Lab Medicine Rounds

Time Stamps

00:00 Podcast Intro

00:39 What is they ‘why’ behind starting up a convalescent plasma program?

04:00 If physicians are taking care of a patient and wanting to get this product how do they go about it?  

11:23 With the Expanded Access Protocol and Emergency IND, how many products does that get for the given patient?

13:00 Where should we direct people who are interested in being a donor?

14:51 Can you give us an idea on who would be eligible to donate convalescent plasma?

17:16 What are some lessons learned from your perspective as you have navigated through COVID-19 and the dynamic situation? 

Resources:

• https://ccpp19.org 
• https://covidplasma.org  
• https://uscovidplasma.org 

00:00 Podcast Intro 

00:56  On a lot of T.V. shows that I’ve watched over the years, I see the surgeons and emergency medicine docs after they see the patient pop back in the lab and perform those critical tests. In reality, is that really what’s going on? 

01:42 Myself as a pathologist, I understand for a lot of physicians I’m probably one degree removed from the bedside, so one degree outside of their mind, and  maybe the medical technologist is another degree. So for our physicians and clinicians listening to this podcast, can you maybe share some of the biggest misconceptions about laboratory technologists and the value that they are actually contributing behind the scenes to that patient care?

03:05 I know in our day to day we kind of think about those patients or situations where we’ve really been challenged and made a difference for the patient. Can you share one of those stories about where you specifically really played a role behind the scenes that made a difference for patient care?

04:39 It sounds like you guys really are the both the first and last line of defense on making sure that the information that is coming out of the laboratory is as accurate as possible?

05:25 You know that front end is really something to highlight for our listeners about, we all got used to ordering tests based on how we were trained and what was available at the time we are training, and as with all things, medical science continues to advance. I think that’s a critical point to make. That Medical Technologist is really up to date on what is an older test, or what test is best to answer that question the physician has?

06:46 If you could elaborate a little bit for students who are just starting to consider this field and maybe even, are there some thoughts for some people who are just starting in laboratory medicine about what the best path might be for them?

8:05 So you’re saying that if I’m somebody that likes variety in my day, there’s a place for me in laboratory medical science, and if I like being an expert in something, there’s ALSO a place for me in laboratory medical science?

08:35 You’ve had a really interesting and valuable career and you’ve kind of seen this profession from a couple of different angles. I was wondering if you have any words of wisdom for someone who is maybe just getting started in laboratory medical science in those first 3-5 years of practice? Do you have any advice for them as to what should they be focusing on and thinking about from a coaching perspective?

13:43 Are there any plans for sharing laboratory pride this year (for Lab Week)?

14:29 Do you have any kind of messages for how pathologists can work best with their laboratory technologists?

16:38 Can you share how you found this field of laboratory science?

21:26 What qualities make for a good lab tech?

25:00 Outro 

Resources:
Career Exploration: https://ascls.org/

Time Stamps

00:00 Podcast Intro

00:50 Why is it important to have a serologic test for COVID-19 when there are already molecular PCR assays for diagnosis?

01:38 How are we going to b using the serologic test in clinical practice? 

03:02 When should and when shouldn’t we be ordering the serologic assay?

04:34 Can you elaborate on some of the limitations of this test?

06:05 Should we be listening to their local area is recommending related to COVID-19?

06:49 What are the challenges that you have to navigate with serologic testing for COVID-19?

09:32 This has really been a collaborative effort across the country to implement this test. Would you mind sharing what implementation of this serologic assay looked like? 

12:58 What are some lessons learned at this point that you think would be worth sharing to the lab professionals and students that listen to this podcast?

Time Stamps

00:00 Podcast Intro 

00:52 Can you start off and give us kind of the status update on where we are on this COVID-19 pandemic?

02:13 When you talk about it has gone from an epidemic to a pandemic, can you highlight for our listeners what the difference between those two are?

03:22 Now to dive into laboratory testing. There have been a couple of tests talked about in the media and I know that you have led a team here at Mayo that has developed a test for COVID-19. Can you help us summarize these different tests that are potentially orderable?

