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Official Publication of the Academy of Clinical Science and Laboratory Medicine
Volume 46 Issue 2 Summer 2020
Bernadette Jackson
Academy President,
2020 - 2022
AGM
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contents Volume 46 Issue 1 Summer 2020
editorial............................................................................................................. 4
message from the president....................................................... 6
academy
Medical Scientists in the Media................................................................................. 7
features
Plagues & pandemics ............................................................................................... 8
CervicalCheck - Getting with the programme.......................................................... 10
An overview of coaching and mentoring theory...................................................... 12
Women in Science................................................................................................... 16
Page 7
cpd
CPD Updates........................................................................................................... 17
CPD - the New Normal............................................................................................. 18
academy
AGM 23rd july 2020................................................................................................... 19
Medical Scientists: work in the new normal............................................................. 22
Intern Medical Scientist............................................................................................ 22
Working from home.................................................................................................. 23
Return to work.......................................................................................................... 27
Page 19 Putting the studies on hold...................................................................................... 28
awards
Blood Repatriation Health Innovation Hub Ireland - Spark Ignite............................ 29
Helen Ryan; HealthCare Innovation......................................................................... 30
The Mercy University Hospital, Cork, Annual Clinical Audit and Quality
Improvement Day..................................................................................................... 31
industry news
The Allplex 2019-nCoV (Seegene) assay: which performances are for
SARS-CoV-2 infection diagnosis?............................................................................ 32
Page 40 research
Multi-triazole-resistant Aspergillus fumigatus and SARS-CoV-2 co-infection:
A lethal combination................................................................................................ 35
Blood Transfusion: Evaluation of electronic issue in the Republic of Ireland -
Over 30 years in existence and still underutilised.................................................... 38
Improving Blood Stock Magagement: A collaborative approach........................... 40
Antimicrobial Resistance Determinants Circulating among Thermophilic
Campylobacter Isolates Recovered from Broilers in Ireland Over a
One-Year Period...................................................................................................... 42
health and biomedical science updates
Compiled by Helen Lambkin................................................................................... 43
book review
The Pull of the Stars................................................................................................. 45
Page 45 crossword..................................................................................................... 46
Summer 2020 • converse • 3
editorial
I have said it so many times but these are session in May. I have included the link in
extraordinary times. So many events had to the Webinar spread. As Helen Lambkin said
be postponed. In our case Biomedica and in her AGM report, research is so important.
our AGM, originally scheduled for April 27th, Medical scientists have access to so much
as well as some planned meetings. Our data and lead on so many developments, yet
AGM was held on July 23rd with a blended rarely publish this work. There are so many
attendance at CUH. Over 20 attended in reasons for this, not least the very heavy
person with strict physical distancing and workload of medical scientists and the absence
about 35 attended by Zoom. Dr Brigid of protected time to write up this work. At the
Lucey’s two year term as President came to very least medical scientists should insist on
an end and she handed over the chain of being included in any published work that
office, under strict distancing, to Bernadette includes benchwork in which they have been
Jackson. Bernadette holds the Presidency involved. Medical scientists won some national
until 2022. Bernadette, as Brigid pointed out awards recently, making a huge contribution
in her address, is a passionate advocate for to healthcare. The Academy plans to capture
laboratory medicine and medical scientists. the incredible work of medical scientists in
I am looking forward to working with her labs across the country in setting up and
and helping to support and advance delivering SARS-CoV-2. Medical scientists are
her objectives. In advance of the AGM encouraged to publish their work in this. It was
the Academy and MLSA issued a media Helen Barry done under difficult conditions and with great
statement. This highlighted some of the urgency. The experience will be useful to have
issues of concern for medical scientists and of this issue. Anne Maclellan has written recorded.
clinical laboratories in this era of Covid-19. on pandemics in our feature section and Even in this “New Normal” CPD remains
These issues included recruitment and also reviewed Emma Donoghue’s latest a requirement for medical scientists. The
retention of medical scientists, lack of facilities novel “The Pull of the Stars”. Although it is a Academy is delivering Webinars to provide
in our laboratories, career progression work of fiction, it deals with one of our most material for medical scientists to keep up to
for medical scientists and the need for IT famous pandemics, the 1918 Flu. Some of date. These are recorded and can be accessed
connectivity. We were delighted that this those medical scientists who returned to the by members through our website acslm.
was picked up by the media and Brigid workplace have written of their experiences. ie. They provide useful material for CPD and
gave a number of radio interviews. The These range from Caoimhe Lynch putting her Journal Clubs. We welcome medical scientists
statement can be seen on the Academy PhD on hold to Clíona O’Shea’s experience who are willing to present their work. This can
website. The Academy and MLSA made a as an intern and Anne Marie Meenan working be recorded in the comfort of your own home
joint submission to the Special Oireachtas from home. I know there are so many across and edited until you are comfortable with it and
Committee on Covid-19. The Oireachtas the country who have volunteered to return. then delivered. No need to perform live!
report can be downloaded: https://data. In the Academy office we had a list of over Mentoring for medical scientists is a key goal
oireachtas.ie/ie/oireachtas/committee/dail/33/ 70 eligible medical scientists offering to of our current and past presidents. Brigid has
special_committee_on_covid-19_response/ return to the labs. I am also aware of some of written a feature piece on it for this issue and
reports/2020/2020-08-05_interim-report-on- those who returned to help out during peak by way of introduction to a programme planned
testing-and-tracing_en.pdf Covid-19, have decided to stay on. They will by Bernadette and our CPD officers.
