Sunday, August 15, 2010

Training for Laboratory Medicine residents

It used to be said that the greatest deficiency in medical school training was the absence of any office management economics for those going into family practice.  I think that probably was true.   Maybe it still is.
But a close second in the absence of any quality management training for residents soon to be in management positions in Pathology around the world.  

Lots of time spend on immunohistochemistry (oops!), lots on Metallo-beta-lactamases (say what?), but precious little on what makes a laboratory competent.  Oh sure, a few spaghetti diagrams, and maybe a discussion by the local guy who does accreditation visits ("I can smell a bad lab within 5 minutes of being there"), but the message is still the same; PT is a pain but accreditation requires it, and "clean up this mess.... accreditation is coming!"

Two years ago I pushed to get 4 sessions in during the resident's "academic half-day"   (no, I won't go there) and covered a bunch of topics like Standardization, International Standards, Quality Partners, Quality Assessment (PT, Accreditation, and Internal Audits), and the Quality Tool Box (mostly LEAN and Six Sigma) and some general stuff on Laboratory Error.  The electronic survey indicated virtually no knowledge prior to the course (<10%), with increase in both knowledge and interest (>75%) after.  The group thought the sessions were sufficiently useful that it should be repeated every 2 years. 
Well, that was a good start.

So now it is 2 years later, and the message will be the same, but the focus is going to be different.
But this time I am being given 5 sessions (about 5 hours)

I am preparing my slides now.  This is my current plan. 

1:What is Quality Management, and why do you need to know about it. (History and perspective)
2: Laboratory Error - What is it?; What are the consequences (including Costs of Poor Quality)?; How can you measure and track it?;
3: Accreditation and Proficiency Testing as tools to support Quality Management and reduce Laboratory Error
4:  Monitoring Quality - Internal Audits, Quality Indicators, Quality Control,
5: Tools that support the Quality - Lean, Measuring Risk, Investigating error - including root cause.

Will continue to monitor knowledge and interest. Makes for an easy presentation at the International Conference on Resident Education.


PS: Input is welcome.  Just hit the tiny "comments" under the post.


  1. Hi Michael
    What a great initiative. Without knowledge of the basis of quality management systems, customer’s satisfaction, EQA, accreditation, future medical directors cannot champion the cause (Quality). I have been following you blog on the “Cost of poor quality” with great interest. This concept is based on the premise that you are in fact looking for errors (near misses, non-conformances, opportunities for improvement) but without a strong quality management system in place you could already be in serious trouble without knowing it. Quality Management must become part of the curriculum for medical directors. Quality Managers all over Canada desperately need the support of knowledgeable medical director. Keep the great work.

  2. Are you going to cover the three stages of testing; pre analytical, analytical and post analytical?

  3. Thanks Mark
    Can't talk about laboratory testing without using the cycle structure which starts and ends with the patient.
    There is another structure that is used which is called the "path of workflow" which is depicted as a linear structure that also starts with the pre-examination and goes through to the post-examination, but does not tie back to the patient.

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