Institute of Biomedical Science. Specialist Diploma Reference Portfolio. IBMS Professional Qualifications www.ibms.org/education-development

Institute of Biomedical Science Specialist Diploma Reference Portfolio IBMS Professional Qualifications www.ibms.org/education-development

Personal Details Name: Degree Qualification(s): Awarding Institution(s): Date(s) Obtained: IBMS Membership Number: IBMS Membership Grade: HPC Registration Number: Date of HPC Registration: Employment Address: Telephone Number: Date Specialist Training Commenced: Name of Training Officer: Confirmation of Completed Training Date Training Completed Training Officer s Signature Candidate s Signature Recommendation for Award of Specialist Diploma Date of External Assessment External Assessor s Signature External Assessor s Name 3 rd Edition (September 2011)

Training Review Reviewed by Date Comments

CONTENTS 1. INTRODUCTION... 7 2. CRITERIA FOR USE OF PORTFOLIO... 13 3. LABORATORY BASED TRAINING... 17 4. EXTERNAL ASSESSMENT PROCEDURE... 21 5. FREQUENTLY ASKED QUESTIONS... 27 6. GLOSSARY... 33 7. DISCIPLINE SPECIFIC... 37 7.1 Urinary Samples... 38 7.1a Microscopy... 38 7.1b Automated Urine Screening Techniques... 40 7.1c Bacterial Pathogens... 42 7.1d Urinary Antibiotics... 44 7.2 Genital Samples... 48 7.2a Microscopy... 48 7.2b Genital Tract Pathogens... 50 7.2c Neisseria gonorrhoeae... 52 7.2d Medico-Legal Implications... 54 7.3 Gastro-Intestinal Tract Samples... 58 7.3a Bacterial Pathogens... 58 7.3b Detection of Viral Pathogens... 60 7.3c Detection of Toxins... 62 7.3d Serological Identification of Bacteria... 64 7.3e Typing Techniques... 66 7.3f Faecal Ova, Cysts and Parasites... 68 7.4 Mucosal and Soft Tissue samples... 72 7.4a Microscopic Interpretation... 72 7.4b Wound and Abscesses... 74 7.4c Mucosal Swabs... 76 7.4d Tissue Samples... 78

7.4e Orthopaedic Samples... 80 7.4f Detection of Toxins... 82 7.4g Typing Techniques... 84 7.5 Cerebral Spinal Fluid and Other Normally Sterile Body Fluids... 88 7.5a Microscopy... 88 7.5b Bacterial Pathogens... 90 7.5c Non-Bacterial Pathogens in CSF... 92 7.5d Rapid Detection Techniques... 94 7.5e Typing Techniques... 96 7.5f National Vaccination Policy... 98 7.6 Blood Culture Samples... 102 7.6a Principles and Use of Blood Culture Systems... 102 7.6b Microscopy... 104 7.6c Bacterial Pathogens... 106 7.6d False-Positive Signals... 108 7.7 Lower Respiratory Tract Samples... 112 7.7a Microscopy... 112 7.7b Lower Respiratory Tract Pathogens... 114 7.7c Mycobacteria and Rapid Detection Techniques... 116 7.7d Cystic Fibrosis... 118 7.7e Containment Level III Facility... 120 7.8 Infection Control Samples... 124 7.8a Patient/Staff Screening... 124 7.8b Theatres and Environmental Screening... 126 7.9 Antimicrobial Susceptibility Testing... 130 7.9a Qualitative Testing... 130 7.9b Quantitative Testing... 132 7.9c Antimicrobial Combinations and Synergy Testing... 134 7.9d Resistance Markers... 136 7.9e Antimicrobial Assays... 138

7.10 Serological Diagnosis of Diseases caused by Bacteria, Fungi and Spirochetes... 142 7.10a Principles of Test Procedures... 142 7.10b Performance of Test Procedures... 144 7.11 Mycology... 148 7.11a Microscopy Interpretation... 148 7.11b Fungal Pathogens... 150 7.12 Disinfection and Sterilisation... 154 7.12a Disinfection... 154 7.12b Sterilisation... 156

1. INTRODUCTION

1. INTRODUCTION The IBMS has developed the Specialist Portfolio to enable the recognition of structured, standardised post-registration training and assessment of newly registered biomedical scientists. The portfolio enables individuals to provide evidence of training, practical skills, specialist knowledge and competency gained in the two years after registration into the profession. Newly registered individuals have the opportunity to evidence their development of specialist knowledge and competencies in their chosen field by completion of the Institute s Specialist Portfolio. They must, as a minimum requirement, be in the IBMS membership class of Licentiate. The training portfolio is issued on application to the Institute with the required payment, which is inclusive of the end point assessment. Applicants must be working in a laboratory with Institute post registration training approval. The portfolio is not available to Associate members of the Institute or individuals undertaking pre-registration training. Completion of the portfolio and successful assessment will lead to the award of a discipline specific Specialist Diploma. The Specialist Diploma confers eligibility to apply to upgrade Institute membership from the class of Licentiate to Member provided the individual has a minimum of 2 years professional experience as a Licentiate member. In order to be awarded an Institute Specialist Diploma the individual must be a fully paid up corporate member of the Institute for at least one year and have completed the Institute s Specialist Training Portfolio in accordance with the Institute s instructions. The portfolio can be used as evidence to help biomedical scientists seeking career advancement, identifying education and training needs if returning to work or working in new disciplines, or by employers when considering eligibility for promotion. The portfolio can also be used by Higher Education Institutions in assessing work-based learning and accredited learning for postgraduate qualifications. It is recognised that the changes in service delivery and reconfiguration of pathology services is leading to combined disciplines or variations in the scope of practice for individuals within some laboratories. Such is the potential variation that a one size fits all specialist portfolio in blood sciences is not practical. A named discipline specific portfolio therefore reflects the range of analyses performed by most routine laboratories in the UK, although some might not be performed in the candidate s own laboratory. All sections must be completed in order to express the ability of the biomedical scientist to operate at the specialist level. Where a particular analysis is not performed in the candidate s laboratory, knowledge of the principles and practice must still be demonstrated, together with an understanding of the key skills required to perform the test. There may be other tests the training laboratory includes in its basic repertoire and therefore requires the individual to be competent in. These can be assessed and then recorded in the reflective log at the end of each sub-section. 7

To support members working in routine service laboratories that reflect a more crossdiscipline requirement for specialist practitioners, provision will be made, following purchase of the most appropriate discipline-specific portfolio, for modules to be substituted with one or more modules from specialist portfolios of other disciplines. The Specialist Diploma award transcript will reflect the main discipline plus altered modules. Requests from laboratory managers wishing to use the specialist portfolios to reflect the test repertoire of their laboratory will be considered upon submission of a written proposal of modules (and rationale for the request) to the Institute s Education Department, ahead of commencement of training. Achievement of the required knowledge and competence of the range of analyses expresses the ability of the biomedical scientist to operate at the specialist level as defined in the learning outcomes below: Learning Outcomes The learning outcomes of the Specialist Diploma are subdivided into the following three areas which candidates must be able to demonstrate they have met through completion of the portfolio and subsequent assessment procedure. Knowledge and understanding a. Demonstrate knowledge of complex scientific and technical aspects of their specialist discipline including: correct procedures for handling specimens before, during and after analysis; maintenance of routine equipment; principles of in-house data management systems and quality control/assurance procedures as evidenced by in-house assessments and laboratory tour. b. Show an awareness of current issues and developments within healthcare and biomedical science as evidenced by presentation and laboratory tour. c. Demonstrate knowledge of the scientific basis of the laboratory tests and the disease process under investigation as demonstrated by in house assessments and tour. Professional skills a. Perform a range of laboratory tests without immediate supervision Demonstrate self-direction in solving problems and exercising personal autonomy in relation to scope of practice as demonstrated by in-house assessments. b. Demonstrate a systematic application of professional knowledge and understanding in interpretation of laboratory data to determine action based on best practice as evidenced by in house assessments and portfolio evidence. Transferable skills a. Demonstrate communication skills within the healthcare environment and as part of the laboratory team as evidenced by presentation. b. Demonstrate the ability to critically reflect in order to inform best practice as evidenced by all aspects of the portfolio. 8

During completion of the portfolio, biomedical scientists will be gathering evidence of continuing professional development (CPD) and competence to practice. This meets the fundamental requirements of continuing registration with the HPC, i.e. compliance with the following areas: Professional autonomy and accountability Professional relationships Identification and assessment of health and social care needs Formulation and delivery of plans and strategies for meeting health and social care needs Critical evaluation of the impact of, or response to, the registrant s actions Knowledge, understanding and skills Internal Assessments Each of the standards within the discipline specific section requires the candidate to demonstrate knowledge and competence elements. It is the responsibility of the trainer(s) to ensure that these elements; a) and b) below have been met through internal assessments and filed in a single specialist portfolio ready for external assessment. a. Questions set by trainer Each standard requires the assessment of competence primarily through the answering of questions set by the trainer on the stated subject areas indicated by the knowledge and competence statements for each module. The portfolio is not prescriptive about the type of assessment which may be done via an oral tutorial, written questions or other suitable task. (Please note: Essays are NOT considered a suitable form of assessment). b. Other evidence Although evidence of training and assessment may be generated as part of good laboratory practice only ONE other example of evidence is required for the Evidence of Achievement section. This is chosen by the candidate as an example of evidence that demonstrates their knowledge and competence in performing a particular technique. The choice of evidence is justified in the Reflective log. Other examples of evidence that may be acquired during the course of training can, if the candidate wishes, be filed for reference purposes in a separate portfolio as additional evidence of competence. THIS IS ENTIRELY OPTIONAL AND IS NOT A MANDATORY PART OF THE EXTERNAL ASSESSMENT PROCESS. This may include the recorded observation of practical skills, case studies or other evidence of knowledge acquired during formal study for a postgraduate award or as part of an internal training regime. 9

