Section: Clinial Chemistry and Microscopy
(including Andrology with an option of Forensic Toxicology)

Duration: 1 month

Goals & Objectives

1. The resident should be provided with an in-depth exposure to the technical and administrative functioning of Clinical Chemistry.
2. The resident should be involved in realistic problem solving via graded responsibility; types of problems may include clinical, administrative, scientific, and technical.
3. The resident should conduct effective medical communication and consultation with medical staff regarding:

• the rational use of diagnostic clinical chemistry tests.
• interpretation of the complete spectrum of clinical chemistry tests.
• pathophysiologic correlation of clinical chemistry test results.

Duties & Responsiblities

In addition to the specialized topics detailed below, the Resident is expected to participate in the following functions:

1. Interpret and report the electrophoretic patterns of serum, urine, and CSF proteins, LD isoenzymes, insulin tolerance tests, lipoprotein electrophoresis, amniotic fluid pat-terns, and pseudo-cholin-esterase stud-ies.\
2. Communicate with and assist physicians and residents from other depart-ments with regard to clinical interpretation of laboratory tests, and the rational selection of appropriate tests for patient care.
3. Obtain patient records with remarkable (abnormal) values from the laboratory computer. These patients will be presented to Drs. Threatte and/or Woo by the resident on service. Bedside rounds will then be performed for these patients by the resident and the attend-ing(s) for the purpose of determining the diagnosis and/or recommending further laboratory procedures that will aid in the diagnosis. These rounds are also teaching rounds for all interested medical students.
4. Attend the Clinical Pathology Core Laboratory inservice conferences on Tuesday at 2:30 p.m.
5. Interface between the laboratory and the medical staff regarding:
   • approval/disapproval of selected STAT requests
   • test availability and specimen requirements
   • inappropriate/mislabeled specimens
   • turn around time
6. Help correct erroneous laboratory reports and communicate with the physi-cian(s) concerned regarding appropriate corrective remedy.
7. Review proficiency testing survey reports. Initiate and record appropriate corrective actions on out-of-limits results.
8. Participate in medical technology teaching and in the in-service education for the technical staff.
9. Review critical value reports and meet regularly with Chemistry attending to discuss difficult cases.
10. Present unusual cases at weekly Clinical Pathology service review meeting.
11. Monitor QC data in the section assigned for that week.

All special topics must be completed during a Chemistry or Advanced CP rotation by contacting the faculty listed and arranging the exercise or discussion indicated. These are listed below on a checklist to be obtained on the first day of the rotation and maintained by the residency office, any resident who has not have all sections completed and initialed by the faculty person will be considered incomplete.

Examples of some of these exercises are listed below:

• Topic: Introduction to Clinical Chemistry Dr. Threatte or Dr. Woo. Review rotation objectives on first day of initial rotation.
• Topic: Amniotic fluid, Electrophoresis & Lipoproteins (Dr. Threatte) Instrumentation: Sebia Hydrasys & Scanning Densitometer: principle of operation and troubleshooting Exercise: Review methodology, and interpret on a daily basis: Protein Electrophoresis, CSF protein electrophoresis, amniotic fluid analysis, and LD isoenzyme analysis
• Topic: Blood gases (Dr. Threatte/Sunheimer) Quality control & statistics (Part l) (Dr. Woo) Instrumentation: Blood gas analyzers: principle of operation and troubleshooting Exercise: Perform Blood gas analysis QC assignments and method evaluation
• Topic: Acid-base disorders and electrolytes (Dr. Threatte) Quality control & statistics (Part 2) (Dr. Woo) Instrumentation: Ion selective electrode Vitros 950: principle of operation and troubleshooting Exercise: Learn methodology and perform Na, K, CO2, Cl QC assignments and method evaluation
• Topic: Liver and cardiac function tests (Drs. Threatte and Woo) Enzyme kinetics (Dr. Threatte) Instrumentation: Spectrophotometry Vitros 950: principle of operation and troubleshooting Centaur: principle of operation and troubleshooting Exercise: Learn methodology and perform AST, CK, CKMB
• Topic: Microscopy (Dr. Threatte) Renal function and metabolic disorders (Drs. Threatte & Woo) Instrumentation: Yellow Iris: Principle of operation and troubleshooting Microscopic examination for urine sediments Exercise: Learn methodology and perform creatinine and BUN Perform analysis on a synovial fluid for uric acid crystals Perform a complete urinalysis on a specimen
• Topic: Endocrinology: Thyroid, Adrenal, Endocrine Pancreas and Parathyroid (Dr. Woo) Instrumentation: Principle of immunoassay Gamma counters Centaur, IMX and Axsym: principle of operation and troubleshooting Exercise: Learn methodology and perform Ca, Mg, TSH, cortisol & hemoglobin A1c
• Topic: Toxicology and Therapeutic drug monitoring (TDM) (Dr. Threatte) Instrumentation: Fluorometry Axsym and Toxilab: principle of operation and troubleshooting Exercise: Learn methodology and perform theophylline, digoxin, and gentamicin Perform a mock inspection of the Clinical Pathology Core Laboratory
• Topic: Laboratory Management (Dr. Threatte) Reference laboratory testing (Dr. Woo) Tumor markers (Dr. Threatte) Instrumentation: Principle of radioimmunoassay and fluorescence immunoassay Centaur: principle of operation and troubleshooting Exercise: Learn methodology and perform CEA and beta HCG Assume the role of Director of Clinical Chemistry As Part of Advanced CP rotation:
• Topic: Special project, e.g. method development, instrument evaluation, quality control program, or other research topics of special interest to the resident.

Evaluation

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