I learned to act more extraverted because my sister was very shy growing up and I wanted to balance it out.

The MBTI focuses on your innate personality preference, organized into four dichotomies:

  • Extraversion vs. Introversion (E –I)
  • Sensing vs. Intuition (S – N)
  • Thinking vs. Feeling (T – F)
  • Judging vs. Perceiving (J – P)

Your preferences in each category, when combined, are your type. For example, if I had a preference for Introversion (I), Sensing (S), Feeling (F), and Perceiving (P), my type would be ISFP. This type gives me insights into how I interact with others, process information, come to conclusions, and approach the outside world. Understanding this will allow me to know my strengths and weaknesses as well as those of others. As a leader, applying that knowledge effectively in different situations and with different people is essential.

 

lotte-small

-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

 

Yin and Yang

Who would have thought that our personality is made of contradicting elements?

I truly enjoyed the MBTI course, it was an eye opener of who I am and a trip inwards. Knowing who we really are, our talents, comfort zones and blind spots will help us become better leaders.

So now I know and after all these years (on a personal or professional level) that I am an “ENFP,” these four letters mean that I tend to be extraverted, intuitive, feeling and perceiving. I do agree with the assessment as it reflects who I am and decided after taking the course to put my Middle Eastern Ego aside and not challenge the blind spots.

ENFPs see new possibilities in people, situations, tasks and projects at hand. We tend to have high energy and flexibility. In my line of work, being the Chief Quality Officer at MedLabs Consultancy Group in Amman-Jordan, I find these personal traits very critical to our success as a company to ensure the highest compliance in implementing quality standards throughout our network of laboratories spanning four countries and exceeding 50 in total. Being a people’s person is a great asset in order to touch the hearts, minds and souls of our staff to sustain these quality standards, being 150% convinced rather than simply following the rules. We are trying to “personalize” Quality and Safety, this can only be accomplished through connecting with each staff member and it requires inspiration, a trait that is “built in” ENFPs.

Looking at the blind spots, I find that we tend to get overexcited about projects, juggling many at the same time and loosing track of priorities in the hope of making a difference. Guilty as charged.

I am learning to take one project at a time, see it through completion and start the next one in the pipeline, this gave me and my colleagues a breather and time to reflect if the road that we are taking is indeed the correct one.

So now I am asking myself, what if I did not have the great opportunity to be part of the ASCP Leadership Program and I have missed out on MBTI? What if I did not realize that I am an ENFP? What if I could not appreciate the blind spots?

The simple answer is: I will be a classical leader in it for the title, with little contributions and not much of a positive effect on those who are around me. My job will be stale, with no spirit and dull, so I guess Yin and Yang actually works.

 

Soudi

-Nael M. Soudi holds a bachelor degree in Microbiology from State University of New York at Plattsburgh (USA). He completed both his Master Degree in Molecular Biology and a postgraduate program in Cytotechnology at Johns Hopkins University (USA). Mr. Soudi is a certified Practitioner in Health Care Quality (CPHQ) and a certified consultant and inspector with the Healthcare Accreditation Council. He is also certified by the International Academy of Cytology (IAC) and the American Society of Clinical Pathologists (ASCP) – Cytology. Mr. Soudi is fully licensed by the American Society of Clinical Pathologists and the College of American Pathologist (CAP) as a Certified Inspector. He is a frequent presenter at regional and international conferences discussing topics in Cytology, leadership, accreditation and healthcare quality. 

Your Reaction to Safety

The toddler’s father let her hand go so he could pay for their dinner at the busy airport. The little girl quickly wandered away and suddenly found herself at the top of a long escalator that was going down. No one was watching.

Mrs. Anders was walking home as she did every day from the neighborhood pool. She was very hard of hearing, but she was as friendly as she could be. As she waved to you while crossing the street, you see the car speeding toward her at too fast a pace.

You may have encountered a situation similar to one of these, or you may have seen something like it in a suspenseful movie or television program. The scenario is something that can create a reaction in you, a feeling of sudden dread, and the urge to take quick action. That’s a good response, and it could save someone from a serious incident.

