Medical Education in the Clinical Microbiology Laboratory
The clinical microbiology laboratory can and should play an enormous role in medical education in teaching hospitals, as well as for community learners, like young adults interested in science careers. Providing laboratory-based education is not a superfluous activity; it is a critical element to providing high-quality patient care, encouraging community involvement and fostering multi-disciplinary collaboration.
The Need for Microbiology Education
The field of microbiology is constantly evolving, a characteristic that makes it exciting for professionals in the field and requires that both microbiologists and clinical professionals continue to learn throughout their careers. However, this attribute can serve as a challenge for preclinical educators, who struggle to keep up with the evolving landscape of microbiology. Now more than ever, collaboration with clinical laboratories is essential to the delivery of relevant and timely microbiology education for clinicians. A 2017 survey of over 200 nurses demonstrated that knowledge of microbiology is essential to the field of nursing, and although deemed highly necessary, has been broadly removed from nursing school curricula (ASM released Microbiology in Nursing and Allied Health Curriculum Guidelines in 2018 to address this issue). Additionally, knowledge of proper test use and interpretation is imperative to successful diagnostic and antimicrobial stewardship and microbiologists are uniquely qualified to teach this subject matter. In fact, the Centers for Disease Control (CDC) defines clinical education as one of the key elements of a hospital antimicrobial stewardship program.
Providing laboratory-based education isn’t just good for optimizing clinical care. It improves morale and communication between clinicians and the laboratory staff, as well as builds credibility and respect for clinical laboratory scientists. Having clinical microbiologists actively involved in educating clinicians helps build their confidence and encourages healthy collaboration. Through the teaching process, microbiologists are encouraged to continue learning and honing their skills in the spirit of teaching others, and clinicians learn key lessons in microbiology, while also gaining a better understanding of what happens in the laboratory.
Offering Education as a Community Benefit
Depending on the type of teaching offered, clinical education may be considered a community benefit. Community benefit is a type of service offered by nonprofit hospitals that addresses health-related needs. Because nonprofit hospitals are tax-exempt, they are expected to provide services and programs that benefit the communities they serve. If a clinical laboratory that is a part of a nonprofit hospital is providing education to clinicians that is not a required component of their medical training, it may be considered community benefit. Additionally, any uncompensated microbiology education provided to individuals outside of the hospital (i.e., youth interested in science) is considered community benefit. Since documented community benefit activities are directly related to the hospital’s tax exemption, offering education as a community benefit might be a way to help justify dedicated microbiologist teaching time.
Offering Microbiology Education in the Clinical Lab
Finding the time, staffing and support to provide education can be challenging for laboratories. However, it is possible to provide effective programs with relatively little effort. As the education coordinator of microbiology at a large pediatric hospital for many years, I learned several tricks that helped me offer meaningful content while working in a very busy laboratory:
Teaching Can Be for Anyone Who Is Interested in Teaching
Microbiologists who work on the bench are already the best people to talk about organisms and how they are tested for in the laboratory. If a bench-level microbiologist is interested in teaching, chances are they will be good at it. Provide training so that teaching methods are consistent, but don’t reserve teaching for only managers, supervisors and directors. Allowing bench-level microbiologists to teach improves morale, fine tunes their technical and communication skills and makes the laboratory more dynamic. Additionally, microbiologists can earn continuing education credit for teaching in the clinical setting.
Make It Routine
I offered a mini-microbiology course once a month and capped how many people could attend. This way, I always knew how many students I had and was committed to a routine I was familiar with. I would sign individuals up as they came through microbiology rounds in the laboratory each morning.
Have a Core Curriculum and Stick to It
It can be a lot of work to develop a microbiology curriculum, so once that is designed, stick with it unless something needs to be updated or changed. Make a “teaching packet” that learners fill out as they learn. This ensures they have something to take with them, but also that laboratory educators are sticking to the same material.
Use What You Have!
Clinical laboratories always have cultures of quality control organisms available. Sub-culturing these organisms the day before a course so that the learners have fresh cultures to work with can be a great way to give learners a hands-on experience with minimal effort. Additionally, if there are inexpensive supplies available (extra catalase reagent, Staphylococcus latex reagent, oxidase reagent), using these during the course to demonstrate important reactions is informative and impactful. Gram stains of organisms can be made from quality control cultures (so you don’t have to wait for the perfect patient specimen to arrive and make a duplicate of it), and 1-2 sets can be made and stored for repeated teaching use. If feasible, clinical Gram stains can be coverslipped and saved for future teaching use as well.
Tie It All Together
Ideally, laboratory-based education uses a clinical case to explain the importance of a microorganism, as well as the laboratory tools used to identify it and perform susceptibility testing. For example, the clinical scenario of a patient with urinary tract symptoms could be used to teach about how urine cultures are plated, how organisms are quantified from culture, what the Gram stain might look like and how automated susceptibility systems are used.
Modern Teaching Toolkit
As long as patient privacy is respected and cases are fully de-identified, using the internet to educate fellow medical professionals can be highly effective and far-reaching. This can be particularly effective if laboratory staff have time to summarize an interesting case and upload pictures of plates or slides (Gram stain or pathology images). Consider these options for using the internet for teaching clinical microbiology:
There are a variety of free blogging platforms that make it easy to publish content in a flash. Dr. Bobbi Pritt (Chair of the Division of Clinical Microbiology and Director of the Clinical Parasitology Laboratory at Mayo Clinic) runs a beautiful example of this on her Creepy Dreadful Wonderful Parasites blog, which she regularly updates with clinical parasitology cases and grotesque (but fascinating) images.
Build A Dynamic and Interactive Website
This option takes a lot more work on the front-end and may require more maintenance, which may not be feasible for busy clinical labs. However, this option allows the educator to publish educational content and interact with users through message boards, chats or online quizzes. During my time running the educational program in the microbiology lab, I built a website that housed didactic content, as well as an online version of our in-person microbiology course that could be taken on demand. Although the site took a significant amount of time to build, it served as a wonderful education option when demand for the course was high and staffing was limited, allowing us to provide lab-based education online any time. Additionally, coordinating with a university that already has a learning management system in place (like Canvas LMS) can serve as a more time-friendly option. Lastly, building a website is not as hard as it sounds! There are many free and easy-to-use platforms that make website-building a breeze.
Make Graphics that Succinctly Summarize ContentNo time to write up a blog or build a website? No problem! There are a variety of free services, like the platform Canva, that allow you to quickly create graphics and save them. This may be a great option for visual learners or learners preparing for board exams. Some templates even allow you to make custom posts for social media sites like Instagram and Facebook.
If you haven’t already heard, the clinical microbiology, pathology and medical education communities on Twitter are thriving. While Twitter serves as a great way to communicate with scientists across the globe, it turns out it is also a very effective teaching tool. Twitter can be used to showcase uncommon bacterial species, teach key clinical pearls, run a journal club, share research and collaborate.
— Andrea Prinzi SM(ASCP), MPH, CPH🧫🔬 (@andreaprinzi) September 21, 2020
As diagnostic technologies and methodologies within clinical microbiology continue to evolve, the role of the clinical microbiology lab in educating clinicians and fellow clinical lab scientists about important diagnostic concepts is imperative. Thinking creatively about how to provide this education will help advocate for the role of the lab, improve job satisfaction and essential microbiology knowledge for lab scientists and help to optimize clinical care for patients.