Training Clinical Chemistry: Where Do We Go from Here?

By Justin Kreuter • August 24, 2017

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In February, Archives of Pathology & Laboratory Medicine published an article about the perceptions that pathology residents have of clinical chemistry. In brief, the authors shared an online survey with all pathology residents. The questions probed the perceived value of clinical chemistry, whether residents think they will be competent in clinical chemistry at the completion of residency, and the appropriateness/supportiveness of the learning environment for clinical chemistry. The survey found that pathology residents have an overwhelmingly negative attitude, perceived failure of training programs, and a poor learning environment for clinical chemistry.

In my opinion, this article was a necessary wake-up call.

My Twitter colleague and medical education guru Sarah Bean, M.D., co-wrote an excellent editorial that outlined this problem and shared several insightful solutions. Thinking about my own experience, I completed a clinical chemistry elective during my final year of residency as well as a clinical consultancy elective where I spent my time tethered to the inpatient hematology-oncology team. Despite strong mentors and these elective experiences, I did get a bit tachycardic when my transfusion medicine job offer included running a reference chemistry laboratory. "Shout out" to Tina Bjorkstrand (quality management coordinator), Dana Nemeth (supervisor), Jon Dali (assistant supervisor), and our team at the Federal Medical Center.

Our team has made my first four years of clinical chemistry practice a wonderful growth experience.

I make a point of sharing my clinical chemistry challenges with residents while on our Transfusion Medicine rotation at Mayo Clinic. Since the February article, I’ve been pondering Dr. Bean’s advice on how to further improve my clinical chemistry teaching. In this context, I read a letter to the editor by a Harvard-Macy colleague, medical student Ryan Gamlin. Although his letter is focused on the preclinical basic science curriculum in medical school, I think the argument translates well to our challenge of clinical chemistry training. This is to suggest that our community of pathologists share and curate training resources. We have an opportunity to leverage technology and deliver foundational education in clinical chemistry. Additionally, we could curate clinical dilemmas that would give trainers access to materials that we could use to challenge our trainees. This would free up significant time from developing or "re-vamping" that thyroid lecture. That time could now be spent directly with trainees, sharing my insights and guiding them through a clinical chemistry case that a colleague has submitted.

Justin Kreuter

Justin Kreuter, M.D., is a clinical pathologist at Mayo Clinic in Rochester, Minnesota. His practice consists of both general and subspecialty aspects of clinical pathology. At Federal Medical Center-Rochester, Dr. Kreuter runs the general laboratory that supports a local in-patient population and does a large amount of reference work. At Mayo Clinic, Dr. Kreuter's time is split between the transfusion medicine service and transplant laboratory. In addition to clinical activities, his academic interests include several aspects of medical education, including teaching clinical judgment, frameworks for feedback, and reflection in medical practice.