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A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(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 mcleducation@mayo.edu
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.
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