It was great to see so many medical be very welcome. We continue providing a notarising service
scientists in the media, showcasing their great In the midst of all of this pandemic work, through our office in Kilmainham. However
work and letting the public see the pivotal medical scientists still found time to publish this has to be booked through the office so
role of medical scientists in the management their research and innovation. Our research we can control attendance and to comply with
of this pandemic. I have captured some of section shows some recent publications. I Covid-19.
the media pieces. Medical scientists are was unable to secure permissions in time Please keep in contact with us. We welcome
very active on social media. This also gives to reprint work done in the Coagulation your suggestions on how we can do things
the profession visibility. Please follow the Laboratory in St James’s Hospital. Mary better and your ideas for events, Converse
Academy on Twitter, Facebook and Instagram. Byrne the Chief Medical Scientist there, articles, Webinars etc.
Pandemic could be the general theme presented the findings at our Webinar Helen Barry, CEO
Editor: Helen Barry Converse is published three times a year. It is
Deputy Editor: Anne Mac Lellan utilised for information exchange, communication
and continuing education, managerial and
Editorial Board: scientific, of the medical laboratory scientists of
Anne MacLellan, Ireland.
Brigid Lucey Publication of an article does not constitute
Advertising: Roger Cole endorsement by the Academy of Clinical Science
Silchester Marketing Ltd. and Laboratory Medicine of the products,
Tel: 01-285 9111 • Mobile: 087-2611597 techniques or organisations described therein.
The Academy of Clinical Science and The Academy of Clinical Science and Laboratory
Laboratory Medicine, Email: roger@silchestermarketing.com
Medicine is an educational and scientific
31 Old Kilmainham, Dublin 8. Production/Design: Artworks Graphic Design organisation designed to serve as a resource
Dalkey Business Centre, to advance the quality of medical laboratory
Tel: 01-905 9730 17 Castle Street, Dalkey, Co. Dublin science.
Fax: 01-902 2764 Tel: 01-2751707 • Mobile: 086-2611598 Members who wish to continue receiving
Email: mail@acslm.ie Email: design@artworks.ie Academy publications should notify the Academy
Web: www.acslm.ie Web: www.artworksireland.com of any change of address.
4 • converse • Summer 2020
message from the president
Message from the President
profession on National and International repatriate these services.
Committees, publish research, collaborate The Academy is not just the Council - it
with other clinical colleagues and still is you the members, medical scientists.
manage to ensure routine and emergency We need you to be more actively involved,
diagnostic services are expertly provided more visible, grasping and demanding
24/7/365. opportunities to demonstrate your value
The ongoing COVID – 19 pandemic and expertise in workplaces at all levels.
has provided the opportunity for medical This means Laboratory Managers ensuring
scientists to step into the limelight – indeed workplaces are sites of learning, Chief
without your tireless work, Ireland would Medical Scientists encouraging young,
not be at the current phase of re - opening enthusiastic and highly qualified graduates
and considering a new normal. Your work (many winning awards both nationally and
in microbiology departments across the Internationally) to contribute, follow up,
country to verify multiple analytical systems research and be enquiring. Finally you
for a new virus described and reported in the scientist– never underestimate your
January 2020 has been commendable. contribution and continue to learn and
Your additional efforts, including sharing of grow in your knowledge, to support the
information, advice and reagents between patient to a rapid diagnosis, appropriate
colleagues and sites, advising nationally on treatment and ongoing optimal and
both equipment and reagent procurement standard driven, care pathways. Educate
I
t is my greatest honour to accept the role has been outstanding and self less. yourself in that which you do not know,
of President of the Academic Body of You have also actively become involved keep learning, listen to and learn from other
my profession - the Academy of Clinical and lead processes to ensure standard clinical colleagues, question everything?
Science and Laboratory Medicine. laboratory quality requirements from For myself, I will be ably supported by a
The Academy – representing medical labelling to tracking are embedded into the knowledgeable team of Council members,
scientists – those unseen, largely unknown SARS – CoV-2 analysis pathway. including past Presidents, Advisory Body
scientists, working in Clinical Diagnostic Of course COVID – 19 does not only Committee members, CPD officers, office
Laboratory Services, who provide analyses, require diagnostic microbiological staff and the CEO. Many of these medical
results, diagnoses and expertise to support molecular focus, but rather ongoing scientists who while leading their own
the patient, with diverse presentations - monitoring using a variety of diagnostic laboratory services and departments, still
across many Pathology disciplines. tools across multiple laboratory specialities find additional time, to reflect on the bigger
Medical scientists who keep the public including clinical chemistry, haematology, picture, continue to have a passion for this
and private hospital wheels turning by coagulation and indeed my own current profession and the expertise of medical
providing essential Clinical Diagnostic speciality of POCT. Restructuring of staffing scientists, and work tirelessly toward the
Laboratory services, 24/7/365. and flexibility, ensured services did not fail, wider recognition of medical scientists and
Medical scientists – who work within and but rather were fully supported to continue single spine structures, late into the night
have driven the implementation of quality both in hours and out of routine hours, to and on their weekends. They also attend
management systems across laboratory ensure rapid turnaround times. HSE, Department of Health meetings and
services in Ireland, to ensure continuing Having stepped up and also stepped National Committees on your behalf. We
compliance with ISO 15189 and 22870 into the limelight, it is now time to continue will continue to promote and demand
Laboratory Accreditation standards and to ensure our real value in the diagnosis collaboration with the Department of
participate in an annual inspection process. and ongoing management of patient care Health, HSE and other clinical groups.