But is your reaction the same in the lab where you work?

Lisa processed some CSF samples at the front desk that were delivered from another lab. She later received a call from the sending lab alerting her that the patient was positive for CJD, a prion disease, and the specimens were sent in error. When she went to clean up the processing area and tell the other staff, Lisa saw her co-worker leaning on the counter and using the computer with no PPE.

In the morning, Ken dropped a glass bottle of hydrochloric acid on the lab floor, and it shattered and spilled. He went to get the spill clean-up kit, but before he returned, the pathologist walked into the department wearing open-toed shoes.

Now let’s try something a bit subtler:

Robert is working in the chemistry department and he uncaps the next batch of tubes to be analyzed behind the safety shield on the counter. He places the tubes in the rack and carries the rack over to the analyzer. He’s not wearing any face protection.

Sheila was the supervisor in hematology, and she was walking through the department as Dwayne was on the phone with a service representative about the broken analyzer. The rep asked to speak to Sheila. Dwayne hands her the phone with his gloved hands, Sheila is wearing no PPE.

As a lab safety professional, one of my goals is to help lab staff have that same urgent gut reaction- that feeling that something is wrong and needs immediate correction- in all of those lab scenarios above, particularly the subtle ones. In each of those moments, the risk of danger or infection is very high and needs to be mitigated. All too often, however, these events occur in labs and no one reacts. That’s a safety culture problem.

There are many possible reasons for that typical lack of response. People are busy, the unsafe practices are common, or safety is simply not a priority. Lab injuries and exposures continue to occur across the nation, so the issues need to be addressed, and there are ways to do that successfully.

One method I use in safety training (that I’ve written about before) is the development of “Safety Eyes.” I call that the latent super-power that everyone possesses, but it needs to be taught and honed. When you work in a particular environment every day, it can become difficult to see the safety problems without training and practice. Take pictures of unsafe lab practices or problems and show them to staff. Have them identify the issue. As they practice, they will begin to see issues more often. Take practice safety walks with staff and look for issues. These actions will help everyone’s “Safety Eyes” to develop and become powerful tools in the department.

Of course, just seeing the issue is not enough. The second important piece here is teaching staff to respond when they do spot a problem. That can take some training and empowerment that may be new ideas for many. Teach staff to coach their peers for safety. This behavior will show others that safety is a priority, and over time more and more staff will begin to follow suit.

To produce the reaction you want in your laboratory—the issue is noticed, there is a sudden sense of dread or a gut reaction, and then there is a correction made—takes consistency. The lab safety leader will need to provide education about the regulations. Next, develop the “Safety Eyes” of the staff through pictures and safety walks. Finally, teach them to respond to the problems. As people, we are aware of the immediate danger when we see a toddler at the top of the stairs. The possibility of harm is clear to us. If you can produce that clarity for your staff with lab safety issues, you can get those reactions that can only improve your safety culture, and you can drastically reduce those injuries and exposures.

 

Scungio 1

Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Medical Laboratory Professionals Week Approaches

Print

In light of Medical Laboratory Professionals Week 2017, I wanted to take this quarter’s post and thank all of you who work hard in so many ways to get patients the results they need. You truly are “All Stars.” I thought it would be interesting to have an interactive sort of post; feel free to write in the comments examples of how you and your lab go above and beyond to help patients.

Here is just one example of how the Molecular Diagnostics Lab here at Nebraska Medicine continues to do our part to serve our patient population. Our hospital (University of Nebraska Medical Center) has become a participating center for the TAPUR trial. This stands for “Targeted Agent and Profiling Utilization Registry” study; it is a non-randomized clinical trial that is essentially matching anticancer drugs to genomic variants in the patient’s tumor. Currently, most drugs are given based first on what type of tumor it is, then by the genomic variants. For example, if a patient has a gastrointestinal stromal tumor (GIST), and that tumor has a duplication in the KIT gene (p.A502_Y503dup), that tumor is sensitive to a drug called Imatinib, among others, and that drug has been shown to help fight the GIST. The TAPUR study’s goal is to see if any tumor that presents with that KIT variant is sensitive to Imatinib, whether the tumor is a GIST or some other type of cancer.

