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Microbiology Clinical Intensive Rotation-

Education’s Response to Changes in Industry

Karen Peterson, M.S., MLS(ASCP), University of North Dakota

Shannon Jongeward, M.S., MLS(ASCP)CM, University of North Dakota

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Objectives

Upon completion of this session, the participant will be able to:

• Identify changes in clinical laboratories that are having a direct impact on Medical Laboratory Science programs

• Conceptualize a clinical rotation in a student laboratory setting

• Demonstrate entry level competence achievement in a non-traditional clinical rotation

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Healthcare Culture• Healthcare industry is changing

• i.e. PAMA, Value-based care models

• Healthcare facilities looking at ways to remain financially viable

• Forcing laboratories to consolidate or outsource testing

Budget Cuts Department Outsourcing

Fewer Clinical

Sites

Fewer Students

Workforce Shortage

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NAACLS Requirements

• Standard VIII.A.2• MLS Curriculum Instructional Requirements

• Address Pre-analytical, analytical, post-analytical components for several laboratory services in 7 different scientific areas

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Impact on Educational Programs• Clinical sites out-sourcing

• Microbiology and Blood Bank major departments affected

• Responsibility placed back on programs

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• CLSEDUC discussion list

• Northcentral Tech College, WI

• Madison Area Tech College, Madison WI

• Wayne State University, Detroit

• Ivy Tech Community College Southern Indiana

• Farmingdale State College, Farmingdale NY

• Quincy College, Quincy MA

• Brigham Young University, Provo UT

• St. Philip’s College, San Antonio TX

• Stark State College, North Canton Ohio

• York College CUNY

• Wenatchee Valley College, WA

• Auburn University, Montgomery AL

• University of Wisconsin, WI

• Austin Peay State University, Clarksville TN

• St. Luke's Hospital, Kansas City

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Impact at UND• Impacting students at UND close to 10

years• MCIR – 4th year

• Currently • 63 total sites, 11 out-sourcing microbiology

• Anticipate additional sites

• Facility size is not a factor7

VA Medical Center-Spokane

Cavalier County Mem Hospital‐Langdon

Sanford Medical Center‐Vermillion

Rainy Lake Medical Center ‐ International Falls

Park Nicollet‐St. Louis Park

Mayo Clinic Health System‐Austin

Other sites that outsource microbiology

Current sites with students

Students able to rotate in separate facility

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Options Examined

• Fewer clinical sites was NOT an option

• Considered asking other sites to take these students• Creates additional complications

• Non-traditional options

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Solution

Microbiology Clinical Intensive Rotation (MCIR)

• Sub-committee formed to plan details

• Requirements: Emulate a clinical rotation

Let the show begin!

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When are we going to teach

it?

Where would we

get samples?

Issues

Incubator space?

What other resources

are needed?

How many cultures? Automation?

Who was going to teach it?

What types of cultures?

How are we going to fund

this?

Serology?

Where are we going to

do this?

How long will the rotation

be?

How many

faculty needed?

How many students?

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Program Overview

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Undergraduate Program

All routes complete the professional program through

UND• On-line course work

• 12 weeks on campus in the summer

• 27 weeks at a clinical site 13

Traditional 2+2 4+1

WCAMLS 3+1 MLT to MLS

Routes

Mayo Cohort

Categorical

Microbiology Courses

All Students:• Summer: MLS 478 Clinical Microbiology I

• Clinical Rotation: MLS 484 Clinical Microbiology II and MLS 495 Clinical Microbiology III

Routes Prior Microbiology Courses

Traditional 2+2 MBIO 202 Intro to Medical Microbiology LectureMLS 394 Medical Microbiology

Traditional 4+1 Undergraduate micro

WCAMLS 3+1 Curriculum aligned microbiology

MLT to MLS Undergraduate microMLS 394 Medical Microbiology

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MLS 478 Clinical Microbiology I• 10 total labs, 3 ½ hours each

• Station based• Perform and interpret identification testing for Staph, Strep, Strep-like, Enterococcus,

Neisseria, Moraxella, Haemophilus, Enterobacteriacea, Non-fermenters

• Interpret susceptibility testing

• Interpret gram stains, including sputum gram stains

• Perform and interpret urine, GI, respiratory, wound, anaerobe, and miscellaneous cultures,

• Correlate bacteria culture results with patient disease/symptoms/treatment

• Student Unknowns• Culture set-up

• Plate read

• Perform and interpret gram stains

• Perform primary/secondary testing

• Set up, read, and interpret susceptibility testing

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MLS 484 Clinical Microbiology II• Builds upon previous coursework

• Self directed learning theory course

• Content delivered through study guides and readings

• Outcomes are assessed through quizzes and examinations

MLS 495 Clinical Microbiology III• Affective domain

• Rubric used to evaluate performance during the microbiology clinical rotation

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The Pilot Episode2015

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MCIR 2015 Pilot EpisodeHow many students? 8

Where are we going to do this? The UND MLS biohazard lab. • Other options were limited and complicated

Who is going to teach or facilitate it?

