Chemistry Rotation

Length: one 2-month rotation

Clinical chemistry at UNM is often melded with informatics as a 3-month rotation with duties split into 2/3 chemistry and 1/3 informatics. The laboratory serving The University of New Mexico Hospital (UNMH) is TriCore Reference Laboratories (TRL). A rapid response laboratory is located adjacent to the residents’ offices and performs lab tests for inpatients and clinics residing within the hospital. The remaining tests are sent to TRL which is a large, comprehensive regional referral laboratory located one mile from the University Hospital. The residents perform duties at both locations. General clinical laboratory topics covered by this rotation include: laboratory quality management, test methodology and instrumentation, new method evaluation, reference range selection, clinical consultation (test selection and interpretation), appropriate test utilization and laboratory accreditation. The resident will also receive basic training (biochemistry and pathophysiology) in the following clinical chemistry subject areas: urinalysis, endocrinology, serum/ urine proteins, renal and hepatic function testing, autoimmune testing, cardiac markers, diabetes, hyperlipidemia, maternal/fetal/pediatric testing, blood gases and electrolytes, therapeutic drug monitoring, clinical and forensic toxicology, hemoglobinopathy testing, and tumor markers.

Specific duties for the chemistry resident include:

• Answering questions regarding all in-house testing. Questions can vary from which test to order for a specific condition to appropriate test utilization to finding specialty laboratories which support a specific esoteric test (i.e. testing for genetic metabolic disorders in children). Questions arise from phone consultation, referral from clinical pathology faculty, inquiries from clinicians and problems that arise in the rapid response lab. The investigation required to answer clinical chemistry issues is a major learning tool which is facilitated by knowing how tests are performed, how samples are processed and what tests are performed at each bench. A good way to acquire this knowledge is to complement didactics and reading with shadowing the technologists at each bench in the rapid response lab.
• Signing out electrophoresis reports. During the Chemistry rotation, the residents sign out about 150 protein electrophoresis reports (urine and serum), 30 immunofixation or immunotyping reports, and 20 hemoglobin electrophoresis reports per week.
• Reviewing College of American Pathologists (CAP) proficiency testing reports. Quality Control (QC)/Quality Assurance (QA) is an important concept and opportunities for becoming more involved include participating in mock inspections (may not happen during all rotations). Again, many systems issues arise out of the myriad of questions that are asked on a daily basis. The more you are involved, the more you will learn!
• Clinical chemistry online didactics: The University of Washington’s lab competency assessment website offers didactics and comprehensive exams in clinical pathology. All residents are required to complete the exams in ANA, Gram Stain, Urinalysis, Protein Electrophoresis, Chemistry, and Coagulation every six months.
• Providing brief, monthly continuing education talks for the techs at the University Hospital Lab and Tricore Reference Laboratories.