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Clinical Microbiology Proficiency Testing program

Clinical Microbiology Proficiency Testing (CMPT) has been a program of the University of British Columbia since 1983.  First envisioned by John Angus Smith and Robin Barteluk as an alternative to importing samples across international borders, the primary goal was to provide clinical microbiology samples for laboratories primarily in the south-west corner of British Columbia, and a few other locations.

Under the direction of its first chair, Michael Noble, CMPT rapidly expanded to providing samples for all medical laboratories in British Columbia, and with rapid succession, for Atlantic Canada (Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland), as well as the Prairie Provinces  (Manitoba, Saskatchewan, and Alberta).  Ontario and Quebec have always run their own programs.

CMPT has from the beginning recognized that medical laboratories differ in complexity in their handling of microbiology samples.  Some are extremely sophisticated addressing samples from high risk patients with special needs, others are more community based and handle mainly conventional samples and refer on the more complex.  Others are in community settings with limited resources and expertise, and are prepared to do only basic analysis, and refer on the rest.  To create a single program, or to provide all samples to all the laboratories would be counter productive, especially for the smaller laboratories, and as such 4 tiers of programs were developed, arbitrarily referred to as categories A, B, C, and C1.

CMPT is a samples based program rather than a microbial based program.  Rather than submitting samples with, for example gram positive cocci only, or having a Neisseria only program, the samples are submitted as urine samples, or sputum samples, or wound samples, or throat swabs, or blood cultures each containing relevant and appropriate background normal flora with or without a pathogen.  The work up intended is to address the considerations of the sample type rather than the microbe.  The best example would be in a microbe based program if a sample was submitted with E. coli, Pseudomonas aeruginosa, Enterococcus faecalis, and Coagulase Negative Staphylococci, the expected result would be to identify each organism to a thorough level.  For a samples based program if this was submitted as a urine sample, the appropriate result would be "Mixed Sample.  Repeat if clinically indicated."

To make a sample based program work, the samples have to actually strongly resemble the sample they are intended to represent.  In our program we do not created lyophilized white powder, but rather provide urine samples that look and act like urine, and sputum samples that look and act like sputum.

Having developed "fresh" samples, it was not a difficult stretch to evolve in new directions.
Based on the organism and substrate similarities we were able to provide a program for laboratories that test drinking and recreational waters for bacterial content.  This program now serves a base of national and international laboratories.

The creation of a samples based program has multiple advantages: first it is realistic, second it meets the international requirements of organizations including ISO and WHO, and third it does not require special or complex equipment.  This then becomes useful not only in Canada, but is very appealing to programs working in regions with limited resources.  Every year we put on training programs to transfer this technology to programs in Asia, Africa, the Middle East that see the advantages of samples based proficiency testing for clinical and water bacteriology.

But education is not provided only for new and developing proficiency testing providers.  Every sample results report provides a strong education oriented report.  For our category B, C, and C1 programs our "critiques" are rated on regular customer satisfaction surveys as their main and most significant source of continuing education information and materials.  If Quality Assurance is the first goal, education and knowledge transfer is at least equal.

CMPT over 27 years have evolved to the point where we meet and provide all the expectations of a university based proficiency testing program.  We provide Service, Education, Quality Assessment, Research, and Development and Training.  Our goal is to continue on all these fronts.

I invite you to visit CMPT at www.cmpt.ca.

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