American Association for Clinical Chemistry
Better health through laboratory medicine
August 2006 Mentor of the Month Q&A Session: Frank Henry Wians, Jr.
Welcome to SYCL's Mentor of the Month.  Questions and Answers will be displayed below...

Dr. Wians- As someone who is so directly involved in the education of residents and fellows, how do you pique (and importantly, keep) the interest of the largely AP-focused pathology residents in Clinical Chemistry? Do you have any tips for providing them with an extraordinary educational experience?
Minnesota

Frank Henry Wians, Jr., Ph.D., MT(ASCP), DABCC, FACB
An excellent question that all CP faculty struggle with. Some of the techniques we have used at UTSW include the establishment of weekly Call Notes and Case Review Conferences, along with small, often one-on-one, tutorials following Sign-Out each day. We get the residents "actively" involved in CP by assigning them (or requesting them to choose) a published manuscript directly related to clinical chemistry for critical review during 30 minutes of the Friday morning Case Review Conference, followed by a presentation by another Resident on a topic (e.g., the value of cystatin C in evaluating renal impairment) directly related to clinical chemistry during the 2nd 30 minutes of the 1 hour Case Review Conference. During Call Notes, residents discuss calls related to clinical chemistry that are used as a springboard for discussion of important, tangential, and directly related issues to the topic of the call, including management issues (e.g., challenging them by asking questions such as "How would you handle this situation better?" "What else could have been done to improve patient care in this circumstance"?, etc.). In addition, assigning residents special projects (not "make work projects," but "real" projects with a well defined purpose and goal) that assist clinical chemistry faculty and staff in improving patient care (e.g., a QA project for which the resident has primary responsibility). Other strategies include cycling both CP lecture topics and presenters so that the same old tired lecture by the same old tired faculty presenter is not repeated ad nauseum (variety is the spice of life). This strategy benefits both faculty and residents. Lastly, consult with the residents. Ask them what they want to get out of the clinical chemistry training period and be prepared to counter the all too typical response - "what do I need to know to pass the chemistry questions on the CP board exam"? Remind them that passing the board exam is a short-lived experience, while training and knowledge of "real world" clinical chemistry lasts a lifetime.

Currently, cancer markers are mainly used for monitoring disease. Do you see a future for proteomic profiling to aid in the diagnosis of cancer? Do you envision us overcoming some of the current challenges of proteomics to make it a reality in the clinical setting?
Boston, MA

Frank Henry Wians, Jr., Ph.D., MT(ASCP), DABCC, FACB
Emphatically, yes and yes to both of your questions! Soluble tumor markers have been a strong interest of mine and one of my favorite expressions is: we are still looking for the "Holy Grail" of tumor markers for diagnosing a cancer at an early stage. After several years of study and thinking about this issue, I believe that we will not (never say never) find such a Holy Grail of tumor markers. What is likely to be more useful in both identifying a cancer at an early stage or an individual's predisposition to a particular cancer is proteomic profiling. In short, if I had my career to do over again today, I would invest my time and effort in proteomics. As a protein biochemist (I spent 4 years of my life studying the physical biochemistry of the bone protein, osteocalcin, and its role in bone mineralization), I am amused that the DNA era appears now to have given way (returned?) to the protein era. Given the rapid advancements that have been and are now being made in resolving the challenges of proteomics, I am confident that these advancements will bear fruit within my lifetime. I am delighted that gene maps are being complemented with protein maps in evaluating a whole slew of various diseases because it is the proteins that are at the "business end" of the etiology of disease. Hence, the focus on proteomics is appropriate, exciting, and likely to be very productive in the diagnosis, management, and treatment of disease at some point in the not too distant future.