Reference to a range of sample types can include blood, serum, plasma, urine, CSF, other fluids and tissues as appropriate to the routine investigation within the discipline, either as a main discipline (e.g. Haematology or Clinical Biochemistry) or a combination of disciplines (e.g. Blood Sciences). It also includes by inference, the knowledge and competence required to assess the suitability of the sample under investigation, for example lipaemic, inadequate, haemolysed, inappropriately labelled, transported, or stored samples within a specific sample type and for analysis using specific equipment. How to Use This Portfolio A summary of the criteria for using the Specialist Portfolio is contained in Section 2. Further information regarding laboratory training is contained in Section 3. Information about the assessment process is contained in Section 4. Answers to frequently asked questions can be found in Section 5. A glossary of commonly used terms is listed in Section 6. PLEASE NOTE: Whilst the award of a higher degree is not a prerequisite for the award of a Specialist Diploma there is the opportunity to integrate the two where possible. For example, inservice training undertaken to complete this portfolio could be recognised by higher education institutions under the category of work-based learning and accrue academic credit towards an M level qualification. Equally, the formal education and assessments undertaken as part of an MSc degree may support in-house laboratory training for completion of the portfolio. 10

2. CRITERIA FOR USE OF PORTFOLIO

2. CRITERIA FOR USE OF PORTFOLIO 2.1 Only the Institute s Specialist Portfolio can be used for the purpose of recording the training of a biomedical scientist for the Institute s award of a Specialist Diploma. 2.2 Specialist portfolio training must take place in a laboratory approved for training by the Institute. 2.3 The Specialist Portfolio will only be issued to a named Institute member upon completion of the application form by the Departmental Training Officer or Manager. 2.4 The portfolio requires specific evidence that indicates that candidates have applied knowledge, comprehension and analytical skills gained at undergraduate level to the (new) situation in which they work as a registered biomedical scientist. 2.5 The portfolio will contain a completed and signed record of laboratory training in the designated speciality, together with a reflective commentary on the learning experience and demonstration of competence. 2.6 Each module contains Knowledge and Competency statements that relate to a laboratory technique or investigative method. 2.7 Requirements for evidence of training and internal assessment of competency are set out in the Evidence of Achievement section of the portfolio. 2.8 The laboratory training officer (or a suitable deputy) and the individual undertaking training must sign and date when the training was completed. 2.9 The candidate must complete the Reflective Log to demonstrate that they can relate knowledge from several areas, draw conclusions and reflect on their own performance as an independent professional learner, thus meeting the requirements for CPD. 2.10 A signed statement must be provided by the laboratory manager, which indicates the laboratory s repertoire and analyses that a specialist practitioner working in that laboratory would be expected to perform without supervision. 13

3. LABORATORY BASED TRAINING

3. LABORATORY BASED TRAINING 3.1 To permit eligibility for the award of the Institute s Specialist Diploma in a named discipline(s), the in-service training and assessment must demonstrate sufficient good scientific practice, based on the knowledge and competence in the stated procedures, to meet the requirements of the external assessment process. 3.2 Suitable training can be obtained only by working in a laboratory approved by the Institute. Several trainers may be involved and it is essential that all training is coordinated and carried out under the control of a designated training co-ordinator or training officer. 3.3 A training programme should be prepared and adhered to in accordance with the Institute s Clinical Laboratory Standards for Pre and Post Registration Training of Biomedical Scientists. 3.4 The training co-ordinator/officer should ensure that regular reports on progress from trainers are reviewed at least once a month, discussed with the individual being trained, and documented in the portfolio. The object of these review pages is to ensure that a constructive, detailed, and contemporaneous record is kept, on which future training activities can be based. 3.5 Competence must be achieved by coverage of all modules within the chosen disciplines. Some tests may be considered as core and require demonstration of practical competence. If an investigation were considered to be outside the core repertoire of a routine laboratory, the tests only requires demonstration of knowledge and understanding that would be applied to the practical situation. 3.6 Short periods of secondment to other Institute approved laboratories may supplement training in order for the individual to gain additional practical skills and experience. 3.7 Candidates and trainers may undertake a selection of the following activities to complete training and assess the application of knowledge and skills, i.e. the assessment of competence. i) Work-based training with direct observation of practical skills (DOPS); ii) iii) iv) Case based discussion to demonstrate knowledge of output of work; Self-directed reading to broaden knowledge; Tutorials and scientific discussion to explore extent of knowledge; v) Reflective practice to self-assess knowledge and skills; vi) Question and answers sessions with trainer to test knowledge. 3.8 Evidence from all of the examples above is not required. The ONLY evidence required for the external assessment process is based on direct observation of skills and questions set by the trainer to assess working knowledge and the selected piece of work related to the knowledge and competency statements of each module as indicated in the Evidence of Achievement section of the portfolio. 17

4. EXTERNAL ASSESSMENT PROCEDURE

4. EXTERNAL ASSESSMENT PROCEDURE 4.1 On completion of training in accordance with the requirements of the Specialist Portfolio, the candidate s employer (laboratory manager or training officer) should apply to the Institute for the appointment of a visiting external assessor. The appointed external assessor will be instructed to contact the laboratory to arrange a mutually acceptable date and time for the assessment visit. Documentation guiding the assessment visit will be sent by the Institute to both the assessor and the training laboratory. 4.2 The aims of the assessment procedure are to: Independently verify that competence has been met (portfolio) and assess the standard of the candidate for suitability for the award of a Specialist Diploma (presentation and laboratory tour); Ensure consistency between disciplines and between laboratories; Check that professional body guidelines and criteria are applied nationally; Reassure the employer that their training is to the appropriate standard; Disseminate areas of good practice; Provide constructive feedback on areas of unsatisfactory practice. 4.3 Role of the External Assessor appointed by the Institute The external assessor for Specialist Portfolios undertakes the dual role of verifier and assessor/examiner. This individual reviews the portfolio to verify appropriate training has been given and completed, and then assesses the candidate through their oral presentation and during the laboratory tour to determine their suitability for the award of the Specialist Diploma. It is not the role of the external assessor to assess the competence of the candidate. This is the responsibility of the trainer, the evidence of which is exemplified in the portfolio. The Institute s role is to verify this has taken place (by checking the portfolio for evidence of training and assessment of competence) and also assess the ability of the candidate to demonstrate an understanding of the scientific basis for tests, quality control, quality assurance, quality management, health and safety and use of equipment commensurate with the learning outcomes in the portfolio. The Institute s representative will also make an assessment on whether or not the laboratory is complying with IBMS standards for approval of the laboratory for training. 21

4.4 The following process enables the Institute to award a Specialist Diploma to individuals that meet the criteria and also award a certificate to show Approved Training Laboratory status. Stage 1: Presentation (Indicative time 15-20 mins) The presentation is to ensure that candidates can demonstrate an understanding of their scope of practice and role in the laboratory. The presentation must be in PowerPoint format. If projection facilities are not available it can be viewed on a computer screen. It is expected that the 15-20 minute presentation will contain the following elements: An indication of the candidate s scope of practice and how it has developed since registration based on the reflective practice elements of the portfolio; Current developments in the laboratory or recent trends; Special interests or professional activities of the individual. Presentations need not be overcomplicated, should be structured to reflect the areas in which experience has been gained and act as a prompt for the dialogue, which supports the work done in the specialist portfolio. The candidate s presentation skills are not being tested so notes are acceptable but not encouraged. They should only be used to support the PowerPoint presentation slides. The external assessor may wish to ask some questions related to the presentation or seek points of clarification. Stage 2: Portfolio Assessment (Indicative time 60 mins) Assessors should aim to review the portfolio in one hour, which is sufficient to look at evidence contained in a single lever arch file. More evidence than this is deemed as excessive although assessors should not use this as a sole reason to fail to the candidate. It is acceptable for the external assessor to check with the laboratory before the visit that evidence is limited to one file, and if not, request that it is. There should be a signed statement from the laboratory manager testifying to the range of laboratory investigations undertaken by the candidate. (see Section 2: Use of the Portfolio, paragraph 2.5). This can be used by the external assessor to guide the areas for questioning during the laboratory tour. It is acceptable for external assessors to request this prior to the visit when they finalise arrangements with the laboratory. 22

