Biochemistry Program – Overview

UNIVERSITY OF BC, DEPARTMENT OF PATHOLOGY, MEDICAL BIOCHEMISTRY RESIDENCY TRAINING PROGRAM

Training Program Overview of Academic Teaching Sessions


 

I. OBJECTIVES

The overall objectives of the UBC program follow those of the Royal College of Physicians and Surgeons “OBJECTIVES OF TRAINING AND SPECIALTY TRAINING REQUIREMENTS IN MEDICAL BIOCHEMISTRY”. Please refer to this document directly at the following link
(http://www.royalcollege.ca/cs/groups/public/documents/document/y2vk/mdaw/~edisp/tztest3rcpsced000912.pdf).
Note: the objectives of training requirements listed above were implemented as of July 1, 2012 and apply to all residents who enter the program after that date. The objectives of training requirements are slightly different for residents who entered the program prior to that date. These older objectives of training are available from the program director or the program administrator.

The site specific objectives for St. Paul’s Hospital, Vancouver General Hospital, and BC Children’s and Women’s Hospital, BC Bio / Fraser Valley, Life Labs, toxicology, molecular genetics and the biochemical genetics laboratory rotations are outlined in separate documents. (see Rotation Specific Goals and Objectives list)

 

II. RESEARCH

Basic science and/or clinical/epidemiologic research is expected during the course of residency training, and a scholarly project with an oral presentation at the UBC Pathology Day is mandatory as a PGY5 resident (PGY 3 and 4 years for residents in the old curriculum). Research can take place at any site.

The program director, as part of the semiannual interviews discusses and directs the resident to mentors who can help him/her to develop their own research plan. There is a research mentor available to those who do not have a specific focus of research predetermined. As part of this process, all research/QA projects that meet the criteria as summarized in the document “Criteria and process for completion of the resident research guide UBC Dept of Pathology & Laboratory Medicine”, should be summarized using the separate document “Resident Research Guide UBC Dept of Pathology & Laboratory Medicine”. Each project should be signed off by the resident, the site supervisor, the program director, with or without a research mentor prior to starting. The resident should be capable of completing the project and should proceed in compliance with their research plan. Projects can be designed such that other residents or staff completes them.

 

III. MEDICAL BIOCHEMISTRY TRAINING PROGRAM OVERVIEW

Laboratory Training

The greatest proportion of the two year component of laboratory based medical biochemistry training is completed in the PGY4 and PGY5 years. The training takes place largely via general medical biochemistry rotations at the Vancouver teaching hospitals. The focus of these rotations is on medical and non-medical expert CanMEDS competencies as listed in the objectives of training. Senior residents have the opportunity to further develop expertise in subspecialty areas via mandated and specialty electives in all three teaching hospitals, as well as affiliate teaching centers. General medical biochemistry electives at private hospital laboratories are optional electives that may be taken at any time in the final two years of the program.

Internal Medicine / Pediatric Training

Training in Medical Biochemistry is closely integrated with the training in Internal medicine, with a focus on internal medicine sub-speciality areas that have a high chemistry laboratory utilization. Residents in the new program are accepted into medical biochemistry after having completed 3 years of internal medicine or general pediatrics. As part of the three years of internal medicine / pediatrics training, the resident is expected to complete 3 to 6 blocks of training in a medical biochemistry related discipline. At least two of these blocks are required to be in general laboratory medical biochemistry rotations. PGY3 residents may apply to Medical Biochemistry from either the internal medicine or the pediatric training programs. Residents in the old program were required to complete 1.5 to 2 years of clinical training in internal medicine or pediatric related disciplines. Candidates who complete their specialty training requirements for both internal medicine and medical biochemistry are eligible to write the certification exams for both disciplines.

Academic Teaching Sessions

During the clinical rotations, residents are expected to attend the internal medicine, or subspecialty discipline, academic half day sessions that are held on a weekly basis. During the laboratory based rotations, residents are required to participate in the medical biochemistry academic half days that are held on a monthly basis in addition to attending the internal medicine academic half days which occur on a weekly basis. Furthermore, during the laboratory based rotations, residents are expected to attend the Professional Advancement Lecture Series (PALS), that is organized by the UBC department of pathology and for which sessions are held on a monthly basis. For all of the described academic sessions, the residents are given leave from service duties.
The residents also receive the schedule for the Anatomic/General Pathology Academic half days, where special management/QA seminars are presented and are given leave to attend where appropriate. Between Sept and June, residents are given leave to attend webinar presentations hosted by the Canadians Society of Clinical Chemists (CSCC) on a semi-weekly basis. Residents are also strongly encouraged to attend (in person or by conference call) and participate in the semi-monthly meetings of the BCALP (BC Association of Laboratory Pathologists) Chemistry Science Section, where laboratory management, testing protocols, laboratory standardization issues, fee schedules, and clinical cases are discussed. Finally, residents are given $1800 annually to attend conferences. An additional $1800 is provided on an annual basis for residents who wish to attend and present research findings at the annual AMBQ-CAMB (Canadian Association of Medical Biochemists) meeting which has an afternoon seminar specifically devoted to a resident teaching session.

