Benchmarks for Student Preparedness for Clinical Rotations

(Last Updated On: )

The NAACLS Standards revisions are focusing more on outcomes for clinical laboratory science programs. Program curricula are already designed to have positive outcomes that include Board of Certification scores that meet or exceed national means, and employer satisfaction with graduates that demonstrate entry level competencies. To have these positive outcomes there have to be some benchmarks along the way. One of the benchmarks is the level of preparedness for clinical rotations.

As an administrative director of a hospital laboratory with students rotating through our laboratory for their clinical experiences, I expect students to demonstrate retention of theoretical concepts. The student should be able to recall and apply the knowledge in the clinical laboratory that they learned in their lectures. I also expect students to demonstrate basic laboratory skills that were practiced in the student laboratory. The essential competencies demonstrated in the student laboratory have to carry over to the clinical laboratory. The clinical laboratory experience helps students apply the theoretical concepts already learned. Due to the fast pace of the workflow and the expectations to meet productivity standards the bench teaching time is limited and the focus of the bench instructor is the patient. The bench instructor introduces the student to automation and teaches the student workflow management and analyzer operations. The student learns to apply theoretical concepts to problem solve and interpret patient laboratory data for accuracy. Putting it all together requires a knowledge base that includes pre-analytical, analytical and post analytical requirements when interpreting analyte levels.

Student preparedness for clinical rotations can have an impact on future student placement. Clinical sites are difficult to recruit especially if a program’s students are not given the tools to prepare for their clinical rotations. Program directors and clinical coordinators in collaboration with hospital affiliate technical specialists can establish the expectations and communicate them to students to prepare for each clinical rotation. Some of the tools that will help are:

1. Clinical Rotation manual with:
   
   1. Clinical assignment schedule.
      
   2. Objectives for clinical rotations. (guidelines for students)
      
   3. Competencies (essentials) for each clinical rotation.
      
   4. Assessment tests for technical skills and problem solving abilities (developed by clinical and campus faculty).
      
   5. Preparedness assignments to facilitate student review before each clinical rotation.
      

      (Have you ever heard a student excuse their knowledge retention because they did not have the clinical course in the semester before starting the clinical?)
      

2. Weekly progression assessments by clinical coordinator or other program faculty in conference with clinical instructor and student. Review of the clinical learning experiences and reinforcement of clinical significance.
   

What are a few of the basic skills and knowledge content areas that MLS and MLT students should be able to demonstrate in each laboratory discipline when they start the clinical phase of their education?

1. Bacteriology
   
   1. Gram stain
      
      1. Procedure
         
      2. Troubleshooting
         
      3. Interpretation
         
   2. Identifying characteristics of clinically significant species
      
      1. Cultural characteristics
         
      2. Biochemical differentiation
         
      3. Clinical significance
         
2. Hematology
   
   1. CBC – define each parameter
      
   2. Histogram interpretation
      
   3. Correlation of results
      
   4. Evaluation of RBC morphology and clinical correlation to anemias
      
   5. Evaluation of WBC morphology and clinical correlation to infectious or malignant condition
      
   6. Identify cells in a normal peripheral blood smear
      
   7. Identify/recognize abnormal cells in leukemias
      
3. Blood Bank
   
   1. ABO System
      
      1. Antigens and antibodies
         
      2. Typing and interpretation of results
         
      3. Troubleshooting ABO discrepancies
         
   2. Rh System
      
      1. Antigen and antibody detection
         
      2. Characteristics of antibodies
         
      3. Clinical significance of Rh antibodies
         
      4. HDN
         
   3. Other blood group systems
      
      1. If encountered then research characteristics, frequency and clinical significance
         
      2. What are the next steps when a patient has a clinically significant antibody?
         
   4. Pre-transfusion Testing
      
      1. Perform ABO, Rh, Antibody screen and interpret results
         
      2. Perform immediate spin or electronic crossmatch
         
      3. Perform AHG crossmatch when indicated
         
4. Clinical Chemistry
   
   1. Chemistry Panels
      
      1. CMP
         
      2. BMP
         
      3. Renal Panel
         
      4. Liver Panel
         
      5. Lipid Panel
         
      6. Cardiac Panel
         
      7. Thyroid Panel
         
         1. Tests in panels
            
         2. Clinical significance of specific analytes
            
         3. Basic methods to measure analytes
            
         4. Critical values and action
            
         5. Delta values and action
            
         6. Specimen acceptability for specific analytes
            
         7. Common interferences (hemolysis, icterus, lipemia)
            
         8. Reference ranges
            
         9. Dilutions
            
   2. Other analytes: tumor markers, drugs of abuse, therapeutic drug montitoring, etc.
      
   3. Coagulation Tests
      
      1. PT
         
      2. PTT
         
         1. Reagents for testing and interpretation of results
            
         2. Mixing studies to differentiate coagulation factor deficiency from inhibitor
            
         3. Purpose of testing to monitor anticoagulant therapy
            
         4. Specimen requirements
            
      3. Other coagulation tests
         
         1. Fibrinogen
            
         2. Factor assays
            

This is not meant to be a complete list. Each program should establish criteria for student preparedness for the clinical sites. Program faculty that proactively partner with clinical sites to establish expectations for students to prepare for the clinical experience will provide a plan that makes the clinical experience a success for students and clinical instructors. Most importantly the clinical affiliates will welcome the students that understand the basics and can demonstrate entry level skills.

By Peggy Simpson, MS, MLS(ASCP)cm
President, Board of Directors