Evidence in the portfolio is prescribed in the EVIDENCE OF ACHIEVEMENT section and this is the ONLY evidence that is required. Evidence should be indexed in the same order as the Specialist Portfolio modules. Additional (optional) supporting evidence of training may be provided in a separate portfolio and referred to if required. The Evidence of Achievement section has three standard requirements: observed by trainer to carry out a specific function/investigation (signature as evidence); answered questions set by trainer (single piece of evidence to demonstrate this); single piece of evidence chosen by candidate (not the trainer) to reflect an aspect of the training. The signed assessment of practice does not require a separate witness statement (unlike the Registration Portfolio). Questions asked by the trainer are informed by the knowledge component and competence requirements of each module. Evidence should support the fact that candidates understand their role and are competent to perform the work, either through questions they have been asked, set (and marked) questions or notes from tutorials. Evidence must be dated and signed by the candidate/training officer as appropriate. The third piece of evidence is selected by the candidate and chosen to demonstrate an aspect of the training and competency assessment. This choice is briefly justified in the Reflective Log, (e.g. as my third piece of evidence I chose to annotate a laboratory printout of results from a test I performed because ). Following the EVIDENCE OF ACHIEVEMENT section the Institute s portfolios must be signed by the internal person who has checked that the requirements for evidence for the module have been completed. The reflective logs are intended to demonstrate that the candidate has developed in the application of their practice and can apply what they have learned in the context of the module. The external assessor will review these reflective reports which should be supported by the evidence contained in the portfolio. This may lead to further discussion on the laboratory tour. 23

Stage 3: Laboratory Tour (Maximum 60 mins) The tour should not exceed 60 mins which is considered to be sufficient time to examine the candidate s knowledge, even in a large department. The candidate should be able to respond to questions asked by the external assessor based on the knowledge components of the portfolio and their scope of practice. The candidate should be able to demonstrate they have knowledge of the underlying principles and practice of laboratory investigations they have performed and the equipment they use. If the candidate is involved in training it is reasonable to expect them to explain how they do this. They should be able to explain NEQAS results, and demonstrate that they know how to apply health and safety. In doing so they demonstrate (in conjunction with their presentation and portfolio of evidence) that they meet the learning outcomes detailed in the introductory section of the portfolio. Stage 4: Approval of laboratory for Specialist Training The Institute has published guidance and criteria for approval of laboratories for pre and post registration training. Based on these criteria the laboratory tour also gives the external assessor an opportunity to judge that the laboratory has the appropriate requirements for training against the following checklist. This is provided as separate documentation and is available on the Institute s website. Stage 5: Feedback Comments to Trainer and Candidates. At the end of the assessment process the external assessor informs the candidate and training officer whether they will be making a recommendation (in their report to the IBMS) that the candidate was successful or unsuccessful, and whether or not a recommendation will be made regarding continued approval of the laboratory for training. This also provides an opportunity to seek further clarification on points of evidence if required. Feedback should be concise, constructive and based on the Institute s guidance for assessors, trainers and candidates in relation to specialist portfolio training and completion. Personal opinions or advice may be offered in the context of examples of good practice, but it should be clear they are NOT a specific requirement of the Institute. Stage 6: Completion of Reports Both the external assessor and the laboratory trainer are required to submit reports to the Institute and send a copy to each other. This provides an opportunity to share the feedback, and reflect on this. 24

5. FREQUENTLY ASKED QUESTIONS

5. FREQUENTLY ASKED QUESTIONS Eligibility I am not a member of the Institute. Can I complete the specialist portfolio? No. A candidate must have current corporate membership of the Institute of Biomedical Science. Corporate classes are Licentiate, Member, or Fellow. Associate members are not eligible. Why do I need to complete the specialist portfolio? Holding a Specialist Diploma is part of the criteria for upgrading your class of Institute membership from Licentiate to Member. It also demonstrates that you have been assessed against a benchmark standard for a specialist practitioner in your chosen discipline. It is therefore different from the registration portfolio required for HPC registration which is used to evidence that an individual has met a threshold standard of fitness to practise which is profession-specific, rather than based solely on a single discipline. The charge by the Institute for the specialist portfolio is 125. Who should pay? This is a local decision. Both the employer and individual benefit from the opportunity provided by the professional body to facilitate, evidence, and formally recognise the acquisition of specialist skills and knowledge. The charge is a nominal one-off amount towards providing this service to Institute members, and will also cover external assessor expenses for the endpoint assessment. When can my portfolio be assessed? You are required to be a corporate member of the Institute for a minimum of one year before a specialist portfolio can be externally assessed by the Institute. How long will it take for a date to be set for my assessment? This is dependent on the availability of an external assessor. It could be up to two months from receipt of your application form. Please apply well in advance of your preferred date in order for the Institute to organise an external assessor. Portfolio Organisation and Evidence When I completed the registration portfolio I was required to have one file of evidence. Must I approach the specialist portfolio in a similar way? Does it involve as much work or do I simply fill in the portfolio? The principles applied to the registration portfolio also apply to the specialist portfolio. Evidence required for both should not exceed one lever-arch file. Much information has been published in The Biomedical Scientist and in sections of this portfolio. Can you provide advice on how to present, organise and complete the specialist portfolio? There should be an index and the evidence should be organised to match the sections of the portfolio. 27

What evidence do I need? The type of evidence is indicated by the Evidence of Achievement section, and this is the ONLY evidence required. It must of course be relevant to the knowledge and competence statements. In order to sign off some of the sections it says "answered questions set by trainer..." (on a particular subject). Does this mean that there is no point getting other evidence for this, and that the only evidence required are some questions I have answered? Also I have several pieces of evidence for some sections but haven't yet been given any questions to answer from my trainer, so I m guessing this section cannot be signed off until I ve done them? The requirements for the evidence of achievement sections are clearly stated. All of them have "questions set by trainer". It is essential that your trainer conducts an assessment exercise that tests your knowledge as applied to the particular techniques - this is the purpose of the "questions asked by trainer". Once completed and you have evidence of this the trainer can sign off this part of the portfolio. Can I use evidence from a laboratory I worked in before I started my SP? I used to work in a reference lab and have copies of published papers with my name on which cover techniques in the SP but not done in my current laboratory. Obviously my trainer couldn't sign to say they'd witnessed my practical skills, but would that be ok to cover the principles? The requirements for the evidence of achievement sections are clearly stated and do not include copies of published papers. (You could put these in your professional portfolio). Who signs? The Evidence of Achievement section requires the trainers name and signature, and therefore should be signed by the person who assesses competence at the end of the relevant training. Underneath is an area in which to confirm the section has been completed and the evidence assessed and checked internally (e.g. by the training officer). In some instances this will be the same person. Is the person who signs the person who actually trained you in that technique, or does it have to be the training officer? Is it okay for a BMS1 to sign (if they did the training) or does it have to be a more senior person? I have a very "reluctant" training officer! Someone in the laboratory who has assessed your competence should provide the signature for the portfolio. As long as they are competent to train and assess you, the grade of staff should not be an issue. However, the training officer (or someone senior) should take responsibility for assessing the evidence is appropriate for each section and sign the section underneath the Evidence of Achievement section. You may wish to discuss these points with your trainer and perhaps with them also review the guidance on the IBMS website. It may also be helpful to clarify the role of your training officer with your line manager if they are "reluctant" as this may affect the training status of the laboratory if there is inappropriate support for training. 28

How do I complete the Reflective Logs at the end of each section? The aim of this part of the portfolio is to encourage you to think about your experience and how you can apply your skills in other areas. Try to capture what the laboratory does in relation to the topic, what you have learned, and how you apply this in the context of patient diagnosis. Future learning is identified by how you wish to build on this experience. It is very much an expression of your personal experience. Training and Standards I have been working as a trainee biomedical scientist, then as a BMS1 for almost two years in a specialist laboratory (four years in total), but only applied for my specialist diploma book after changing my job and starting an MSc. Should the date of my specialist training be when I became registered with the Health Professions Council (HPC) or when I received my book? It is normal for a newly registered practitioner to commence a period of specialist training in order to consolidate and extend their skills and knowledge in their specialist discipline. Therefore you may have accumulated evidence suitable for your portfolio in advance of receiving it. Can I use anything I sent for assessment for my MSc, as I completed this while HPC-registered for the past two years? It may support you training but evidence should be specific to your training and assessment in the laboratory. Do I need to complete all sections of the portfolio? Yes. However, not all sections require evidence of practical competence (it may state Be able to describe...'). Similarly, some skills may be transferable such that, together with knowledge, competence in some techniques may be considered to be achievable, even if the laboratory does not perform the method routinely. How long does training take? Although training can be expected to take up to two years after registration, it may be possible to complete the portfolio in less time if an individual has previous relevant experience to build upon for their specialist training (e.g. experienced gained in a single discipline while on a 12-month university placement). As a training officer I have just received a specialist portfolio for a member of staff. How best should I proceed? There can be no substitute for careful reading of the introductory sections of the portfolios, relevant articles in The Biomedical Scientist and the Education and Careers/Specialist Portfolios section of the IBMS website. You may also wish to contact training officers in other departments to share ideas and good practice so that you fully understand what is required. It is important that you develop a training programme. This can be based on the old 'logbook', but should, of course, be geared to the specialist portfolio. The crux of the qualification is the ability of the individual to articulate knowledge relevant to their specialist practice (e.g. training junior staff). 29

