Medical Biochemistry

Andrew Don-Wauchope, MB.BCh, MD, FRCPE, FCPath, FRCPath, FRCPC
Medical Biochemistry Program Director
Associate Professor, Pathology & Molecular Medicine
Program Director, Medical Biochemistry
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McMaster University Medical Centre


We are currently closed to independent, foreign applicants.




Program Overview

The Residency Training Programme in Medical Biochemistry at McMaster University is a totally integrated programme involving the University and the four teaching Hospitals within the City. There is a co-ordinated series of regional laboratory programmes which has developed areas of expertise and specialized facilities at one or other of the participating hospitals. This rationalization provides a high standard of care for the community and excellent educational opportunities for residents in the various specialty programmes.

The Medical Biochemistry Programme is fully accredited by the Royal College of Physicians and Surgeons of Canada. The first three postgraduate years (PGY1-3) will be based in Internal Medicine or Pediatrics. The candidate will be expected to complete the PGY 1-3 component satisfactorily, including the RCPSC examination in either Internal Medicine or Pediatrics.

During the PGY1-3 years the medical biochemistry resident will be expected to use their elective time in clinical laboratory rotations. A range of these electives are available to cover very specific topics (e.g. Therapeutic Drug Monitoring) through to a more general overview of laboratory function.

The final two years (PGY4-5) will be spent training in the medical biochemistry laboratories in Hamilton. The rotations will be divided between the 4 hospitals and the planned schedule allows the resident to spend 6 consecutive months at each hospital. The content of these years is very dense as there is a wide variety of methodology that the resident is  required to know before the examination. In addition the pathophysiology of disease needs to be well entrenched in the residents knowledge so that the utility of testing can be understood. During the medical biochemistry laboratory training the resident will be expected to continue to develop their area of clinical practice through out-patient clinic rotations.


Program Description

The Medical Biochemistry Program trains physicians to effectively understand the use of biochemical testing in clinical practice. The program prepares residents for both laboratory and clinical practice. The role of a Laboratory Physician is very variable and includes taking on the role of Laboratory Director; running the clinical chemistry component of the laboratory, running the core laboratory and special chemistry sections of the laboratory. In addition many medical biochemists have active research programs and Medical Biochemistry is well placed for residents who have an interest in the Clinician Investigator Program. (CIP).

Integration of the Medical Biochemistry Programme with the post doctoral training programme in Clinical Biochemistry and the medical biochemistry component of the General Pathology Programme provides the residents with an opportunity to work with colleagues in these closely related fields. Residents carry the Clinical Biochemistry pager when they are ready acting as front-line consultants for Medical Biochemistry. Although responsibilities for delivery of analytical services is limited, residents are involved in all aspects of selecting and instituting new pieces of instrumentation or new procedures. Residents are expected to follow such a project to its introduction into the laboratory routine providing expertise and acting as a resource for laboratory personnel. Whenever possible, residents are involved in management team decisions regarding staff selection, quality control surveillance, budget review, etc. Trainees are, from the outset, regular members of the Clinical Chemistry and Immunology Advisory Committee and as such attend all meetings and participate as full members along with their faculty colleagues. Each of the Clinical Biochemistry laboratories is organized to ensure that quality service can be provided independently from resident activity thus ensuring that educational events have the highest priority and residents never forgo academic sessions in order to provide service.

All residents are expected to present a research project at Regional, National or International meetings and funding is provided for attendance at the National meeting of the CSCC each year. Residents are evaluated at the completion of each 2 month rotation, however, it is expected that they will develop self-evaluation skills, an integral component of the self-directed learning which is strongly emphasized in the Programme.


Programme Goals

This Programme aims to provide the resident with the opportunity to become knowledgeable and competent medical biochemists with the skills required to be both an effective consultant for clinical colleagues and a capable Clinical Biochemistry laboratory professional. This requires, and the Programme provides the environment necessary for the individual resident to develop skills in self-evaluation, self-directed learning and critical appraisal enabling the medical biochemist to proficiently pursue life-long learning. Individuals completing the Programme should be equipped to adapt to the changes that will occur in the profession throughout their careers. At the completion of the training period, the resident will be able to:

• Discuss normal biochemical pathways and the etiology and pathogenesis of the biochemical disorders of disease
• Act as a consultant in the selection of appropriate laboratory tests
• Understand the interpretation of biochemical data and its integration with the clinical practice of medicine
• Understand the principles of selection of laboratory equipment
• Establish and maintain a quality control programme
• Organize an analytical biochemistry laboratory and assume responsibility for its administration
• Demonstrate an ability to develop research protocols and interpret research data
• Demonstrate an ability to teach medical biochemistry
  
  

Curriculum

The 5 year program consist of the PGY 1 -3 year which is designed to meet the needs for either Internal Medicine or Pediatrics  and as far as possible to accommodate special interests of the trainee. This is followed by 2 years of laboratory rotations during which the resident is expected to meet all the goals of the specialty committee in Medical Biochemistry in preparation for the Medical Biochemistry RCPSC examination.  Throughout the program residents are encouraged to participate in specialty out patient clinics up to one half day per week, enabling them to maintain clinical skills and enhancing their opportunity to interact with clinical faculty and with resident colleagues in various clinical services.

The curriculum allows the residents to be exposed to all the topics prescribed by the Royal College specialty training committee. Residents are involved from the outset in the clinical consultative activities of the faculty. The laboratory rotations expose the residents to all the methodological principals of laboratory analysis. The operation of different analytical platforms, method evaluation, comparison and quality control are all essential components of the training program. Monitoring of the day-to-day operation of the laboratory is also required including the principals of Total Quality Management. Specialty training within Medical Biochemistry is  also undertaken with dedicated time in pediatric clinical chemistry, molecular diagnostics, chromatography and mass spectrometry.

From PGY 2 onwards residents are expected to undertake a research project which will result in a presentation at residents research day in laboratory medicine and in most cases an abstract submitted to the annual general meeting of the Canadian Society of Clinical Chemistry and/or submission of a paper for publication in an appropriate journal. Skills with specific analytical instrumentation are often acquired during the research project, e.g. HPLC, mass spectrometry or a PCR. They are from the outset of the Laboratory component of training regular members of the Clinical Chemistry and Immunology Discipline Committee and as such attend all regular meetings and participate as full members, carrying out various responsibilities on behalf of the committee in addition to attending the annual general meeting of the CSCC/CAMB. Arrangements are made for trainees to attend all local Medical Biochemistry related conferences, meetings and new instrument presentations.

Evaluation

Performance appraisal is on-going and in-course training assessment in the format of written, oral and practical examination are given annually. Residents will also have the chance to participate in faculty evaluations.