Patients and Patience

Holiday season is around the corner! And, as such, I’d like to take this opportunity to share a few thoughts I have on how our professional scope as laboratorians extends all the way from the bench to the dinner table.

How many times have you been asked by friends and family what it is exactly you “do” at work? And how many times have you done your best to explain, being met with references to unrealistic television shows or generalizations that go beyond your scope of practice? It’s happened to me a million times. It’s the nature of our laboratory culture. It’s a vital role in patient outcomes, but often behind the scenes. But just for a moment, let’s say you get beyond those surface explanations—what happens next? Probably, in most cases, not much.

One of the main tenets of the ASCP mission which we all work together is advocacy: for our communities, our institutions, our teams, and our patients. More often than not I would bet that family members venture into that turnpike, mostly as patients. When a grandparent, uncle, sister, or friend says they’ve got an upcoming procedure or test, how many of us would share our knowledge with him or her? I know I would. Not in a way that goes beyond our scopes as phlebotomists, medical laboratory scientists, or cytotechnologists, or medical students, or pathologists—but as someone who wants to empower their loved one to be the most informed and prepared patient they can be. In 2012, the Agency for Healthcare Research and Quality (AHRQ) promoted their campaign “Questions to Ask Your Doctor.” In it, they cite that good health depends on good communication and that patients should not be afraid to ask their physician questions about their health outcomes. You remember, the commercials with the guy at the cell phone store that asked a hundred free train-of-thought questions but was speechless in front of his doctor…I loved those.

In that same holiday spirit that celebrates thankfulness, family, and relationships, let’s include laboratory professionals! If you have a loved one who it applies to, explain just what happens after those six different colored tubes were drawn, explain how that removed mole was set, sectioned, and reviewed, explain how staining different cells in a body fluid give a clinician important data about their health. Hundreds of thousands of laboratory professionals in the United States could offer not just invaluable information to their friends and family, but peace of mind. Demystifying the medical process might make those patience more confident in asking informed questions and, together with their provider, improve their health outcomes.

I find myself in an interesting position today. Having years of explaining what CBCs or CMPs actually measure and why someone might have to fast before a lipid panel, I’ve started a slow transition to learning how to explain what that means to an individual’s health. What a fantastic foundation lab medicine gave me to build on! (Really a recurring theme you’ll see in lots of my posts.) By moving from what different stains mean to a clinician, I am now on a path toward being able to use that information for the next step in professional scope: diagnosis and management.

Just like I’m on this academic and professional journey, lots of us are on a path through or toward something. But back to our ASCP message, advocacy for patients means recognizing their journey—especially when they’re our family and friends. The best outcomes for any patients rely on valuable information, communication, and rapport. And while you help your loved ones through the steps of their journey as a patient you might empower them to be a more involved member of their healthcare team. As a result, they might experience more personal and effective care. And a bonus just for us: maybe more people would appreciate some behind the scenes lab medicine. Who knows?

So, from me and mine to you and yours, have a great holiday season and a wonderful new year! I’ll return with stories, cases, and commentary on medical school clinicals in January!

Take care and thanks for reading!

 

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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.

Telemicroscopy: Applying Technology to Solve an Old Problem

The Gram Stain

Everyone knows that the Gram stain is an essential microbiological method which aids in the differentiation of bacteria. When a specimen is sent to the clinical microbiology laboratory for culture, the Gram stain result is frequently the first information provided to the clinician. It is used to first determine a) if infection is present and b) what type of infection (i.e., gram positive vs. gram negative? monomicrobial vs. polymicrobial?). Furthermore, if organisms are observed in a normally sterile fluid/tissue (i.e., blood, cerebral spinal, fluid, cardiac tissue, etc.) the Gram stain result can be a critical result. More importantly, the Gram stain result often drives patient care. 

The Issue

Although the Gram stain is an essential clinical tool, many laboratories struggle to maintain competent technologists, especially on off-shifts or in laboratories that lack microbiology expertise (generalists). The need for second review is common when performing Gram stains as they are often subject to variability due to inconsistent staining techniques, antibiotic pressure, as well as artifacts. Even under best case scenarios, Gram stain interpretation can be challenging and may require multiple reviewers. 

