My aims of this section will be achieved through independent research, reading and reviewing articles, books, newspapers and accredited websites which will be demonstrated throughout this process of reflection.
State the activities that you have carried out to help you to achieve your learning goal?
To build a basic understanding in pathology and laboratory medicine organisation several activities were carried out to reflect the learning goals. Initially, through the attendance of lectures, the basic understanding of the five major disciplines such as microbiology, histopathology, cytopathology, clinical chemistry, Haematology and transfusion science was developed which enabled me to appreciate the various roles in pathological science. In supplementation to the notes taken, a variety of books related to the learning objectives of each lecture, were analysed in order to build upon the knowledge gained. This was done through the use of taking notes after actively processing information absorbed. Subsequently, detailed research was undertaken to gain up to date information on the quality standards laid by accredited governing bodies such as IBMS and HPC. To demonstrate, focused learning took place that reflect individual learning goals by looking at relevant journal articles, websites, government reports and newspaper articles. Furthermore, peer group discussion helped in expanding knowledge beyond the scope of the module content by discussing the financial factors which influenced the delivery of pathological and laboratory medicine. To conclude, a continual process of reflection will take place to appreciate setbacks, changes and developments in the learning process.
How have these activities helped you with your learning?
Activities undertaken have had a varied impact on my learning and development of the subject matter. Attending lectures and listening has enabled me to actively process the information by writing down notes. Notes have enabled me to have a basic understanding of the subject matter for example, one of my learning goals was to understand the different disciplines involved in pathological and laboratory medicine. Subsequently, learning objectives were used as a basis for further research in literature. For example, one of my learning objectives was ‘current and future settings for the delivery of pathology and laboratory medicine organisation’. The relevant chapters within and beyond the recommended reading lists was read and further notes were taken to supplement my notes thus, further developing my understanding. Moreover, a more complex understanding of certain aspects with in the subject matter was achieved through the activity of reading and analysing current journals and government reports for instance, the ‘Carter Report’ on National Health Service (NHS) pathology services. Furthermore, examining peered reviewed websites, which were easy to access, gave me valid and up to date information on the quality standards lay down by different governing bodies such as the Health Professional Council (HPC). This enabled me to gain a more focused understanding of the subject content as required. Another activity which aided my learning was taking part in peer group discussion in tutorials. This provided me with knowledge beyond the subject content. For instance, financial impacts on the role a biomedical scientist undertakes. Finally, rigorous reflection has supported my learning by allowing me to change and adapt my learning goals and developed my thought processes.
Describe your progress with this topic during the previous three weeks
Development within each week was made in accordance to the learning goals I set myself in that week. I created a logical sequence in order to meet aims set within each week, as demonstrated below:
Week 1: Learning goals: 1, 5 and 7
To achieve my first learning goal, I attended week 1 lecture on ‘What is pathology and laboratory medicine’. This lecture and written notes gave me the understanding of the five major disciplines and sub-specialities and the professional roles associated such as doctors and clinical scientists. Moreover, the relevant books were read to gain a more detailed understanding, these were ‘biomedical science practice: experimental and professional skills’ and articles such as ‘general pathology’ helped in consolidating and extending my understanding of the subject.
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Subsequently, learning goal five was accomplished through lecture 1 and, again, written notes which were highlighted and condensed gave me a broader understanding into quality standards laid down by different governing bodies such as CPA and MHRA and how stringent guidelines, which are followed by pathological laboratories, enable quality and accurate service to be provided. In addition, books and articles such as ‘biomedical science practice: experimental and professional skills – chapter 19’ were read. Moreover, specialist website such as www.CPA.org.uk and www.mhra.gov.uk/index.htm was looked at to gain an idea of the specific guidelines that need to be followed by laboratories.
