MEDICAL BIO CHEMISTRY  

DEFINITION:Medical Biochemistry is that branch of medicine concerned with the study and measurement of biochemical abnormalities in human disease. The medical biochemist is trained in the operation and management of hospital biochemistry laboratories, and acts as a consultant in all aspects of their use. As an academic specialist, the medical biochemist develops and integrates a basic research program with clinical practice in a field of biochemical interest, and maintains an active role as a teacher of clinically applied biochemistry.

GENERAL OBJECTIVES:In all specialties of medicine, but especially in those that are technology driven such as medical biochemistry, it is not sufficient to have a broad awareness of the field at the time of completion of formal training. Major changes during the ensuing years of practice are inevitable and the residency period is the time to acquire skills for life-long learning. Role learning, although effective for a resident to reach baseline knowledge, must be supplemented by skills in self-directed learning. The techniques of problem solving, formulation of hypotheses, directed information searching, and critical appraisal of data are essential for maintaining currency and are indispensable for the pursuit of original investigation.

Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Medical Biochemistry. In addition, all residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.

SPECIFIC OBJECTIVES:On completion of the educational program, the graduate physician will be competent to function as a consultant in Medical Biochemistry. The resident will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-Maker

General Requirements

    • Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
    • Access and apply relevant information to clinical practice
    • Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

Pathophysiology

Acquire a thorough knowledge of normal and abnormal biochemistry and physiology and to apply this knowledge to the understanding of human disease. This objective includes an understanding of nutritional principles, genetics, and pharmacokinetics.

Consultation

Integrate history and physical findings with the laboratory investigation and plan further investigations to aid in differential diagnosis and management, and to incorporate these into a formal written medical biochemistry consultation report.

Interpretation of Results

Understand the principles and limitations of biochemical analyses and apply these concepts to the interpretation of test results. The resident must demonstrate a thorough knowledge of statistics, methods of estimating reference values, concepts or normality and drug and other interferences with test results.

Analytical Methods

Knowledge of general and special technical analyses currently used in clinical biochemistry laboratories to be able to supervise their performance. This will include knowledge of their principles and an understanding of the limitations of the procedures.

Instrumentation

Understand the operating principles of manual and automated analytical instruments, to establish the precision, accuracy, and linearity of response of instruments and to understand the limitations of their use and their maintenance requirements.

Communicator

    • Establish therapeutic relationships with patients and families.
    • Obtain and synthesize relevant history from patients, families and communities.
    • Listen effectively.
    • Discuss appropriate information with patients and families and the health care team.

Collaborator

    • Consult effectively with other physicians and health care professionals.
    • Contribute effectively to other interdisciplinary team activities.

Manager

General Requirements

    • Utilize resources effectively to balance patient care, learning needs, and professional activities.
    • Allocate finite health care resources wisely.
    • Work effectively and efficiently in a health care organization.
    • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements

Quality Control

Understand the principles of quality control, and be able to develop an effective quality control program, to interpret quality control data and to recommend appropriate corrective action.

Management of a Laboratory

Understand the administrative, legal, and physical requirements for the operation of a hospital biochemistry laboratory; understand the functional organization of a hospital biochemistry laboratory and be able to establish protocols for specimen collection, result reporting, quality assurance and laboratory safety. This will include an understanding of laboratory information systems.

Health Advocate

    • Identify the important determinants of health affecting patients.
    • Contribute effectively to improved health of patients and communities.
    • Recognize and respond to those issues where advocacy is appropriate.

Scholar

General Requirements

    • Develop, implement and monitor a personal continuing education strategy.
    • Critically appraise sources of medical information.
    • Facilitate learning of patients, house staff / students and other health professionals.
    • Contribute to development of new knowledge.

Specific Requirements

Research

    • Understand the principles of basic and clinically applied research, and to learn the techniques of costing research, writing grant applications, and communicating results.
    • Demonstrate an ability to develop research protocols and interpret research data.

Teaching

 
Demonstrate an ability to teach medical biochemistry. This will require that the resident learn the techniques of effective teaching in both informal and formal settings.

Professional

General Requirements

    • Deliver highest quality care with integrity, honesty and compassion.
    • Exhibit appropriate personal and interpersonal professional behaviours.
    • Practise medicine ethically consistent with obligations of a physician.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty. The content and organization of each accredited program in medical biochemistry must be consistent with the specialty training requirements.

Residents must be provided with individual professional responsibility, under appropriate supervision, according to their level of training, ability and experience in the interpretive and technical skills that relate to the specialty, as well as in the provision of consultations to clinical colleagues, and the management of a biochemistry laboratory.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in medical biochemistry.

