Linda Goossen, Clinical Lab Science

CLS 495
ISSUES IN CLINICAL LABORATORY SCIENCE

Course Description: Exploration of issues that impact health care, particularly laboratory professionals. Includes in depth discussions of research literature and its relevance to clinical laboratory science. Students will work individually and in groups to prepare a paper, presentation, and a poster. CLS capstone course. SWS.

Course Prerequisite: Senior-level status
Course Corequisite: CLS 490

Instructor:
Office:
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Office Hours:

Credit Hours: 3 credits

Lecture Meets: Alternating Fridays 9-12 and 1-4 during Clinical Practicum II (CLS 490)

SWS Statement: This course is designated as SWS. Completion of WRT 150 or the equivalent with a grade of C or better (not C-) is the prerequisite. SWS credit will not be given to a student who completes this course before completing the prerequisite. SWS courses adhere to certain guidelines. Students turn in a total of at least 3000 words of writing during the term. Part of that total may be essay exams, but a substantial amount of it is made up of finished essays, reports, or research papers. The instructor works with the students on revising drafts of their papers, rather than simply grading finished pieces of writing. At least four hours of class time are devoted to writing instruction. At least one third of the final grade in the course is based on the writing assignments.

Required Texts: 
CLS Education & Management. Wallace & Klosinski; WB Saunders
Publishing and Presenting Clinical Research. W.S. Browner; Lippincott Williams & Wilkins
Recommended Texts:
A Pocket Style Manual. 3rd ed. Hacker, D.; Bedford/St. Martins
OR Easy Writer. 2nd ed. Lunsford, A.; Bedford/St. Martins

Overall Course Objectives:
After completing this course, the student will
1. be able to demonstrate acquisition of learning skills, including problem solving, self-directed learning, critical reasoning, and group skills.
2. be able to demonstrate acquisition of communication skills, including writing and speaking in a manner appropriate to the profession.
3. be able to integrate the various disciplines in the CLS curriculum.

These learning outcomes will be evidenced by the following activities*:
a. students will prepare (write) and present a poster suitable for Michigan Society for Clinical Laboratory Sciences (MSCLS) submission;
b. students will develop, write, and present two case studies to the class;
c. students will develop and write two lesson plans, including behavioral objectives;
d. students will develop, write, and report on a Quality Assurance project; and
e. students will critically review (in writing) current primary research articles from laboratory-related scientific journals.

Schedule:
WEEK 1: 

• Introduction and course requirements
• Writing lesson/discussion/activities
• Introduction to poster development and presentation
• How to prepare and present a case study
• Education: Principles and theories of learning "The Art of Teaching"

WEEK 2: Due: Topic for poster

• Writing lesson/discussion/activities
• Group work on question and methods for poster project
• Education: Preparing a lesson plan
• Case study presentations--modeled and presented by CLS faculty

WEEK 3: Due: Draft of 1st Case study 

• Writing lesson/discussion/activities
• Education: Writing behavioral objectives
• Critical thinking skills
• Group work on poster

WEEK 4: Due: 1st Draft of 2 critical reviews of journal articles; 1st Draft of 2 Lesson Plans 

• Writing lesson/discussion/activities
• Introduction and explanation of in class debates
• Case study presentations - presented by all students (Final submission of 1st case study)

WEEK 5: Due: 1st Draft of Debate; 1st Draft of 2nd Case study; 1st Draft of Quality Assurance project; 2 critical reviews of journal articles (Final submission of first two reviews)

• Writing lesson/discussion/activities
• Clinical laboratory Quality Assurance programs
• Group work on debate topic
• Group work on case study
• Case study presentations - presented by CLS faculty

WEEK 6: Due: 1st Draft of Poster; 1st Draft of 2 critical reviews of journal articles; 2 Lesson Plans (Final submission)

• Writing lesson/discussion/activities
• Debate on Laboratory ethics issue
• Group work on posters
• Case study presentations-- presented by all students (Final submission of 2nd case study)

WEEK 7: Due: 2 critical reviews of journal articles; Quality Assurance Project (Final submission)

• Writing lesson/discussion/activities
• Finalize poster project
• Poster presentation (Final submission)
• Cumulative Final Exam

1st drafts will be returned to students at least two full weeks before the final copy is due. The due dates for the final revised writing assignments are listed above.

