fall 2017 – summer 2018 medical laboratory …

Fall 2017 – Summer 2018

NEW RIVER COMMUNITY & TECHNICAL COLLEGE | 280 University Drive, Beaver, WV 25813

MEDICAL LABORATORY TECHNICIAN PROGRAM

Clinical Education Guide

CLINICAL EDUCATION GUIDE For Students and Clinical Faculty

INTRODUCTION

Effective clinical education in the Medical Laboratory Technician Program at New River

Community & T e c h n i c a l College ( N e w R i v e r C T C ) can only be accomplished

when each participant fully understands the various responsibilities and other important factors

involved during the practicum experiences. This Clinical Education Guide should provide both

the student and clinical affiliate with the necessary information regarding policies, procedures,

and expectations which govern the student during the internships. This Clinical Education Guide

should not be considered a complete official statement of all policies of New River CTC and

the Medical Laboratory Technician Program, but rather this should serve as a guide to assist

the affiliates in providing the appropriate educational experience for the students and to assist

the students in achieving their goals. This training guide is supplemental to the New River CTC

student manual and the MLT Program Policies & Procedures manual.

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TABLE OF CONTENTS

SECTION 1 – PROGRAM OVERVIEW New River Community & Technical College - Faculty and Administration…………………………………………………… 1 Health Sciences Division – Administration ………………………………………………………………………………………..…………….1 Medical Laboratory Technician Program ………………………………………………………………………………….……………………..1 Clinical Affiliates - Faculty and Administration……………………………………………………………………………………..…………2 List of Current Clinical Affiliates …………………………………………………………………………….………………………………………..2 MLT Program Mission Statement……………………………………………………………..……………………………………………………..3 MLT Program Training Objectives ……………………………………………………………………………………………………………………3 MLT Program Training Methods ………………………………………………………………………………………………………………………3 MLT Program Training Materials …………………………………………………………………………………………………….…………….. 3 MLT Program Assessment & Evaluation ………………………………………………………………………………………………………….3 MLT Program Policies ………………………………………………………………………………………………………………………….……….. 4 Service Work …………………………………………………………………………………………………………………..…………………………….. 4 Alternate and Clinical Waiting Lists ……………………………………………….…………………………………………..………………….. 4 Outside Employment ……………………………………………………………………………………………………………….……………………. 4 Student Injury ………………………………………………………………………………………….……………………………………………………. 5 Clinical Electronic Device Policy …………………………………………………………………………………………………………………….. 5 Program Probation/Dismissal/Withdrawal/Re-Entry ………………………………………………………………….…………………. 6 Program Philosophy ……………………………………………………………………………….……………………………………………………… 8 Program Goals ……………………….……………………………………………………………………………….……………………………………… 8 Program Supporting Goals ……………………………………………………………………………………………………………………………… 8 Program Entry Level Competencies ………………………………………………………………………………….…………………………….. 9 MLT Program Curriculum ………………………………………………………….……………………………………………………………….... 10 Required Textbooks for MLT Program …………………………………………………………………………………………………………. 11 Student Pre-requisites for Clinical Education ………………………………………….…………………………………………………….13 Criminal Background Checks …………………………………………………………………………………………………………………………..13 Health Requirements ……………………………………………………………………………………..…………………………………………….. 13 Successful Completion of Didactic Courses …………………………………………………………………………………………………… 13 Clinical Education/Practicum Courses …………………….…………………….………………………………………………………………. 13 General Rotation Schedule ………………………………….……………………………………………………………………………………….. 13 New River CTC Student Badge ……………………………………………….……………………………………………………………………… 13 Hospital Identification Card/Badge ……………………………………………………………….………………………………………………. 13 Practicum Internship Pre-Requisite Checklist …………………………………………………………….………………………………….. 14 Dress Code and Personal Appearance…………………………………………………………………………………………………………….15 ASCP BOC Professional Certification Application Information……………….……………………………………………………...17

SECTION 2 - EDUCATIONAL GUIDELINES & POLICIES Clinical Education Expectations ………………………………….………………………..……………………………………………………….. 18 MLT Clinical Education Rotation Calendar …………………..………………………………………………………………………………… 19 Clinical Education Guidelines …………………………………………………………………………………………………………………………. 20 Rules and Regulations ………………………………………………………………………….………………………………………………………… 20 Attendance ……………………………………………………………………………….…………………………………………………………………… 20 Miscellaneous ……………………………………………………………………………………………………………………………………………….. 21 Clinical Education Supervisor Responsibilities …………………………….………………………………………………………………….23 Description ………………………………………………………………………………….…………………………………………………………………. 23 Qualifications ……………………………………………………………………………….………………………………………………………………… 23 Responsibilities …………………………………………………………………………..…………………………………………………………………..23

Clinical Instructor Responsibilities …………………………………...……………………………………………………………………………..25

Objectives ……………………………………………………………………….……………………………………………………………………………….25 Responsibilities …………………………………………………………………………..………………………………………………………………….. 25

Student Responsibilities …………………………………………………………….……………………………………………………………….. 26 Objectives ………………………………………………………………………………………………………………………………………………………. 26 Training Methods …………………………………………………………………….………………………………………………………………………26 Materials & Resources for Training Include ……………………………………………………………………………………………………. 26 Assessment & Evaluations ……………………………………………………………………………………………………………………………… 26

SECTION 3 – EVALUATION FORMS & INSTRUCTIONS Appraisal of Intern Performances ……………………………………………..…………………………………………………………………… 27 Student Evaluation of Clinical Site …………………………………..…………………………………………………………………………….. 29

SECTION 4 – PHLEBOTOMY/SPECIMEN PROCESSING Phlebotomy/Specimen Processing Performance Checklist ………………………………………..………………………………………30

SECTION 5 - HEMATOLOGY Hematology/Coagulation Performance Checklist ………………………………………..…………………………………………………….35

SECTION 6 - IMMUNOLOGY Immunology Performance Checklist ……………………………………………………..……………………………………………………………43

SECTION 7 – URINE & BODY FLUIDS Urinalysis Performance Checklist ………………………………………………………………………….……………………………………………50

SECTION 8 - IMMUNOHEMATOLOGY Transfusion Services & Donor Center Performance Checklist ………………………….…………………………………………………57

SECTION 9 – MICROBIOLOGY Microbiology Performance Checklist …………………………………………………………..……………………………………………………..66 Mycology Performance Checklist ……………………………………..……………………………………………………………………………….75 Parasitology Performance Checklist …………………………………………………………………………………………………………………..80

SECTION 10 – CLINICAL CHEMISTRY Chemistry Performance Checklist …………………………………………..……………………………………………………………………………87

SECTION 11 – CLINICAL TIMESHEET

Clinical Affiliation Hours Log .......…………………………………………..……………………………………………………………………………95

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FACULTY AND ADMINISTRATION

Health Sciences Division - Administration:

Dean of Transfer & Department Chair: Pre-Professional Programs Paula Johnson (acting) Program Director Dr. Richard Pagan Paramedic/EMS Programs VP, Academic Affairs R164 R210 304-929-2450 304-929-5493 [email protected] [email protected]

Medical Laboratory Technician Program

Program Director/Faculty: Clinical Coordinator/Faculty: Diane Tyson, MS, MLS(ASCP)CM Robert Stanton, MLS(NCA) R137 Instructor – Heme, Coag, Chem, Micro 304-929-5038 R181 [email protected] 304-929-5487

[email protected]

Program Administrative Associate: Tamara Rahal R188 304-929-3324 [email protected]

Clinical Instructors - Several employees from the area hospitals, called Clinical Instructors, assist in teaching “at the bench” in each of the clinical sites.

Clinical Education Supervisors - At each clinical site there is a Clinical Education Supervisor that coordinates the student experiences at that site, usually the Laboratory Manager.

Advisory Committee - An advisory committee, composed of professionals from various hospital and educational institutions, exists to provide guidance and input into the programs.

This program is in the process of obtaining NAACLS accreditation.

mailto:[email protected]





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CLINICAL AFFILIATES - FACULTY AND ADMINISTRATION

LIST OF CURRENT CLINICAL AFFILIATES

The following clinical affiliates have current signed affiliation agreements with New River Community and Technical College MLT program:

Please note that communications and assignments are handled by the program officials. Students are not to call affiliates directly. Only after assignments have been made can students contact the affiliate site directly.

Beckley Appalachian Regional Hospital 306 Stanaford Rd.

Beckley, WV 25801 Laboratory Manager/CES: Ms. Carla L. Johnson

304-255-3389 Greenbrier Valley Medical Center

202 Maplewood Ave. Ronceverte, WV 24970

Laboratory Manager/CES: Mr. Gary Mink 304-647-4411

Raleigh General Hospital 1710 Harper Rd.

Beckley, WV 25801 Laboratory Manager/CES: Ms. Janet Halstead

304-256-4157 Raleigh Regional Cancer Center

275 Dry Hill Rd. Beckley, WV 25801

Laboratory Manager/CES: Ms. Debbie Lacek 304-253-6060

New River Health Associates 57 Sutphin Lane

Scarbro, WV 25917 Laboratory Manager/CES: Ms. Barbara Bennett

304-465-2085

Summers Co. Appalachian Regional Hospital 1500 Terrace St.

Hinton, WV 25951 Laboratory Manager/CES: Ms. Teresa Keys

304-466-2906 Plateau Medical Center

430 Main St. Oak Hill, WV 25901

Laboratory Manager/CES: Ms. Debbie Robbins 304-469-8628

Summersville Regional Medical Center 400 Fairview Heights Rd. Summersville, WV 26651

Laboratory Manager/CES: Ms. Erin Massey 304-872-8441

Pocahontas Memorial Hospital 150 Duncan Rd.

Buckeye, WV 24924 Laboratory Manager/CES: Ms. Kathy Irvine

304-799-1040

VA Medical Center 200 Veterans Dr.

Beckley, WV 25801 Laboratory Manager/CES: Ms. Becky Browning

304-255-2121

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MEDICAL LABORATORY TECHNICIAN PROGRAM INFORMATION

MISSION STATEMENT The Associate of Applied Science degree in Medical Laboratory Technician provides the academic and practical experience necessary to attain entry-level competency in the practice field. This educational model has a strong academic structure and offers intensive technical development. This model also emphasizes the critical importance of leadership in the field of clinical laboratory science through the application of principles related to problem solving and evaluation, education, communication, research and management. The faculty of the MLT Program has a responsibility for the impact the student enrolled in the MLT Program may have on patient testing. In order to fulfill this responsibility, the program has established minimum technical standards that must be met, with or without reasonable documented accommodation, in order to participate in the program and graduate.

TRAINING OBJECTIVES At the conclusion of 16 weeks in clinical training period, a MLT intern will be able to:

• Perform laboratory analyses in all disciplines of the clinical laboratory• Describe the clinical significance of laboratory assays and test results• Employ good laboratory practice by demonstrating proper patient identification, careful

handling of specimens, reliable assay performance and accurate and timely reporting of results• Correlate test results with disease states• Operate and troubleshoot a variety of laboratory instruments and analyzers including the LIS• Implement systems of quality control, maintenance of records, equipment maintenance and

professional communications• Describe the function and implementation of laboratory management• Behave professionally at all times

TRAINING METHODS The various means used in the MLT internship program to conduct training are:

• Didactic materials provided in pre-clinical lectures and student practice• Scheduled clinical laboratory training at an affiliated laboratory for clinical rotations• Computer-based courses and tutorials• Laboratory practicals, including unknowns• Observation of demonstrated laboratory techniques and skills• Self-study and self-assessment

TRAINING MATERIALS • Required textbooks, purchased for campus session• Written procedures, operator’s manuals and package inserts• Flowcharts, tables and graphs• Computer tutorials, videotapes and online education modules• Practice materials• Self-study & research

ASSESSMENT & EVALUATION The effectiveness of training may be assessed and evaluated with New River CTC provided materials such as:

• Written examinations or quizzes, oral quizzes• Record review• Direct observation of psychomotor skills using provided materials such as unknowns

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• “Appraisal of Intern Performance” forms to be complete by trainers • Training checklists and evaluations submitted by clinical instructors

MLT PROGRAM POLICIES Service Work

Occasionally, there are health fairs or blood drives for which the students may volunteer to help, which is fine as a volunteer. It is the policy of the MLT program that students will receive no financial remuneration for the clinical practicum experience. Students are not allowed to work as regular staff (eg phlebotomist or tech) during the internship rotation. They must be supervised at all times, and cannot work independently as part of the laboratory staff. Students may seek employment in the laboratory in which they are assigned for the clinical practicum. This is termed “service work” and must be performed outside the scheduled hours of the clinical practicum. Any service work must be noncompulsory, paid, supervised on site and subject to employee regulations. Alternate and Clinical Waiting Lists

Students are offered admission to the program to begin coursework in the Fall term. Students are assigned to the clinical sites near the end of the Spring term just prior to the practica/internships. To obtain maximum experiences for internship, students may be assigned to more than one clinical site. Students will complete a Clinical Preference form and indicate his/her first, second, third choices for internship sites, as well as the reason for the first choice. We will make every effort to place you in your first choice, if possible. However, there are other factors that will also need to be considered by the program officials. The decision made by the program officials will be final. Our policy states: “The number of students admitted is based on the capacity of the clinical facilities to accommodate students. If there are not enough clinical sites to accommodate all students in a given year, selection will be made from an alternate list based upon the student’s most recent numerical ranking (GPA).” In the event that more students are admitted to the program than the availability of clinical site placement, students will be assigned clinical placement based upon their current GPA. If the student does not receive a “C” in the core courses or specified supportive courses, the student will be unable to participate in any practicum experiences. Outside Employment

Full time students are advised to limit outside employment to twenty (20) hours per week and must arrange their work schedule so that it does not interfere with their educational objective. Working more than twenty (20) hours per week may impede students’ learning and affect their success in the program.