The portfolio says: "Answered questions set by the trainer". What questions do I set? Questions must relate to the knowledge and competence sections and are informed by your own professional working knowledge of the principles and application of the techniques. The level of knowledge should reflect that required of a specialist practitioner (see Learning Outcomes in the introductory section). Questions may be verbal during a tutorial session (if so, keep a record of them), written short questions and answers or multiple-choice exercises. The format is at the discretion of the individual trainer and will depend on local circumstances. Are there any courses available to support completion of the specialist portfolio? No specific courses are run by the IBMS, although you may wish to contact your local IBMS branch or university to see if anything is available or can be arranged. Some universities have developed MSc courses with work-based modules linked to the specialist portfolio. Do I need to complete my training in one laboratory? No. There is no requirement to complete in one laboratory and in some cases it may be desirable to have a secondment to another laboratory for some modules. However, the laboratory must be approved by the Institute for training. Specialist Practitioner Status Do I need the specialist diploma to advance my career? Although the Institute's qualifications are not mandatory for professional advancement, they do provide a mechanism by which the employer can measure someone's competence to practise at a higher level. When can I do on-call? When your employer (and yourself) believes you are competent. Ability to do on-call is defined by the employer and depends on the scope of practice required to perform an outof-hours laboratory service competently to the required standard. As with the registration portfolio, the specialist diploma in not linked explicitly to on-call (although it might link to certain elements). I am changing disciplines. Do I need to undertake a second specialist portfolio? Not necessarily. There is no requirement to complete a second specialist portfolio; however, there is a requirement under HPC regulation to be competent in one s scope of practice, and the specialist portfolio is one way you can gain this competence and evidence it. This could also be guided by the requirements of the knowledge and skills framework (KSF). I work in a Blood Sciences department. Which Specialist Portfolio should I apply for? Your laboratory manager must apply on your behalf for the most appropriate disciplinespecific portfolio that represents the bulk of your scope of practice (i.e. test repertoire). Modules can be substituted with one or more modules from specialist portfolios of other disciplines. The Specialist Diploma award transcript will reflect the main discipline plus altered modules. 30

6. GLOSSARY

6. GLOSSARY The following terminology is used throughout the portfolio. BE AWARE OF A general appreciation of the content of the key task. KNOW UNDERSTAND A working knowledge (can describe) of the facts associated with the key task. Thorough comprehension (can explain) of the principles and concepts of the content of the key task. COMPETENT Has the ability to perform a test, procedure or area of practice to a set standard on more than one occasion, in a consistent manner and with minimal or no supervision, together with a thorough comprehension of the principles and concepts of the content of the key task. The Institute s Specialist Diploma will only be awarded if there is supporting evidence (as indicated in the portfolio s Evidence of Achievement section) that competence has been achieved. This evidence will be presented as a portfolio, logically and cross-referenced to the relevant module or sections it supports. Suggested examples of evidence: EVIDENCE OF ACHIEVEMENT Audit trail results Annotated photomicrographs Annotated copies of QC/EQA records Tutorial notes for question and answer sessions PowerPoint presentations by the candidate Training records Witness testimonies Assessment logs (must clearly indicated level of knowledge and skill achieved) 33

CPA Clinical Pathology Accreditation HPC Health Professions Council SOP Standard Operating Procedure. SoP Health Professions Council Standards of Proficiency. 34

7. DISCIPLINE SPECIFIC

7. DISCIPLINE SPECIFIC This section covers the range of tests appropriate to specialist practice in Medical Microbiology and therefore reflects the range of analyses performed by most routine laboratories in the UK, although some might not be performed in the candidate s own laboratory. All sections must be completed in order to express the ability of the biomedical scientist to operate at the specialist level. Where a particular analysis is not performed in the candidate s laboratory knowledge of the principles and practice must still be demonstrated, together with an understanding of the key skills required to perform the test. There may be other tests the training laboratory includes in its basic repertoire and therefore requires the individual to be competent in. These can be assessed and then recorded in the reflective log at the end of each sub-section. To support members working in routine service laboratories that reflect a more cross-discipline requirement for specialist practitioners, provision will be made for modules to be substituted with one or more modules from specialist portfolios of other disciplines, e.g. Virology, Clinical Immunology. The Specialist Diploma award transcript will reflect the main discipline plus altered modules. Requests from laboratory managers wishing to use the specialist portfolios to reflect the test repertoire of their laboratory will be considered upon a written submission of proposed modules (and rationale for the request) to the Institute s Education Department ahead of commencement of the training. 37

7.1 Urinary Samples 7.1a Microscopy Be able to perform microscopy on a range of urine samples. KNOWLEDGE Know the basic principles behind microscopes and how to use them correctly. Understand the significance of reporting casts in urine wet films. Understand the significance of reporting all eukaryotic cell types in urine wet films. Be aware of reasons other than bacterial infection why white blood cells are found in urine wet films. Know the key parasites that can be found in urine. Be aware of the different pathological crystals that may be found in urine. COMPETENCE You must be able to: Demonstrate safe and efficient use of the appropriate microscope(s). Identify the different cell types present. Quantify cell types according to laboratory procedure. Report results accurately and in accordance with laboratory procedure. 38

EVIDENCE OF ACHIEVEMENT This section requires the trainer to sign that the specialist trainee has successfully achieved fitness to practice as a biomedical scientist at the specialist level. The specialist trainee is required to present the supporting evidence indicated below as a separate specialist portfolio of evidence. Assessed by trainer to work in accordance with standard laboratory procedures. Answered questions set by trainer on the principles and practice of named procedure. One other piece of evidence chosen by the candidate as an example of their competence in this area. Evidence of competence for this standard has been assessed and passed by the internal person who has checked that the requirements in the Evidence of Achievement section have been met. Internal Assessor s signature: Internal Assessor s name: Date: 39

7.1b Automated Urine Screening Techniques Be aware of alternative strategies for processing urines. KNOWLEDGE Be aware of the different automated techniques available for processing urine samples both within and outside the laboratory setting. Know the key principles behind the different screening procedures. Understand the advantages and disadvantages of automated techniques. Be aware of biochemical markers and their use in screening for urinary tract infection, e.g. urinary dipsticks. COMPETENCE You must be able to: Demonstrate a working knowledge of the different automated urine screening methodology available. Demonstrate an understanding of the benefits and drawbacks of introducing automated screening techniques into a microbiology department. 40

7.1c Bacterial Pathogens Be able to interpret and identify the presence of bacterial pathogens. KNOWLEDGE Know the theory behind the quantification of urine culture and variables involved. Be aware of different procedures used for quantifying urine cultures. Be aware of the common bacterial pathogens of the urinary tract and the clinical conditions in which they are found. Know how to give a presumptive identification of the common pathogens. Understand the reasons why isolates from hospital patients may differ from those found in the community. Be aware of the composition and method of action of various media used in isolation of urinary tract pathogens. Understand why urinary tract infections (UTIs) caused by more than one organism may occur. Be aware of the different sample types available and their advantages and disadvantages. Understand the use of preservatives for urine samples. Know the reasons behind asymptomatic bacturia. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of urine samples. Make a presumptive identification of the different organisms present. Quantify the organisms present according to laboratory procedure. Interpret the result and report results. 42

7.1d Urinary Antibiotics Be able to perform sensitivity testing on urine isolates. KNOWLEDGE Be aware of the standard antibiotics commonly used to treat urinary tract infections and their limitations. Understand the basic pharmacological principles of the antibiotics used in the treatment of urinary tract infections. Know how to perform and interpret sensitivity results on urinary isolates. Understand the limitations of performing direct susceptibility testing on urine samples. Be aware of how the presence of antibiotics in the patient s sample can easily be demonstrated. COMPETENCE You must be able to: Perform and interpret appropriate direct sensitivity testing on suspected positive urine samples. Record these results and compare them with a more standardised method. Determine, in accordance with laboratory procedure, whether these results should be reported. Perform and interpret appropriate routine sensitivity testing, if different from above, and know when further tests are necessary. 44

Reflective Log This section is used to demonstrate you can relate knowledge from several areas, draw conclusions and reflect on your own performance as an independent professional learner, thus meeting the requirements for CPD. It is therefore a useful source of information for your CPD profile should you be audited by the HPC. The external assessor will review these reflective reports which should cross reference to the evidence contained in the portfolio. This may lead to further discussion on the laboratory tour. Period of Training: Summarise the laboratory role in the previous section(s):

Personal reflection on training and example of evidence:

7.2 Genital Samples 7.2a Microscopy Be able to perform a range of microscopy techniques on genital samples. KNOWLEDGE Know the basic principles behind microscopes and how to use them correctly. Understand the range of different micro-organisms that can be found in the genital tract. Understands the role of the normal flora. Know the different staining and microscopy techniques that may be used to detect genital tract infections. Understand the significance of reporting clue cells in the different genital samples. COMPETENCE You must be able to: Demonstrate safe and efficient use of the appropriate microscope(s). Interpret microscopy results. Quantify cells present according to laboratory procedure. Record and report results according to laboratory procedure. 48

7.2b Genital Tract Pathogens Be able to interpret and identify the presence of bacterial pathogens and yeasts. KNOWLEDGE Understand the range of different pathogens that can be found in genital tract and how they may be genital site specific. Be aware of the role of the normal flora. Know how to give a presumptive identification of the common pathogens. Know how to confirm the identification of the various pathogens. Be aware of the use of molecular technologies for the detection of genital tract pathogens Demonstrates underpinning knowledge of composition and method of action of various media used in isolation of genital tract pathogens. Know the different techniques used to detect other pathogens, including Chlamydia trachomatis and viruses. Be aware of the impact that the patient s condition (e.g. pregnancy) may have on the result. Understand the need for the use of transport media for genital swabs. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of genital samples. Identify the different organisms present. Confirm the identity of suspect isolates in accordance with laboratory procedure. Interpret the result taking into account all the information provided. Set-up, read and record correct susceptibility tests. Report results according to laboratory procedure. 50