As I reflect on my own journey in my is no longer overlooked. There are many I too will be working tirelessly on your
profession, commencing many years ago who would presume to understand our behalf. I know and believe in the value of
in DIT, Kevin St and fondly revisited, earlier services, underestimate our expertise our expertise, clinically, analytically, and
this year on the open day, with one of my and presume quality laboratory service diagnostically, supporting routine, and
classmates, I am struck by the journey of provision and interpretation, is a simple out-of-hours clinical diagnostic laboratory
our profession, a journey led by visionary enough process of automation (if only services 24 /7/365. I will be working to
scientists. !!!). How many days do we hope for new ensure your expertise and data is not
Indeed at one time in the distant past, we assays that perform correctly at clinical usurped by others but rather through
were considered technical with a vocational cut off points, are not flawed and do mentoring and other novel pathways
education however, as we all know, our not require manufacturer modifications, including research in chronic disease
education from that time to the current day, IT systems that deliver without multiple management, and ED attendance
has been focussed on clinical diagnostic novel workarounds and new automated prevention and greater visibility on
laboratory services for patients, across all equipment that is fit for purpose. student clinical placements to ensure
pathology departments. As a testament to However, and unfortunately for many your invaluable contribution to the patient
our expertise, some 80% of BSc graduates young women in Ireland and their families, clinical pathway and diagnostic journey is
working in clinical diagnostic laboratory these presumptions to know our service, recognised and acknowledged.
services, attain a minimum of an MSc, disregard our expertise and ignore our
and many additionally add PhD, FRCPath, advice, have already and continue to
MBA, Bioinformatics, IT, Six Sigma and remind us, that the decisions to outsource
other qualifications to their CVs. Cervical Services abroad were flawed.
Many medical scientists represent their Indeed it remains a not so simple task to
6 • converse • Summer 2020
academy
Medical Scientists in the Media
Irish Examiner, Abigail Salmon by Harry Walsh h.walsh@donegalnews.com
Testing times: Dr Jacqui Clarke,
The science of Donegal Daily
fighting Covid-19 “IT was like going to war. We were all scared
but we had to stand up and meet the Covid-19
Pádraig Hoare pandemic head on.”
It has been a baptism of The words of Dr Jacqui Clarke, Pathology
fire for the Chief Medical Laboratory Manager, Letterkenny University
Scientist of Microbiology Hospital, strike a chord.
at St Vincent's University
“What we learned as a department is invaluable. So many younger
Hospital (SVUH) in Dublin.
members of staff have developed, matured and really shown what
Abigail Salmon, Chief Medical Scientist at St Vincent's University Hospital they can do. It was marvellous to see so many young people at the
Dublin, with colleague Aoibheann Sally. Pics: Moya Nola start of their careers really show what they’re made of in terms of their
knowledge, application and ways that we do things,” she said.
Severe lack of medical scientists
The Medical Independent
in Irish
Covid-19 highlights need for more
laboratories
“There is a severe shortage of medical
medical scientists in hospitals
scientists in Irish laboratories, which Speaking at the Academy’s AGM today, Dr Lucey highlighted the need
means longer testing turnaround to invest in medical scientists and hospital laboratory infrastructure.
times for patients. The problem has been amplified by the outbreak of the “Laboratories are constantly fire-fighting and the demands of Covid-19
Covid-19 pandemic, with hospitals struggling to fill key posts, despite demonstrated the lack of investment. The pandemic shows that the required
heavy advertising and promotion. Chief medical scientist in microbiology expertise is available in medical scientists, but capacity and infrastructure
at St Vincent's University Hospital in Dublin, Abigail Salmon, said the stark are sadly lacking. Laboratories account for 5 per cent of the hospital
nature of the lack of staff was apparent before the current crisis.” budget, yet laboratory results inform 70 per cent of clinical decisions.
“Medical scientists must be part
SUNDAY, MAY 24, 2020 - 23:05 PM Pádraig Hoare of an immediate planning process
with the HSE and should have
a formal link and access to the
national public health emergency
Business Post team (NPHET). They understand
the entire testing pathway and the
Dr Brigid Lucey, need for quality management across
the continuum of patient care.”
explaining testing The calls were also made as part of
validation criteria. a joint submission to the Oireachtas
special committee on Covid-19
by the Academy and the Medical
Laboratory Scientists Association.
MEDIA COVERAGE of joint statement
from the Academy and MLSA Yvonne Lynagh,
Chief Medical Scientist,
• Newstalk news: (with distribution to Today FM, Q102 and main
Virology, St James's
local stations across the country.)
Hospital, who was on
• Medical Independent: https://www.medicalindependent.ie/ RTÉ recently.
covid-19-highlights-need-for-more-medical-scientists-in-hospitals/
• Activelink: www.activelink.ie/community-exchange/news/76581
• Kildare FM: https://kfmradio.com/news/23072020-0914/listen-
hospitals-urged-employ-more-scientists-their-labs
Pat Mulhare talks to Matt Cooper on Laboratory
Testing: Tuesday 28th April) Listen back www.acslm.ie
Summer 2018 • converse • 7
feature
Plagues &
pandemics
I
nterspersed struggling through the current pandemic:
amongst the the world has faced fearful bacterial and
histories which viral threats and recovered. Optimism as
celebrate the battles, Covid-19 appears to come under control
sieges, triumphs and in Ireland must, of course, be tempered
politicking of the elites by an acknowledgment of the death toll
such as the artistocracy, and the difficulties along with the fear and
Royalty, the Church, the struggle.