Finally, learning goal seven was achieved through lecture 1 and written notes gave me and understanding of the current and future settings for the delivery of the pathological medicine and how the current hospital based lab may become a factory warehouse to maximise space and meet the demands of the workload. To supplement this goal, articles such as the ‘Carter Report’ was read to further focus my learning on how changes such as ‘Hub and Spoke’ working could increase effectiveness of the delivery of pathological medicine.
Week 2: Learning goals: 2 and 3
The second learning goal was achieved through attendance of the second lecture on ‘pathology and laboratory medicine organisation’. This lecture and written notes, again, enabled me to gain the understanding of the services provided by pathology and how it is split into core and specialists services. Furthermore, e-books such as ‘An introduction to biomedical science in professional and clinical practice’ and from NHS specialised services website, information on specialist services was looked at to supplement my learning.
Lastly, learning goal three was accomplished by the end of week 3 through the combination of lecture two and notes taken from e-books and articles such as ‘Pre-analytical Variables in the Chemistry Laboratory’ helped to further enhance and focus my learning; presenting to me different prospective on the same matter thus, allowing me to reach my own conclusion
Week 3: Learning goals: 4, 6 and 8
To attain learning goal four, lecture three in pathology and laboratory medicine allowed me to gain an understanding of the different professional bodies within pathology and their purpose. Notes and further reading in the relevant materials allowed me to actively process the information presented to me and develop my knowledge. To help supplement by progression towards achieving this learning goal, I looked at specialist websites created by the governing bodies in pathology medicine, such as www.cpa.org.uk to enable me to gain a specialist insight for instance, the role the professional bodies play in the successful delivery of BSc (Hons) in Biomedical science degree.
Moreover, lecture three also allowed me to achieve learning goal six which was to understand the overall contribution of pathology medicine on healthcare. It demonstrated to me how the work undertaken by pathology laboratory is vital to the success and treatment of many diseases such as Tuberculosis (TB). Also, further research in to books like ‘Biomedical sciences: essential laboratory medicine’ allowed me to gain appreciation of the broad spectrum of work carried out by biomedical scientist and their influence on healthcare.
Finally, goal eight was also, achieved in lecture three as it gave me an brief insight into the role of private health care, NHSBT and pharmaceutical companies on pathology medicine. Furthermore, notes and further reading in newspapers such as the Guardian allowed me to understand that Private Finance Initiatives (PFI) is a way of creating Public Private Partnerships (PPP’s) to alleviate the financial constraints on the NHS as it cannot afford to do all the tests that is required of them however, in return for their funding, the repayments on the debt owed, is more than what was put in.
Describe any setbacks that you have encountered in trying to achieve your learning goal.
I believe the word ‘setback’ can be seen as a positive step in achieving my goals in academia because they are not setbacks but, steps I should avoid when trying to achieve other goals.
Setbacks came in many different forms when accomplishing goals in this section. To begin with first setback that I encountered was that my goals didn’t reflect the objectives of the lectures. This meant that it was harder to come into the lecture prepared with a brief understanding as I had prepared for different learning goals which were in accordance with my plan. To overcome this I will try to create a plan that can adapt to change and try not to let this have too much of an impact or have an effect on performance within the lecture. Furthermore, another setback was that different array of resources were available in trying to achieve each learning goals. For example, for my first learning goal a wide array of resources was available such as books to articles to newspapers whereas, for some goals not all the types of resources were available. To overcome this I will try to allow more time for researching a particular goal and then while I am gathering information on the topic, I will research again to look at more focused learning sources such as articles. Moreover, on some occasions, when I did locate the necessary articles the abstract was only available. This gave a brief insight, it would have been easier to draw valid conclusions and understand the subject content proposed, if the whole information was available. This was only a slight setback as to overcome this just meant refining my research so that I could locate the complete articles. Another setback was that we did not have a tutorial after the first lecture in pathology and laboratory medicine organisation this meant this impeded my ability to test whether the information that was taught in the lecture was understood and tutorial were also used to provide me with any further detail. However, this was no fault of mine but I just felt a tutorial after the first lecture would have been beneficial in testing the understanding of the lecture. Simply, for this setback I will continue to attend all future tutorials. Lastly, another setback was to try and complete the necessary section in time with the interim deadlines that I set myself, to effectively complete the learning log to a decent standard. This was because I did not anticipate the duration of which some the sections of the learning log will take. For example the section where it stated ‘explain what you have learnt’ took longer than expected due to the further reading that I did. To overcome this I will set myself more realistic interim deadlines which are more reflective of ability to achieve them.
