MEDICAL MICROBIOLOGY

DEFINITION:Medical Microbiology is a branch of medicine concerned primarily with the prevention, diagnosis, and treatment of infectious diseases. The profession of Medical Microbiology consists primarily of four major spheres of activity:

  1. Scientific and administrative direction of a clinical microbiology laboratory.
  2. The establishment and direction of a hospital infection control program.
  3. Provision of clinical consultations on the investigation, diagnosis, and treatment of patients suffering from infectious diseases.
  4. Public health and communicable disease prevention and epidemiology.

In addition to these primary activities, medical microbiologists are often responsible for teaching of undergraduate and postgraduate medical students, students in other health disciplines, postgraduate science students and other residents. They also provide continuing education to medical and other health care professionals. Many are involved in medical research and in the supervision of research projects of graduate students. They also are often consultants for the prevention, diagnosis, and therapy of infections in the community environment.

Microbiology training should provide residents with knowledge which is up to date. Microbiology residents shall be prepared to conduct their practices in a ethical, cost effective manner. Emphasis is placed on effective communication in partnership with laboratory technologists, physicians and other health care providers, patients, and the community.

On completion of the education program, the resident's position will be competent to function as a consultant in medical microbiology.

SPECIFIC OBJECTIVES:

  1. Medical Expert/Clinical Decision Maker

1.1

Laboratory Practice of Microbiology

At the end of training, the resident must demonstrate:

 

1.1.1

Knowledge of the nature of infecting organisms, the pathogenesis of infectious diseases, diagnostics and treatment.

 

1.1.2

Knowledge of the clinical features of infectious diseases.

 

1.1.3

Knowledge of the epidemiology of infectious diseases and the strategies which may be applied to their prevention including public health and infection control aspects of infectious diseases.

 

1.1.4

Knowledge of anti-infective agents, their mechanisms of action, spectra of activity, pharmacokinetics and pharmacodynamics, adverse affects and their role in the treatment of infectious diseases as well as hospital wide policies regarding drug utilization.

1.2

Clinical Practice of Microbiology

History taking skills: In addition to responsibilities as laboratory physicians, medical microbiologists are also expected to possess knowledge and skills required to assess and manage patients with infectious diseases. The resident should be able to obtain and record a complete history, including:

 

1.2.1

Reasons that medical health is being sought (chief complaint).

 

1.2.2

The important symptoms, in sufficient detail, to present a clear picture of the clinical problem(s) (History of present illness).

 

1.2.3

All other important information from the past history, medications, allergies, review of systems, family history and social history.

 

1.2.4

The resident will carry out, an efficient, orderly, and competent physical examination, demonstrating sensitivity of the patient's needs, modified according to the patient's age, gender, race, and problem, and to record this information by regions or systems.

1.3

Problem Solving and Decision Making

At the end of training, the resident should demonstrate:

 

1.3.1

The ability to correlate, evaluate, prioritize and synthesize information, including the relevant ethical issues acquired by history taking and physical examination. The resident should recognize and define problems and generate differential diagnosis and problem list.

 

1.3.2

Effective communicating skills in presenting assessments and recommendations in both verbal and written form.

 

1.3.3

Recognize personal limitations and demonstrate a willingness to call upon others with special expertise and make referrals when appropriate. A consultative approach is appropriate in terms of patient care, education, and legal and ethical issues as they arise.

1.4

Technical Skills

The resident should demonstrate knowledge and skills relating to the effective performance of microbiology testing, including the pre-analytic, analytic, and post-analytic factors which affect such tests.

 

 

1.4.1

The assessment of specimens as to their appropriateness and the extent and nature of testing.

 

 

1.4.2

The performance and interpretation of microbiology testing within the clinical laboratory.

 

 

1.4.3

The performance of molecular methods applied to the detection of micro-organisms and their virulence factors and to determine the epidemiologic links between isolates.

 

 

1.4.4

The performance of all relevant microscopy, including but not limited to light, fluorescent and electron microscopy.