The Solution

Telemicroscopy offers an easy to use and relatively inexpensive solution to provide formal and informal second opinions to various sections of the laboratory (microbiology, hematology, pathology). With the proper tools, telemicroscopy allows Gram stain interpretation from anywhere there is internet access.  Every hospital laboratory has a microscope and a computer with internet, so the only item that may need to be purchased is a microscope camera (≥$5,000). There are also various microscope adapters available for phone cameras that provide equal results for less capital (≥$90). The microscope adapter encases the smart phone and then fits into the eyepiece of most microscopes.

Telemicroscopy utilizes technology to improve diagnostic accuracy, by providing expert consultation for technologists who are uncertain of their results. Telemicroscopy allows laboratories to “present” still or live images to a reference laboratory via a web-based software application such as Skype (or FaceTime if using an iPhone).

About Geisinger Medical Laboratories Telemicroscopy Program 

Geisinger Medical Laboratories is an eight hospital integrated health service organization, serving >2.6 million residents throughout 46 counties in Pennsylvania. Geisinger Medical Center serves as the reference laboratory for 4 minimal laboratories (Gram stain reading, no culture work-up) and 2 partial laboratories (Gram stain reading, limited culture work-up). The Telemicroscopy program consists of presenting still or live images [Olympus BX40, BX41 microscope, Nikon cellSense software (version 1.7.1)] to the reference laboratory via Skype [Logitech 920 camera (version 2013)]. The telemicroscopy result, which is a consensus finding, is manually recorded and followed up with culture review to determine patient impact. 

The Outcome

We evaluated the effect of implementing a telemicroscopy program on patient care.  A retrospective look back at our telemicroscopy data showed that nearly 40% of consults resulted in a change to the original interpretation. The consensus Gram stain result correlated with culture 85% of the time. Overall, 49% of the cases assessed by telemicroscopy were impacted by the consult. Of which, patient care was positively and negatively impacted in 72% and 28% of cases, respectively.

The Conclusion

Gram stain consultations via telemicroscopy from remote hospital sites can improve patient care. Telemicroscopy offers a simple, inexpensive, and innovative approach to providing expert consultation services to off-shift or inexperienced staff. This is also a great way to promote interdepartmental consultation and collaboration (i.e., between microbiology and hematology or pathology).

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Image 1. Telemicroscopy via traditional microscope camera. Microscope with camera attached and computer screen showing Gram stain.
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Image 2. Telemicroscopy via s mart phone. Close up of microscope adapter attached to microscope. Image of Gram stain displayed on phone screen.

References:

  1. Microbiology Strong: Enhancing Microbiology Services and Technical Support in an Integrated Laboratory System. ASCP.  Las Vegas, Nevada. September 2016. Oral presentation.
  2. Martinez, R.M., Shoemaker, B.C., Riley, J.A., and Wolk, D.M. 2016. The TeleGram of the 21st Century: the Digital Gram Stain. American Society for Microbiology (ASM) General Meeting. Boston, MA. Poster presentation.

 

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-Raquel Martinez, PhD, D(ABMM), was named an ASCP 40 Under Forty TOP FIVE honoree for 2017. She is one of two System Directors of Clinical and Molecular Microbiology at Geisinger Health System in Danville, Pennsylvania. Her research interests focus on infectious disease diagnostics, specifically rapid molecular technologies for the detection of bloodstream and respiratory virus infections, and antimicrobial resistance, with the overall goal to improve patient outcomes.

 

 

Reacting to Change

People react to change very differently, but almost everyone has a strong opinion about it. Personally, I love change and I often go out of my way to create it whenever possible. I rearrange my furniture at home every few months.  I lived and worked abroad for years; I moved so often that for three years the longest I stayed in one place was five weeks. Now, the change I look to create is less locational and more organizational and cross-cultural. Understanding how others react to change is an essential component of the process.