 

IV. LABORATORY BASED MEDICAL BIOCHEMISTRY TRAINING ROTATION OVERVIEW

Vancouver General Hospital (VGH) is the largest quaternary teaching, research and referral hospital for trauma and specialized care in British Columbia. VGH is home to many provincial programs, such as Spinal unit, Burn unit, Bone Marrow and Solid Organ Transplant, as well as tertiary services such as Trauma unit, Cardiac surgery, Neurosurgery, and Emergency, ICU, and Medical Clinical teaching units. The laboratory also provides services to outpatients and affiliated hospitals (UBC, Richmond, Lions Gate, GF Strong, George Pearson). With respect to rotation opportunities at VGH, there is a special formal academic rotation each winter in blocks 8 through 10. During this academic rotation, medical biochemistry trainees attend didactic session for 2 hours each day of the workweek excepting Friday. Two teaching session are held each Friday: a) an oral quiz based on the learning material from the previous 4 days of academic sessions, b) case presentations by each trainee regarding current VGH inpatient clinical and laboratory findings. The 12 week teaching series is hosted by the VGH chemistry division with support from the teaching faculty at St Paul’s Hospital and the Children’s & Women’s Health Centre. Amidst this series of academic didactic sessions, there are bench side teaching sessions with technologists, case based investigations and review / approval of esoteric testing requests, and review and sign out of specialized testing involving HPLC, mass spectrometry, protein electrophoresis and CSF investigations for multiple sclerosis. Residents complete the VGH rotation twice with the senior year being focussed on presenting a substantial portion of the didactic academic sessions, participating in managerial decisions regarding instrument purchasing and method validation. In the senior year, the first week of block 8, is typically reserved for a one week immunology rotation (see separate description).

St. Paul’s Hospital (SPH) is a tertiary acute-care, academic and research hospital serving the downtown core and is recognized internationally for a number of specialty programs and services, including endocrinology services that support a diabetes, lipid and thyroid clinics in addition to a large endocrine tumor surgical service, the heart centre with the Healthy Heart Program Prevention Clinic, cardiac and renal transplant programs, nephrology, hemo and peritoneal dialysis wards, the HIV centre for excellence, eating disorder clinics, as well as the PROOF centre (Prevention Of Organ Failure) in addition to maternity, neonatal, ICU, CCU, CSICU wards. The Medical Biochemistry rotation consists primarily of projects focussed on each of several areas relating to accessioning and pre-analytical errors, test instrumentation and method validation, external and internal quality control, point of care program administration, utilization of statistics in laboratory medicine. In addition, the resident is assigned to daily review of a subsegment of the laboratory testing results relating to one of endocrine testing (with particular reference to functional stimulation or suppression tests, and specialized venous sampling for diagnosis of Cushing disease, PTH adenomas, and Conn syndrome), electrophoresis (including serum protein, beta 2 transferrin, and lipoprotein electrophoresis), nephelometric testing (including IgG subclasses and free light chains), and esoteric test requests / results. Residents also participate in laboratory bench rotations for teaching by technologists. These bench rotations include extensive opportunities for microscopic urine and joint fluid analysis. Finally, residents organize inservice teaching sessions for technologists and investigate absurd test values on a daily basis. In the senior rotation (SPH2), residents are expected to have greater independence in completing projects of a similar nature to those previously described. In both the junior and senior rotations, the trainees are expected to attend and participate in at least one of the clinical rounds for the endocrine surgery, endocrinology or nephrology.

Children’s & Women’s Health Centre of BC, is the quaternary referral centre for Obstetrics and Pediatrics for the British Columbia. Residents rotate through BCCWH for two blocks during their obstetric / pediatric laboratory training. This rotation includes a review of the laboratory testing services unique to this institution including the maternal prenatal screening program (insert link), and the trace element and heavy metal testing laboratory. In addition, the trainee is expected to become familiar with the automated Vitros analyzers that are used for routine and endocrine testing. Case reviews occur on a daily basis and highlight the approach to investigation of neonatal, pediatric and obstetric disease syndromes which range from the exceptional to the common.