 

 

1.4.5

The performance of quality control/assurance testing of media and laboratory instrumentation.

 

 

1.4.6

The utilization of laboratory information systems for results, storage, retrieval and analysis.

 

  1. Communicator: Medical microbiologists establish effective relationships with patients, physicians, laboratory technologists and other health care professionals. Communications skills are essential for the functioning of a medical microbiologist and are necessary for obtaining information from, conveying information to patients and their families and to other members of the health care team. Residents should give close attention to the impact of ethnocultural background, social support and emotional influences on patients' illness. The resident must be able to demonstrate the ability to:

2.1

Listen effectively and obtain synthesized relevant history from patients, families, and communities.

2.2

Communicate effectively and discuss appropriate information with laboratory technologists, patients and their families, physicians and other members of the health care team.

2.3

Educate laboratory technologists and other health care professionals in formal and informal health educational settings.

2.4

Present problems clearly and concisely and correctly in both verbal and written reports.

2.5

Respect individual patients, families, colleagues and other health care workers and for their value systems which may be different from the resident's own values.

  1. Collaborator: Medical microbiologists work to direct the activity of laboratory technologists and in partnership with others who are appropriately involved in patient care. It is, therefore, essential that medical microbiologists collaborate effectively with other members of the health care team and with the patients and their families to provide optimal patient care, education, and research. The resident should:

3.1

Establish and maintain cooperative interpersonal relationships with a multidisciplinary team and with patients and their families.

3.2

Contribute effectively to other interdisciplinary team activities.

  1. Manager: Medical microbiologists function as managers and make day-to-day decisions involving human and financial resources, co-workers, policies, and their professional lives. Medical microbiologists must demonstrate the ability to prioritize and to effectively direct staff through team work and make systematic decisions when allocating finite health care resources. Microbiologists take leadership positions within the context of their professional organization and within the broader health care community.

The resident should demonstrate:

4.1

Understanding of basic personnel/ labour issues as applied to a diagnostic laboratory.

4.2

Knowledge of the various ways in which the practice of microbiology is undertaken in different settings (eg. tertiary care, public health, community hospital and for profit laboratories).

4.3

Understanding of the advantages, disadvantages, and relative costs of providing diagnostic services in different settings, including academic and non academic hospitals and private laboratories.

4.4

Understanding of the role of microbiologists and provision of preventative and therapeutic health care based on sound scientific evidence, and the various means of assessing quality in medical care.

4.5

Knowledge of ways and means of avoiding unnecessary investigation and hospitalization.

4.6

Knowledge of budget planning and allocation of resources in a diagnostic microbiology laboratory.

4.7

The definitions and role of audits, quality improvement, risk management, occurrence and incident reporting, and complaint management.

4.8

Knowledge on the systems of internal and external proficiency testing programs and of laboratory accreditation programs throughout the country.

4.9

Knowledge on the cost benefit ratios of diagnostic and therapeutic interventions, cost containment and efficiency, effectiveness and efficacy as they relate to medical care.

4.10

Awareness of the needs to continually balance professional, personal, institutional, and social commitments.

4.11

An open mindedness in consideration of alternate methods of service delivery.

4.12

Awareness of the societal, and governmental aspects of health care provision.

  1. Health Advocate: Medical microbiologists recognize the importance of advocacy activities relating to challenges in today's health care system. Health advocacy is appropriately expressed, both by the individual and collective responses of microbiologists in influencing public health and policy. The resident should:

5.1

Learn to identify important determinants of health affecting patients.

5.2

Recognize and respond to issues where advocacy is appropriate.

  1. Scholar: Medical microbiologists are engaged in a life long pursuit of mastery of their specialty. They recognize the need for continuous learning and to model this for others. Through their scholarly activities, they contribute to appraisal, collection, and understanding of health care knowledge and facilitate the education of their technologists, students, housestaff, patients, and other health care professionals. The resident should:

6.1

Recognize the importance of self assessment of professional competence and acceptance of responsibility for self directed learning as a life long goal. Learning should incorporate clinical appraisal and evaluation of medical and other relevant literature.

