Purpose of Course
The role of laboratory testing in the practice of medicine continues
to expand. Laboratory testing includes chemistry, hematology, microbiology,
immunology, and, increasingly, DNA-based tests on blood and other
body fluids. Physicians do not need detailed familiarity with the
diverse technologies that underlie these tests. However, the need
is greater than ever for physicians to appreciate the strengths and
limitations of laboratory tests, and know how to employ them in a
cost-effective manner.
The purpose of this course is to encourage a rational, evidence-based
approach to laboratory investigation. The central thesis is that the
value of a test is a function of several variables: patient preparation,
specimen collection, analytical error, diagnostic sensitivity and
specificity, disease prevalence, and the clinical consequences of
acting upon positive and/or negative results. The course format will
be in part didactic—to review pertinent pathophysiology and to
discuss strategies—but emphasis will be placed upon the case
method approach to clinical problem-solving, with limited selective
bench-side experiences.
Course Description
This course is offered during the month of February of the fourth
year. It is given at the Health Sciences Center in Stony Brook. It
is a multi-departmental offering under the direction of the Department
of Pathology.
Course activities include:
1. Discussion of basic decision-making principles related to
laboratory tests: clinical sensitivity and specificity, prevalence,
predictive value, prior and posterior probabilities (Bayes' theorem).
2. A general discussion of test methodologies, analytical accuracy
and precision, sources of error, quality control, etc.
3. Review of the pathophysiology underlying laboratory testing
in several areas: thyroid and adrenal disease, diabetes, autoimmune
disease, infectious disease, immunodeficiencies, malignancy, anemia,
etc.
4. Selected bench-side exercises of practical importance: gram
stain, blood smear examination, tests for parasitic disease, and point
of care testing.
5. Demonstration of selected tests in the clinical laboratory,
including point-of-care tests.
6. Discussion of administrative, fiscal, and regulatory issues
in laboratory testing that are important to the physician.
7. Lectures on selected topics: immunohematology and blood
transfusion; markers of organ damage; assessment of immune status;
laboratory evaluation of drug overdose; cardiovascular risk assessment;
antibiotic susceptibility testing; appropriate specimen collection
procedures in microbiology; therapeutic drug monitoring; metabolic
bone diseases.
8. Clinical problem solving sessions covering the following
topics:
a) Electrolyte disturbances
b) Pulmonary function and blood gas analysis
c) Biochemical panels
d) Evaluation of anemias and bleeding disorders
e) Immune deficiency
f) Suspected myocardial infarction
g) Thyroid disease
h) Evaluation of the comatose and/or poisoned patient
i) Problems in drug monitoring
A course outline, together with appended reading in the form of
pertinent review, summaries and suggestions for further reading
will be incorporated in a Course Manual.
The course presupposes completion of all major clerkships.
Maximum of 35 students.
Recommended Reading
Because this is a short course in a broad, rapidly changing discipline,
the course has not been organized around a textbook. Your Medicine
textbook can serve well for much of the course. Besides addressing
application of lab tests in specific disease states, many texts
have a good general chapter on test interpretation, e.g.
"Decision Making in Clinical Medicine" in Harrison's.
Several handbooks are available that are useful references for use
and interpretation of laboratory tests. One good one is:
Tietz, Clinical Guide to Laboratory Tests, 3rd Ed., Saunders, 1995.
A good handbook that is more like a short text is:
Carl Speicher, The Right Test, 3rd Ed.,Philadelphia, Saunders, 1998.
Major texts in the field include:
Henry, Clinical Diagnosis & Management by Laboratory Methods,
20th Ed., Saunders, 2001.
McClatchey, Clinical Laboratory Medicine, Williams & Wilkins,
2nd Ed., 2001.
More specific recommended reading is given for individual sessions.
A great deal of relevant material is available on the Web, and the
course will emphasize exploring avenues of web-based learning.
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