Time will be devoted during each class (approximately 30 minutes per 3 hour block) to the teaching of writing. A Pocket Style Manual by Hacker and Easy Writer by Lunsford (Bedford/St. Martin's) will be used as a reference for students. Writing "rules" will be explained, discussed, and practiced by the class. Excerpts from student writing will be the focus of writing lessons. Examples of weak sentences and paragraphs as well as examples of exemplary writing will be used as models.

A word about plagiarism. Plagiarism is, as defined by the Grand Valley State University Student Code (P.19, Student Code, 2002-2003), "Any ideas or material taken from another source for either written or oral presentation must be fully acknowledged. Offering the work of someone else as one's own is plagiarism. The language or ideas taken from another may range from isolated sentences, formulas, or paragraphs to entire articles copied from books, periodicals, speeches, or the writings of other students. The offering of materials assembled or collected by others in the form of projects or collections without acknowledgement also is considered plagiarism. Any student who fails to give in written or oral work for the ideas of materials that have been taken from another is guilty of plagiarism." Any student found guilty of plagiarism on an assignment will receive a score of zero for the assignment. Referral to the Dean of Academic Affairs is possible, depending upon the degree of plagiarism.

Assignment Points

Lesson Plans for any CLS discipline, 2 @ 30 points each, 60 points
Case studies, 2 @ 80 points, 160 points
Written QA project, 50 points
Journal Reviews, 4 @ 25 points each, 100 points
Debate on current CLS issue, 50 points
Journal writing about debate, 20 points
Poster/presentation, 160 points
*Final Exam, 250 points
Total, 850 points

* The final exam will have one essay question, requiring a minimum of 250 words, worth 25 points.

Writing Assignments, Points, and Minimal Word Requirements
Lesson plans (2), 60 points, 500 words total (250 each)
Case studies (2), 100 points, 1000 words total (500 each)
QA project, 50 points, 250 words
Journal reviews (4), 25 points, 2000 words total (500 each)
Debate, 25 points, 250 words each
Poster, 100 points, 500 words
Final exam essay question, 25 points, 250 words
* TOTAL, 385 points, 4750 words

* The writing assignments constitute 385 out of the total of 850 points; thus 45% of the total grade is from writing.

Grading Scale:
93-100 = A
90-92 = A-
87-89 = B+
83-86 = B
80-82 = B-
77-79 = C+
73-76 = C
70-72 = C-
67-69 = D+
60-66 = D
Below 60 = F

Grading Criteria for assignments:

LESSON PLANS 2 @ 30 points each (These are writing assignments)
Each lesson plan must be applicable to clinical laboratory science. Each lesson plan must have the following components. Points will be assigned based on the completeness and appropriateness of each section. Maximum points are listed for each section.

Grading Criteria for Lesson Plans:
1. Title - describing the activity and your name. (1 pt)
2. Instructional Objectives - provide a list of 1 to 4 general things you expect students to learn from the lesson, written in behavioral objective format. (2 pts)
3. Scientific Concepts - List the science concepts to be taught. (3 pts)
4. Assessment - Discuss how you will assess your students' understanding of the science behind the lesson. Include the following in your discussion: a) What types of things will you ask students? b) What should they be able to do? c) How will you know when and what your students learned? (5 pts)
5. Scientific explanation - Give a complete and correct explanation of the science behind the lesson. Your explanation should be of the depth and content found in a good laboratory science reference book for faculty at the college level. Use proper terminology and definitions. (5 pts)
6. Materials needed - List all materials someone would need to teach this lesson. Include the source of supplies. (2 pts)
7. Advanced preparation - Describe things the laboratory coordinator would need to get ready for class ahead of time. Include any modification of materials, special instructions for setting up the presentation, and recipes for the preparation of any reagents used in the lesson. (2 pts)
8. Classroom procedure - briefly outline the time allotment for teaching the various components of the lesson. (2 pts)
9. Safety - List all chemical, electrical, and biologic safety precautions that must be taken by the students and instructor in this lesson. Are there any rules to be followed in the handling of waste materials? What safety equipment is required (latex gloves, goggles, lab coats)? (3 pts)
10. References - List all references used to develop the lesson plan. References of web sites must include the complete web address. Journals and books must include author, publisher, date, and pages. (2 pts)
11. Grammar and spelling - As educators, your writing must include proper spelling and grammar. (3 pts

