A new graduate's experience: the challenges and advantages.

For me, choosing to study the Bachelor of Medical Laboratory Science programme at AUT felt almost like a natural choice. After speaking with my guidance councillor this was the course she most recommended, taking into account my love of science, hospitals and shift work options. She was also able to sell me on the idea due to the degree being job specific.

After applying to AUT I was accepted before sitting my bursary exams (as they still were when I was a young'n). The change from high school to university was marked, and I found that having a regimented programme of classes was great. There was no having to find a timetable to suit the papers I chose, the entire schedule was mapped out already without containing any clashes. All lectures preceded the practical classes meaning I had the understanding required to get the "lab" done. AUT gives its BMLSc students exposure to all the disciplines it offers in the first two years before having to make a specialist decision. This means as a student I acquired basic skills in all facets of medical laboratories and I was able to make an informed decision before specialising in the third year.

The knowledge that I was expected to gain on the BMLSc programme is very vast and comprehensive. The textbooks are HUGE! It was expected that I would understand entire diseased states, not just how results will be affected in the laboratory. I should also know how a given condition can be treated and the advantages and pitfalls of all options. This is beneficial as a student, but it also makes one become the first point of call for any medical condition relating to a family member (not the best job to have)!

In the BMLSc course there are five routine subjects (microbiology, biochemistry, haematology, immunology and transfusion science), with every second year cytology and histology being offered. AUT does not provide a specific genetics speciality paper, but students are allowed to undertake the Massey University paper and cross-credit back to AUT. Students must pick two specialist subjects from these. The lecturers at AUT are all very friendly and approachable. Any question asked of them will be answered to your level of understanding and they all have years of experience working in the laboratory industry. For specific topics in which they don't have the experience, visiting lecturers are brought in from hospital or community laboratories to aid in the teaching process and ensure that students are gaining knowledge on current workplace practices.

To my mind the biggest perk to studying at AUT was that all my relevant study was completed before going onto my placement, so I knew what I was doing when I got to "the real world". Assignments issued during my final year were all relevant to the work I was exposed to as a student employee in my placement year. AUT gets special bonus points in my mind as they allowed me to sit four examinations overseas. After applying to the examination board I was able to courier my completed exam papers back for marking. One disadvantage of the BMLSc degree at AUT is that placement exams are only undertaken at the end of the year. I acknowledge that this is so all students are expected to have the same knowledge and understanding, but it is always harder to recall accurately all steps involved during my first semester speciality. The hardest part of placement year for me was being required to move away from home. There is strong competition for placements being offered in Auckland, with those first being offered to students with children, as it would be harder to uproot them from their current education and homes. Other considerations are given to those students with a spouse and/or a mortgage. I can understand why the people with children are given priority, but I do feel that in beginning this degree there is an understanding that you may have to leave the greater Auckland area, and this rule should be applied fairly to all students.

Being required to leave Auckland for the placement year is stressful, as there is no aid from AUT in finding accommodation. I became isolated from the support system I had in place and generally part time employment is hard to find as one is in each city for such a short time frame. AUT is vigilant in monitoring the progress of each student. I was required to submit my logbook fortnightly so they could see the progress being made. The programme leader makes scheduled phone calls and/or visits to see how students' placements are going.

Textbooks seemed like the single biggest expense I had to pay, and as textbooks can cost up to $200 each, they make the first week of any semester VERY costly. The AUT prescribed textbook editions I found, were more recent than those used in the laboratory libraries that I encountered. Textbooks are worth the initial expense though as they are invaluable learning tools and I still refer to mine.

My first placement was with NZBS at Wellington Hospital. I opted for working full time, in order to get my placement done as quickly as possible so I could return home to Auckland where I didn't have to pay accommodation expenses. During my time in Wellington I got to work both in the hospital Blood Bank and at the processing centre. Upon returning to Auckland I did a further three week part time placement in the accreditation area.

The initial reality shock of working in a laboratory was obvious. For example, at University doing a practical, a student is given 3 samples and completes them. In the hospital laboratory there is at least 10 times that volume of work just in the first three hours of a day. There were also more anti-natal titres than I would have guessed. I seemed to do numerous panels during my placement. There was also a roster system that I had to come to terms with. Staff starts the day where they are rostered, but as the day moves on they seem to move around and work in all areas.