7.2c Neisseria gonorrhoeae Be able to accurately confirm the presence of Neisseria gonorrhoeae. KNOWLEDGE Be aware of other Neisseria species that can be isolated from the genital tract. Know the key principles behind the biochemical identification of Neisseria gonorrhoeae. Be aware of the various antigenic methods available for confirming Neisseria gonorrhoeae identification. Know the advantages and disadvantages of molecular techniques in the detection of Neisseria gonorrhoeae infection. COMPETENCE You must be able to: Interpret appropriate Gram film results of suspect colonies. Confirm the identification of Neisseria gonorrhoeae biochemically, in accordance with laboratory procedure. Confirm the identification of Neisseria gonorrhoeae antigenically, if appropriate, in accordance with laboratory procedure. 52

7.2d Medico-Legal Implications Be able to produce results that would withstand medico-legal scrutiny. KNOWLEDGE Be aware of the increased medico-legal implications when Neisseria gonorrhoeae is isolated. Be aware of why some samples have greater medico-legal implications than others. Know which other organisms from genital samples may be looked for in medico-legal samples Know the receiving, recording and reporting procedures necessary for medico-legal samples. COMPETENCE You must be able to: Record and report all the relevant information required, in accordance with laboratory procedure. 54

7.3 Gastro-Intestinal Tract Samples 7.3a Bacterial Pathogens Be able to isolate and identify bacterial pathogens for gastro-intestinal samples. KNOWLEDGE Be aware of the common bacterial pathogens associated with gastro-intestinal disease. Be aware of the role of the normal flora. Be aware of the mechanisms involved in the bacterial production of gastro-intestinal disease. Know how to give a presumptive identification based on colonial morphology and simple laboratory tests. Know how to fully identify isolated pathogens including the use of biochemical and serological tests. Know the composition and method of action of various media used in isolation of gastro-intestinal tract pathogens. Know the typing techniques available. Be aware of patient management and control of infection measures. Know of the therapeutic regimes for common gastro-intestinal pathogens. Knows the culture media and procedures necessary for the optimal isolation of Clostridium difficile, when required. COMPETENCE You must be able to: Demonstrate safe and efficient processing of faecal samples. Identify the different bacterial pathogens isolated. Perform agglutination tests where appropriate. Perform and interpret biochemical tests where appropriate. Choose investigations based on local policy and clinical details. Report results according to laboratory procedure. 58

7.3b Detection of Viral Pathogens Be able to determine why, when, and how faecal samples are examined for the presence of viral pathogens. KNOWLEDGE Know the viral causes of gastro-intestinal disease. Be aware of the techniques available for the detection of the common viral pathogens. Know the reasons why certain patient groups are more likely to develop viral gastrointestinal disease. Be aware of relevant patient management and control of infection measures. COMPETENCE You must be able to: Demonstrate the safe and efficient processing of faecal samples for viral detection. Interpret at least one method for the detection of viral pathogens in faeces. Record and report results according to laboratory procedure. 60

7.3c Detection of Toxins Be aware of role of toxins in the development of gastro-intestinal disease. KNOWLEDGE Know the main toxins associated with gastro-intestinal disease and their modes of action. Know the key principles behind at least one assay for the detection of toxin(s) associated with gastro-intestinal disease. Know the advantage and disadvantage of the methods involved in toxin detection. Understand how the disease process is associated with at least one type of bacterial enterotoxin. Know the role of reference laboratories in the detection of bacterial enterotoxins. Be aware of current recommendations for the processing of faecal samples for Clostridium difficile toxin(s). Be aware of molecular methods for detection of Clostridium difficile toxins. COMPETENCE You must be able to: Describe the principles and practice of the techniques used for the detection of key toxins involved in gastro-intestinal disease. Demonstrate the safe and efficient processing of faecal samples for toxin detection. Interpret toxin detection results. Record and report accurate result according to laboratory procedure. 62

7.3d Serological Identification of Bacteria Be able to identify target pathogens using serological tests. KNOWLEDGE Know the principles of serological methods for the identification of gastro-intestinal pathogens. Know which pathogens require a serological identification. Be aware of the limitations associated with these techniques. Know how to use the Kauffmann-White scheme in the identification process for Salmonella serotypes. Understand the reporting procedures of serological results. COMPETENCE You must be able to: Perform a range of slide agglutination tests to aid in the identification of pathogenic bacteria from faecal samples. Propose how a full serological identification could be performed and comment on the techniques involved. Determine how these results are reported in association with other test results according to laboratory procedure. 64

7.3e Typing Techniques Be able to describe the role typing of bacterial isolates has in providing epidemiological information. KNOWLEDGE Know when it is necessary to type gastro-intestinal isolates and the techniques involved. Be aware of molecular methods for the typing of gastro-intestinal pathogens. Know the correct laboratory procedure for sending isolates to reference laboratories. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Recognise when it is necessary to send isolates for typing. Prepare isolates in appropriate transport medium/system for transportation. Label and package isolates and send to appropriate reference laboratory. 66

7.3f Faecal Ova, Cysts and Parasites Be able to identify common ova, cysts and parasites using microscopy. KNOWLEDGE Know the diversity of ova, cysts and parasites that can be seen in faecal samples. Know how to use microscopy (including use of calibrated eye-piece) in identifying ova, cysts and parasites. Know the staining procedures used on faeces samples. Know the concentration techniques used. COMPETENCE You must be able to: Demonstrate safe and efficient use of the appropriate microscope(s). Demonstrate safe and precise staining and concentration techniques. Identify any ova, cysts or parasites present. Report any positive isolates in accordance with laboratory procedure. 68

7.4 Mucosal and Soft Tissue samples 7.4a Microscopic Interpretation Be able to perform a range of microscopy techniques on samples and isolates. KNOWLEDGE Know the basic principles behind microscopes and how to use them correctly. Know the various staining techniques that are commonly used. Know the procedure for correct interpretation and reporting of Gram films. Know the significance of seeing spirochaetes in Vincent s stained slides. COMPETENCE You must be able to: Demonstrate safe and efficient use of the appropriate microscope(s). Use staining techniques in accordance with laboratory procedure. Interpret the different cell types and organisms present. Report results in accordance with laboratory procedure. 72

7.4b Wound and Abscesses Be able to interpret and identify the presence of bacterial pathogens in wounds and abscesses. KNOWLEDGE Know the common pathogens associated with wounds and abscesses. Know the composition and method of action of various media used in isolation of these bacterial pathogens. Know how to make a presumptive identification of these pathogens. Know how to confirm the identification of these pathogens. Understand the theory behind the different confirmation techniques. Know when it is necessary to send bacterial isolates for further typing. Be aware of the different sample types available and their advantages and disadvantages. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of wound and abscess samples, in accordance with laboratory procedure. Presumptively identify the different organisms present, using all the information provided. Identify the significant organisms present in accordance with laboratory procedure. Determine which isolates require susceptibility testing and set-up relevant susceptibility tests. Record and report an accurate result according to laboratory procedure. 74

7.4c Mucosal Swabs Be able to interpret and identify the presence of bacterial pathogens in mucosal swabs. KNOWLEDGE Know the common pathogens associated with mucosal surface infection. Know the composition and method of action of various media used in isolation of mucosal pathogens. Know how to give a presumptive identification of these pathogens. Know how to confirm the identification of these pathogens. Know the theory behind the different confirmation techniques. Know when it is necessary to send bacterial isolates for further typing. Know when it is necessary to send bacterial isolates for toxigenicity testing. Be aware of the different sample types available and their advantages and disadvantages. Know the safety implications when performing procedures likely to create aerosols. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of mucosal samples, in accordance with laboratory procedure. Presumptively identify the different organisms present, using all the information provided. Fully identify the significant organisms present, in accordance with laboratory procedure, using relevant kits when appropriate. Determine which isolates require susceptibility testing and set-up relevant susceptibility tests. Record and report an accurate result according to laboratory procedure. 76

7.4d Tissue Samples Be able to interpret and identify the presence of bacterial pathogens in tissue samples, excluding orthopaedic samples. KNOWLEDGE Know the common pathogens associated with tissue infection. Know the composition and method of action of various media used in isolation of pathogens from tissue samples. Know how to give a presumptive identification of these pathogens. Know how to confirm the identification of these pathogens. Know the theory behind the different confirmation techniques. Know the procedure for performing broth subculture, if appropriate. Be aware of the different sample types available and their advantages and disadvantages. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of tissue samples. Demonstrate safe and efficient subculture of any broths inoculated. Presumptively identify the different organisms present, using all the information provided. Fully identify the significant organisms present, in accordance with laboratory procedure, using relevant kits when appropriate. Determine which isolates require susceptibility testing and set-up relevant susceptibility tests. Record and report accurate results according to laboratory procedure. 78

7.4e Orthopaedic Samples Be able to interpret and identify the presence of bacterial pathogens in orthopaedic samples. KNOWLEDGE Know the common pathogens associated with orthopaedic site infection. Know which media to inoculate and why broth culture is usually required. Know how to give a presumptive identification of any pathogens isolated. Know how to confirm the identification of these pathogens. Know the theory behind the different confirmation techniques. Know the procedure for performing broth subculture. Be aware of why (ideally) multiple samples from the same site are needed. COMPETENCE You must be able to: State why orthopaedic samples are treated differently to most other tissue samples. 80

7.4f Detection of Toxins Be aware of the role of toxins in the development of bacterial disease. KNOWLEDGE Be aware of the main toxins and modes of action, associated with bacterial disease. Be aware of the key principles behind demonstrating if an isolate of Corynebacterium diphtheriae is toxigenic, e.g. Elek test. Be aware of the role of reference laboratories in the detection of bacterial toxins. Know the correct laboratory procedure for sending isolates to reference laboratories. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Describe the principles and practice of the techniques used for the detection of key toxins involved in bacterial disease. Describe the procedure for referring suspect isolates for toxigenicity testing. 82

