This correspondence has also provoked me to respond.
Whilst William Marshall is correct that we cannot attribute lack of
knowledge of some seniors to the new medical curricula,I think he does
touch on a key issue relating especially to new medical graduates.
Many new curricula,such as the one we have here in Liverpool,are now
virtually entirely problem based-(our first set of graduates became
residents this August)- this meant that if the core elements of clinical
biochemistry were to be covered by all students, these elements had to
appear at appropriate places across a total of some 40 problems in three
years. During this time,students are focussing on problems in a quite
different way from traditional learning- all aspects of the problem from
basic science and pathology through to clinical investigation and
management,and social and public health issues are integrated-the
laboratory component has to compete with all of these for a small amount of
the student's attention. In our old course, some didactic teaching in
clinical biochemistry was followed by data interpretation problems,in a
systematic way which ensured a fairly comprehensive knowledge base.
Despite our best efforts to ensure a presence of clinical biochemistry
across the course, both in the PBL scenarios and several SSMs( Special
Study Modules),the reduced exposure of our students to laboratory medicine
makes them less aware and knowledgeable about data interpretation as
residents than their counterparts under the old curriculum.This does not
make them worse doctors, since they have different skills, but laboratory
staff should be aware of the inexperience of new graduates in this type of
activity.This becomes all the more important when, to meet reduced doctors'
hours,individual doctors may be covering larger numbers of patients.
The need for laboratory staff to draw attention of medical staff,especially
juniors,to abnormal results, to discuss trends in results, and further
investigation and management is a basic laboratory responsibility. If that
responsibility cannot be met,the answer is not to pretend it does not
exist,but to argue,as all other clinical specialties do,that there is a
need for additional staff to meet the clinical needs of the service.
Alan Shenkin
Department of Clinical Chemistry
University of Liverpool.
--On 04 December 2001 10:53 -0600 William Marshall
<[log in to unmask]> wrote:
> Mike Addison's response has provoked me, but on another issue
> 'As we adopt PBL learning the knowledge base of clinical biochemistry
> amongst doctors is in the decline'.
> 1. Many medical schools are not using PBL and few are using it as the sole
> learning method.
> 2. I am not sure how many schools in the UK that are using PBL have yet
> graduated doctors.
> 3. The seniors' faults certainly cannot be visited on PBL.
>
> How many clinical biochemists in schools that are using PBL have written
> problems or are acting as PBL facilitators? If our graduates have
> insufficient knowledge of our discipline for clinical practice, it is our
> fault.
>
> WM
> At 09:20 AM 12/4/01 -0000, [log in to unmask] wrote:
>> I have restrained myself from entering the saga of clinical validation
>> of laboratory results both in and out of hours but have been finally
>> provoked beyond endurance by Dr MacNamara's contribution. This
>> I can paraphrase as 'give me what I want and give it me now'
>> Unfortunately all medical staff are clearly not as familiar with the
>> selection and interpretation of laboratory tests as Dr MacNamara.
>> Indeed it is my experience that as we adopt PBL learning the
>> knowledge base of clinical biochemistry amongst doctors is in the
>> decline. The incidence of bizarre requests is increasing and the
>> arguments put to justify them show a frightening ignorance even
>> amongst more senior staff. This is of personal concern to me as I
>> come to the age group where I am as likely to meet a doctor as a
>> patient as a colleague.
>>
>> In my small paediatric lab looking at all reports is feasible during
>> the day but I can understand that in general labs high throughput
>> means that clinically validating all results is time consuming and
>> boring. However, the use of a computer, delta checks and a few
>> rules could allow the greater part of reults to be issued without
>> checking leaving the more important results to occupy the clinical
>> scientist or chemical pathologist. Out of hours requests will
>> almost always fall into the group which can be automatically
>> validated.
>>
>> Others have demonstrated that medical staff often value comments
>> and find them useful inpatient management so the evidence base is
>> there for Dr MacNamara but I suspect her practice is entirely
>> hospital based while most UK labs have a large element of GP
>> work.
>>
>> Perhaps this subject has reached it's natural end with fixed views
>> based on different philosophies and resource driven practical
>> approaches. We know preanalytical and postanalytical phases of
>> lab tests are just as prone to problems as the analytical phase so
>> will anyone kick off with an email on clinical validation of requests?
>>
>> Mike Addison
>> Dr G.Michael Addison
>> Royal Manchester Children's Hospital
>> Pendlebury
>> Manchester M27 4HA
>> United Kingdom
>>
>> Tel 0161-727-2250(AM)or 0161-220-5342(PM)
>> FAX 0161-727-2249
>> Email [log in to unmask]
>>
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