The Reacting to Change course focuses understanding how you and others react to change situations and how to effectively plan and create change. Acknowledging both the emotional and practical aspects of change creates the space for coworkers and employees to get on board with the new direction and plans. Allowing people to have input wherever possible and creating session in which people can ask questions, provides valuable input and a sense of ownership, which is essential to make the change last. Furthermore, giving people time to process and move into action at their own pace is essential to create buy-in. For those people familiar with the DiSC Styles (hyperlink to that blog), typically those who have a C or S style tend to prefer longer timelines, while those with D and i styles can handle a faster change process more comfortably.

This course determines your thinking style: constructive, passive/defensive, or aggressive/defensive. Each style is further divided into four styles, so there are twelve total. The ultimate goal is to reduce both defensive styles and to increase your constructive thinking, which leads to constructive behaviors. This assessment indicates which behavior you exemplify when in stressful situations, for instance when a change is implemented at work. If you already have a tendency for passive/defensive thinking, it indicates that you are more likely to react that way when faced with a policy change, office relocation, or anything else that causes you stress. This assessment helps you provide an action plan of where to move your thinking and behavior towards.

Change is part of our daily interaction with the world. Gaining that self-awareness and understanding of others is critical when leading people through any type of change process, whether a policy change or a merger. Woodrow Wilson said “if you want to make enemies, try to change something”. What can you do as a leader to create even higher levels of collaboration, productivity, and satisfaction through change?

 

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-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 working 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.


 

During my tenure in the Blood Bank, institutions have moved from immediate spin crossmatches (manual crossmatch) to electronic crossmatches (computer crossmatch). Computer Crossmatching allows the Blood Bank computer system to match donor and recipient ABO Rh type for compatibility. In order to do so, certain standards must be met. A minimum of two ABO typings must be in the system, the patient must have a negative antibody screen, and no history of ABO Discrepancies or clinically significant antibodies can exist. If any of the mentioned circumstances are present, an immediate spin or Coombs crossmatch must be performed.

Implementing this change improved turnaround times which reduced rates of delayed transfusions and elevated patient satisfaction rates. Perhaps more importantly, another patient safety initiative was created, since two ABO types need to be performed on two different specimens. This means patient identifiers are checked and confirmed on two different specimens before transfusion. While these changes aligned with the Joint Commission’s Safety goals, internally this change impacted the Nursing and Blood Bank Departments in ways that made the transition less than smooth.

The ASCP Leadership Institute’s “Reacting to Change” module uses methodology from different industries to create powerful change. Dr. John Kotter has an 8-Step Process for Change, which resonated with my experience.  Engaging & Enabling the Organization include: communicate the vison, empower action, and create quick wins.

Since our rollout of this change lacked these steps, it wasn’t as successful as it could have been. The lack of communication and proper departmental educational in-services lead some individuals within the Blood Bank to have several concerns. Older technologists worried technology would eventually take their job, and novices worried they would unintentionally harm a patient since they didn’t physically complete a crossmatch. As for the Nursing Department, most nurses did not know about this new requirement. The importance of the second-specimen requirement was seen as a nuisance rather than an improvement to patient care. Proper educational in-services were not instilled, which resulted in more questions for the Blood Bank to answer. In addition,   two specimens were drawn at the same time, which negated the utility of the second specimen. Since education wasn’t finalized prior to implementation, the nurses and blood bank staff were frustrated.

Dr. Kotter’s Engaging & Enabling is a means of collaboration. In this scenario, collaboration between departments and having an education liaison for each department could have assisted in the execution. The use of knowledgeable, talented personnel can allow both departments to cohesively provide seamless operations. Seeking out our talented staff and encouraging them to be great enriches their sense of purpose and allows us to acknowledge them for their talents.

In order for change to be effective, we have to minimize negative reactions to change. This involves communication, education and providing data-driven results. Change is inevitable, and proper execution can help make that change successful.

 

 

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-Tiffany Channer honed her skill and knowledge of Blood Banking at Memorial Sloan Kettering Cancer Center in New York, NY, where she completed her 9 year tenure at Memorial Sloan as Blood Bank Educational Lead Medical Technologist III/ Safety Officer. She’s currently working as a Laboratory Lead Technologist III at Bayfront Medical Center in St. Petersburg Florida. At ASCP, Tiffany is the Mid-Atlantic Regional Representative for the Council of Laboratory Professionals Council. Tiffany was a Top Five 40 under Forty Honoree in 2015 for her dedication and advocacy to education and laboratory medicine.

