American Association for Clinical Chemistry
Better health through laboratory medicine
November 2010 Mentor of the Month Interview: Paula Santrach
Biography
  1. What is your job title and affiliation?
    I am a Consultant in the Divisions of Transfusion Medicine and Clinical Core Laboratory Services in the Department of Laboratory Medicine and Pathology at the Mayo Clinic in Rochester, Minnesota. I am also an Associate Professor of Laboratory Medicine and Pathology in the Mayo Clinic College of Medicine.
  2. Briefly tell us about your educational and career background.
    I attended Carleton College in Northfield, MN as an undergraduate majoring in Biology. Although pre-medicine was my intention, I went “underground” after realizing that half of my class wanted to be pre-med (who needs that much pressure). After college, I was a technician in the Allergic Diseases Research Laboratory at the Mayo Clinic where I worked on laboratory testing and desensitization protocols for patients with bee sting allergies and pollen allergies. This was a fantastic experience in 1) having a real job, 2) solidifying my interest in medicine, and 3) experiencing the academic side of medicine. When I left, I swore that I would never come back to Rochester – I wanted the city life! I subsequently attended medical school at the University of Minnesota in Minneapolis, MN. Although I originally wanted direct patient care, I fell in love with pathology (it’s the latent detective in me) and did my anatomic and clinical pathology residency at the University of North Carolina in Chapel Hill (nice warm climate as well as an excellent training program). Although I originally wanted to be a world famous surgical pathologist (who knew much about the clinical labs?), I got hooked by transfusion medicine, which is as close as you can get to patient care in pathology. I came back to Minnesota for a Transfusion Medicine fellowship at the Mayo Clinic thereby completing the full circle. I joined the staff at Mayo in 1990 and have held a multiplicity of positions within my department (including interim chair) and in the institution. My current roles are:
    • Medical Director, Autotransfusion Team
    • Co-Director, Point of Care Testing
    • Chair, Clinical Practice Quality Oversight Committee
    • Member, Rochester Clinical Practice Committee & Hospital Practice Committee
    • Member, Rochester Executive Operations Team
    • Vice Chair, Board of Directors, Mayo Clinic Medical Transportation
  3. What are your Board certifications?
    I am certified in Anatomic & Clinical Pathology as well as Blood Banking/Transfusion Medicine by the American Board of Pathology.
  4. With which professional societies/organizations (e.g. AACC) are you involved?
    I have been involved with AACC for the past 15 years in a variety of capacities, most recently as the Chair of the Program Coordinating Commission and an ex officio member of the Board of Directors. I have been an assessor for the Accreditation Program of the American Association of Blood Banks for 20 years and led the development of the accreditation standards for perioperative autologous transfusion activities. I have served on the Point of Care Testing Committee for the College of American Pathologists. I have also been a member of the Board of Directors of the Society for the Advancement of Blood Management. Currently, I serve as a member of the Clinical Laboratory Improvement Advisory Committee (CLIAC) with the Department of Health and Human Services.
  5. Just for fun, tell us a few interesting facts about yourself:
    • I am the proud and doting aunt of a nephew & 2 nieces – still trying to convince them that medicine is a good thing to go into.
    • I am a foodie and wish I could cook like a celebrity chef.
    • I collect Northwest Coast & Inuit art.  I dearly want to visit Alaska and the Arctic – don’t seem to have enough experience with frigid temperatures in Minnesota.
Career
  1. What area(s) do you specialize in?
    My specialties are perioperative transfusion medicine, point of care testing particularly for hemostasis, and quality, both in laboratory medicine & patient care.
  2. What initiated your interest in this (these) area(s) and how did you eventually choose this (these) area(s) for your career?
    My interest in perioperative transfusion medicine developed during the first few years of my career. I was introduced to the Autotransfusion Team during my fellowship and then was assigned to assist the medical director with that group. I also found an early career cardiac anesthesiologist who was very interested in the effects of cardiopulmonary bypass on the coagulation system, ways to decrease the incidence of microvascular bleeding post bypass, and effective means of treatment. This early partnership was a tipping point for my career.
    At the same time, I had also become the director of the blood gas/stat laboratory which was the beginning of my practice in clinical chemistry. At that time, point of care testing was very new. One of my first projects was the introduction of the iSTAT into the medical helicopter. Shortly after, I began working on point of care INR testing as well as point of care testing to support transfusion in the operating room. So the direction of my career partly came from being in the right place at the right time when a new technology emerges. But it also came from making the most of the opportunity and developing expertise in a clinical area that needed it, bringing together rapid laboratory testing to improve transfusion practice and patient care. At one point, I could describe myself as a perioperative clinical pathologist – a very unique and needed role.
