- Email: [email protected]
The education of clinical chemists
BIOCHEMICAL EDUCATION
I
THE EDUCATION OF CLINICAL CHEMISTS
In Biochemical Education 1976, 4, 70, Dr. Cut-now described the activities of the Education Committee of the International Federation of Clinical Chemists. In October 1976, he and I were invited to the first meeting in Barcelona of the Spanish Society of Clinical Chemists. They started their meeting with a discussion on the Education of Clinical Chemists. In view of the increasing demand for biochemists in the hospital service it may be of interest to give a shortened version of our two talks since they reach broadly similar conclusions with respect to the employment of biochemistry graduates from rather different viewpoints. While I am very interested in Clinical Chemistry, I have little experience of running a hospital service while Dr. Curnow has great experience in this respect.
Basle Biochemistry at the pregraduate level Intended for future Clinical Chemists P. N. Campbell. Courtauld Institute of Biochemistry, Middlesex Hospital Medical School, L o n d o n W l P SPR. Clinical Cht~!~t~
at present:
It seemed to me that before talking about the education of Clinical Chemists I should say a few words about how I see them and the development of their work, for until one has a fairly clear idea about this it is difficult to consider education. In considering the present state of Clinical Chemistry I think we must divide the employees into those who are medically qualified and are pursuing a career in medicine and those who are scientists. On the whole I fear that the speciality of Chemical Pathology for medics has not been popular. Certainly in the U.K. there are good jobs available but they do not attract many good applicants. I think that the major reason for this is that, certainly in the large teaching hospitals, any good Physician whether he be a general Physician, an Endocrinologist, a Paedetrician or Cardiologist, will regard himself as capable of deciding what Chemical Pathology he wants and how to interpret the results when he gets them. In general he does not want an intermediary between himself and the lab. This is not to say that he does not need one. There are plenty of Clinical Chemists who continue to be amazed at the ignorance of Clinicians in this field. In any event the situation may well be different in a large general hospital in the provinces, where a good medical Chemical Pathologist can be a great help. I think that even in the main centres the Chemical Pathologist Consultant may come into his own when money gets short and there has to be some selection of tests as surely there will be in most countries before long. Let us turn to the non-medic about which we are more concerned. The basic debate here has been the attitude of the medics to the Clinical Biochemists. I think that on the whole they are still regarded as technicians who are there to produce the results. One could say that this does not matter in that they are well paid and in the U.K. have a reasonable career structure. I think however that this is too facile a view and that it does matter in that ultimately they will be excluded from the more interesting aspects of what should be their subject.
~ n e a i m f o r C l i n i c a l Chemi~i,xy What are we aiming at? Surely, that among the medical profession the Clinical Biochemist should be respected for his expertise and should be at the forefront of developments and research in the application of biochemistry to medicine. The same kind of aim is described by P. Astrup in his paper in Clinical Chemistry, 1975, 21, 1709 entitled "Clinical Chemistry - - A
January 1977 Vol. 5 No. 1
9
P. N. CAMPBELL
changing discipline". In some ways I think that the Physicists have done much better and are a model which Clinical Chemists would do well to emulate. Too often have the Clinical Chemists complained that they are treated as mere technicians but often this description has fitted them too well. We may ask who it is that is asked to do interesting research related to say Arteriosclerosis or Multiple Sclerosis, not the Clinical Chemists but the so-called pure biochemists. A symptom of the technician image can be seen in the U.K, where there is a demand in important circles that the staffing should be "common spine", in other words we would no longer have Academics and Technicians. Put briefly the reasoning is that two grades do much the same job - - the Technician job has been uplifted by the provision of automatic equipment and the Academic has become machine orientated. Moreover much effort has gone into the education and pay of the Technicians so that in many ways they have caught up with the Academics. This is compounded by the lack of jobs for science graduates so that we have now many graduate Technicians and the two grades appear pretty similar. The arguments for a common spine therefore look quite impressive and they will have to be countered by a new approach.
What hss gone
wrong?
