“Too much information…”

Sorry I have not a chance over the last few weeks to post anything. I have been too busy following other people’s agendas….

The Kiestra TLA audit trails are really quite amazing in their detail. You can track down where every plate is at any time throughout the whole culture process. Because everything is automated and digital, more or less everything has an audit trail. There is no hiding place for anything, or anyone.

The accreditation agencies love it…

And you can even view how many plates an individual staff member reads per hour, every hour of the day. You could even hazard a guess at when they went to have a coffee.

Too much information perhaps…?

Everybody works at their own pace in the laboratory. Some people are naturally fast, some people are naturally slow.

That’s ok.

Some people like to have a chat between samples, and some people like to daydream. Some people even like to go for a wander every 10 minutes.

…and that’s ok as well.

The point being that to try and force people to work harder or faster is almost always both unsuccessful and counterproductive.

It is all about trust. If you trust people to do a job to the best of their ability, then the vast majority will.

It is a bit like those companies who have recently adopted a policy to give unlimited annual leave to their employees. What seems illogical at first glance actually works very well. Most people will work a sufficient number of weeks to provide benefit to their employer, whilst taking enough annual leave to both retain their sanity and have sufficient time with their family.

So I don’t care how many plates person X reads per hour. I have absolutely no interest in it whatsoever. What I do care about is that they are happy, and they are able to produce quality results.

Some audit information is best just ignored…

Michael

“Indole positive or negative?”

If you asked me whether E. coli was indole positive or negative, I wouldn’t have a clue.

Despite being told the answer many times over the years, the answer just doesn’t stick. I simply don’t care..

My colleagues must despair of me.

It is a wonder that I managed to pass any exams at all…

Which brings me to college microbiology exams and my increasing disillusionment with them.

Formal exams in general have not changed much in style over the past few hundred years. They essentially test knowledge that can be held in the head. (I hold very little in my head..)

But most young people have an I-Phone in their back pocket…

The skills that young microbiologists need nowadays are not related to hoarding large amounts of microbiological facts. This is becoming increasingly irrelevant. They need to be able to problem-solve and troubleshoot. They need to be computer savvy and innovative. They need to be observant and be able to spot the unusual. They need to have the patience to tolerate a degree of repetitive work, and they need to be able to get on with their colleagues and build a rapport with lab users.

Do the microbiology exams of today really test these skills?

If it were up to me, I would get the students into the microbiology lab on day 1 of their training (so they can see if they really enjoy it) and keep them there as much as possible. I would pay them part-time for doing some simple tasks in the laboratory (so they don’t finish their degree in lots of debt). The academic part of the course would be primarily online, with occasional small group tutorials. I would ban large group didactic lectures altogether. I would focus on the diagnostic microbiology of today and tomorrow, not of yesterday. I would not have a formal written exam at the end, but rather continuous assessment throughout the training period. I would however advocate an oral examination at the end to ensure the student has a good understanding of the basic concepts of microbiology and has good safety awareness in the laboratory. I would be brutally honest with them in terms of future job prospects and where I see future work opportunities within clinical microbiology.

There are too many people within academic institutions who have too much of a self-interest in keeping things the way they are at the moment.

This has got to change…

Modern microbiology degrees are needed for modern microbiologists.

Michael

I see that most E. coli are “indole positive”. I have just checked Google on my smartphone…

“Running to stand still…”

When I started working as a Clinical Microbiologist in 2007, anti-NMDA receptor encephalitis had not yet been discovered. The diagnostic test, looking for anti-NMDA receptor antibodies, only appeared commercially around 2010.

Now it is the latest fashionable test to perform…

I am getting old.

The whole area of auto-immune encephalitis has progressed rapidly in the last 10 years, and this potentially treatable cause of encephalitis (options include steroids, IV immunoglobulins, plasma exchange and immunomodulators) is now thought to be similar in prevalence to some viral encephalitides.

Anti-NMDA receptor encephalitis represents the vast majority (approx. 80%) of all cases of autoimmune encephalitis. It usually presents with a short prodromal period followed by a range of symptoms such as auditory and visual hallucinations, delusions, behavioural change, decreased level of consciousness, seizures, and autonomic dysfunction. 

A majority of patients (58%) with anti-NMDA receptor encephalitis will have a CSF leucocytosis(Raised CSF protein and oligoclonal bands are also seen in a proportion of patients.) So testing for anti-NMDA receptor antibodies becomes the obvious default for a patient with a CSF leucocytosis and negative bacterial culture and negative CSF viral PCR…

Other causes of autoimmune encephalitis include unfamiliar names such as anti-LGl1, anti-AMPAR, anti GABA  and anti-CASPR to name but a few. You will likely see these crop up from time to time on CSF request forms.

It is of course not microbiology per se. However we need to know about it as we end up getting the CSF samples and we need to triage the test requests, and deal with the perennial problem of separating a ml or two of CSF for several different tests, which often get sent away to different laboratories…

I didn’t need to worry about these exotic tests 10 years ago. Now I do.

Sometimes it feels like you need to keep running just to stand still…

Michael

p.s.  For the academics amongst you, NMDA stands for N-methyl-D-aspartate.