What does this have to do with our lab? Well, there are certain criteria necessary for a patient to be eligible for this trial. In addition to being 18 years or older, not currently pregnant or planning to become pregnant, the patient must have a solid tumor, multiple myeloma, or B cell non-Hodgkin lymphoma that is not responding to standard anti-cancer treatment and they must be able to be active for at least half the day, every day. Lastly, they need to have had a genomic or molecular test performed on their tumor. I and the technologists that I work with have seen an increase in our testing since our hospital has become a center for this trial because of that last point. We run an assay that tests areas of 50 genes that are known to contain “hotspot” regions that are commonly mutated in different types of cancers, and we run this by next generation sequencing (more to come regarding this type of technology–stay tuned for next quarter’s post!). We have been testing tumors of patients that have not been responding to treatment, and we all realize that each one of the tests that we perform has an impact on how that patient’s tumor will be treated. And here I have to commend the techs in our lab for thriving when faced with the challenge of this increase in testing–they have done an excellent job with the added workload and with keeping up with the changes that are made in this rapidly evolving area of the lab. I think we all appreciate this aspect of our careers–knowing that the hard work we put in every day to do our jobs to the best of our abilities can and does have an effect on people’s lives. Thank you all for everything you do!

For more information on the TAPUR trial, follow this link: http://www.tapur.org/.

 

rapp_small

-Sharleen Rapp, BS, MB (ASCP)CM is a Molecular Diagnostics Coordinator in the Molecular Diagnostics Laboratory at Nebraska Medicine. 

Interference in Lab Assays

A 69 year old patient with cirrhosis presented to the ER with fever. Her bilirubin was markedly elevated at 7.4 g/dl and her hemoglobin and hematocrit were measured at 13.4 g/dl and 35.6% respectively with a MCV of 103.2 fl and MCH of 38.5 pg. The next day her H/H were 11.9 g/dl and 31.3 % respectively. While her hemoglobin one day later was 11.9 g/dl, the reported hematocrit was 39.3%. Patient had a bilirubin level of 8.7 g/dl at this time.

The fluctuating numbers together with the discrepancy between hemoglobin and hematocrit over a very short period of time was concerning. We realized that presence of markedly icteric plasma was responsible for these discordant values. Saline replacement and spun crit were performed in order to correct interference by bilirubin. Subsequent measurements of H/H revealed hemoglobin in the range of 12.9 g/dl with a hematocrit of 38% and a MCV of 113 fl. As the bilirubin levels started dropping (in the range of 6.5 g/dl) the hemoglobin level measured by the analyzer fell in the range of 10.3 to 11 g/dl. The instrument (XN-200) gave no error codes and therefore we were able to report out the analyzer results without correction. It was however very important to convey to the clinical team that the H/H values did not truly represent a fall from the previous values. As the two methodologies were different (spun crit and plasma replacement was being no longer performed) the numbers should be interpreted accordingly. Patient was not bleeding actively and did not require any blood transfusion.

Interference occurs when a substance or process falsely alters an assay result. Interferences are classified as endogenous or exogenous. Endogenous interference originates from substances present in the patient’s own specimen. Exogenous interferences are substances introduced into the patient’s specimen. Interference from hemolysis, icterus and lipemia are most frequently studied. Protein interferences are most often associated with paraproteins and predominantly with IgM or IgG and rarely with IgA. Drug interference may be due to the parent drug, metabolite(s) or additives in the drug preparation. Determining if interference is significant requires deviation limits from the original result. Once interferences are identified there is a need to establish procedures for handling affected results as part of the quality system.