If I am right in thinking that in some respects at least the Clinical Chemists in the U.K. have not succeeded in their aim, it is worth asking why this is so, so that you in Spain can ensure that you do better. First, While recognising that complex apparatus is essential, I think it is a mistake to worship instruments. Too often the objective seems to have been to welcome every possible test and then to purchase a complex piece of apparatus that is only economic if it does even more tests. The result is to Empire-build so that more and more tests of doubtful value are performed at the behest of the Medics. This results in a distortion of the aims of the Department. The aim therefore should be, to do the work with a reasonable amount of flexible apparatus and to help the Medics to decide which tests are useful. Surely, the day is near when in many countties someone is going to have to limit the amount of routine analysis, for the amount of money spent on medicine cannot continue to increase. Secondly, I think that too many recruits into Clinical Chemistry have been Analytical Chemists who have had little knowledge of biochemistry. This was not surprising for there has until recently been a scarcity of biochemists and in many cases the tests that were done did not make much sense in terms of biochemistry. The result has been that older staff while making fine contributions to the development of new methodology were less good at research activities. I realise that this is a pretty sweeping generaiisation for we all know some excellent Departments of Chemical Pathology where they have made fine advances in methodology such as Radio lmmuno Assay. Thirdly, I think that the Clinical Chemist has been too keen on apeing the other specialities in medicine in setting up high sounding bodies to monitor recruitment. This has provided an incentive for the young to learn and the teachers to teach but has stifled the interest of talented people. It could be said that at least in the U.K. no one is free to think as a Clinical Chemist until he is thirty years old. In the end all this organization has not brought the respect of the Medical Profession. There is no doubt that the emphasis on years of service as a condition of promotion has done much to ensure the separation of Clinical Chemists from the research work that I have already mentioned. It may be noted that the so-called
10
BIOCHEMICALEDUCATION
Academic Biochemists don't have all this examining and grading and their recruitment to the Universities is designed to promote those who will enliven their departments. The aim should he therefore to recruit intelligent people into your profession who should have a good training in biochemistry. They should be well based in Chemistry and Analytical Techniques. I suggest that in-service training should be used to teach the biochemists the language of medicine and the relevance of their analytical techniques. Those who are interested should be encouraged to do research on the diagnosis and cure of disease. In this way the Academics will be enabled to show their potential in a way that is often not possible at present and so, at least in the major teaching hospitals, the call for a common spine structure will be refuted. In short, the Academics will have their jobs as initiators and the Technicians theirs as skilled operators. I might mention that the Courtauld Institute is responsible for the teaching of biochemistry to Medical students and the Service requirements of the hospital. While this is an unusual situation I think it has much to commend it if we are to develop along the lines I have described.
January 1977 Vol. 5 No. 1
CIinlcsl Biochemistry at the prewradume level-scope and prolprammes D. H. Curnow. Department of Clinical Biochemistry, Perth Medical Centre, Nedlands, 6008, Western Australia. It is my contention that for the main part, Clinical Chemistry must be studied at the postgraduate level. In other words, I too do not ask for an undergraduate degree course in Clinical Chemistry. Students of Biochemistry and Chemistry should, however, be exposed to some experience of Clinical Chemistry for otherwise they miss the opportunity to be interested in it and cannot make a proper choice to take it up in their postgraduate years. I would like to remind you that the essential feature of a degree course is that it should be educational (learning to know) rather than a training (learning to do). The place of Clinical Chemistry among the sciences and medicine can be depicted as follows: Chemistry
Biochemistry
\
Undergraduate Com'~s If you agree with my diagnosis as to the role of the Clinical Chemist, you will be surprised that I am not in favour of an undergraduate degree in Clinical Biochemistry. In the U.K. we have a few Courses for Science students in our Universities which are described as Medical Biochemistry but they are in fact very similar to others which are merely described as Biochemistry. The aim should be a sound background in biochemistry based on chemistry with the opportunity for the students to learn something of life in a Clinical Chemistry laboratory during their Course. I say that the Biochemistry must be soundly based on Chemistry. In many courses, especially on the Continent I note that students of Biochemistry are first introduced to 1 or 2 years of Chemistry, Physics and Biology. In other words, they see nothing of biochemists until say the third year. I must say that it is our experience that if you want intelligent students in Biochemistry this plan will not do. You have to go to the Schools and encourage the children to apply for Biochemistry and then you have to keep the enthusiasm alight by at least providing some Course in Biochemistry at University from the start. This should only be a minor component for there should be a good deal of Chemistry in the first years. As to the component of Clinical Chemistry l think this is best done in practice. There are two common ways of achieving this both of which have their merits. In the normal degree course we are used to the students doing either a one term or a two term project which they choose from a list according to their interests. They should certainly have a chance of choosing one in the Department of Chemical Pathology or in the Hospital. In the other scheme they do what we call a Sandwich Course. In this, case the student leaves the University for either 6 months (a thin sandwich) or I year (a thick sandwich) to go and work in a Hospital lab during his degree course. This works very well too but it does mean that the degree course is longer. On the other hand, the student earns some money on the way and gets a real appreciation of what he wants to do.