Governments and armies, Even though we have a better
are accounts of frightening understanding today of the cause of the
and lethal contagions, poorly latest pandemic, with the SARS-CoV-2
understood but known to be virus quickly sequenced, many of the
passed from one human to public health measures that have been
another. From BC to the present adopted – quarantine, isolation, hygiene
day, plagues and pandemics – would be very familiar to our ancestors.
have interrupted civic life, As we debate whether to cover our
emptying villages, towns and faces in public, the iconic masks of the
cities, stopping commerce plague doctors spring to mind. These
and trade, confining people beaked masks, rendering the doctor
to their homes, and challenging anonymous, contained herbs supposed
healthcare providers. Germs were an to ward off the miasmas that were
unintentional source of genocide when thought to cause the plague. The head
new parts of the world were ‘found’ to toe covering worn by the doctor is
bringing together European germs and the forerunner of the hazmat suit while
immunologically naïve native populations the rod was to fend off victims who tried
in the ‘new world’. to get too close (the forerunner of the 2
From the Plague of Athens, which metre rule?).
occurred in 430 BC to the present day The enumeration of deaths on a
Covid-19 pandemic, the world has been regional basis is not something that
subject, periodically, to waves of infectious originated with NPHET or the WHO. The
diseases which often crossed borders and same fascination with numbers was
even continents. The histories of plagues evident in the 1600s – bills of mortality for
and pandemics may provide something the various parishes provided the figures
of a comfort to today’s medical scientist during the great plague of London and
Plagues and Pandemics throughout history
Plague of Athens, 430 BC - Estimated 75,000-100,000 dead
Antonine Plague, AD 165-180 Estimated 5 million dead - Plague of Justinian,
AD 541-542 May have been Yersinia pestis Estimated 30 to 50 million dead
The Black Death, 1346-1353, Asia to Europe, Yersinia pestis. - Estimated
25-50 million dead
American plagues, 16th century, Europe to America ‘genocide’ - Great
plague of London, 1665-1666 Estimated100,000 dead
A physician wearing a 17th century
plague preventive. Credit: Wellcome
Spanish flu, 1918-1920 - Estimated 40 million dead
Collection. Attribution 4.0 International Covid19, 2019-2020 - Number dead to date: 716,075 (8th August 2020, WHO)
(CC BY 4.0)
8 • converse • Summer 2020
feature
their house was shut up. Rather than house and other places) be admitted to
voluntary self-isolation, two watchmen common use till their coaches be well
were appointed, one for the day and aired, and have stood unemployed by
one for night to ‘have a special care that the space of five or six days after such
no person go in or out of such infected service.’
houses whereof they have the charge, Defoe’s narrator has some
upon pain of severe punishment. And suggestions to add to the public
the said watchmen to do such further response. He warned about the infection
offices as the sick house shall need and being brought into homes via food
require.’ This is somewhat reminiscent of shopping and also how more hospitals
the Chinese response to Covid19. for the infected were required: ‘(1)
Defoe details how women searchers The infection generally came into the
were appointed to seek out dead bodies houses of the citizens by the means of
and ensure proper burial. Searchers their servants, whom they were obliged
were not to carry out any other business: to send up and down the streets for
‘That no searcher during this time of necessaries; that is to say, for food or
visitation be permitted to use any public physic, to bakehouses, brew-houses,
work or employment, or keep any shop shops, &c.; and who going necessarily
or stall, or be employed as a laundress, through the streets into shops, markets,
or in any other common employment and the like, it was impossible but that
whatsoever.’It was important to get they should, one way or other, meet with
the numbers right so a number of distempered people, who conveyed the
Chirurgeons were appointed to work fatal breath into them, and they brought
only with plague victims; their task it home to the families to which they
was to stamp out the ‘great abuse in belonged. (2) It was a great mistake that
while the method of dissemination of misreporting the disease.’ such a great city as this had but one
the information differed, the public was Nurse-keepers, who looked after the pest-house…’
equally eager to hear ‘today’s numbers’. sick, were to observe an isolation period: He also mentioned the effects of
For me, one of the most compelling ‘If any nurse-keeper shall remove herself the plague on everyday life: ‘all trades
reads when it comes to plagues and out of any infected house before twenty- being stopped, employment ceased:
pandemics is an account of the great eight days after the decease of any the labour, and by that the bread, of the
plague of London written by Daniel person dying of the infection, the house poor were cut off; and at first indeed the
Defoe, better known as the author of to which the said nurse-keeper doth so cries of the poor were most lamentable
Robinson Crusoe. While Defoe was not remove herself shall be shut up until to hear, though by the distribution of
an eye witness, this fictive account was the said twenty-eight days be expired.’ charity their misery that way was greatly
extensively researched, is informative Bedding and apparel were to be aired abated.’ Change the archaic language,
and easy to read. For more ‘real’ before re-use after death or infection. and extracts of Defoe’s Journal are eerily
accounts, try Samuel Pepys’ diary or In a response that will resonate with similar to the online media accounts
the dryer London’s Dreadful Visitation, a anyone who had a loved one pass away that we have been reading daily on our
book of the “bills of mortality” and all the recently, it was ruled that ‘No neighbours phones as Covid19 unfolded. There is
burials in the city compiled in 1665. nor friends be suffered to accompany nothing new under the sun?
