Graduate Medical Education Training Programs

MICROBIOLOGY

Resident Rotation Summary

Rotation Philosophy and General Purpose Statement:

The Microbiology rotation at West Virginia University is designed to instruct trainees in microbiologic practice in a tertiary care, academic setting as well as a large community hospital. As they evaluate patient specimens, physicians in training are instructed in evaluation of bacteriology, mycobacteriology, mycology, virology, and parasitology cases and procedures. By providing residents with increasing responsibilities and duties, as their level of training increases, the teaching faculty hope to instill in the resident the skills and tools necessary to develop a life-long course of continued professional development.

Teaching Faculty Members

West Virginia University

Patricia Canfield, M.D.

Linda L. Cook, M.D.

John Thomas, Ph.D.

Charleston Area Medical Center

Kevin Tu, Ph.D.

EDUCATIONAL GOALS AND OBJECTIVES:

The goals and objectives of the Microbiology experiences are to prepare and enable residents to:

• Demonstrate competency in the laboratory procedures involved in the work-up and diagnosis of laboratory cases in order to practice Microbiology independently.
• Demonstrate professional behavior regarding patients, other physicians and all clinical laboratory personnel.
• Demonstrate a commitment to reviewing and improving Microbiology practice patterns and to life-long learning. 
• Explain the scientific basis of Microbiology and the ability to utilize the medical literature and modern techniques to provide accurate Microbiology diagnoses. 
• Communicate effectively in verbal and written form with their clinical colleagues, administrative, technical, and clerical personnel.
• Discuss the policies and regulations affecting health care (i.e., CAP accreditation, HIPAA, compliance to Medicare and billing regulations, etc.) 

REQUIRED COMPETENCIES:

PATIENT CARE

·Residents gather essential and accurate clinical information about the patients on whom they receive clinical consults, including

• Discussion of history with clinical housestaff and/or attendings,
• Preview of laboratory reports of previous pathologic specimens
• Review of the online medical record when applicable.

Residents are able to be actively involved with Microbiology consultations and are able to handle clinical questions with increasing degrees of independence including:

• Researching and reviewing medical information.
• Preparation and interpretation of clinical consults.
• Timely and effective communication with clinicians.

 Residents demonstrate competence in the performance of procedures considered essential for Microbiology practices, including:

• Review of bacteriology, mycobacteriology, and mycology stains and cultures.
• Review of secondary tests to confirm speciation of various bacteria.
• Review of parasitology specimens.
• Review of virology tests including cultures and molecular testing.

Residents make informed decisions regarding diagnostic workup of clinical consults:

• Consider special stains, specialized testing, etc. based on patients’ clinical history, up-to-date scientific evidence gleaned from textbooks, journal articles, internet-based searches, and clinical judgment. 
• Expected to be able to handle more difficult cases and their approach and diagnosis should more closely correlate the final diagnosis as they progress through their residencies.

Residents use available information technology (hospital and laboratory information systems, internet-based literature searches)

• To support workup and diagnosis of microbiology consults.
• To help educate clinicians by providing relevant literature references.

Residents work with health care providers, in the generation of accurate and clinically useful Microbiology reports and effective communication of results to clinicians.

Evaluation:

• Rotation evaluation

  Resident portfolio of cases of the month, presentations to medical technologist, and clinical consult cases. 

• 360o Global evaluation

MEDICAL KNOWLEDGE

·Residents demonstrate an investigatory and analytical thinking approach to clinical situations, including:

• Development of reasonable and complete differential diagnoses for Microbiology cases based on the available clinical information, laboratory tests, and current published information.
• As part of their workup of cases, they suggest appropriate additional testing (growth in different media and biochemical testing and further clinical testing such as molecular diagnostics, etc.) if applicable.
• Formulation in a comprehensive, cohesive, and coherent fashion the above differential diagnoses and discussion of pathologic findings in the final microbiology report.
• Are encouraged to participate in at least one research project, such as clinicopathologic studies, or case reports with literature review.

Residents explain and apply the basic and clinically supportive sciences which are appropriate to the specialty of Microbiology, including:

• Discuss epidemiology of various infectious diseases during discussion of Microbiology cases, and use of such knowledge to formulate pathologic diagnoses.
• Explain clinical presentations and manifestations of various infectious diseases during discussion and workup of Microbiology cases, and use of such knowledge to formulate pathologic diagnoses.
• Discuss media based differential diagnoses, including biochemical and immunologic principles, methods, and applications and principles of molecular testing.
• Explain microbiologic principles and human pathophysiology during discussions with clinicians. 

Evaluation:

• Rotation evaluation

Microbiology score for the in-service examination compared to national means

PRACTICE-BASED LEARNING

Residents show the ability to analyze practice experience and perform practice-based improvement activities using a systematic methodology, including:

• As senior residents, actively participate in monthly Clinical Pathology Quality Assurance Committee meetings, learning how to identify and report on a variety of QA monitors (case turnaround time, mislabeled/unlabeled specimens, clotted specimens, etc.).

Residents show ability to locate, appraise, and assimilate evidence from scientific studies related to patients’ health care problems, including:

•  Literature searching and review to find relevant scientific references to aid in the workup of Microbiology cases (computer-based searches).
• Obtain and incorporate information about their patient population (via COPATH computer searches and medical records chart review) for clinicopathologic study of selected diseases.
• Discuss study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
• Explain information technology to manage information, access on-line medical information, and support their own education, including:
• Accessing of patient clinical information and previous pathology accessions via Medsite and Copath.
• Performance of computer searches of the medical literature.
• Perform digital imaging technology.
• Accessing web-sites pertaining to specific pathologic diagnoses (grading systems for tumors, etc.).