04:00 Molecular Tests

05:10 Serologic Tests

07:14 I’ve been seeing in the news a lot of speculation based on past experiences about low sensitivity of SARS-CoV-2 diagnostic testing. Can you speak to that and help us understand this from the lab medicine professional’s point of view?

11:00 We’ve been hearing a lot about rapid tests, point-of-care tests for SARS-CoV-2. I was wondering if you could help us understand those, and how do they fit with what we’ve discussed so far?

14:37 Can you take us through what are some lessons learned or unexpected challenges for our laboratory professionals that are listening?

18:19 I was wondering if we could reflect with our audience on some lessons learned for our learners to take away from this experience?

22:33 Outro

Resources
·         https://www.cdc.gov/coronavirus/2019-ncov/index.html

·         https://coronavirus.jhu.edu/map.html

Time Stamps

00:00 Podcast Intro

01:26 Why is it important to consider how we're staffing our laboratory during this pandemic? 

02:58 What are the different models or what are some different ways people have been talking about running a lab to mitigate this risk of the lab going down? 

07:07 I like how you know, you're also talking about these challenges of space and some of the conversations that you're having with infection control at the institution level.

09:05 When you were talking and looking at those different schedules and going to the different shifts, you mentioned that there was a lot of time that was invested in doing that. Do you have any tips for our listeners about lessons learned from that experience about how they can do that and learn from your experience? 

12:17 If we could follow that thread a little further, I'm curious about how your communication has been with the clinical practice. I know that you mentioned you actually have three labs that you oversee. I know especially the cellular therapy lab has many connections with the clinical practice, a lot of co-dependence there when we're talking about transplant and cell therapy. What's that communication been like with the clinical practice?

18:03 I think there's lots of gems that you've laid out there for our listeners and really kind of a big part of this is keeping a humble, this inter-professional collaboration, whether it's working with your supervisors for staffing, communicating with clinical colleagues for  what they are expecting as far as volumes and maintaining those lines of communication for how things are going to change. With that, is there anything that you want to add that we haven't touched about?

18:57 Outro 

Time Stamps

00:00 Podcast Intro 

02:20 For those of us that aren’t in the education technology movement can you give us a little bit of that 50,000 foot view and orientate us, and where we should think about starting?

03:15 Quick tips to consider as a starting place for Virtual Learning: 1.) Presence 2.) Communication 3.) Authenticity

05:25 Synchronous vs. asynchronous environments

07:21 What are some ways we can make this virtual environment work for effectiveness?

09:48 Do you have some tips as far as, are there two or three things that come to the forefront of your mind? I think many people haven’t thought about wait time or down time in a virtual domain. Can you give an example or two of where someone might get off the ground trying this?

12:16 What are your thoughts about how we can facilitate, encourage, and coach that engagement in our learners in a virtual environment?

12:52 What is netiquette? 

13:47 How does the netiquette feed into this engagement of learners?

16:30 Free collaborative tools available: Google Forms, Google Docs and MindMeister

17:58 Transitioning more to the learner mind and learner perspective, are there any recommendations for someone who hasn’t learned this way historically in the past, to give this virtual learning its best opportunity?

21:04 How could educators monitor this environment to get that valuable feedback?

24:35 A lot of things are changing when we are using a virtual environment. What things are not changing?

27:28 Outro

Additional Resources:

Mayo Clinic:

· https://mayocliniceducatorscentral.blubrry.net/2020/03/17/virtual-class-now-how-to-move-your-education-online-in-a-hurry-ep14/ 

Twitter:

· @erhall1

· @MayoFacDev

· #HMICommunity 

MedEd/HPE: 

· https://www.aliem.com/teaching-age-covid-19-wrap-up/

· Flipped Classroom in Medical Education: Engaging Students to Build Competency https://journals.sagepub.com/doi/full/10.4137/JMECD.S23895 

Higher Education Resources:

· Association of Colleges and University Educators: https://acue.org/online-teaching-toolkit/

· Chronicle in Higher Education: Going Online in a Hurry

· Recent Learning Scientist.org Blog 

· https://teachremotely.harvard.edu/

· https://ai.umich.edu/keep-teaching/
1.     Learning to Teach Online: Understanding & Optimizing an Online Learning Experience by Elizabeth Syben King (@elizabethonline) for Medium.

