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A standardized rotation solved our teaching problems.

This month, our laboratory concludes its third year of training medical technology students from nearby Thomas Jefferson University, and the second year under a new rotation approach.

Our start as a teaching laboratory was shaky. The technologist weren't used to being instructors and, since they rotate from section to section themselves, the early program lacked continuity at work stations. Meeting the demands of teaching and keeping pace with the laboratory workload became a challenge.

We created order by standardizing the elements of instruction throughout the training rotation, so that anyone could step in and teach, given that day's schedule. We also placed more of the responsibility for learning on students, via detailed written guidelines and instructions.

Another key move was to determine at the outset how much each student knew about a particular laboratory discipline. This is critical because our students have differing amounts of lab experience to begin with, and they split their rotations between the university hospital's laboratory sections and ours.

The university's MT program is open to undergraduates who have completed two years of general college course work and associate-degree MLTs who are pursuing a bachelor's. The initial year of the MT curriculum includes practice in the university's well-equipped student laboratory. The final year combines class time with clinical rotations at both the 687-bed university hospital and our 218-bed medical center, giving participants a taste of laboratory routine at a large urban facility and a smaller community-oriented hospital.

A few months into our original training effort, it was clear that we needed to regroup. Thirty students, in waves of five to 10 at a time, had descended too quickly upon a laboratory with only 30 medical technologists on the day shift.

Over and over, fundamental questions arose. What exactly were the students supposed to do? How much did they already know? When should they be in the lab? Where were they supposed to be on a given day? How should we impart the information necessary to perform each procedure? Why did students have to learn a certain procedure in the first place?

The laboratory started turning the situation around with the appointment of two student coordinators. In answering the questions about "who, what, when, where, and why," my colleague and I developed a standard rotation module that students would adhere to in each of their training sites--chemistry, hematology, urinalysis, coagulation, the blood bank, and parasitology (additional aspects of microbiology and the other disciplines are covered in the university hospital lab).

Students first take a pretest to determine how much they know about the section. We then distribute copies of the section's educational, objectives, in line with the curriculum; a training schedule; a student manual detailing the material to be covered during that part of the rotation; and a checklist of laboratory tasks that must be completed. At the end of each rotation, students undergo a written test, a practical examination, and a professional evaluation by technologist instructors.

To minimize surprises, we meet the students at the university and outline the rotation format before they ever see our laboratory. We also consult with the university faculty on how to insure that students make the most of their time with us.

The 30-student class is divided into four groups. Seven or eight students rotate through our laboratory departments every two weeks from November through June. All o four technologists work with the undergraduates on a one-to-one basis at some point during the rotations.

When the workload gets heavy, however, students are prepared to proceed on their own. The training schedule tells them what they should be concentrating on, and the manual, checlist, and section objectives provide specifics and guidance on the subject. Some checklist items call for the student to observe, as in the case of weekly maintenance or troubleshooting instrument problems.

On other occasions, students have to practice reading slides, prepare worksheets, write reports, or rehearse talks onlab subjects. What they are not allowed to do without direct supervision is operate instruments or process actual patient speciments.

Let's go through our standard rotation module, one component at a time:

* Pretest. The pretest allows us to examine each student's capabilities. For example, the entire chemistry rotation lasts for six weeks--two at our lab and four at the university hospital. Some of the students begin their rotation with us; others arrive after completing four weeks at Thomas Jefferson; and some come to us in the middle. The pretest quickly highlights each student's strength and weaknesses.

All students take the 10-question pretest on their first day in each of the six laboratory sections. Administering these tests helps us establish an individual baseline and insures that students have sufficient knowledge to begin their particular rotation.

Pretest questions focus on the basic theories and principles learned in the classroom. In chemistry, for example, we might ask a student which of the following to avoid when drawing blood for potassium analysis:

1) Allowing the serum to remain on the clot for an extensive period of time.

2) Having the patient open and close the first prior to drawing the blood.

3) Hemolysis.

4) A fasting speciment.

The first three items should be checked off, of course. It's important that students know what constitutes a proper speciment before beginning the rotation.

The passing score for the pretest is 60, or six correct answers out of 10. Because of the limited time in the lab, the university generally permits anyone who fails to begin the rotation anyway and repeat the exam later. In most cases, a simple review is enough to boost the score. Knowing that they must face the pretest, students tend to study in advance and are ready to take their place at the bench when they arrive.

* Objectives. Students receive the section objectives--along with the schedule, student manual, and checklist--upon completing the pretest. From these objectives, students learn precisely what is expected of them and what they will be capable of performing upon completing the rotation. The objectives also serve as ready-made lesson plans and training exercise.

In chemistry, students have separate objectives fodr the four work stations: electrophoresis, the CentrifiChem 500, the Astra 4, the aca III. The CentrifiChem 500 objectives are shown in part in Figure I. In addition to learning about its components and its operation, students can look forward to instruction on maintenance, troubleshooting, and the procedures that are the CentrifiChem operator's responsibility. To facilitate independent study, the objectives include corresponding page numbers from the student manual.