Explain what you have learnt
‘Gain an understanding of the different disciplines involved in pathology, for example, microbiology and histopathology, and the professional careers associated’.
As defined by Bezabeh et al. (2004) [online]), pathology is the scientific study of disease. It is derived from the Latin words ‘patho’ meaning disease and ‘logy’ meaning study. Therefore, pathology is the study of disease using scientific methods for example a haematologists will examine blood content by taking a blood test.
There are five major disciplines and sub-specialities under pathology:
Microbiology and Virology
Cytopathology and immunology
Haematology and Blood Transfusion
It is the study of pathogens that penetrate the body’s defences and cause disease. A microbiologist will understand the mode of function of a variety of different fungi, bacteria and parasites; they will identify the correct pathogen that has infected the host and recommend the correct antibiotic treatment to eliminate the disease. Many pathogenic diseases identified by microbiologists include tuberculosis, tetanus and meningitis.
This is the study of viruses and their mode of action in terms of penetration and infectious ability. Viral diseases that are commonly identified are human immunodeficiency virus (HIV), chickenpox and German measles. Virologists also have major roles in the production and efficiency of vaccines.
This is the study of tissue structure and components which can relate to the establishment of disease. Common samples are from living individuals during surgery or deceased individuals in a post mortem. Sample size ranges from small samples such as biopsies to whole organs to identify the ailment afflicting the individual (Glencross, 2011). Moreover, histologists will look at abnormal features or functions of tissue to establish which disease is infecting the individual. Many types of tumours such as benign or malignant ones which lead to cancerous diseases such skin cancers are identified due to their appearance on the skin.
This is the study of cells not tissues and abnormal features or components in cellular material will allow cytologists to identify the infecting disease. The samples are from a wide variety of sources such as cervical smears or natural shedding in the mouth when a swab is taken (Glencross, 2011). This is then studied under a microscope. Clinical cytopathologists, medical staff and biomedical scientists work closely together to interpret the results from a patient and administer the correct diagnosis to the affected individual.
It is the study of the immune system and its role in inhibiting infectious diseases such as tumours, parasitic infestations and allergies. Their samples come from a wide array of sources such as blood samples and urine samples. Variety of tests which are carried out by immunologists on samples can be either automated or manual (Glencross, 2011). A disease of the immune system is acquired immunodeficiency syndrome (AIDS) which is the result of a HIV infection. AIDS disables the immune system thus, allowing infected individual to become more prone to diseases and without a defence mechanism the individual dies.
Tests on blood or other biological materials such as urine are carried out to understand and diagnose diseases such as diabetes which renders a person unable to absorb sugar properly which can lead to dangerously high blood-sugar levels in the blood plasma which leads to a Hyperosmolar Hyperglycaemic State (HHS) which is life threatening (Diabetes UK, 2012) [online]). Toxicology studies on the liver and kidney are also carried out and tests can be done to monitor the development of disease.
This is the study of the physiology of blood samples taken by nurses. Samples are required by medical staff such as doctors to identify diseases such as anaemia or leukaemia. Haematological tests will identify in the blood sample, the amount erythrocytes or haemoglobin is present so that medical staffs and biomedical scientists can determine if the patient is anaemic so that treatment can start immediately.
