CLS 4184 CLINICAL PRACTICUM II
    HEMATOLOGY, URINALYSIS AND BODY FLUIDS ROTATION

                                    SYLLABUS AND INTRODUCTION

Welcome to the world of the clinical laboratory for hematology, urinalysis and body fluids. You will complete your clinical practicum rotation at one of the following sites that you have confirmed with the Clinical Coordinator.
    American Esoteric Laboratories                                      Memphis, Tennessee
    Arkansas Methodist Hospital                                           Paragould, Arkansas
    Forrest City Medical Center                                            Forrest City, Arkansas
    Crittenden Regional Hospital                                          West Memphis, Arkansas
    Cross Ridge Hospital                                                          Wynne, Arkansas
    Five Rivers Medical Center                                              Pocahontas, Arkansas
    Great River Medical Center                                             Blytheville, Arkansas
    Lawrence Memorial Hospital                                           Walnut Ridge, Arkansas
    Harris Hospital                                                                   Newport, Arkansas
    Pemiscot Memorial Health Systems                                Hayti, Missosuri
    Piggott Community Hospital                                            Piggott, Arkansas
    Popular Bluff Regional Medical Center                           Popular Bluff, Missouri
    St. Bernard’s Medical Center                                          Jonesboro, Arkansas
    St. Edwards Mercy Medical Center                                Ft. Smith, Arkansas
    South Mississippi County Regional                                  Osceola, Arkansas
   Twin Rivers Medical Center                                             Kennett, Missouri
    White County Medical Center                                           Searcy, Arkansas
    White River Medical Center                                              Batesville, Arkansas

Differentiating between the clinical practicums for the 2-year and 4-year student.

01    A student enrolled in either the CLS 2524 Clinical Practicum II or CLS 4184
        Clinical Practicum II (during the same semester) does not train together at
         the same bench or in the same clinical affiliate with another student enrolled
         in the other clinical practicum .

02    The clinical instruction for technical skill development and learning procedures
         for hematology, coagulation, urinalysis, and body fluid testing will vary some
        what between clinical affiliates. The following are things that you may expect.
        A.    The student clinical evaluation form lists two pages of technical
                assessment items. The listing of these items are the same for both
                the two- and four-year student.
                a.    The State of Arkansas is a non-licensured state and there are no
                       legislative rules that are applicable to the clinical laboratory profession.
                b.    All laboratories in the state are CLIA approved and are subjected to
                       Federal regulations. For this reason, the technical assessment items
                       that are listed are the same.
                c.    The clinical laboratory to which you are assigned will evaluate you
                       who are enrolled in the CLT Program will evaluate you at the CLT
                       expectancy level. If you are enrolled in the CLS Program, you will be
                       evaluated at the CLS expectancy level.
        B.    The four-year student evaluation form will have similarities, but different
                from that for the two-year evaluation form.

03    The four-year student complete activities in the areas of problem solving
          and critical thinking competencies that addresses case studies, higher levels
         of clinical testing, demonstration of understanding clinical disease processes,
         management issues, and educational methodologies. These are NOT
         required of the 2-year student.  The CLT and CLS clinical practicum have
          their own forms.
        A.    The majority of these forms are available in the Blackboard system for
               downloading at your convenience.
        B.    All other forms are available from the faculty instructor who has
                responsibility for this clinical rotation.
        C.    Items that you must request from the faculty instructor are:
                a.     glass slides for making the required slides.
                b.     plastic case for keeping slides.
                c.     bubble sheets for recording answers to required questions.
                d.     special case study packets (to be completed during the clinical
                        rotation assignment).

