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

 

Prerequisite

The student must have complete the second year of medicine.

 

After completing the rotation, the medical student will be able to:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Describe the broad categories of situations that may result in test interference (eg, incomplete tube fill, hemolysis, lipemia, bilirubinemia, cross-reacting and interfering substances).
  8. Explain why one should expect differences in results between laboratories using different methodologies when evaluating tests.
  9. Demonstrate the ability to properly draw blood via venipuncture.
  10. 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.
  11. 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.
  12. 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.
  13. 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