Clinical Microbiology Rotation
During the rotation, residents rotate through the core areas of the
clinical microbiology laboratory: bacteriology, anaerobes, virology,
mycology, parasitology and molecular diagnostics. In the first month
residents receive a series of hand on
exercises to introduce them to common techniques, tests, and
organisms isolated in the laboratory. Subsequently, residents spend time
at the reading bench with the microbiology
technologists, reviewing cultures and other specimen materials.
During the rotation residents will become familiar with:
- The proper collection of specimens.
- Sensitivity and specificity of different culture methods for specific
organisms.
- Procedures followed to isolate pathogens from particlar specimens.
- Staining methods for identifying microbial species from laboratory
or tissue specimens.
- Procedures for the reporting of preliminary and final culture results.
- Antimicrobial suceptibility testing and the use of the
WHONET database
for tracking nosocomial pathogens.
- Use of biochemical, molecular, antigen, specimen stains and serological
tests under different conditions.
- Correlating microbiological data with other areas of laboratory testing
(CD4 counts, CSF/body fluid electrolytes, urinalysis..)
- Function of the laboratory information system (LIS) in efficiently
organizing the work-flow in a microbiology laboratory.
In subsequent months of the rotation residents round with one of
the infectious disease teams. During this time you work closely with the
members of the ID team, and will be responsible for following and presenting
laboratory and anatomic pathology data on patients seen by the service.
In addition, you will receive a series of unknowns to isolate and characterize
within the microbiology laboratory.
Throughout the rotation residents take
pager calls, review send-out tests and sign-off on the daily virology and
Quality Assurance (QA) reports. In addition, residents are called upon to
identify and speciate organisms isolated in the mycology and parasitology
labs, and may be called to present & discuss microbiological data at autopsy
conferences or for conferences in the Division of Infectious Disease.
Conferences
- Infectious Disease Conference: 8AM Mondays, ID Division. Conference
for ID staff, fellows, residents and students at which interesting cases
from the preceeding week are discussed.
- Joint BWH/MGH ID Rounds: 8AM Wednesdays, Channing Laboratory.
Teleconference among BWH and MGH infectious disease services. Fellows
present interesting cases and discuss current topics related to ID.
- Infectious Disease Pathology Conference: 11AM Thursdays
(bi-weekly), Pathology Conference Room. Correlation of clinial cases
pertinent to ID with laboratory and anatomic pathology findings.
- Plate Rounds: 2PM Thursdays, Bacteriology lab. CP residents and
fellows present unusual laboratory findings and culture material to the
infectious disease teams.
- Resistance Rounds: 10AM, Fridays (monthly). Residents receive
a series of isolates from the microbiology lab and determine patterns of
antimicrobial resistance, compare results with the BWH WHONET database,
and propose underlying molecular mechanisms for the patterns seen.
The results are presented in an informal session with the medical
directors and laboratory staff.
- Culture Updates ("Bug of the Week"): Monthly conferences for the
laboratory staff presented by the residents.
Teaching rounds in clincal microbiology
Weekly teaching sessions constitute part of the clinical microbiology rotation.
Topics covered in the weekly and the Director's teaching rounds include:
-
The microbiology laboratory in patient management
-
WHONET database system / Role of the microbiology laboratory in Infection Control
-
Biologic signals: detection and amplification
-
Bacterial classification
-
The enterobacteriaceae
-
Gram-positive organisms
-
Antibiotic resistance
-
Antimicrobial suceptibility testing
-
The Mycobacteria
-
Instrumentation in clinical microbiology
-
Issues in budgeting, staffing and personnel in the microbiology lab
-
Overview of diagnostic virology
-
Management of the modern virology laboratory
-
Overview of diagnostic parasitology
-
Helminths, nematodes and cestodes
-
Blood borne parasites
Clinical Pathology Residency Program
Department of Pathology
Brigham & Women's Hospital
Harvard Medical School