You have five weeks in which to complete 168 contact hours of clinical rotation experience at your designated site (selected from the above list).  Plan on arriving between 7:00 a.m. and 8:00 a.m. on the first assignment day and ask for the laboratory manager.  This person’s name will be given to you by the Clinical Coordinator.  On the succeeding days, you will arrive at the time assigned by the laboratory preceptor which is usually between the hours of 6:00 a.m. to 8:00 a.m.  You will maintain a daily attendance log, listing the cumulative hours, which you will complete and the assigned instructor will initial at the end of the work shift.  You will need the following to complete the requirement of this course.  You will be expected to perform with an accuracy rate of 90% or better.
01    One set of 225 exam questions which may be down loaded from
         Blackboard or obtained from the instructor if you are unable to down
          load the exam.
02    An answer page (red computer bubble sheet) to record answers for exam. 
         You will need two answer sheets.  Be  sure to ask the instructor (for this
          clinical practicum) for two answer sheets.
03    The CLS Program Clinical Rotation Handbook and CLS Program Handbook
         are available on the Lab_Sci list serve.   Both are available at the beginning
         of each semester and upon request.  If you need to download a copy, of
         either contact the CLS/RS secretary, room 101 in the Chickasaw Building.
         The student handbook contains  contain directions on how to get to your
         clinical site.  The clinical rotation handbook contains the attendance sheet,
         phlebotomy check sheet, and clinical site evaluation form (to be completed
         by the student).

The following general schedule will be followed and will be modified by the Clinical Preceptor.

First day:     Arrival to the clinical site and introducing yourself to the Clinical
                    Preceptor.   Expect to receive instruction on laboratory safety,
                    confidentiality, phone etiquette, and other orientation requirements.
                    You may be required to being reading the procedure manual for
                     that department and be allowed to observe instrumentation,
                    quality control, calibration and maintenance  activities, as-well-as
                    other hematology and coagulation lab operations.
Second day: This may be a characterized by reading assignments, going on the
                     floor for phlebotomy experiences, and observations of lab
                     operations. It is possible that the lab may begin to work you into
                     laboratory activities with supervision and assistance.
Third day:    Begin to function in lab activities with supervision and assistance.
Fourth day   and remaining days of the rotation assignment, you will be expected
                    to develop your proficiency and skills in laboratory assignments
                    with minimal supervisory oversight.

When you arrive at the clinical site, the laboratory preceptor will provide direction and instruction as you progress through this segment of the laboratory experience.  As a student laboratorian you will be expected to perform the clinical laboratory procedures (refer to the laboratory evaluation sheet) using mock and/or actual patient specimens.  All actual patient specimen tests that you perform MUST be verified by the medical technologist responsible for that department (or someone designated by the department supervisor.)   As a student, in your assigned clinical site, you are expected to able to accomplish the following with a high degree of accuracy (90% or higher):
A.     Complete the following goals after receiving appropriate instruction and
         practice:
        1.     list several sources of error for each procedure.
        2.     list normal values and where they are applicable, describe variations
                that may result from age, sex, etc.
        3.     identify which specimens are unacceptable and state why.
        4.     describe the different types of hematology specimens, how they are
                collected and state the testing purpose for each type of specimen.
        5.     describe the handling procedures for blood in terms of timing,
                preservation techniques, handling requirements, and temperature
                restrictions.
        6.     briefly state the testing principle so that an understanding of the
                basic concepts of the procedure may be demonstrated.
        7.     prepare reagents for test procedures as appropriate and explain
                the function of the reagent and the purpose of each ingredient.
        8.     list the advantages, disadvantages and limitations of each procedure,
                as well as sources of error.
        9.     perform math calculations to correct test results as necessary with
                90% or greater accuracy.
        10.   correctly transcribe test results in a legible manner from one form to
                 another.
        11.     interpret test results in the following ways:
                   a.     distinguish normal results from abnormal.
                   b.     list and/or discuss possible causes for abnormal results.
                   c.     when given test data
                            i.    compare to other data from the same/similar case and
                                  correlate results.
                            ii.    identify and suggest other tests that would be helpful in
                                   the diagnosis process.
        12.     recognize those test results which represent critical (panic) values
                  and describe and/or take an appropriate course of action.
B.   Demonstrate, while under the supervision of a laboratory preceptor, the
       following basic laboratory techniques:
       1.     handle the specimen and perform the testing procedures according
               to the laboratory standards and policies for safety.
       2.     process specimens in accordance to the affiliate's laboratory policies.
       3.     preparation and use of reagents, controls, standards, etc.
       4.     select and use appropriate laboratory glassware and equipment.
       5.     correctly preserve any specimen where the testing procedure must
                be delayed for a period of time.
       6.     perform all Q.C. procedures, then correctly and legibly record the
               results.
       7.     use correct units when reporting results.
       8.     demonstrate correct handling of stained blood smears and microscopic
                UA sediment slides, evaluating each with accuracy.
       9.      correctly and legibly report all results in accordance with the
                laboratory policy.
       10.    demonstrate knowledge and understanding of the QA process in the
                assigned laboratory.
C.     Successfully demonstrate the following for those instruments within the
          hematology department of the clinical laboratory:
        1.     briefly describe the principle and/or theory for each instrument used.
        2.    demonstrate correct use of the instrument.
        3.    describe and/or demonstrate correct technique in the care and
               upkeep of the instruments.
        4.     maintain one or more of the following records of each instrument (or
                 equipment item):
                a.     calibration
                b.     temperature
                c.     maintenance/repair
                d.     quality control
        5.     describe and/or demonstrate basic trouble shooting techniques for
                each instrument.
        6.     describe the limitations of each instrument.
        7.     describe the reliability limits of each instrument.