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Students may NOT use scheduled work hours for their practicum/internship hours.

The program places restrictions on employment of students at affiliations where they are receiving clinical training. The restrictions imposed are:

1. students must not be working during the scheduled hours of training.2. students should only be employed in the area and/or perform procedures which they have

previously demonstrated competence and are considered entry-level.3. students should not be employed in an area where there is no supervision.

Student Injury Student Injury at Clinical Site Accidents will be reported immediately to the Clinical Education Supervisor at the site. The CES will notify the Program Director or Clinical Coordinator and complete the clinical site’s incident report form. The student will be financially responsible for their own medical treatment. A New River CTC Incident Report Form will also need to be completed.

Patient Incident If an incident, such as fainting during a phlebotomy procedure, occurs, the following must be done:

1. If a person on campus has an incident, the New River CTC Incident Report Form will need to becompleted by the instructor immediately.

2. This incident form will need to be submitted to the dean within 24 hours.

If an incident occurs to a patient that is the fault of the student, the clinical facility will complete an incident report form and notify the Clinical Coordinator immediately. A New River CTC Incident Report Form will also need to be completed and Clinical Coordinator will notify the dean immediately.

Clinical Electronic Device Policy In order to:

• Focus on patient care, where the laboratory is an integral part of the delivery of high qualitydiagnostic health care services, and

• Minimize distractions and time away from the department and its functions, and• Allow the clinical affiliate laboratory department to run with maximum efficiency and attention

to detail,the following Electronic Device Policy has been developed for our students at the clinical site:

Use of personal electronic devices is unnecessary and acts as a distraction during normal laboratory operations. Personal electronic devices are to be turned off while the students are “on the clock” during the daily clinical experiences. The personal electronic devices may be used during the student’s break/lunch, but must be returned to the off position once the student returns to the workplace. If anybody needs to contact the student in case of an emergency, he/she may call the laboratory on the institution’s regular phone, or leave a message for the student to call back during break/lunch.

Electronic devices include, but are not limited to: • iPod or other MP3 audio player• Palm pilot or other PDA type devices• Cellular telephones• Portable media players such as DVD or CD players• TENS or musculoskeletal stimulator units except at the written direction of a physician due

to electrical field interferences.

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• Net pads or Net books (including iPads)• Electronic readers• Hand held games• Pagers

This means no audio, verbal, or texting. Any non-work related electronic device must be turned off and must remain off during working hours. If the student needs a timing device, then a watch can be used.

Any violation of this policy may result in dismissal from the program.

Program Probation/Dismissal, Withdrawals, Re-Entry Probation Upon failure to achieve a “passing” grade in a clinical department rotation or discipline, the student will be placed on academic probation. The student will be allowed to attend another clinical site for that rotation as soon as the schedule allows. If the student fails the rotation at the second clinical affiliate, the student will be dismissed from the program and will not be allowed to reapply to the program.

Dismissal Any conduct violation, as delineated in the MLT Policy & Procedure Handbook, “Unprofessional Behavior of a Student,” such as cheating, stealing, etc, either in the academic or clinical setting, will result in dismissal.

A student will be dismissed from the program when he/she: 1) Fails to attain a "C" (75 %) in a core didactic course (lab or lecture) or a “passing” in a second

clinical education discipline rotation. 2) Fails to meet the program course's pre-requisites.3) Removes (steals) any laboratory equipment or supplies from New River CTC or clinical facility.

A student who fails to achieve/attain a 75 % (C), according to the above terms, will receive an “F” in the course and will subsequently be dismissed from the program.

Withdrawal/Dismissal Involving Didactic Coursework: Students may apply to re-enter the Program one time after dismissal/withdrawal from the program (involving didactic program courses), following the re-entry procedure outlined below. The student will be responsible for any financial costs incurred for the repeating these courses.

If the student originally failed the didactic course (lecture or lab component), the student must reapply to the program, and retake all courses in the program.

If a student fails a (second) core course after being admitted into the program a 2nd time, he/she will be dismissed from the program, without the opportunity to re-enter.

Students re-admitted into the program have only one opportunity to reinstate and complete the program. Any subsequent core course failures will result in dismissal from the program, and the student will not be accepted for re-entry into the program. For students who have been re-admitted into the program, subsequent re-admissions for any personal/medical leaves will be considered on an individual basis.

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Re-Entry Procedure: To be considered for re-entry, a student must:

1. Submit a written request to the program director within 3 months of withdrawal or dismissal,stating the Term and Year in which he/she wishes to return. The student will have to complete a new application.

2. Meet current program entrance requirements.3. Meet program curriculum requirements for the academic year in which he/she is re-instated.4. Follow the program policies and procedures in that are in place the year of reinstatement.

Continuing students will be given priority over re-entering students to ensure adequate spacein the class.

Withdrawal/Dismissal involving clinical/internship discipline coursework: The practicum course for the MLT program consists of multiple disciplines.

If one discipline in MLT Practicum Course is failed, the student will receive a grade of “I” and have one opportunity to repeat and successfully complete the failed discipline at a different affiliate site, to be completed by the end of the following fall term.

If two disciplines are failed in either the same or subsequent term in the MLT Practicum/Clinical course, the student will receive an “F” for those failed disciplines and Practicum course. The student will not be allowed to continue in the program. The student will not be allowed to apply for re-admission into the program.

Voluntary/Temporary Withdrawals: The option to withdraw at New River CTC ends one (1) month prior to the end of any term. Please also refer to the New River CTC Student Handbook for withdrawal policies and procedures. The student will be given a “W” for the course(s). Students are expected to consult the Program Director to complete the process.

Students in good standing may voluntarily and temporarily withdraw from a program. The student must initiate the process, and begin the process with the Program Director who has the forms. The student will then need to re-apply to the program to continue. Refer to previous Re-Entry Policy and procedures.

Leave of Absence Leave of Absences (such as for funerals or maternity) will be handled on an individual basis. These will be at the discretion of the Program Director, and must be approved prior. If it involves clinical experiences, then the Clinical Coordinator must be involved as well in order to coordinate details with the clinical sites.

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MEDICAL LABORATORY TECHNICIAN PROGRAM

PROGRAM PHILOSOPHY The philosophy of the Medical Laboratory Technician program at New River Community and Technical College is to ensure that students are exposed to unique and dynamic experiences in order to develop entry level MLT practitioners that have acquired a body of knowledge and skills.

The Program is based on the altruistic and compassionate values shared by the Medical Laboratory profession and New River Community and Technical College which acknowledge the significance of human differences and promote respect for the dignity of the individual.

PROGRAM GOALS The overall goal of the program is to prepare graduates who are knowledgeable and respected clinical laboratory technicians, and who are lifelong learners with the potential for progression to clinical laboratory scientists and leadership as supervisors, manager, and educators. The primary goals of the program are:

• to train competent and reliable medical laboratory technicians for successful employment• to provide well-trained medical laboratory technicians to meet hospital and community

needs• to provide educational programs and experiences in all sections of the clinical laboratory• to provide sufficient didactic and technical information for the student to understand

analytical processes, interpret analytical results and appreciate the clinical significance ofanalyses performed in a modern clinical laboratory

• to develop in the student the technical laboratory skills to perform manual and automatedprocedures with confidence and reliability

• to provide instruction in laboratory instrumentation, quality control and quality assurance,laboratory management, research and educational methodology

• to provide a stimulating atmosphere to encourage continuing education of clinical laboratorytechnicians

• to have the student achieve passing scores on external certification and licensureexaminations

• to develop flexibility to adapt to changing needs, new procedures and new topics in clinicallaboratory science practice

• to maintain the standards of the national accrediting agency for clinical laboratory sciences• to instill in the student an awareness of themselves as professionals and an awareness of

their responsibility to the growth of their profession

PROGRAM SUPPORTING GOALS • to obtain the appropriate resources for the MLT program to support retention of qualified

faculty and staff; operating and capital expenses (including but not limited to equipment,supplies, and technology for instructional purposes); program space; library and learningresources; student services; and technical support

• to maintain appropriate admissions processes, criteria, and program pre-requisites tofacilitate successful program completion

• to align program enrollment with available resources• to maintain qualified adjunct and supporting faculty• to ensure qualified clinical education affiliate faculty are supervising students and provide

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development activities for clinical education affiliate faculty as resources allow PROGRAM ENTRY LEVEL COMPETENCIES

The main objective of MLT internship education and training is to prepare the student to become a licensed, certified professional medical laboratory technician. At the end of the internship at New River CTC and the clinical affiliated laboratories, the student will be able to:

• perform emergency, routine and complex special analyses in the disciplines of hematology, hemostasis, urinalysis, parasitology, mycology, virology, clinical chemistry, serology, immunohematology, and microbiology honestly and without bias

• understand and interpret the clinical significance of laboratory assays and test results • assume responsibility and accountability for accurate and precise results without

unnecessary delay by demonstrating proper patient identification, careful handling of specimens, reliable assay performance and accurate reporting of test results

• correlate test results with disease states so as to recognize expected patterns and solve discrepancies

• understand, operate and troubleshoot a variety of automated laboratory instruments including personal computers and laboratory information systems

• design and implement systems of quality control, maintenance records, equipment maintenance and professional communications

• describe the functions of laboratory management and how they are carried out • understand and apply principles of educational methodology • research, develop and select clinical assays and laboratory instruments based on laboratory

needs, space and budget • behave professionally at all times by:

o punctually attending work on each scheduled day o showing initiative and actively participating in learning and work opportunities o assuming responsibility and accountability for his/her own work decisions o demonstrating honesty and integrity in performing work and dealing with patients,

coworkers and other personnel o dressing in accordance with laboratory and hospital standards and observing good

personal hygiene o interacting cooperatively and respectfully with patients, instructors, fellow students

and other personnel o maintaining high morale by accepting constructive criticism, concentrating on

materials presented, registering complaints with proper sources, assisting in creating a pleasant environment in which to learn and work, and sharing in team responsibilities

o providing leadership in educating other health personnel and the community • participate in continuing education and professional growth

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Program Technical Core Requirements

Students must be accepted into program before starting MLTN courses.

