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Continuing education in the boondocks.

Continuing education in the boondocks

Hello, Jill. Listen, how are we supposed to meet this continuing education requirement for our JCAHO inspection? You know we're 100 miles from the closest teaching hospital. In a 30-bed hospital like ours, the technologists always seem to be on call. Besides, there' no way administration is going to spring for even one of us to stay overnight for CE meetings in Dallas."

"Hello. "I've got a problem with a test that I ordered last week. Who does your thyroid profiles, again? I can never remember that when I need help."

"Hi, this is Dr. Brown's office nurse. Our quality control numbers look good, but the patient cholesterol results are running high. What should I do?"

Patiently the pathologist--director of our small regional reference laboratory listened as I relayed these urgent pleas from small hospitals and office laboratories in the area. He suggested that we look into a way to solve these and other communication problems that arise so often in small, interdependent laboratories scattered over a largely rural area. The need for CE in physicians' office labs in particular has become even more pressing with the advent of CLIA '88.

In the past, our laboratory had sponsored sporadic CE programs in the five-county area of Texas that we cover. What the laboratory director had in mind was a well-organized, regularly scheduled program for all the labs in our area.

The programs we envisioned would bring together a large number of people who performed lab tests. They would offer basic information about methods, quality control, standardization, and instrumentation. We hoped the monthly sessions would become a springboard for problem solving of all kinds, especially any problems involving our laboratory's reference services.

Another goal was to provide a way for laboratorians to satisfy the CE requirements of inspecting agencies. Finally, we wanted to provide a means of social exchange. We sought to create an atmosphere in which lab employees in the area could become personal acquaintances, not mere voices on the telephone.

POLs in particular, we thought, wcould benefit from a CE program. We had been concerned about the growing number of offices that performed their own tests, often without trained personnel or anyone to turn to for assistance.

This concern didn't stem from any loss of business. Our courier still brought in nonroutine and esoteric tests from doctors' offices. We were uneasy, however, about the quality of laboratory medicine in some of those offices: Was it being compromised? CE seemed a good way to attack the problem.

Because we are the only small regional reference laboratory in the area and our two full-time pathologists are on staff at all area hospitals, we knew where to send invitations for the initial meeting, scheduled for September 1985. Announcements went to six hospital laboratories and to all POLs that performed extensive in-house testing. We followed up with telephone calls.

* Format and location. A basic format that we established at the outset worked so well that we continued to use it for future meetings: dinner at 6:30 p.m., catered by a local barbecue restaurant at our laboratory's expense, followed by a program that started at 7:00 and lasted no longer than an hour and a half. Because many participants would have to drive 40 miles or more, we wanted them to be able to start for home by 9:00 p.m.

For easy accessibility, we chose as our meeting site a large fellowship hall in a church located at a highway crossroad. The church had plenty of parking space and a complete kitchen. We later held some sessions at our reference lab when it was important to demonstrate instruments or a technique.

* First meeting. We explained to the assembled group that our goal was not to create another professional organization with bylaws, officers, or dues. What we had in mind was a more loosely structured arrangement. The consensus favored our approach.

The introductory meeting included two topics of universal interest: a discussion of AIDS epidemiology and the currently available tests for HIV antibody detection. We knew that workers who handled body fluids worried about the geometric increase in the number of AIDS cases. Surely they would make a special effort to learn more about protecting themselves. Prepared and presented by our laboratory's two full-time pathologists, the program drew 26 lab representatives--not bad for a start. The pathologists reviewed and discussed implications of new state and American Hospital Association guidelines on handling specimens.

A later meeting at which we presented an AIDS update attracted 100 participants. One recent highly successful program dealt with biohazard awareness and disposal techniques, including local and regional requirements.

As the first meeting drew to a close, we asked the audience to suggest topics for the future. We compiled a list of the ones hat seemed to be in greatest demand and recruited volunteers to present them. We reserved a few subjects for outside guest lecturers.

Each hospital laboratory was encouraged to take responsibility for one program in an area in which its staff showed particular expertise. A laboratorian working at a state psychiatric hospital, for example, volunteered to present a program on therapeutic drug monitoring. Another hospital's chief technologist agreed to discuss urinalysis with emphasis on quality control and standardization of result reporting. A third volunteer, a blood banker, said she would lead a review of transfusion therapy, transfusion reactions, and hemolytic disease in newborns.

After the first meeting, we were satisfied that the result would be worth the effort. Our laboratory agreed to continue to host dinner sessions free of charge and to issue documentation of attendance. No organization would empower the program to award CE credits. The point was to demonstrate that laboratorians in our area had received education beyond what was provided "at home," thus satisfying inspection requirements of Medicare, CAP, and JCAHO.

