Monday, September 4, 2023

Teaching Points about EQA.


I was going through some of my past teaching files and came across a presentation that I put together for a guest presentation in a class at the local Institute for Technology in 2016. I had already been active in proficiency testing for many years.  Often when I I look at back at my teaching  wish I had done it differently.  This time is different.  I think the comments were actually spot on, and are still both relevant and insightful. 

These were  students in their first year of training to become laboratory technologists.  Some had some university background, but most were direct from high school.  I am not sure where or how they picked up the idea that working in a medical laboratory might be a good job. 

Few had any prior to medical education or laboratories, and I’m pretty sure that none of them had any prior education or training in the concepts of Quality. 

My first task thus was to establish a familiar foundation to which which they could relate.

“Most science laboratory students are familiar with Proficiency Testing, but probably under another name.  Often they are given samples by their teacher, which  they are expected to test, to prove that they have learned a procedure properly and are able to perform tests correctly.  This is usually referred to as receiving and testing “unknowns”.  If “unknowns” are important during training, they are even more important during professional clinical practice.”

Then I tried to make the point the more often than not when mistakes do happen, they are usually not the person’s fault.  They happen.

“Proficiency testing is used for detecting a broad array of potential errors.  Sometimes there are human errors that are made as a result of slips, or distractions, or mistakes as a result of misinterpretations or misunderstandings.  Sometimes, people forget procedures or are unaware of changes because they have been away because of illness or extended vacation or are off regular laboratory rotations.  Other times errors are more systemic, the result of silent problems with equipment or reagents, errors or confusions within the procedure.

Students need to understand that while making errors can happen, they are always a big deal, and can put lives at risk.

But, physicians and patients don’t care about laboratory problems; they  want, indeed expect and demand the information they receive to be the right answer, accurate and interpretable and relevant and on-time.  Quality assessment  tools, including proficiency testing allow the laboratory and appropriate authorities to be aware of competencies on a regular basis.”

Next I introduced to the students the concept of Quality through Assessment, Prevention and Improvement. 

Proficiency Testing is an important component of the total Laboratory Quality Assessment  which also includes accreditation, internal audits,  quality indicators and customer satisfaction surveys.  Each Quality Measure gives a view of an aspect of the whole organization.  Proficiency Testing can challenge every aspect of laboratory performance including  every phase of laboratory performance (pre-examination, examination, post-examination) as well as activities that surround testing such as safety, quality control (peri-examination)… every phase of laboratory performance”

I wanted to warn them about the consequences of not taking Proficiency Testing seriously. 

“With regret, some laboratories staff do not understand or appreciate why they are expected to participate in proficiency testing by authorities or accreditation bodies.  Some of them may even try to suck the value out of PT/EQA through deception (sending the sample to a reference laboratory for investigation) or overwork (not processing the sample with their usual procedure or with their usual workers), and worst, failure to Investigate why and how errors occurred.”


I summed up with…
“In Summary, Proficiency Testing is an internationally embraced Laboratory  Quality Assessment measurement tool similar in purpose as a grown-up extension of student “unknowns”.   It is a  technique that lets laboratories  demonstrate their quality and competence and at the same time provides the opportunity to discover silent system problems that lead to laboratory error.  Proficiency Testing can and should be a valuable  part of laboratory life for the full extent pf a laboratory based career.”

As I look back now, I’m pretty pleased with the message I put forward, now some 7 years ago.  As I recall the class response was positive.   I wish I had had the opportunity to keep in contact and later survey the students over the intervening years, to see if any part of the message actually stuck.