Clinical Biochemistry/ Clinical Biochemist
- What is a Clinical Biochemist - at a glance..
- Clinical Biochemistry
- Clinical Biochemistry Departments
- Becoming a Clinical Biochemist in the Republic of Ireland
- In- service Training
- Career Pathway
- HSE Eligibility Criteria Links
What is a Clinical Biochemist?The post of biochemist has a long standing place in the Irish healthcare system, commencing in the late 1940’s and early 1950s. The Fitzgerald report (1968) identified a deficiency of scientific knowledge within the hospital pathology diagnostic services and recommended the urgent establishment of a new career structure for hospital biochemists. Since that time the role of Clinical Biochemists has evolved in their contribution to the delivery of clinical biochemistry and diagnostic endocrinology services throughout Ireland. In broad terms the contribution of the biochemist may be defined through clinical, scientific, quality, management and leadership roles. For the latter, more senior members of the profession are Heads of Department and are responsible for the clinical and scientific governance and strategic direction of clinical biochemistry services in Ireland. All roles and responsibilities which define a clinical biochemist’s scope of practice are commensurate to their training, development and experience.
Clinical Biochemists contribute to service delivery through the provision of test results for diagnostic, screening, therapeutic and disease monitoring purposes. Such analyses largely involve the use of automated systems which have replaced many of the manual steps previously undertaken by scientists. This has in part evoked change in the role of the clinical biochemist. Clinical Biochemists are also involved in developing and implementing point-of-care services in many hospitals.
Beyond service provision, Clinical Biochemists play key roles in service development by applying their scientific knowledge, skills and expertise, which have seen services implemented locally and nationally. Through horizon scanning and clinical liaison Clinical Biochemists develop services with a view to meeting clinical need, currently and in the future, by introducing and developing the latest diagnostic tests to ensure optimal patient diagnosis and management in Irish clinical laboratories. In this regard, Clinical Biochemists have developed significant expertise nationally and and have embraced important technologies such as Mass Spectrometry and Next Generation Sequencing.
Clinical Biochemists undertake many clinical duties commensurate to their training which include clinical interpretation and advice to all clinical users. This includes advice and guidance on necessary further testing to support GPs in diagnoses and appropriate management as well as hospital based teams for diagnosing and monitoring complex patients. This advice is often delivered in writing, through result reports and letters as well as verbally through telephone conversations, participation at Multi-Disciplinary Team (MDT) meetings, case discussions, clinics and ward rounds. In conjunction with other healthcare professionals, this clinical liaison also increasingly involves patient contact.
Quality and Patient Safety
Clinical Biochemists are responsible for ensuring the quality of clinical biochemistry and diagnostic endocrinological investigations, fulfilling not only the requirements for laboratory accreditation (ISO15189:2012), but initiating and leading other Quality Improvements which further help to mitigate risk and ultimately help safeguard patient safety. Clinical Biochemists play key advisory roles in External Quality Assurance/Assessment programmes both nationally (e.g. Irish External Quality Assurance Scheme) and in the UK (UK National External Quality Assessment Services). Clinical Biochemists also undertake accreditation roles, working with the Irish National Accreditation Board (INAB) and the UK National Accreditation Scheme (UKAS).
Clinical Biochemists play an important role in teaching activities within hospitals and universities, to undergraduate and postgraduate (MSc, PhD) science and medical students. Clinical Biochemists are also involved in the scientific and clinical training of Clinical Biochemists including those more senior Clinical Biochemists who undertake clinical training with Fellowship examinations through the Royal College of Pathologists (FRCPath, UK). Clinical Biochemists are also involved in the training of other professions working in laboratory medicine including Medical Scientists and Pathologists.
Clinical Translational Research and Development is core to much of the above training for which clinical biochemists have led in developing research ideas and proposals, study design and submitting bids for funding. Beyond the day to day benefits of translating such research, one further output by Clinical Biochemists is the publication of such work in clinical and scientific manuscripts in peer-reviewed science and medical journals. Such work is also presented at local meetings, and at national and international conferences (poster or oral presentation).
Clinical Biochemists also provide educational input by presenting at Grand Rounds, Journal Clubs and GP liaison forums.
Through its professional body the Association of Clinical Biochemists in Ireland (ACBI), Clinical Biochemists also contribute to Continuous Professional Development (CPD), for which it has an online CPD scheme. The ACBI hosts an annual two day conference and also organises other clinical and scientific workshops for the benefit of Clinical Biochemists and its other members, some of which are co-organized and delivered in a multi-disciplinary capacity.
National and International contributions
Clinical Biochemists have key roles in national and international clinical and scientific bodies and initiatives where they are involved in providing professional and expert advice and the provision of best practice guidance, policy and procedure, for implementation nationally and beyond. Beyond those mentioned already, these include the National Cancer Control Programme (NCCP), the National Gestational Trophoblastic Disease Registry, the Irish Endocrine Society (IES), the Faculty of Pathology (RCPI) and the Royal College of Pathologists (UK). As a national society for the European Federation of Laboratory Medicine (EFLM), which represents the International Federation of Laboratory Medicine (IFCC) in Europe, the ACBI’s clinical biochemist members contributes to the EFLM’s/IFCC’S many Working Groups and publications.