In his journal of the plague year, the corpse to church, or to enter the Anne Mac Lellan has a PhD in the
readily available online, Defoe recounts house visited, upon pain of having his history of medicine and is a surveillance
doctors and quacks selling ‘Infallible house shut up or be imprisoned. And scientist (jobsharing) in Connolly
preventive pills against the plague’, that no corpse dying of infection shall be Hospital, Dublin
‘Neverfailing preservatives against buried, or remain in any church in time of
the infection,’ ‘Sovereign cordials common prayer, sermon, or lecture.’
References:
against the corruption of the air.’ ‘Exact There was little debate over stigma: Daniel Defoe’s Journal of the plague year,
regulations for the conduct of the body practicality trumped sensitivity with every available to read online: http://www.gutenberg.
in case of an infection.’ ‘Anti-pestilential visited house marked with a red cross org/files/376/376-h/376-h.htm
pills.’ ‘Incomparable drink against the ‘of a foot long in the middle of the door, Stacking the Coffins: influenza, war and
plague, never found out before.’ The evident to be seen, and with these usual revolution in Ireland, 1918-19, Ida Milne,
marketplace, then as now, was quick printed words, that is to say, “Lord, have Manchester University Press, 2018.
to respond to perceived needs, while mercy upon us,” to be set close over the The Greatest Benefit to Mankind: a medical
playing to people’s fears. Anyone for same cross, there to continue until lawful history of humanity from antiquity to the present,
bleach or chlorohydroquinine? opening of the same house.’ Roy Porter, Fontana Press, 1999.
Defoe details the public health Just as issues with public transport The Western Medical Tradition 1800-2000,
response with examiners appointed to and shared transport have emerged W.F. Bynum, Anne Hardy, Stephen Jacyne,
every parish, to learn who was ‘sick of with Covid19, during the plague it was Christopher Lawrence, E. M. (Tilli) Tansey,
infeciton’ and to ‘command restraint of ruled ‘That care be taken of hackney- Cambridge University Press, 2006.
access until it appears what the disease coachmen, that they may not (as some https://www.theguardian.com/books/
shall prove.’ If the dreaded plague was of them have been observed to do after booksblog/2020/may/19/beyond-daniel-defoe-
infecting any member of a household, carrying of infected persons to the pest- the-real-journals-of-the-plague-year
Summer 2020 • converse • 9
feature
CervicalCheck
Getting with the programme!
Dr Dave Nuttall, PhD, MPhil, DipRCPath, CSci, FIBMS - CervicalCheck Clinical Laboratory Advisor
Definition of population disease is falling and that is due to the participant management protocols. All
screening various cervical screening programmes these requirements must be underpinned
The aim of population screening is to in operation worldwide. by a strong foundation of quality
detect a given disease in an individual Cervical disease progresses through assurance (QA) to ensure the greatest
before the symptoms of that disease several intra-epithelial stages prior to benefit to the individuals served.
appear, for example, cervical screening invasive cancer and the condition is The woman has her part to play also
aims to prevent cervical cancer through detectable in these early stages and and regular adherence to screening
early detection of precancerous changes treatment prior to invasion has a high invitations and attending for the test is
on the cervix. Early detection of disease success rate. known to be vital in successful screening.
has several patient benefits, including: Previously, cytology was performed
• Increasing the treatment options on screening samples to detect these An overview of CervicalCheck
precancerous changes associated The CervicalCheck cervical screening
available to the patient
with the early stages of the disease. programme commenced on 1st
• Reducing invasiveness of treatment
In recognising oncogenic HPV as the September 2008 following a pilot
• Reducing morbidity and mortality
prime cause of cervical disease, many programme in the mid-west of Ireland. Its
• Improving survival rates
programmes are screening for the primary goal is to reduce the incidence
• Improving quality of life
presence of the high risk variants of the of cervical precancer by screening a
HPV virus, in a risk stratification modality, target population of approximately 1.33
How is a population screening and positive samples then have cytology million women. The eligible screening
programme introduced? performed in order to assess the severity population consists of individuals with
A population screening programme for of any disease, thus: a cervix within the age range of 25-65
disease should satisfy the Wilson and • HPV test = Test of risk of cervical years.
Jungner (1968) criteria for a screening disease
programme which help ensure that the • Cytology = Test for cervical disease QA in laboratory cervical
proposed programme achieves those
health benefits intended from screening.
screening
What makes an effective Laboratory standards and requirements
cervical screening for QA in cervical screening encompass
Aetiology of cervical cancer programme? the following disciplines:
and screening for the disease Fundamentally, the programme must • Cytopathology
The natural history of cervical disease identify and invite eligible women and • Molecular HPV Testing
is now much better understood and the it is vital that they attend for the test to • Cervical Histopathology
role of Human Papillomavirus (HPV) as realise the potential health benefits.
the causative agent is beyond dispute. CervicalCheck aims for 80% attendance These laboratory services are
Cervical cancer is an important health from invitation for screening and commissioned by the National
problem, with 15.1 cases diagnosed maintains a register of eligible women Screening Service (NSS) on behalf of
and 4.3 deaths per 100,000 reported invited at regular intervals for their CervicalCheck. Service specifications
in Ireland each year. In the EU, the screening test. with detailed and explicit requirements for
disease affects 11.3 women with 3.7 The screening programme must compliance with the latest programme
deaths per 100,000 (2012 European provide appropriate information to QA standards are documented and
age-standardised rate) annually. The participants. There must be clear, agreed via service contracts and
good news is that mortality from cervical evidence-based testing, treatment and memoranda of understanding.