I
Medicine
In other words, it depends on both Chemistry and Biochemistry and interacts with Medicine and Patient Care. It is not surprising therefore that the names Clinical Chemistry, Clinical Biochemistry and Chemical Pathology are larply synonymous. The functions of a Department of Clinical Chemistry may be defined under the following headings: 1.
Analytical and Data Handling
2.
Consultant and Educational
3.
Research and Collaborative
4.
Administrative and Managerial
In order to fulfil these functions a Department will usually employ graduates of medicine and science (and in some countries, pharmacy) who come together to help in the analytical, interpretative, research and teaching activities of the discipline. So far as undergraduate medical students are concerned we will not train clinical chemists but it is worth mentioning that we must not forget to inform the medical undervaduate about the essentials of Clinical Chemistry. The Pathologists, I ~ l o s i s t s and Microbiologists have demanded a lot of student time and their case is in many ways no stronger than that of the Clinkal Chemist. It has been argued that biochemistry for medical students could be taught with a much more clinical chemistry flavour, as it were, but I do not wish to pursue this at the moment; rather let us concentrate on the science student. An educational and training structure for Clinical Chemists may be depicted with alternative pathways as follows:
/MS¢ (Researchandcoursework)
Smmmary I may summarise by saying that in my view a good Department of Clinical Chemistry depends on close cooperation between Medics, Scientists and Technicians. That the Scientists must not be merely Technicians, If they are to avoid this they must he concerned with and have time for research activities. That the aim must be to attract the most intelligent people into Clinical Chemistry and that you will do this if the main core of scientists have a good education in Biochemistry which in itself is well based on Chemistry.
/
Clinical Chemistry
/or
I MAAB (Australian Membe~htp)
t
Senior Clinical Chemists
|
Oth~ Careers
BIOCHEMICAL EDUCATION
January 1977 Vol. 5 No. 1
An essential feature of this structure is that at any point a person may branch off and enter a career other than Clinical Chemistry; the Clinical Chemist should not feel to be trapped. This is a strong reason for not having an undergraduate course. It is my beHof that every senior Clinical Chemist should have had the rigorous intellectual experience of a research degree. He needs this to fulfil his role as a leader for which he needs quality of thought. The scheme should also be flexible enough to ensure that the demand [or Clinical Chemists is roughly matched by the supply. One can state that the basic core of knowledge of the Clinical Chemists is Chemistry, Physics, Maths, Biochemistry, Biology and Physiology. We must, however, remember that the subject needs people with a variety of backgrounds, and so we must allow for a large range of options to be available, from electronics and computer science to management and business studies. Departments of Clinical Chemistry are essentially interdisciplinary teams and so human qualities and the ability to understand the attitudes of those with different backgrounds to your own are also very important. At the undergraduate level this calls for a broad base of cultural and intellectual experience. If we recall the tremendous changes that have taken place in Clinical Chemistry in the past thirty years it is clear that any
educational programme for Clinical Chemists must be education for change. The best way to achieve this is to concentrate on fundamentals rather than current techniques and fashions. The following references may be useful [or those who are interested in the subject.