    My interest in quality began with being an assessor for blood bank accreditation with the AABB. Increased FDA enforcement in blood banking led to the introduction of quality systems and a focus on patient and transfusion safety. Over the years, I have expanded my expertise in quality into laboratory medicine and now into direct patient care. The key to my success was the strong relationships that I built with my clinical colleagues. I became the go to lab person for the operating room, the emergency department, and the intensive care units. This exposure gave me opportunities within my institution and in other disciplines.
  3. What are your clinical and research interests?
    • The use of laboratory & point of care testing with situation-specific algorithms to guide transfusion practices
    • The use of autologous blood techniques to minimize the need for allogeneic blood transfusion
    • The optimal delivery of laboratory testing services to meet the clinical need and improve patient outcomes
  4. What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
    The introduction of objective measures to optimize transfusion decisions in the operating room through the use of point of care testing.
  5. Are there specific aspects of practicing laboratory medicine that you find unappealing?
    My largest frustration with laboratory medicine is the lack of standardization among testing methods. It has been a constant challenge when trying to provide services across the spectrum from point of care testing to satellite testing to main lab testing. These differences can’t be ignored because our clinical colleagues struggle to understand not only that these differences exist, but that they can also have a significant impact on clinical decision-making.
  6. What were some of the most rewarding and/or challenging moments of your career?
    The most rewarding moments for me come from solving challenging/complex clinical problems in order to provide the best care for the patient. They also come from sharing my expertise with others in an engaging way – I love to teach. The most challenging moments have been when I have had to start new ventures: starting a new division, opening a new laboratory, building a strategic approach to quality.
  7. How would you recommend achieving an optimal work/life balance?
    Take time out for yourself and your family everyday. Find something outside of work that really interests you or that you enjoy and do it on a regular basis. Periodically treat yourself to something special as a reward for your accomplishments. Stay connected to your friends and your colleagues – be social.
  8. What excites you about practicing laboratory medicine everyday?
    I go to work every day because there is an opportunity to make a difference for an individual patient, for my practice, for my profession or for my institution. There’s always something new to learn or do. And sometimes there are very challenging problems to solve.
  9. What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
    The next ten years will be exciting as we see the promise of personalized medicine become an every day reality. Advances in medical knowledge coupled with new technology will allow us to do remarkable things. However, at the same time, we may see a revolution in the delivery of health care and we will be challenged to demonstrate our value to patient care. Given the increasing complexity of testing, our value can lie in the development of specific and efficient algorithms for diagnosis, prognosis, and risk assessment.
  10. What do you see as the challenges facing young scientists in laboratory medicine?
    • Successfully leading and managing increasingly complex laboratories – the scientific, the medical, the regulatory, and the business aspects.
    • Establishing your clinical and academic credibility.
  11. What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
    • Develop one or more areas of expertise that will serve as the basis for your academic career and your clinical recognition.  It’s OK if they evolve and change over time.
    • Develop strong connections to the clinical practice and truly understand how the patient care process works.  You will have more credibility and greater influence if you can speak your colleague’s language and understand their point of view.
    • Get involved with professional organizations like AACC.
    • Develop your leadership skills as well as your technical & scientific skills.
    • Don’t be afraid to take on new challenges – success can evoke wonderful opportunities that you would never expect.
  12. Describe how you have been able to give back or contribute to the organizations and the profession in general through your involvement in AACC.
    As Chair of the Program Coordinating Commission, I have been able to bring new topics and new perspectives to AACC educational programming, expanding the horizons of clinical chemistry. I have also been able to provide opportunities for younger scientists to get involved in AACC activities in a variety of ways.
  13. How did you get started in these organizations and what advice do you have for young people wanting to get involved?
    I got started by participating in workshops and giving brown bags. Then as I got to know more people and began to publish, I got opportunities to participate in committee and governance activities through the recommendations of senior colleagues. I was also very involved in the Critical and Point of Care Testing Division holding the offices of treasurer and chair – this opened many doors for me as well.

    My advice would be:
    • Start local & strive for global.  Get involved in local section activities and find a division or two that fits with your clinical and academic goals.  Volunteer and work your way into leadership positions.  The more you participate, the more you get noticed.
    • Make your interest in participating known to your colleagues and influential AACC members that you know.