Total minimum units for the associate degree 71

Program Pre-Requisite Courses Must be taken prior to applying to the program

NRCTC Course Number Title Units ENGL 101 Composition 3

BIOL 231/233L Human Anatomy and Physiology I with Lab 4

CHEM 101/103L General Chemistry with Lab 4 MATH 109 Algebra (or higher) 3

MDST 120/121L Phlebotomy with Lab 4

Program General Education Courses

* Can be completed anytime prior to or during the program NRCTC Course Number Title Units

ENGL 102 * Research 3 COSC 101 * or

BUSN 130 * Microsoft Office Applications or

Microsoft Word and PowerPoint 3

COMM 208 * or BUSN 232 *

Fundamentals of Public Speaking or Business and Proffessional Communication 3

*** Can be completed any time prior to or during the 1st semester of the program

BIOL 232/234L *** Human Anatomy and Physiology II with Lab 4

CHEM 102/104L *** General Chemistry with Lab 4

First Semester - Fall

Course Number Title Units

MTLN 220/222L Hematology & Hemostasis with Laboratory 5 MLTN 226/228L Urinalysis & Body Fluids with Laboratory 2

Second Semester - Spring Course Number Title Units

MLTN 230/232L Immunology & Immunohematology with Laboratory 5 MLTN 233/235L Clinical Chemistry & Lab Math with Laboratory 5 MLTN 236/238L Clinical Microbiology with Laboratory 5

Third Semester - Summer

Course Number Title Units

MLTN 240 MLT Practicum 12 MLTN 245 MLT Capstone Seminar 2

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REQUIRED TEXTBOOKS FOR MLT PROGRAM Revised 6-2017

Indented books were purchased for a previous class and are to be used in this class. The following is/are recommended references for all courses:

1. http://www.labtestsonline.org 2. www.webmd.com 3. www.arup.utah.edu/MLS/

Hematology & Coagulation

Rodak’s Hematology, Clinical Principles and Applications, by E. Keohane, L. Smith & J. Walenga, Elsevier publ, 5th ed, 2016 ISBN # 9780323239066 Clinical Hematology Atlas, B. Rodak & J. Carr, Elsevier publ, 5th ed, 2017 ISBN # 9780323322492 Mathematics for the Clinical Laboratory, by L. Doucette, Elsevier publ, 3rd ed, 2016 ISBN # 9780323339964 Clinical Chemistry

Clinical Laboratory Chemistry, by R. Sunheimer & L. Graves, Pearson publ, 2011 ISBN # 9780131721712 Mathematics for the Clinical Laboratory, by L. Doucette, Elsevier publ, 3rd ed, 2016 ISBN # 9780323339964 Immunology, Serology & Immunohematology

Immunology & Serology in Laboratory Medicine, by Mary L. Turgeon, Mosby Elsevier publ, 5th ed, 2014. ISBN # 9780323085182 Basic & Applied Concepts of Blood Banking & Transfusion Practices, by K. Blaney & P. Howard, Mosby Elsevier publ, 4th ed, 2017. ISBN # 9780323430623 Mathematics for the Clinical Laboratory, by L. Doucette, Elsevier publ, 3rd ed, 2016 ISBN # 9780323339964 Urinalysis & Body Fluids

Graff’s Textbook of Urinalysis & Body Fluids, by L. Mundt & K. Shanahan, Wolters Kluwer publ, 3rd ed, 2016 ISBN # 9781496320162

http://www.labtestsonline.org/

http://www.webmd.com/

http://www.arup.utah.edu/MLS/

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Microbiology Introduction to Diagnostic Microbiology, by M. Delost, Jones & Bartlett Learning publ, 2015. ISBN # 9781284032314

A Photographic Atlas for the Microbiology Laboratory, by M. Leboffe & B. Pierce, Morton Publishing Company, 2011. ISBN # 9780895828729

Clinical Parasitology: A Practical Approach, by Elizabeth Zeibig, W.B. Saunders (Elsevier) publ, 2nd ed, 2012 ISBN # 9781416060444 (Elsevier)

CDC-CPDx Parasitology CD-Rom (free from CDC)

Clinical Seminar Review (suggested) Success! In Clinical Lab Science, by A. Ciulla, D. Lehman, Pearson publ, 2010 ISBN # 9780135126486

Board of Certification Study Guide for CLS, ASCP Press, 2009 ISBN # 9780891895879

Clinical Laboratory Science Review, a Bottom-Line Approach, by P. Jarreau, LSUMC Foundation, 4th ed, 2011

MediaLab Exam Simulator (LabCE), www.medialab.com

Phlebotomy Phlebotomy Essentials, by R. McCall & C. Tankersley, Wolters Kluwer publ, 6th ed, 2016 ISBN Package # 9781496320162 Text, workbook and Prep-U package.

http://www.medialab.com/

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STUDENT PRE-REQUISITES FOR CLINICAL EDUCATION The following forms are required of all students in the MLT program:

HIPAA (Confidentiality) Blood Borne Pathogens MLT Program Policies & Procedure Agreement Social Policy Agreement FERPA (general & financial) AAR Student Information Advisor & Curriculum Emergency Contact Photo Release Essential Requirements for MLT students Consent for Procedures as Human Subjects for Education

Criminal Background Checks

This must be completed prior to any clinical experiences. Reports generated from criminal and abuse background checks will be evaluated by a single point of contact to determine professional experience eligibility. The cost of the background checks will be the responsibility of the student. The student will contact CastleBranch, Inc. directly to initiate this process. Health Requirements

Student is to provide Immunizations records. Drug screening is required upon entry into the MLT Program and may be required by individual clinical sites as warranted. Successful Completion of Didactic Courses

All program core course and support courses must be completed with a minimum of a “C”. Clinical Education/Practicum Courses

Student must be available for 5 days/week for the number of weeks required for all Clinical Education/Practicum Disciplines. Twelve (12) hour shifts may be available at various clinical sites. General Rotation Schedule

Chemistry/Urinalysis 4 weeks Hematology/Hemostasis 4 weeks Microbiology 4 weeks Immunology/Immunohematology 4 weeks New River CTC Student Badge

A New River CTC Student Badge (with photo) will be needed for the clinical affiliate, and required by the college to be worn at all times. Hospital Identification Card/Badge

A Hospital badge identifying the student by name and as a MLT student may be provided by the hospital prior to the beginning of the clinical education rotation. The badge is to be worn on the front of the lab coat.

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PRACTICUM/INTERNSHIP PRE-REQUISITE CHECKLIST If any of the following items are not met by the deadlines or first day of internship, you will immediately be pulled from your internship site until such time as they are completed. You will make up the time missed at the end of your scheduled rotation, at the discretion of the site.

The following must be complete and in your files prior to any internship/practicum:

Health requirements: • Immunization Records• TB skin test (2 step PPD)• Hepatitis B series vaccine• Copy of Health Insurance/Coverage• Influenza vaccine (if season) or waiver• Drug Screen

College requirements: • Completion of all core/support courses with a minimum of a “C”• Enrollment/registration in Practicum/Clinical and Capstone/Survey Course• HIPAA/Confidentiality form• Bloodborne Pathogens form• Criminal Background Check

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DRESS CODE AND PERSONAL APPEARANCE

Although fashion trends in dress, accessories, hair color and hair styles are part of a student’s personal life, these same trends can be seen as less than professional by the public and detract from their perceptions of the student’s capability to practice safely. Therefore, MLT students’ dress and appearance for clinical experience and practicum must be professional.

Grooming and dress code policies are based on the following general standards:

Client Safety: • Patients are to be protected from tissue damage from fingernails, jewelry, etc.• Infection control - patients are to be protected from known sources of infection, actual or

potential

Professional Demeanor: • MLT students are expected to represent themselves, New River CTC, and the clinical

laboratory in a professional manner.

Compliance: • New River CTC has an obligation to comply with the dress code standards of any clinical

affiliates or agencies.

The following is not meant to be all-inclusive and any questions or concerns are to be brought to the Program Director. Agency and/or clinical affiliate policy supersedes school policy if the requirements are more stringent. Student is expected to abide by the more stringent requirements.

1. Personal hygiene - since it is necessary to work very closely with patients, body odors and badbreath can be very unpleasant, especially to sick people, and may on occasion be annoying tofellow workers. It is your responsibility to perform the necessary cleansing of the body and utilizethe required toiletries and personal hygiene aids.

2. Odors - of any kind may be offensive to patients or may make them sick. Products with strongodors (i.e. perfumes, tobacco, etc) must be avoided when in uniform or while working in theclinical site.

3. Hair - should be well-groomed, clean and neat. Long hair must be off the shoulders - tied back orup on head. There are to be no radical hair styles or colors.

4. Facial hair (men) - must be clean, trimmed, and worn in such a manner that it will not obstructactivities.

5. Make-up - is to be natural/subtle, in moderation.

6. Nails - are to be well-manicured without polish, and no longer than ¼ inch beyond end of fingers.Any form of artificial nails is prohibited. This pertains to issues of infection control and safety.

7. Earrings - Only 2 pair of earrings per ear are allowed (regardless of how many holes are present).For pierced ears, earrings should be small, and simple (no long dangly ones). This is for the safetyand protection of the student.No other facial or body piercing must be visible. No gauges may be worn.

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8. Tongue rings or posts - may NOT be worn as they often prevent the student from speaking clearlyor professionally. More importantly, this has to do with health and safety issues. The only visiblebody piercing that is acceptable is in the ear lobes.

9. Tattoos - There should be no visible tattoos. If on a visible area, they must covered up.

10. Shoes - are to be leather of sturdy construction, with low heels, rubber soles, free from holes ofany kind, and clean at all times. No sandals/canvas/tennis shoes, work boots, clogs, etc, are to beworn.

11. Dress Code - The Dress Code is to be observed with strict attention at the clinical site. These areto be clean (pressed if necessary). Skirts should not be worn (unless for religious reasons andmust be at least knee length). Tops must be long enough to cover hips.NO: jeans/denim attire, work boots, etc, are to be worn.NO: T-shirts, shirts with printed messages, shorts, or jeans.

Lab coats - Hospital labs will provide moisture barrier lab coats to wear while in the lab. These must be left in the lab when leaving for lunch or break.

Students will be suspended from the clinical practicum area for continued failure to adhere to grooming and dress expectations.

The care you take on your grooming and appearance reflects your attitude towards others. Lack of concern in these matters reflects a lack of concern for patient, co-workers, and friends.

Most of these guidelines correlate with those of the various affiliates. If there is a discrepancy, you are to follow the stricter guidelines.

Remember, you are a professional, so dress and act like one.

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ASCP BOC PROFESSIONAL CERTIFICATION APPLICATION INFORMATION

You, the student, are responsible for sending your transcript and any other information to ASCP. Neither New River CTC nor the MLT Program sends anything to ASCP.

Go to the ASCP website to complete the Board of Certification application process.

www.ascp.org Click on “Board of Certification” Click on “Get Certified” on the right Click on the individual tabs that you need:

Introduction Eligibility Documentation Applying App status Scheduling Studying Exam Day Results & Certificate US Military

Instructions there are very complete and easy to follow.

New River CTC Program Exam to be taken Route # NAACLS school

code needed?* Program Director

MLT Medical Laboratory Technician 1 Yes No

*Applicants do not need the school code number. During the application process, a drop-down menuwith a list of all the program names will appear. Just select “New River Community & Technical College”.

Only on-line applications will be accepted. Payment will be made with credit card.

Upon receiving all the required information, ASCP will contact the Program Director to verify the applicant’s completion of the NAACLS Accredited program and the awarding of the degree/diploma.

If you have any questions, you may call ASCP BOC, 1-800-267-2727, option 2, 1.

These tabs are presented in a logical order, left- to-right, for information that you will need – in the order that you will need it – for the complete application process, from beginning to end.

http://www.ascp.org/

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CLINICAL EDUCATION EXPECTATIONS

Students will receive clinical experience which will include:

1. Maximum supervision and instruction by the Clinical Education Supervisor or a Clinical Instructorat all times.

2. Orientation to the operation of the affiliate hospital both at the general and laboratory levels, sothat he/she may blend into the functioning facility without difficulty.

3. Performance of replicate analysis of all required procedures to achieve acceptable standarddeviation of laboratory results or comparable standards of proficiency established by theProgram Official.

4. Evaluation of competence on those procedures he/she has become proficient in by achievingacceptable precision or the equivalent.

5. Evaluation of competencies in these procedures in which he/she has become proficient byacceptable performance on practical exam.

6. Reporting patient results after he/she has been evaluated as competent on a procedure with thestipulation that all such work must be countersigned by a qualified technician.

7. Rotation through each lab department to include a plan for orderly progression of studentproficiency from the simpler through the more complex competencies/skills.

