Wednesday, January 11, 2012

So You Want To be a Medical Technologist - Practicum Tips






So you have entered the medical technologist program, and are about to embark on your first practicum, away from your classmates and familiar environs. You've arranged a new place to live for the quarter (as most practicums at BCIT and NAIT are speckled throughout B.C and Alberta), and are armed with your Blue Book of Learning Requirements. For some of you, this will be your first foray into a workplace.

Welcome.

Some things to remember though about your soon to be teachers.

Teaching technologists are a thing of the past.

All technologists showing you the ropes will be expected to do so on top of holding their regularly scheduled benchwork. The majority of us will not be paid for teaching you during your practicum. Those that will, will be paid at most an extra three dollars a day (oh, wonderful 0.30/hr differential). If they are to do a through and useful job teaching you, you can bet they have put in time at home to prepare lesson plans, review sheets, and to dust off the hows and whys to explain things they know bone deep. They will have shown up five or ten minutes early to plan out the day's work, pull some interesting cases for you, and figure out how to fit giving you the most experience as well as the odd rare test (oh, fecal meat fibres) into the schedule. In return for this, they expect three things.

1) Respect for the fact that they are taking the time to do so.
2) That you listen, learn, and review pertinent theory before time if asked.
3) That you follow instructions.

They are, for the most part, not millenials. The style of discourse you may be used to among your peers (and to your parents) is not found in this particular work environment. Talk-back, whining, or arguement when your instructor or section head asks you to do something is both unappreciated and will frankly prejudice against your hiring (and your school's students being accepted back) for in the future.

After putting in said thought, it highly irks to give instructions for a student to help out for a few minutes with a skill they have already mastered, and be met with talk-back and stated entitlement of Learning All Teh Time. Simple logic states that if you want more of your teacher's time to help walk you through doing new things, the workload must be met too. Loading samples onto machines, or aliquoting tubes under supervision can help make that twenty minutes to talk about fluid pH theory, or to learn how to troubleshoot an osmometer. What is helpful is having two or three topics you want to cover in your head, so if we have a spare ten minutes, you can bring that up and we can plan that into the day.

Your Blue Book:

Yes, we are aware you have one. Every program sends their students with some version of competency requirements. We absolutely do not want you to bring the book to every bench day. As it must be returned to your practicum supervisor at the end of the three years, we want to keep it non-biohazardous. ^^ Ideally, you would bring it on your second to last day on each area, so we can then zero in on anything not covered during the usual process.

Appropriate Dress:

In general, scrubs are safe. Some labs allow street clothing, if gowns are worn overtop, and others prefer business casual. All of these work.

Do not wear shirts with obscenities on them, revealing clothing such as tube tops or shortie-shorts, or flip flops. You may think that an obvious statement, but we've had to memo two separate schools for students thinking "casual" meant variations of club-wear.... And flip flops will not protect you if you drop a glass tube on your foot. Think professional.

Break Times:

Finally? Each department generally has a break schedule of where they go each day. Take at least the first few days and follow along to get to know people, and how the department functions. Show off your social skills, and that you can fit in. After those few days, feel free to eat where you want, but if you don't follow your trainer to where ever the pack eats, people will think you are stuck up, socially maladusted, or simply not remember you from the multitude of other students coming through. All are negatives when it comes hiring time.

[Case Study] Bright Green Urine




Patient A is admitted for cardiac surgery on January 10. All his pre-op chemistry tests are normal, and he is cleared for surgery. His surgery is sucessful, and post-op blood and urine samples are submitted to check his status. His urine sample immediately drew notice upon arrival to the lab. Upon analysis, the urine showed:

Colour: Bright Green
Clarity: Clear
pH : 5.5
Specific Gravity: 1.015
Leukocytes: Negative
Hemoglobin: Trace
Protein: Negative
Ketones: Negative
Urobilinogen: Negative
Nitrite: Negative

Microscopic analysis confirmed the occasional red blood cell and 6-10 epithelial cells. No bacteria were seen.

The pre-operative urine sample was pulled, and the colour was a normal clear yellow with normal results.

But what was causing the urine to be so oddly coloured? Was it clinically significant? Upon investigation, the ward confirmed sample quality and a list of possible causal drugs were produced. Among those drugs was a short-acting, intravenous sedative-hypnotic agent by the name of Proprofol (Diprivan). Used to induce and maintain anesthesia or sedation, one of the more infrequent side effects (in < 1%) from Proprofol is a production of bright green urine. It is not clinically significant, and the colour change is known to cease once the proprofol is discontinued.

Other more common causes of the colour change are:

  1. Methylene Blue: (Blue + Yellow = Green): used in treatment of malaria (third world countries due to cost), methemoglobinemia, cyanide poisoning, and cancer. Also a component of an older urinary analgesic.
  2. Pseudomonas infection: This produces a deeper, forest green colour with a grapey smell.
  3. Dietary changes: Examples are excess quantities of Clorets or Blue Listerine
  4. Magnesium Silicate (Doan's pills): A NSAID used for back pain. OTC medication.
  5. Medical imaging: Some dyes such as biliverdin are used to assist in in vivo scanning.



Medscape has done an article on similiar cases here.
Link