I have to say a big thanks to all the staff of Wellington NZBS, they were very welcoming to me. They are really supportive and it was liking working with friends, it never seemed like going to work was a chore. All the staff function well together, and interacted in a highly professional manner with all hospital staff.

My second placement was also at Wellington Hospital working in the immunology and serology departments. This was another reality shock, as work was batched and done daily or weekly, so that meant larger batch sizes. As these are smaller departments I was only able to work four days a week. There were only 2 or 3 staff who could supervise me. Both the serology and immunology departments had a closer interaction with the doctors than in blood bank, and weekly meetings were scheduled between laboratory staff and department doctors.

The workflow in immunology was regularly interrupted by bone marrow extractions, as these could never be pre-planned until the day before, so it was hard to get a consistent workflow. It also meant 2 of the staff would be out of the laboratory collecting samples leaving only 1 person to supervise me. A positive aspect was that I got to go and observe them preserving the bone marrow and the facilities used for long term storage.

Assays were done in larger batch sizes, the purpose of which was cost savings. Testing for HIV viral loads were done weekly and were only performed by the scientists, not myself, as kits were $10,000 each! The DHB could not afford for a student to undertake a batch and make a costly mistake. The serology and immunology departments have very skilled staff. They are interpreting many results visually and must be accurate and consistent. Reading of results is restricted to those who are qualified and all results that require interpretation are read by at least two independent staff to ensure agreement before reporting.

So, I completed my life in Wellington safely, came back to Auckland and sat my final exams successfully which meant I got to graduate in March 2005. Next on the agenda was to gain employment. The "fortunate" employer was Counties Manukau District Health Board. After being interviewed for the biochemistry department I was offered a job. This was another shock, as neither of my placements were in this speciality. The department was larger than any I had worked in before. They have many part-time staff whose schedules vary. This meant inconsistencies in my day-to-day inauguration of specific areas. I had to find out who held the knowledge to best answer the questions I had and most importantly I needed to observe the team dynamics and fit in with them.

I felt like I was still a student, as I was being rostered around all the areas of the department with a scientist who could supervise and explain everything to me. To ensure I was gaining the correct knowledge I was given a logbook to fill out with details of pertinent tests that are preformed here and the understanding of why the test is done and how the result is obtained.

The biggest change that I noticed after my first roster through the department was that responsibility was now on me. I did not have to get everything I did signed off, and I was able to authorise others' work. My name would be released with patient results if I authorised the work. The year I started as a scientist was also the year that the CPD programme came into being. There were still a few questions surrounding the programme, especially for me being on an Interim Practicing Certificate. We were unsure if I needed all 100 points that first year as I didn't start work until April and wasn't actually a scientist until October. No matter what ruling was made on that front I did not need to worry as for my year from April to December I earned 99 points.

As I was now an employee I realised that to extend myself I needed to ask for things, such as getting internet access, going on training courses and getting supplies. If I asked I did receive, and this has helped me in doing my job well. The biggest shock to being an official employee and having the "buck stop with me" was being rostered on phones, talking to doctors and nurses and answering their questions, such as what colour tube, how much longer until tests are completed, where does the test get sent, how much sample needs to be collected, and why did we reject a previous sample? This reinforced the knowledge I gained while being rostered throughout the department.

The final shock came when I began participating in the 24 hour roster system, working weekends and night shifts. Prioritising work, control of many analysers at once, embracing quality control protocol and having a basic ability to fix errors as they occur on the analysers without calling in help was expected of me.

Overall my experience in the laboratories I have worked in has been very positive. There does need to be a profile lift of "what we do" to the general public. We are highly skilled specialists who do have a great responsibility in patient care even though we mostly never see the patients directly. I appreciate that the NZIMLS is working to raise the profile of medical laboratory scientists, the "backroom girls and boys" of the diagnostic world of medicine, through the career expos held at colleges throughout the country.

Acknowledgement

I wish to thank Jacquie Case of Counties Manukau District Health Board for her guidance in preparing this article for publication.

Caroline Knight, BMLSc

Biochemistry Department, Counties Manukau District Health Board, Auckland

Address for correspondence: Caroline Knight, Biochemistry Department, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland. Email: [e-mail]

n z j med lab sci 2008; 62 (1): 10-11