Monday, February 18, 2013

Reading Quality Tea-Leaves in Laboratory Medicine Residency Training.

Reading Quality Tea-Leaves in Laboratory Medicine Residency Training.

I have put on a Quality Management Seminar Series for Medical Laboratory Residents three times since 2007.  As far as I am aware it is the only Quality Seminar series for Laboratory Residents in the Country.  I have written about this before [see:].

Each time the series has covered the spectrum of Quality topics over a period of 7-8 hours over 3 or 4 days.  We include topics like historical perspective, standards, error, Quality tools, Management Review and Leadership.  It is not intended to be definitive course, but it is a start towards awareness.  Some of the residents have started taking our 20 week course to get a much fuller Quality experience.  I think that is a good thing, and I trust we will find that they think it is a good thing as well.  

In the first session, I was a neophyte on putting on courses, and missed the opportunity to get much pre seminar or post seminar information.  I fixed that the next series and improved the process again this time.  Either we belief in Quality Improvement or we don’t.  

There is one question that I have asked repeatedly, which is:
In your opinion, is the information in the Quality Seminar Series most apt to:
A: Your experiences as a resident in laboratory medicine
B: Your end-of-residency examinations
C: Your future career as a pathologist
D: None of the above.

Since we started I have seen each year that the most common response is always (C ) your future career as a pathologist, and that makes sense to me. 
But to me, the most interesting results are that over the period the (A) option has increased each year and the (B) option has decreased, and no one has ever used the (D) option.

Now to be fair, we get to ask the question every two years, and to date it has been answered only 3 times, and the total sample of responders each year is small; so I know that trying to interpret these results is a lot like reading tea-leaves and it would be a BIG mistake to put too much stock in this, BUT…

I see the trend of increasing awareness of the value of Quality as part of the general pathology and laboratory medicine residency (training period) as both real and positive. 
Here’s why.  A quick visit to PubMed [] the search engine for scanning articles in the US National Library of Medicine found over 120 articles where the phrases “Pathology and Laboratory Medicine” AND “Quality Management” OR “Quality Improvement” were found.  If I changed “pathology and laboratory medicine” to “laboratory testing” the number jumps to 15,634.  If I use just the term “six sigma” I find another list of some 1,295.  What that means is that any resident (trainee) who is regularly reading journal literature is seeing these words on a regular basis as part of the accepted peer-review literature.

Second, residents are commonly on the outlook for short term projects in which they can get involved.  Quality Improvement initiatives such as Internal Audits or Quality Indicator studies fit well with that.  

Third, some residents are becoming more aware of structured Quality Assessment including Proficiency Testing and Accreditation.  Some are even getting the opportunity to participate in site visits.

And fourth, many of the old pathologists who neither knew or cared about all that stuff have been retiring and are being replaced with younger staff who know and understand the value that Quality programs can add to the dynamic laboratory.  Getting rid of deadwood is always a good thing.  

Lastly, in my experience, people interested in pathology and laboratory medicine are not well known for being shy or particularly “politically correct”.  If they think something is a waste of time, there will usually be at least one person who will let you know.  That none of them have chosen this opportunity to point out that the Quality stuff is junk by choosing the option D, suggests that positive awareness is underway. And that is a good thing.

We will see what happens when we run the course again in 2014.

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