EDUCATION AND TRAINING FOR CLINICAL CHEMISTRY EDUCATION AND TRAINING FOR CLINICAL CHEMISTRY Prepared for Publication by MARTIN RUBIN, PhD, Georgetown University Medical Center, Washington, DC, USA PER LOUS, MD, PhD, Bispebjerg Hospital, Copenhagen, Denmark Published for The International Federation of Clinical Chemistry Committee on Education and Training in Oinical Chemistry by MTP Press Limited Published in the UK forIFCCby MTP Press Limited St Leonard's House, Lancaster, England © Copyright 1977 International Federation of Oinical Chemistry Softcover reprint of the hardcover 1st edition 1977 First published 1977 No part ofthis book may be reproduced in any form without permission from the publishers except for the quotation of brief passages for the purposes of review. ISBN-13: 978-94-011-6178-7 e-ISBN-13: 978-94-011-6176-3 DOl: 10.1007/978-94-011-6176-3 A. Wheaton &Co., Exeter Contents 1 BACKGROUND 1 The IUPA C Commission on Teaching of Oinical Chemistry 1 The IFCC CommiUee on Education and Training in Clinical Chemistry 2 2 INTRODUCTION 3 The Development of Clinical Chemistry 4 Historical Development 4 Origin of the Term 'Clinical Chemistry' 4 Chemical Analysis of Body Fluids for the Diagnosis of Disease 5 Introduction of the Concept of Homeostasis 5 Introduction of Colorimetry and Photometry as Analytical Tools 6 Enzyme Activities as Indicators of Cellular and Organ Disorders 6 Introduction of Automation and Electronic Data Processing 6 National and International Societies and Publications Devoted to Clinical Chemistry 7 Current Status 9 Role of the Clinical Chemist in Health Assessment, Diagnosis and Treatment 9 Role of the Clinical Chemist in Medical Education 10 Role of the Clinical Chemist in Service 12 Role of the Qinical Chemist in Research 13 Present Problems in Clinical Chemistry 14 Future Trends 15 3 THE EDUCATION AND TRAINING OF THE CLINICAL CHEMI4lT 17 Role of the Qinical Chemist 17 Aspects of Education 17 Basic Research 17 Applied Research and Development 18 Service 19 Management 19 Supplementary Education after Graduation from Programs in Medicine, Science and Pharmacy 20 For the Medical Graduate 20 For the Science Graduate 21 For the Pharmacy Graduate 22 Continuing Education Experience in the Practice of Clinical Chemistry 23 Education of Technical Staff 23 The Senior Chemistry Technologist 23 The Senior Non-Chemist Technologist 24 Technologist 24 4 CONCLUSIONS AND RECOMMENDATIONS 26 5 WORLDWIDE CLINICAL CHEMISTRY 28 Individual Countries: Argentina 28 Australia 33 Austria 39 Belgium 43 Bolivia 47 Brazil 48 Bulgaria 50 Canada 51 Chile 57 Colombia 61 Czechoslovakia 63 Denmark 68 Ecuador 72 Egypt 74 Ethiopia 77 Federal Republic of Germany 79 Finland 86 France 94 German Democratic Republic 99 Ghana 101 Hungary 103 India 109 Ireland 112 Italy 113 Japan 121 Mexico 122 The Netherlands 124 New Zealand and Malaysia 126 Nigeria 129 Norway 132 Poland 134 Portugal 138 Rumania 139 South Africa 142 Sweden 146 Switzerland 148 Syria 151 Union of Soviet Socialist Republics 154 United Kingdom 161 United States of America 173 Venezuela 189 Yugoslavia 190 Preface While the historic roots of clinical chemistry originate from the chemical sciences the growth of the subject has been dependent upon the poli tical, social, economic and technologic national soil in which it has developed. Thus the present leaders in this field have backgrounds variously in chemistry, medicine, pharmacy or sometimes biology. Today, clinical chemistry has attained stature as a unified independent discipline. It is characterized by active and productive international and national societies; its function codified in the law of many countries; its scientific content the sole subject of international and national journals as well as textbooks and educational programs; and its inter national, regional and national meetings have become focal points for major exchange of scientific, clinical and technical information and exhibition. The positive impact of the discipline upon the delivery of health care has given it a significant position in the economics of public health. As a consequence it has become the most rapidly-growing segment of the industrial and commercial component of health main tenance. These changes have brought the need to define the educational and training processes to prepare future leaders of