UNDERSTANDING THE CLINICAL ROTATION EVALUATION PROCESS

The clinical practicum rotation consists of experiences that utilize your having satisfactorily met the cognitive, psychomotor, and affective domain objectives for the following  courses (with permission of the program director):
        CLS 1521 Urine and Body Fluid Analysis
        CLS 1531 Laboratory for Urine and Body Fluid Analysis
        CLS 2521 Laboratory for Basic Concepts of Hematology
        CLS 2523 Basic concepts of Hematology
The following courses are part of your pre-practicum requirements and will facilitate your successful completion of this clinical practicum. 
        CLS 3221  Laboratory for Hematology II
        CLS 3223  Hematology
Refer to the respective course syllabi (of the above courses) for a listing of these three types of objectives.

Your clinical laboratory practicum experience encompasses these four areas: hematology, coagulation, urinalysis and body fluids. This will be accomplished by evaluating you, the student, in these four areas (hematology, coagulation, urinalysis, and body fluid analysis) in the cognitive, psychomotor, and affective domains.

Review the Affective Domain criteria (Unit IV) presented in the Student Evaluation Form. The clinical instructors will use these to assess you when you complete your time commitment in the clinical rotation.   Refer to the Student Handbook for a detailed listing of affective domain objectives (which also includes behavorial objectives).

The Psychomotor evaluation will be performed by your assigned clinical instructors when you have completed your clinical experience. These criteria are presented in Unit I (Technical Skills), Unit II (Procedures for Hematology and Coagulation), and Unit III (Procedures for Urinalysis and Body Fluids).

The Affective Domain and Psychomotor evaluations will constitute 45% of your grade which is designated as the “Clinical Rotation Evaluation II.” This “Student Evaluation Form” is a form that is used to assist the supervising ASU faculty member in assigning the grade. As a reminder, you must remember that each time you complete a clinical practicum in this professional course of study, you need to carry this information forward into your next courses and clinical practicum experiences. The “Student Evaluation Form” for the hematology, coagulation, urinalysis, and body fluid practicum will be evaluated in the following manner. There are a minimum of 59 evaluation items for the psychomotor domain designated as I, II, and III. The preceptor will write in an appraisal number between 0 – 10 for each item used in the evaluation process for those that are appropriate for you. The numbers will be summed and entered into a formula to obtain a score that will be combined with the formula results obtained for the affective domain evaluation. There are other factors which will contribute to your overall grade. You are expected to earn a minimum of 70 percent to satisfactorily complete this part of the evaluation process. Failure to meet these evaluation items may result in a failing grade.