In those cases where a university has sufficient resources to provide most of the training in medical biochemistry but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

  1. Teaching Faculty

There must be a sufficient number of qualified teaching staff to supervise residents at all levels and in all aspects of the specialty, and provide teaching in the basic and clinical sciences related to the specialty. The teaching staff should have an appropriate nucleus of full-time teachers.

  1. Laboratory Components of the Program

Laboratory training must be based on adequate resources to ensure full training in all areas of medical biochemistry. The description of the program should specify how the responsibility for each of the components of the program is shared by the participating institutions. The resources of the program, including volume and variety of specimens; laboratory space and equipment; and medical, non-medical professional, and technical staff, must be deemed satisfactory by the Specialty Committee of the Royal College in relation to each of the following components:

    1. General Medical Biochemistry. There must be adequate laboratory space and facilities and adequate numbers and diversity of specimens for training in the general laboratory procedures that are essential to the operation of a biochemistry laboratory. Instrumentation should be up-to-date and sufficiently varied to ensure full training in the operation of essential equipment, and in the techniques and analytic methods of clinical chemistry. In addition to routine facilities, laboratory facilities organized for teaching must be available in the following areas: fecal and urine analysis, general endocrinology, enzymology, radioisotopic studies, and toxicology.
    2. Specialized Biochemistry. The program must provide training for residents in specialized areas of biochemistry related to the full range of organs and tissues, such as gastroenterological or nephrological biochemistry, as well as special endocrinology. Experience should be provided in the diagnostic aspects of intermediary metabolism: general homeostatic mechanisms, all forms of metabolic disturbances, immunochemistry and radio-immune assays, and biochemical genetics.
    3. Laboratory Management. Instruction and experience must be provided in the management of a hospital laboratory, including quality control, automation, data processing and computing, laboratory screening procedures, and advanced instrumentation.
    4. Pediatric Medical Biochemistry. There must be opportunity for training in the biochemistry of the neonatal and pediatric age groups, supported by an adequate volume and variety of patients and material and all necessary staff and facilities.
    5. Consultations. An active consultation service is essential to provide experience in acting as a consultant to clinical colleagues. Residents should participate in consultations, both elective and emergency, on a continuing basis during training.

In addition, the resident must develop the ability to give sound advice to clinical colleagues on the selection and interpretation of appropriate biochemical tests, provide competent formal written consultation when requested, and undertake the education of physicians and other members of the hospital staff in all matters pertaining to medical biochemistry.

  1. Supporting Services — Clinical, Diagnostic, Technical

There must be appropriate liaison with teaching services in general surgery and in obstetrics and gynecology. In fulfillment of the training requirements, there must be definite mechanisms within the faculty to ensure that training provided in internal medicine or pediatrics, meets the needs of residents in medical biochemistry. During the whole period of training, residents should be in regular contact with their clinical colleagues, whom they should assist in the selection and interpretation of tests for the diagnosis and management of patients.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

  1. Organized Scholarly Activities

Organized scholarly activities such as journal clubs, research conferences and seminars must be a regular part of the program.

  1. Basic and Clinical Sciences Relevant to Medical Biochemistry

The program must include organized teaching in the basic sciences and laboratory aspects of medical biochemistry and the advanced scientific and clinical knowledge essential to the practice of the specialty. The program may include lectures and seminars, which may be interdisciplinary in nature, teaching rounds, special conferences, technical demonstrations, and journal clubs. The program should include teaching aids such as reading lists and audiovisual materials.

Continuation of basic science training during the early years of the program, with completion of requirements for a Master of Sciences or Doctorate in Biochemistry, is encouraged.

  1. Biomedical Ethics

The academic program must provide opportunities for residents to gain an understanding of the basic principles of biomedical ethics as it relates to medical biochemistry.

  1. Communication Skills

There must be opportunities for residents to learn effective communication skills for interacting with patients and their families, colleagues, allied health professionals, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.

  1. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

  1. Quality Assurance/Improvement

The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

  1. Research Opportunities for Residents

The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. The program should have the capacity to provide a year of supervised research acceptable to the program director in an approved hospital laboratory or university department.

  1. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

  1. Outside Conferences

The program should provide opportunities for residents to attend conferences outside their own university.

SPECIALTY REQUIREMENTS:

Approved residency training period includes:

1. Basic clinical training including rotations in medicine, pediatrics, obstetrics and surgery.

2. Training in medical biochemistry preferably spent in one university centre.

 

PROGRAMS (WITH TRAINING REQUIREMENTS):

Master of Philosophy(M.Phil Medical Biochemistry):

Thirty six months of approved training.

Doctor of Philosophy(Ph.D Medical Biochemistry):

Forty eight months(four years)of approved training.