Increasing trainee engagement and laboratory feedback during an internal laboratory inspection

Abstract

The inadequacy of laboratory management training has long been reported in the literature,^1-4 with various suggestions on ways to improve this aspect of pathology education and better prepare our trainees for the work of a staff pathologist.^5-8 The ACGME (Accreditation Council for Graduate Medical Education) milestones directly reflect this educational need and include a requirement of participation in an internal or external laboratory inspection to reach level four, the goal level for graduation, in the residency milestone Systems-based practice 5: Accreditation, compliance, and quality (AP/CP). There are similar requirements for many of the pathology fellowships, including Systems-based practice 4: Accreditation, compliance, and quality for blood banking/transfusion medicine, chemical pathology, cytopathology, dermatopathology, forensic pathology, hematopathology, medical microbiology, neuropathology, and pediatric pathology and Systems-based practice 5: Accreditation, compliance, and quality in molecular genetic pathology⁹ (for a description of milestones by level, seeTable 1). Furthermore, such participation has long been part of laboratory management curricula.⁸

The literature provides a few specific examples of departmental efforts toward using an internal inspection to support trainee advancement to level four of the accreditation, compliance, and quality milestone. In one report from the University of Florida, the trainees made up the entire inspection team, with the associate program director serving as the team leader. Four lunchtime seminars covering a range of laboratory management topics were provided, and preinspection and postinspection assessments were performed, showing a significant improvement in trainees' knowledge after the inspection.¹⁰ Another report from the University of California Irvine Medical Center describes a resident-led self-inspection of the department's histology laboratory and the subsequent decrease in deficiencies and improvement in staff satisfaction survey results for that laboratory.¹¹ Finally, a group out of Emory University created a clinical laboratory management curriculum that included preparation for and performance of an out-of-cycle mock inspection in one of the areas of the laboratory.¹² Those authors report that the curriculum was well received and provided objective measurements of mastery for a range of laboratory medicine concepts. Some subspecialties within pathology have created subspecialty-specific laboratory management education options as well.¹³

At our institution, we have long included residents and fellows in external inspections when possible and based on specific laboratory management interests and in our internal laboratory inspection in at least a cursory fashion; however, this past year, we made a special effort to increase trainees' comfort level and engagement with the inspection process. Our aims were to teach the trainees to see themselves as citizens and future leaders of the laboratory, to provide a lasting educational experience, and to deliver valuable feedback to our laboratory staff.