Junior Doctors 'Don't Understand Lab Tests' - Clinical Biochemists Urge Review Of Curriculum, UK

Main Category: Biology / Biochemistry
Article Date: 03 Feb 2008 - 0:00 PDT

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The elimination of pathology and laboratory medicine from the curriculum in many medical schools and consequent lack of knowledge of basic science among junior doctors is jeopardising patient safety, says a report in the Annals of Clinical Biochemistry.

In an editorial, Dr Danielle Freedman, a spokesperson for the Association for Clinical Biochemistry, asks: "With no standardisation of the medical curriculum for the teaching of basic sciences, how will junior doctors become competent in requesting and interpreting investigations in laboratory medicine?" She points out that, although patient safety became a fundamental priority for the NHS in 2000, "most acutely ill patients are cared for by the most junior medical staff with the least knowledge and experience. Thanks to the reduction in the amount of teaching of pathology and lab medicine, these doctors have little understanding of what tests to order and how they should be interpreted."

From her own experience and that of colleagues around the UK, Dr Freedman concludes that Foundation Year 1 and 2 doctors "appear to have little concept of how tests should be used, and their role in diagnosis" and adds "many seem unaware that laboratories have staff able to help them, not only with interpretation, but also with advice on appropriate testing.

While there is very little literature to demonstrate the impact of the knowledge of basic sciences by junior doctors and its bearing on patient outcome, there is no shortage of anecdotal and circumstantial evidence. For example, Dr Freedman and many of her colleagues in the profession have seen patients who were discharged into the community only to return to hospital having suffered a major myocardial infarction (heart attack) because of a poorly-performed troponin test. "Juniors are performing tests at the wrong time, and sometimes with little understanding of what to do with the results when they get them back from the lab. Even worse, they are teaching other juniors and so bad practice is becoming ingrained."

The findings of a survey by Victoria Khromova and Trevor Gray, in the same edition of Annals of Clinical Biochemistry, demonstrate the need for additional teaching in clinical biochemistry. In the study, junior doctors felt more confident in their knowledge of when to request tests than their ability to interpret the results.

The Royal College of Pathologists is reviewing the undergraduate curriculum for pathology and laboratory medicine. "It is essential that the General Medical Council, universities and medical schools take note to protect both patients and junior doctors." concludes Dr Freedman.

Is the medical undergraduate curriculum fit for purpose? (Danielle B Freedman) and Learning needs in clinical biochemistry for doctors in foundation years (V Khromova and T Gray) are both published in the current issue of Annals of Clinical Biochemistry.

Annals of Clinical Biochemistry is published by RSM Press, the publishing wing of the Royal Society of Medicine, on behalf of the Association for Clinical Biochemistry. It is one of the leading journals in its field and is the official journal of a number of international clinical biochemistry organisations. Its editor is Julian H Barth MD FRCP MRCPath.

Founded in 1805, the Royal Society of Medicine is an independent organisation that promotes the exchange of knowledge, information and ideas in medical science and continued improvement in human health.

Royal Society of Medicine