Clinical Chemistry Residency Training Programat the Oklahoma University Medical Center

Kenneth E. Blick*

At the University of Oklahoma Health SciencesCenter Department of Pathology, we view excel-lence in training in clinical chemistry as an impor-tant element of our highly regarded clinicalpathology residency training program. Over theyears, this program has evolved into essentialcomponents that overall have proven to be mosteffective in producing high-quality clinical patholo-gists. These components are described below.

Clinical Chemistry Training Overview

Our chemistry resident teaching rotation con-sists of 14-week blocks (Table 1) that span 3 sepa-rate months of training in chemistry as well asother areas of the automated core laboratory, in-cluding phlebotomy, specimen processing andreceiving, point-of-care testing, toxicology, endo-crinology, hematology, coagulation, urinalysis, andspecimen referral testing. The 3 separate monthsinclude introductory training (first-year residents),intermediate training (second-year residents), andadvanced training (third- and fourth-year resi-dents) in an effort to make our program progres-sive and therefore consistent with AccreditationCouncil for Graduate Medical Education (ACGME)(1) accreditation requirements. This progressivetraining “journey” allows a resident to gradually as-sume the role of a fully competent LaboratoryDirector.

The textbooks used for the chemistry rotationare The Professional Practice in Clinical Chemistry:A Review (2), Contemporary Practice in ClinicalChemistry (3), and, more recently, educationalcontent for pathology trainees at the ClinicalChemistry Trainee Council (4). We also begintraining on information technology in a prelimi-nary fashion during this period (5). The begin-ning “introductory” month and first 4 blocks aredesigned to rapidly orient residents to the clini-

Department of Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK*Address correspondence to the author at: Box 26307, Department of Pathology, College of Medicine, University of Oklahoma HealthSciences Center, Oklahoma City, OK 73190. Fax 405-271-1651, e-mail ken-blick@ouhsc.edu.DOI: 10.1373/jalm.2016.020180© 2016 American Association for Clinical Chemistry

Table 1. Topics covered in a 14-week clinicalchemistry residency training.

Introductory blocks A–D: Measurement theory/specimenrequirements, spectrophotometry/immunoassays/instrumentation, extractions/electrophoresis/proteins,laboratory statistics/quality control/regulations, lipids/cardiac, tumor markers/cancer

Intermediate blocks E–H: Acid-base/electrolytes/point-of-care testing, renal function/fluid balance, liverfunction/hepatitis/HIV, carbohydrates

Senior blocks I–L: Endocrinology/thyroid/adrenals/mineral & bone metabolism, toxicology/chromatography, therapeutic drug monitoring

Expert blocks M–N: Special electives in clinical chemistry/projects, referrals, molecular testing/genetics,management

Program goals: residents should:• Be able to provide technical consultation for testingperformed in clinical chemistry

• Be able to provide clinical consultation for clinicalchemistry testing

• Be able to provide administrative and medicaloversight for the clinical chemistry laboratory.

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cal laboratory. I have entitled this the “boot campintroductory phase of laboratory medicine train-ing” because it is designed to quickly bring resi-dents to the level of training required to handleour clinical pathology call schedule.

Introductory “Boot Camp” ChemistryTraining Focus and Project

All of the new residents are assigned as a teamto this “boot camp” rotationwhen they arrive at thefirst of July. The initial days of chemistry training arefocused on the science ofmeasuring various bloodconstituents and important issues involved inspecimen collection. Pocket-size handouts areprovided for the residents to have with them at alltimes and contain instructions on how to collectthe right specimen, in the right container, with thecorrect test order (Fig. 1). These pocket guidesprove to be most helpful to the new residentswhen handling calls from other residents and at-tending physicians. In addition, we also include the

basics of chemistry, including spectroscopic mea-surement, chemical methods, immunoassays, ex-traction/separation science, and statistics early on,since a clear understanding of these fundamentalprinciples form the foundation of all measure-ments in clinical pathology, regardless of the labo-ratory section involved.All of the new boot camp residents are as-

signed a laboratory project to work on as a team.This project usually involves a method evalua-tion or issue that has the potential to be pub-lished as an abstract or poster presentation. Werequire that the new resident team work to-gether and try to complete the project within the1-month period; however, this latter goal israrely achieved. Nevertheless, more often thannot, an abstract or poster is completed later,which lists all of the new residents as coauthors.We have observed that this project experienceserves to bond the new residents together into acoherent team.

Fig. 1. OklahomaUniversity pocket guide reference for information regarding laboratory testing in thecore laboratory (9).

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Handouts for Introductory, Intermediate,and Advanced Training

Each Friday, chapter handouts from the text-books are provided for the following week’s train-ing block. A chemistry rotation binder is alsoprovided, and residents are expected to placehandouts and other relevant materials in thisbinder. Residents are also required to answerquestions listed at the end of each chapter hand-out; these questions are graded and placed in theresidents file to document training and skill level inchemistry.

