Shared Experience: Participating on a Laboratory Inspection Team

(upbeat synth music) - This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, "The Bow Tie Bandit of Blood," a transfusion medicine pathologist at Mayo Clinic. Today we're rounding with Dr. Emily Shaffer, a resident physician in laboratory medicine at Northwell Health in Roslyn, New York, to discuss her experience participating on a laboratory inspection team. Thanks for joining us today, Dr. Shaffer.

- Thank you so much for having me. - So let's kind of kick off, you're a resident right now. You've gotten a lot of training under your belt and we started having this conversation about this experience you had with participating in in inspection.

Maybe you could kind of kick off for us, what's your kind of origin story? What led you to pursuing pathology as a career? - Sure. So I actually didn't come to discover pathology until very late in the game and it was really the result of a late third year elective. I say that I really grew up in the golden age of CSI, and so I thought that that would be something that would be almost like a little gift to myself where I scheduled a forensic path rotation.

But when I was actually doing the work and I was in there, not only did I feel like I was doing something of value and like contributing meaningfully, but one of the chief medical examiners looked at me and said, "Have you ever thought about doing pathology? I think you could be really good at it." And, you know, hearing that put that way, it just, it hit a note and it stuck. And so here I am several years later but very happy with the choice. - That's awesome.

I had a similar experience. I thought I was gonna go into anesthesia and it was for me a similar kind of story, a late third year experience that he helped me find pathology as well. So walk us through kind of, what was your experience like participating in a laboratory inspection? Because you know, we have kind of a diverse listener group, so students, laboratory professionals and clinicians.

Some may have something, some idea about what a laboratory inspection might look like but I'm sure a lot of others don't. - Sure. So for me, and I'm sure for a lot of other residents, my understanding of lab inspection or CAP lab inspection was, it's like a be on your best behavior sort of deal. You know, make sure that all of your ducks are in a row, all of your boxes are checked. You know, why are we doing this so well? We have to make sure that we are falling in line with CAP.

But personally, I have always been much more

of a learn by doing type of learner. And I was also kind of looking for a way that I could add value, you know, whenever I get out into the workforce. And I noticed that a lot of job listings, you know, were asking for people who have, who are able to do a lab directorship. And so I at least wanted to get the training and understand better what it meant to be an inspection team member. - So that's kind of what drove you to kind of have some of that initial interest.

Was there any kind of prep beforehand that you did? Or, you know, what was the actual inspection day or days like? How did that unfold? - Sure. So actually getting into it, the first thing that I did was I went onto the CAP website and they have free training for CAP team inspection members. And so I went through that. It was really well organized and it was something where you know, if you have a good knowledge base like you can go more quickly through certain sections than others.

And I was really just kind of looking to get a broad understanding of kinda what goes into that. And I noticed on my CAP profile that I, you know, could adjust, you know, "Am I interested in doing a team inspection?" You know, and so I thought, "Sure, okay."

And interestingly, you know, it was probably about 10 days after I had filled in that I was interested and that this was my availability whenever, I received an email contact from a inspection assignment specialist at CAP that said, Are you free on these days? We have something coming up." - Well points to the CAP team for not letting too much time pass there. That's wonderful, for that quick follow up. What'd you do next? - So, well, I said yes.

Actually first I was a little bit nervous and so I did hesitate for just a hot second and I ran it past my mentor who said, "Why wouldn't you say yes? This sounds like a great opportunity." And so once I did that they put me in contact with the team leader. I had a couple of pre-meeting sessions with the team leader, with other members on the CAP team as a resident. They gave me a little bit of extra homework, if you will, just so that I could be prepared, you know 'cause I'm was jumping out.

I was the only resident on this team with a lot of very experienced inspectors. And so I did some in-house kind of mock inspection work, limited in scope, but I found that very helpful in getting a little bit more familiar with the checklist and I also completed the team leader training. - Excellent. And so then that's what you did in prep, kind of get some experience with the checklist, see how that might be applied.

I guess as you were doing some of that self-inspection, were there some people at your home laboratory that were kind of taking you through a little bit of what that might look like or questions you could ask to a assess the checkbook?

- Absolutely. Absolutely. So we had actually just recently gone through our large CAP inspection. So we had all of these materials already curated together.

And so one of our lab directors met with me and we spent an afternoon kind of going through even just the common checklist looking at all the efficiency testing, you know, and it really proved helpful to me because whenever I went on the actual day of inspection it's interesting to see how what you do at your home lab is not necessarily how things look done somewhere else. And neither is correct or wrong, it's just different.

And so that was one of the great things and one of the messages that was really driven home by my team leader was that this is not about, you know, looking for deficiencies or looking to critique someone else's work. This is all of us coming together to learn from each other. - Yeah, I love that, that outlook, that perspective. I think that kind of brings, it's important certainly for a team leaders to cultivate

and it makes my heart go pitter patter that, that, you know this is also kind of getting conveyed for you, a new professional in our community, and you're getting this experience. Was the lab you inspected a bit similar to your home laboratory or was it much larger, much smaller? What was that like? - So it was different. I am part of a large healthcare organization. We have, I believe, 26 hospitals under our, under our group.

