STP IACC Domain 2 – Scientific Practice example

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I have gained knowledge and practical skills in many qualitative and quantitative methods used in laboratory medicine (SLS100:4, SLS103:4). This has established a good breadth of knowledge and shows my abilities in standard 2.1.3. However, when I first started shadowing the duty biochemist role and reflected on these sessions (SC110:13), I realised gaps in my knowledge in some of the analytical methods specific to clinical biochemistry. Therefore prior to starting on the duty biochemist rota, I further enhanced my knowledge of automated and manual analytical methods. One way in which I did this was through completing multiple assay verifications for the biochemistry service, demonstrating 2.2.4 and 2.2.5. These verifications necessitated an understanding of the underlying principles of methods in order to design assay verification experiments and interpret the verification data (SC110:22, SC110:23). These efforts to improve my analytical knowledge were beneficial in a variety of technical situations I subsequently encountered as duty biochemist. For example, I was contacted by a consultant paediatrician regarding an ammonia result that had been withheld due to haemolysis. After discovering the paediatrician’s primary aim was to exclude a metabolic condition by showing the absence of substantially elevated ammonia, I provided the numerical result (SC110:26). I faced a similar situation after a consultant haematologist requested urate measurement on an icteric sample to guide treatment dosage, which I also agreed to provide the numerical result for. However, I explained clearly to the clinicians in both instances that it is difficult to predict the effect of the interferences on the true result and recommended a repeat sample, exemplifying my capabilities in providing scientific and technical advice (2.1.2, 2.2.1). I felt confident making these decisions due to technical knowledge I had developed of analytical methods and the effect of common interferences on different analytes (2.2.3).

Development of my scientific and technical knowledge base has also had transferable benefits in my handling of other situations, for example in dealing with a 25-hydroxy Vitamin D result of 1190 nmol/L I encountered. For a variety of reasons, some of which are discussed in (SLS126:DOPS13), I wondered whether assay interference could be a factor. I therefore sent the sample for analysis by a different immunoassay platform and by mass spectrometry (SLS126:DOPS13), which both also indicated high levels. Nonetheless, this highlighted to me the specific analytical investigative strategies that can be useful in the investigation of immunoassay interference (2.1.1).

Another situation that proved useful for me in understanding the utility of specific investigative strategies, though in a more clinical context (2.1.1), was another clinical case I became involved in. The case was of a young woman presenting with chronic hypokalaemia who had been investigated for months and no definitive diagnosis had been ascertained. Following a detailed review of the patient’s serum and urine biochemistry, I suspected vomiting could be the underlying cause to which a biochemist colleague recommended further urinary investigations. The results revealed uncoupled sodium and chloride excretion, specifically elevated sodium to chloride ratio which is a lesser-known biochemical characteristic of vomiting (2.1.6). This investigative strategy helped establish the diagnosis of vomiting, and was appreciated by the clinicians since they had also suspected self-induced vomiting despite the patient’s strenuous denial. Furthermore, the biochemical evidence provided by the additional urinary investigations contributed to the patient agreeing to psychiatric assessment after months of refusing. Showing my commitment and enthusiasm to communicate innovative approaches in my discipline, I subsequently published this case as lead author in a laboratory medicine journal and presented the case at local and national meetings (SC110:8, SC110:25), exemplifying 2.1.5.

Regular training and contribution to departmental quality management has also been a key aspect in the development of my scientific practice. Duties and responsibilities in this role have included the assessment of external quality assurance performance (SC110:23, SLS125:DOPS11), report generation for IQC measurement uncertainty data, and statistical analysis for method verifications (SC110:23), all of which demonstrate 2.3.1, 2.3.2, 2.3.3, and 2.3.4. Completing health and safety competencies has also highlighted the importance of practices such as risk management in the overall laboratory quality management system (SC110:17), showing my knowledge in standards 2.2.7 and 2.2.8. One experience in particular that illustrated first-hand the importance of risk management was a discussion I had with our laboratory manager regarding liquid nitrogen disposal. They questioned the safety of my disposal method, and suggested an alternative method different to that which I had been taught, but also different to that written in standard operating procedures (SOP). In hindsight, I realise I should have identified the risk involved myself and sought clarity on proper disposal. Ultimately, I took full responsibility, and offered to improve the SOP protocol (2.3.4). This event was a learning experience for me in questioning taught practices and the need to step back from the complexities of situations and identify and manage potential risks, behaviours I will be sure to apply in my future practice.

Last updated on 19th May 2022