Duration of Rotation: Four full time weeks (F)
The Laboratory Medicine elective introduces the students to the main aspects of the discipline as a supplement of their pathology course and as aid during their clinical years. The student will be exposed to a variety of techniques and procedures during their rotation through the laboratories:
- Laboratory of Clinical Immunology and Infectious Diseases
- Laboratory of Parasite Immunology and Pathology
- Laboratory of HLA and DNA
- Laboratory of Molecular Pathology
- ASEM Clinical Laboratory
- Clinical Laboratory of University Adult Hospital
- ASEM Blood Bank
- ASEM Transfusion Medicine Services
The student must have complete the second year of medicine.
After completing the rotation, the medical student will be able to:
- Demonstrate an understanding and ability to apply the concepts of diagnostic sensitivity and specificity of a laboratory test to a specific clinical situation; define negative and positive predictive value and explain how these values are influenced by the prevalence (prior probability) of disease in defined populations (Bayes theorem); apply these concepts in clinical situations; describe situations in which predictive values provide critical information for developing patient care screening, diagnostic, prognostic, and therapeutic pathways/algorithms.
- Describe how reference intervals are derived and use and the different types of reference intervals, including those derived from population distributions, from expert consensus recommendation, or from evidence-based determination of “threshold” values based on a test’s predictive value in a clinical algorithm; explain how reference intervals may be compartmentalized by age sex, race, clinical state (eg, pregnancy), or other factors explain why 5% of laboratory test results from healthy individuals might fall outside a reference range.
- Explain the concept of variability in repeated measurements, as well as variability within and between individuals; describe the contributors to analytical uncertainty (precision, accuracy, bias, coefficient of variation) and how the sources of variability relate to clinical interpretation of changes in test results.
- Discuss the long-reaching consequences of ordering unnecessary testing; consider whether routine daily monitoring tests constitute unnecessary testing; based on an understanding of reference intervals, explain why unnecessary testing may lead to higher health care costs and increased risk for the patient; similarly, discuss the consequences of failing to utilize noninvasive or minimally invasive diagnostic procedures before proceeding to invasive approaches.
- Explain the roles of preanalytical and postanalytical variables in affecting test results and thereby impacting patient care; identify common sources of preanalytical errors; describe the effects of blood-drawing technique on test results; compare and contrast the use of specimen tubes with various colored tops, as well as other specimen containers, and why they cannot be used interchangeably; explain the importance of proper and unique identifiers for patient specimens.
- Define “critical value” and “turnaround time”, and explain why critical values are directly reported to the health care provider for immediate action; compare and contrast uses of “stat” and “routine” test priorities.
- Describe the broad categories of situations that may result in test interference (eg, incomplete tube fill, hemolysis, lipemia, bilirubinemia, cross-reacting and interfering substances).
- Explain why one should expect differences in results between laboratories using different methodologies when evaluating tests.
- Demonstrate the ability to properly draw blood via venipuncture.
- Describe what “point-of-care” (POC) testing is, and discuss why values generated using POC methods may differ from values generated in the clinical laboratory; list the basic components of quality control that must be integrated into POC procedures.
- Compare and contrast “universally” recognized test panels as defined by the American Medical Association Current Procedural Terminology and test “panels” defined by individual practitioners; list the advantages and disadvantages of using test panels when placing patient orders.
- Explain the broad differences between Food and Drug Administration-approved tests and tests developed by individual laboratories; briefly outline the regulatory agencies and issues involved in physician-office laboratories, home testing, and provider-performed microscopy.
- Distinguish between testing appropriate to the clinical laboratory and testing appropriate in the research environment; explain how clinical laboratory tests undergo extensive external and internal validation according to strict criteria, prior to being made available for patient care.
Faculty in charge: Dr. María I. Santé