Hemoglobin is quantified based on its absorption characteristics. Conditions such as hyperlipidemias, hyperbilirubinemia, a very high white blood cell count, and high serum protein can interfere with this measurement and result in falsely elevated hemoglobin values. When the values of hemoglobin, red cell count, and MCV are affected, MCH and MCHC also become abnormal, since these indices are calculated and are not directly measured. Sometimes a set of spurious values may be the first clue to an otherwise unsuspected clinical condition (e.g., the combination of low hematocrit, normal hemoglobin, and high MCV and MCHC is characteristic of cold agglutinins).

Although one must pay attention to very high amounts of bilirubin within the plasma, most hematology analyzers do not presently demonstrate any interference with bilirubin, at least for concentrations up to 250 mg/l. Above these values attention is however needed.

High serum or plasma bilirubin concentrations can cause spectral interference with assays near the bilirubin absorbance peak of ~ 456 nm. Chemical interference e.g. with peroxidase-catalysed reactions may also occur.

 

Vajpayee,Neerja2014_small

-Neerja Vajpayee, MD, is the director of Clinical Pathology at Oneida Health Center in Oneida, New York and is actively involved in signing out surgical pathology and cytology cases in a community setting. Previously, she was on the faculty at SUNY Upstate for several years ( 2002-2016) where she was involved in diagnostic work and medical student/resident teaching.

Social Accountability Inside and Outside the Laboratory

Being a medical laboratory scientist is more profession than occupation. Those of us who are affiliated with ASCP through our certification or work know the value of being part of an organization that values education, certification, and advocacy for patients. Finding a place in this network has given me a strong foundation through years of understanding a “best practices” paradigm. If you’ve been following my posts these last few months, you’ll have heard all about my work with Zika virus prevention and detection initiatives on the island country of Sint Maarten. Being here at the right time and right place have provided ample opportunity to flourish as a medical student with a history of laboratory experience. Recently, my school honored me with the Social Accountability Award and Scholarship for outstanding service during my time as a student with respect for my colleagues and the surrounding community of Sint Maarten. Having authored proposals and leading initiatives coalesced into an ongoing functional public health initiative, partnered with local government and NGOs. My experience as a certified scientist allowed me to build on three major ASCP foundations:

  1. Leadership. Receiving the award from the school validated my confidence in the work that I and my team have been doing this last year. Letters of recommendation came from my service-learning course director and Dean of Community Affairs, and the consultant advisor to the public health prevention office of the local Ministry of Health. The Dean of Medical Sciences even spoke about me with kind words and an inspired tone that really meant a lot to me, personally. This overall validation was not just for me—it was for the work, my team, and our efforts in local public health. The exercise in textbook-to-field informatics, education, and interventions could not have come to fruition without experiences I drew from in my lab years. Responding to CAP inspections, spearheading changes to SOPs or operations, and being a voice at the conference table taught me how to collaborate as well as lead.

 

  1. Education. If there’s anything I would say has been paramount in my time (both here in medical school and back in the lab) it’s the value of education. I could not do the work or pursue the projects I do today without backgrounds in molecular science, lab informatics, or general pathology and disease. Through numerous degrees and opportunities to work in the field of laboratory medicine, there are countless venues for someone to continue to patient care. My journey included a foundation of molecular biology, a graduate degree in lab science, an ASCP certificate with continuing maintenance as an MLS—now in post graduate work; I continue to work and learn in a dynamic environment. I have created SOPs from scratch, researched literature on seroprevalence and epidemiological statistics, managed and interpreted specimen collection and ELISA testing, and contributed to public health awareness and education. If you want diverse and exciting, this field has it! Education doesn’t stop with the degrees and certificates on the wall behind my desk, however. A very important, and arguably mandatory part, of being a scientist/clinician is being able to engage in an educational conversation with a wide variety of audiences. Talking about Zika virus prevention, seroprevalence, and risk mitigation is a different conversation with children, or local adults, or medical colleagues.
  1. Advocacy. Finally, I should say: if there’s one major thing professional organizations like the ASCP do for its members and our communities, it’s advocacy. Giving a concrete voice and substantial representation to the causes we care about as professionals yields positive returns for our overall shared goal of improved patient outcomes. My work here is first as a medical student, and second as a public health partner. Sharing and collaborating on how this community can best utilize its resources to address a local epidemic is at the forefront of my team’s work. When I started this project, I was inspired by the aims and goals of the Partners for Cancer Diagnosis and Treatment in Africa Initiative from the ASCP Foundation. I first heard about this at the annual meeting in Long Beach, and, as I prepared for my own stint overseas, I tried to keep that close to heart. Improving global health outcomes and increasing laboratory visibility were two of the major tenets of this project. Proudly, I would say I’ve been involved in both aims. Clear success has been documented (and continues to be seen!) in my Zika initiatives, and more and more people engage in conversations with me about translational medicine. With all my documents signed “C. Kanakis, MS, MLS (ASCP),” people have been surprised by all the things someone with “just a lab” background can really do! Breaking stereotypes and inspiring others to reach out for improving patient outcomes is all part of the same conversation I have with my community partners.

