H. D. Grumer
The College of Medicine The Ohio State University Columbus, Ohio 43210
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The Training of Clinical Chemists
W i t h the introduction of Medicare and more programs to follow, the health aspects of our national efforts have gained a new impetus. With the progress of social reforms, health care may well become a basic right of all citizens. The implementation of these reforms will not only require a greater number of clinical chemists than previously, but also more highly qualified clinical chemists, who will play a more active role in various basic and applied health investigations in their respective health centers than in the past. The modernization of the clinical chemistry laboratory requires additional skills not readily available everywhere. The greatest single handicap of the clinical chemist, has been his limited ability to communicate effectively in medical problems with his clinical colleagues. On the other hand, clinicians and pathologists, for the most part, do not fully understand chemistry-related problems. Consequently, the training of chemists should include not only analytical chemistry and biochemistry but also the chemistry of disease as well as some fundamentals of morbid and clinical pathology and bedside care, thus making it possible to communicate easily with his clinical colleagues. A good knowledge of the diseased state will enable the clinical chemist to select or develop wisely methods suitable for improved bedside diagnosis and therapy. The clinical chemist should also prepare himself to be increasingly involved in the evaluation of laboratory results. The clinical chemist's selection of methodology, biological material to be examined, and his evaluation of metabolic findings might be the major contribution to the final diagnosis. It may be expected that this development will intensify as our knowledge of biochemical disorders progresses and the clinical chemist establishes his competence in this area. Until rather recent years virtually no training facilities were available other than training by chance in the routine laboratory. The result was often a supertechnician rather than a properly trained clinical chemist. Many medical schools have a department of biochemistry of their own that, in conjunction with the central clinical chemistry laboratory of the school's hospital, can form the basis for a graduate and/or postgraduate program in clinical chemistry. Such ~
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Excerpt from Future Developments in the Training of Clinical Chemists: Symposium on Future Developments for Clinical Chemists. 20th National Meeting American Associrttion of Clinicd Chemists and 12th Annual Meeting Canadian Society of Clinicd Chemists, August 18-23, 1968, Washington, D. C. KINNEY, T. D., AND MELVILLE, R. S., The Clinical Laboratory Scientist, Lab. Invest., 20, 382 (1969).
enterprises have already taken place a t many universities and are expanding fast. (For announcements see Clin. Chem., Journal of the American Association of Clinical Chemists, under section "The Clinical Chemist.") Recently, The Duke Conference on Training for Clinical Laboratory Scientists,' has made some general recommendations of required competence for clinical laboratory scientists. They are: biochemistry, general biology, physics, physiology, general pathology, instrumentation, computer systems and data processing, statistics including quality control, medical aspects of patient care, and principles of management. If one considers the additional qualifications for specialization on a PhD level in clinical chemistry as inorganic, analytical, and organic chemistry; calculus; physical chemistry; advanced biochemistry; biochemistry of disease; hematology; microbiology; serology; electronics; drug metabolism; and research, one can only come to the conclusion that the accumulation of such knowledge with some degree of competence should he started as early as possible, that is, in a predoctoral training prpgram. These guidelines, although not new in principle, are now being incorporated into the academic curriculum at some universities. Graduate Programs Leading lo the PhD in Clinical Chemistry
How then, could one envision graduate training programs leading to the PhD in clinical chemistry? Since the academic background of the candidates entering the program may vary widely, their education should be tailored to individual needs, but the average program will require four years post-baccalaureate. The candidates should have a baccalaureate degree with a major in one of the biological or physical sciences and a good background in chemistry including physical chemistry that qualifies them to take a 1-yr course in biochemistry a t the start of the 4-yr program, followed by a course in advanced biochemistry, courses in clinical chemistry, statistics, drug metabolism and toxicology, physiology, endocrinology, general and clinical pathology, personnel management, computer science, and instrumentation. Depending on the background and experience of the candidate, the course in clinical pathology may require some additional education in general microbiology, cytology, and immunology. The curriculum should also include some informal training such as working in the clinical chemistry laboratory itself, quality control, setting up and development of procedures, automation, seminars in clinical chemistry and clinical pathology, medical grand rounds, and, wherever possible, some lecturing experience. Volume 47, Number 1 1 , November 1970
