Title:The design and implementation of a novel standardised training and assessment tool at LabPLUS, Auckland Hospital, NZ for anti-nuclear antibody (ANA) pattern reading using IIF methodology in a non-automated digital microscopy setting

Author:Paul Austin and Helena T Thompson-Faiva.

Abstract:Background: To reach a level of mastery in reading anti-nuclear antibody (ANA) pattern patterns using indirect immunofluorescence (IFF) methodology is a complex and difficult process. In New Zealand, for new BMLSc graduates, this process becomes far more difficult as both the Universities offering the degree course do not invest strongly in the procedure during the first three years. Furthermore, the fourth year clinical placements, can, at best, only provide a brief introduction due to time restrictions. It therefore falls to the employing diagnostic laboratories to both train and validate individual practitioner competency. As a consequence of the low levels of theoretical and practical experiences of new graduates, we recognised that the historical methods of training and assessment were inappropriate for both the organisation and the new graduates.
Aims: To design, implement and assess the value of a novel integrated training and assessment tool for ANA testing using IIF methodology.
Methods: Five new recent BMLSc graduates employed at LabPLUS, Auckland were the test subjects of the novel training and assessment system. Individual performance data was collected, analysed and fed back to participants in real time both verbally and in graphical format. All participants, after completing the programme, were invited to respond to a questionnaire where each question (10 in total) had a choice of five selectable options. Responses were collated and results presented.
Results: All five participants reached the set KPI values within one month of starting their assessment phases. All participants demonstrated an initial rapid reading agreement which then settled into a phase of gradual incremental improvement. Feedback from the survey was positive overall, with highlights for participants being (1) the “real-time” graphical presentation of their progress (2) identifying with the process being supportive and improving their analytical skill sets and (3) the system was superior to other programmes they had been involved with.
Conclusions: The conceptualisation and implementation of a novel ANA IIF training and competency assessment system at LabPLUS, was an operational success. The system effectively allowed the objective assessment and development of participants in what is essentially a subjective test setting. The features of the system gave it high flexibility and allows adaptation to other tests or areas either within or external to the diagnostic pathology laboratory.
Key words: Anti-nuclear antibody, indirect immunofluorescence, training, competency, participant feedback.
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