Clinical Pathology Program

Clinical Chemistry

 

Rotation Director:
William Castellani, MD
 

This rotation is designed to provide an in-depth exposure to the clinical and technical aspects of the clinical chemistry laboratory. It is presented as a structured series of discussions covering the breadth of clinical chemistry from the viewpoint of the responsibility of the medical director. Opportunities to observe and participate in bench activities are both a formal part of the rotation as well as available for further experience based on the resident's interest. While on rotation, the resident is expected to serve as a resource for the chemistry laboratory in communicating unusual findings and determining the most appropriate course of action after discussion with the clinical service.


Goals and Objectives:

Patient Care:

Residents must understand the technical requirements necessary for medical decision-making and the role of the medical director in ensuring that the needs of the patient and the ordering clinician are served. Residents are expected to:

  • Recognize and correctly interpret the clinical significance of common chemistry tests, including test patterns that characterize specific organ involvement or disease states
  • Assess aberrant or atypical laboratory findings and understand the strategies to evaluate and resolve them

Medical Knowledge:

Residents must demonstrate knowledge about established and evolving test methodologies and application of this knowledge to patient care. Residents are expected to:

  • Develop knowledge of the standard chemistry test offerings through discussion and reading as described in the Components section of this rotation description
  • Understand the relationships between laboratory test findings, the underlying pathophysiology, and disease associations
  • Understand the workup of test findings or disease states and serve as a resource to the clinical services for test interpretation, utilization and selection

Practice-based Learning and Improvement:

Residents must be able to demonstrate the ability to evaluate and improve their clinical practices based on new and evolving scientific evidence. Residents are expected to:

  • Apply current medical knowledge and recent literature to unusual cases
  • Recognize the value and limitations of resources that can be used to understand and evaluate laboratory findings (manufacturer's instructions for use, proficiency testing results, quality control data, reference laboratory manuals)
  • Utilize library, web-based, and other educational sources to evaluate methodologies and laboratory findings

Systems-based Practice:

Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide optimal pathology services. Residents are expected to:

  • Understand regulatory issues and regulatory compliance requirements
  • Become involved with management issues in the chemistry laboratory, including quality control issues and unusual findings, and communicate their significance to other health care professionals as necessary
  • Recognize and develop skills necessary to serve as medical director of a chemistry laboratory
  • Consider cost-effectiveness in laboratory testing without compromising patient care
  • Understand the pathologist's role and professional practices in relation to other health care professionals

Interpersonal and Communication Skills:

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and learning with other health care providers, patients, and patients' families. Residents are expected to:

  • Exhibit effective listening skills and the ability to interact with laboratory personnel in addressing issues that arise
  • Interact with departmental and extradepartmental personnel, including healthcare professionals, administrators, and other staff in an appropriate manner
  • Provide effective and professional consultation to other health care professionals demonstrating care and respect for them, and sustain ethically sound professional relationships with colleagues, staff, patients, and patients' families as necessary
  • Provide accurate communication of pathology information using non-verbal and verbal skills
  • Work effectively as a team with other health care professionals and other staff

Professionalism:

Residents must demonstrate a commitment to fulfilling professional responsibilities and ethical principles and sensitivity to a diverse patient population. Residents are expected to:

  • Demonstrate commitment to ethical principles pertaining to confidentiality of patient information, informed consent, and business practices
  • Demonstrate respect, compassion and integrity in all interactions with patients, their families, faculty, other trainees, technologists, and other staff
  • Demonstrate sensitivity and responsiveness to the ethnicity, diversity, age, gender, sexual orientation, and disabilities of patients, colleagues, and staff
  • Demonstrate a commitment to excellence and on-going professional development
  • Demonstrate adherence to guidelines and regulations set forth by regulatory and accrediting agencies
  • Demonstrate ability to identify deficiencies in peer performance


Requirements:

  • No prerequisites are necessary
     

Duration and Timing of the Rotation:

  • Two four week blocks, not necessarily contiguous
  • At least one block is necessary before the resident can participate in the Clinical Pathology Consult rotation


Teaching Staff:

  • William Castellani, MD, Medical Director of Clinical Chemistry
  • Chris Pederson, MT(ASCP) and Monica Straub, MT(ASCP), supervisors of chemistry in the Automated Testing Laboratory


Components:

1.  Background reading (covered independently by resident) and select topics discussed with Rotation Director

   First block (Chemistry/Toxicology):

  • Enzymology: Basic Biochemistry; Creatine Kinase;Lactate Dehydrogenase; Serum Transaminases; Other serum enzymes
  • Lipids and Lipoproteins: Cholesterol; Triglycerides; Metabolism of serum lipids; Hyperlipidemias
  • Drug Testing: Immunoassay methodologies; Pharmacokinetics; Toxicology and chain of custody
  • General Topics: Electrophoresis; Nutritional assessment

   Second block (Chemistry/Regulatory):

  • Regulatory Issues: Coding -- CPT, ICD-9, DRG; Bundling and unbundling of tests; Organ-based panels and Medicare
  • Specific Laboratory Panels and Tests:
  • Basic Metabolic Panel (Sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose and calcium), the Electrolyte Panel, osmolality and the anion gap
  • Liver Panel (Total protein, albumin, transaminases, total and direct bilirubin, alkaline phosphatase)
  • Renal Panel
  • Comprehensive Metabolic Panel
  • Obstetric Panel
  • Evocative/Suppression Testing
  • Arterial Blood Gases

The standard text for this rotation is Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 4th edition, edited by Burtis, Ashwood and Bruns. Selected chapters will be covered. Occasional topics will be covered using Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st edition, edited by McPherson and Pincus


Method(s) of Evaluation:

  • Resident evaluation by faculty for each rotation block
  • Staff assessment
  • Residents will be evaluated based on direct observation by faculty
  • After each rotation, residents will be evaluated by faculty in New Innovations

 

Updated: 3/2012