Resident Manual

Three Month Resident Rotation in Microbiology

General Objectives

The resident should gain sufficient knowledge at each workstation to: (1) understand the basic functions at this workstation; (2) have the capability to perform these basic functions under supervision, as judged by the Medical Director of the Microbiology Section.

The resident should review daily with the workstation technologist as many gram smears as possible (at least 50%). In addition, the resident should observe all special procedures, i.e. MIC's, etc. as they arise.

The resident will provide interface with other services when special patient care problems arise. This will be done under supervision of the Medical Director of the Microbiology Section.

The resident will meet daily with the Medical Director of the Microbiology Section to review and discuss daily reading assignments, as well as interesting problems observed at each workstation.

Under supervision of the Medical Director, the resident will attend conferences and rounds in the Division of Infectious Disease.

Under supervision of the Medical Director of the Microbiology Section, residents will also undertake special projects, where possible, in developmental microbiology, laboratory management and cost containment. These projects will provide an introduction to service functions performed by the Medical Director of the Microbiology Section in a community hospital and/or university teaching hospital.

WEEK 1   PROCESSING STATION

• Read planting manual; become familiar with processing and general workflow of specimens.
• Be familiar with labelling policy and use of verification form.
• Stain Gram smears.
• Prepare and read India Ink smear.

WEEKS 2 - 3   URINE/SEND-OUT STATION

• Read urine manual; become familiar with reading and reporting cultures.
• Review all tests sent-out; become familiar with collection and transport criteria.

WEEKS 4 - 5   RESPIRATORY STATION/VITEK INSTRUMENT

• Read respiratory manual; become familiar with reading and reporting cultures.
• Read Gram smears.
• Read Vitek identification and sensitivity manuals; observe setting up of cards. Be familiar with release of ID and sensitivities. Review Vitek Sensitivity QC Program.
• Read Legionella manual; observe DFA procedure.
• Review microbiology routine quality control procedures.

WEEKS 6 - 7   BLOODS/ANAEROBES STATION

• Read blood manual; be familiar with workflow and work-up of positives.
• Read anaerobe manual; be familiar with work-up including the current species identification procedures in use.
• Read Gram smears.
• Read anaerobic susceptibility procedure; observe setting-up and reading test.
• Read microscan MIC susceptibility procedure; observe setting-up, reading and reporting test.
• Read Schlichter procedure; observe setting-up, reading and reporting test.

WEEKS 8 - 9   WOUND STATION (includes body fluids, stools, and gential cultures)

• Read manuals; become familiar with reading and reporting cultures.
• Read Gram smears.
• Be familiar with manual enteric and non-enteric identification kits.

WEEK 10   AFB/FUNGUS STATION

• Read manuals.
• Be familiar with AFB concentration procedure and general workflow.
• Observe KOH and LPCB procedures
• Be familiar with all AFB stains.

WEEKS 11 - 12   SEROLOGY AND SUMMARY

• Read ANA and RPR procedures; observe setting-up and reading of tests.
• Review those stations and tests where training may have been incomplete.

Required Reading for Residents in Clinical Microbiology

1. Jawetz, E., Melnick, J.L., Adelberg, E.A. (1984). Review of Medical Microbiology, 16th ed., Los Altos, Ca, Lange Medical Publications. This book is revised and re-edited every two years, so it is essential that the latest edition be acquired.
2. Koneman, E.W., Allen, S.D., Janda, W.M., Schreckenberger, P.C., Winn, W.C. (1992). Color Atlas and Textbook of Diagnostic Microbiology, 4th ed., Philadelphia, J.B. Lippincott.

Supplemental Reading

1. Balows, A., Hausler, W.J., Jr., Herrmann, K.L., Isenberg, H.D., Shadomy, H.J. (1991). Manual of Clinical Microbiology, 5th ed., Washington, D.C., American Society for Microbiology.
2. Baker, R.D., Callaway, J.L. (1971). Manual of Clinical Mycology, 3rd ed., Philadelphia, W.B. Saunders.
3. Chatterjee, K.D. (1974). Parasitology, Protozoology and Helminthology, 9th ed., Calcutta. (Available in Dr. Appelbaum's office only).

Recommended Journals for Reading in Clinical Microbiology

1. New England Journal of Medicine
2. Lancet
3. Journal of Infectious Diseases
4. Reviews of Infectious Diseases
5. American Journal of Clinical Pathology
6. Annals of Internal Medicine
7. Journal of Clinical Microbiology

General Duties of Residents in Clinical Microbiology

1. 8:00 a.m. - 10:30 a.m.: rotate through work stations with technologists
2. 11:00 a.m. - 11:30 a.m.: read plates with section head
3. 1:30 p.m. - 2:00 p.m.: daily discussion with section head: this will range over the entire range of Clinical Microbiology (including mycology, parasitology, and virology), and cover all essential information for the Boards and for later running of a laboratory. The subject of the talk will be known the previous day, so that adequate preparation will be possible.
4. In non-specified times, time is spent solving problems with clinicians, and in the developmental project which is chosen by the section head. Also, where necessary, Gram-stains are read and problems discussed with technologists.

NOTE: Daily reading assignments will be made from the two required texts. The resident will have an opportunity to discuss this material, as well as experience at workstation, during daily meetings with the Medical Director of the Microbiology Section.

Additional reading assignments may be made from the supplemental texts and recommended journals.

Evaluation

During the first day of rotation, the faculty supervisor will: Review objectives with the resident; provide an orientation to the section; provide a "pre-test" examination that includes the material to be learned during Microbiology rotation. The resident will have an opportunity to "score" this examination and to identify areas for further study.

At the end of each week, the faculty supervisor will discuss with the resident his/her progress toward meeting objectives and will make suggestions for improvement if any problems are noted.

During the last week of rotation, the faculty supervisor will provide a "post-test" examination that will be graded. The faculty supervisor will discuss with the resident results of this examination. The faculty supervisor also will: (1) prepare a written subjective evaluation, noting apparent strong points and suggested areas for improvement; (2) review this written evaluation with the resident; (3) forward a copy of this evaluation to the Division Chief.

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