Help! OSHA is in My Lab!

Hospitals and other healthcare facilities have been on OSHA’s “high-risk” workplace list for a few years. That means the regulatory agency has noticed an increased number of employee injuries there, and therefore OSHA inspections have increased in hospitals and labs as well. If an OSHA inspector arrives at your facility, you should not panic, but you should know some very specific steps to follow.

If inspectors come directly to your department and you belong to a hospital or larger facility, be sure to contact your administration and accreditation departments immediately. This is a government agency on site, and the facility representatives need to be aware and involved. Verify the identity of the inspector(s). Sadly, there are imposters who pose as inspectors for the purpose of collecting money. OSHA inspectors will never talk about fine amounts during an inspection, and they certainly would not collect money on site. To prove the inspectors’ identity contact the state or federal OSHA office and verify that an inspector is scheduled to be on site. Twenty seven U.S. states and territories operate OSHA-approved State Plans, and if that is true in your area, it will be the state inspector on site rather than someone from the federal government.

OSHA is legally authorized to conduct workplace inspections to enforce health and safety standards, so it is usually best to allow them to inspect if requested. That said, you do have the right to require the inspector to obtain a search warrant before allowing them into your lab. However, as you can imagine, this will give an inspector the wrong idea about what you may or may not be hiding. They may dig deeper when they do return with that warrant, so it may not be the best course of action to turn them away.

An OSHA inspection begins with an opening conference which details the scope and purpose of the inspection. In the initial meeting, it is acceptable to ask the purpose of the inspection and its anticipated length. Ask what documents the inspector will want to see, and ask if there are any specific employees he or she will need to interview. If the inspection was triggered by an employee complaint, ask for a copy of the written report. The inspector may review certain lab documents pertinent to the investigation, and these may include the chemical hygiene plan, exposure control plan, or other policies and procedures.

While on site, the OSHA inspector should always be accompanied by a representative of your employer, an escort, and their next steps will usually be a walk-through of the inspected areas to look for safety hazards and to talk to employees. The inspector may talk to staff, take notes, and take pictures. The lab escort should take copious notes while this is happening, and it is advisable to take pictures of whatever the inspector documents with photographs.

If the inspector asks to interview an employee, he may do so in private so long as the employee agrees to that. Train staff to never volunteer information during an OSHA inspection; they should answer only what is asked. An OSHA inspector may ask if the employee familiar with lab safety policies and procedures, and whether or not the employee follows those procedures. They will try to determine if staff is aware of hazards in the workplace. If the inspector points out safety violations he notes, do not agree to them; it may be taken as an admission of wrong-doing and could incur a fine. If you are able to correct the violation on site, do so immediately, but understand that you could still be cited. However, this goes a long way toward showing the inspector that your interest truly is in cooperating and keeping employees safe.

Once the investigation is complete, the inspector will hold a closing session on site. During that time the lab will be notified about citations that will appear in the written report. The inspector will explain your right to appeal noted violations and give information on how and by when to appeal. They will answer any questions you may have. If on-site corrections were allowed during the inspection, be sure the inspector states that the follow up was completed.

If a citation will be incurred, start right away to prepare your response while the information is fresh in your mind. An OSHA report can take up to six months to be sent to the facility. Post OSHA citations at or near the site of the violation in the department.  If the correction of the violation takes longer than three days, the posting must remain until the correction is completed. After correcting a hazard, notify OSHA in writing. Employers have up to 25 days to submit OSHA an abatement of the safety issue or issues. If the abatement will take a long time (greater than 90 days), the first abatement progress report is due to OSHA within 55 days.

OSHA fines increased in 2016 for the first time in over 30 years. A single fine amount can range from $12,500 up to $125,000 depending on the seriousness of the violation. That’s just one reason to make sure your lab is following OSHA safety regulations. Keep your staff safe, but if OSHA knocks on your door, remain calm, and follow the steps to ensure a smooth inspection and follow-up process.

 

 

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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.