8. Evaluation of clinical competency at regular intervals during the course of training primarily byeither the Clinical Education Supervisor or the appropriate Clinical Instructor, as the situationdictates.

9. Proficiency in performing venipunctures and dermal punctures as a part of clinical education.

10. Awareness of the limitations of their clinical performance.

11. Completion of Study Guide for each lab section/department.

12. Graded Reports for each lab section for the clinical practice on the basis of the following:a. Clinical competenciesb. Departmental Appraisal of Intern Performancec. Practical examinationsd. Quizzes (where given)e. New River CTC standardized written final exams at the end of the specific clinical

section/department rotation; proctored by clinical site or Clinical Coordinator and gradedby Clinical Coordinator

f. Final grade for each section will be compiled by the Clinical Coordinator

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New River Community & Technical College

MLT CLINICAL ROTATION SCHEDULE 2017

May 15, 2017 June 9, 2017

1. Microbiology ---------- Gloria Coleman -------- RG2. Hematology ---------- Sanjita Shrestha ------- BARH3. Blood Bank ----------- Latasha Traynham ----- GBMC4. Chemistry ------------- Elyssa Johnson ------- RG5. Microbiology ---------- Kongka Smith -------- PMC

June 12, 2017 July 7, 2017

1. Microbiology ---------- Sanjita Shrestha ------- VA2. Hematology ----------- Kongka Smith ------- VA3. Blood Bank ------------ Gloria Coleman ------- RG4. Chemistry -------------- Latasha Traynham ---- GBMC5. Microbiology ---------- Elyssa Johnson ------- RG

July 10, 2017 Aug 4, 2017 1. Microbiology --------- Latasha Traynham ------ RG2. Hematology ---------- Gloria Coleman -------- BARH3. Blood Bank ----------- Elyssa Johnson ------- RG4. Blood Bank ------------- Kongka Smith------- VA5. Chemistry ------------- Sanjita Shrestha------- VA

Aug 7, 2017 Sept 1, 2017 1. Hematology ---------- Elyssa Johnson ------- RG2. Chemistry ---------- Kongka Smith ------- VA3. Chemistry ------------- Gloria Coleman ------- BARH4. Hematology ---------- Latasha Traynham ---- GBMC5. Blood Bank ----------- Sanjita Shrestha ------ RG

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CLINICAL EDUCATION GUIDELINES RULES AND REGULATIONS

Students are expected to adhere to all rules and regulations as described by college student handbook and MLT program policy & procedure manual. The student is expected to also follow all rules and regulations of the clinical facility where they are training. Students may be dismissed for breaking any rule set by the clinical site as well as the college. Violation of program/academic/clinical policies/rules/regulations that results in dismissal from a clinical site will result in dismissal from the program with no option for internship at another site. More specific rules are found in the MLT Program Policy & Procedure Manual. ATTENDANCE

Consistent attendance and punctuality are essential for success in Clinical Education. Students are expected to be present each day of clinical practice. An attendance log sheet will be used for each program’s discipline. In any case of absence or tardiness the student is required to telephone the departmental clinical instructor or his/her designee at least 1 hour prior to the scheduled starting time. Students must also contact the affiliate CES and New River CTC Clinical Coordinator to notify of absence or tardy. As with any employee, the student will need backup plans for sick children, as the student is still expected to show up for clinicals as would be expected of any employee. Students with excessive tardies or leave earlies or absences are in jeopardy of being placed on probation and/or being dismissed from clinical practice. NOTE: The CES at the affiliate site will immediately notify the Clinical Coordinator upon the first infraction of any part of this attendance policy, either tardies or absences.

1. An attendance log sheet will be kept on each student for each discipline. All students must sign-in and sign out, with all times verified by the teaching/supervising technologist/technician and comments may be added. The site will contact the MLT Program’s Clinical Coordinator of any deviation from this policy.

2. All absences must be made up at a time and manner convenient for the affiliate site. Options might include so many hours added on to subsequent days, or days during school breaks (eg, spring or summer breaks).

3. Students are to work the shift that is regularly scheduled by the affiliate site for that department/discipline. No adjustments are allowed.

4. A tardy is defined as anything > 5 minutes after the scheduled starting time. 5. Students with excessive tardies/leave earlies or absences are in jeopardy of being placed on

probation and/or being dismissed from clinical practice. Anything > 3 tardies or leave earlies will result in dismissal from the program.

6. Students are allowed 2 absences, maximum, per term – 1 excused (> 24 hr notice) and 1 unexcused (< 24 hr or same morning notice). Anything more than 2 absences will require a “Leave of Absence” (see below), and he/she will be placed on probation. Anything more than 4 absences and the student will be dismissed from the program.*

7. First ‘no call’ results in probation. Second ‘no call’ results in dismissal from the program. 8. *If the student is sick longer than 2 days, arrangements for a “Leave of Absence” must be made

with the Program Director, and a Doctor’s excuse is needed for approval of an extended leave.

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Leave of Absence:

Any “Leave of Absence” for extended absences (more than 3 days), such as: • Funeral of an immediate family member • Extended illness of 3 or more days

must also be arranged and approved with the Program Director. Special arrangements will need to be made for time blocks to make up this many days with the affiliate, which may then occur during school breaks or over the summer term.

NOTE: Vacations do not qualify for “Leave of Absence”. Vacations are only allowed during regularly scheduled school breaks, and then only if there is no time to be made up with the clinical sites. Make-up Time:

All time lost due to absences must be made-up at a time which is convenient for the clinical site. Students are responsible for making arrangements with the clinical instructor, and also for informing the clinical education supervisor of the arranged details prior to make-up sessions. Weekends are not expected to be utilized for make-up time, except with special permission of Program Director and clinical site. Leave of Absence – Clinical

Students who are encumbered with debilitating problems which will necessitate an absence in excess of five days may apply for a leave of absence (through the Program Director) from clinical practice. Each request is considered individually. Many factors are considered in granting a leave. Among these are: reasons for the request, the length of absence, the disruptiveness to clinical practice, the probability of make-up time, and the availability of clinical faculty as well as facilities and equipment. Students who fail to return after the approved leave period are dismissed from clinical practice and, therefore, the program. This time is expected to be made up at a time that is convenient for the clinical affiliate. Students are responsible for making arrangements with the clinical instructor, and also for informing the clinical education supervisor of the arranged details prior to make-up sessions. Illnesses

Any illnesses taking longer than 3 consecutive days will require a physician's slip to return to clinicals. The original needs to be given to program officials and a copy to the clinical affiliate. The missed time will need to be made up at a time convenient for the affiliate. MISCELLANEOUS

Confidential Information Information obtained during clinical experience which pertains to patients, physicians, or hospital business is CONFIDENTIAL. Confidential information must not be disclosed to unauthorized individuals, including family and friends. Violation of this will result in immediate dismissal from the program. Most, if not all, affiliates will require a signed confidentiality form. Travel Students are totally responsible for travel to and from the affiliate site. Liability Insurance The College provides liability insurance coverage for all clinical practice students.

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Permission to Leave Training Area No student is permitted to leave his/her department for any reason outside of blood drawing without first obtaining permission from the clinical instructor. Telephones Hospital telephones are not to be utilized for personal calls. The use of cell phones on the premises or in the buildings of any affiliate is strictly prohibited. Refer to Section 1 of CEG for Electronic Device Policy. Visitors Students are not permitted to have visitors at affiliation training sites. Interpersonal Relationships Productive interpersonal relationships and communication are prerequisites to successfully completing clinical training. The CLS student is expected to establish and maintain such relationships, with the following people:

Clinical Coordinator Any grievances and matters that do not relate directly to the student's hospital clinical training are to be discussed with the MLT Program clinical coordinator, e.g. personal problems, complaints, etc.

Clinical Education Supervisor This individual is responsible for the overall quality and operation of the clinical training program. Students should relay problems regarding their clinical instructions and training to the education supervisor. The supervisor, as well as clinical instructors, may require written assignments and examinations.

Clinical Instructors These are the bench instructors that teach the student the various analytical techniques. When learning a procedure, it is up to the student to review and study the principles of the test in a textbook, so that he/she can ask questions and discuss the procedure with the clinical instructor. Active interaction between the student and the designated instructor is crucial to the evaluation of the student's successful learning.

Pathologist The pathologist is available for any guidance or assistance that the education supervisor cannot provide.

Staff Technologists, Technicians, and Hospital Personnel All technologists and technicians should be given the same respect accorded to instructional faculty. Students should treat all persons in allied health fields with the respect and courtesy due by their knowledge, skills, training and position.

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CLINICAL EDUCATION SUPERVISOR (CES) RESPONSIBILITIES DESCRIPTION: Plans, participates, schedules, supervises, and evaluates the MLT Program’s

students in their clinical education in collaboration with the Program faculty. QUALIFICATIONS: Must be Professionally Certified. RESPONSIBILITIES:

• Coordinate, plan, and participate in initial orientation to clinical affiliate.

1. Arrange for student attendance at general hospital safety lectures/in services as deemed beneficial.

• Oversee clinical rotation schedule. • Assist student in relating theory to practice. • Maintain course profiles, student records and program records.

1. Keep accurate record of student attendance.

2. Provide necessary forms to clinical instructors, i.e., department checklists, student evaluation forms, etc.

• Prepare mid-rotation and summary evaluation and report grades to Internship Coordinator as

designated.

1. Summarize all student's Performance Evaluations.

2. Verify the types of tests noted on the Department Checklists.

3. Record comments and date. Initial and forward the records to Clinical Coordinator. Make copies of all forms for own files. You must maintain duplicate copies of all forms for each student.

• Supervise designated instructors. • Inform the College’s Clinical Coordinator and/or Program Director prior to the initiation of any

disciplinary actions. Maintain complete documentation of all incidents in student’s file, and make copies (or summarize) for the college.

• Provide clinical instructors with departmental instructor evaluations at the completion of the

clinical rotation. • Compile inventory of laboratory equipment, library resources, laboratory statistics, and

personnel records when required for NAACLS accreditation/approval. • Seek in-service and continuing education activities to maintain professional growth. • Communicate pertinent information to the Clinical Coordinator, laboratory administration and

clinical instructors. • Provide Clinical Instructors with a Description of their responsibilities to the students in the

Programs.

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• Confer with student and Clinical Coordinator concerning student performance and progress.

1. Suggest additional work for improvement of deficiencies or new material if the student ismastering the basic work rapidly.

2. Follow up on suggestions or comments of Clinical Instructors at student sessions (minimum -weekly).

3. Evaluate each student's clinical progress through:

a. observation and discussion with designated clinical instructors.b. completion of Student Progress Reports at prescribed intervals.c. review of mid and final rotation Clinical Appraisal of Student Professional Behavior

Evaluations in the department.d. review of departmental practical examination results.e. review of departmental checklists.f. review of departmental study questions.

• Provide input into program development through attendance and participation in the semi-annualAdvisory Committee meeting.

• On last day of each rotation:

1. Review all forms with the student.2. Obtain student’s signature on all forms.3. Make sure your signature is on all forms.4. Send all forms to MLT Program Clinical Coordinator.

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CLINICAL INSTRUCTOR RESPONSIBILITIES Objectives:

• Guides, supervises, instructs and evaluates the MLT students toward entry-level professional competency.

• Communicates clearly and provides feedback. • Offers accurate information and/or refers the intern to resources. • Corrects performance problems in a timely and respectful manner. • Prepares and organizes the training event, as applicable.

Responsibilities: • Submit resume/CV to Clinical Education Supervisor and maintain current continuing education

file. Send previous 3 years of CEUs to Program Director when requested (for accreditation process).

• Confer with student and Clinical Education Supervisor (CES) concerning student performance and instructional process.

• Instruct, supervise and assist students in the development of clinical competencies, attitudes, and behaviors required by the syllabus (CEG) and the profession.

1. Be available as an information source for student questions. 2. Suggest reading assignments that will complement practical experience. 3. Orient students to their departments. (Tests done, instruments used, location of

necessary materials for test determination, procedure manual, etc.) 4. Maintain student departmental clinical rotation as established. Outline general approach

for learning the required procedures and techniques and expectations. 5. Supervise student work. 6. Assign a replacement for themselves when necessary. 7. Administer any quizzes and practical exams given in the department.

• Evaluate student progress of clinical competency and appraisal of intern performance during each discipline rotation.