In short, my work with Zika virus prevention is an ongoing project, with new events and achievements tallied weekly. But before I get back to recounting the most successful events each month, I wanted to take a step back and say that I could not have been a Social Accountability Award recipient in this community without first learning the way to be a leader, educator, and advocate in our community.

Thanks for reading! Until next time…

 

ckanakisheadshot_small

Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

The Learner Experience in a Blended Model of Curriculum Delivery

Key to successful delivery of an online course (or as in our case, a blended model of online and traditional), along with achievement of the learning objectives, is the learner experience. I’ll never forget the feelings of trepidation I had on our first day with our inaugural class, piloting this new model of curriculum delivery with our bacteriology course.

Our lesson plan requires that the students prepare for class by studying the online lecture material as homework, prior to the next day’s laboratory section. Our students were excited about starting our program and eager to learn, yet some were hesitant. I remember one student stating that they “might not be so sure about this new format.” After all, we hadn’t tried it before, and to be frank, it was scary. I remember thinking to myself, “What are we going to do if they do not study the online content? What if they do not prepare for class? What if they dislike this format? What will we do if they flunk their first exam?
Fortunately that was not the case, and our student’s performance in our program has been and continues to be highly successful.

Alex, a student in our current class put it this way:

“It is worth noting that this is not your typical college course. The program here really emphasizes the “reverse classroom” technique. For those unfamiliar, this term means that one will read about the lesson the night before and come to class the next day and perform a laboratory assignment based on that reading.

I came into the program experiencing nothing like this before, so I wasn’t sure how this learning strategy would work for me. After completing our didactic schedule, many of my peers would agree with me that this learning technique is fantastic and is very beneficial to the overall learning experience.

However, to maximize this benefit, time management is vital. Simply reading the lesson at the last minute does not cut it. Whether it helps you to take notes as you go, doing a re-read, or fill out a study guide, this style of learning is a classic example of getting out what you put into it.”

I loved hearing our student reflect that “you get out of it what you put into it.” To me, that is the ultimate goal of education, to prepare our students to be able to think critically and self-direct their learning. In this regard, our inaugural class was a success.

 

Lehman_small

-Susan M. Lehman, MA, MT(ASCP)SM graduated from the University of Wisconsin-Madison in 1983 with a BS in medical technology. She is program director for the Medical Laboratory Science Program and course director for Clinical Microbiology I and II; her areas of interest include distance education and education methodology.

Zika Virus: The Struggle is Still Real

Well, even though the groundhog has predicted another 6 weeks of winter, it’s not too early to start thinking about those summer pests – mosquitos – and the diseases they bring with them. Zika virus, in particular. Even though the winter weather has dulled our sensitivity to this emerging threat, it remains a significant problem. The virus is now circulating in 65 countries, mostly in the Americas (1). Currently, the CDC has issued travel alerts to areas where Zika is spreading including Miami-Dade, Florida, Puerto Rico, American Samoa, and the US Virgin Islands (2).  Laboratory professionals should be aware of Zika virus because the diagnosis of Zika Virus Disease (ZKD) relies on the laboratory, and many healthcare professionals require guidance from the laboratory on how to proceed with diagnostic testing.