2.     Welcome to ACUE's Online Teaching Toolkit by Association of College and University Educators (@ACUE_HQ)

3.     Uploading lecture videos on YouTube by Dr Megan Sumeracki (@DrSumeracki)

4.     Going Online in a Hurry: What to Do and Where to Start by Michelle D. Miller for the Chronicle Vitae

Additional Episode Notes:

Virtual/Remote Learning – 50,000 Ft View 

Start simple when thinking shifting to virtual – even if you have to move fast (identity dissonance) 

Facilitator presence is key in virtual environments 

1.       Connect:  How do connect with learners? 

·         Synchronously  - Shift to a video conferencing platform (Zoom, Blackboard Collaborate, other)

·         Asynchronously – Traditional and non-traditional learning management systems, email, Slack

·         Be available and accessible: Virtual Office Hours, 

2.       Communicate: What do my learners need to know? 

·         Reduce cognitive load by sharing expectations of learners/ participants – help them understand how to interact  in this new context (netiquette – virtual etiquette) 

·         Audio: 

·         Video: 

·         Be Transparent – concise communication key and narrating the flow of the experience (be deliberate)

·         Include wait time – not only processing by muting and unmuting technology 

3.       Be Authentic: How can I maintain my personal touch? 

·         Address people by name

·         Make eye contact 

·         Encourage, acknowledge, and reinforce contributions 

·         Reinforce what supporting each other looks like

·         Demonstrate appreciation and gratitude 

·         Have fun – add humor 

·         Give people grace – we are all in this together 

One you have done these three things we are ready to start thinking about: 

Delivery:  Now, what do I do once I am connected to my learners? 

Engagement Strategies and Tactics –Learners contribute to Community 

I want to frame this question on the premise that learning is social by nature and science of learning principles.  In other words: 

·         How are we maximizing techniques in which people learn by engaging with others - active learning techniques to organize new learning and link to previous knowledge - exposure to how others think, think critically

·         How do we engage learners in retrieval of information, elaboration of ideas, and using specific examples to understand abstract ideas

·         How do we plan for learners to thinking about their thinking - metacognition

It is common to think about content first which is important in order to scaffolding learning. Establishing what direction instruction is necessary – 

·         Essentially how it can be used to a focal point for design...

Time Stamps

00:00 Podcast Intro 

01:00 What exactly do you mean when you say, diversity in blood supply, and why does that matter?

02:15 Are you saying that there might be differences in blood among different ethnic groups? 

02:50 If we only issued O- blood to everyone, would we still need diversity in blood supply?

04:25 You mentioned a hemolytic reaction, so if I have a friend or family member going in for a surgery, do I need to call up the blood bank and talking to them and demanding something? Or what should I be looking for to make sure they won’t have one of those reactions?

07:51 Some of the patients that are going to be receiving multiple blood products throughout their lifetime, might be the people that matching is more important for? What types of characteristics do these patients have? 

11:11 What happens if one of the patients that needs a special unit of blood comes in from a bad car accidents and we don’t have that blood on the shelf? 

14:00 Is there some sort of barrier that needs to be overcome to help encourage more donations from diverse communities? 

16:28 Red blood cells seem pretty simple, shouldn’t you be able to manufacture a red blood cell and then the diversity in blood supply wouldn’t be a problem because you can put whatever antigens on them that you wanted, couldn’t you?

20:14 Are there other areas in regards to the diversity of blood supply that will be important to keep in the forefront for the near future?

22:40 Are there any specific key takeaways you want people to take away from this topic?

25:25 Outro

Time Stamps

00:00 Podcast Intro 

01:08 Introduction of Stacey Rizza, M.D.

01:50 What is the natural course of HIV if left untreated, and what effects would it have on the body? 