• Assist Clinical Education Supervisor (CES) with student record keeping by validating daily worksheets, recording student grades, and reporting attendance.

1. Complete Appraisal of Intern Performances on student. 2. Review student work daily, seeing that all evaluation results are recorded. 3. Enforce policy of initialing checklists and countersigning all student work. 4. Daily review and sign student checklists.

• Provide lab results for all student tests where statistical Quality Control can be performed, so that students may perform duplicate standard deviation.

• Provide input into program development through attendance and participation in the semi-annual Advisory Committee meeting.

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STUDENT RESPONSIBILITIES Objectives:

• Provide the CES with your emergency contact information (form on next page). • Answer all appropriate study questions • Have various resources available to study for national cert exam during down time • Bring Clinical Education Guide daily and document regularly on Discipline Performance

Checklists. • Be punctual (if late/absent, you must call CI, CES, and College Clinical Coordinator). • Contact CES for any excused absences. • Explain the procedures and processes taught during clinical training • Perform the procedures and required safety precautions correctly • Adhere to all hospital and laboratory policies

Training Methods:

• Enter into each clinical day fully prepared by completing any pre-required reading or review (i.e. procedures, package inserts, references, manuals, etc)

• Ask questions of your training supervisor or education coordinator when you feel you need clarification; being mindful of the workload demands. Keep a journal (pocket notebook) to provide a source to revisit some questions you may have

• Fulfill items indicated in each department’s training checklist as instruction is provided. If a test is “not performed,” interns are still responsible for the content as certification exams may include the topic. In these circumstances, research the test procedure and review the didactic material

• Obtain the clinical instructor’s signature on training checklist. • Perform standard operating procedures as instructed on practice material. • Investigate laboratory results and correlate with disease manifestations. • Do self-assessments and research.

Materials & Resources for Training Include:

• Clinical Education Guide includes departmental/discipline objectives, schedule training checklists. Refer to MLT Program Policies & Procedures manual.

• Utilize MLT textbooks, procedure manuals, package inserts, demonstrations, practice materials, Medtraining.org, MediaLabInc.net, Lab CE (on MediaLabInc.net).

• Certification Exam content guidelines for ASCP certification. • ASCLS MLT Body of Knowledge and Entry Level Curriculum.

Assessments and Evaluations:

To demonstrate what you have learned, you are required to:

• Perform procedures, under observation; perform unknowns, if applicable. • Complete and pass written final exams with 75% or above. • Answer any oral questions. • Obtain the trainer(s) sign off on training checklists with affective evaluation (end of each

checklist). • Provide your trainer(s) with the “Appraisal of Intern Performance” form. • Complete the clinical training/trainer evaluations for each discipline.

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Medical Laboratory Technician Program APPRAISAL of Intern Performances (clinical training)

NAME: _____________________________________________ DATE: ____________________

ROTATION: _____________________________ CLINICAL SITE: ________________________________ RATINGS: 3 = Exceeds expectations 2 = Competent 1 = Unsatisfactory

Knowledge 3 2 1

Demonstrates a clear understanding of the material by attaining a grade of 75% or better on written exam

Comprehends and correlates lecture and lab material so as to recognize abnormal results, associate test results with possible disease states, and determine a course of action

Understands test principals, equipment, and methods; is well prepared for the bench; is able to answer most questions

Technical Skills 3 2 1

Demonstrates the ability to accurately and precisely perform and interpret laboratory tests/procedures and their diagnostic value, in a timely manner

Demonstrates proper care and use of instruments

Records test results neatly and correctly on report forms or in the computer

Demonstrates an awareness of safety procedures and biohazard handling of specimens

Properly performs QC procedures and takes appropriate corrective action

Leaves work area clean, neat and disinfected

Demonstrates very good manuals skill and dexterity

Applies critical thinking/problem solving skills

Communication 3 2 1

Demonstrates the ability to carefully, comprehend instructions and follow directions

Demonstrates the ability to formulate thoughts, speak clearly and relay information

Demonstrates the ability to answer questions in a written format

Planning/Organization 3 2 1

Takes responsibility for knowing individual daily workload requirement, planning to execute it, and efficiently achieving it so that all assigned procedures are completed.

Completes work quickly and does more than is required

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Relationships with Others 3 2 1

Works with instructors in a courteous and respectful manner

Acts as a cooperative team player when in a group

Displays professional conduct with a business-like demeanor and a positive attitude while performing work and dealing with people inside and outside the laboratory

Asks pertinent questions, is an active learner & accepts constructive criticism

Attendance and Punctuality 3 2 1

Attends work each day of the clinical phase of training

Reports to work without tardiness

If absent, reports to the Education Coordinator and assumes responsibility to make up time and missed assignments

Behavioral Factors 3 2 1

Maintains good personal hygiene and a professional appearance at all times

Exhibits self-confidence by demonstrating the ability and the initiative to work without constant supervision, while remaining conscious or personal limitations

Comments: (please provide indicators for less than “competent” ratings)

__________________________________________________ _____________________________ Ed. Coordinator/Instructor’s Signature Date

__________________________________________________ _____________________________ Student’s Signature Date

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STUDENT EVALUATION OF CLINICAL SITE PLEASE SUBMIT THIS FORM TO MLT PROGRAM DIRECTOR

Site: ___________________________________________________________________ Dates: _________________________________to ______________________________ Department: _____________________________________________________________ Instructor(s):_____________________________________________________________

This form will remain confidential and have no effect on your final grade.

Please rate the clinical rotation from 1 to 5 according to the following scale: 1-unacceptable 2-poor 3-average 4-good 5-excellent

Clinical Facility: 1. Quality of equipment 1 2 3 4 5 2. Quantity of equipment 1 2 3 4 5 3. Number of procedures

you performed 1 2 3 4 5 4. Variety of procedures

you performed 1 2 3 4 5

Personnel: 1. Ability to teach 1 2 3 4 5 2. Knowledge of subject 1 2 3 4 5 3. Willingness to spend time

with student 1 2 3 4 5 4. Professional attitude 1 2 3 4 5 5. Sets good example 1 2 3 4 5 6. Accepts students 1 2 3 4 5

Would you like to be employed in this laboratory? If not, please give explanation. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Did you feel you were prepared for this clinical rotation? Please be specific. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Please mention any of the faculty who you would like to commend _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

New River CTC MLT Program

Phlebotomy/Specimen Processing Performance Checklist (5/2017)

Name: _________________________________________

Functional Area/Competency Criteria Critical Control Points (CCP)

Competency and Performance Evaluation (Evaluator)

Post Performance (Student)

Evaluation Code

(Check all that apply)

Rating Score (Circle One)

Self Assessment (Circle One)

Page 1 of 5

Student must be proficient in the following procedures: Technical Skills

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent

3 = Exceeds Expectations

\

1 = I do not know how to do this or do not understand concept

2 = I need some practice with supervision or need

to review concept

3 = I can perform this task independently

or thoroughly understand concept

1. Summarize to the satisfaction of the instructor, the importance of proper patientidentification; describe what information is verified, how to handlediscrepancies, and what to do if a patient’s ID band is missing.

1 2 3 1 2 3

2. Utilizes proper techniques and equipment in blood collection with syringe orvacutainer system; and/or drawing capillary blood samples from adults andchildren

1 2 3 1 2 3

3. Selects the appropriate collection tubes noting the correct additives. 1 2 3 1 2 3 4. After performing phlebotomy procedure, labels specimen tubes correctly,

observing any special handling needs and appropriately disposes ofbiohazardous waste and general waste.

1 2 3 1 2 3

5. Explain, to the satisfaction of the trainer, the principle behind the establishedorder of draw for the evacuated tube system.

1 2 3 1 2 3

6. Perform at least two practices a phlebotomist should do to reduce the risk ofexposure to bloodborne pathogens. (i.e. hand washing, PPE, blood culture skinprep, other).

1 2 3 1 2 3

7. Explain, to the satisfaction of the trainer, complications associated with bloodcollection and how each may affect the patient or the integrity of the specimenand subsequent results.

1 2 3 1 2 3

8. List the general criteria for suitability of a specimen for analysis, and reasons 1 2 3 1 2 3

30 | Page



Name: _________________________________________




Evaluation Code




Page 2 of 5

for specimen rejection or recollection (hematology, coagulation, blood bank) 9. Describe substances that can interfere in clinical analysis of blood constituents

and ways in which the phlebotomist can help to avoid these occurrences. 1 2 3 1 2 3

10. Describe sign and symptoms of physical problems with the patient that mayoccur during blood collection.

1 2 3 1 2 3

11. Demonstrate understanding of quality assurance and quality control inphlebotomy and specimen processing

1 2 3 1 2 3

31 | Page



Name: _________________________________________






Page 3 of 5

1. Punctuality and attendance: (3) = Never late or absent, never abuses break time (2) = Late or absent 1-2 times, attempts to arrange for and completes makeup time in a timely fashion, extends break time 1-2 times. (1) = Late or absent more than 2 times, unable to complete makeup time in a timely fashion, or frequently abuses break time.

1 – Unsatisfactory 2 – Competent 3 – Exceed Expectations

1 – Fails Standards 2 – Meets Standards 3 – Exceeds Standards

2. Accuracy – obtains reliable results; recognizes results as normal/abnormal/questionable; recognizes instrument, clerical andtechnical errors and takes corrective action.



3. Initiative – Is willing and able to assume responsibility; seeks opportunities to learn; utilizes time to its maximum; can bedepended on to follow through



4. Productivity – Completes assignments within an acceptable amount of time; performs tasks under pressure without loss ofaccuracy.



5. Ability to learn – Performs tasks after minimal instruction; transfers information from lecture to bench work.1 – Unsatisfactory 2 – Competent 3 – Exceed Expectations


6. Thoroughness – Performs tasks to completion; transcribes or enters results accurately and legibly; demonstrates ability tomaintain equipment; follows safety procedures.



7. Cooperation and ability to accept criticism – Cooperates with others; accepts and conforms to rules; accepts constructivecriticism and tries to correct deficiencies.



8. Communication – Gives verbal and written information clearly, accurately and courteously.1 – Unsatisfactory 2 – Competent 3 – Exceed Expectations


9. Organization – Plans and completes work in a manner that effectively utilizes available resources and time.1 – Unsatisfactory 2 – Competent 3 – Exceed Expectations


10. Safety – Observes laboratory safety procedures to include proper use of personal protective equipment.1 – Unsatisfactory 2 – Competent 3 – Exceed Expectations


32 | Page



Name: _________________________________________






Page 4 of 5

Grading Criteria:

1= UNSATISFACTORY Fails to demonstrate acceptable performance for many key elements. 2= COMPETENT Demonstrates acceptable performance in all key elements with direct supervision 3= EXCEEDS EXPECTATIONS Meets all key elements, exceeds acceptable performance; capable of working

independently

1) The student’s laboratory competency evaluation should be completed by at least one clinical faculty trainer who workedwith the student.

2) Once completed the performance checklist will NOT be given to the student. The performance checklist will be submittedto the clinical coordinator or faculty member assigned to the clinical practicum.

3) * Research paper at a minimum is a one-page report (See template below attach to the checklist). Student will research the topic if not performed, observed or discussed at assigned clinical site.

33 | Page


Page 5 of 5

Important Notes: Any Performance Checklist block evaluated as “Unsatisfactory” requires a written remediation plan and retesting to acceptable levels prior to continuation.