Zika is a flavivirus borne by the Aedes mosquito. Symptoms of ZKD usually last 2-7 days and include mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache. There is scientific consensus that Zika virus infection during pregnancy is the cause of congenital brain abnormalities of the fetus, including microcephaly. This devastating effect of the virus sets it apart from the other Aedes-borne viruses dengue, chikungunya, and yellow fever.

Diagnosis of Zika virus relies on laboratory testing, and yet, there are no FDA approved assays for Zika virus currently available. There are however a number of assays that have been given approval for emergency use, including: Real-Time PCR, MAC-ELISA, and a plaque neutralization reduction test. In the United States, these tests are available from the CDC and some state health labs. An algorithm describing the appropriate use of these tests can be found here. Unfortunately, in developing countries where Zika is endemic, access to the appropriate diagnostic test can be very difficult.

Impediments to accurate diagnosis of ZKD in developing countries include lack of education and access to quality laboratories that offer the right test. Lack of education encompasses not only transmission and prevention of the virus, but also who should seek medical attention and when and who should be tested and when. In many countries where visiting a medical professional is a financial burden to a family, it is less likely that a family will seek medical attention for a disease that has such mild symptoms symptoms as ZKD. While most cases of ZKD don’t require medical attention beyond comfort care, if patients don’t report to clinics or health centers, it is difficult to track and confirm cases if no one presents with a suspected case! Also, there is a need for consensus about what should be called a suspected ZKD case and then how to proceed with confirmatory testing. Some countries, including Brazil, the respective Ministries of Health have issued definitions of a suspected Zika case. The Brazilian definition includes: “patients who present with pruriginous maculopapular exanthema accompanied by two or more of the following signs and symptoms: fever, conjunctival hyperemia without secretion and pruritus, polyathralgia, and periarticular edema” (3). Suspected cases can be confirmed with diagnostic testing, but this is another challenge. The easiest and least expensive test for a clinic in the developing world is a Ig-M based rapid diagnostic test. There are several of these available commercially, mostly from European markets. However, these demonstrate significant cross-reactivity with other flaviruses such as dengue and chikungunya, which are also endemic in areas where Zika is now circulating. The most appropriate tests – RT-PCR, MAC-ELISAs, and plaque reduction tests – are only available in national laboratories it at all. The combination of lack of patients reporting Zika-like symptoms, lack of consensus of what constitutes a suspected case, and limited availability of confirmatory testing means that there is a significant likelihood that the number of Zika cases in many developing countries are underreported.

In January 2016, the WHO presented the Strategic Response Framework and Joint Operations Plan in response to the growing Zika virus epidemic. In October 2016, a quarterly update was released that described the goals and scope of the plan through December 2017. The plan is Strategic Response Plan comprised of four areas: 1) Detection, 2) Prevention, 3) Care and Support, and 4) Research. $10.9 million are dedicated to the detection arm of the strategic plan, which in addition to laboratory testing and diagnosis includes assessment and implementation of preparedness measures, and surveillance and monitoring in it’s scope. $41.2 million are dedicated to the research arm of the plan, which includes the “fast track and scale up of research development and availability of diagnostic tests.”

Hopefully in the next year we will see not only new diagnostic testing, but also medical interventions such as vaccines. In the meantime, it is important that we as laboratory professionals continue to be apprised of available testing, to educate our healthcare partners on the use of lab testing for ZKD, and to support research and development of Zika diagnostics.

References

  1. Falcao et al. Ann Clin Microbioal Antimicrob (2016) 15:57
  2. MMWR, February 12, 2016: 65(05); 122-127
  3. Zika Strategic Response Plan Quarterly Update. 25 October 2016.

 

Sarah Brown Headshot_small

Sarah Riley, PhD, DABCC, is passionate about bringing the lab out of the basement and into the forefront of global health.