03:41 So given those numbers then, who should be tested for HIV?

04:32 How should HIV be treated?

05:29 Do people living with HIV then when they are on therapy need any additional, special kind of care?

06:44 So if someone who’s living with HIV is actually receiving the treatment and doing everything they should be doing, will the disease naturally shorten their life?

07:28 Now given that we’re talking about sexually transmitted diseases, is it safe for a person with HIV to have unprotected sex?

09:57 Given those conversations, is that usually how it goes when people ask how HIV can be prevented, or is there more to it?

11:59 Another thing that’s coming out every month or so we hear about the new technological advances towards a cure for HIV, so how are we doing on that? Is HIV curable? 

13:35  So one of the things that comes up fairly frequently every few years is the Delta 32 mutation, which is a mutation that it’s my understanding intrinsically confers some level of resistance against HIV infection?

15:50 HIV is a very large global burden and as a result there has been a lot of outreach around the world from many different organizations. Here in American in 2003, President George W. Bush signed PEPFAR, The President's Emergency Plan For AIDS Relief.  What are your thoughts on how well it’s been doing?

17:48 To shift gears here, we’re going to shift from viruses to bacteria. One in particular with a tumultuous history is syphilis. What is syphilis and what effects does it have on the body?

21:08 So that being said, with it having an asymptomatic period where it doesn’t look like you have it at all, who should be tested for syphilis?  

21:57 How is syphilis treated?

22:36 So if someone is treated for syphilis, can it reoccur? 

23:30 What about prevention? Can syphilitic infection be prevented?

24:14 According to the CDC congenital syphilis cases has risen consecutively over the last five years, is there anything we should be doing for increased surveillance?

25:42 What does congenital syphilis look like?

26:23 Is there a vaccine for syphilis?

27:39 Outro

Time Stamps

00:00 Podcast Intro 

00:31 Introduction of Matt Binnicker, Ph.D.

01:07 Can you talk about why it’s so important for people to discuss chlamydia and gonorrhea and why healthcare providers and the general public today need to have a good understanding of the causes of these STDs? 

02:32 So we just spoke to Dr. Rizza about how over the last five years, STDs have risen each year consecutively. Is there any reason why we have an increased incidence over this timeline with these infections?

03:31 How are these diagnosed in the laboratory? How do we actually figure out if you have this or not?

04:22 Those diagnostic processes, do you think those are going to change at all in the future or evolve, or do you think what we have is good?

06:28 So why is important then to have accurate and rapid laboratory test results for chlamydia and gonorrhea? 

07:17 So with regards to the disease itself, if a patient becomes infected how are they managed?

08:50 With drug resistant gonorrhea being in the news so often, the next real concern is how worried should we be about it?

09:58 What should be the big takeaway the audience should get from talking about gonorrhea and chlamydia?

11:45 Outro

Time Stamps

00:00 Podcast Intro 

01:25 What is proficiency testing?

04:10 Proficiency testing insures my lab is actually getting the accurate results? 

05:26 What is proficiency testing referral and why is it important for laboratory medical directors, administrators, supervisors and staff to be aware of PT referral rules? 

07:54 Why would laboratories refer proficiency testing to another external lab?

12:05 What’s happening at working to reduce this risk for me? Taking Essential Steps for Testing (TEST) Act of 2012

15:23 These are “near-miss” events and definitely something to learn from, discussing how the holes lined up, what occurred, and now here’s your opportunity to patch that hole?

17:04 What new trends in laboratory medicine have increased the risk of sanctions for proficiency testing referral?

19:55 What are the most effective strategies to prevent proficiency testing referral?

22:26 Are there good resources for this education? Or is every lab on their own to create content?

23:17 In your experience, being on committees and doing inspections at hospitals, what has surprised you most about this issue of PT and referral?

26:17 How do you approach training pathology residents and fellows in understanding proficiency testing, what they are responsible for, how do they trouble shoot a proficiency failure? I imagine it’s difficult to introduce that topic.

28:10 Outro

Additional Resources:

CMS Brochure on PT Referrals @ cms.gov