Education Evolution, Part 2

The basic materials that have been taught in the laboratory for years are still relevant and important, but there is a need to incorporate critical new skills. These new skills may displace traditional didactic and laboratory materials that have been utilized over the past decades. After long discussions with clinical colleagues and current technologists, the three areas in the education of clinical laboratory scientists that need significantly more consideration in our present and future curriculum to meet the needs of employers are: Microbiology Education

Critical thinking skills.
Knowledge and experience with molecular methods.
An understanding of the concepts of quality assurance, verification and validation and inspections.

As the emphasis in clinical microbiology continues to move away from the interpretation of multiple manual tests, smears, stains and complex algorithms of biochemical tests and toward automated systems performing the testing and providing an identification, the critical role of the technologist is to determine if the result or identification is rational and appropriate for this patient, disease process or body system. The modern microbiology lab places more emphasis on questions such as:

– How does this result relate to previous results and other test results?
– Is this a critical result?
– Do I need administrative or technical input?

A recent example from the clinical microbiology laboratory illustrates this pointedly.

A relatively new technologist was assigned to the urine culture bench. A urine culture that had been inoculated and incubated for 24 hours, greater than 100,000 colonies of an organism that appeared as small, club-like Gram-positive bacilli consistent with Corynebacterium spp. When the identification from the MALDI-TOF crossed the computer interface to her workstation as Trueperella pyogenes, she was mildly surprised since she did not recognize the name.

SEE ALSO: Education Evolution, Part 1

What was her next action? A Google search, of course! Seeing that this organism was previously classified as Arcanobacterium pyogenes and, before that, as Corynebacterium pyogenes, the technologists followed our laboratory standard process of investigation and checked the patient’s history. A month prior, the patient had a urine culture that was reported as “[greater than] 100,000 corynebacterium-like organisms, consistent with contamination, suggest recollect.” The organism from the previous culture was still available and, when tested using the MALDI-TOF system, was identified as Trueperella pyogenes. What might have been considered two unrelated contaminated urine samples became a clinical concern of a chronic infection with an unusual organism because of the critical thinking skill of the technologist.

Skills for Curriculum Integration
An important area of microbiology that is often ignored or not well covered has been brought to light with the explosion of molecular methods entering the lab. Because of the very different kinds of studies needed to verify and validate new molecular platforms and the changing quality assurance requirements, which are much more involved than traditional QC, we need to expand the didactic and/or case-based teaching on these important topics. The first time a technologist is questioned by an inspector from a national agency should not be the first time that the technologist has thought about the impact of errors on patient care or the sample types needed to ensure that a test system is working correctly.

SEE ALSO: Education Evolution, Part 3

What are some concepts that are not as relevant in today’s lab that can be significantly deemphasized in the classroom? Upon review of the “Body of Knowledge” task list from ASCLS for Microbiology, less than 10% of the tasks listed are assigned to the section on Molecular methods compared to the section concerning methods for identification for other organisms. For example, a significant amount of the task list was taken up on manual phenotypic methods for the identification of Gram-negative bacilli, such as TSI/LIA, ONPG, methyl red, MUG, bile esculin, fermentation versus oxidation of any carbohydrate, oxidase and decarboxylation reactions. Few, if any, of these tests are used in routine clinical laboratories today.

In the 2012 Curriculum Guidelines for Undergraduate Microbiology,1 as published by academicians involved with the ASM, competency and skills identified as necessary for the microbiology undergraduate include the following objectives:

– Use of appropriate molecular, media based and serologic methods to identify microorganisms
– Use of appropriate molecular lab equipment
– Analysis, interpretation and application of results

Are these same objectives and concepts being incorporated into MLS curriculum? Specifically, how are students educated in the appropriate molecular lab equipment and result interpretation if the teaching laboratory does not have access to the current analyzers?

In another document , Molecular Pathology Curriculum for Medical Laboratory Scientists: A Report of the Association for Molecular Pathology Training and Education Committee,2 the opening paragraph clearly states, “Educational programs in medical laboratory science must address the training of clinical scientists in molecular diagnostics, but the curriculum for this field is not defined”.

This article posted results of a survey by employers on the preparedness of entry level graduates with molecular diagnostic lab skills. Using a range of 1-4, with 4 indicating expert skill level, the average molecular diagnostics skill level of a bachelor level graduate was a 2.42, with those graduates showing familiarity with the concept, but also in need of on the job training for those.2

Another example of outdated classroom versus bench expectation was noted in the virology section of the ASCLS Body of Knowledge, where there were a number of tasks related to cell culture concepts in virology. With very limited exceptions, virtually no classic virology methods are performed in the majority of clinical laboratories. There are definitely exceptions, and very important ones in research and state-level public health laboratories, but this type of training is provided in that setting if it is needed at all.

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