The remaining part of the evaluation is designated as the “cognitive evaluation” and has several components to it. It is designated as “Clinical Rotation Evaluation I” and will make up 55% of the grade. “Evaluation I” is made up of several parts. These grades are combined for the final grade.
01     Now that you you have enrolled in  CLS 4184, you are required to complete other assignments which are also found in Bb6.    Go to the "Course Information" section and scroll down to COURSE PROJECTS FOR CLS 4184 Follow the instructions and you will find the assignments and instructions for completing the requirements of this course.  These points will be incorporated into the grade.
02     Compiling the grade for “Clinical Rotation Evaluation I” will be accomplished by that faculty member who was responsible for your campus based instruction in hematology, coagulation, urinalysis, and body fluids or who was assigned to evaluate you during this clinical experience.  This is accomplished in part by providing a final clinical rotation exam, to be completed at the end of the clinical rotation, that will become part of your overall evaluation.  This final test consists of 30 written questions from each of the four areas for a total of 120 questions. Thirty-five (35) illustrations/ pictures from hematology cell morphology, and twenty-two (22) illustrations/pictures from urine sediment.   This testing unit is designed to evaluate the baccalaureate student in critical thinking and problem solving skills.  A minimal score of 70% is expected for this part of the evaluation process.
03     There is an exam of 225 study questions that is available to you at the beginning of the rotation that is to be completed during the clinical rotation period and turned in at the time you take the final rotation test of 120 questions. This exam may be downloaded from the "Course Information" section.  Contact the instructor for answer sheets, you will need two (one answer sheet for the first 200 questions and the second for the last 25 questions) .
04     Three sets of stained blood films, each set with a hospital generated CBC report for each set of slides, are required. Each set is to contain a minimum of five (5) stained slides. The grade earned from this activity will be added into the “Evaluation I” grade as part of the grade.  Each set is worth 15 points based upon the quality of the smear and stain.     Unstained, poorly prepared, and/or unsatisfactorily stained slides will be graded "zero".
        A.     The patient’s name and I.D. number must be deleted from CBC
                 report but the age and gender needs to be indicated, if it is permitted
                 by the laboratory.
        B.     To clarify the meaning of the term "set", each set must consist of
                 five slides appropriate for a stained blood film evaluation using the
                 following example.
                a.     If the patient is John Doe, then make 5 high quality blood
                        smears, allow to dry well, and then stain each slide.
                        NOTE:  If the slides are poorly made and/or stained, grades
                                    will be significantly reduced.
                b.     Label each slide with an identification number that matches the
                        CBC report that is to accompany that set of slides. Do NOT
                        place a cover glass over the stained blood film. The instructor
                        will do this step.
                        NOTE:   Do NOT put oil on these slides nor are you to perform
                        "diffs" on them.
                c.     Turn in the CBC report sheet with the patient's name and
                        ID number removed or obliterated, BUT with the age and
                        gender of the patient noted.   
                d.     Repeat the process by collecting two more sets of slides from
                        two other patients.
       C.     Five (5) extra bonus points will be credited for an extra set of 5 slides
                turned in.  You may turn in extra sets (up to 3), for extra bonus
                points for each set.   The slides must be be well made and stained to
                receive full points.
        D.     Note: Two sets of slides may be from a normal patient, but must
                             be pediatric patient (also indicate the age of the patient). 
        E.     The other sets should be from patients diagnosed with a hematology
