University of Texas Medical Branch

School of Health Professions – Department of Clinical Laboratory Sciences

Galveston, Texas 77555-1140

Preceptorship Performance Evaluation

Student Name:

Section of Laboratory IMMUNOHEMATOLOGY PRECEPTORSHIP

Clinical Affiliate

Dates of Training

Name of student’s clinical instructor

______

Purpose

The UTMB CLS student is required to meet cognitive (knowledge), psychomotor (skill) and affective (attitude) objectives of each preceptorship. This document outlines the cognitive and psychomotor objectives of the program. The following objectives can be used as a checklist for what the student can perform and/or to discuss or observe. The clinical instructor of the student will indicate how the items below were met by placing a check in one of the columns. The student is responsible for any item that cannot be discussed, observed or performed on site by reading or researching the information on line. The Last column will be initialed by the clinical person or by the student if researched or read about the objective.

O=Observed; D=Discussed; P=Performed; R=Read/researched by the student

ABO GROUPING, Rh TYPING, AND IAT/DAT

O

D

P

R

Initial

1. Perform ABO grouping, Rh typing and antibody screen (IAT) and correctly formulate the appropriate interpretation.
2. Given the results of a DAT, correctly formulate an appropriate interpretation.
3. Given an abnormal set of ABO grouping results, propose:
a. the possible causes, and
b. Resolution of abnormal ABO grouping results
4. Given an abnormal set of Rh typing results, propose:
a. the possible causes, and
b. proper course(s) of action for the resolution of abnormal Rh typing results
5. Given an abnormal set of IAT/antibody screen results, propose:
a. the possible causes, and
b. proper course(s) of action for the resolution of abnormal IAT results
6. Given abnormal Autocontrol results, propose:
a. the appropriate mechanism for determining if it is a true positive DAT,
b. The possible causes for a positive Autocontrol, as well as a DAT, and
c. Proper course(s) of action for the resolution of the abnormal results.
7. Compare the autocontrol and DAT, as well as the significance of positive results
8. Given a set of ABO, Rh, and IAT results which contain some abnormalities, define the relationship between the abnormal results and propose how the basic problem with the patient sample could interact with the various tests to cause multiple abnormal results.

ANTIBODY IDENTIFICATION AND Hemolytic Disease of the Newborn

Initial

1. Perform routine antibody identification for single and multiple antibody problems including rule outs and antigen typing. .
2. Given antibody panel results and the antigrams from a different set of panel cells, select cells required to determine the antibody specificity, given the initial panel reactions.
3. Given the results of regular and enzyme treated cells, determine antibody specificity/ies and additional specificities that may be ruled out on the reactions observed.
4. Discuss the use of Gel and Solid Phase technology. Interpret reactions based on these methodologies.
5. Diagram a plan for the use of auto absorption in resolving antibody problems.
6. Develop a strategy (why, when, how) for the use of chloroquine and EGA in resolving antibody problems.
7. Explain saline replacement technique in resolving antibody problems.
8. Perform, observe or discuss procedure and interpretation of antigen typing.
9. Given the results of an antigen typing, judge the accuracy of the results.
10. Formulate a strategy for performing an elution using the elu-kit and Lui Freeze.
11. Determine what is done with an eluate:
a. Compare the results of an elution with the serum/plasma panel
b. Use of the results for component therapy.
c. Determine the antigens present on patient cells
12. Given the results of ABO, Rh and other antigen typings, propose the most likely genotype and any alternate genotypes.
13. Correctly use the Fisher-Race and Weiner nomenclature, given the patient’s phenotype
14. Observe, perform or discuss ABO grouping, Rh typing, and DAT on cord blood specimen
15. Identify the possible causes for false results on cord blood specimen testing
16. Identify/explain the type of HDN, given the results of maternal & cord studies .
17. Observe, perform or discuss testing and determine the eligibility of an individual for antenatal, postnatal and post-abortion Rh Immune Globulin
18. Identify & explain the possible causes for false result with the Fetal Bleed Screening Test
19. Interpret the Fetal Bleed Screening Test
COMPATIBILITY TESTING: /

Initial

1. Given the labeled specimen and blood request for a patient, correctly evaluate the acceptability of the specimen and accompanying documentation for compatibility testing.
2. Given the results of the ABO Grouping, Rh typing, IAT, and information from prior blood bank records on a patient, correctly determine the appropriate ABO Group and Rh type of units for transfusion and the type of crossmatch required.
3. Given a sample for compatibility testing, perform all required testing, read & record results, interpret within the laboratory’s prescribed time limits
4. Given a patient sample for which group specific units are not available, correctly select the appropriate ABO/Rh units for the patient.
5. Given a problem compatibility result, propose the proper course of action, in sequence to be taken in resolving the compatibility problem.
6. Given a patient with a clinically significant antibody, propose the proper steps to be taken in order to obtain units which are safe for infusion into the patient.
7. Given a request for release of units on a patient, correctly define the steps to ensure the release of appropriate units to the patient.
8. Delineate the appropriate steps for releasing blood for emergency transfusion when there is not time to determine the patient’s ABO group and Rh type.
9. Propose the correct steps to be taken in completing the laboratory testing and paper work on the units released to a patient for emergency transfusion.
10. Given a patient’s Type and Screen results and past history, assess whether an extended, immediate spin or a computerized crossmatch is acceptable.