Clinical BiochemistryDisease causes changes in the complex biochemistry of the body. Clinical Biochemistry is concerned with detecting these changes in blood and other body fluids thus aiding in the diagnosis of disease and monitoring of therapy. These changes can often be detected by alterations in the concentration of substances in the blood - for example, glucose increases in diabetes mellitus and diseased organs, such as the liver, can cause increased tissue enzymes levels. Some diseases, for example, cancers cause different substances to appear in the circulation. Increasingly, Clinical Biochemistry tests are been used as a means of determining which patients would benefit from and as importantly would not require more invasive procedures and/or expensive therapies.
Clinical Biochemistry DepartmentsClinical Biochemistry Departments (usually based within a hospital) are responsible for providing rapid analytical results of high quality, interpreting the significance of the data obtained and advising on whether further investigations are required. Such departments make extensive use of information technology and robotics. Tests required in large numbers (such as potassium and urea in blood) are analysed on highly sophisticated automated equipment. Other techniques used in Clinical Biochemistry include absorption spectroscopy, electrophoresis, many types of chromatography, mass spectrometry, immunoassay and DNA analytical technology. Most Departments will also carry out fundamental or applied research, and develop and investigate new analytical methods for the detection of disease. A number of sub specialties exist within the general area of Clinical Biochemistry including Paediatrics, Endocrinology, Toxicology and Molecular Biology.
Becoming a Clinical Biochemist in the Republic of IrelandThe minimum qualification requirement for becoming a Basic Grade Clinical Biochemist (as laid down by the Department of Health and Children) is a Bachelor of Science (BSc) degree in which Biochemistry was taken as a subject in the final examination or degree equivalent. In reality, in recent times, most new entrants will have attained either a MSc or PhD relevant to Clinical Biochemistry prior to their first appointment.
Clinical Biochemist posts in public and private hospitals are usually advertised on the website www.irishjobs.ie and in national newspapers. A significant number of new entrants gain experience in temporary locum positions prior to obtaining their first Clinical Biochemist post. Locum positions become available on an ad hoc basis and it is advisable to contact the HR Departments / Head of Clinical Biochemistry Departments in the various hospitals to inquire about their policy on filling locum positions.
Clinical Biochemists are one of twelve professions included in the Health and Social Care Professionals Act 2005 which provides for statutory registration of the named professions. Coru, the Health and Social Care Professionals Council was appointed in 2007. The aim of Coru is to set and enforce the standards of education, practice, performance, conduct and ethics for each of the professions. One of the first steps towards registration is the setting up of individual Registration Boards for each of the twelve designated professions. The Social Workers Registration Board was set up in August 2010 with the remaining Boards to be set up on a phased basis. Up to date information on the regulation of the Clinical Biochemist profession can be found on Coru’s website, www.coru.ie.
In- service TrainingAfter appointment, a Clinical Biochemist will spend time studying for further professional qualifications, generally a suitable career–focused MSc followed by the Fellowship of the Royal College of Pathologists, UK (FRCPath). The Association of Clinical Biochemists in Ireland (ACBI) runs regular scientific meetings, including a two day Annual Conference each October, together with specific staged tutorials to support Clinical Biochemists preparing for the FRCPath examination. During the course of their studies, Clinical Biochemists also normally attend UK National training courses (currently a rolling series of six one week courses over three years) in addition to a management issue focused course. Attainment of the FRCPath qualification requires at least five years of registered postgraduate study and indicates the individual’s competence to take independent Consultant charge of a hospital Biochemistry Department.
During their in-service training, Clinical Biochemists will gain wide-ranging experience in all aspects of the provision of a Clinical Biochemistry service. They must become competent in the practice and understanding of a wide range of analytical techniques and in the practice of quality assurance including external quality assessment. During their training, they will also become skilled in the interpretation of test results and actively participate in liaison with clinical colleagues in providing advice on further relevant analysis. In addition, as a Clinical Biochemist progresses in their career, there is the opportunity to specialise in one of the many sub specialties and to engage actively in research projects either initiated within the laboratory or in collaboration with clinical colleagues.
Career PathwayThere are four grades of Clinical Biochemist posts within the hospital career structure: Basic, Senior, Principal and Consultant.
The minimum qualification requirements currently laid down by the Department of Health and Children for progression beyond Basic Grade are as follows:
Senior Clinical Biochemist
BSc degree in which Biochemistry was taken as a subject in the final examination, or equivalent PLUS at least three years satisfactory experience in clinical biochemistry and/or chemical pathology in the laboratory of a hospital or allied institution.
Principal Clinical Biochemist
As specified for Senior Grade PLUS an MSc in Biochemistry or Clinical Biochemistry, PLUS at least five years satisfactory experience in clinical biochemistry and/or chemical pathology in the laboratory of a hospital or allied institution.
Consultant Clinical Biochemist
A PhD in Biochemistry or FRCPath examination in Clinical Biochemistry, or a qualification in clinical biochemistry equivalent to either of these, PLUS at least eight years post graduate experience including not less than five years in Clinical Biochemistry.
>> See HSE Consultant Applications here