clinical chemistry. The diverse backgrounds of the present directors of clinical chemicallabora tories has required that the viewpoints of chemists, pharmacists, physicians and biologists be brought into harmony. This has been achieved by the years of discussion, debate and review by colleagues of varied professional backgrounds. This monograph reflects their consensus viewpoint for the practice of clinical chemistry at its most advanced level. As an essential part of this task it was important to gather as much information as possible about the status of clinical chemistry throughout the world. The results ofthis survey conducted mostly between 1972 and 1976 is incorporated in the last section of the text. The rapidly-changing nature of clinical chemistry in all the countries of the world means, inevitably, that the printed information is already dated. Errors, incom plete reporting and all the other inaccuracies of this kind of document are the responsibility of the editors. Our colleagues have been patient and invariably most helpful in the years in which this effort has gone forward. The members of the International Union of Pure and Applied Chemistry, Section of Clinical Chemistry, Commission on Teaching of Clinical Chemistry have been: M. Rubin, PhD, Chairman; P. Lous, MD, Secretary; D. Curnow, PhD; A. Latner, MD; A. Defalque, D.Pharm.; Pharm.; J. Porter, PhD; and M. K. Schwartz, PhD. The contributors to the Committee on Education of the International Federation of Clinical Chemistry have been: R. Balado. F. Fares Taie (Argentina); D. H. Curnow. W. Roman (Australia); E. Kaiser (Austria); W. Blomme. A. Defalque. A. DeLeenheer. J. P. Dinant. J. Duvivier. R. Ruyseen. E. Tytgat. H. Wachsmuth (Belgium); M. Mostajo Baya (Bolivia); D. M. Nogueira. G. Hoxter (Brazil); Y. T. Todorov (Bulgaria); D. 1. Campbell. S. H. Jackson. R. H. Pearce. J. Porter (Canada); 1. Lizana (Chile); J. Homolka. J. Horejsi. V. Hule. K. Masek (Czecho slovakia); R. J. Haschen. H. J. Raderecht (DDR); P. Astrup .. O. Lauritsen. P. Lous (Denmark); R. Chediak (Ecuador); M. M. Abdel Kadar (Egypt); K. B. Bjornesjo (Ethiopia); H. Breuer, J. Buttner. G. Hillman (Federal Republic of Germany); H. Adlercreutz. N. Saris (Finland); J. E. Courtois. L. Hartman. P. Louisot. P. Metais (France); D. A. Mensah. G. R. E. Swaniker (Ghana); A. Fischer. I. Horvatth. B. Ringelhann. J. Sos (Hungary); A. Baghdiantz. H. Gauguik (Iran); S. Rangaswami (India); T. G. Brady. R. Cahill. W. C. Love (Ireland); C. Castelli. I. Masi. A. Rossi. G. Vanzetti (Italy); Z. Tamura, Y. Yamamura (Japan); R. Perez Herrera. M. L. Castillo de Sanchez (Mexico); Th. Strengers. E. J. van Kampen (Netherlands); B. K. Adadevoh. P. A. Akinyanju (Nigeria); L. Eldjarn, H. Palmer (Norway); J. Krawczynski (Poland); G. da Costa. J. A. Lopez do Rosario (Portugal); S. Comorosan (Rumania); L. S. de VilJiers (South Africa); C. H. de Verdier (Sweden); H. Ch. Curtius. M. Roth (Switzerland); J. R. Daly. H. Lehmann. F. Mitchell. H. G. Sammons. J. H. Wilkinson (United Kingdom); P. Besch. D. Birenbaum. B. E. Copeland, H. D. Gruemer. R. M. Hackman. D. R. Harms. E. W. Hull. A. Kaplan. D. A. H. Roethel. A. M. Salton. M. K. Schwartz (United States of America); E. G. Larsky, V. V. Menshikov. V. N. Orekhovich (USSR); G. Gonzales (Venezuela); M. Mikac Dev.ic. I. Ruzdic. B. Straus (Yugoslavia). 1 Background The problems of education and training in clinical chemistry were of early concern when the Commission of Clinical Chemistry of the Division of Biological Chemistry of the International Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry (IFCC) were jointly and simultaneously founded in 1952. Interest in these questions, manifest in the organizational charters and statement of objectives of both organizations was enhanced by the ratification of the IFCC constitution and by-laws by eighteen national societies of clinical chemistry in 1962. The subject became a matter for agenda discussion at the joint IUPAC and IFCC meeting in Paris in 1963. At that time the IUPAC Commission established a subcommittee on Teaching of Oinical Chemistry. The start of the present effort can be traced to this body which was the first to be entirely devoted to this subject. With the administrative and organizational separation of the IUPAC Commission of Clinical Chemistry and the IFCC, foreshadowed at the VI