Boards and Wards

As a little detour before I start my medical school clerkship rotations as a 3rd year student, I’d like to take a moment to appreciate—yes appreciate—board exams. I just sat for the daunting and arduous United States Medical Licensing Exam (USMLE) called “Step 1.” It is roughly an eight-hour endeavor to prove that some of the tomes of information I was exposed to throughout my first two years of medical school made it somewhere into my hippocampus. That said, yes board exams are always daunting and yes, they can even be quite stressful. There’s a lot depending on your scores, in any field you find yourself testing in. Some are pass/fail and some provide you with a scaled score performance.

For what feels like forever ago to me now, I sat for a state licensure exam for the Illinois Department of Public Health as an Emergency Medical Technician Basic provider, or EMT-B. I absolutely failed it—missed it by a point or so. Scheduled a retake, studied hard, and passed round two. Lesson learned. That license opened many doors for me back in the day, and that’s precisely the point: professional certification, official licensures, and (often) professional society membership will bolster anyone looking to get ahead in their career.

Other times, these board exams are highly encouraged. After graduate school at Rush for my MLS degree I had to sit for the ASCP BOC Board Exam for the professional credentials of a Medical Laboratory Scientist, or MLS (ASCP). When I passed, I was able to advance in my career then and have excellent opportunities that would be unavailable otherwise. More so, certain jobs would have been completely unavailable to me without those clinical credentials! I would say that like ASCP cites 70% of patient results originate from the lab, 70% of my CV depends on those professional credentials.

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Figure 1. A previously renewed ASCP BOC certificate, proudly displayed.

This brings up a somewhat related point. There is a professional debate that’s been going on for a few years: board certification vs. regulatory licensure. Organizations like ASCP and CAP have been on board with licensure for a while, citing the critical roles we play in patient care and the specialized education training required. An article from 2015 had circulated well explaining the advantages and regulatory compliance improvement offered by licensure as medical laboratory science evolved since the Clinical Laboratory Improvement Act of 1988 (known as CLIA ’88). Those authors established that virtually all laboratory professional organizations, as well as local state public health departments, favor licensure to guarantee regulatory oversight for the quality of personal and testing results (Rohde et al., 2015). With so many questions today about what qualifies laboratory personnel since the Center for Medicaid Services decision in 2016 that says a bachelor’s degree in nursing is sufficient to perform and manage laboratory moderate to complex testing, professional organizations like ASCP, CAP, and ASCLS continue to investigate what measures would maintain quality and regulations for positive patient outcomes.

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Figure 2. States with licensure, and without. I was trained and practiced medical laboratory science in Chicago, Illinois, a state that does not require licensure. (Rohde et al., 2015)
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Figure 3. These graphs show the number of sanctions under CLIA imposed on labs in the following states. This demonstrates the ineffectiveness of CLIA improving laboratory testing or personnel quality. (Rohde et al., 2015)

Like the EMS exam, the USMLE is absolutely mandatory if I in any capacity wish to continue my medical education, match into a residency program, and ultimately practice as a physician. So, as daunting as these tests might be, they provide a good benchmark standard for the quality of physicians from around the world who want to practice in the United States. USMLE actually has a series of four board exams I’ll be taking in the coming years—so bear with me as I try to stay positive. The Step exams check the depth and breadth of one’s understanding of medical concepts from anatomy to the minutiae of biochemistry. Like ASCP’s board exam, it was a mix of hematology, microbiology, immunology, with added clinical vignettes and patient outcomes. At the end of the test day, I didn’t have a single neuron left working at 100%, but I’ve since recovered. And now it’s onto the next chapter: clinicals. Hope to catch you all again soon, as I’ll try to write up some interesting lab-related cases I will most assuredly come across. Thanks!

 

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Figure 4. One of many medical students’ bibles. (Stock photo from Amazon.com)

References

Rohde, R., Falleur, D. Ellis, J. (2015) “Almost anyone can perform your medical laboratory tests – wait, what?” Elsevier.com March 10th, 2015; retrieved from: https://www.elsevier.com/connect/almost-anyone-can-perform-your-medical-laboratory-tests-wait-what

 

Centers for Medicaid and Medicare Services (2016) Personnel Policies for Individuals Directing or Performing Non-waived Tests, Revised due to typographical error under citation of §493.1443(b)(3). Center for Clinical Standards and Quality/Survey & Certification Group. April 1, 2016; retrieved from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-18.pdf

 

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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.