7.4g Typing Techniques Be able to describe the role typing bacterial isolates has in providing epidemiological information. KNOWLEDGE Know when it is necessary to type bacterial isolates from mucosal and soft tissue. Be aware of the techniques involved. Know the correct laboratory procedure for referring isolates to reference laboratories. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Recognise when it is necessary to send isolates for typing. Prepare isolates in appropriate transport medium/system for transportation in accordance with laboratory procedure. Correctly label and package isolates to send to appropriate reference laboratory. 84

7.5 Cerebral Spinal Fluid and Other Normally Sterile Body Fluids 7.5a Microscopy Be able to perform microscopy on the various sterile body cavity fluid samples. KNOWLEDGE Know the risks and the principles behind the safe handling of CSF samples from high risk patients, e.g. CJD, TB. Know the basic principles behind microscopes and how to use them correctly. Know how to count and quantify both white and red blood cells in sterile body fluids. Know the normal ranges of white blood cells in CSF samples and other sterile body fluids (i.e. CAPD). Understand the need for urgency in providing a quick and accurate result. Know reasons other than bacterial infection why white blood cells may be raised in such samples. Know of microscopic procedures to aid in the diagnosis of Sub-Arachnoid Haemorrhage. Know how to differentiate any white blood cells present. Know the significance of the cell differential result. Know how to use microscopic investigation to detect more unusual isolates (e.g. Cryptococcus neoformans). Know staining techniques used for sterile body fluids. Know when it is necessary to concentrate fluid samples. COMPETENCE You must be able to: Demonstrate safe and efficient use of the appropriate microscope(s). Demonstrate safe and correct staining technique. Demonstrate safe and correct concentration technique. Interpret stained microscopy results. Quantify both white and red blood cells according to laboratory procedure. Differentiate white blood cells, if appropriate. Record and report results according to laboratory procedure. 88

7.5b Bacterial Pathogens Be able to interpret and identify the presence of bacterial pathogens. KNOWLEDGE Know the bacterial pathogens usually associated with bacterial meningitis. Know why the most probable pathogen isolated is often dependent on the age of the patient. Know how to give a presumptive identification of these pathogens. Know how to confirm the identification of these pathogens. Know how biochemical markers can aid in the diagnosis of bacterial meningitis. Know the composition and reasoning behind why the various different media are used Understand when the use of broth enrichment is recommended. Be aware of the different sample types available and their advantages and disadvantages. Be aware of reasons why routine culture of CSF samples may prove unproductive. Know of the safety implications when performing procedures likely to create aerosols. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of normally sterile fluid samples, in accordance with laboratory procedure. Demonstrate safe and efficient subculture of any broths inoculated. Presumptively identify any organisms present, using all the information provided. Identify the significant organisms present, in accordance with laboratory procedure, using relevant kits when appropriate. Set-up relevant susceptibility tests, including direct susceptibility tests where appropriate. Record and report results according to laboratory procedure. 90

7.5c Non-Bacterial Pathogens in CSF Be able to interpret and identify the presence of pathogens other than bacterial. KNOWLEDGE Know the pathogens other than bacterial that can be isolated from CSF samples. Know which viruses are associated with CSF samples, mainly causing viral encephalitis. Know how the underlying condition of the patient (e.g. AIDS) can greatly affect the possible isolate. Know how to give a presumptive identification of these pathogens. Understand the urgency of CSF samples. Know of the safety implications when performing procedures likely to create aerosols. COMPETENCE You must be able to: Describe the various non-bacterial causes of meningitis/encephalitis. 92

7.5d Rapid Detection Techniques Be able to describe the role of rapid detection techniques in diagnosing bacterial meningitis. KNOWLEDGE Know the techniques available in a standard laboratory setting. Be aware of reasons why routine culture of CSF samples may prove unproductive. Be aware of how samples other than CSF may prove useful in diagnosing bacterial meningitis. Know the techniques available at reference laboratories. Know the samples required by reference laboratories. Know the correct laboratory procedure for referring isolates to reference laboratories. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Describe rapid detection techniques available for diagnosing bacterial meningitis. Correctly label and package correct samples and refer to appropriate reference laboratory. 94

7.5e Typing Techniques Be able to describe the role typing bacterial isolates has in providing epidemiological information. KNOWLEDGE Know when it is necessary to type bacterial isolates from CSF samples and the techniques involved. Be aware of how samples other than CSF may prove useful when typing possible bacterial meningitis cases. Know the techniques available at reference laboratories. Know the samples required by reference laboratories. Know the correct laboratory procedure for sending samples/isolates to reference laboratories. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Explain when it is necessary to send samples/isolates for typing. Correctly label and package samples/isolates, and send to appropriate reference laboratory. 96

7.5f National Vaccination Policy Be able to describe the impact that the National Vaccination Policy has had on the number of cases of bacterial meningitis. KNOWLEDGE Be aware of the different vaccines currently available and any that are currently being developed. Be aware of any weaknesses in the national vaccination policy. Be aware of the impact of the national vaccination policy. Be aware of the necessity of typing bacterial meningitis cases to inform both the current clinical situation and future vaccination strategy. COMPETENCE You must be able to: Describe the current national vaccination policy and the role of the laboratory in helping inform future strategy. Give an example where the vaccination strategy failed to protect travellers from bacterial meningitis. 98

7.6 Blood Culture Samples 7.6a Principles and Use of Blood Culture Systems Be able to describe the use of blood culture systems. KNOWLEDGE Know of the principles of at least one continuous monitoring blood culture system. Know the mechanisms whereby a positive signal is generated. Know the reasons for generation of a false positive signal by the instrument. Know the different types of media used in blood cultures systems and why they are used. Know of the procedures used for taking samples and optimal transport and processing. Know of the different approaches necessary when bacterial endocarditis is suspected. Be aware of the safety aspects of processing blood cultures. Be aware of how neutralisation of antimicrobial agents and other inhibitory factors can be achieved. COMPETENCE You must be able to: Demonstrate safe and efficient loading operation and basic troubleshooting and maintenance of the system. Demonstrate how positive and negative samples are processed. Describe the different approaches necessary when bacterial endocarditis is suspected. Demonstrate how to access and interpret additional system data including graphs depending on laboratory system. Report results according to laboratory procedure. 102

7.6b Microscopy Be able to provide a microscopic interpretation of the cause of a positive blood culture. KNOWLEDGE Know the basic principles behind microscopes and how to use them correctly. Know the safety aspects of processing positive blood cultures for microscopy. Know the techniques available for processing the sample for microscopy. Be aware of characteristic microscopic features that differentiate bacterial genera/groups. Know the procedures available in the event of negative microscopy. Be aware of the reporting procedures for microscopic findings. Know how the sample is processed based on microscopic findings. Know the local retention guidelines for storing microscopic preparations. COMPETENCE You must be able to: Demonstrate the safe and efficient processing of positive blood culture samples for microscopy. Demonstrate safe and correct staining techniques including alternative techniques when indicated. Distinguish the different bacterial groups using microscopy. Interpret record and report results according to laboratory procedure. Demonstrate the correct procedure for processing bottles that give a positive signal, but have no organisms detected on direct microscopy. Store microscopic preparations in line with current local retention guidelines. 104

7.6c Bacterial Pathogens Be able to describe the bacterial causes of septicaemia and bacteraemia. KNOWLEDGE Know the pathogens most likely to be the cause of septicaemia and bacteraemia and how they are identified. Know the principles of how bacteria cause bloodstream infections. Know the principles of how bacteria cause endocarditis. Know the symptoms of septicaemia. Be aware of other markers of blood stream infection. Be aware of the principles of antimicrobial therapy for septicaemia. Be aware of rapid methods to identify blood culture isolates including molecular techniques. COMPETENCE You must be able to: Demonstrate optimal methods for processing positive blood cultures. Determine the identity of the positive isolate. Use a range of techniques to fully identify the isolate. Demonstrate procedures for investigating a culture negative sample. Use antigen tests to identify the causative agent where appropriate. Set up appropriate susceptibility testing dependent on the expected isolate. Describe rapid methods available for identifying blood culture isolates including molecular techniques. 106

7.6d False-Positive Signals Be able to process samples generating false-positive signals. KNOWLEDGE Understand the reasons for generation of a false-positive signal by the instrument. Know the procedure for dealing with samples that have generated a false-positive signal. Know the reporting procedures according to laboratory procedures. COMPETENCE You must be able to: Describe why bottles appear to generate false-positive signals. Explain the possible reasons for the result using instrument and other data as appropriate. Process the sample correctly according to laboratory procedures. 108

7.7 Lower Respiratory Tract Samples 7.7a Microscopy Be able to perform a range of microscopy techniques on lower respiratory tract samples. KNOWLEDGE Know the basic principles behind microscopes and how to use them correctly. Understand the range of different micro-organisms that can be found in the lower respiratory tract. Be aware of the role of the normal flora. Know the different staining and microscopy techniques that may be used to detect infections in the lower respiratory tract. Know the procedure for detecting and confirming Acid Alcohol Fast Bacilli (AAFB) in lower respiratory tract samples. Know the need for some degree of urgency when AAFB are detected in a patient for the first time and the reporting procedure. Know the procedures for both homogenising and concentrating lower respiratory samples, as appropriate. Know the procedures for dealing with samples that may contain hazard group III organisms. COMPETENCE You must be able to: Use appropriate microscope(s). Perform staining technique. Perform concentration technique. Use containment level III facilities. Interpret microscopy results. Follow the procedures when AAFB are detected for the first time in a patient. Record and report results according to laboratory procedure. 112