Evaluator: __________________________ ________________________ _______________________ (Print Name) (Signature) (Date)


Evaluator Comments:

Student: __________________________ ________________________ _______________________ (Print Name) (Signature) (Date)

Student Comments

34 | Page


Hematology/Coagulation Performance Checklist (5/2017)

Name: _________________________________________




Evaluation Code




Page 1 of 8

Student must be proficient in (i.e. able to perform independently) the following procedures:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent




to review concept

3 = I can perform this task independently or thoroughly understand concept

1. Quality controla. Levey-Jenning’s chart review

1 2 3 1 2 3

2. Automated cell countera. Automated cell counts (WBC, RBC, PLT, RETIC)b. RBC indicesc. WBC differentials

1 2 3 1 2 3

3. Manual differential with morphology (Perform 50)a. WBC morphology with differentialb. WBC estimate from blood smearc. WBC artifacts and inclusionsd. RBC inclusions/morphologye. Platelet estimate from blood smear

1 2 3 1 2 3

4. Slide preparation (extends 2/3 the length of the slide, does not touch the edges,and has a feathered edge)

1 2 3 1 2 3

5. Automated stainers (Principles of Operation, Preventative Maintenance,Troubleshooting)

1 2 3 1 2 3

6. Sedimentation rate 1 2 3 1 2 3 7. Photo-optical detection of fibrin clot for

a. PT, APTT 1 2 3 1 2 3

34 | Page34 | Page

35 | Page



Name: _________________________________________




Evaluation Code




Page 2 of 8

Student must be able to perform satisfactorily the following procedures (via practice specimens):

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent




to review concept


8. Fibrinogen 1 2 3 1 2 3 9. D-Dimer Assay 1 2 3 1 2 3 10. Factor V Leiden (discuss) 1 2 3 1 2 3 11. Thrombin clotting time 1 2 3 1 2 3 12. Electromechanical detection of fibrin clot (discuss) 1 2 3 1 2 3 13. Other 1 2 3 1 2 3

At a minimum students must observe/discuss the following:

Obs

erva

tion

1 = Unsatisfactory

2 = Competent




to review concept


14. Scattergrams/ Histograms 1 2 3 1 2 3 15. Vitamin B12 (as related to hematology) 1 2 3 1 2 3 16. Folate (as related to hematology) 1 2 3 1 2 3

34 | Page

36 | Page



Name: _________________________________________




Evaluation Code




Page 3 of 8

17. Hemoglobin electrophoresis 1 2 3 1 2 3 18. Mixing studies 1 2 3 1 2 3 19. Bone marrow evaluation 1 2 3 1 2 3 20. Protein S 1 2 3 1 2 3 21. Protein C 1 2 3 1 2 3 22. G6PD 1 2 3 1 2 3 23. Factor Assays 1 2 3 1 2 3 24. Activated Clotting Time (ACT) 1 2 3 1 2 3 25. Flow Cytometer 1 2 3 1 2 3 26. Platelet Function Analyzer 1 2 3 1 2 3 27. Special Stains

a. Periodic acid-Schiffb. Myeloperoxidasec. Sudan Blackd. Non-specific esterase stainse. Tartrate-resistant acid phosphatasef. Prussian Blueg. Leukocyte alkaline phosphataseh. Terminal Deoxynucleotidyl Transferase (TdT)i. Chloracetate esterase

1 2 3 1 2 3

28. Laboratory information system (LIS) 1 2 3 1 2 3 29. Specimen processing and handling, and criteria for specimen rejection

Discuss Universal Precautions as applicable 1 2 3 1 2 3

30. Instrument /test system considerations before reporting New reagent lots / verification of performance

(May include the following, but is facility specific) Reference range Linearity checks Calibration and calibration verification Maintenance schedule

1 2 3 1 2 3

34 | Page

37 | Page



Name: _________________________________________




Evaluation Code




Page 4 of 8

Function checks Troubleshooting 31. Quality assurance programs/ regulatory compliance

a. proficiency testing – treat specimens like a patientb. competency assessmentsc. moving average programs (MAPS/x X Bar B) and delta checks

1 2 3 1 2 3

32. Review environment of care (location)Manuals, Policies, MSDSFire extinguishersEye wash stationsPersonal Protective equipment

1 2 3 1 2 3

38 | Page



Name: _________________________________________






Page 5 of 8




2. Accuracy – obtains reliable results; recognizes results as normal/abnormal/questionable; recognizes instrument, clericaland technical errors and takes corrective action.



3. Initiative – Is willing and able to assume responsibility; seeks opportunities to learn; utilizes time to its maximum; canbe depended on to follow through



4. Productivity – Completes assignments within an acceptable amount of time; performs tasks under pressure without lossof accuracy.





6. Thoroughness – Performs tasks to completion; transcribes or enters results accurately and legibly; demonstrates abilityto maintain equipment; maintains cleanliness of working area.












39 | Page



Name: _________________________________________






Page 6 of 8

Grading Criteria:


independently

1) The student’s laboratory competency evaluation should be completed by at least one clinical faculty member who workedwith the student. 2) Once completed the performance checklist will be given to the Education Coordinator and NOT to be given to the student.The performance checklist will be submitted to the clinical coordinator or faculty member assigned to the clinical practicum. 3) * Research paper at a minimum is a one-page report (See template below attach to the checklist). Student will research the topic if not performed, observed or discussed at assigned clinical site.

40 | Page



Page 7 of 8




Evaluator Comments:


Student Comments:

41 | Page



Page 8 of 8

STUDENT RESEARCH TOPICS Date:_________________

PRINCIPLE AND METHODOLOGY

Specify test name:____________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Describe how the compound is measured:____________________________________________ ______________________________________________________________________________ _____________________________________________________________________________

Explanation of the principle involved:_______________________________________________ ______________________________________________________________________________ _____________________________________________________________________________

List any interfering substances:_______________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Name any preanalytical considerations / issues / problems with this test: __________________________________________________________________________________________________________________________________________________________

CLINICAL SIGNIFICANCE

Normal Values, critical values:_____________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Disease states associated with abnormal results:_______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Organ(s) of the body involved:_____________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________

REFERENCES____________________________________________________________________________________________________________________________________________________________________________________________________________________________

42 | Page


Immunology Performance Checklist (5/2017)

Name: _________________________________________




Evaluation Code




Page 1 of 7


Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsat.

2 = Comp

5 = Exceeds



to review concept

3 = I can perform this task independently or

thoroughly understand concept

Rapid Plasma Reagin Test (RPR) 1 2 3 1 2 3 MonoTest 1 2 3 1 2 3 Latex Agglutination 1 2 3 1 2 3 Reagent QC 1 2 3 1 2 3 HCG (qualitative) 1 2 3 1 2 3 Cold Agglutinin 1 2 3 1 2 3 C-Reactive Protein 1 2 3 1 2 3 EIA 1 2 3 1 2 3 Other: 1 2 3 1 2 3 Other: 1 2 3 1 2 3 Other: 1 2 3 1 2 3

35 | Page35 | Page

43 | Page



Name: _________________________________________




Evaluation Code




Page 2 of 7

Students must observe/discuss the following procedures:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent




to review concept

3 = I can perform this task independently or

thoroughly understand concept

1. Antinuclear Antibodies 1 2 3 1 2 3 2. Immunoglobulins 1 2 3 1 2 3 3. Hepatitis Testing 1 2 3 1 2 3 4. Rubella Antibody 1 2 3 1 2 3 5. VDRL 1 2 3 1 2 3 6. Antistreptolysin O Antibody (ASO) 1 2 3 1 2 3 7. Tests representative of Hemagglutinin 1 2 3 1 2 3 8. Tests representative of Immunodiffusion 1 2 3 1 2 3 9. Tests representative of Indirect Immunofluorescence 1 2 3 1 2 3 10. Instrument /test system considerations before reporting (May include the following, but is facility specific)

New reagent lots / verification of performanceCalibration and calibration verificationMaintenance schedule

1 2 3 1 2 3

8. Laboratory information system (LIS)(May include the following, but is facility specific)Interface useAutoverificationManual resulting vs autotransfer of results from instrument

1 2 3 1 2 3

44 | Page



Name: _________________________________________




Evaluation Code




Page 3 of 7

9. Quality assurance programs/ regulatory compliancea. proficiency testing – treat specimens like a patient

b. competency assessmentsc. Reagent QC

1 2 3 1 2 3

10. Specimen processing and handling, and criteria for specimen rejection (May include the following, but is facility specific)

a. correct collection vessel / anticoagulantb. correct collection / storage temperaturec. labeling requirements on primary / secondary transfer tubesd. Prioritization (stat, NOW, timed, ED dept, routine, etc.)

1 2 3 1 2 3


1 2 3 1 2 3

45 | Page



Name: _________________________________________






Page 4 of 7



























46 | Page



Name: _________________________________________






Page 5 of 7

Grading Criteria:

1= UNSATISFACTORY Fails to demonstrate acceptable performance for many key elements 2=COMPETENT Demonstrates acceptable performance in all key elements with direct supervision 3=EXCEEDS EXPECTATIONS Meets all key elements, exceeds acceptable performance; capable of working

independently

1) The student’s laboratory competency evaluation should be completed by at least one clinical faculty trainer who workedwith the student. 2) Once completed the performance checklist will NOT be given to the student. The performance checklist will be submittedto the clinical coordinator or faculty member assigned to the clinical practicum. 3) * Research paper at a minimum is a one-page report (See template below attach to checklist). Student will research the topic if not performed, observed or discussed at assigned clinical site.

39 | Page

47 | Page


Page 6 of 7

Important Notes:

Any Performance checklist block evaluated as “Unsatisfactory” requires a written remediation plan and retesting to acceptable levels prior to continuation.



Evaluator Comments:


Student Comments:

48 | Page


Page 7 of 7

STUDENT RESEARCH TOPICS

Date:_________________











REFERENCES____________________________________________________________________________________________________________________________________________________________________________________________________________________________

49 | Page


Urinalysis Performance Checklist (5/2017)

Name: _________________________________________




Evaluation Code




Page 1 of 7

Student must be proficient in the following procedures:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent


\



to review concept

3 = I can perform this task independently

or thoroughly understand concept

1. Automated examination of urine 1 2 3 1 2 3 2. Manual Urinalysis Procedure

a. Physical examination of urineb. Chemical examination of urine

1 2 3 1 2 3

3. Microscopic examination of urine – cellular components 1 2 3 1 2 3 4. Microscopic examination of urine - crystals 1 2 3 1 2 3 5. Microscopic examination of urine - casts 1 2 3 1 2 3 6. Microscopic examination of urine - parasites 1 2 3 1 2 3 7. Microscopic examination of urine - artifacts 1 2 3 1 2 3 8. Ictotest 1 2 3 1 2 3 9. Test for ketones (beta-hydroxybutyric acid) 1 2 3 1 2 3 10. Urine reducing substances (Clinitest) 1 2 3 1 2 3 11. Urine pregnancy test 1 2 3 1 2 3

50 | Page



Name: _________________________________________




Evaluation Code




Page 2 of 7

At a minimum students must observe/discuss the following:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent

3 = Exceeds Expetations


2 = I need some practice with

supervision or need to review concept


12. SSA 1 2 3 1 2 3 13. Urine porphyrins 1 2 3 1 2 3 14. Urine eosinophil stain 1 2 3 1 2 3 15. Automated urinalysis instrument 1 2 3 2 16. Laboratory information system (LIS) 1 2 3 1 2 3 17. Specimen processing, handling, and criteria for specimen rejection

Discuss Standard Precautions as applicable1 2 3 1 2 3

15. Quality assurance programs/ regulatory compliancea. proficiency testing – treat specimens like a patientb. competency assessments

1 2 3 1 2 3


1 2 3 1 2 3

17. Instrument /test system considerations before reporting New reagent lots / verification of performance Reference range 18. Linearity checks

1 2 3 1 2 3

51 | Page



Name: _________________________________________




Evaluation Code




Page 3 of 7

Calibration and calibration verification Maintenance schedule Function checks Troubleshooting

52 | Page


Urinalysis Processing Performance Checklist (5/2017)

Name: _________________________________________






Page 4 of 7



























53 | Page


Urinalysis Processing Performance Checklist (5/2017)

Name: _________________________________________






Page 5 of 7

Grading Criteria:


independently




54 | Page


Page 6 of 7




Evaluator Comments:


Student Comments:

55 | Page


Page 7 of 7


Date:_________________






Name any preanalytical considerations / issues / problems with this test: _______________________________________________________________________________________________________________________________________________________





REFERENCES____________________________________________________________________________________________________________________________________________________________________________________________________________________________

56 | Page


Transfusion Services & Donor Center Performance Checklist 5/2017

Name: _________________________________________




Evaluation Code




Page 1 of 9

Student must be proficient in the following procedures (via practice specimens):