CASE STUDIES 2 @ 80 points each
Excerpt from Code of Ethics, American Society of Clinical Pathologists
"Realizing that the knowledge obtained concerning patients in the course of my work must be treated as confidential, I hold inviolate the confidence (trust) placed in me by patient and physician."

Care must be taken to maintain patient confidentiality. Neither the patient's name nor chart number will be used in the case study presentation. At no time will the student speak to the patient concerning the chart. If the student needs help in understanding the data, he/she should see one of the pathologists, technical specialist, or the program director.

The student will present two formal case studies. The formal case study may be a patient presently in the hospital or a retroactive study from medical records. The case chosen must have abnormal laboratory results involving two or more departments. The presentation should be 20-30 minutes in length and the entire laboratory staff will be invited. Presentation will be graded.

The formal case study presentation (30 pts each):
1. Begin with a short introduction, which will include:
a. Age
b. Race
c. Sex
d. Initiating complaint
2. Present initial laboratory orders and results.
3. Present any follow-up laboratory orders and results.
4. Interject as many questions as possible to keep the audience active in the case. Example: "The WBC count was 24,000/cu mm. Is this a normal result?"
5. Lead students through case so that they can come up with a diagnosis. This discussion will include pathophysiology and prognosis.

Grading criteria for formal case study presentation
1. Delivery (5 pts)
a.) speed
b.) projection of voice
c.) disturbing mannerisms
2. Presentation (10 pts)
a.) presented in an organized fashion
b.) student involved audience by asking questions
c.) allowed students to answer questions with the use of pauses and/or gave additional hints so that question could be answered by class
d.) able to answer questions during presentation
3. Content (10 pts)
a.) laboratory results involving 2 or more departments
b.) all abnormal and/or unexpected lab results explained
c.) pathophysiology and prognosis of disease given
d.) case selected was a good review for class
4. Use of audio-visual aids (5 pts)
a.) quality of aid
b.) enhanced presentation

Written Case study (50 points each) (This is a writing assignment)
The written case presentation is a thorough, concise review of the patient's clinical profile as presented in the case study presentation. The information presented in the case will reflect the writer's understanding of clinical laboratory science, thorough research and analysis of the problem, and ability to deductively arrive at a final diagnosis. Typically, the case study is two to four pages in length.

Grading criteria for the written case study:
A. Identifying Data: This section identifies the patient (age, gender, occupation, etc.). (5 pts)
B. Chief Complaint: The chief complaint gives the reason why the patient is seeking medical care. The chief complaint should also contain information regarding the duration of the complaint. (5 pts)
C. History of Present Illness: This is a narrative that outlines the problems leading to the current medical encounter and amplifies the chief complaint. Other history to be included are allergies and medications. (5 pts)
D. Physical Examination: A description of the complete physical exam should begin with a statement of the patient's general appearance. All vital signs should be given. (5 pts)
E. Laboratory and other diagnostic studies: This section should contain a listing of all appropriate studies ordered and should include pertinent and abnormal findings. The labs ordered should demonstrate the student's understanding of the differential diagnoses as well as the thought process the student is following to rule in or out specific disease entities, based on laboratory findings. (10 pts)
F. Final Diagnosis: The final diagnosis is often dependent on laboratory results. Because the emphasis of this program is clinical laboratory science, please indicate the diagnosis felt to be most consistent with the patient's presentation in addition to the laboratory studies. This section presents a thorough review of the pathophysiology, etiology, presentation, and treatment of the disease indicated by the final diagnosis. (10 pts)
G. Additional Laboratory studies: This section should contain all the appropriate studies that need to be ordered in view of the previous laboratory results and the final diagnosis. (5 pts)
H. Writing - organization, spelling, grammar, concision (5 pts)

WRITTEN QA PROJECT 50 points (This is a writing assignment)
Students will select an activity conducted by the institution that is directed toward assuring the quality of the services provided. The focus of the quality assurance project should be on the monitoring of outcomes or indicators of care.