International Congress of Clinical Chemistry in Munich in 1966 and consummated at the IUPAC meetings in Prague in 1967, the basis was set for a substantive effort on the part of both organizations. Upon the abolition of the IUPAC Division of Biochemistry in 1967, the former Commission of Clinical Chemistry was elevated to section status. The newly created section established the present IUPAC Commission on Teaching of Clinical Chemistry in 1967. At the same time the IFCC appointed a Committee on Education and Training in Clinical Chemistry to collaborate with the IUPAC Commission. The relations of the two groups and the nature of their respective and joint efforts have provided a good example of the roles and functions of the IUPAC and IFCC organizations in relation to the worldwide developments of clinical chemistry. On the one hand IUPAC provides a forum for the formulation of major concepts whose definition and implementation can be accom modated by the national societies which comprise the International Federation of Clinical Chemistry. The result of this iterative interaction should produce a sound theoretical and practical base for the continued growth of the discipline of clinical chemistry. THE IUPA C COMMISSION ON THE TEACHING OF CLINICAL CHEMISTRY The objectives of the Commission and its task of advancing the teaching 1 of clinical chemistry by appropriate activities were set forth with the formation ofthe Commission in Prague in August 1967. In an exchange of views the members of the Commission decided to undertake a survey of the status of clinical chemistrj throughout the world, to review the potential developments in the field as they affected professional require ments, and to propose guidelines for future development. In consonance with the nature of IUPAC, the Commission was organized to serve as a body of international experts without regard to specific national interests. The Commission met 12 times between 1968 and 1976, three of these meetings being held jointly with the members of the IFCC Committee. The Commission assumed responsibility for the planning, orgniza tion and drafting of this monograph. Early in its deliberations it was recognized that important suggestions for educational programs in clinical chemistry would be forthcoming from those with a primary background in medicine, the sciences or pharmacy. Consequently subcommittees were appointed with members in these fields. Their thoughts and suggestions were woven into the fabric of this report. At all stages consultation and exchange of views were fostered with the IFCC Committee. In the intervals between Commission and Committee meetings, the work proceeded by intensive correspondence. When a penultimate draft ofthe document was available in late 1973, the IUPAC elected to publish only a portion of the effort as an Information Bulletin relinquishing the responsibility to IFCC for publication of the full text. THE IFCC COMMITTEE ON EDUCATION AND TRAINING IN CLINICAL CHEMISTRY The IFCC Committee was established in Prague in August, 1967. The stated objectives of the Committee, in keeping with the constitution of the IFCC were to 'advance the science and practice of clinical chemistry and to enhance its services to health and medicine through education and training'. In contrast to the IUPAC organization, the Federation provides a forum for the presentation and exchange of national views in clinical chemistry. For these reasons it was deemed appropriate that the Federation undertake responsibility for the assembly and organization of information relating to the status of clinical chemistry in the various countries of the world. The analysis of this material, its organization and its interpretation in terms of future developments was agreed to be undertaken as a joint task with the IUPAC Commission on Teaching of Clinical Chemistry . Whenever possible the official viewpoints of the various National Societies were solicited and incorporated into the document. Where this was not feasible, knowledgeable individuals were requested to prepare a report for their country or region. As stated previously, the Committee met jointly with the IUPAC Commission on three occasions. A continu ing exchange of documents by correspondence permitted the attainment of the harmony of viewpoint represented in this monograph. 2