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: http://www.medicallaboratoryquality.com/2011/02/resident-quality-seminars-as-adult.html].

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 [http://www.ncbi.nlm.nih.gov/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.

National Standard Academic Challenge

Canadian Standards Association (CSA) has always been an international leader organization in the arena of Quality.  Created in 1919 it was focused on ensuring the quality of bridge construction for the railroad.  As mentioned here before, early (Z299) documents from the CSA were used as the seed documents for the creation of ISO 9000.  CSA has active in the environmental industry, nuclear industry and the nanotechnology industry.  So it should not be a surprise to anyone that they would be always be so very well positioned to take the step forward in innovation and engagement.

Look across the standards world and you will see a lot of grey hair.  Granted that interest in standards development is a pre-occupation that people grow into; first you need to be engaged in an occupation or profession or field of activity long enough to know that there are such things as good practices and not-so-good practices, and the source of good practices can usually be found through reading and understanding consensus based standards.  In my experience that usually takes 5 to 10 years (maybe more – maybe less) to reach that level of insight.  But the experience is also that once in the standards enthusiasts get energized, eventually they become the standards fogies.  I would guess the mean age in the standard arena is well above 60, which means for every person age 50 there is one at age 70, and for every person age 40 there are two near 74.   As one person said, in a lot of committees it is not necessary to set 6 or 8 year term limits on chairs because lots of us won’t make it anyways.

So the answer is to start younger.  

There are all sorts of younger people who would be appropriate to engage in standards awareness and standards development.  Standards awareness should be a component of every training program in electrical, mechanical, healthcare trades and professions.  Every student should be able to know the difference between an effective standard and an ineffective one.  Every student should know which organization in their region or country is engaged in consensus based objective relevant standards.  Every student should understand how standards are the basis for consistent quality practice.  And in time once they have got their hands and head dirty in their field of interest, those folks who want to, should have the opportunity to get engaged in creation of the next generation of documents.  These are the kids who will become our next group of standards developers and quality creators.

So the CSA started with a new pilot “National Academic Challenge” this year associated with its Annual General Meeting with some young undergraduates from an Ontario university.  The presentations were appropriately enthusiastic and well done.  The subjected were perhaps young and naïve, but that’s OK. The pilot was a great success and good for the students and good for a first shot by the organization.  The students loved it and the members loved it.  The exercise was clearly a winner and well worth repeating.  

It pointed out that as a way to recruit some young blood into CSA, this model has some legs.  The yield to CSA will likely be stronger when the challenge involves participants with a little more age and experience, and a more of a focus on a career choice, but that will evolve over time.

On another level it shows that Canada is well positioned to move forward on the world stage through hosting a World Standards Cooperation Academic Day.  We have the organizations, the academics and students at a wide variety of levels.  

There is every reason for Canada to play on the world stage.

More to come.