7.7b Lower Respiratory Tract Pathogens Be able to interpret and identify the presence of bacterial pathogens, fungi and yeasts. KNOWLEDGE Understand the range of different pathogens that can be found in lower respiratory tract. Be aware of the role of the normal flora. Know the composition of various culture media used in the isolation of lower respiratory tract pathogens. Know how to give a presumptive identification of the various pathogens. Know how to confirm the identification of the various pathogens. Know when to look for more unusual pathogens (e.g. Legionella pneumophila). Be aware of the impact that the patient s condition (e.g. cystic fibrosis patients, intensive care patients) may have on the result. Know the procedures for both homogenising and concentrating lower respiratory samples, as appropriate. Understand the significance of growing fungi from respiratory samples. Know the procedures for dealing with samples that may contain hazard group III organisms. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of lower respiratory samples. Presumptively identify the different organisms present. Confirm the identity of suspect isolates in accordance with laboratory procedure. Interpret the result using all the information at hand. Perform, interpret and record susceptibility tests as appropriate. Report results according to laboratory procedure. 114

7.7c Mycobacteria and Rapid Detection Techniques Be able to describe various methods available for isolating Mycobacteria species, including the role of molecular techniques in rapid diagnosis. KNOWLEDGE Know the techniques available in a standard laboratory setting. Be aware of how samples other than sputum may prove useful in diagnosing infection caused by mycobacteria. Be aware of the requirement to occasionally send culture-negative samples for molecular testing Be aware of the techniques available at reference laboratories. Know the correct laboratory procedure for sending isolates to either other routine laboratories or reference laboratories, as appropriate. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Describe the standard isolation and rapid detection techniques available for isolating Mycobacteria species. Correctly label and package correct samples and send to appropriate reference/routine laboratory. 116

7.7d Cystic Fibrosis Be able to describe the investigation of samples from cystic fibrosis patients. KNOWLEDGE Be aware of the cause and consequence the cystic fibrosis condition. Be aware of the implications to the patient from a microbiology perspective and how this may vary throughout life. Know the increased range of organisms involved in infecting/colonising cystic fibrosis patients. Know the composition and method of action of various media used in isolation of these pathogens. Know how to confirm the identification of the various pathogens. Be aware of the antibiotics routinely used in cystic fibrosis patients. Know the procedures for dealing with samples that may contain hazard group III organisms. COMPETENCE You must be able to: Explain why cystic fibrosis patients need to have an increased awareness of microbiology. Describe the isolation/detection techniques used to detect infection/colonisation in cystic fibrosis patients. Describe the antimicrobial agents used to treat cystic fibrosis patients and why accurate in-vitro susceptibility testing is difficult to achieve. 118

7.7e Containment Level III Facility Be able to work safely and correctly in a Containment Level III facility. KNOWLEDGE Be aware of the Advisory Committee on Dangerous Pathogens (ACDP) and Control of Substances Hazardous to Health (COSHH) guidelines for micro-organisms. Know which organisms are categorised as Hazard Group III and IV. Know the additional safety precautions necessary when dealing with Hazard Group III samples. Know how and when to use Personal Protective Equipment (PPE). Know how to maintain and check the efficiency of PPE. Know the evacuation procedure in the event of a serious spillage, as appropriate. Know the laboratory procedure governing authority to work in Containment Level III facility. COMPETENCE You must be able to: Describe guidelines governing working in Containment Level III facilities. Describe local procedures governing working in Containment Level III facilities. 120

7.8 Infection Control Samples 7.8a Patient/Staff Screening Be able to interpret and identify the presence of bacterial pathogens in patient/staff screening samples. KNOWLEDGE Know which pathogens may require the laboratory to instigate a screening procedure. Be aware of the impact of molecular techniques on screening. Know the composition of the various media used in isolation of these bacterial pathogens. Know how to give a presumptive identification of these pathogens. Know how to confirm the identification of these pathogens. Understand the theory behind the different confirmation techniques. Know when it is necessary to send bacterial isolates for further typing. Know when it is necessary to send bacterial isolates for toxigenicity testing. Be aware of the different sample types available and their advantages and disadvantages. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of screening samples, in accordance with laboratory procedure. Presumptively identify the different organisms present, using all the information provided. Identify the significant organisms present in accordance with laboratory procedure. Determine which isolates require susceptibility testing and set-up relevant susceptibility tests. Record and report an accurate result according to laboratory procedure. 124

7.8b Theatres and Environmental Screening Be able to explain the requirement to monitor the microbial cleanliness of both theatres and the hospital environment. KNOWLEDGE Be aware of the current guidelines governing air quality in theatres. Be aware of the disinfection policy used in the hospital. Be aware of the disposal policy used in the hospital. Know how the air quality in theatres is monitored. Know how the microbial cleanliness of the hospital environment and equipment is checked. COMPETENCE You must be able to: Describe current national guidelines for environmental monitoring within the hospital. 126

7.9 Antimicrobial Susceptibility Testing 7.9a Qualitative Testing Be able to perform in-vitro qualitative antimicrobial susceptibility testing and interpret the results accordingly. KNOWLEDGE Understand the difference between qualitative and quantitative susceptibility testing. Be aware of the current national/international guidelines available. Be aware of the different qualitative techniques available. Know the limitations of testing certain antimicrobial agents in-vitro. Know when certain antimicrobial agent profiles for an organism are invalid. Know the laboratory procedure for performing and interpreting qualitative susceptibility results. Know how to record and report results. Know the recommended media types for qualitative susceptibility testing. Know standardized methodology available for susceptibility testing. COMPETENCE You must be able to: Describe different qualitative susceptibility testing methods. Obtain a pure inoculum at the correct concentration and incubate in appropriate conditions, according to laboratory procedure. Choose the appropriate range of antimicrobial agents for the organism under investigation. Interpret and record qualitative susceptibility results. Report the results in accordance with laboratory procedure. 130

7.9b Quantitative Testing Be able to perform in-vitro quantitative susceptibility testing and interpret the results accordingly. KNOWLEDGE Understand the difference between qualitative and quantitative susceptibility testing. Be aware of the current national/international guidelines available. Be aware of the different quantitative techniques available including automated technologies. Know the limitations of testing certain antimicrobial agents in-vitro. Know when certain antimicrobial agent profiles for an organism are invalid. Know the laboratory procedure for performing and interpreting quantitative susceptibility results. Know how to record and report results. Know the recommended media types for quantitative susceptibility testing. Know the significance of Minimum Inhibitory Concentrations (MIC). Know the significance of Minimum Bactericidal Concentrations (MBC). Know the difference between bacteriostatic and bactericidal agents. COMPETENCE You must be able to: Describe different quantitative susceptibility testing methods. Describe the significance of quantitative susceptibility testing results. Obtain a pure inoculum at the correct concentration, according to laboratory procedure. Choose the appropriate range of antimicrobial agent for the organism under investigation. Interpret and record quantitative susceptibility results. Report the results in accordance with laboratory procedure. 132

7.9c Antimicrobial Combinations and Synergy Testing Be able to describe which antibiotic combinations prove to be synergistic in-vivo and how this is examined for in-vitro. KNOWLEDGE Know a procedure for testing antimicrobial synergy between two different agents. Be aware of how antimicrobial combinations can produce synergistic, antagonistic, additional, and indifference effects. Know which agents are commonly used in combination because of their synergistic effect. Know under which clinical circumstances antimicrobial combinations are often given. COMPETENCE You must be able to: Explain when and where it is necessary to test for antimicrobial synergy. Describe how antimicrobial synergy can be detected. Describe which antimicrobial combinations are effective. Give examples of clinical situations where antimicrobial combinations are often used. 134

7.9d Resistance Markers Be able to detect resistance markers that are difficult to detect using standard qualitative susceptibility testing. KNOWLEDGE Know which antibiotics the most common pathogens are intrinsically resistant to. Know the different techniques available for detecting the common inactivating enzymes. Know which resistance markers may prove useful in detecting more widespread resistance to that class of antimicrobial agent e.g. Extended Spectrum Beta Lactamases (ESBLs). Know when certain antimicrobial profiles for an organism are invalid. Know the procedure for recording and reporting resistance markers. COMPETENCE You must be able to: Detect the presence of common inactivating enzymes, in accordance with laboratory procedure. Give examples of which antimicrobial agents act as markers for more widespread resistance in that class of agent. Record and report the detection of resistance markers, in accordance with laboratory procedure. Recognise invalid antimicrobial profiles. 136

7.9e Antimicrobial Assays Be able to perform antimicrobial assays and determine the significance of the result. KNOWLEDGE Know the theory behind chemotherapeutic index values. Know the range of antimicrobial agents that require patient s serum level monitoring. Know the procedure for monitoring serum antimicrobial levels and the principles of the methodology. Know the acceptable range of peak and trough serum levels for the commonly monitored antimicrobial agents. Know how to calibrate, maintain and quality control the equipment used. Know the recording and reporting procedure of the result. Know the procedure if an inappropriate result is obtained. Know the procedure for dealing with samples from Hazard Group patients. Know of the necessity to use Personal Protective Equipment (PPE). Be aware of the range of antimicrobial serum level monitoring available at reference laboratories. Know the correct laboratory procedure for sending samples to either other routine laboratories or reference laboratories, as appropriate. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Describe the principles of the test used. Calibrate and maintain the equipment. Process samples in a safe and correct manner. Interpret and record the result. Recognise when a result is invalid and how to proceed. Report the results in accordance with laboratory procedure. Correctly label and package correct samples and send to appropriate reference/routine laboratory. 138