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent



2 = I need some practice with supervision or

need to review concept

3 = I can perform this

task independently or thoroughly understand concept

1. ABO(Both forward and reverse, and resolves anydiscrepancies)

1 2 3 1 2 3

2. Rh Typings (Weak D Testing)(Resolves any discrepancies)

1 2 3 1 2 3

3. Antibody Screening and identification tests 1 2 3 1 2 3 4. Direct Antiglobulin Test 1 2 3 1 2 3 5. Crossmatch IS, AHG 1 2 3 1 2 3


Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent





3 = I can perform this

57 | Page



Name: _________________________________________




Evaluation Code




Page 2 of 9

task independently or thoroughly understand concept

1. Antibody Enhancement by Polyethylene Glycol (PEG) 1 2 3 1 2 3 2. Properly Use an Automated Cell Washer 1 2 3 1 2 3

At a minimum students must observe/discuss the following procedures:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent


1 = I do not know how to do this or do

not understand concept

2 = I need some practice with supervision or need to review concept


1. Phenotyping 1 2 3 1 2 3 2. Prewarming Technique 1 2 3 1 2 3 3. Enzyme Treatment 1 2 3 1 2 3 4. Elution 1 2 3 1 2 3 5. Antibody Removal by Adsorption 1 2 3 1 2 3 6. Cord Blood Testing 1 2 3 1 2 3 7. Antibody Titering 1 2 3 1 2 3 8. Transfusion Therapy:

a. Red Blood Cells 1 2 3 1 2 3 b. Platelets 1 2 3 1 2 3 c. Plasma ( Frozen and Thawed) 1 2 3 1 2 3 d. Cryoprecipitated Antihemophilic Factor 1 2 3 1 2 3

58 | Page



Name: _________________________________________




Evaluation Code




Page 3 of 9

e. RhIg 1 2 3 1 2 3 f. Transfusion Reaction Work-up 1 2 3 1 2 3 g. Hemolytic Disease of the Newborn 1 2 3 1 2 3

9. Instrument / test system considerations before reporting:New reagent lots / verification of performanceCalibration and calibration verification

Maintenance schedule / Troubleshooting Function checks

1 2 3 1 2 3

10. Laboratory information system (LIS)(May include the following, but is facility specific)Interface useManual resulting vs autotransfer of results from instrumentRecognition/documentation/notification of critical results

1 2 3 1 2 3

11. Specimen processing and handling, and criteria for specimen rejection(May include the following, but is facility specific)a. correct collection vessel / anticoagulantb. correct collection / storage temperaturec. labeling requirements on primary / secondary transfer tubesd. Prioritization (stat, NOW, timed, ED dept, routine, etc.)

1 2 3 1 2 3


1 2 3 1 2 3

59 | Page



Name: _________________________________________




Evaluation Code




Page 4 of 9

13. Quality assurance programs/ regulatory compliance(To include reagent QC)a. proficiency testing – treat specimens like a patientb. competency assessments

1 2 3 1 2 3

At a minimum students must observe/discuss the collection, processing, preparation and testing of the following components (what procedures are required, how is the BB inventory managed): This can be achieved by simulations, field trips, research papers, websites, etc.

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent

3 = Exceeds expectations





1. Whole Blood 1 2 3 1 2 3 2. Packed Red Blood Cells 1 2 3 1 2 3 3. Leukoreduced Red Blood Cells 1 2 3 1 2 3 4. Fresh Frozen Plasma 1 2 3 1 2 3 5. Cryoprecipitated Antihemophilic Factor 1 2 3 1 2 3 6. Single Donor Platelets 1 2 3 1 2 3 7. Identify donor requirements for:

60 | Page



Name: _________________________________________




Evaluation Code




Page 5 of 9

a. Allogeneic Donation 1 2 3 1 2 3 b. Autologous Donation 1 2 3 1 2 3

8. Identify causes for permanent deferral 1 2 3 1 2 3 9. Identify causes for temporary deferral 1 2 3 1 2 3

61 | Page


Transfusion Services & Donor Center Performance Checklist (5/2017)

Name: _________________________________________


Performance Evaluation (Evaluator)




Page 6 of 9

1. Punctuality and attendance: (1) = Late or absent 4-5 times, attempts to arrange for and completes makeup time in a timely fashion, extends break time 4-5 times. (2) = Late or absent 3-4 times, arranges for and completes makeup time in a timely fashion, extends break time 3-4 times. (3) = never late or absent, never abuses break time.

1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations











5. Ability to learn – Performs tasks after minimal instruction; transfers information from lecture to bench work.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations








8. Communication – Gives verbal and written information clearly, accurately and courteously.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations


9. Organization – Plans and completes work in a manner that effectively utilizes available resources and time. 1 – Unsatisfactory 2 – Competent

1 – Fails Standards 2 – Meets Standards

62 | Page



Name: _________________________________________


Performance Evaluation (Evaluator)




Page 7 of 9

3 – Exceeds Expectations 3 – Exceeds Standards

10. Safety – Observes laboratory safety procedures to include proper use of personal protective equipment.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations


Grading Criteria: 1= UNSATISFACTORY Fails to demonstrate acceptable performance for many key elements. 2=COMPETENT Demonstrates acceptable performance & competency in all key elements with direct supervision 3=EXCEEDS EXPECTATIONS Meets all key elements, exceeds acceptable performance; capable of working

independently 1) The student’s laboratory competency evaluation should be completed by at least one clinical faculty trainer who workedwith the student. 2) Once completed the performance checklist will NOT be given to the student. The performance checklist will be submittedto the clinical coordinator or faculty member assigned to the clinical practicum. 3) * Research paper at a minimum is a one-page report (See template below attach to checklist). Student will research the topic if not performed, observed or discussed at assigned clinical site.

63 | Page



Page 8 of 9

Important Notes: Any Performance Checklist block evaluated as “Unsatisfactory” requires a written remediation plan and retesting to acceptable levels prior to continuation. .



Evaluator Comments:


Student Comments:

64 | Page



Page 9 of 9


Date:_________________

Name of Test/procedure:_________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Principle and Methodology:________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________

Expected results:________________________________________________________________ ______________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Clinical Significance:______________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

References:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________

65 | Page


Microbiology Performance Checklist & Evaluation (5/2017)

Name: _________________________________________



Evaluation Code


* Student must showdocumentation of

research if not performed

Page 1 of 9

Student must show competency in the following procedures (via practice specimens if possible):

Obs

erva

tion

Con

cept

D

iscu

ssed

Stud

ent

Perf

orm

ed

*Res

earc

h

Trainer Initials

Student Initials

1. Specimen processing and specimen plating2. Gram stain3. Throat culture (rule out strep); reflex from pediatric neg screen4. Urine culture5. Sputum culture6. Wound/abscess culture7. Rapid Group A Strep antigen test8. Antimicrobial susceptibility (MIC) set-up9. Blood culture10. Urogenital culture11. Body fluid culture12. Anaerobic culture13. Beta lactamase detection (Iodometric, acidometric or chromogenic)14. Bacterial ID: (MicroScan / Vitek)15. Susceptibility: (MicroScan / Vitek)16. Manual ID procedures17. Acid fast stain (Fluorochrome and Kinyoun)18. Acid fast culture (Conventional)19. Blood culture instrumentation20. C. difficile testing21. MRSA screening22. Other Testing:

66 | Page



Name: _________________________________________



Evaluation Code




Page 2 of 9

Student must show competency in the following procedures (via practice specimens if possible):

Obs

erva

tion

Con

cept

D

iscu

ssed

Stud

ent

Perf

orm

ed

*Res

earc

h

Trainer Initials Student

Initials

23. Laboratory information system (LIS)

24. Specimen processing and handling, and criteria for specimen rejectionDiscuss Standard Precautions as applicable


26. Quality assurance programs/ regulatory compliancea. Proficiency testing – treat specimens like a patientb. Competency assessments

67 | Page



Name: _________________________________________



Evaluation Code




Page 3 of 9

Students must observe/discuss the morphology and identification procedures for the following organisms (via practice specimens or research):

Obs

erva

tion

Con

cept

D

iscu

ssed

Stud

ent

Perf

orm

ed

*Res

earc

h

Trainer Initials

Student Initials

1. Staphylococcus aureus2. Staphylococcus epidermidis3. Streptococcus veridans4. Beta Streptococcus Group A5. Beta Streptococcus Group B6. Enterococcus faecalis/faecium7. Streptococcus pneumoniae8. Eschericia coli9. Klebsiella10. Enterobacter11. Serratia12. Proteus13. Providencia14. Morganella15. Pseudomonas aeruginosa16. Neisseria spp.17. Haemophilus influenzae18. Listeria spp.19. Citrobacter spp.20. Campylobacter jejuni21. Salmonella22. Shigella23. Acinetobacter spp

61 | Page

68 | Page



Name: _________________________________________



Evaluation Code




Page 4 of 9

24. Moraxella (Branhamella) catarrhalis25. Bacteroides fragilis/ fragilis group26. Clostridium perfringens27. Other coagulase negative Staphylococcus28. Other beta hemolytic Streptococcus29. Other Group D Streptococci/Enterococci30. Other Corynebacterium spp.31. Other Bacillus spp.32. Lactobacillus spp.33. Eschericia coli 0157:H734. Aeromonas spp.35. Yersinia enterocolitica36. Stenotrophomonas (Xanthomonas) maltophilia37. Pasteurella multocida38. Haemophilus spp.39. Gardnerella vaginalis40. Bacteroides (Prevotella) melaninogenicus-oralis group41. Clostridium spp.42. Mycobacterium spp.43. Chlamydia trachomatis44. Edwardsiella45. Other Acid or partially Acid-fast organisms

69 | Page



Name: _________________________________________



Evaluation Code




Page 5 of 9

TECHNICAL SKILLS: Microbiology, Mycology, Parasitology Student Self-Assessment

1. Performs and interprets microscopic stains (i.e. Gram, etc.)1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations


2 = I need some practice with supervision or need to review

concept


2. Performs identification of microorganisms1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

3. Performs and interprets biochemical tests1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

4. Performs and interprets susceptibilities1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

5. Demonstrates proper operation and maintenance of analytical equipment1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

6. Follows all quality control and safety protocols1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

7. Reports critical results to appropriate personnel within established timelines1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

8. Correctly evaluates specimen integrity and identification for analysis1 – Unsatisfactory 2 – Competent 3 – Exceeds

1 2 3

9. Applies appropriate usage of internal and external QC.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

10. Maneuvers through Laboratory Information System (LIS) to review test results andconforms to established reporting policies and procedures.


1 2 3

70 | Page



Name: _________________________________________



Evaluation Code




Page 6 of 9

AFFECTIVE PERFORMANCE COMPETENCIES Student Self-Assessment

1. Punctuality and attendance: (3) = never late or absent, never abuses break time. (2) = Late or absent 3-4 times, arranges for and completes makeup time in a timely fashion, extends break time 3-4 times. (1) = Late or absent more than 5 times, unable to complete makeup time in a timely fashion, or frequently abuses break time.


1 2 3

2. Accuracy – obtains reliable results; recognizes results as normal/abnormal/questionable; recognizesinstrument, clerical and technical errors and takes corrective action.


1 2 3

3. Initiative – Is willing and able to assume responsibility; seeks opportunities to learn; utilizes time to itsmaximum; can be depended on to follow through


1 2 3

4. Productivity – Completes assignments within an acceptable amount of time; performs tasks under pressurewithout loss of accuracy.


1 2 3

5. Ability to learn – Performs tasks after minimal instruction; transfers information from lecture to bench work.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

6. Thoroughness – Performs tasks to completion; transcribes or enters results accurately and legibly;demonstrates ability to maintain equipment; follows safety procedures.


1 2 3

7. Cooperation and ability to accept criticism – Cooperates with others; accepts and conforms to rules; acceptsconstructive criticism and tries to correct deficiencies.


1 2 3

8. Communication – Gives verbal and written information clearly, accurately and courteously.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

9. Organization – Plans and completes work in a manner that effectively utilizes available resources and time.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

10. Safety – Observes laboratory safety procedures to include proper use of personal protective equipment.1 – Unsatisfactory 2 – Competent 3 – Exceeds Expectations

1 2 3

71 | Page



Name: _________________________________________



Evaluation Code




Page 7 of 9

Grading Criteria:

1= UNSATISFACTORY Fails to demonstrate acceptable performance for many key elements. Does not complete task(s) accurately, requires guidance and references, does not complete tasks within established time limits.

