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Have you had your six-month proficiency checkup?

Isn't it time you had a checkup? I'm not referring to your physical well-being but to an evaluation of your need for in-service training. It's essential in laboratories where technologists rotate through specialty reas or provide weekend and night coverage for the entire department.

Rotation and night coverage stimulate medical technologists to learn a variety of new skills and procedures while giving management a pool of trained workers to call on. However, they also create the troublesome need for frequent retraining.

The microbiology service at the National Institutes of Health includes eight specialty laboratory sections: admissions (specimen processing), routine diagnostic testing, sensitivites (antimicrobial susceptibility testing), special bacteriology/quality control, mycology/AFB, parasitology, anaerobes, and serology. A night staff covers the specimen processing section until midnight. After midnight, the area is staffed by one technician with technologists rotating on emergency call-back duty.

The technician is primarily responsible for routine processing, but the on-call technologist must be able to perform procedures in any of the specialty areas, from reading a Gram stain on an open lung biopsy to setting up a spinal fluid. Since our 25 technologists share the on-call responsibility, they seldom get to perform many of these procedures. Periodic retraining and updating outside their specialty areas are essential.

After imperfectly dealing with this problem for years, we settled on a training checklist to jog technologists' memory of on-call procedures and policies. Itemizing what employees should know, it is used both as a guide to initial training and later to asses how much retraining and updating each individual requires.

The checklist began rather casually in 1974 when a recently hired technologist prepared her own one-page summary of the procedures she might encounter on call. Today, separate sections in our much larger document are devoted to each of the lab's specialty areas, and there's also a compilation of general reminders.

The checklist quickly tells technologists what they ought to be aware of--if they can't fill in the details about procedures, policies, and location of supplies, they are due for a refresher course. The list even touches on troubleshooting skills that may be needed in an emergency, such as repairing a tear in the glove of the anaerobe chamber. Some items refer the reader to specific pages in the lab's procedure manuals or computer directory for further information.

Excerpts from the checklist are shown in Figure I. It is a product of the combined efforts of section supervisors and the procedure manual coordinator. Every six months, each supervisor revises her portion of the list, adding new items and updating old ones. The head of the sensitivities area, for example, may note a switch from one method of susceptibility testing to another.

Then the procedure manual coordinator, who keeps a record of all changes in the department, reviews the entire checklist. She is often able to add points that have been overlooked and suggest references to the procedure manual that are particularly helpful. The rough draft with all of our penciled amendments is always a striking display of the number of changes that occured in the last six months.

Twice a year, I issue the newly revised checklist to all technologists who have on-call responsibility. The technologists must check off those items they would like reviewed and return the list to me. I, in turn, prepare an analysis for each section supervisor, noting the areas that require review and the names of the technologists who wish to participate in the different sessions. The supervisors plan the sessions and report back to me when all the technologists who signed up have completed their training.

Seeing the list every six months has several additional benefits. It reminds me of new procedures that need to be discussed at staff meetings. We treat a number of AIDS patients these days, and nearly every checklists revision includes an update on procedures for dealing with these cases.

The checklist can give us feedback on new procedures. If a number of technologists indicate they're not certain about the same item, I look closely to see if there is a problem with the methodology. That's how difficulties with a method for assaying gentamicin came to light. At least half the microbiology technologists needed retraining on the instrument. We found that the assay could be done more costs-effectively by the chemistry section.

New employees receive the checklist when they begin their training. The instructor makes sure that every item on the list is thoroughly covered. At the end of the training period, both the new employee and the instructor certify that the technologist is familiar with the entire list. This method insures that all new staff members learn the same basic information.

The checklist also corrects management oversights. For example, when we moved to our new laboratory, we transferred all our supplies to a locked communal storage area--but we often forgot to tell each new employee where the key was kept. "Put it on the checklist" was the answer to this and many other vital but easily overlooked details.

I think the checklist has worked well for us for so many years because it fills some very real needs. It gives technologists a sense of security when they're called upon to perform tasks that are outside their daily routine. In addition, the list informs technologists of resources available to them in those "what if" situations: What if the equipment malfunctions? What if the computer goes down?

It's reassuring for new staff members to have the phone numbers of the computer and equipment maintenance section and to know that help is available around the clock. And we want to be positive that they know how to call the police or report a fire and what to do in case of personal injury while on duty.

A caution about checklists, however: They're habit-forming! Once you start, you may not be able to stop. We have gone on to develop a training and review checklist for new technicians on the night shift (Figure II). They work primarily in the specimen processing area but have duties in other sections of the lab as well.

Much like the on-call checklist, this list covers all responsibilities for the night position. At the end of each section, the area supervisor must sign off, certifying the technician ready for night duty.

The lists not only make sure all items are covered, but they also make the training process more cost-effective. It now takes less time to train new technicians. For one thing, the trainee adds his or her energy to the training process. Since the learning objectives are all stated on the checklist, the trainee can work ahead by looking up procedures in the manual or by watching and learning from other staff members. As with the on-call technologists' checklist, the technicians' summary is revised and reviewed every six months.

As far as we're concerned, checklists are indispensable. We recently hired seven new technologists over a period of only three months and were faced with a major crash training program. The lists were invaluable to me in planning training time in the various sections and keeping track of the training that each technologist had completed.

Of course, our checklists won't be directly applicable to your operation, but the idea is easily adapted. I urge you to give it a try.
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Author:Spina, Peggy
Publication:Medical Laboratory Observer
Date:Feb 1, 1984
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