6.2

Maintain a questioning and inquisitive attitude towards medical information and an appreciation of the necessity of ongoing research to develop new knowledge.

6.3

Facilitate the education of technologists, patients, students and other health care professionals and contribute to the development of new knowledge.

6.4

Demonstrate the ability to utilize information technology to optimize patient care, for ongoing medical education and other activity.

  1. Professional: Microbiologists have a unique role in improving the quality of diagnostic services provided to patients with suspect infection and in their treatment and the prevention of infections. Microbiologists are committed to the highest standards of excellence in clinical care and ethical conduct and continually strive to master their discipline.

The resident will demonstrate:

7.1

Knowledge of the principles of medical ethics, including the best interests of the patients, autonomy, beneficence, and non maleficence, confidentiality, truth telling, justice, respect for persons, conflict of interest, and resource allocation.

7.2

Knowledge of ethical decision making processes.

7.3

Knowledge of legal and ethical codes of professional behaviour and the obligations of the physician that apply to microbiology, including issues relating to the notification of communicable diseases.

7.4

Trustworthiness (honesty, confidentiality) with respect to technologists, patients, and other health care providers.

7.5

Recognition of personal limitations and a willingness to call upon others for their expertise.

7.6

Willingness to accept peer and supervisor review of professional competence.

7.7

Appreciation of moral ethical implications of various forms of patient care and research.

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 microbiology must be consistent with the specialty training requirements.

In addition to offering the components noted in the specialty training requirements all accredited programs in medical microbiology should offer community-based learning experiences.

Residents must be provided with increasing individual professional responsibility, under appropriate supervision. This responsibility must include the interpretive and technical skills that relate to the specialty, as well as the provision of consultations and the management of microbiological laboratories.

During the whole period of training, residents should be in regular contact with their clinical colleagues, whom they should assist in their activities related to the diagnosis and management of patients and the prevention of infections.

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 microbiology.

In those cases where a university has sufficient resources to provide most of the training in medical microbiology 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.

Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to medical microbiology.

  1. Teaching Faculty

There must be a sufficient number of qualified teaching staff to supervise residents 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.

There must be a minimum of three medical microbiologists, one of whom is the program director, involved in the direct training of the residents. A medical microbiologist is defined as a medical graduate who is certified in medical microbiology.

  1. Laboratory Components of the Program

Laboratory training must be based on adequate resources to ensure full training for each resident in all areas of medical microbiology. The description of the integrated 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, scientific, and technical staff, must be satisfactory in relation to each of the following components:

    1. General Medical Microbiology

There must be adequate laboratory facilities and adequate volume and variety of material to ensure full training in microbiological techniques, the reporting of test results, infection control, and consultations. The laboratory should be under the full-time direction of a medically qualified microbiologist who holds certification in medical microbiology. The director of the laboratory should have a university appointment in the department of medical microbiology in the medical school, and will be responsible for the conduct of the training program in the institution. There must be a sufficient number of qualified medical microbiologists on the staff of the laboratory to provide continuous instruction and supervision.

The following are the essential components of the laboratory training program: bacteriology, mycology, parasitology, virology, molecular epidemiologic and diagnostic methods, and the immunology relevant to these areas.

The necessary range of experience of each resident should be assured by rotations or other mechanisms, in order to provide full training in the microbiology of acute and chronic cases in both adult and pediatric medicine and surgery. It is recommended that arrangements be made, for short periods, in laboratories outside the program, when this is necessary, to ensure experience in areas of microbiology only carried out in reference laboratories such as syphilis serology, molecular finger-printing, and enteric reference bacteriology.

    1. Laboratory Procedures and Management

Instruction and experience must be provided in the procedures essential to the operation of a full service diagnostic microbiology laboratory, including bacteriological and serological quality management, data processing, media preparation, maintenance of equipment, antimicrobial agent sensitivity testing, anaerobic technology, electron microscopy, and immunofluorescent techniques.