Andwendung yon hotopen In der Organisehmt Chemic tmd Bioehemle. Vol. 2. Meunng yon radioaktlven und stabllm hotopen
could be produced separately as a saleable monograph. This is particularly true of section F, which is a well written, authorative account of radiochromatography. Continuous and discontinuous methods for paper and thin layer chromatograms, and electrophoretograms are described. Row-through techniques for monitoring column effluents, and radio gas-chromatography are discussed at some length. Useful hints are also given on the measurement of the radioactivity of cell suspensions on filter paper, and of tissue slices, and the in vivo scanning of small animals is described. Digital and analogue presentation of radioactive scanning results, and electronic peak integration are described and their various advantages and disadvantages are discussed. This section is concluded with the use of radiuehromatgraphy for purity control of radioactive materials. In view of the ever increasing use of stable isotopes in organic chemistry and biochemistry, the remaining section of the book is very appropriate. It is devoted to the preparation of samples [or the measurement of D, stO, 170, lSN, 1~C, ncl, 17cl. The quantitative treatment of mass spectrometric results is discussed in depth. The emission spectral analysis of isotopes, particularly that of SSN, [or which an apparatus is now commercially available, is described. Further topics are the densitometric analysis of water and the quantitation of isotopes by infra red spectroscopy. Direct, intramolecular analysis of isotope distribution by mass spectrometry, NMR and ESR is presented quite fully, and this will be appreciated by those interested in the biosynthesis of compounds such as alkaloids and antibiotics. This multi-author work is written rather in the style of a review, with copious literature references. Like a good review, the references are there [or further reading, but the information is complete in itself and immediately useful. In fact, there is some risk that my copy will become stained with scintillation chemicals through its constant use at the laboratory bench. T. A. Scott
By P. Rauschenbach, H. -L. Schmidt, H. Simon, R. Tykva and M. Wenzel (editor: H. Simon). Pp. 430, 87 figures. Springer-Verlag, Berlin, Heidelberg & New York. 1974. D M 98, US$ 40.00. (In G e r m a n . ) This is a valuable text for the research worker using radioactive or stable isotopes. While it is definitely not an undergraduate student text, it would prove useful to a teacher in the preparation of a theoretical or practical course on the use of isotopes. In the first section, units of radioactivity are defined and the characteristics of isotopes are discussed. The radioactive isotopes used in organic chemistry and biochemistry are listed with their half lives, maximum energy and type of radiation, compounds in which they are normally available, most important nuclear reaction for their preparation, best counting method, etc. Such a list requires only four pages of the 430, but it is an example of the useful data that are scattered throughout the book. Section B discusses the principles involved in measuring radioactivity. The characteristics of different counting systems, such as ionization chambers, semi-conductors, scintillation spectrometers, are presented. In addition to the theory of the scintillation process and its measurement, advice is also given on the choice of material for scintillation vials. In section C, accuracy, reproducibility and error of radioactivity measurements and their mathematical analysis are discussed. Section D is largely practical instructions for the preparation of samples for measurement. Various combustion systems are described in detail, including useful recent methods for the production and absorption of combustion products in counting vials. Readers will find very useful the advice on solubllization of samples for liquid scintillation counting. Section E discusses the problems of measuring very low levels of radioactivity. It is interesting to note in this connection that semiconductors will possibly find more application in the future, especially those based on germanium or silicon. The measurement of multiply labelled samples is described in section F. Such samples can, of course, be totally burned and the variously labelled products separated prior to measurement. Such a procedure is described for compounds contaning sI-I, 1q2 and asS. Simultaneous counting of different isotopes is then explained together with the mathematical treatment of the results. Emphasis here is naturally placed on scintillation counting, but the differentiation of isotopes by using ionization methods or semiconductors is also briefly mentioned. Each section of the book
11
Clin. Chem. Acta. 1975, 61, F2-10 Clin. Biochem. 1976, 9, 56-61 Clin. Chem. 1973, 19, 1419-1422 The Zuckerman Report published in Great Britain is concerned with the employment of Scientists in the Health Services and is also a rich source of information and views.
Edltodal Note A notice was published in the last issue of Biochemical Education (4, 70, 1976) inviting readers interested in the educational activities of the International Federation of Clinical Chemists to write to Professor Curnow. He has now returned to Australia and letters should be sent to the address above and not the one in England which was given. Professor Curnow is the Chairman of the Education Committee of the I.F.C.C.