10 • converse • Summer 2020feature
Whilst the clinical governance for check that laboratory facilities, records advent of HPV primary testing and
screening participants resides with and procedures are compliant with QA centralisation, the number of cervical
CervicalCheck, the clinical responsibility standards. Interim inspections can be cytopathologists in the UK has declined
for CervicalCheck screening samples carried out where deemed necessary sharply. These factors, combined with
for cervical cytology and molecular (for example, as a result of an identified the increased number of non-medical
HPV testing is the responsibility of the non-conformance). cytopathologists (who currently cannot
cytopathology service under the lead work in Ireland), have further decreased
pathologist. This is primarily because The future of laboratory the recruitment opportunities for the Irish
the largest interaction by far between cervical screening services in service.
laboratory and clinical services is with
Ireland
cytopathology and histopathology via
Laboratory cervical screening services in Introducing the Consultant
colposcopy multi-disciplinary team (MDT) Medical Scientist
Ireland are at a watershed. The transition
meetings. However, the QA standards The pressures on medical histo/
to a molecular HPV primary screening
require that access to virology specialist cytopathologists were recognised
test heralds a new era in the detection
advice is available. in the UK in the 1990s, which led to
of cervical precancer and a combination
Irish screening laboratories must the development of the Consultant
of state-of-the-art automated molecular
be accredited to the ISO 15189:2012 Biomedical Scientist (CBMS) role. A
assays and traditional morphological
“Standards for the Medical Laboratory”. CBMS is a non-medical consultant
analysis requiring highly skilled scientists
Laboratories providing services for specialising in defined fields within
offers an improved service to the women
CervicalCheck that are outside of pathology. The role was created by
of Ireland as well as exciting career
the EU must have accreditation to the Institute of Biomedical Science
opportunities for medical scientists in
the appropriate standards within the (IBMS)/Royal College of Pathologists
Ireland.
country of origin of the contracted Conjoint Board – initially in cervical
The Health Service Executive has
laboratory. The scope of the laboratory been planning for a National Cervical cytopathology, and now extended
accreditation must include HPV primary Screening Laboratory (NCSL) for some practice includes diagnostic cytology,
testing with reflex cytology and the HPV time and the project is progressing. One gastro-intestinal, cervical and
assay of choice must be approved by of the workstreams is concerned with ophthalmic histopathology. CBMSs play
CervicalCheck. the provision of sustainable staffing to an integral role in supporting laboratory
Bethesda terminology is the standard deliver a high quality molecular HPV/ cervical screening services, thus:
in use for cervical cytopathology cytology service. • Reporting abnormal samples
morphology reporting. Every result for a • Performing case reviews for MDT
test is accompanied by a management meetings
recommendation – the recommended
Sustainable staffing for the • Training pathology specialist
next step for the woman in the screening NCSL registrars
programme. HPV primary screening provides new • Can now take on the Clinical Lead
roles for medical scientists allowing role for the laboratory
multi-skilling of the workforce, whilst
Cyto-histological correlation
making the most of transferrable skills. The CBMS is qualified to Masters
as a “gold standard” To be successful, robust workforce degree level, with a minimum number
Histology results received by the planning for the new service is required. of years’ experience in the relevant
Cervical Screening Register are used The combination of new and old discipline. Attendance at a recognised
as the “gold standard” to perform screening tests is an opportunity to training course is mandatory as is a
cyto-histological correlation to measure extend the role of the medical scientist, minimum period of supervision – usually
and monitor programme performance. and this is to be welcomed, but delivery via shadow reported cases supported
Key Performance Indicators (KPIs) are of this goal will require access to the by a nominated consultant pathologist,
calculated for the laboratory, these appropriate training and development. who is approved by the examination
include: Training schemes need to embrace board. Finally, success in the
• HPV positive rates for primary care recent advances in molecular tests for appropriate examination, which includes
and colposcopy samples disease as well as established laboratory a practical element of microscopy and
• Sensitivity and Specificity technologies. In the meantime, the case review, allows the medical scientist
• Positive Predictive Value (PPV) NCSL will need cytologists – currently to attain consultant status along with the
• Abnormal Predictive Value (APV) a limited resource – and consultant opportunities and responsibilities of the
• Total Predictive Value (TPV) medical staff specialising in cervical grade.
cytology are simply not available. This grade of staff was a success
QA audits of laboratory Ireland is a small island, with limited story in the UK, and the CBMS is now
services numbers of specialised medical recognised as a valuable member of
CervicalCheck standards require that pathology staff. Increased demand, the clinical pathology team. Extending
on-site QA audit visits are conducted at combined with new technologies the career expectations for Medical
least every 2 years. Provider laboratories and specialisation, has resulted in Scientists in Ireland and enhancing the
were last audited in 2019, prior to the increased pressures on an already prospects of the role will attract high
introduction of HPV primary testing and limited workforce. There are currently achieving individuals and, in turn, will
further visits are anticipated once the no medical trainees in cervical contribute positively to sustainable
new programme has stabilised. The visits cytopathology in Ireland and, with the pathology services for the future.
