IFCC Professional Scientific Exchange Program (PSEP)

My experience at Emory University School of Medicine, Atlanta, US,
by Harsh Vardhan Singh,
Consultant Biochemist, Department of Pathology, Hindu Rao Hospital, Delhi, India

The healthcare sector is transforming each day. For advances to occur in the diagnostic field, medical laboratory professionals are required to be well versed in quality so that their advancement is achieved in an effective manner. To this end, I am extremely happy to write about my experience at Emory University School of Medicine, Atlanta, GA, and testify that my sojourn has improved my understanding of laboratory medicine.

I was given the opportunity to work under the supervision of Dr. Ross Molinaro (Medical Director, Emory University Hospital Midtown, Atlanta, GA, USA, Co-Director, Emory University School of Medicine, Emory Clinical Translational Research Laboratory) from July 1^st to September 2^nd, 2011. Dr. Molinaro introduced me to Dr. James Ritchie, the Associate Director of Emory Medical Laboratories, who also guided and helped me during my training period. I was given the opportunity to work both in the core laboratory of the CLIA-certified Emory University Hospital and in Dr. Molinaro's CLIA certified clinical research laboratory.

My objective was to better understand the processes involved in Total Quality Management (TQM) from a CLIA certified laboratory standpoint. My exposure to an environment conducive to high-level process improvement, method development, troubleshooting and quality systems provided me with (a) new knowledge and skills in quality management as applied to laboratory testing in healthcare, and (b) the ability to complete clinical research studies for better outcomes in disease management.

My active participation in the development, validation and application of a tandem-mass spectrometry method for the measurement of serum testosterone led to an abstract accepted for presentation at the Mass Spectrometry: Applications to the Clinical Lab (MSACL) annual meeting in 2012. This hands-on project allowed me to better appreciate issues in project management, method development, quality control processes and other documentation skills.

I could also participate to a project aiming at 1) Improving the turn-around-time (from specimen collection to result reported) with the Emergency Department; 2) Mapping out the Emergency Department procedures to determine gaps in laboratory service; 3) Assessing the Emergency Department physician's satisfaction status. Discussions on the causes of delays in reporting results helped reduce turnaround time in the Emergency Department.

I also worked with Dr. Molinaro on evaluating the current usage of HbA1c testing at Emory University Hospital Midtown, and whether physician ordering followed current recommended guidelines of the American Diabetes Association (ADA). The observed over-utilization and non-adherence to current ADA practice recommendations, led to tutoring clinicians to help them better understand 1) the clinical utility of HbA1c and 2) the caveats of HbA1c interpretation in the presence of hemoglobin variants.

Finally, I contributed with Dr Molinaro to a retrospective analysis that helped to reduce the number of microscope slides reviewed by medical technologists in the clinical laboratory. The results of this study have been submitted as an abstract for the 2012 American Association for Clinical Chemistry (AACC) Annual Meeting in Los Angeles, CA, USA.

Being at Emory, I was able to attend the 2011 AACC Annual Meeting held in Atlanta and participate to the Society for Young Clinical Laboratorians (SYCL) reception where I met with several clinical chemists and laboratory professionals who, like me, are early in their careers.

My stay at Emory University fulfilled my main objective and allowed me to obtain experience in quality control, method validation, test utilization, quality planning and quality assurance as applied to laboratory testing in health care. It also enabled me to plan, implement, and evaluate management principles and practices effectively.

Acknowledgment
I would like to thank Dr. Molinaro for hosting me at Emory University and granting me access to his clinical research laboratory and to the Emory Hospital core laboratory. I am grateful to Dr. Jeanne Rhea, Post-Doctoral Research Fellow in Dr. Molinaro's clinical translational research laboratory, Mr. Bradford Burgett, research technologist, who both assisted me with my projects and helped to make my visit at Emory a success. I am also thankful to Dr. James Ritchie for the help he provided to me during my stay at Emory, and Ms. Cynthia Rikard, Quality Control Coordinator for Emory Medical Laboratories, for taking the time to sit with me and discuss quality control management. I am extremely grateful to Dr. Jocelyn Hicks, Past-President and Dr. Graham Beastall, current IFCC President for supporting the Professional Scientific Exchange Program that has not only allowed me to achieve my goals described above, but also will enable me to move laboratory medicine forward at my own institution.