Continued from page 18
Dec. Dr. Karel Slavik, DrSc. Scientific Secretary Laboratory of Protein Metabolism Faculty of Medicine, Charles University of Prague Unemocuice 5 128 00 Praha 2, Czechoslovakia
Univ~dty of Amsterdam Laboratory of Biochemistry BCP Jansen Institute H a n t a p Muidergracht 12 Amsterdam, The Netherlands Profenur Dr. C. Veeger Departmemt of Biochemistry Agricultural University Wq~,uingan, The Netherlands I
I
THE EDUCATION OF CLINICAL CHEMISTS
In Biochemical Education 1976, 4, 70, Dr. Cut-now described the activities of the Education Committee of the International Federation of Clinical Chemists. In October 1976, he and I were invited to the first meeting in Barcelona of the Spanish Society of Clinical Chemists. They started their meeting with a discussion on the Education of Clinical Chemists. In view of the increasing demand for biochemists in the hospital service it may be of interest to give a shortened version of our two talks since they reach broadly similar conclusions with respect to the employment of biochemistry graduates from rather different viewpoints. While I am very interested in Clinical Chemistry, I have little experience of running a hospital service while Dr. Curnow has great experience in this respect.
Basle Biochemistry at the pregraduate level Intended for future Clinical Chemists P. N. Campbell. Courtauld Institute of Biochemistry, Middlesex Hospital Medical School, L o n d o n W l P SPR. Clinical Cht~!~t~
at present:
It seemed to me that before talking about the education of Clinical Chemists I should say a few words about how I see them and the development of their work, for until one has a fairly clear idea about this it is difficult to consider education. In considering the present state of Clinical Chemistry I think we must divide the employees into those who are medically qualified and are pursuing a career in medicine and those who are scientists. On the whole I fear that the speciality of Chemical Pathology for medics has not been popular. Certainly in the U.K. there are good jobs available but they do not attract many good applicants. I think that the major reason for this is that, certainly in the large teaching hospitals, any good Physician whether he be a general Physician, an Endocrinologist, a Paedetrician or Cardiologist, will regard himself as capable of deciding what Chemical Pathology he wants and how to interpret the results when he gets them. In general he does not want an intermediary between himself and the lab. This is not to say that he does not need one. There are plenty of Clinical Chemists who continue to be amazed at the ignorance of Clinicians in this field. In any event the situation may well be different in a large general hospital in the provinces, where a good medical Chemical Pathologist can be a great help. I think that even in the main centres the Chemical Pathologist Consultant may come into his own when money gets short and there has to be some selection of tests as surely there will be in most countries before long. Let us turn to the non-medic about which we are more concerned. The basic debate here has been the attitude of the medics to the Clinical Biochemists. I think that on the whole they are still regarded as technicians who are there to produce the results. One could say that this does not matter in that they are well paid and in the U.K. have a reasonable career structure. I think however that this is too facile a view and that it does matter in that ultimately they will be excluded from the more interesting aspects of what should be their subject.
~ n e a i m f o r C l i n i c a l Chemi~i,xy What are we aiming at? Surely, that among the medical profession the Clinical Biochemist should be respected for his expertise and should be at the forefront of developments and research in the application of biochemistry to medicine. The same kind of aim is described by P. Astrup in his paper in Clinical Chemistry, 1975, 21, 1709 entitled "Clinical Chemistry - - A
January 1977 Vol. 5 No. 1
9
P. N. CAMPBELL
changing discipline". In some ways I think that the Physicists have done much better and are a model which Clinical Chemists would do well to emulate. Too often have the Clinical Chemists complained that they are treated as mere technicians but often this description has fitted them too well. We may ask who it is that is asked to do interesting research related to say Arteriosclerosis or Multiple Sclerosis, not the Clinical Chemists but the so-called pure biochemists. A symptom of the technician image can be seen in the U.K, where there is a demand in important circles that the staffing should be "common spine", in other words we would no longer have Academics and Technicians. Put briefly the reasoning is that two grades do much the same job - - the Technician job has been uplifted by the provision of automatic equipment and the Academic has become machine orientated. Moreover much effort has gone into the education and pay of the Technicians so that in many ways they have caught up with the Academics. This is compounded by the lack of jobs for science graduates so that we have now many graduate Technicians and the two grades appear pretty similar. The arguments for a common spine therefore look quite impressive and they will have to be countered by a new approach.
What hss gone
wrong?