Decoding Generations

When I started my professional life, nobody talked about generations. Experience was everything: none, little, some, significant or expert. Now, conversations about generational similarities and differences are integrated into professional and personal life.

There are currently five generations at work today: Traditionalists, Baby Boomers, Generation X, Generation Y/Millennials, and Generation Z.

generations

Understanding generations allows people to adapt their behavior according to certain preferences.Take, for example, communication styles. When communicating with someone from the Baby Boomers generation, picking up the phone might be appreciated, while sending an email to a Generation X is the best way to communicate with them. Always keep in mind, however, that generational preferences are generalizations, and knowledge about them does not substitute understanding each employee and colleague on an individual basis.

Another example of the differences between the generations is how they define their aspirations. Traditionalists value home ownership, Baby Boomers want job security, Generation X aspires to achieve work-life balance, Generation Y prefers flexibility and freedom, and Generation Z values security and stability. Understanding each generation’s aspirations allows leaders to tailor their communication style and job aspects to each individual.

 

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-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 working 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.

 


 

As a former member of the ASCP Resident Council, I volunteered for the opportunity to serve as a beta tester for the ASCP Leadership Institute. To obtain certification, I completed 10 modules which often included a pre-course reading or interactive video assignment along with a pre-recorded webinar, post-test, and post-course evaluation. Some of these courses are also available in-person at live meetings and can include personal coaching live, online, or by phone.

A cursory internet search will reveal a plethora of written and video resources available on the topic of leadership. Additionally, many of us have participated in evaluations or trainings that sought to not only define our personal leadership skills/style but also help us to gain essential self-awareness and skills to better lead or be part of a team. Despite such experiences and even though I’ve held many leadership positions over the years, I still find it difficult to reconcile what it means to be a leader, both in terms of expectations that I hold for myself and those that others hold of me and how to build these expectations to realize a shared objective.

I was intrigued by the title of the module “DeCoding Generations”. This module was especially salient for me since I was a non-traditional medical student after initially studying to be a neuroscientist. I’ve generally been older than my fellow trainees and younger than the majority of my teachers. This generational gap has also been similarly evident within the teams I’ve participated in since I matriculated into medical school.

This module explored the core values of the following “generations”: traditionalists, baby boomers, gen X, gen Y (also known as millennials), and gen Z to help the learner understand what drives members of each group. The course then further defined the aspirations, attitudes toward technology and their careers, and preferred communication media and preferences of members of each generation. This was all with the goal of facilitating interactions, especially as a leader, with members from each generation. For instance, different generations prefer and respond better to different types of communication: in-person, phone, email, video conferencing, text, or a combination of these modalities. That’s where the “decoding” part of the module comes in. As leaders, we need to recognize how best to interact with each team member to acknowledge their core values and foster the most harmonious working relationships while working toward a shared goal.

I’m a very visual learner and intuitive person but not the most eloquent or at ease with verbal communication despite friends remarking that I’m a “social butterfly”. This module helped me evaluate ways to adapt my communication style especially when interacting with others in the two most numerous generations in the workforce: millennials (42%) and baby boomers (29%). I fall in the middle as a gen X’er (23%) and have often found myself confounded by the attitudes and behaviors of millennials and this module helped me to understand their perspective and preferred modes of communication. But what I learned most was to look at not only the differences that impair our interactions but also the similarities we share that can be used to prevent or resolve conflicts and to encourage team creativity and solidarity.

 

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-Betty Chung, DO, MPH, MA recieved a BA from The University of Chicago, MA from Boston University School of Medicine, DO from UMDNJ-School of Osteopathic Medicine (now Rowan-SOM), and MPH from Columbia University and a decade of experience in basic science research. She completed her AP/CP residency at the University of Illinois at Chicago (PGY1-2) and Rutgers Robert Wood Johnson Medical School (PGY3-4). Her current interests lie in graduate medical education, quality improvement, hematopathology, and molecular genetic pathology.