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The graduate program should be concluded by a dissertation carried out either in the clinical chemistry laboratory or in one of the research laboratories, affiliated with the hospital or a basic science department, preferably where a disease-related problem is investigated; however, analytical alternatives might be thought of in individual cases. Emphasis should be placed upon the student having close contact with clinical departments throughout the whole curriculum. Such curriculums will supply the needed manpower for clinical chemistry scientists and fulfill the requirements set forth by federal and many state laws for clinical laboratory directors. These requirements can, however, also be met by postgraduate training. Postgraduate Program for the Non-Clinical Chemist
Postgraduate training programs for non-clinical chemists have been in existence for some years. These programs permit individuals, who have a doctoral degree in the basic or medical sciences, to become familiar wit,h the principles and the organization of a clinical chemistry laboratory. This kind of training usually stresses the practical aspects of clinical chemistry and is essentially informal. It consists of seminars with residents in clinical pathology and other laboratory personnel, rotation through some special laboratories of the University Hospital as endocrinology, radioisotopes, etc. The trainees participate in the general routine work of the clinical chemistry laboratory. They are involved in setting up new techniques and in the research program of the laboratory. Courses as deemed necessary for the advancement of the trainees are also taken. The requirements of the board examination in clinical chemistry are fulfilled soon thereafter by the candidates.= Master of Science--Clinical Chemist
Somewhat more emphasis than in the past ought to be given to those students with a baccalaureate in the basic sciences and at least a minor in chemistry, who desire to complete their academic curriculum with an MS degree. Special emphasis should be placed on the training in clinical interpretation of laboratory data, electronics and instrumentation, biochemistry, biostatistics, and quality control, as well as the non-cytological aspects of hematology. Thus, these individuals would be suitable for supervision or taking charge of special and routine chemistry laboratories, depending on the size and function of these laboratories. Here is an area that universities setting up graduate curriculums
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in clinical chemistry could concentrate on before eventually expanding it to a PhD program. BS Clinical Chemists
An interesting pilot program has recently been announced by Drs. Podkieloucik and Zimmerman at the chemistry department of Seattle University. This group intends to develop an undergraduate program in clinical chemistry with mandatory courses in general, organic, physical, and nuclear chemistry, biochemistry, physics, electronics, and biology. During t,he senior year courses are offered in clinical instrumentation and methodology, as well as clinical practice or research. Some electives in the biological field, computer science and in chemistry are recommended. The concept of this education deviates from the present scheme in that a broad education in the various basic sciences is deemphasized in favor of an early training in clinical chemistry. There is no doubt that clinical chemistry laboratories can advantageously utilize these BS-Clinical Chemists as technologists in the daily routine laboratory. Research
The emphasis in the education of clinical chemists is be ideally suited to serve as an active consultant for his medical colleagues in many research problems. He himself should conduct applied or basic research in his field of endeavor. The question to be answered might be an analytical one or one might attempt to obtain a solution to a metabolic problem At any rate, new applications of the basic and medical sciences will have to be developed in the clinical chemistry laboratory for improved patient diagnosis and treatment of disease. Conclusions
The emphasis in the education of clinical chemists is a t present mainly directed toward the PhD director and scientist and to a lesser degree toward the MS supervisor. As the manpower supply of these categories over the years approaches the demands, a concurrent increase in clinical chemistry technologists will be urgently needed. With the availability of formal educational programs, the standards of the clinical chemists' profession can be expected to improve. The American Board in Clinical Chemistry is a joint venture of the American Association of Clinical Chemists, The American Chemical Society, The American Association of Biological Chemists and The American Institute of Chemistry.
