Clinical Chemistry Rotation

The objective of the 2 month Clinical Chemistry rotation is to foster pathology education consistent with the needs and expectations of the current and future practice of the discipline. This is accomplished, in part, by learning the tools that are used in chemistry testing, which are broadly applicable as the specialty changes with the overall practice of pathology. Therefore, this rotation imparts a foundation of objective, analytical, and logical analysis of medical problems through teaching methods of obtaining, organizing, and reporting those results. Additionally, the resident learns statistical relevance, predictive-value theory, physiologic and analytical variability and interferences, and plausibility arguments relative to chemistry and serologic testing. Test interpretation also is emphasized; for example associations among the data in a pattern of objective findings may strongly suggest a disease process even if none of the results is individually convincing, or vice versa.

Rotation Structure

The Chemistry rotation includes didactics, rounding in the laboratory, physician interaction with clinical laboratory scientists (also known as medical technologists), bench experience, and sample testing. Didactics are presented as one component of the program. The broader approach of regular morning bench work orientations followed by discussions with the clinical chemist and/or clinical laboratory scientists forms the basis for the total experience. Frequent trips to the floor to review patient data not otherwise available within Medical Center databases add another crucial component. Patients themselves are interviewed as necessary. Attending physicians are contacted and their patients discussed as appropriate. Laboratory management aspects are learned by participation in the daily operations including staff meetings. The rotation includes instruction in proteomics, solid state chemistry, mathematical modeling as an adjunct to measurement, "systems biology" and related schemata, and quality control/quality assurance/laboratory management.

Conferences include the department's mandatory daily conferences (AP-CP) and specialty conferences as appropriate. Periodically rounds and conferences offered in other departments may be recommended to the resident for specific purposes.
 

Sample Daily Schedule
 DidacticsBenchReadingClinical
7:30Conference (when scheduled)  
9:00Bench assignment  
11:00Meeting with pathologist/chemist/CLS 
12:00Conference  
1:30Review delta check  
4:00Discuss cases with pathologist  
5:00Reading  

Specific Clinical Chemistry Goals and Objectives

Patient Care:

  • Gather essential and accurate patient information and incorporate it into interpretations of clinical chemistry and serologic laboratory results.
  • Effectively analyze and interpret chemistry and serologic testing.
  • Consult on interpretation or follow-up of unusual or unexpected test results.
  • Order appropriate special testing when appropriate.
  • Function as a consultant to the ordering physician regarding test interpretation, assistance in test selection and regarding laboratory concerns.

Medical Knowledge:

  • Apply the appropriate testing algorithms in areas of clinical chemistry and serologic testing.
  • Define the basic principles, methods, and applications of the assays used in clinical chemistry and serologic evaluations.
  • Recognize the role of the pathologist as a clinical consultant in the laboratory.

Interpersonal and Communication Skills:

  • Participate as an expert in Chemistry and Serologic Testing at multidisciplinary conferences.
  • Demonstrate the ability to write a comprehensive and coherent consultation note.
  • Demonstrate the ability to clearly communicate test results and discuss their implications with the referring physician or appropriate clinical personnel.
  • Educate colleagues and other health care professionals regarding the role of the clinical chemistry laboratory and associated testing.
  • Demonstrate the ability to educate non-pathology clinicians and other health care workers about fundamental principles of test design/interpretation and the approach to test selection.

Professionalism:

  • Demonstrate compassion, understanding of and respect for patients, their families, and the staff and physicians caring for them.
  • Model positive work habits, including punctuality, dependability, and professional appearance.
  • Demonstrate principles of confidentiality with all patient information.
  • Demonstrate understanding of the social consequences of testing for drugs of abuse

Systems-Based Practice and Practice-Based Learning:

  • Demonstrate the ability to work with other health care personnel to develop clinically advantageous and cost-effective care-delivery strategies.
  • Practice cost-effective health care and resource allocation that does not compromise quality of care, understanding the need for and cost of special studies, extended testing, and send-out testing.
  • As senior residents, attend the CP QA committee meetings to be able to explain how to partner with the administrative and technical staff to assess, coordinate, and improve health care and know how these activities can affect system performance.