EVALUATION OF POSSIBLE TRANSFUSION REACTIONS

Initial

1. Outline the procedure for the initial transfusion reaction work-up.
2. Justify visual comparison of the pre-transfusion and post-transfusion serum/plasma.
3. Compare the major types of transfusion reactions and their causes.
4. Compare the possible significance of hemolysis in a post-transfusion specimen when not present in the pre-transfusion sample.
5. Explain the significance(s) of a positive DAT in a post-transfusion specimen.
6. Explain the significance(s) of a mixed field in a post-transfusion specimen.
7. Propose the most probable reason for an ABO transfusion reaction occurring.
8. Propose what, if any, additional work must be done, given the initial work-up of a transfusion reaction.

PREPARATION, QUALITY CONTROL & STORAGE OF COMPONENTS

Initial

1. List the residual white cell count for leukocyte-reduced RBCs by filtration.
2. Compare platelets combined from multiple single whole blood donor units versus an apheresis donation in terms of shelf life, concentration, and risk of immunization to platelet and HLA antigens.
3. List complications which have made fresh frozen plasma a less desirable component for volume expansion
4. Differentiate between the storage temperatures and shelf lives for packed RBCs, leukocyte-reduced RBCs by in-line filtration, pooled platelets, leukocyte-reduced pooled platelets, thawed fresh frozen plasma, pooled cryoprecipitate, deglycerized frozen RBCs and washed RBCs.
5. Determine the appropriate compatibility testing required for each of the components listed above
6. Differentiate between the shelf-life of CPDA-1, CPD, and additive preserved RBCs.
7. List the quality control criteria for concentration of “cells” in packed RBCs, leukocyte-reduced RBCs, frozen RBCs, and platelet concentrates.
8. Describe the quality control criteria for Factor VIII and fibrinogen in cryoprecipitate.
9. Differentiate the rational for using packed RBCs, washed RBCs, leukocyte-reduced RBCs, platelet concentrate, fresh frozen plasma, and cryoprecipitate.
10. Prepare a RBC unit for issue to a patient for transfusion.
11. Describe the preparation for issuing fresh frozen plasma, cryoprecipitate, platelet aliquots for neonates, and leukocyte-reduced components for transfusion.
12. Formulate a procedure for placing into inventory the blood and components received from the blood collection center.
13. Describe how blood is transported/stored throughout the hospital.
14. Outline the procedure for “returning blood to inventory” once issued.
15. Determine how temperature is controlled for all products in different situations
QUALITY ASSURANCE and Quality Control /

Initial

1. Compare Quality Control versus Quality Assurance.
2. Identify the items that must be quality controlled; include the frequency of performance and range limits.
3. List the quality control required on blood instruments, ie centrifuges, refrigerator alarms, pipettes, cell washes, sterile connecting devices, automated cell and serum typing instruments.
4. Given reagent reactions, recommend a course of action which will confirm the source(s) of error.
5. Determine the laboratories standards for maintaining required records.
6. Differentiate between record, document and form in terms of Quality Assurance.
7. Perform reagent Quality Control.

Scale:

3 = exceeds entry level requirements (>80%) – produces work of high quality

2 = Meets entry level requirements (70%) – requires little duplication of instruction and makes few errors

1 = does not meet entry level requirements (<70%) - improvement needed.

Criteria: please circle the box which you feel represents this student’s ability during and/or after this preceptorship rotation. / Exceeds entry level Requirements (>80%) / Meets entry level requirements (70%) / Does NOT meet entry level Requirements (<70%)
Technical Knowledge and Competence
1. Recalled the scientific principles of laboratory test procedures / 3 / 2 / 1
2. Discussed technical and procedural concepts / 3 / 2 / 1
3. Assess sample integrity specific to the laboratory area / 3 / 2 / 1
4. Detected the need for and used problem solving procedures / 3 / 2 / 1
5. Integrated and practiced safety regulations / 3 / 2 / 1
6. Explained the principles of quality assurance and quality control / 3 / 2 / 1
7. Discussed scientific information and the application of principles as they related to tests performed/sent to reference lab by this area / 3 / 2 / 1
8. Recognized abnormal laboratory data and made correlations with associated pathology / 3 / 2 / 1
9. Confirm the validity of test results and suggest additional test procedures / 3 / 2 / 1
10. Performed and interpreted diagnostic tests with accuracy / 3 / 2 / 1
11. Used quality control procedures / 3 / 2 / 1
12. Calibrated instruments or determined QC requirements for instruments / 3 / 2 / 1
13. Evaluate laboratory results / 3 / 2 / 1
14. Effectively analyzed malfunctions and trouble shoots instruments and/or procedures / 3 / 2 / 1
15. Selected appropriate samples and test methods / 3 / 2 / 1
16. Selected appropriate reagents/ blood products and instruments. / 3 / 2 / 1

Please indicate your appraisal of the individual’s performance as a clinical laboratory science professional by checking one box:

Above Average [ ] Average [ ] Below Average [ ]

Please provide examples of any marks of “Does not meet entry level Requirements” level 1 and/or any other comments you would like to make about this student: If you would like the comments to be private, please email . Thank you.
OPTIONAL: Each year one student is picked for the McGanity Scholarship of $500 and recognition at graduation. We are asking you to help us pick this student by completing a survey online. Do you think this student’s overall performance was exceptional or a student who represents what you think is the ideal clinical employee? If yes, please click here to go to the survey site to enter your evaluation: https://survey.utmb.edu/TakeSurvey.aspx?SurveyID=8lL19p8
You may also give this link to any of your staff. Thank you for your time.

Thank you for your appraisal of this student’s experience at your facility.

Clinical Facility Instructor signature: Date:

Section Supervisor/Clinical Coordinator: Date:

if different than above

This evaluation must be given to the student. The student is responsible for scanning and submitting on Blackboard.

Revised 2013 3