* Schedule. The rotational schedules let everyone in the lab know who is supposed to be where and when. They help technologists keep track of individual students and also help the students keep track of their lab assignments.

Since the schedules are posted in the lab, botht he students and technologist instructors are able to prepare for each assignment. This saves time at the bench and enhances the teaching/learning experience. The schedules are somewhat flexible, enabling students to swtich to a different station if, say, an instrument breaks down.

During an average week, we have nine students in the lab: three in chemistry, two in hematology, two in the blood bank, one in coagulation, and one in microbiology working on parasites. With the exception of parasitology, all the rotations follow th schedule shown in Figure II. Each week of clinical instruction works out to five half-days in the laboratory.

Student spend two weeks each in chemistry and hematology and one week each in coagulation, the blood bank, and urinalysis. For the parasitology rotation, they spend Wednesday morning and all day Thursday in the section. When not in the lab, students attend lectures at the university.

* Student manuals. The manuals are designed specifically to supplement what students learn at the bench. Each of the four chemistry manuals--CentrifiChem. Astra, aca, and electrophoresis--numbers more than 100 pages and contains in-depth information on principles, procedures, clinical significance, and basic troubleshooting skills. The student holds on to the manuals during the rotation and can study them at home.

* Checklist. This is probably the most useful component of our module. The section checklist provides an itemized account of exactly what must be accomplished. For every procedure, the checklist tells the students whether to read, observe, or perform. It also specifies how many times they are required to run each test.

After completing a task, both the student and instructor place their initials on the checklist and date the entry (Figure III). The same technoloigst need not be present every day to guide a student through a section. A quick glance at the checklist reveals what a student has accomplished and what still remains to be done.

We don't waste time covering the same ground twice, and the rotation is not disrupted when a technologist is ill, goes on vacation, or moves to another section. For the university professor, the checklist provides documentation that a student has mastered all of the required tasks.

* Post-test. This exam, which is far more comprehensive than the pretest, helps us measure how much technical knowledge students have acquired in our laboratory. The chemistry test consists of 25 questions for each analyzer and electrophoresis. We delve into students' problem solving and decision making abilities, and we ask them to recall specific clinical information. When students fnish the combined six-week chemistry rotation at our laboratory and the university hospital, the university administers its own examination. * Practical examination. Here we assess students' hands-on skill by having them perform a procedure and interpret the data. In electrophoresis, for example, students must run an unknown. It's safe to assume that students completing an anlyzer on their checklist have successfully operated it many times. Just to make sure, we ask them to give a five-minute talk on an interesting facet of the instrument.

This approach has two benefits: We're confident that students know the instrument, and they get a chance to make their first presentation to colleagues. * Professional evaluation. Each technologist instructor helping a student on a particular assignment fills out an evaluation form similar to the sample shown in Figure IV. If three technologist participate in aca instruction, all three evaluate the student's performance on the analyzer. In addition, they indicate whether a student is behaving in a conscientious and professional manner.

The exams and evaluations not only tell students and their university professors how much was learned and where more work is needed, but also help us assess teaching methods and the performance of technologist instructors. Students comment on our performance, too. For example, their suggestions prompted revisions of objectives and checklists. We clarified points and added a great deal of detail. As a result, students are now able to do even more on their own.

As an appendix to each of the modules, we have put together a packet of spare-time activities. It includes articles on current topics, case studies, and other material for students to read or work on when the workload slows down. For example, one of the projects is an Astra crossword puzzle that heightens interest in learning the parts of the instrument.

Everyone is pleased with the structured, standardized approach to clinical rotations. The technical staff feels less hurried, students are learning what they need to know, and university professors are satisfied with their progress. The program now runs so smoothly that I'm able to devote more time to my new responsibilities as educational coordinator for both students and technologists, and also keep up with my duties as assistant supervisor.

We emphasize to students that patient care is our primary concern. They understand that technologists must someties cut an explanation short to do a Stat, for example, and when that hapens, they gain valuable insight into the day-to-day realities of their chosen profession.

Most of the time, however, instructors and students are able to cover laboratory lessons in depth. One recent graduate said: "This was an excellent program for me. It allowed the bench technologists to teach and take a personal interest. They made sure I learned the laboratory procedures and performed them well." Other students report that the program helps them organize their time and also obtain more hands-on experience than they might get under another system.

Laboratory supervisors like the revamped program because it leaves them free to attend to their management duties. They also find the student manuals useful when they train new employees. As for the technologists, one of our instructors praises the program's organizing power. "The checklist in particular helps me know wha the student has done or must do so I can allot my limited time appropriately. I never feel hassled or bogged down."

Finally, as one of the program's creators, I'm satisfied that our students are placed on the road to becoming high-quality medical technologist. I really have confidence in our graduates--in fact, we have already hired four of them.
COPYRIGHT 1984 Nelson Publishing
Copyright 1984 Gale, Cengage Learning. All rights reserved.

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Author:Hallahan, Mary T.
Publication:Medical Laboratory Observer
Date:Jun 1, 1984
Previous Article:An in-service training program for the nontechnical staff.
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