Transfusion science involves the sorting, identification and administration of blood and blood products to individuals that require it. For example, anaemic patients, patients suffering from blood loss or individuals involved in a road traffic accident. The primary source of blood is from blood donors who can donate their blood which is then stored and prepared for re-administration to individuals that require it (Glencross, 2011). Blood is regarded as a product so, it is highly regulated by the MHRA which makes sure that hospitals and other organisation follow EU directives which were transferred into UK law through the Blood Safety and Quality Regulations 2005 in UK Blood transfusion and tissue transplantation service (UKBTS), 2012) [online].
There are many professional careers that are in pathology. They are:
Medical Laboratory Assistants
Anatomical Pathology Technicians
Administration and Clerical staff
There are many routes to each of the professions for example, to become a biomedical scientist, who can specialise in any of the five departments of pathology after further training, a Bachelors of Science (BSc) degree in biomedical science must be obtained and state registration on the Health and Care Professional Council (HCPC) register is also required to be able to practice as a biomedical scientists in the National Health Service (NHS) or other organisations.
‘To understand the organisation within pathology and laboratory medicine including the variety of specialist services provided.’
There are services in pathology and laboratory medicine that can be classified under: traditional, core and specialist services. The five major departments within pathology are categorised under these three services. As stated by Beastall (2008) the NHS laboratories have always provided twenty-four hour services in clinical biochemistry, haematology and blood transfusion. However, services in microbiology and histopathology have been provided by core laboratories may that be not always on a daily basis. The above services cover the five major departments which should be provided to everyone and at most if not every NHS hospital. Specialist services as defined by (NHS specialised services, 2012) [online] is a service that has a planning population of one million which means that it will not be available to everyone or by every hospital, typically, it is provided by less than 50 hospitals. Such services relate to rare disorders or conditions such as mutations in lymphomas and leukaemias which require specialist equipment in pathology laboratories for diagnosis and treatment.
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There are a variety of services of specialist services that have developed for example Ophthalmic Pathology Services which diagnoses and provides advice on eye conditions. Services include diagnosis for malignant and non-malignant conditions for a variety of specimens including eyelid, conjunctiva and cornea. Moreover, a more recent development of specialised services in histopathology and haematological oncology services is molecular pathology which looks at genetic analysis for the diagnosis and prognosis of tumours in breast cancers, lymphomas and leukaemias.
A demonstration of good practice is the Fluorescent in-situ hybridization (FISH) testing human epidermal growth factor receptor 2 protein (HER2) in breast cancer to select patients suitable for Herceptin ®. Herceptin ® is the first monoclonal antibody which binds onto the HER2 receptor blocking human growth factor from binding thus preventing the chance of uncontrolled replications which lead to tumours. To determine whether patients require Herceptin ® patients are tested using immunohistocompatibility (IHC) test which detects HER2 proteins through staining tumour cell membranes (Breastcancer.org, 2012) [online].
Many other specialist services are provided by the pathology laboratory medicine departments in the NHS to treat complex disorders that your average NHS hospital cannot deal with such as Bone Marrows, Colourimetric in Situ Hybridisation (CISH) and Polymerase Chain Reaction (PCR) tests.
‘To understand the process that takes place when the samples arrive in pathological lab to when it leaves’
There are three stages in the processing of samples from when it arrives to when it leaves, these are:
It is a phase in the process which deals with the request for a sample to be taken to when it is ready for the analytical phase in a laboratory. In this phase nearly 32 – 75% of errors occurs which delays and makes the job of a biomedical scientist harder (Magee (2005) [online]). There are many types of errors than can occur, these are:
Patient Identification: this is important as you need to take the sample from the correct patient. If it is done incorrectly then this can contribute to laboratory error
Patient Preparation: this is again very important because if one needs to take a blood sample to test glucose level, the patient has to fast prior to the sample collection so that when the sample is taken it will not give an inaccurate reading
Proper Tube Mixing: once the blood sample has been taken correctly then good mixing needs to occur to distribute the clotting factors in the tube evenly so that the sample does not clot in anyway
Correct Specimen Volume: this s essential as each specified volume on the tube has the correct additive and if too much is added to a tube which is above the specified, it will distort the blood-additive ratio thus contributing to a lab error (Magee (2005) [online])
There are many other errors that could occur, above is a synoptic view of the wide variety of errors that could occur.