Residents should also develop experience in the area of information technology, developing competence in the use of relational databases, spreadsheets, and presentation software, as well as familiarity with the organizational structure of laboratory information systems.

The resident should also be provided with experience in the areas of budget preparation, planning for the implementation of new laboratory procedures and programs and in their subsequent evaluation.

    1. Pediatric Medical Microbiology

There must be opportunity for training in the medical microbiology and infections in the neonatal and pediatric age group, supported by an adequate volume and variety of patients and material and all necessary staff and facilities.

    1. Consultations

An active consultation service is essential to provide experience in acting as a consultant to colleagues on clinical services. Residents must participate in consultations, both elective and emergency, on a continuing basis during training. This training must take place on a teaching clinical infectious disease service with sufficient volume and variety of patients to ensure the medical microbiology resident develops the ability to:

      1. Act as a consultant to clinical and laboratory colleagues on the selection and interpretation of appropriate tests and the treatment and prevention of microbial disease.
      2. Provide competent formal written consultations in cases of infection.
    1. Community Learning Experiences

The community experience might take the form of a public health laboratory experience, private sector microbiology experience or rotation in a regional hospital or free-standing diagnostic laboratory. Community experiences should be available which provide a learning environment with appropriate supervision and evaluation based on rotation specific objectives. This assumes administrative support and linkages with the program.

  1. Supporting Services Clinical, Diagnostic, Technical
    1. Liaison with other Specialties and Subspecialties

There must be appropriate liaison with teaching services in internal medicine, general surgery, obstetrics and gynecology, and pediatrics. There must be definite mechanisms within the faculty to ensure that training provided in internal medicine including infectious diseases, pediatrics, or surgery, in fulfilment of the training requirements, meets the needs of residents in medical microbiology. Hospitals with a major role in the medical microbiology program should also be engaged in the undergraduate teaching.

    1. Infection Control and Antibiotic Utilization

There must be appropriate opportunity for the resident to gain experience in the area of hospital infection control and antibiotic utilization management. The resident should regularly participate in activities relating to these areas of training.

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

A coordinated educational program must be provided in medical microbiology and associated fields. The teaching program should also provide experience in participation in rounds and conferences, in developing ability in self-education, and the skills of formal and informal teaching.

  1. Basic and Clinical Sciences Relevant to Medical Microbiology

The program must include a central program in the basic science of microbiology and systematic teaching in medical microbiology. This should involve course work and directed reading in pathogenesis, diagnosis and treatment of infectious disease; and in general medicine and surgery, sufficient to allow effective communication with colleagues in all specialties.

  1. Biomedical Ethics

The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to medical microbiology.

  1. Communication Skills

The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.

  1. Patient Care Team

Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.

  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.

The program must provide the resident with the opportunity to acquire competence in microbiology and in laboratory management. In addition, the resident must develop the ability to undertake the education of physicians and other members of the hospital staff in microbiology and infectious diseases in informal seminars, ward rounds, and formal lectures.

  1. Management Skills

Residents must be given opportunities to develop skills in management as applied to medical microbiology such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.

  1. Quality Assurance/Improvement

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

  1. Research Opportunities for Residents

There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. The program should be capable of providing a year of full-time study in basic sciences, or other investigative experience relevant to medical microbiology.

  1. Faculty Research

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

  1. Life-Long Learning

All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university.

 

SPECIALTY REQUIREMENTS:

Five years of approved residency training. This period will include:

  1. Basic clinical training.
  2. Diagnostic laboratory residency in an approved department or division of microbiology, including bacteriology, immunology, mycology, mycobacteriology, parasitology and virology.

PROGRAMS (WITH TRAINING REQUIREMENTS):

Doctor of Medicine(M.D Clinical Microbiology):

Eighteen months of approved training.

Master of Philosophy(M.Phil Medical Microbiology):

Thirty six months of approved training.

Doctor of Philosophy(Ph.D Micobiology):

Forty eight months(four years)of approved training.