Contents

Preface

Acknowledgements

1 Introduction to a career as a biomedical scientist

1.1 What is a biomedical scientist?

1.2 Early development of clinical laboratory sciences

1.3 Development of the biomedical science profession

1.4 Role of the IBMS as the professional body for biomedical scientists in the 21st Century

1.5 Health Professions Council

1.6 Education and training for biomedical scientists

1.7 Codes of conduct

1.8 Conclusion

2 Organization of pathology departments and the role of pathology in healthcare

2.1 Introduction

2.2 Organization of pathology departments

2.3 Staff groups within pathology

2.4 Role of pathology in healthcare

2.5 Users of the service

2.6 Evidence-based laboratory medicine

2.7 Improving the pathology service

2.8 Point of care testing (POCT)

2.9 Role of POCT in patient care

2.10 Conclusion

3 Communication for biomedical scientists

3.1 Introduction

3.2 Communicating as a scientist

3.3 Communicating as a healthcare professional

3.4 Delivering the message: applying principles of effective communication

3.5 Communication techniques

3.6 Conclusion

4 Quality management in the clinical laboratory

4.1 Introduction

4.2 Quality in pathology

4.3 Quality Control

4.4 Quality Assurance

4.5 Quality assessment

4.6 Quality audit

4.7 Clinical governance

4.8 Quality management system (QMS)

4.9 Accreditation

4.10 Factors affecting the quality of work in a pathology laboratory

5 Basic principles of working in a clinical pathology laboratory

5.1 Introduction

5.2 Working as a professional biomedical scientist in the laboratory

5.3 Flow of work in a clinical laboratory

5.4 Health and safety in the clinical laboratory

5.5 Confidentiality, the Data Protection Act 1998 and the Caldicott Principles

6 Introduction to the biomedical science disciplines

6.1 Introduction

6.2 Haematology and transfusion science

6.3 Clinical biochemistry

6.4 Histopathology and cytopathology

6.5 Medical microbiology

6.6 Liaison between pathology disciplines

6.7 Evaluation of a new diagnostic test

6.8 Sensitivity and specificity of an assay

7 Biomedical science laboratory techniques

7.1 Introduction

7.2 Haematology

7.3 Clinical chemistry

7.4 Medical microbiology

7.5 Histopathology

8 Development of knowledge and competency for biomedical scientists

8.1 Introduction

8.2 Gathering evidence of knowledge and competency for HPC registration

8.3 Continuing professional development

8.4 Professional body support for CPD

8.5 Reflective practice for biomedical scientists

8.6 Approaches to reflective practice

8.7 Critical incident analysis

8.8 Learning styles

8.9 Planning a career as a biomedical scientist; generic skills and employability

8.10 Conclusion

Index

This edition first published 2009

© 2009 by John Wiley & Sons, Ltd.

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Library of Congress Cataloguing-in-Publication Data

Pitt, Sarah J.

An introduction to biomedical science in professional and clinical practice / by Sarah J. Pitt and James M. Cunningham.

p.; cm.

Includes bibliographical references and index.

ISBN 978-0-470-05714-8 (hb) — ISBN 978-0-470-05715-5 (pbk.)

1. Pathologists—Vocational guidance. 2. Medical scientists—Vocational guidance.

I. Cunningham, James M. II. Title.

[DNLM: 1. Pathology, Clinical—methods. 2. Professional Competence. 3. Pathology, Clinical—organization & administration. QY 21 P688i 2009]

RB37.6.P58 2009

616.07023—dc22

2008044203

A catalogue record for this book is available from the British Library.