Components of an Online CLS Course

When interviewing prospective candidates for Mayo Clinic’s program in medical laboratory science (MLS), I provide an overview of one of our blended courses and compare and contrast it to one of our more traditionally taught (lecture-based) courses. This gives me the opportunity to emphasize expectations and recommended study habits based on some of the “best practices” we’ve learned from our students.

Our online MLS courses include the following components:

  • Syllabus
  • Weekly calendar
  • Online lessons
  • Homework assignments
  • Discussion boards
  • Study guides
  • Self-assessments
  • Practice exams
  • Resources (links to related online resources)

Our students are expected to review each online lesson before coming to class as preparation for their laboratory session. Since we teach “immersion style” courses, two at a time (where a typical four-credit course is condensed into six weeks), we recommended that our students plan to study a minimum of 4 to 6 hours per day.

Each lesson is presented in a written format, following instructional-design recommendations for online learning that includes “chunking” of the content—using bullets to convey information instead of complete sentences (where appropriate) along with concisely written text that emphasizes “key concepts,” graphics, and images. The lessons are straightforward and present basic knowledge, and the higher learning concepts are integrated into the discussion-board assignments.

Each online course is easy to navigate and is presented in such a way that it’s intuitive and requires little “outside” instruction. All the courses in our program follow the same format, so once the students become familiar with navigation of their first course, they do not have to re-learn the lesson format each time they start a new course.

We provide a study guide of objectives for every written examination. Our students are encouraged to create a learning document from the study guide that they can use for review over the duration of the program and to prepare for their national certification examination in medical laboratory science offered through the American Society for Clinical Pathology.

To give you an idea of how our online courses are designed in Blackboard Learn, I have taken a series of screen shots demonstrating the layout of a course and lesson plan (shown below).

When our students log into Blackboard Learn and open a course, they land on the home page, which includes a navigation menu and links to the syllabus and introductory discussion boards. The home page discussion boards include “student introductions,” “faculty expectations,” “updates and handouts,” “ask your instructor or classmates,” and an “MLS Café” (for social interactions).

1_Welcome

From the menu, our students can open the course content. The first page opens to the weekly course calendars. At a glance, our students can examine the week’s activities.

2_Weekly Calendar

Clicking the “Course Week” link opens the week’s lesson plans.

3_Lesson Plan_Week 2 List of Lessons

Each lesson is formatted the same way and begins with a brief description, overview (goals or learning objectives), author, and references.

4_Lesson Plan_Overview

The second page is a table of “steps to completion” so that our students know exactly what is required of them.

5_Lesson Plan_ Steps to Completion

The lesson is presented in a written format. A table of contents allows the students to navigate the pages of the lesson.

 

 

6_Lesson Plan Introduction

The lesson concludes with a self-assessment. The self-assessment is embedded in the lesson, includes feedback loops, and is also linked to the home page menu. The students are able to take the self-assessments as often as they’d like, and the course grade book is set to record their highest score.

7_Example of Self Assessment

In this course, there is a weekly discussion board. The students are directed to work as a team in assigned groups to answer the questions in the discussion. Credit for this discussion is based on participation in the thread and “substantive” contributions to the dialogue. Students are encouraged to build upon one another’s commentary, generating comprehensive answers to the questions. Each group member must contribute at least two to three substantive answers to receive credit for the assignment. One group member is designated to post a summary of the discussion on behalf of the group.

8_Example of Discussion Board

There are 15 didactic courses in our MLS curriculum. All of our courses have an online component with approximately one-third of the courses applying the “reverse-lecture-homework” paradigm, one-third are lecture based (traditional), and one-third are a combination of both.

This variation in presentation of content provides our students a mixed learning experience, and the online format allows for us to map everything out for them. Additionally, the curricular model itself lends to the formation of study groups, which in turn helps our students build upon their teamwork and communication skills.

Since our program was instituted 10 years ago, we have seen excellent outcomes, with 100% graduation rates, 100% employment of our graduates, and 96% first-time pass rates on the national certification examination (based on a three-year average). Notably, the breakdown of the certification results by category demonstrates that overall student performance in content areas of the curricula that apply the reverse-lecture-homework paradigm are, on average, higher than those categories following a traditional course format (i.e, lecture-based).

 

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-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.