This phase is when the specimen that has been taken, for example, a blood sample is tested in an auto analyser or other analytical machines to get a full blood count of red blood cells, white blood cells and platelets. This is done electronically and there is a very low error rate. The possibility of error only occurs with human intervention during reading and recording result or when the specimen is put into the machine. An error could also occur if the machine is faulty and that its fault is not picked up in time.
This phase involves the time form when it has been fully analysed to when it arrives back at the organisation from where it came from. This phase also can have a lot of errors in it which again reduces the accuracy of results. There are many errors that could occur, for example:
If an analyst is under pressure to produce test results required urgently, he or she may be tempted to present the results which look credible but has been achieved through the breach of Westgard’s rules which is identified through internal quality control (Pitt and Cunningham, 2009, pp. 111) [online]). This error or factor may highlight someone as ill when they are not, which is very serious.
Post analytic data entry error: this is dangerous as it can highlight someone as ill when they are not
Oral miscommunication of results
Error in reporting to downstream printer and fax
Provider fails to retrieve test result: this causes further delays and the sample has to be searched and retrieved
Failure to communicate critical value
Provider misinterprets lab result: this and the above error again could harm the patient as they could be given drugs that they do not require
There are many other errors that could occur in this phase and these errors are a direct result of human error. To make the system more efficient the pre and post-analytical phase should become more automated to reduce the risk of human error however, this action may reduce the number of jobs available to medical laboratory assistants which again is another factor to consider when trying making pathology medicine more efficient.
‘To find out about the different professional bodies within pathology and their purpose’
There are four main professional bodies that governs pathology, they are:
Institute for Biomedical Science (IBMS)
Health and Care Professions Council (HCPC)
Clinical Pathology Accreditation (CPA)
The IBMS is a professional body for biomedical science in the United Kingdom. It was founded in 1912 and has 16000 active members. The body aims to promote and develop biomedical science and its members.
It has three primary roles in biomedical science:
General – This involves setting standards of practices for biomedical scientists to protect patients. Also, the institute represents the interests of biomedical science to the universities, media and government. Furthermore, they promote public awareness and advises government departments on all matters relating to biomedical science
Educational – The institute accredits university degrees and assess qualifications for registration with the HCPC. Also, they assess the competence for biomedical scientists to practice and they award ‘Chartered Scientists’ status.
Scientific – They update members through meeting and professional events and organise continual professional development schemes. Furthermore, they publish scientific research and professional development documents. They help part fund critical research in the development of medicine. Also, they can be assessors for senior job interviews
The role of the IBMS is not explicitly narrowed down to the above as they also, work closely with the institute of HCPC to help develop and accredit competent biomedical scientists.
The HCPC is a UK-wide regulatory body which is responsible for setting and maintaining standards of proficiency, professional training, performance and conduct of healthcare professionals. The purpose of imposing regulations is to protect the patient, the professionals and to prosecute anyone who breaks their rules and regulations.
Moreover, the HCPC publishes a wide variety of documents to help registered scientists to understand exactly what is required of them when practicing. Also, in the documents on the HCPC website, there are several rules on how to act in the best interest of your patient and how to keep high standards of personal conduct. For example, one of the rules is that ‘you should be aware that conduct outside your programme may affect whether or not you are allowed to complete your programme or register with us’ (HCPC (2012) [online]). This means that the conduct of a biomedical scientist regulated in and out of the work place and any wrongdoing of a biomedical scientists will be referred to the HCPC for conduct unfitting for a professional outside of work and although this does not mean they will be struck of the register, there is still a possibility of this happening (Ricketts, 2012). Moreover, to continue to remain on this register, it is obligatory to sign a personal declaration every two years, confirming that he or she meets their standards of proficiency and competence to practice. Also, evidence for Continual Professional Development (CPD) is required to prove the validity of the personal declaration document (Glencross, 2011).