Summer 2020 • converse • 11feature
An overview of coaching
and mentoring theory
Dr Brigid Lucey
Introduction and that the human is always directed to someone or some-
Mentoring has been defined in one paper as a dyadic, face- thing outside of himself: “the more he forgets himself, the more
to-face, long-term relationship between a supervisory adult human he is and the more he self-actualises”. Frankl believes
and a novice student that fosters the mentee’s professional, that self-actualisation is not actually an aim at all, as the “more
academic or personal development (Donaldson, Ensher, & he would strive, the more he would miss it” and that self-actu-
Grant-Vallone, 2000). A clear definition for coaching is more alisation is a side-effect of self-transcendence.
difficult to find in the available peer-reviewed literature and Being given the role of mentoring a colleague therefore pro-
often seems to encompass the words mentoring and counsel- vides what is a privileged opportunity to fulfil the highest of the
ling. Usefully, in one case it has been described as a method needs of the mentor themselves. It does suggest, however,
to allow unlocking a person’s potential to maximise their own that the stage of professional and personal development that
performance (Grant et al., 2006). the mentor is afforded through their work may have a bear-
The facilitation of the development of others is a higher ing on whom in the workplace they are suitable to mentor. It
calling, which requires the facilitator, mentor or coach to be in seems likely to be the case that a whole series of intercon-
a position from which this is possible. Maslow’s hierarchy of nected mentors and mentees is what is needed, and this on a
needs (Maslow, 1943) outlines the order in which any individ- continual basis.
ual’s needs must be met, from the basic security needs as a It must be stated here that an exploration of the absolute
priority, to the actualisation of the self which may be attained need for ethically sound behaviour in the mentor that guar-
after the other needs have first been met. This original model antees putting the interests of the mentee first is beyond the
was followed by Maslow’s expanded form of this principle, scope of this article, but its importance is implicit throughout.
which is shown in Figure 1. This expanded plan shows the
actualisation or facilitation of others placed above the actual- Maslow's Motivation Model
isation or the realisation of the ambitions of the self, in what
has been termed transcendence. Maslow’s own definition of
transcendence was as follows: Transcendence refers to the
very highest and most inclusive or holistic levels of human
Growth Needs
consciousness, behaving and relating, as ends rather than
means, to oneself, to significant others, to human beings Trancendence
in general, to other species, to nature, and to the cosmos Self Actualisation
(Maslow, 1971). It should also be mentioned here, howev-
er, that from his ongoing studies, regarding the structure of Aesthetic Needs
his hierarchy, Maslow (1987) proposed that the order in the
hierarchy “is not nearly as rigid” as would be implied from Cognitive Needs
the diagram in Figure 1 (1971). A large study conducted by
Deficiency Needs
Tay & Diener (2011) tested Maslow’s theory by analysing the Esteem Needs
data of 60,865 participants from 123 countries, representing
Belonging and Love Needs
every major region of the world. The survey was conducted
from 2005 to 2010. They stated from their findings that the Safety Needs
emergent ordering of need fulfilment for psychosocial needs
was consistent across country conditions, thereby validating Physiological Needs
Maslow’s upper deficiency and all of the growth needs, but
that the fulfilment of basic and safety needs was contingent on
country membership. In the context of a profession, it is likely Figure 1. Maslow’s hierarchy of needs (McLeod (2017)
https://www.simplypsychology.org/maslow.html
that the basic or safety needs are those that might be expect-
ed to be met, or at the least, defended by a Trade Union. The
psychosocial needs might be expected to fall within the remit Coaching and Mentoring models
of the mentor, among others, however. As to self-actualisation, There are key mentoring and coaching theory and practice
it is interesting that Victor Frankl, in his book Man’s Search for experts, whose principles underpin those of many others.
Meaning (1946) tells us that “the true meaning of life is to be One such mentoring expert is Carl Rogers a psychologist and
discovered in the world rather than in man or his own psyche” psychotherapist who was nominated for a Nobel peace prize
12 • converse • Summer 2020feature
in 1987, for his work with intergroup conflict in South Africa Coaching to success through the GROW model (Figure 3) is
and in Northern Ireland. Rogers is known for practicing what another way in which the learne r might develop. This model,
he has termed unconditional positive regard, which he has developed by John Whitmore in the 1980s, author of Coach-
defined as accepting someone without negative judgment of ing for Performance (Whitmore, 1992), provides a process for
basic worth (Rogers, 1980). Earlier, Rogers had stated that a encouraging learning, action and growth, the aim of which is
person cannot teach another person directly and that a person to unlock people’s potential to allow them to self-actualise.
can only facilitate another’s learning (Rogers, 1951). Within One aim of this method was to learn through enjoyment and to
the teachings of Rogers is the personality theory, which states engender a sense of purpose in the learner.
that everyone exists in an ever-changing world of experience
in which they themselves are at the centre. Each person reacts
and responds based on their perception and experience. The
belief, therefore, is that the actions of the mentee are more
important than those of the mentor. (Rogers, 1951)
In line with the teachings of Carl Rogers, the teachings of
Chris Argyris are based on the foundation of Argyris’s funda-
mental faith in human nature. Argyris believed that organisa-
tions depend on people and that the personal development of
people can be inherent to their work, and through his thinking,
an effective mentoring style was developed, in which a mentor
may help a mentee (and themselves) to develop both person-
ally and professionally.
