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Short course updates physicians' microbiology skills.

For a decade, this busy lab supervisor has instructed medical students wishing to delve into the complexities of microbiology.

Over the years, residents, fellows, medical students, and other health professionals at our hospital have frequently asked our laboratory to update them on the intricacies of microbiology testing. We were always happy to comply but often encountered obstacles in attempting to fulfull their requests.

We might be asked to explain special stains when our overall workload was unusually high, for example. Interns tended to drop in after their morning rounds, a time that was rarely convenient for us. In addition, not all our technologists enjoy teaching; we needed a routine and a preselected instructor. Finally, test results, which of course take priority, sometimes disrupted teaching sessions by coming up negative just when someone was about to demonstrate a technique. This hit-or-miss method of education was not working well. It was time to find a better way.

The problem was solved about 11 years ago when James K. Todd, M.D., chairman of our infectious disease department, and I developed a microbiology mini-course. It was designed specifically to reacquaint nonlaboratory personnel with basic microbiology skills. The initial planning took about three months. We refined the syllabus as we went along and continue to make changes and update materials as needed.

The sessions have been taken and well received by more than 200 medical professionals at our hospital. As a side benefit, our laboratory has made many new friends among the house staff. Our students soon become familiar faces in the lab and remain allies for the rest of their training periods. They frequently call us after the course has ended, having learned to consider us a valuable resource. Teaching the course, which takes about two hours per day for three days plus and additional 30 minutes of preparation per day, has been a rewarding experience for me as well.

* Logistics. I limit the number of participants to two per course. My busy schedule usually allows me to offer the course only once a month. This works out fine, since only two residents and one medical student per month take the infectious disease elective. When their rotations in infectious disease begin, they are invited to sign up for our course, for which they get credit. Most do so.

Sometimes my schedule allows me to give two sessions in one month. During those sessions we include nonphysician health professionals at our facility who have asked to participate, such as child health nurse practitioners. We are pleased that word of mouth has been positive. I may apply for a grant that would enable us to expand the program or offer it to more people in the future.

* Preparation and syllabus. It doesn't take much time for me to set up each session. Before the first day, I prepare six mocked-up specimens in broth containing organisms commonly found in a pediatric setting (Figure I). Because our hospital is a pediatric facility, the patients in our hypothetical clinical histories (Figure II) are nine years old or younger. In facilities that treat adults, examples would have to be chosen from a broader range of age groups.

When the students arrive, I distribute handouts (Figures I through III), go over charts and tables in the worksheets for the first session (Figure IV), and demonstrate proper streaking techniques. Participants plate the mocked-up cultures.

Before the second session (Figure V), I make smears and Gram stain the colonies growing on the plates. Students practice staining as time permits. I also set up the minimum inhibitory concentration (MIC) plates they will read on the third day (Figure VI).

* Open atmosphere. I try to create an environment in which participants feel free to ask questions. I tell them that while no one becomes a microbiologist in three mornings, they can learn the basic vocabulary in that time and read at greater depth later. The least they will get from the course is to observe at first hand what goes on in the laboratory. That experience, I have found, increases their appreciation of the microbiologist's skills and knowledge.

The figures showin in this article present our course objectives, the clinical histories for specimens to be analyzed by our students, the tasks performed by them, and reference material they are expected to read. Multiple copies of required reading items are kept on a special shelf in the laboratory for students to consult or sign out.

Besides the materials included here, we distribute a list of safety rules instructing students not to smoke, drink, eat, or pipet by motth when in the laboratory and to wear lab coats or removable protective clothing. The sheet provides general information on how to handle general cleanup, spills of body fluids or culture materials, and disposal of sharps and biologic waste.

* Evaluation. At the end of the course, participants complete an evaluation sheet. They are asked to respond either "Somewhat," "Yes," or "No" to four questions: Were the course objectives met? Did the objectives meet your needs? Were you able to use your time in the laboratory efficiently? Was the microbiology staff helpful? Ample space is provided for comments. In addition, an open-ended section at the bottom welcomes "suggestions to improve this learning experience."

Participants give the forms to the follow on the medical staff who is in charge of the infectious disease rotation. The fellow and I go over the forms quarterly. Responses have been overwhelmingly positive, with only minor variations. We have made several improvements as a result of students' comments.

For example, we added some procedures that had been imperfectly understood, such as latex screening. We revised the course to place greater emphasis than before on the interpretation of MICs. When we learned that medical students and residents were not proficient in calling up lab results on the computers in the hospital wards, we made sure the computer people in the lab went to the floors more often to give instruction and answer questions.

We take pride in knowing that our brief course has assisted hundreds of health professionals in understanding the workings of the microbiology laboratory. As fledgling physicians leave our facility to pursue their medical practices, they take with them the memory of a warm relationship with the laboratory. We believe that the laboratorians with whom they work elsewhere derive similar benefits from the course and the connection we have provided.

The author is microbiology supervisor at Children's Hospital, Denver, Colo.
COPYRIGHT 1991 Nelson Publishing
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes course overview and class worksheets
Author:Roe, Martha H.
Publication:Medical Laboratory Observer
Date:May 1, 1991
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