The CPA originated in 1992, from a collaboration of four institutes: the Royal College of Pathologists, the Association of Clinical Pathologists, the Institute of Biomedical Science, and the Association for Clinical Biochemistry. CPA primarily accredited medical laboratories but now they have extended their accreditation to External Quality Assessment (EQA) schemes. The CPA is a non-profiting distributing institute that act in the best interest of the public (CPA (2012) [online]).
Moreover, the CPA evaluates and declares the capability of the medical laboratories and External Quality Assessments (EQA) schemes in the UK and overseas. This will give the public the confidence that there specimens, are sent to laboratories that adhere to the strictest regulations and will be treated properly. Although this registration for laboratories is voluntary, if they do enrol it will demonstrate that they have been assessed against the accepted standards and will ensure that there is the highest standards in the NHS laboratories (CPA (2012) [online]).
There are many other governing bodies such as the Medicines and Healthcare products Regulatory Agency (MHRA) which regulate the blood products in a pathological laboratory. This is essential in pathology as people’s lives are at stake and the results are needed to be accurate as it can determine whether a patient is critically or not. This gives the public confidence that the tests are carried to the highest accuracy and that the laboratory abides by the strictest rules to provide highly quality outcomes.
‘To learn about the quality standards laid down by different governing bodies which all biomedical scientists and pathological laboratories are obliged to follow.’
The environment of healthcare is very controlled, with internal and external quality control checks to ensure that the highest standards are maintained at all times. To assess this conformation, there are formal standards to comply with also there are clinical and non-clinical checks by independent assessors of the laboratory from the CPA, if the laboratory is registered with them. This will ensure a high standard is maintained in every individual associated with the laboratory. There are many governing bodies, United Kingdom Accreditation Service (UKAS), CPA, Human Tissue Authority (HTA) and MHRA, which assess clinical laboratories against a wide variety of standards. This is done through professional quality inspectors and peer assessors from within the profession.
The CPA which is a part of UKAS works to accredit medical laboratories to standards laid down in ISO 15189, Medical laboratories – Particular requirements for quality and competence which incorporates ISO 9001 which are adhered to by the CPA. In these international standards, they cover eight major areas:
Organisation and quality management system (A standards)
Personnel (B standards)
Premises and environment (C standards)
Equipment, information systems, and materials (D standards)
Pre-Examination process (E standards)
Examination process (F standards)
Post examination process (G standards)
Evaluation and quality assurance (H standards)
CPA assessment will take place every four years by three assessors, two from UKAS and one peer assessors which are normally clinical experts in specific fields such as immunology (Glencross, 2011). All of this is done to ensure that patient specimen examinations are done accurately, to a high standard and conform to high health safety standards to give the patient the highest confidence that the tests will be carried out properly and the results will be accurate.
The Medicines and Healthcare Products Regulatory Agency (MHRA) regulates medicines, medical devices and equipment used in healthcare and investigates harmful incidents. Also, they regulate blood and blood products to ensure that when administered to patients that the blood sample has been treated, stored and administered in accordance with the rules set down by the Blood Safety and Quality Regulations (BSQR) (MHRA (2008) [online]).
MHRA inspection takes place when a laboratory fills in an online compliance report to the MHRA, they will then assess the report in accordance to the BSQR and then if any further action is required, MHRA will send an inspector who will check the traceability, quality and storage of blood to ensure the laboratory is complying to the MHRA standards, this will normally take about a day to complete (Glencross, 2011) Also, MHRA publish standards on medicine and medicinal devices to ensure that any medical product has been stringently regulated to ensure highest patient safety. They regulate a variety of thing such as new biological compound or chemical compounds, new forms of existing medicines and r
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