Education and Training in Analytical Quality Management, Part III: Basic QC Training
Over the years, the practice of quality control has been corrupted (all those repeat runs, widening control limits, and even worse). It's time to get back to the basics. To that end, using all the technology of the late 20th and early 21st century, Dr. Westgard introduced a Basic QC Practices training course available online, on CD, and in one of those "old-fashioned" books. (If you ask nicely, he'll probably do it in person at your next conference, too.)
- The "Corruption" of QC
- A new Basic QC Practices training program
- Internet course
- CD course
- Hardcopy course
- Many thanks to others
In considering how to improve quality control and develop the next generation QC system, parties sometimes express a desire to perform QC in a completely different way. They want to do away with the statistical QC, do away with the old QC charts, do away with the standard control rules, do away with multirule QC. While I believe that improvements are necessary, I'm of the opinion that the next generation QC system should be built on statistical QC and be an evolution of this practice, rather than revolution that starts over.
There are certain fundamental techniques that are basic to analytical measurements. Standardization of measurements is one of them; statistical QC is another. These fundamental techniques will never go away. However, they may be performed less frequently as the stability of the measurement system improves.
My perspective is that we need to focus on performing the "old" QC in the right way. That will be the easiest way to actually make progress in the art of QC!
Here's a simple illustration of a difficulty with our current practices that may be the cause of much of the frustration in laboratories today. Many laboratories still use 2 SD control limits. Because of this, they often automatically repeat the controls when QC shows the method is "out-of-control." This action is rationalized because we all know there are false rejections when 2 SD control limits are used. Even when other control limits with lower false rejections are used, we often continue the practice of repeating the controls. In short, our current QC practice is corrupted because of the false rejection problem. Everything we do is colored by the expectation that a rejection doesn't really indicate a problem
While we all have sympathy for getting rid of corruption, the practical solution is to be more selective in the statistical QC procedures that are implemented to be sure that false rejections have been minimized. What's the chance of eliminating false rejections in a completely new QC system whose principles and performance characteristics are not yet understood. Wouldn't it be better to deal with the corruption we already know about and solve the problem that limits current performance?
That's the reason we introduced a new training program for Basic QC Practices. We think that the best way to improve a laboratory's QC is to perform statistical QC properly.
In addition, this new training program provides a good example of the use of Internet training technology that will be advantageous in the future. It provides a practical illustration of the approach discussed in part I (developing a lesson-base) and part II (developing Internet courses) in this series on education and training. The basic QC training takes advantage of our existing lesson-base and makes those materials available in three different formats - an Internet course, a CD version of the course, and a hardcopy manual.
The online version of Basic QC Practices was introduced by the American Society for Clinical Laboratory Science at their 1998 national meeting in Chicago. The course was approved for 15 P.A.C.E. credits, which will satisfy the yearly continuing education requirement in several states. The Internet version has a number of features which are advantageous: color graphics to make it easier to explain and describe control rules and data interpretation; online calculators to assist with calculations of the mean, SD, CV, monthly control limits, and cumulative control limits; links that allow you to move back and forth in the material, as well as access a glossary of terms at any time without losing your place; an ongoing discussion forum for interaction with other participants and with the course instructor; and the latest up-to-date materials that include ongoing improvements and changes to the course. For further information, see the presentation at the 1998 ASCLS meeting in Chicago.
The CD version of the course provides the same course to participants who do not have good access to the Internet. A computer with a CD drive is required. The user then installs a web-browser which is contained on the CD. The browser is directed to the CD drive to access materials, rather than the internet. The course functions essentially like the online course, except that links to external websites are inactive and there is no online discussion forum.
The book version provides the same course materials, with minor editing to remove the links and circular references to other web-materials. See the Book Description Page for a list of materials. The manual retains both the lesson structure of the course and the informality of the web-materials, which may be an advantage over traditional texts. The lesson plans add some direction and structure to the learning process. The informality allows use of non-scientific stories and analogies which are often very helpful in making a point, without the required scholarly tone of a textbook. The appendix also provides introductory materials to support QC planning, e.g., tabulation of CLIA proficiency testing criteria for acceptability, discussion of OPSpecs charts, normalized OPSpecs charts for Ns of 2 and 4, and a description of Total QC strategies.
This Basic QC Practices course illustrates some of the possibilities with the new training technology that focuses on the Internet as the primary medium. We started this project about in mid-1997 and finished in mid-1998. In one year, we prepared training materials for the Internet and converted them into CD and hardcopy formats. These three formats make this training available to virtually everyone in healthcare laboratories today.
The development of Basic QC Practices was accomplished in the relatively short time and with the limited resources of a few people. I'm extremely proud of this accomplishment.
There are many people to thank, but foremost is my son Sten who has championed the web development and managed the publication of these materials. Trish Barry and Elsa Quam have added the practicality to the theory and made this course user friendly. Sharon Ehrmeyer and Bernie Statland who have contributed essential materals to the course.
ASCLS has been very supportive in the development of this course, particularly Elissa Passiment, Karen Karni, and Kathy Waller.
Many others have reviewed some of the materials on the WQC website and provided valuable feedback.