Learning molecular pathology during residency

[deschutes]

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I'm going to rehash my role as being the asker-aloud of stupid questions in residency and stand up for the flak:
"What are the goals and objectives of a rotation in molecular pathology?"

At this point I feel like even if I've never seen an assay before, I have an approach, i.e.
(1) look at the controls and the water
(2) if all looks fine, look at the specimen result and compare with the controls
(3) if it looks like the positive control, it's positive. if it looks like the negative control, it's negative.

But now I'm like, 😕
Isn't there more to this? Are people doing "little" projects like bringing on new assays during their time on molecular? Because apart from T/B gene rearrangements, I don't know that a lot of this necessarily requires an M.D.

 

[yaah]

Our molecular lab director is relatively new. His idea is to get residents involved somewhat in bringing up new assays (or evaluating various aspects of it). But his theory on molecular is that basically it is easy once you know the basics. People run molecular labs in private practice with very little training and they do a competent job of it.

But yes, I would say adequate molecular training allows you to understand basic principles as well as understanding the importance of controls and following the directions (for kit-based assays).

A main hurdle for residents in molecular is simply confidence with terminology. Most of the assays are straightforward to interpret once you get familiar with them.

 

[b&ierstiefel]

I'm going to rehash my role as being the asker-aloud of stupid questions in residency and stand up for the flak:
"What are the goals and objectives of a rotation in molecular pathology?"

At this point I feel like even if I've never seen an assay before, I have an approach, i.e.
(1) look at the controls and the water
(2) if all looks fine, look at the specimen result and compare with the controls
(3) if it looks like the positive control, it's positive. if it looks like the negative control, it's negative.

But now I'm like, 😕
Isn't there more to this? Are people doing "little" projects like bringing on new assays during their time on molecular? Because apart from T/B gene rearrangements, I don't know that a lot of this necessarily requires an M.D.

Along the lines of what yaah said, there are some texts out there that describe your typical molecular tests, issues in how the assays are done, and how they're signed out. This will familiarize yourself with terminology too. A lot of molecular involves quality control, for obvious reasons, and a lot of the tests are kit-based. No, you do not need an MD to "do" any of these tests. The MD would help to understand the clinical context in which the test is performed.

Maybe I buy you one for the holidays (plus, I really appreciate the Prokofiev book you got me for my b-day...sightread the first few sonatas...they're gonna be a bitch to learn!).

 

[deschutes]

Thanks. I've been trying to not lose sight of the big "clinical correlation" picture going through this rotation. While I could envision boards asking questions like, "What is the role of sonicated salmon sperm DNA in molecular techniques?", I'm finding it more difficult to determine just how much I'm supposed to know about say, primer design and hairpins, and the relative merits of the Invader assay vs. branched DNA.

Bier, you're welcome... though you might as well save the money and get me a nice wedding gift instead.

(Not tongs, please.)

 

[b&ierstiefel]

Thanks. I've been trying to not lose sight of the big "clinical correlation" picture going through this rotation. While I could envision boards asking questions like, "What is the role of sonicated salmon sperm DNA in molecular techniques?", I'm finding it more difficult to determine just how much I'm supposed to know about say, primer design and hairpins, and the relative merits of the Invader assay vs. branched DNA.

Bier, you're welcome... though you might as well save the money and get me a nice wedding gift instead.

(Not tongs, please.)

That's a deal! Tongs are lame gifts anyway...it's your damn fault if you put tongs as items in your registry anyway Tongs? Seriously? WTH?

 

[yaah]

deschutes is getting married?

 

[b&ierstiefel]

deschutes is getting married?

Indeed she is. Where the hell have you been? Just kidding... 🙂

 

[GeoLeoX]

back in the day the Assoc for Mol Path published guidelines for residency programs. i have the reference printed out (though i don't know where it is and my pubmed-fu has failed me this evening). i think that it was in AJSP or Archives between 1996-2000. i'll look some more, but it's high time to update.

 

[jayman]

Along the lines of what yaah said, there are some texts out there that describe your typical molecular tests, issues in how the assays are done, and how they're signed out. This will familiarize yourself with terminology too. A lot of molecular involves quality control, for obvious reasons, and a lot of the tests are kit-based. No, you do not need an MD to "do" any of these tests. The MD would help to understand the clinical context in which the test is performed.

Maybe I buy you one for the holidays (plus, I really appreciate the Prokofiev book you got me for my b-day...sightread the first few sonatas...they're gonna be a bitch to learn!).

Would you happen to know off the top of your head any names of said texts on molecular tests? Thanks!

 

[GeoLeoX]

Would you happen to know off the top of your head any names of said texts on molecular tests? Thanks!

The new Debra Leonard book is excellent. Also, CAP has a guideline for the reporting of molecular test results.

 

[Ale]

Book
Molecular Diagnostics William B. Coleman Gregory J. Tsongalis 2nd ED
ISBN 1-58829-356-4

Smith BR, et al Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal. Am J Clin Pathol. 2006 Jun;125 Suppl:S3-37.
PMID: 16830955
Goals and objectives for molecular pathology education in residency programs. The
Association for Molecular Pathology Training and Education Committee. J Mol Diagn. 1999 Nov;1(1):5-15.
PMID: 11272908

 

[GeoLeoX]

Book
Molecular Diagnostics William B. Coleman Gregory J. Tsongalis 2nd ED
ISBN 1-58829-356-4

Smith BR, et al Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal. Am J Clin Pathol. 2006 Jun;125 Suppl:S3-37.
PMID: 16830955
Goals and objectives for molecular pathology education in residency programs. The
Association for Molecular Pathology Training and Education Committee. J Mol Diagn. 1999 Nov;1(1):5-15.
PMID: 11272908

nice work.