Residents actively participate in the teaching of medical students and other health care professionals employed in the Microbiology section, including:

• Teaching medical students as lecturers (senior residents only), leaders in small groups and laboratory sections.
• Teaching medical technologists and other clinical residents during microbiology rotations. 

Evaluation:

• Rotation evaluation

Review of resident portfolio yearly to assess improvement and discuss self-education

INTERPERSONAL AND COMMUNICATION SKILLS

Residents demonstrate effective communication with other health care providers, patients, and patients’ families by:

• Presenting cases at in-house tumor boards and conferences under direct faculty supervision.
• Interacting with clinicians, patients, and patients’ families during performance of clinical consults and by providing support to clinicians and families during on-call assignments.

Evaluation:

Rotation evaluation

360o Global evaluation

PROFESSIONALISM

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest with prompt response to calls from the clinical section lab, faculty and clinicians during their Microbiology and on-call rotations and accountability for this.
• Exhibit a commitment to excellence and on-going professional development by utilizing the study materials within the department including the slide file, the image data base, and books and journals for their own professional advancement.
• Demonstrate a commitment to ethical principles pertaining to provision of microbiology services, confidentiality of patient information, informed consent, and business practices
• Demonstrate appropriate behavior with the faculty, clinicians, their peers, and the administrative, technical and clerical staff of the hospital.

Evaluation:

• Rotation evaluation
• 360o Global evaluation

SYSTEMS BASED PRACTICE

• Residents must demonstrate an awareness and responsiveness to the larger context and system of health care and the ability to call on system resources to provide pathology services that are of optimal value.
• Residents are expected to discuss how microbiology diagnoses affect health care decisions for patients and the health care system.
• Explain the types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
• Practice cost-effective health care and resource allocation that does not compromise quality of care, understanding the need for and cost of special stains, extended testing, and other send-out testing. 
• As senior residents attend the CP QA committee meetings to explain how to partner with the administrative and technical staff to assess, coordinate, and improve health care and know how these activities can affect system performance
• Residents may also inspect the section of Microbiology during a CAP inspection.

Evaluation:

• 360o Global evaluation

Supervisory Guidelines for Patient Care and Specimen Handling

Residents interact with clinical specialty residents, clinical faculty, and technologists under close faculty supervision. Residents discuss the diagnoses of unusual cases with the attending faculty member and microbiology supervisor. The faculty microbiologist is responsible for all microbiology diagnoses.

The on-service teaching faculty members are physically present during standard operating hours; faculty members not physically present are rapidly available by phone or pager. At all times, a supervising faculty member is on-call for evening and weekend questions. Communication of results and issues to clinicians occurs after discussion with a faculty member.

Daily Duties and Responsibilities - Microbiology

In the first month, residents are exposed to the basics of microbiology beginning with traditional bacteriology followed by test applications in special microbiology including virology, mycobacteriology, mycology, and parasitology through didactic sessions and demonstrations by faculty and technical personnel, supplemented by reading assignments. Residents also participate in interpretation of CP specimens, including microbiologic specimens, by essentially apprenticing themselves to faculty with whom they are working who function in Clinical Pathology.

In the second month, residents function as junior consultants. As junior consultants, it is expected that they will be able to answer some questions in the beginning of the second month, and most questions by the end of the month. In the afternoon, they take first call, and interpret case material with faculty.

In the third month, residents function as senior consultants. As senior consultants, responsibility extends from their own ward rounds to acting as a consultant and / or mentor t any more senior residents who are also on CP. In the afternoon, they respond to calls and make initial interpretations prior to bringing case material to CP faculty. 

Residents have additional opportunities to serve as consultants when on-call by investigating unusual assay requests, unusual or medically urgent test results, and quality control or technical problems. Opportunities for participation in research projects are available. There are no medical microbiology fellows in the department.

Opportunities to Function as Consultant to Other Physicians

The resident is expected to integrate gram stains, culture results, and other microbiology tests with additional laboratory findings including bone marrow biopsies, surgical pathology and cytopathology specimens and CSF/body cavity fluids. Residents have the responsibility, under faculty supervision, of discussing the interpretive consultative reports with appropriate members of the clinical/surgical teams. Through their discussions with the clinical team members residents have the opportunity to directly impact patient care. The resident is expected to interact on a daily ongoing basis with the Patient Cares in gathering important clinical history, reviewing gram stain and cultures, and making recommendations for further assessment of microbiology issues. Through their discussions with the clinical team members, the residents have the opportunity to directly impact patient care. Other departments on the WVUH campus, with ACGME approved post graduate training programs include, but are not limited to the following: Anesthesiology, Internal Medicine, Family Practice, Neurosurgery, Obstetrics & Gynecology, Ophthalmology, Otolaryngology, Orthopedic Surgery, Pediatrics, Radiology, Surgery, and Urology.

On Call Duties:

During clinical pathology call the resident provides first call consultation and problem solving. During this period, the residents will on average have at least one out of every seven days free of hospital duties. The resident is directly supervised by the CP faculty member on-call. While on-call, residents are supervised by a Faculty Member, who is available at all times, either via their office phone, pager, or home phone. During the WVU rotation, all calls are reviewed at an on-call conference. The resident is expected to be available to laboratory personnel, either in person or by pager, throughout the working day

Due to the at-home nature of call, the call duties are constructed in the following fashion. The residents are on at-home/pager call every other week. The on-call periods last from 7:00 a.m. on Monday morning through the following weekend, ending at 7:00 a.m. on the subsequent Monday.

Charleston Area Medical Center

Same as WVUH except that there is no weekend on-call rotation.

Communication with On-duty Faculty

During general working hours, the on service teaching faculty is available in person; other faculty members are available by scheduled appointment, by phone, by pager, and most of the time residents may just feel free to walk into their offices. During the on call hours, the teaching faculty is continuously available either at home by phone or by pager.