Double loop theory represented a major leap forward in
addressing the difference between limited versions of improve-
ment in organisations through learning, and a more profound
view of a much-extended version of increased improvement.
This is based upon a theory of action outlined by Argyris &
Schön (1974). An important aspect of the theory is the distinc-
tion between an individual’s self-understood theory and their
actions, and their recognition of this dichotomy as a basis for Figure 3. The GROW model (Whitmore, 1992)
continuous improvement via double loop learning, which is
shown in schematic form in Figure 2 (Bryant, 2009). In 1984, Kolb, published a seminal book entitled Experiential
Learning: experience as the source of learning and
development. This book essentially worked on the principle
that a person would learn through discovery and experience.
This is summarised in a schematic diagram in Figure 4.
Figure 2. Schematic diagram by Bryant (2009) of what is
meant by double-loop learning as described by Argyris &
Schön (1974)
This thinking by Argyris and Schön included a belief that
organisations can block employees from reaching their
maximum potential, described as ‘when organisational error is
detected and corrected in ways that involve the modification
of underlying norms, policies, and objectives’. Furthermore:
‘Most organizations do quite well in single-loop learning (when
the detection and correction of organizational error permits
the organization to carry on its present policies and achieve
its current objectives but have great difficulties in double-loop Figure 4. Schematic diagram of Kolb’s experiential model
learning)” (Argyris and Schön 1974). Their double-loop learn- cycle
ing theory unlocks the potential inherent in an organisation https://co.pinterest.com/pin/303430093623097311/?amp_
when a broader vision is embraced within its management and client_id=CLIENT_ID(_)&mweb_unauth_id=%7B%7Bdefault.
within other employees. session%7D%7D&from_amp_pin_page=true
Summer 2020 • converse • 13feature
Experiential learning theory provides a model of the
learning (and coaching) process and is in line with how
we might expect to learn, grow and develop. The theory
is called experiential learning to stress the fundamental
role that experience plays in the learning process. In
healthcare in Ireland as we know, in recent years, an
emphasis is placed on reflective practice following
experiential learning, in a continuous professional
development cycle, (that is largely self-monitored) and
Kolb’s model is very much reflected in this practice.
Another mentoring authority, Senge, with others,
developed the Fifth Discipline Fieldbook (1990), to act indicated.
as a guide to an educational institution. This guide was Figure 5. Phases of the mentoring relationship (Lane &
based on Senge’s five principles for learning: personal Clutterbuck, 2004)
mastery, mental models, shared vision, team learning
and systems thinking (Zachary, 2005). Senge’s intention
There have been different permutations of mentoring
is that this model should foster deep thinking and he
suggested over the years. These include team and
says in his book that “we are talking about how people
sequential mentoring, for example. In team mentoring, the
create new ways of working together”. Part of his thesis
team leader would mentor group members who also mentor
is about changing people’s thinking and the way in
one another (Williams, 2000), and sequential mentoring,
which people see the world. Senge talks about our
where a mentee may have a series of mentors (Baugh &
assumptions about others that may prevent us from
Scandura, 2000).
seeing our colleagues as essential learning allies, and
thus preventing us from bringing about positive change.
In mentoring, one of the challenges for the mentor Discussion and Conclusion
is in managing to provide active listening and not to It is likely that the greatest benefits to the mentee will come
superimpose the mentor’s view of the mentee’s situation about when their actions resonate with the mission of their
during meetings. The points made in Egan’s skilled organisation. The self-acknowledgment of mentoring by and
helper model are very instructional here and include of ourselves in our daily working lives, in a reflective way,
exploration, challenging and action planning (Egan, would help us to improve our skills in this regard. A per-
2013). The development of a mentoring system should son’s own search for meaning is also made easier through
ideally be preceded by mentor training. Whether mentor reflection on this fact, perhaps. Furthermore, as taught by
training is provided to the prospective mentor prior Senge (1990), organisations learn through the learning of
to taking on a mentoring role or not, it might also be individuals. This must be as true for the CEO as for the
helpful to have an observer present for the mentor in the student, and which makes effective communication, univer-
early stages of the mentoring processes, as there are sal respect, teaching and mentoring vital. Senge’s teaching
challenges inherent in trying to learn objectively to be a (1990) includes the wisdom that for any of us a state of
skilled helper while focusing on the actual matters being personal mastery includes the realisation that the reward is
outlined and expanded by the mentee during a meeting. the journey. Such a climate of mentoring could foster the
Klasen and Clutterbuck (2002) suggest that mentoring best environment for meeting the changing needs of an
involves an integrated approach combining four individual.
development approaches: coaching, counselling, One of the current missions of the Academy is to immi-
networking/facilitation, and guardianship. These nently set up a support for mentoring of its members at all
incorporate both intellectual and emotional needs of stages of their careers. The Advancement and Engagement
the mentee. It is a process whereby the needs of the Advisory Body are demonstrating their usual innovative ap-
relationship are dictated by the mentee and not the proach at the moment, for new members of the profession,
mentor. (Klasen and Clutterbuck, 2002). This mention as one example. Watch this space!
of both coaching by and mentoring together by Klasen
and Clutterbuck (2002) suggests the need for a how-to-
References
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