Educational Goals and Objectives

Although similar goals and objectives are set for all PGY levels, the expectation is that residents’ proficiency will improve as they progress through their rotation.

Specific objectives of the Microbiology rotation are:

Technical

1. To become familiar with microbial taxonomy and have a firm understanding of organisms’ relationship to one another
2. To become familiar with commonly used procedures so that one can converse comfortably with an experienced technologist. Accuracy and understanding should be emphasized instead of speed.
3. To recognize attributes of the important microbial pathogens, including major in vitro characteristics
4. To become capable of recognizing and differentiating the commonly isolated commensal microorganisms
5. To become proficient in performing and interpreting direct examinations, in distinguishing potentially contaminated material from diagnostic material, and in making decisions about the extent of specimen evaluation
6. To become familiar with the common methods for determining antimicrobial susceptibility and their interpretation, including an understanding of resistance mechanisms
7. To learn to deal with frequently occurring clinical problems expeditiously
8. To develop an understanding of, and to participate in interactions with units outside of the laboratory (e.g. Infection Control, Infectious Disease, etc.)

Medical

1. To become familiar with the indications for microbial testing and preferred specimen types processed in the microbiology laboratory
2. To become familiar with the interpretation of common results from each of the tests and specimen types
3. To develop an approach to medically relevant diagnosis in each area of the laboratory -- how far to go and when
4. To develop an appreciation of the clinical presentation and therapy of common infectious diseases. The expectation is not that one will become an infectious disease clinician, though the clinical pathologist should be capable of conversing with clinical colleagues authoritatively and as a peer
5. To develop an appreciation of the role of the hospital infection committee.
6. To develop an appreciation of the role of the hospital pharmacy and therapeutics committee.

Training

During the first rotation, residents have assigned responsibilities in each area in Microbiology with emphasis on acquisition of technical experience and clinical application of the data provided to the attending physician. When possible, this rotation is given in a two-month block. Once reasonably familiar with procedures and methods, residents will progressively assume responsibility for organizing and presenting at the weekly Microbiology/Infectious Disease conference. During the subsequent, single-month rotation, residents will be responsible for handling procedural and interpretive questions from technical staff, presenting the Microbiology/Infectious Disease conference and, when feasible, presenting a 30-minute talk to the technologists on a selected topic for continuing education and/or preparing a case of the month report.

The resident receives technical training in Clinical Microbiology by qualified technologists and, under direction, is expected to participate in the work routinely performed in this area. Emphasis is placed on specimen quality and processing, microbial identification and susceptibility testing. Where appropriate, the resident will participate in direct specimen testing for specific significant organisms. The use of “unknowns” for the resident to work-up will complement the daily work to increase the resident’s technical abilities. Opportunities for residents to become involved in or participate in administrative functions are available, but generally require the full-time presence of the resident in this section. The second rotation emphasizes this type of participation. Quality assurance and cost-effectiveness activities are useful for the resident to enhance the clinical correlation aspects of microbiologic data.
Specific responsibilities assigned to the resident include reading and interpretation of a variety of Gram stains. The resident also serves as a consultant by recommending appropriate cultures and culture processing for autopsies. The resident reports significant positive cultures – CSF, blood, mycobacterial, enteric, deep fungal, viral and parasitic. Daily laboratory rounds, weekly plate rounds and a continuing education presentation are given by the resident during both rotations.

Conferences

The pathology residents are expected to attend the Infectious Disease Rounds on Tuesday mornings. During this hour cases are discussed with the Infectious Disease physicians and the resident is expected to participate.

Every Friday morning at 9:30, plate rounds are conducted by the Microbiology laboratory and the Pathology Resident is expected to participate in and supervise this conference. The attending pathologist and Infectious Disease physicians are present. A topic is decided upon by the Infectious disease Fellows and they present a case report.

Infection Control Committee meetings are held once every month and the senior pathology residents may wish to attend with the pathologist. Monthly departmental QI meetings and weekly Microbiology Lab Management meetings are required of senior residents.

Reports

Although no reports are specifically generated by the pathology resident, culture and sensitivity reports are reviewed by the resident while rotating in Microbiology. If there are any problems that arise in Microbiology with the specimens or results, the pathology resident is expected to investigate these and discuss them with the attending pathologist and then the attending clinician.