Teaching Style and Overall Goals of Training

Throughout our residency clinical chemistrytraining, we indicate that we are using AACC (6)board review materials developed by experts inthe field. In our view, residents should begin pre-paring for board exams in clinical pathology thefirst day they arrive. Our teaching involves a So-cratic style of instruction, with questions over theassigned materials put to the residents interac-tively. For example, residents are asked questionsthat are similar to those frequently posed by callsfrom attending physicians or technologists—usually involving some laboratory issue or problemregarding the laboratory service—and indeed is-sues that must be handled correctly by the resi-dent. Usually, the questions and the interactivediscussions that follow relate to the assigned chap-ter handout materials for the week, but in general,any issue regarding the laboratory service is con-sidered “fair game.” We have noted that some ofour residents respond favorably to this interactivestyle of teaching, while others would much preferto have a traditional lecture at the board using aless confrontational approach. However, in our ex-perience over the years, this Socratic approachhas proved more effective than the lecture ap-proach, and our residents tend to average over the90th percentile in the chemistry section of the Res-ident In-Service Examination (RISE) (7).

Clinical Core Laboratory RotationExperience

During introductory, intermediate, and advancedtraining rotations (Table 1), residents are assigned tovarious workstations and technologists throughoutthe core laboratory. A log is provided to residents todocument their rotation experience at a particularcore laboratory workstation, with their written evalu-ation and comments on the effectiveness of thetechnologist involved.Also, at theendof introductorytraining, residents are required to take faculty on ascheduled core laboratory tour, where faculty askdetailed questions to test each resident’s under-standing of the various equipment andworkstationsin the core laboratory. They assess the resident’s de-gree of competency to effectively handle a clinicalpathology call.During intermediate and advanced training

blocks, residents are required to handle calls fromattending physicians and laboratory personnelwith minimal assistance. Intermediate and ad-vanced residents also assist technologists in call-ing “critical results” to attending physicians. Weexpect our residents in these advanced trainingblocks to master statistical methods as they relateto quality control and new method evaluation. Wealso begin resident instruction in Lean Six Sigmamethodology and concepts. In addition, as part ofadvanced training, we have residents give lecturesin our core pathology courses in our colleges ofallied health and nursing.For advanced training, we have residents per-

form scheduled inspections of each laboratorysection using College of American Pathologists(CAP) (8) inspection checklists. Various items iden-tified by the residents as deficiencies are then re-viewed by faculty and, if appropriate, correctiveaction is initiated based on recommendations ofthe resident and faculty member involved. Resi-dents who are advanced in their training are alsoinvolved in approving the medically necessity ofexpensive “send-out” tests.

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Clinical Pathology Call Conference

Residents are assigned a clinical pathology callwith a rotating pager call number designated for thispurpose. EachMondayat8AM, theclinical pathologyweekly resident call conference is held with the as-signed resident(s) reporting on how they handledphysician calls to the laboratory for the previousweek. A 1-page call document is completed by theresident for each physician call. Pathology facultymembers are expected to attend and comment onhow call issueswere handled. A short “scientific” pro-gram is provided by one of the residents during thelast 20 minutes of this call conference.

Progressive Resident Assessment and FinalChemistry Rotation Grades

For training assessment and feedback, we pro-vide each resident a written and oral evaluation

at the end of the introductory, intermediate, andadvanced training months. After advanced train-ing, we issue a final written assessment of theresident’s competency. The final chemistry rota-tion examination includes a written exam with aminimum score required along with a final “lab-oratory tour” oral examination provided by eachresident. At this point, the resident should beable to explain the purpose and science of everyworkstation and/or instrument present in thecore laboratory. For example, faculty should beable to point to an instrument and ask whattypes of tests are provided, the principle of themethod of each test, and the clinical use of thetest. Resident feedback regarding our clinicalchemistry training program is very positive and,in general, our program is rated as “excellent” byour graduating residents.

Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 4requirements: (a) significant contributions to the conceptionanddesign, acquisition of data, or analysis and interpretationof data; (b) draftingor revising the article for intellectual content; (c) final approval of the published article; and (d) agreement to be accountable for all aspects ofthearticle thus ensuring thatquestions related to theaccuracyor integrity of anypart of thearticle areappropriately investigatedand resolved.

Authors’ Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.

REFERENCES1. ACGME. Chicago (IL). http://www.acgme.org.2. American Association for Clinical Chemistry. Professional

practice in clinical chemistry: a review. Washington (DC):AACC Press; 1996.

3. Clarke W, Dufour DR, editors. Contemporary practice inclinical chemistry. Washington (DC): AACC Press; 2006.

4. Clinical Chemistry Trainee Council (CCTC). QuestionBank, Pearls of Laboratory Medicine, Podcasts, ClinicalCase Studies, Guide to Scientific Writing, Journal Club,Q&A. http://www.traineecouncil.org (Accessed April2016).

5. Hassell LA, Blick KE. Training in informatics, clinics review

articles, pathology informatics. Parwani AV, editor.Philadelphia: Elsvier; 2015.

6. AACC. Washington (DC). www.accc.org.7. American Society of Clinical Pathology (ASCP). Resident

in-service examination RISE. http://www.ascp.org/Residents/Study-Materials (Accessed April 2016).

8. College of American Pathologists (CAP). Northfield (IL).www.cap.org.

9. Blick KE. Reference guide for core laboratory, OklahomaUniversity Medical System Laboratories. OUMCdocument 0613–307, revised June 2013. Oklahoma City(OK): Oklahoma University.

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