The lab that I inspected was also a large reference lab but we were actually only looking at anatomic pathology. They had recently been through their accreditation

inspection for CP at their various sites just a few weeks before we came through. So we really got to focus in on AP and a lot of the sites, it was just looking at say, intraoperative consultation and that was all that they did there. I spent majority of my time working hand in hand with the team leader and we spent majority of that at the core lab, their base site. - Wow, so and was this a one day inspection or did this kind of bleed over into two days or? - It was two days.

It was a two day inspection. And, you know, the first thing that we did on day one was we went on this tour of lab. And one of the great things about being able to be there as kind of the resident and working hand in hand with the team lead was that I got to see just how he was able to incorporate not just the tour but you know, asking questions so that he can inspect efficiently.

You know, asking questions along different parts of the tour, noticing things that would pop up on the different checklists that we were inspecting for that site. And you know, there's really an art to it and I was really glad that I got to see, you know, observe instead of having to learn firsthand. - And I imagine you're quite the perceptive person. I mean, you're, you're a pathologist, so, but I'm kind of curious about that mentorship that happened there.

Was that something that the site leader kind of discussed

a little bit with you ahead of time or after the inspection was kind of pointing out how he or she said those questions during the tour? - So it was kind of a combination. I mean, one thing that CAP is doing whenever they've been incorporating residents in these larger national inspection teams is they're really only putting one resident on each team so that that resident can have that kind of mentored experience.

And I believe that they're all being paired with these more experienced team leaders so that they really have it, you know in their wheelhouse to be able to take the time to mentor.

Now I was prepped, you know with kind of pre-presentation material and, you know I had done my pre-reading of the checklist but really as we went through, you know he would ask questions and most of the time I could come up with where those correlated to checklist items and if there was something where they couldn't produce it right away, you know he was very direct with the person giving the tour. And that's another thing about, you know, CAP inspections it's all about transparency.

It's not like you were looking for these things in secret. You are very open about why you're asking these questions and why you need to know that information. And so, you know, they were very clear and I was very clear and I found that extremely helpful. - Wow, it sounds like you had a wonderful experience with getting to see, you know, this expert approach to this lab inspection. Just like you're probably seeing expert pathologist mentors showing you how they approach a surgical specimen.

I'm kind of curious now, kind of having gone through that experience, what is your reflection on? What did you really take away from this experience? - You know, in addition to just having that hands-on experience, which I had heard kind of, you know, secondhand that, "Oh, well this would be great. You'll learn so much." And I thought, "Okay, well I have a lot to learn."

Not only, you know, is having that kind of familiarity I think a big bonus and frankly having the experience was a huge benefit to my confidence and my ability, you know to know confidently that I can go out into the workplace and that I understand what's involved in a CAP inspection. But for me, the biggest lesson was really to lean in and, you know, say yes even if it's a little scary because getting the email offer was exciting but very scary.

You know, it's intimidating, the idea that you'll be the only resident and you know this team of very experienced people and you want to add something about you.

And I was, I guess, relieved to find that I had something that they thought was a value add. - Absolutely. I think that's a message I just wanna, you know highlight and underline for the, the listeners, I think particularly junior faculty physicians in training, a lot of times really feel that imposter syndrome of not feeling like they have anything of value to give.

And so many times just your curiosity, your process and then also you have a lot, you know that you have accumulated, cultivated so far, you do have a lot of value you bring to the table. So thanks for highlighting that for our listeners. You know, it also makes me think about those of us training the next generation, right? That this regulatory and quality. Now, as a transfusion medicine physician, this rings true right through my heart.

I think that all pathologists have this appreciation for quality and regulatory

and understand why this is important for our work. Do you have any kind of reflections on having gone through this experience now? Is there, you know, one or two ways that you think that some of the listeners who are educators out in our community might think about improving the way that we teach quality and regulatory in our programs? - Wow, what a question.

I know that this is a lot of stuff that tends to be like the dry lecture, you know, very, you have to memorize this standard or this standard but for me, like I said, learn by doing is really like, what makes me latch onto something and makes it stick.

And what I really love about continuous quality improvement is that it really is this mission where we as a group, as pathologists, are all looking to show our best but to make our best better and opportunities where we can really highlight that like, "Yeah, we were doing great but here's how we can take what was our best and make that better." That's really what I would emphasize, you know in any kind of curricular initiative going forward. - Absolutely.

I love the way you stated that and are highlighting the importance of active learning, right? That that certainly is a key principle to make this learning sticky and I think, as you're highlighting, far more enjoyable as well. Now I know you mentioned how you got started in this. You wanna just mention for our listeners again, maybe residents, junior faculty, fellows who may be interested in approaching CAP College of American Pathologists to do an inspection.

What kind of those step one, step two step threes are to kind of follow in in your footsteps? - Absolutely. And CAP is really eager to have residents getting involved and getting on the ground. And the very first thing that you can do is to go online to the CAP website and complete the free self-paced team member training. And once you've completed that, go into your CAP profile and update your information on lab inspections. They will have your updated certification.

You just tell them about your availability, speak to your program director, make sure that they will give you the time off. If you are a program director, please consider giving your residents time off and time as credited learning days because this is some of the best CP training that we'll get during residency. - We've been rounding with Dr. Shaffer. Thank you so much for taking the time to tell us and show us your experience of participating in the lab inspection.

And to all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email. Please direct any suggestions to [email protected] and reference this podcast. If you've enjoyed Lab Medicine Rounds podcast, please subscribe. Until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through insightful conversations. (upbeat synth music)