There is a need to provide a strong fundamental course in molecular methods in the classroom-with laboratory experience and case-based examples. In addition, there is a need for significant integration of molecular concepts into every section of microbiology through emphasis on cases and critical thinking. At minimum, current techniques in the areas of separation, detection, sequencing, amplification practices and interpretation must be incorporated into MLS curriculum, along with fundamentals of microbial identification. The discussion of each test system or platform needs to include QA, QC, verification and validation and the issues associated with outside inspection.
In addition, lectures need to present critical thinking by connecting organisms, organ systems and diseases to direct laboratory issues. An example would be weekly case studies with interpretation and actual case reports. Finally, examinations today on traditional didactic lectures usually follow the format of those lectures. Basic knowledge is certainly needed by all students, but focusing on arcane biochemical reactions using simple multiple-choice format may not reflect the need for critical thinking.
Obstacles in Curriculum Integration
An issue that has to be acknowledged is that national certification examinations focus on the basic material without much recognition of the changing needs of the workplace. As educators, we are faced with the task of preparing students for the certification exam based on outdated content outlines and outdated questions. While the educational facility uses these exam scores as outcome measures, how does the preparedness of the graduate factor into being employed in a state-of-the-art microbiology laboratory and prepare students for the new modern lab of molecular techniques and total lab automation?
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Methodologies in other disciplines have come and gone, such as the “gold standard” of flame photometry and RIA testing, and the corresponding material has been replaced on the exams. Now is the time to update the content outlines as well as the curriculum for microbiology. How unfortunate for students to arrive in a clinical practicum only to hear that a certain biochemical tube test has not been utilized at the bench in years.
In a recent post on a highly trafficked educator listserv, Kathy Doig, PhD, MLS(ASCP)SH CM 3 stated, “We really have not had a need to know micro biochemicals beyond spot tests since the invention of the [API] strip.”
Has the curriculum been revised to address the change? Minimum entry level competencies have changed, although the majority of the questions on the certification exam have not followed suit.
Taylor et.al, surveyed 91 laboratory managers2 regarding the projected techniques to be implemented in their molecular diagnostic testing areas within the next five years. Based on this survey, the following data was obtained:
– Micoarray platforms have an expected growth from 49-67% utilization
– MALDI-TOF testing is expected to increase from 18-35% utilization
– Next gen sequencing showed the greatest expected increase in implementation with a growth from 35-74% implementing the technique in the next five years
These statistics should be of utmost importance to educators in preparing current students for careers in the modern laboratory. As educators, we are charged with preparing our students for gainful employment in the field of medical laboratory science by arming them with the knowledge to succeed, not simply regurgitate material to pass a test leading to the reaccreditation of the MLS program. ASCP’s board of certification recently released a survey4 for medical laboratory professions regarding the current tasks performed in the workplace to get a better view of the required skills needed today. This will lead to new questions in all areas of the examinations, specifically microbiology.
Proposed Curriculum Changes
So, as the educator, what are the options? Listserv members suggested setting up limited tubed media as a demonstrated reaction to reinforce the biochemical identification. Others have moved to using the slightly more modern, but still dated MicroScan panels, RapidID panels and API strips in place of the tubed media (same reactions, different format). The consensus seems to be in agreement that, until the use of biochemical questions are removed from the certification exams, biochemical testing must be maintained in the teaching laboratory.
In teaching laboratories, there is a need to provide extensive experience with molecular methods. For example, the isolation of DNA; setting up and running gels; running BLAST data for identification of bacteria and fungi; running some of the simpler NAAT systems available through Meridian or Alere; and running PNA FISH in the teaching laboratories would provide real-world experience over the exclusive demonstration of classical biochemical reactions.
Another approach to providing education is to enhance the standalone molecular diagnostic course to incorporate all disciplines of laboratory medicine, such as hematology, microbiology, molecular basics and fundamentals, as well as the pre-analytic, analytic and post-analytic components for various current methodologies. Rodney Rohde PhD, MS, SV/SM/MB(ASCP)CM , along with David Falleur MEd, MT (ASCP) and Phil Kostroun MEd, MT(ASCP), have published an overview of the comprehensive molecular laboratory science course used at Texas State University in the ASCLS Clinical Laboratory Science Journal.5
How best to teach and integrate molecular methods into the curriculum is an important question. There are undoubtedly a number of different approaches to meet students’ needs. However best accomplished, our students need an understanding of several basic areas, including the theory of multiple molecular methods; classroom and laboratory experience with various methods; a clear understanding of the strengths and weakness of methods and laboratory systems or platforms; a strong knowledge of the issues of quality assurance and quality control of molecular methods; and the critical thinking skills to pull the pieces of the puzzle together.