ISBN: 978-0-470-05714-8 (HB)

ISBN: 978-0-470-05715-5 (PB)

First Impression 2009

SP: For my husband Alan and my parents, John and Margaret

JC: For my partner Lesley and my family

Preface

This book is intended to help biomedical scientists undertaking their preregistration training; we aim to help them understand the important aspects of working as a professional biomedical scientist in the clinical laboratory. It will be useful for students on ‘coterminous’ or ‘integrated’ Applied Biomedical Science BSc programmes, graduate trainee biomedical scientists and other staff who need to be aware of the knowledge and competency required to be a Health Professions Council registered practitioner. The book will also help qualified staff involved in training, by providing background information, key definitions and sources of further information. It brings together the essential information into a single text and points the reader towards more detailed sources where they might be appropriate. The suggested exercises that accompany each chapter are designed to provide ideas for suitable evidence for the Institute of Biomedical Science Registration Portfolio; the trainee and trainer can work together to adapt them to the local situation.

The recently established Applied Biomedical Science degrees in biomedical science, which this book is intended to support, arose as ventures between universities and clinical pathology departments across the UK. These programmes, supported by the professional body, have in our view given rise to new levels of excellence in partnership between academics and practitioners and are proven to be ‘fit for purpose’ by providing graduates who are ‘fit to practise’ by meeting the standards for professional registration. In addition to being a resource to support student-trainees and educator-trainers, we hope that this book exemplifies the success that this closer collaboration between academics and practitioners in biomedical science has brought. As the nature of the professional skills practised by biomedical scientists evolves in response to innovations in diagnostic science and changing patterns of healthcare delivery, this partnership should be an invaluable foundation to support and shape further the future developments in healthcare science education and training.

Acknowledgements

We would like to thank our colleagues at Brighton and Sussex University Hospitals NHS Trust and the University of Brighton for their expert advice and practical assistance, especially Sarah Bastow, Lindsey Dixon, Natasha Maderson, Anne Trezise, Helen Varney, Gary Weaving and Lakshmi Yaliwal. We are also grateful to Rebecca, Luke and Katherine Hulatt, Christopher Dark, Georgina Ellis, Ewan Lomax, Lynnsay Fuller, Sylvia Meisenberg, Andrew Parr and Anna Tarasewicz for contributing to the photographs. Particular thanks are due to Dr Alan Gunn for his support by providing suggestions for the text and supplying some of the figures, along with tireless proof-reading. We would also like to thank Rachael Ballard, Fiona Woods and their colleagues at John Wiley and Sons for their help and guidance.

1

Introduction to a career as a biomedical scientist

1.1 What is a biomedical scientist?

Biomedical scientists are scientifically qualified, registered practitioners who work in clinical pathology departments. They play a vital role in patient care, by carrying out diagnostic tests on samples such as blood, tissue and urine. As healthcare professionals, biomedical scientists work with a range of staff in hospitals and in primary care, to provide clinical laboratory services. About 70% of clinical diagnoses rely on pathology test results. This means that the laboratory work must be performed to the highest possible standards, that the correct specimen type from the right patient must be tested and that the results must be available, to the staff treating the patient, in good time.

Pathology test results are used to:

Diagnose illnesses. For example, a person with symptoms of tiredness and dizziness might be suffering from iron deficiency anaemia, which could be confirmed by a blood test for haemoglobin concentration.

Monitor conditions. For example, blood HbA1c levels are regularly monitored in diabetic patients to check that their blood sugar levels are well controlled.

Screen for diseases in people who are at risk of having the condition, but do not appear to be ill, such as the test for Chlamydia infection.

The laboratory testing is performed or supervised by registered biomedical scientists (Figure 1.1), so although they do not have as much direct contact with patients as doctors and nurses, their contribution is vital. If there were not enough nurses available in a particular hospital, individual wards might have to be closed, whereas with insufficient biomedical scientists to run the pathology service, the work of the whole hospital would be compromised. Since the main role of biomedical scientists is to choose the most suitable testing method and then carry out the laboratory work accurately, it is clearly important that they are well trained and work to the highest standards at all times. This means that after the initial training, biomedical scientists have to continue to learn new techniques and keep up to date with scientific advances.

Figure 1.1 (a) Biomedical scientists discuss the operation of a laboratory analyser. (b) Biomedical scientists examine slides prepared from patient samples under a light microscope

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