Addressing Student Confidence in Clinical Laboratory Practice and Communications: A Simulation-Based Approach

Shawn W. Luby; Kristine Barnette

doi:10.29074/ascls.2025003305

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Figure 1.
Preanalytical processes: evaluating clinical confidence pre- and postsimulation. Survey questions are shown on the y-axis. Mean values for presimulation (n = 21) are shown in blue, and the postsimulation (n = 20) survey results are in green. Mann–Whitney U-derived P values included on y-axis. CIs: (1) not confident at all, (2) slightly confident; (3) somewhat confident; (4) confident; and (5) very confident.
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Figure 2.
Analytical processes: evaluating clinical confidence pre- and postsimulation. Survey questions are shown on the y-axis. Mean values for presimulation (n = 21) are shown in blue, and the postsimulation (n = 20) survey results in green. Mann–Whitney U-derived P values included on y-axis. CIs: (1) not confident at all, (2) slightly confident, (3) somewhat confident, (4) confident, (5) very confident.
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Figure 3.
Post-analytical Processes: Evaluating Clinical Confidence Pre- and Post-simulation. Survey questions are shown on the y axis. Mean values for pre-simulation (n = 21) are shown in blue and the post-simulation (n = 20) survey results in green. Mann-Whitney U derived p values included on y axis. Confidence Intervals: (1) Not confident at all (2) Slightly confident (3) Somewhat confident (4) Confident (5) Very Confident.

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Table 1.

Learning objectives for Designing and Operating a Clinical Laboratory

#	Learning Objective	Learning Domain (Blooms)
1.	Identify and implement strategies for developing efficient laboratory workplace design.	Cognitive, psychomotor
2.	Develop an employee schedule to meet the needs of laboratory operations.	Cognitive, affective
3.	Develop and demonstrate communication skills required to perform collaborative laboratory operations.	Affective, cognitive
4.	Recognize the role of, and perform, various laboratory bench operations, including specimen processing, specimen analysis, result reporting, and specimen storage.	Psychomotor, cognitive
5.	Perform, assess, and monitor quality control analysis required for patient testing.	Psychomotor, cognitive
6.	Assess the quality and suitability of specimens based on knowledge of analyte characteristics, known interferences, and procedural information.	Cognitive, psychomotor
7.	Take appropriate action when patient specimens are unsuitable for analysis (eg, collection error, specimen interference).	Cognitive, affective, psychomotor
8.	Take appropriate action to obtain accurate results when patient values exceed linearity (eg, perform dilutions).	Cognitive, psychomotor
9.	Take appropriate action when reporting critical values (eg, communicate results to provider and document communication).	Cognitive, affective, psychomotor
10.	Monitor and respond to TAT requirements for each analyte.	Cognitive, psychomotor
11.	Use the preanalytical and postanalytical checklist to prepare for analysis and report results.	Cognitive, psychomotor

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Table 2.

Timeline of simulation activity

Day	Activity	Details
Day 1: designing a clinical laboratory	8:30 a.m. Presimulation survey	Conducted in a separate lecture classroom
	12:00 p.m. Faculty-led briefing	Introduction to laboratory design Define simulation parameters • Personnel requirements • Position descriptions • Test menu/analytical benches • Physician space
	12:30 p.m.–3:00 p.m. Designing a clinical laboratory (student led)	Determine laboratory positions • analytical bench assignments • employee schedule • laboratory layout/design Review SOPs for each bench • Identify/request required instrumentation Complete individual checklists Store documents • bench assignments/schedule, design, checklists
Day 2: operating a clinical laboratory	12:00 p.m. Faculty-led briefing	Review SOPs: specimen receipt/accessioning, handling, TATs, rejection, interference, reporting, critical values, cancellations, data/specimen storage. Distribute laboratory documents (Table 3).
	12:30 p.m.–3:00 p.m. Operating a clinical laboratory (facilitated simulation)	• Specimen processing: order review, confirm proper collection/handling, aliquots, store primary specimen, deliver aliquots to appropriate bench. • Analytical benches: manage TATs, evaluate specimen integrity, perform quality control, follow analytical and result reporting procedures. • Documentation and storage: patient orders, patient specimens, analytical worksheets, patient reports.
	3:30 p.m. Faculty-led debriefing	Group discussion on roles, responsibilities, experiences, impressions of simulation.
Day 14	8:30 a.m. Postsimulation survey	Conducted in a separate lecture classroom.

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Table 3.

Issued documents required for Designing and Operating a Clinical Laboratory

Issued	Document	Description
Day 1	SOP	Includes description of simulation, objectives, position descriptions, procedure for all simulation benches.
	Position and bench assignments worksheet	List of students and analytical benches. Bench assignments documented by student-elected supervisors.
	Day 1 checklist	Completed and submitted to supervisors by all participants.
Day 2	Patient order sheet	Patient order form (delivered during simulation with specimens).
	Specimen receipt worksheet	Specimen accession/processing document.
	Specimen rejected worksheet	Specimen accession/processing document.
	Analytical bench worksheet(s)	Separate quality control and patient worksheets for each analytical bench.
	Patient report worksheet	Patient final results worksheet for each analytical bench.

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Table 4.