• Collaborated with Riverview in Crookston, MN• Outside instructor

• Allowed students to get another perspective

• Hired the lab manager to facilitate this course as well as provide samples

• Karen and Shannon co-instructors• Help from other faculty

• Provide individual bench teaching

How many faculty are needed? Aimed for a 1:2 ratio• Faculty sat between 2 students

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MCIR 2015 Pilot EpisodeWhen? Immediately after Summer Session

• August 17 – September 4, 2015

Considerations• Student housing • Department schedule• Outside instructor availability• Student/Faculty/Staff burnout• Other course responsibilities for students

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How long will the rotation be? 3 weeks, 4 hours each day• Students completing other classes on-line prior to

clinicals

Where would we get samples? Contracted with collaborating lab• Smaller lab, limited samplesAltru Health System• “Filled-in” samples

What types of cultures? • Sputum, throat, Beta Strep screen back-up, aerobic wound, anaerobic wound, blood, genital, ear, eye, urine

How many cultures? Aimed for 5 each day.• Dependent on coordinating lab• Each student saw a total of 95 cultures

MCIR 2015 Pilot Episode

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MCIR 2015 Pilot EpisodeAre we going to incorporate automation?

Vitek• Students transported to facility to set up cultures

Other resources needed? Standard Operating Procedures• Provided copies of Riverview SOP’s,

Requisitions and report forms

Is there enough incubator space?

OK this rotation• 2 table top • 1 double door table top

How will we fund this? General department funds

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Execution • Each student has their own workstation

• Bench SOP manual, primary and spot testing supplies, incinerator, microscope

• Left up for the duration of the rotation

• Samples brought daily from Riverview• Re-labeled with fake patient names

• Completed requisition for each specimen

• Samples used by all students

• Documented work on culture workup form

• Reports “sent” to providers on Requisition form – turned them into instructors

• Most identification and susceptibility testing performed via MicroScan

• Select cultures set up on Vitek

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2015 Pilot Schedule• Week 1

• Students plate cultures, perform direct gram stain, work up cultures

• Week 2 and 3• Students performed direct gram stains, worked up cultures

• Students plated “new” cultures

• Faculty, staff, GTA’s plated all other cultures

• Students rotated benches the third week

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“Series” Potential?

Yes!

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“Series Premier” of the MCIR2016

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2016 MCIR• 7 students

• Extended to 4 weeks • August 15 – September 9, 2016

• One week off between summer session and MCIR

• Eliminated other course conflicts

• Added stool cultures and Group B Strep screens

• Collaborated with Altru • Specimen schedule

• Supplemental lectures from Marijo Roiko, Ph.D.

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2016 MCIR Schedule• Week 1: Wounds, blood cultures

• Week 2: Sputum, Beta Strep screen, anaerobe

• Week 3: Urine, stool, Group B screen

• Week 4: Compilation of all cultures

o Students only plated new cultures each Monday as well as all stool cultures.

o Staff/GTA plated all other cultures

o Instructor sat with 2 students each Tuesday and Wednesday weeks 1-3

o Content lectures with Karen and Shannon every Monday morning

o Supplemental lectures with Marijo every Tuesday

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2016 MCIR• Benches were assigned a number, each bench had a

binder and rack associated with it.

• Student Binders• Requisitions and culture report forms

• Organized by date

• Reviewed daily

• Feedback provided

• CO2 incubator purchased

• Instructor set of plates

• Students rotated benches in the second week

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2016 MCIR

• Minor changes for future MCIR’s• Update policies to reflect UND processes

• Incorporate Vitek

• Check off their gram stains and organism ID’s prior to leaving for the day

• Clinical Microbiology Handbooks

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Thoughts from 2017

• Depending on class size, extra faculty help not needed → Monday morning lectures

• Adding automation modules

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Financials• Supplies

• 2015

• ~$10,000 in supplies or $1,250 per student

• 2016

• Budgeted $12,000-$16,000

• $1,500-$2,000 per student

• Actual: ~$7,400 in supplies

• ~$1,060 per student

• 2017

• $~5,325 total supplies

• ~$890 per student

• Adjunct Instructor

• Sample pickup fee

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Summary

• Healthcare facilities are struggling to stay in budget.

• Results in budget cuts, including outsourcing departments such as microbiology.

• Limits the number of clinical sites.

• Programs struggle as a result, forced to take fewer students or take on additional roles.

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Questions?

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