From left to right: Dr. Jeanne Rhea, DR. Molinaro Ross, Dr. Harsh Vardhan Singh

My sabbatical leave at the Vita-Salute San Raffaele University, Milan, Italy,
by Dr. Mabel A. Charles-Davies
Immediate Past IFCC National Representative (Nigeria),
Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.

INTRODUCTION
The purpose of spending my sabbatical period in Prof. Maurizio Ferrari's laboratory was to improve my capacity of applying advanced technologies, particularly molecular biology, in the of diagnosis of diseases, and in research in the field of reproductive endocrinology. My exposure to the 'state of the art' molecular biology techniques in Prof. Ferrari's Laboratory has allowed me to fulfil my dreams and aspiration. My attendance at the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) course in Molecular Biology in Milan in 2006 was intended to achieve the above objective but time was short, and facilities were then unavailable in our laboratory to continue with what was learnt.

EXPERIENCE
In the last few months, I have been through various aspects of molecular diagnosis of 21β-hydroxylase enzyme deficiencies. Southern blotting and hybridization as well as polymerase chain reaction (PCR) and sequencing were applied after having extracted deoxyribonucleic acid (DNA). Observation and hands-on experience in the various phases of this process have greatly improved my confidence in the use of these techniques. These analyses require top quality controls and laboratory safety, to which the staff strictly adheres. The environment and friendly atmosphere are conducive to the success of the laboratory. I am now applying what I have learned to the molecular diagnosis of azoospermia. I designed the required primers and I am presently setting the conditions for multiplex PCR.

On the social side, hospitality and courtesy are part of the ltalian culture. I found everyone friendly and ready to help, even not convenient. My enrolment in an Italian school for foreigners 2 hours a week greatly enhanced my interaction with others, particularly outside the laboratory where English language, my mode of communication, is scarcely understood.

COLLABORATION
This Professional Scientific Exchange Programme was the beginning of a true collaboration between my institution, the University of Ibadan, and the Vita-Salute San Raffaele University, Milan, Italy.

RECCOMMENDATION AND CONCLUSION
I recommend the continuation of the IFCC PSEP program in settings with advanced technologies, in particular for individuals from developing countries. This will, beyond courses organised by the IFCC both within and outside their countries, build capacity and increase confidence in the use of advanced technologies in their laboratories. The additional knowledge and experience I have gained in Milan will impact on my colleagues and students, and the Association of Clinical Chemistry of Nigeria (ACCN).

AKNOWLEDGEMENT
I am very grateful to the IFCC for granting me the PSEP. It was financially very stressful before this aid, because of the relative cost of transportation and accommodation between Nigeria and the European Union.

I must extent my wholehearted thanks to Prof. Maurizio Ferrari, who generously opened his doors, and offered his staff and facilities in the development of my career. I am particularly grateful to Dr. Paola Carrera (in charge of my training) and Dr. Mascia Di Marzio (who supervised my hands-on experience in 21β-hydroxylase enzyme work, including interpretation), and the whole laboratory staff of the Department of Molecular Biology and Cytogenetics for their assistance and friendliness. I am also grateful to Ms Denise Bottoni (Prof. Ferrari's Secretary) and Dr. Monica Zanusi for their availability that made my stay socially comforting.  I cannot thank them enough. I also wish to thank Prof. E.O Agbedan, my Department Head at the College of Medicine, University of Ibadan, for his support and advice.

From left to right: Prof. Maurizio Ferrari, Dr Mabel Charles-Davies