Criteria for grading of QA Project:
1. Statement of Problem (5 pts)
2. Design of assessment and monitoring system (10 pts)
3. Collection and organization of data (5 pts)
4. Evaluation of data (10 pts)
5. Develop correction action plan to include any new policy or policy change
(10 pts)
6. Assess action, document improvement (5 pts)
7. Writing - organization, spelling, grammar, concision (5 pts)

JOURNAL REVIEWS 4 @ 25 points each (These are writing assignments)
Students will review four primary research articles from peer-reviewed scientific journals. The studies must be relevant to clinical laboratory science. Each article review must contain the following:

1. The introduction (literature search and research question):
a. What is the question or problem? Is the research question clearly stated or do you have to search for it?
b. What relevant research has been previously published on this topic? How do these studies support the research question posed by the authors?
c. Does the author make a prediction about the outcome? What are the predicted results?
Can you determine from the literature cited why this particular prediction is being
made? Are the predictions clear enough that you know what data would be necessary to support the conclusions that are deduced from the data?
2. Materials and methods:
a. What type of design is used by the authors of the paper (experimental, quasi-experimental, descriptive, qualitative, quantitative, survey, observation, interview, blinded, randomized, controlled, cross-sectional, longitudinal, prospective, retrospective, ex post facto&)? It can be more than one of these. Is this design the correct one for the research questions asked in the introduction? Why or why not?
b. Are there any ethical or practical issues that led to this type of design? If so, what are they?
c. Who are the subjects chosen for the research? How were they selected? How were they assigned?
d. Why were these particular subjects chosen for the study?
e. If the design is experimental or quasi-experimental, what is the independent
variable(s)? Is it consistent with the questions asked in the hypothesis? Is it clearly defined?
f. If the design is experimental or quasi-experimental, what is (are) the dependent
variables? Are they consistent with the questions asked in the hypothesis?
Are they clearly defined?
g. If the design is not experimental or quasi-experimental, but is still quantitative, what
variable is (are) being measured? Are they consistent with the question asked?
Are they clearly defined?
h. What are the techniques (instruments) for gathering data (measuring the variables)?
Are they consistent with the type of data sought by the authors? What evidence does the author give about the reliability of the instrument? What evidence does the author give about the validity of the instrument?
3. Results:
a. Are the data clearly presented? Do you understand the data presented?
b. Are the graphs and tables consistent with the stated materials and methods?
Be sure to read the legends under the tables and graphs!
c. What descriptive statistics are used?
d. What inferential statistics are used?
e. Are the statistical methods appropriate for the design used by the authors?
f. If a statement is made about statistical significance or reliability, what is the level of
significance (a) set by the researchers?
g. What level of p is attained in the study?
h. What is the null hypothesis (H0)?
Is the null hypothesis accepted or rejected according to the p obtained in the study?
4. Discussion and conclusion:
a. In terms of the stated questions(s) in the introduction, what did the study find?
What questions does it answer? What questions does it leave unanswered?
b. What are the limitations of this study? What could have been done differently?
What changes should be made in the next research project on this subject?
c. Are the results generalizable? Do you have any concerns about the generalizability or applicability of the results or lack thereof? If so, what are they?
d. What is your opinion of the clinical/ practical significance of this study?
e. Do the results of this study open any new areas of research on this subject?
If so, what are they?
f. What is your overall opinion of this article - did you learn anything; could you understand it; was it a worthwhile study?