If I am right in thinking that in some respects at least the Clinical Chemists in the U.K. have not succeeded in their aim, it is worth asking why this is so, so that you in Spain can ensure that you do better. First, While recognising that complex apparatus is essential, I think it is a mistake to worship instruments. Too often the objective seems to have been to welcome every possible test and then to purchase a complex piece of apparatus that is only economic if it does even more tests. The result is to Empire-build so that more and more tests of doubtful value are performed at the behest of the Medics. This results in a distortion of the aims of the Department. The aim therefore should be, to do the work with a reasonable amount of flexible apparatus and to help the Medics to decide which tests are useful. Surely, the day is near when in many countties someone is going to have to limit the amount of routine analysis, for the amount of money spent on medicine cannot continue to increase. Secondly, I think that too many recruits into Clinical Chemistry have been Analytical Chemists who have had little knowledge of biochemistry. This was not surprising for there has until recently been a scarcity of biochemists and in many cases the tests that were done did not make much sense in terms of biochemistry. The result has been that older staff while making fine contributions to the development of new methodology were less good at research activities. I realise that this is a pretty sweeping generaiisation for we all know some excellent Departments of Chemical Pathology where they have made fine advances in methodology such as Radio lmmuno Assay. Thirdly, I think that the Clinical Chemist has been too keen on apeing the other specialities in medicine in setting up high sounding bodies to monitor recruitment. This has provided an incentive for the young to learn and the teachers to teach but has stifled the interest of talented people. It could be said that at least in the U.K. no one is free to think as a Clinical Chemist until he is thirty years old. In the end all this organization has not brought the respect of the Medical Profession. There is no doubt that the emphasis on years of service as a condition of promotion has done much to ensure the separation of Clinical Chemists from the research work that I have already mentioned. It may be noted that the so-called
10
BIOCHEMICALEDUCATION
Academic Biochemists don't have all this examining and grading and their recruitment to the Universities is designed to promote those who will enliven their departments. The aim should he therefore to recruit intelligent people into your profession who should have a good training in biochemistry. They should be well based in Chemistry and Analytical Techniques. I suggest that in-service training should be used to teach the biochemists the language of medicine and the relevance of their analytical techniques. Those who are interested should be encouraged to do research on the diagnosis and cure of disease. In this way the Academics will be enabled to show their potential in a way that is often not possible at present and so, at least in the major teaching hospitals, the call for a common spine structure will be refuted. In short, the Academics will have their jobs as initiators and the Technicians theirs as skilled operators. I might mention that the Courtauld Institute is responsible for the teaching of biochemistry to Medical students and the Service requirements of the hospital. While this is an unusual situation I think it has much to commend it if we are to develop along the lines I have described.
January 1977 Vol. 5 No. 1
CIinlcsl Biochemistry at the prewradume level-scope and prolprammes D. H. Curnow. Department of Clinical Biochemistry, Perth Medical Centre, Nedlands, 6008, Western Australia. It is my contention that for the main part, Clinical Chemistry must be studied at the postgraduate level. In other words, I too do not ask for an undergraduate degree course in Clinical Chemistry. Students of Biochemistry and Chemistry should, however, be exposed to some experience of Clinical Chemistry for otherwise they miss the opportunity to be interested in it and cannot make a proper choice to take it up in their postgraduate years. I would like to remind you that the essential feature of a degree course is that it should be educational (learning to know) rather than a training (learning to do). The place of Clinical Chemistry among the sciences and medicine can be depicted as follows: Chemistry
Biochemistry
\
Undergraduate Com'~s If you agree with my diagnosis as to the role of the Clinical Chemist, you will be surprised that I am not in favour of an undergraduate degree in Clinical Biochemistry. In the U.K. we have a few Courses for Science students in our Universities which are described as Medical Biochemistry but they are in fact very similar to others which are merely described as Biochemistry. The aim should be a sound background in biochemistry based on chemistry with the opportunity for the students to learn something of life in a Clinical Chemistry laboratory during their Course. I say that the Biochemistry must be soundly based on Chemistry. In many courses, especially on the Continent I note that students of Biochemistry are first introduced to 1 or 2 years of Chemistry, Physics and Biology. In other words, they see nothing of biochemists until say the third year. I must say that it is our experience that if you want intelligent students in Biochemistry this plan will not do. You have to go to the Schools and encourage the children to apply for Biochemistry and then you have to keep the enthusiasm alight by at least providing some Course in Biochemistry at University from the start. This should only be a minor component for there should be a good deal of Chemistry in the first years. As to the component of Clinical Chemistry l think this is best done in practice. There are two common ways of achieving this both of which have their merits. In the normal degree course we are used to the students doing either a one term or a two term project which they choose from a list according to their interests. They should certainly have a chance of choosing one in the Department of Chemical Pathology or in the Hospital. In the other scheme they do what we call a Sandwich Course. In this, case the student leaves the University for either 6 months (a thin sandwich) or I year (a thick sandwich) to go and work in a Hospital lab during his degree course. This works very well too but it does mean that the degree course is longer. On the other hand, the student earns some money on the way and gets a real appreciation of what he wants to do.