7.10 Serological Diagnosis of Diseases caused by Bacteria, Fungi and Spirochetes 7.10a Principles of Test Procedures Be able to explain the use of serological diagnosis. KNOWLEDGE Know under what circumstances serological diagnosis is necessary. Know of the principle of the antigen/antibody interaction and how it can be visualised. Be aware of the basic function of immunoglobulins within the body. Be aware of the time periods, within the illness, when serological diagnosis may prove most beneficial. Know the principles of several techniques that detect either antigen or antibody in patients serum samples. Know of non-specific markers that may aid serological diagnosis. Be aware of the principles of available molecular based tests. COMPETENCE You must be able to: Describe how serological diagnosis aids in the identification of infections caused by certain bacteria, fungi and spirochetes. Describe the function of immunoglobulins within the body. Describe the principles and practice at least three different serological techniques used in the identification of pathogens. 142

7.10b Performance of Test Procedures Be able to perform serological procedures and interpret significance of result. KNOWLEDGE Know under what circumstances serological diagnosis is necessary. Know of the principle of the antigen/antibody interaction and how it can be visualised. Be aware of the time periods, within the illness, when serological diagnosis may prove most beneficial. Know the principles of several techniques that detect either antigen or antibody in patients serum samples. Know of non-specific markers that may aid serological diagnosis. Know the recording and reporting procedure of the result and the procedure if an inappropriate result is obtained. Know the procedure for dealing with samples from Hazard Group III patients. Know of the necessity to use Personal Protective Equipment (PPE). Be aware of the range of serological diagnosis procedures available at other routine laboratories or reference laboratories. Know the correct laboratory procedure for sending samples to either other routine laboratories or reference laboratories, as appropriate. Know the correct posting and packaging procedures in accordance with current legislation. COMPETENCE You must be able to: Describe the principles and practice of the test used. Process samples in a safe and correct manner. Interpret and record the result accurately. Recognise when a result is invalid and how to proceed. Report the results in accordance with laboratory procedure. Calibrate, if appropriate, and maintain the equipment. Correctly label and package correct samples and send to appropriate reference/routine laboratory. 144

7.11 Mycology 7.11a Microscopy Interpretation Be able to perform microscopy on a range of fungal samples. KNOWLEDGE Know the basic principles behind microscopes and how to use them correctly. Know the various techniques available for preparing direct films for mycelial elements. Understand the significance of reporting mycelial elements in direct films. Know why direct films are particularly important for skin scraping, particularly with the clinical details of pityriasis versicolor. COMPETENCE You must be able to: Demonstrate safe and efficient use of the appropriate microscope(s). Identify the presence of mycelial elements. Quantify mycelial elements and record appropriately. Report results accurately and in accordance with laboratory procedure. 148

7.11b Fungal Pathogens Be able to isolate and identify the presence of fungal pathogens. KNOWLEDGE Know how to process samples for fungal culture. Be aware of the different sample types available and their advantages and disadvantages. Know the composition and method of action of various media used in isolation of fungal pathogens. Know the procedures available to identify fungal isolates. Know how to give a presumptive identification of the common fungal isolates. Know the various dermatophytes that can be isolated and how they can be differentiated. Know how to differentiate the various aspergillus species and their significance. Know which other fungi are normally considered significant. Know the reason why environmental fungi can sometimes cause illness. Be aware of the role of the of mycology reference laboratories in the diagnosis and management of patients with fungal infections. COMPETENCE You must be able to: Demonstrate safe and efficient inoculation of fungal samples. Make a presumptive identification the presence of different fungal pathogens. Fully identify the fungi present according to laboratory procedure. Interpret and record the result taking into account all the information provided. Report the result accurately and according to laboratory procedure. Refer isolates or samples to the relevant mycology reference laboratory 150

7.12 Disinfection and Sterilisation 7.12a Disinfection Be able to effectively use disinfectants to make contaminated surfaces safe. KNOWLEDGE Be aware of the biological hazards associated with samples sent for microbiological testing and any subsequent waste created. Be aware of the range of disinfection products available and to which microbiological processes they apply. Know how to use disinfectants safely, in accordance with the manufacturer s instructions. Be aware of how risk assessments and COSHH guidelines apply to disinfectants. Know how to deal with a leaking samples and spillages of potentially infective material and body fluids. Know the procedure for dealing with a spillage in a Containment Level 3 laboratory. Be aware of the procedure for the fumigation of a Containment Level 3 laboratory. Know the procedure for dealing with a breakage in a centrifuge. Know the process for decontamination of equipment prior to servicing. COMPETENCE You must be able to: Safely disinfect surfaces, materials and equipment for use in the microbiology laboratory. Effectively deal with leaking specimens and spillages of potentially contaminated material. Describe how to deal with a breakage in a centrifuge. Prepare equipment for servicing. 154

7.12b Sterilisation Be able to effectively sterilise products for use and/or disposal. KNOWLEDGE Be aware of the various methods employed for the sterilisation of materials for use in Microbiology, including their advantages and disadvantages. Know how to operate the autoclave, hot air sterilisers and any other sterilisation equipment used within the department. Be aware of the range of temperatures/pressures used by autoclaves and when they are applicable. Know the hazards associated with sterilisation equipment and the various health and safety legislation regarding their operation. Know the controls/indicators used to demonstrate that sterilisation has been achieved. Know how to process infective microbiological waste, including that from a Containment Level 3 laboratory. Know how to dispose of clinical materials potentially contaminated with CJD products. COMPETENCE You must be able to: Describe the processes involved when disposing of infective microbiological waste, including that from a Containment Level 3 laboratory. Describe the autoclave cycle for sterilising materials for use in the clinical microbiology laboratory. Using a print-out from an autoclave, describe the different stages of the cycle and their significance. 156

About this document Document title: Produced by: Contact: Record of Laboratory Training for the Specialist Diploma in Medical Microbiology Microbiology Advisory Panel Executive Head of Education on education@ibms.org Version: Edition 3 Date active: September 2011 Comments: Copyright and disclaimer This document and its contents including the IBMS logo are the property and trademarks of the Institute of Biomedical Science. The copyright on this material is owned by the IBMS (unless otherwise explicitly stated). This document or no part of it may be copied, reproduced, republished, downloaded or transmitted in any way, other than for your own personal, non-commercial use. Prior written permission must be obtained from the IBMS for any other use of this material. All rights are reserved. copyright Institute of Biomedical Science 2011 About IBMS Publications The Institute publishes a wide range of professional and scientific publications and guidance. Further information and downloadable publications: www.ibms.org/publications IBMS vision and purpose. About biomedical science Biomedical science is the application of the natural sciences to the study of medicine. Although relating principally to the causes, consequences, diagnosis and treatment of human disease, biomedical science is used in other areas, such as academia, research and veterinary medicine. It has been estimated that approximately 70% of medical decisions or interventions require the knowledge and expertise of biomedical science. This may range from the results of simple blood tests, the identification of disease causing organisms, the monitoring of chronic conditions (for example diabetes), through to more complex situations such as interpreting and reporting abnormal cervical cytology. Those who practice biomedical science must be competent and professional because lives may depend upon their knowledge and skills.

IBMS vision The Institute of Biomedical Science (IBMS) is the professional body for those who work within the field of biomedical science. Its principal aims are to represent its members, set standards of behaviour for its members, enable career development, educate its members, promote biomedical science to the public and award qualifications appropriate to the collective knowledge and skill base of its members. The Institute was founded in 1912 and represents over 19,000 members employed predominately within the healthcare arena, but also within university and veterinary laboratories, government agencies and other services. Other members also work in related commercial fields and academia. Although most Institute members live and work in the United Kingdom and the Republic of Ireland, many other members are employed throughout the world. IBMS roles To aid and support the development of biomedical science, both nationally and internationally. Develop professional standards to guide those who practice biomedical science and to ensure patient safety. Assess competence to practise as Health Professions Council (HPC) registered biomedical scientists. Represent the interests of biomedical science, provide advice and work with UK governments, public & independent healthcare providers, media, universities, industry and commercial sector, professional organisations and all other partners. Provide professional support and benefits for members. Develop qualifications, training and diplomas for members to demonstrate levels of expertise and competency along a career pathway. To enable members to achieve their highest potential via continuing professional development and other professional activities. Inform and guide biomedical scientists through media, professional and scientific publications, meetings and events. Promote public awareness of biomedical science. Award the designation of Chartered Scientist to qualifying members. Fund research and support charitable causes in biomedical science. Maintain a historical archive of the Institute and biomedical science profession.

Contact details Institute of Biomedical Science 12 Coldbath Square London EC1R 5HL United Kingdom T: + 44 (0)20 7713 0214 F: + 44 (0)20 7837 9658 E: mail@ibms.org Facebook: www.facebook.com/biomedicalscience Twitter: twitter.com/biomedscience The Institute of Biomedical Science is a company limited by guarantee registered in England, No 377268, and a registered charity, No 261926 Institute of Biomedical Science.