                 disorder (those indicated by an * are highly preferred) or are under
                 therapy for an illness or cancer. Examples of preferred slides, which
                 includes a variety of disorders are listed as follows:
                       *Infant patients (under 1 y/o)
                       *Young children (1 to 10 y/o)
                       *Cord blood
                        Iron Deficiency Anemia,
                        Pernicious Anemia
                        *B12 and/or Folic Acid Deficiency Anemia
                        Chronic Myelocytic Leukemia
                        *Hairy Cell Leukemia
                        *Polycythemia vera.
                        Any Acute Leukemia (M1 - M7 and L1 - L3)
                        *Pelger-Huet Anomaly
                        *Alder-Reilly Anomaly
                        Chemotherapy
                        Disseminated Intravascular Coagulation.
                        *May-Hegglin Anomaly
                        Infectious mononucleosis
                        Appendicitis
                        Animal or snake bite victims
                        Patients diagnosed with bacterial or viral infections
                        Any slide of hematological interest.
                        DO
       Note: Be sure to ask the instructor for a box of new slides to make
        the blood smears and also a box to store your slides as you
         complete this part of the clinical rotation requirements.
05    You are required to participate in phlebotomy activities while you are in
         your rotation assignment.  
         A.    A minimum of 35 blood collections must be completed.
         B.    If you are asked to collect blood, do not refuse....to do so as it will
                 negatively affect your overall grade.
         C.    If you are employed as a phlebotomist in a clinic or hospital, see
                 the course instructor for additional instructions on this assignment.
06     In summary, your grade for this CLS clinical practium is calculated from
         the following parts:
            A.     “Clinical Rotation Exam I” (55% of the grade)
                    a.      Two Hundred question exam.
                    b.      Final Rotation Exam.
                    c.     Optional library report (this may be done to earn
           bonus points). Allowed only by permission of the
           instructor.  Maximum of 12 bonus points.
                    d.     One to two page essays on designated topics (as these are practiced
                              in the laboratory/hospital you are assigned to). are practiced
                              in the laboratory/hospital you are assigned to). There are four
                              of these essays. You will find these in Bb6 in the "Course
                              Information" section under item "Other assignments for CLS
                              4184)".
                    e.      Three sets of stained hematology slides.
                    f.      Case study assignments.  These are located in the same Bb6
                              section as the designated topics.
                    g.      Earned bonus points.
         B.     “Clinical Rotation Exam II” (45% of the grade).
07    You must turn in to faculty the following documents when you have completed
        A.     Completed attendance sheet, properly initialed by the clinical preceptor.
        B.    Your evaluation sheet of the clinical site and experience in the lab.
        C.    Answer sheet for the clinical rotation exam A.
        D.    Library report (if required or submitted for bonus points).
        E.    Set I. Case studies. There are 8 to be reported on from an assigned
                web site.
        F.     Set 2. Two case studies provided by the instructor.
        G.     Special one to two page essays, one each for confidentiality, HIPPA, lab
                 safety, and continuing education (a total of  four separate pages).
        H.    The completed student evaluation sheet by clinical preceptor.  (This
                 document may given to you be in a sealed envelope or they may elect to
                 mail it.)
        I.    Turn in the stained blood smears with the hospital CBC reports. 
        J.     Two lab procedure writing assignments.
        K.    Take the clinical rotation exam B on campus when you have finished
                your clinical rotation.   See the instructor for a copy of the exam and
                allow yourselves up to two hours to complete the exam.