Private laboratory rotations are also available as electives for resident trainees who are interested in high volume testing. BC Bio laboratory and the Fraser Valley Health Authority hospitals combine to provide a 4 week elective that introduces trainees to the managerial and clinical issues associated with providing chemistry testing in these settings.

Lifelabs Medical Laboratory Services similarly provide a 4 week elective that focuses on laboratory issues with respect to a high volume community laboratory. Specifically, the rotation focuses on the pre-analytical process for sample collection and processing, quality control procedures associated with a high volume chemistry analyzer systems, key performance indicators used to monitor chemistry oriented quality, factors that are taken into account when calculating cost per test, and Lean-Sigma approaches to process optimization.

The cardiovascular disease prevention clinic (LIPID-SPH) is situated in the St Paul’s Hospital Healthy Heart Clinic. The clinic is the tertiary care referral centre for BC patients with primary and secondary dyslipidemias. The clinic is run by Dr Gordon Frances. Dr Jiri Frohlich coordinates and supervises the rotations with regard to the medical biochemistry rotations. At SPH, there are also diabetes and hypertension clinics. At VGH, there is also a diabetes clinic. There are comparable clinics at the Children’s & Women’s Health Centre of BC. In each case, the trainee can participate in the clinic on a ½ day / week basis for an extended series of blocks or may participate full time for one block. On a full time basis, there are other options for 4 week clinical rotations including: the osteoporosis clinic at the Children’s & Women’s Health Centre, rapid access clinics, and inborn errors of metabolism.

The biochemical genetics rotation is a two to four week rotation that covers the laboratory testing that is unique to this section of the laboratory. These testing services include the blood dot newborn screening program for 22 separate metabolic / congenital disorders (http://www.bcwomens.ca/Services/PregnancyBirthNewborns/NewbornCare/NewbornScreeningProgram/default.htm), amino acid profiling, acyl carnitine profiling, urine organic acid profiling, thin layer chromatography for oligosaccaharide analysis, urine screening for mucopolysaccharides, transferrin isoelectric focussing, WBC enzymatic testing for lysosomal storage disorders, and muscle biopsy electron transport chain analysis for diagnosis of mitochondrial disease.

The provincial toxicology centre is a provincial referral laboratory that provides biochemical testing for clinical and forensic toxicology applications as well as for therapeutic drug monitoring applications. There are 1700 forensic toxicology evaluations performed per year at this centre. Residents rotate through this site for a mandatory 4 week rotation and may return for additional elective rotations or research projects. The focus of this rotation is to teach the methodology of routine reference laboratory procedures for clinical toxicology analysis. Trainees are also expected to be able to list the clinical implications of the drug test results, and to be prepared to discuss medicolegal implications of the drug test results. Toxicology is also taught in other rotations: the VGH rotation where urine GC/MS screening for drugs of abuse, and serum GC/MS testing for toxic alcohols are performed; VGH, SPH and ObsPds rotations where automated urine immunoassay drug screens are performed, and ObsPds where heavy metal analysis is performed via ICP-MS.

The principles of chromatography and mass spectrometry are taught during various components of the residency training program. During the VGH1 rotation, residents are given an introduction the laboratory methodology. The methodologies are also encountered during each of the general chemistry rotations as each of the major training sites heavily utilize this technology, and it thus forms the basis of multiple projects which the resident may encounter. Finally, residents are given a 4 week rotation at SPH in which each resident has the opportunity to work with a technologist with expertise in mass spectrometry to design from scratch a routine therapeutic drug monitoring liquid chromatography mass spectrometry test. Test development includes preparation and testing of artificial samples.

The molecular genetics rotation is a 2 to 4 week rotation that takes place on an annual basis at various sites. The rotation is undergoing revision but is planned to encompass didactic teaching and practical applications. The didactic teaching component is planned for a one week period that will teach the principles of laboratory medical genetics to all of the UBC pathology residents. The one week period will coincide with the first week of the PGY4 year for medical biochemistry residents, and will be followed by at least a one week but up to three weeks of practical applications in a clinical laboratory setting. A two week portion of this practical application training may take place in the context of the biochemical genetics rotation that was previously described.

The immunology rotation is an elective 2 week rotation that takes place on an annual basis. The first week is a course format taught and organized by Dr Paul Keown at VGH. There are didactic and practical applications related to the principles of clinical immunophenotyping for disease susceptibility and to support transplant matching. The second week of the rotation is organized by Dr Mike Nimmo at VGH. It focuses on the laboratory testing principles associated with serology testing for rheumatic diseases.