We encouraged active participation by audience members through self-tests and group discussions. Handouts outlining the material to be covered in a session were provided for reference and to enable participants to document their external education.

* Aiding attendance. As the meetings progressed, it became apparent that certain tiny lab staffs couldn't attend because they had to mind the store. This problem was quickly solved. The chief technologist at each hospital devised a rotating system for program attendance so that no one had to miss two sessions in a row. We provided handouts for technologists who remained behind.

Attendance by hospital laboratory employees attracted POL personnel from the same communities. Mutual assistance networks developed.

* Presenters. For speakers who had scant experience in writing or presenting programs, we encouraged early preparation. We offered access to our laboratory's audiovisual equipment, slides, booklets, self-teaching sets, review sets, and printing services.

The full- and part-time pathologists at our lab have been extremely helpful in providing information and reference materials for presenters. They continue to research and present programs themselves as well.

* Communication. The ongoing success of our CE program for all these years has surpassed our hopes. An unanticipated benefit is the extended problem- and solution-sharing between representatives of different laboratories simply because they are being brought together regularly and encouraged to discuss their problems. When employees of one laboratory said they were having trouble calibrating serological pipets with the equipment on hand, staff members from another lab divulged their own solution to a similar problem. Rather than reinventing the wheel, the first group availed themselves of the second's hard-won experience.

In another case, a laboratory assistant was troubled by the disparity between average glucose values obtained on patients drawn in her POL and on patients drawn in our outpatient laboratory. She didn't know whom to ask for help. In casual conversation with a technologist at our lab, it became clear that she didn't understand the importance of prompt separation of serum from cells. After that discussion, she began to follow instructions precisely as they appeared in our specimen collection manual. The lab assistant, who had previously accused us of being "super-picky" about collection techniques, now understood the need to be meticulous.

In a third instance, an area physician who attended a CE session was amazed to learn that our reference laboratory staff was so highly educated. He couldn't believe such talent was available in a rural setting. He had been under the impression that the only way to insure high-quality results was to send his tests to a national reference laboratory 2,000 miles away. One meeting between the physician and our technical representatives was worth countless sales calls to the doctor's office.

The meetings have proved invaluable as a means of imparting technical standards for many routine laboratory procedures. On differential cell counts, a band neutrophil is now a band neutrophil in all labs in the area. We have emphasized and standardized the critical timing of a dipstick reading in urinalysis. While these points may seem basic to the trained technologist, they were eye-openers to meeting participants who lacked formal training.

We found that less-skilled laboratorians who had gained most of their experience on the job were more comfortable and felt more free to ask questions in such a setting than they might have at a presentation on a level that assumed more formal education on their part--a professional association workshop, for example.

The meetings help us disseminate information on documents from the National Committee for Clinical Laboratory Standards soon after receiving them. We discuss ways to implement the standards and guidelines. Participants get a good head start on averting inspection deficiencies.

Certifying attendance is easy enough with a word processor and printer on which to prepare printed forms. Each document, signed by one of our pathologists, briefly describes the session attended and provides a space for the date and the participant's name. Copies are sent to the attendee's office or institution for inclusion in its personnel records. A collection of these documents and handouts from the sessions authenticate the participant's CE history.

* Expenses. Costs to our laboratory are minimal when weighed against advantages. Dinner for 20 to 30 participants and rental of the hall cost about $125 per session. One of the benefits of small-town life is that the price has risen only moderately over five years, to about $175. Because our courier service distributes announcements and documentation to client laboratories, postage is not a factor. Our word processor and printer keep printing costs minimal.

Paying an outside lecturer to address our own staff would be worthwhile in itself. The opportunity to share experts' knowledge with a wider audience is a wonderful bonus. Our annual budget for the first eight sessions--we skip December and the summer months--was $1,200. This was no more expensive than sending a technologist or two to an out-of-state CE session. Our latest budget was $1,500.

* Adaptability. Our grassroots program takes continuing education to eager and grateful professionals who might otherwise be deprived of such an important undertaking. A modified version could be adapted by almost any lab working in geographic isolation or hampered by limited budgets. Hospital and reference laboratories in even the most remote regions might consider undertaking a similar program. Both the short-term and the long-term efforts can be deeply rewarding.

At the time she wrote this article, the author was reference division supervisor of Clinical Laboratory Associates in Greenville. Tex. Still based in Greenville, she is now field technical service representative for a major reagent manufacturer.
COPYRIGHT 1991 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Author:Goodwin, Jill O.
Publication:Medical Laboratory Observer
Date:Feb 1, 1991
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