                                ATTENDANCE AT THE CLINICAL SITE
Attendance is an important part of the evaluation process. ALL ABSENCES MUST BE MADE UP. Excessive and unexcused absences will result in a failing grade regardless of the total points earned.  
01    Once you have arrived at the clinical site, you are required to remain until
        you have completed the day's assignments and that is approximately eight
        (8) hours.  Failure to adhere to laboratory attendance protocol will result in
        disciplinary action.  
02    Leaving and returning to the clinical site is not permitted unless it is an
         emergency. 
03    Failure to notify the clinical site and/or the Clinical Laboratory Program
         of your not being able to be in attendance at the clinical practicum site will
         result in point reduction penalties for the affective domain grade. 
04    If, after arriving at the laboratory and an interval of time lapses, the clinical
         laboratory then asks you to leave the lab to go home for the day, YOU ARE
         REQUIRED TO NOTIFY THE CLS PROGRAM OF THIS OCCURRENCE.
05    You are expected to stay at the clinical site for eight hours.  If you leave the
         clinical site without permission and justification, you are subject to discipline
         by the CLS Program.  Failure to notify the clinical site and/or Clinical
         Laboratory Program that you will not be in attendance at the clinical
         practicum site will result in point reduction penalities for the affective domain
         grade.
 
Notice.   If you are enrolled in a web-based course, you are NOT EXCUSED from your clinical rotation to leave the hospital site and go work on any web-based assignment.  Web based assignments can be completed at other hours.

                                           OTHER USEFUL  INFORMATION

[1]     There are no generalized review / study questions for the hematology, coagulation, urinalysis, and body fluid rotation experience to study.  A two-hundred twenty five question test has replaced the study questions.
        A.    These have been put together to help you prepare for the final rotation
                 examination and to serve as a review for the national certification 
                 examination. 
        B.    Your textbook and classroom notes will be helpful review resources.
 
[2]     The following information is included to help you plan your study strategy for one of the national registry examinations.
        A.     ASCP Board of Registry Study Guide (4th edition) Clinical Laboratory
                 Certification Examinations. Order #4160. Approximate cost: $50. You may
                 go to www.ascp.org and order this item.
        B.     Dictionary of Questions. There are two 8½ × 11 inch booklets of about 45
                 pages that provides descriptor information of the entire bank of exam
                 questions offered by the ASCP Board of Registry. There is a booklet each for
                 the Medical Laboratory Technician and the Medical Technologist. Each
                 booklet will describe:
                    a.     Process of examination development.
                    b.     Examination Content Guidelines.
                    c.     Competency Statements.
                    d.     Exam Content Outline
                    e.     Frequently asked questions.
                    f.     Item descriptors which is an abbreviated explanation of the types of
                            questions than can be expected on the exam. The following lists four
                             examples of descriptors with their explanation.

            If you wish to order the booklet of Dictionary of Questions, request it as
            follows:   Dictionary of Questions for the Medical Laboratory Technician or
            Medical Technologist.   The cost will be approximately $25 for each booklet.
                      this item is also available online from www.ascp.org

C.     Clinical Laboratory Science Review.  Its cost is approximately $45.00, includes
         shipping costs.   It may be ordered from:
                    LSUMC Foundation
                    Department of Clinical Laboratory Sciences
                    1900 Gravier Street
                    New Orleans, LA 70112
                    Phone: 1-504-568-4276
        Note: This book is highly recommended by ASU CLS/CLT graduates.

D.    A review book formerly known as  “Pearls of  Wisdom” is under a new title,
        "Quick Review Q & A's." It is a book of more than 3000 concise questions
         and facts for those who wish to study for the registry exam.  Cost
       is approximately $40.00. Shipping costs are not known. This book may be
       ordered by going to one of two web sites as follows:
                    www.clsquickreview.com    
                    www.ascls.org/publications/edconn/asp     

    E.    NCA Review for the Clinical Laboratory Sciences (4th Edition) by Susan
            Beck.  It is published by:
                            Lippincott Williams and Wilkins
                            ISBN # 0-7817-3190-9
            It may be ordered through the campus bookstore or at the web site: 
                            www.LWW.com
            For more information call the publisher at   1-800-638-3030

If you contact one of the faculty or staff, there are copies of the above books that
will be made available to you to use (just by asking for them).  If you will return
the books (after taking and passing the registry exam), we can recycle them to
other students for their use.  Also if you (after completing the registry exam) share
with the Program your experiences with the registry exam, that information will
be passed to others. 

There is a set of practice exams available to you on the CLS web site.  Ask any
faculty about accessing these exams.   They are free and have proven to helped
graduates in passing the registry exams.  Remember the more practice tests"
and questions you participate in, the greater your chances of passing the exam the
first time with an impressive score.

This web site is maintained by Whitney Williams, wwilliam@astate.edu

This page last updated 07/28/08