2=COMPETENT Demonstrates acceptable performance in all key elements with direct supervision. 100% accuracy, may require some assistance, refer to protocols, additional time may be needed to complete tasks accurately.

3= EXCEEDS EXPECTATIONS Meets all key elements, exceeds acceptable performance; capable of working independently. 100% accuracy, works independently without supervision, does not require written guidance or protocols, results tests within established time limits.

1) The student’s laboratory competency evaluation should be completed by at least one clinical faculty trainer who workedwith the student. 2) Once completed the performance checklist and evaluation will be given to the clinical coordinator or program director andNOT to be given to the student. 3) * Student is assigned a research paper at a minimum in a one-page report (see template at end of checklist). Student will research the topic if not performed, observed or discussed at assigned clinical site.

72 | Page


Microbiology Performance Checklist (Rev 5/2017)

Page 8 of 9

Important Notes: Any Performance checklist block evaluated as “Unsatisfactory” requires a written remediation plan and retesting to acceptable levels prior to continuation

Evaluator: ______________________________ _____________________________ (Print Name) (Signature)

Date: _____________________________

Ed Coordinator: __________________________ _____________________________ (Print Name) (Signature)

Date: ____________________________

Evaluator Comments (optional):

Student: __________________________ ________________________ (Print Name) (Signature)

Date: ______________________________

Student Comments:

73 | Page


Microbiology Performance Checklist (Rev 5/2017)

Page 9 of 9


Date:_________________

Name of Test/procedure:_________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Principle and Methodology:________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________

Expected results:________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________

Clinical Significance:______________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

References:________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________

74 | Page


Mycology Performance Checklist (5/2017)

Name: _________________________________________


Competency and Performance Evaluation(Evaluator)

Evaluation Code




Page 1 of 5

Student must be able to perform satisfactorily the following procedures (if available), or document research of topic:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

Trainer’s Initials

Student Initials

1. Germ tube2. LCB3. Slide culture4. Tease mount5. Wet prep6. Yeast fermentation/assimilation (Commercial kits)7. Fungal culture

Students must observe/discuss the identification procedures for the following organisms, or document research of topic:

Obs

erva

tion

Con

cept

D

iscu

ssed

Stud

ent

Perf

orm

ed

*Res

earc

h


Student Initials

1. Dimorphic fungi2. Rhizopus spp.3. Mucor spp.4. Penicillium spp.5. Aspergillus fumigatus

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75 | Page



Name: _________________________________________


Competency and Performance Evaluation(Evaluator)

Evaluation Code




Page 2 of 5

6. Cryptococcus neoformans7. Microsporum canis8. Tricophyton rubrum9. Candida spp.10. Coccidioides spp.

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Student Self-Assessment

Evaluation Code




Page 3 of 5

Grading Criteria:




1) The student’s laboratory competency evaluation should be completed by at least one clinical faculty trainer who workedwith the student. 2) Once completed the performance checklist and evaluation will be given to the clinical coordinator or program director andNOT to be given to the student. 3) * Research paper at a minimum is a one-page report (See template below attach to checklist). Student will research the topic if not performed, observed or discussed at assigned clinical site.

77 | Page



Page 4 of 5



Date: _____________________________


Date: ____________________________

Evaluator Comments (optional)


Date: ______________________________

Student Comments:

78 | Page



Page 5 of 5

STUDENT RESEARCH TOPIC

Name:_________________________ Date:_______________

Fungal Organism:_____________________________

Pathogenicity:__________________________________________________________________________________________________________________________________________________________________________________________

Colony Morphology – Surface and Reverse:_______________________________ ____________________________________________________________________________________________________________________________________

Microscopic Morphology – Description and Simple Drawing:________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student Signature:________________________ Date:______________

Evaluator Signature:______________________ Date:______________

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Parasitology Performance Checklist (5/2017)

Name: _________________________________________



Evaluation Code


*Student must showdocumentation of

research

Page 1 of 7

Student must be able to perform the following procedures (via practice specimens):

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

Trainer Initials

Student Initials

1. Prepare and read stool direct saline wet prep (with or without iodine)2. Prepare and read direct saline wet prep (with or without iodine) (commercial

kits)3. Stool concentration procedures4. Prepare, stain (Trichrome) and read permanent slides5. Prepare, stain (Wright/Giemsa) and read Malaria thick smears6. Fecal WBCs7. Arthropod ID (scabies)

Students must be able to identify the following organisms from patient specimen, prepared slides or online source (if available):

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

Trainers Initials

Student Initials

1. Entamoeba histolytica2. Entamoeba coli3. Giardia lamblia (Antigen EIA)4. Trichomonas vaginalis (commercial kits)5. Cryptosporidium spp.6. Babesia spp.

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Name: _________________________________________



Evaluation Code



research

Page 2 of 7

Observed Discussed Performed *Research Trainer’s Initials

Student’s Initials

7. Hookworm8. Strongyloides spp.9. Enterobius spp.10. Trichuris spp.11. Dientamoeba fragilis12. Other intestinal flagellates13. Trichinella spp.14. Diphyllobothrium latum15. Taenia spp.16. Hymenolepsis nana17. Hymenolepsis diminuta18. Paragonimus westermani19. Chlonorchis sinensis20. Fasciola hepatica21. Fasciolopsis buski22. Plasmodium spp.23. Pneumocystis spp.24. Toxoplasma spp.25. Leishmania spp.26. Trypanosoma spp.27. Filarial nematodes (ex. Loa loa, Wuchereria)28. Schistosoma spp.

81 | Page



Name: _________________________________________



Evaluation Code



research

Page 3 of 7

At a minimum students must observe or discuss the following procedures:

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h


Student’s Initials

1. Instrument /test system media, reagents, stock culture and organisms considerations

Maintenance schedule Troubleshooting 2. Describe life cycle of each parasite:

- Protozoa – blood & intestinal - Nematodes – intestinal, blood & tissue - Cestodes - Trematodes

3. Specimen processing and handling, and criteria for specimen rejectionReview the laboratory’s fire safetyLocation of Personal Protective equipment and MSDSDiscuss Universal Precautions as applicable


5. Specimen processing and handling, and criteria for specimen rejectionDiscuss Standard Precautions as applicable

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Name: _________________________________________



Evaluation Code



research

Page 4 of 7


Obs

erva

tion

Con

cept

D

iscu

ssed

Stud

ent

Perf

orm

ed

Res

earc

hed Trainer’s

Initials Student’s Initials

7. Review environment of care (location)Manuals, Policies, MSDSFire extinguishersEye wash stations


9. Laboratory information system (LIS)

10. Other Testing: Please list

11.

12.

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Evaluation

Evaluation Code

(Check all that apply) Comments

Page 5 of 7

Grading Criteria:




1) The student’s laboratory competency evaluation should be completed by the clinical faculty or clinical coordinator.2) Once completed the performance checklist and evaluation will be given to the Education Coordinator and NOT to be givento the student. 3) * Research paper at a minimum is a one-page report. See template below.

84 | Page



Page 6 of 7

Important Notes: Any Performance checklist block evaluated as below standards requires a written remediation plan and retesting to acceptable levels prior to continuation. .


Date: _____________________________


Date: ____________________________

Evaluator Comments (optional):


Date: ______________________________

Student Comments:

85 | Page



Page 7 of 7

STUDENT RESEARCH TOPIC

Name:_________________________ Date:_________________

Parasite:______________________Classification:__________________________

Disease:_________________________________________________________________________________________________________________________________________

Geographic Distribution:___________________________________________________

Life Cycle and Mode of Infection:____________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Diagnostic Specimen:________________________________________________

Diagnostic Test:____________________________________________________

Microscopic Morphology – Description and Simple Drawing:________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student Signature:________________________ Date:_______________

Evaluator Signature:______________________ Date:_______________

86 | Page


Chemistry Performance Checklist (5/2017)

Name: _________________________________________




Evaluation Code




Page 1 of 8

Student must be proficient in the following procedures (via practice specimens):

Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent






1. Quality controla. Levey-Jenning’s chart reviewb. Westgard Rulesc. Assayed vs. unassayed controlsd. Mean, median, and modee. Standard deviationf. Coefficient of variationg. Precision vs. accuracyh. Random vs. systematic errori. Sensitivity vs. specificityj. Shift vs. trendk. Delta check

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

2. General Chemistry Panels on Instrument 1 2 3 1 2 3 3. Cardiac Assessment (CK CKMB, Troponin, BNP) 1 2 3 1 2 3 4. Creatinine clearance 1 2 3 1 2 3 5. B-HCG (quantitative) 1 2 3 1 2 3 6. Ionized calcium 1 2 3 1 2 3

87 | Page



Name: _________________________________________




Evaluation Code




Page 2 of 8

7. Iron, TIBC, Ferritin, Transferrin 1 2 3 1 2 3 8. Therapeutic drug monitoring:

a. timing requirementsb. peak vs. trough vs. randomc. documenting last dose given

1 2 3 1 2 3

8. Hgb A1C 1 2 3 1 2 3 9. Osmolality 1 2 3 1 2 3 10. Body Fluid Chemistries:

Ex: glucose, protein, LDH, Trigs or cholesterol, pH 1 2 3 1 2 3

1 2 3 1 2 3 11. Thyroid Panel (T3, Total T4, TSH, TBG) 1 2 3 1 2 3 12. Urine Chemistries 1 2 3 1 2 3 13. Glucose Tolerance Test (GTT) 1 2 3 1 2 3 14. Toxicology 1 2 3 1 2 3 15. 1 2 3 1 2 3 16. 1 2 3 1 2 3 17. 1 2 3 1 2 3 18. 1 2 3 1 2 3 19. 1 2 3 1 2 3 20. 1 2 3 1 2 3

88 | Page



Name: _________________________________________




Evaluation Code




Page 3 of 8


Obs

erva

tion

Con

cept

Dis

cuss

ed

Stud

ent P

erfo

rmed

*Res

earc

h

1 = Unsatisfactory

2 = Competent




to review concept


1. Protein electrophoresis 1 2 3 1 2 3 2. Cryoglobulins 1 2 3 1 2 3 3. Haptoglobin 1 2 3 1 2 3 4. Blood Gases 1 2 3 1 2 3 5. Hgb electrophoresis 1 2 3 1 2 3 6. Lactic acid / Calcitonin 1 2 3 1 2 3 7. Lipoproteins 1 2 3 1 2 3 8. Screening for drugs of abuse

Medical vs. legal testing considerations; confirmatory testing 1 2 3 1 2 3

9. Tumor markers 1 2 3 1 2 3 10. Other cardiac assessment tests: Myoglobin, homocysteine, hsCRP, BNP 1 2 3 1 2 3 11. PSA 1 2 3 1 2 3 12. pH testing 1 2 3 1 2 3 13. Other: 1 2 3 1 2 3 14. Other: 1 2 3 1 2 3 15. Instrument /test system considerations before reporting

New reagent lots / verification of performance (May include the following, but is facility specific)

1 2 3 1 2 3

89 | Page



Name: _________________________________________




Evaluation Code




Page 4 of 8

Reference range Linearity checks Calibration and calibration verification Maintenance schedule Function checks Troubleshooting 16. Laboratory information system (LIS) 1 2 3 1 2 3 17. Specimen processing and handling, and criteria for specimen rejection

Discuss Universal Precautions as applicable 1 2 3 1 2 3


1 2 3 1 2 3


1 2 3 1 2 3

90 | Page



Name: _________________________________________


Competency and Performance Evaluation

(Evaluator)




Page 5 of 8



























91 | Page



Name: _________________________________________


Competency and Performance Evaluation

(Evaluator)




Page 6 of 8

Grading Criteria:


independently




92 | Page



Page 7 of 8

Important Notes: Any Performance Checklist block evaluated as below standards requires a written remediation plan and retesting to acceptable levels prior to continuation.



Evaluator Comments:


Student Comments:

93 | Page



Page 8 of 8


Date:_________________











REFERENCES____________________________________________________________________________________________________________________________________________________________________________________________________________________________

94 | Page


Clinical Affiliation Hours Log

Facility Name: _______________________________________________ Dates: ____________________________ through _______________________

___________________________________________________________ _________________________________________________________

Student Signature CI Signature

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

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fall 2017 – summer 2018 medical laboratory …

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