Bench labels for specimen processing/specimen storage

	Label	Purpose
1.	Specimen delivery	Drop off location for incoming specimens.
2.	Urinalysis collection cup	Storage location for aliquoted urine specimens.
3.	Rejected specimens	Storage of specimens rejected for collection errors.
4.	To centrifuge	Placement of primary specimen requiring centrifugation with labeled aliquot tubes.
5.	Spun	Aliquoted specimen delivery, postcentrifugation.
6.	Completed specimens	Completed specimens with released results. Canceled specimens because of specimen integrity issues.

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Table 5.

Patient test orders, frequency, and specimen type

Order Type	Frequency	Patients	Specimen Type
Glucose (GLUC/FGLUC)	3	A, B, E	Faculty developed
Alanine aminotransferase (ALT)	3	C (redraw), D	Faculty developed
Total protein (TP)	3	A, C (redraw), D	Faculty developed
Urinalysis (UMAC)	4	A, B, D, E	Faculty developed
Hematocrit (HCT)	3	C, D, E	Deidentified patient
ABO type	3	C, D, E	Expired donor red cell/faculty-developed plasma

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Table 6.

Pre- and postsimulation survey questions

For the following questions, use the confidence scale (below) to rate your confidence level in performing the following laboratory practices: (1) not confident at all, (2) slightly confident, (3) somewhat confident, (4) confident, (5) very confident
1.	Confirming proper specimen collection (including collection time, container, and patient requirements)
2.	Identifying when to cancel a specimen due to a collection error
3.	Determining which samples require centrifugation or aliquoting
4.	Aliquoting samples for multiple benches
5.	Performing and assessing quality control results
6.	Performing analytical testing within the published turn-around-time
7.	Identifying results above AMR
8.	Performing dilutions on patient specimens
9.	Identifying samples that require cancellation for possible sample interferences (hemolysis, bilirubin, lipemia)
10.	Identifying samples issues that require a new sample to be collected before analysis
11.	Identifying a critical value
For the following questions, use the following confidence scale (below) to rate your confidence level when delivering the following laboratory communications: (1) not confident at all, (2) slightly confident, (3) somewhat confident, (4) confident, (5) very confident
1.	Notifying care team of a canceled specimen order due to a tube collection error
2.	Notifying care team of a patient sample exhibiting sample interference
3.	Notifying care team of a canceled order and request a new sample for collection/analysis
4.	Notifying care team of a critical value
Additional postsimulation survey questions
1.	This exercise increased my understanding of specimen processing
2.	This exercise increased my understanding of laboratory workflow
3.	This exercise encouraged group collaboration
4.	I enjoyed participating in this exercise
Open-ended post-simulation survey items
1.	In your opinion, what were the strengths of this exercise?
2.	In your opinion, how could this exercise be improved?

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Table 7.

Responses to open-ended questions (postsimulation)

In your opinion, what were the strengths of this exercise?
It was a great simulation that provided insight into the flow of a clinical laboratory and demonstrated how multiple tests can be performed from patient samples. I think it also gave a many of us a better appreciation of specimen processing
It was fun and let me actively learn instead of just reading or hearing about it
It was really helpful in understanding how a lab communicates and how workflow runs on a day to day basis in the lab.
Being able to simulate a lab was helpful for teaching us sample processing as well as learning communication strategies with our peers. I think it was a good simulation to have before running through clinicals at an actual lab
The ability to work as a team and go through the period of waiting for samples while simultaneously running quality control helped to better prepare us for the real lab setting.
Number of assays and stats along with group work
This exercise was a really great example of work flow and how different benches work together in the lab.
It was too short
Allows for us to work together toward a common result
Engaging and fun
It included very real factors of working in a clinical lab like having to work with people in various roles, having to communicate information to providers, evaluating samples and analyzing them within a given time.
Well organized, really fun, mimicked a real lab very nicely.
Team work and the procedures used to execute each test
I thought this exercise was AWESOME! I had so much fun getting to work with my peers in a professional sense, and really enjoyed the experience!
In your opinion, how could this exercise be improved?
I think it would be a neat idea to have a couple of people be able to “work” as generalists and be able to bounce between benches if need be. I think that would limit how many people are idle at a given moment and would add another level of complexity and appreciation
A few more pts for the tests that take less time so one group doesn’t feel like everyone is waiting on them
I feel like I didn’t get to see as much of the specimen processing side as I would’ve hoped for. If I were to redo it, I think the specimen processing bench would be most beneficial for learning purposes.
It would be nice to have a back button on here, I think I missed a question because I got confused. Other than that, everything seemed very well organized. It would have been helpful to have some sort of sheet for keeping track of turn around times as a supervisor though.
Maybe more spread out samples/more samples for groups with quicker tests. The ALT took a bit longer, but other groups finished quite quickly. It may be beneficial to add a few more tests/patients (if possible of course) to each bench for the exercise.
Adding more samples for some benches so that everyone isn’t waiting on one bench to be done and all finish around the same time.
Get rid of ALT
More samples with problems such as hemolysis or critical values
Too much downtime after completing assays
Include more samples for benches whose tests run faster and less for the ALT bench. Maybe allow students to cycle through different roles so everyone can experience specimen processing or being a lead MLS.
More samples
If a shorter assay could replace ALT, I think that would help with down time throughout other benches.

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Table 8.

Participant evaluation of simulation experience

	Statement	Neutral (%)	Agree (%)	Strongly Agree (%)
1.	This exercise increased my understanding of specimen processing.	0	45	55
2.	This exercise increased my understanding of laboratory workflow.	0	35	65
3.	This exercise encouraged group collaboration.	5	10	85
4.	I enjoyed participating in this exercise.	0	20	80