Criteria for Grading Journal Article Reviews
1. Review covers required material (10 pts)
2. Review is an accurate synopsis of the study (10 pts)
3. Writing mechanics (spelling, grammar, etc) (5 pts)

DEBATE ON CURRENT CLS ISSUE (50 points)
For each debate, there will be a topic such as "Stem cell research is necessary for the ultimate treatment of such diseases as Lou Gehrig's Disease." A team of three students will argue in favor of the proposition; another team of three will argue against.

The format of the debates will be as follows:
Affirmative case -- 10 minutes
Negative case -- 10 minutes
Affirmative rebuttal, cross-examination, and summary -- 5 minutes
Negative rebuttal, cross-examination, and summary -- 5 minutes

In preparing for your debate, keep the following points in mind:
-- Begin by analyzing the proposition carefully. Precisely what does it mean? Are there any terms that need to be defined. Just what is the position your side is taking?
-- Gather data. It will be useful to consider evidence for both the affirmative and negative positions. Be sure that your information is accurate, from a reliable source, current, and relevant to your case.
-- Develop a sound position. Be sure your case responds directly to the proposition, is based on sound assumptions, and is clear and logical. Further, be sure that your argument is political. For example, if the debate topic concerns stem cells, do not rely solely on your religious beliefs; also consider the importance of science, thought, and religion in a democracy.
-- During the debate, do not simply read your notes. Know your argument well enough so that you only need to refer to your notes for an occasional quotation or other piece of evidence. Also, pay attention to the other side's presentation. During your last five minutes, you will want to respond to their argument, to ask questions of them, and summarize your
own position.

Criteria for Grading Debates:
Team points (40 points possible):
1. Preparation 10 points
research (4 pts)
planning (4 pts)
group coordination (2 pts)
2. Argument 10 points
well organized (2 pts)
clear (2 pts)
logical (2 pts)
analysis of proposition (4 pts)
3. Evidence 10 points
sufficient quantity (2 pts)
appropriate sources (3 pts)
current (2 pts)
relevant (3 pts)
4. Rebuttal and cross-examination 10 points
sound defense (3 pts)
response to opponent (2 pts)
thorough (2 pts)
summary of position (3 pts)

Individual contribution - 10 points possible - preparation, effectiveness, and delivery

Following each debate, there will be an opportunity for the class to respond or ask questions. Then the debaters will write a journal based on the debate. (This is a writing assignment)

Criteria for Grading Written Review of Debate (250 words, 25 points):
1. Well organized (5 pts)
2. Thorough yet concise review of the debate (10 pts)
3. Sources appropriately cited (5 pts)
4. Spelling, grammar, syntax (5 pts)

POSTER 100 points (This is a writing assignment)

All students will be completing a small research project when they register for this course -- an assigned requirement for the CLS program. During CLS 495, each group will prepare a poster for presentation at the Michigan Society for Clinical Laboratory Science annual meeting.
Grading will be as follows:
1. Initial sketch of the overall design of your poster: pay close attention to the instructions sent o you by the ASCLS meeting organizers about posters. (10 pts)
2. Introduction/Background Panel: The first panel should have some text that will catch the attention of the casual observer on the first panel. The remainder of the background panel should include enough information about your study to enable the reader to understand why you did it. (10 pts)
3. Subjects/Methods Panels: 2 - 4 panels for your methods -- provide the basic details about the study design, subjects' measurements, and analysis methods. (30 pts)
4. Results Panels: usually 3 - 5 panels of results -- using tables and/or figures -- the title of each must explain what is in the table or figure. The title of each panel should tell the reader what the results in the panel show. (30 pts)
5. Limitations Panel: include the main limitations of your study. (10 pts)
6. Conclusions and Implication Panel: EXPLAIN your results. Tell the reader what the results mean. Indicate specific directions for your future projects. Make scientific and clinical recommendations if appropriate. (10 pts)

Criteria for grading Presentation of Poster (60 points)
You will be graded based on the following criteria:
1. Clear and concise presentation of:

• Research question (5 pts)
• Literature review (10 pts)
• Methods (10 pts)
• Results (10 pts)
• Discussion (10 pts)
• Conclusion and implications (5 pts)

2. Evidence of preparation and organization and coordination among team members (5 pts)
3. Time management (5 pts)