Results of a recent survey show pathology residents do not have a positive attitude toward clinical chemistry. How can labs change this?

A: Residents in pathology programs typically pursue anatomical pathology as a career, but many positions available after residency require experience in both anatomical and clinical pathology. Consequently, residents tend to learn both subjects to market themselves, but don’t place the same emphasis on their clinical pathology training. This sometimes leads to dual anatomical pathology/clinical pathology residents being granted oversight of clinical laboratories despite the fact that they feel undertrained in clinical chemistry and in quality assurance.

As medical educators in clinical chemistry, we need to constantly remind residents of their possible involvement in these subject areas and to find new ways to engage them in the material. Likewise, a dynamic shift in the way we teach clinical chemistry is needed. As in other areas of medicine, education of pathology residents must incorporate case-based adaptive and perceptual learning exercises rather than continuing to use traditional passive teaching methods.

What are the current challenges of teaching clinical chemistry?

There are many obstacles in teaching clinical chemistry. From experience and conversations with others, I have found that oftentimes residents view clinical chemistry as a laidback clinical pathology rotation. While on their clinical chemistry rotation, residents will commonly take vacation time, study for board exams, or perform duties from a past anatomical pathology or clinical pathology rotation. 

The sheer scope of clinical chemistry combined with the limited rotation time—which lasts approximately 2-4 months depending on the program—also makes it difficult for the training pathologist to manage all the necessary education materials. Fortunately, recommendations found in “Curriculum Content and Evaluation of Resident Competency in Clinical Pathology: A Proposal” (Am J Clin Pathol 2006;125 Suppl:S3-37) or the more recent Pathology Milestone Project could help to refine clinical chemistry training and requirements. For clinical chemistry educators, an institution’s residents’ handbook in particular is one of the best places to compare defined and current training practices.

What is being done to advance clinical chemistry education?

Several new educational techniques are available to teach clinical chemistry. For example, pathology residents who rotate through clinical chemistry see sophisticated instruments capable of performing millions of tests per year, but frequently lose sight of the core chemistry principles embedded within these automated systems. To avoid this pitfall, I recommend using abnormal results and chalk talks to highlight specific cases, pathologies, and analytical principles associated with a method.

Additional clinical chemistry-related teaching techniques rely on recent innovations in electronic and online resources. Digital circulation and presentations of daily or weekly multiple-choice quizzes are exceptional tools for engaging residents with real-time feedback and can be created with online templates provided by sites such as www.surveymonkey.com or www.polleverywhere.com. Other online programs such as customizable Jeopardy- and Family Feud-style review games, AACC’s Clinical Chemistry Trainee Council, and the more recently launched AACC Learning Lab are being recognized rapidly as valuable active learning resources, too.

Another novel educational tool that several clinical pathology and clinical chemistry programs are implementing is the diagnostic management team (DMT)—a concept originally spearheaded by Michael Laposata, MD, PhD, when he was a professor at Vanderbilt University in Nashville, Tennessee. Pathology programs that utilize DMTs actively engage residents in personalized medicine, consultation, and appropriate test selection in an effort to optimize patient care. Trainee projects aimed at reducing unnecessary testing, imaging, and overall delays in diagnosis also are seeing the benefits of DMTs.

Resident education in clinical chemistry definitely is no easy task. However, one thing is certain: With innovative approaches and an enthusiastic attitude, unfavorable perceptions of clinical chemistry will hopefully become a thing of the past.

Joesph R. Wiencek, PhD, is associate director of clinical chemistry at the University of Virginia Health System in Charlottesville. He also serves as director of the Immunochemistry and Biochemical Genetics Laboratories and is an assistant professor of pathology at University of Virginia School of Medicine. +Email: joesph.wiencek@virginia.edu