I
Medicine
In other words, it depends on both Chemistry and Biochemistry and interacts with Medicine and Patient Care. It is not surprising therefore that the names Clinical Chemistry, Clinical Biochemistry and Chemical Pathology are larply synonymous. The functions of a Department of Clinical Chemistry may be defined under the following headings: 1.
Analytical and Data Handling
2.
Consultant and Educational
3.
Research and Collaborative
4.
Administrative and Managerial
In order to fulfil these functions a Department will usually employ graduates of medicine and science (and in some countries, pharmacy) who come together to help in the analytical, interpretative, research and teaching activities of the discipline. So far as undergraduate medical students are concerned we will not train clinical chemists but it is worth mentioning that we must not forget to inform the medical undervaduate about the essentials of Clinical Chemistry. The Pathologists, I ~ l o s i s t s and Microbiologists have demanded a lot of student time and their case is in many ways no stronger than that of the Clinkal Chemist. It has been argued that biochemistry for medical students could be taught with a much more clinical chemistry flavour, as it were, but I do not wish to pursue this at the moment; rather let us concentrate on the science student. An educational and training structure for Clinical Chemists may be depicted with alternative pathways as follows:
/MS¢ (Researchandcoursework)
Smmmary I may summarise by saying that in my view a good Department of Clinical Chemistry depends on close cooperation between Medics, Scientists and Technicians. That the Scientists must not be merely Technicians, If they are to avoid this they must he concerned with and have time for research activities. That the aim must be to attract the most intelligent people into Clinical Chemistry and that you will do this if the main core of scientists have a good education in Biochemistry which in itself is well based on Chemistry.
/
Clinical Chemistry
/or
I MAAB (Australian Membe~htp)
t
Senior Clinical Chemists
|
Oth~ Careers
BIOCHEMICAL EDUCATION
January 1977 Vol. 5 No. 1
An essential feature of this structure is that at any point a person may branch off and enter a career other than Clinical Chemistry; the Clinical Chemist should not feel to be trapped. This is a strong reason for not having an undergraduate course. It is my beHof that every senior Clinical Chemist should have had the rigorous intellectual experience of a research degree. He needs this to fulfil his role as a leader for which he needs quality of thought. The scheme should also be flexible enough to ensure that the demand [or Clinical Chemists is roughly matched by the supply. One can state that the basic core of knowledge of the Clinical Chemists is Chemistry, Physics, Maths, Biochemistry, Biology and Physiology. We must, however, remember that the subject needs people with a variety of backgrounds, and so we must allow for a large range of options to be available, from electronics and computer science to management and business studies. Departments of Clinical Chemistry are essentially interdisciplinary teams and so human qualities and the ability to understand the attitudes of those with different backgrounds to your own are also very important. At the undergraduate level this calls for a broad base of cultural and intellectual experience. If we recall the tremendous changes that have taken place in Clinical Chemistry in the past thirty years it is clear that any
educational programme for Clinical Chemists must be education for change. The best way to achieve this is to concentrate on fundamentals rather than current techniques and fashions. The following references may be useful [or those who are interested in the subject.
Andwendung yon hotopen In der Organisehmt Chemic tmd Bioehemle. Vol. 2. Meunng yon radioaktlven und stabllm hotopen
could be produced separately as a saleable monograph. This is particularly true of section F, which is a well written, authorative account of radiochromatography. Continuous and discontinuous methods for paper and thin layer chromatograms, and electrophoretograms are described. Row-through techniques for monitoring column effluents, and radio gas-chromatography are discussed at some length. Useful hints are also given on the measurement of the radioactivity of cell suspensions on filter paper, and of tissue slices, and the in vivo scanning of small animals is described. Digital and analogue presentation of radioactive scanning results, and electronic peak integration are described and their various advantages and disadvantages are discussed. This section is concluded with the use of radiuehromatgraphy for purity control of radioactive materials. In view of the ever increasing use of stable isotopes in organic chemistry and biochemistry, the remaining section of the book is very appropriate. It is devoted to the preparation of samples [or the measurement of D, stO, 170, lSN, 1~C, ncl, 17cl. The quantitative treatment of mass spectrometric results is discussed in depth. The emission spectral analysis of isotopes, particularly that of SSN, [or which an apparatus is now commercially available, is described. Further topics are the densitometric analysis of water and the quantitation of isotopes by infra red spectroscopy. Direct, intramolecular analysis of isotope distribution by mass spectrometry, NMR and ESR is presented quite fully, and this will be appreciated by those interested in the biosynthesis of compounds such as alkaloids and antibiotics. This multi-author work is written rather in the style of a review, with copious literature references. Like a good review, the references are there [or further reading, but the information is complete in itself and immediately useful. In fact, there is some risk that my copy will become stained with scintillation chemicals through its constant use at the laboratory bench. T. A. Scott
By P. Rauschenbach, H. -L. Schmidt, H. Simon, R. Tykva and M. Wenzel (editor: H. Simon). Pp. 430, 87 figures. Springer-Verlag, Berlin, Heidelberg & New York. 1974. D M 98, US$ 40.00. (In G e r m a n . ) This is a valuable text for the research worker using radioactive or stable isotopes. While it is definitely not an undergraduate student text, it would prove useful to a teacher in the preparation of a theoretical or practical course on the use of isotopes. In the first section, units of radioactivity are defined and the characteristics of isotopes are discussed. The radioactive isotopes used in organic chemistry and biochemistry are listed with their half lives, maximum energy and type of radiation, compounds in which they are normally available, most important nuclear reaction for their preparation, best counting method, etc. Such a list requires only four pages of the 430, but it is an example of the useful data that are scattered throughout the book. Section B discusses the principles involved in measuring radioactivity. The characteristics of different counting systems, such as ionization chambers, semi-conductors, scintillation spectrometers, are presented. In addition to the theory of the scintillation process and its measurement, advice is also given on the choice of material for scintillation vials. In section C, accuracy, reproducibility and error of radioactivity measurements and their mathematical analysis are discussed. Section D is largely practical instructions for the preparation of samples for measurement. Various combustion systems are described in detail, including useful recent methods for the production and absorption of combustion products in counting vials. Readers will find very useful the advice on solubllization of samples for liquid scintillation counting. Section E discusses the problems of measuring very low levels of radioactivity. It is interesting to note in this connection that semiconductors will possibly find more application in the future, especially those based on germanium or silicon. The measurement of multiply labelled samples is described in section F. Such samples can, of course, be totally burned and the variously labelled products separated prior to measurement. Such a procedure is described for compounds contaning sI-I, 1q2 and asS. Simultaneous counting of different isotopes is then explained together with the mathematical treatment of the results. Emphasis here is naturally placed on scintillation counting, but the differentiation of isotopes by using ionization methods or semiconductors is also briefly mentioned. Each section of the book
11
Clin. Chem. Acta. 1975, 61, F2-10 Clin. Biochem. 1976, 9, 56-61 Clin. Chem. 1973, 19, 1419-1422 The Zuckerman Report published in Great Britain is concerned with the employment of Scientists in the Health Services and is also a rich source of information and views.
Edltodal Note A notice was published in the last issue of Biochemical Education (4, 70, 1976) inviting readers interested in the educational activities of the International Federation of Clinical Chemists to write to Professor Curnow. He has now returned to Australia and letters should be sent to the address above and not the one in England which was given. Professor Curnow is the Chairman of the Education Committee of the I.F.C.C.
Continued from page 18
Dec. Dr. Karel Slavik, DrSc. Scientific Secretary Laboratory of Protein Metabolism Faculty of Medicine, Charles University of Prague Unemocuice 5 128 00 Praha 2, Czechoslovakia
Univ~dty of Amsterdam Laboratory of Biochemistry BCP Jansen Institute H a n t a p Muidergracht 12 Amsterdam, The Netherlands Profenur Dr. C. Veeger Departmemt of Biochemistry Agricultural University Wq~,uingan, The Netherlands I