Clinical Biochemistry Post-Doctoral Residency Program

The Post-Doctoral Clinical Biochemistry Training Program in Manitoba was established in 1977, with the objective of training individuals at the postgraduate medicine level in the field of clinical biochemistry, leading to eligibility to apply for certification by the Canadian Academy of Clinical Biochemists (CACB).

This program includes practical and professional training in all aspects of laboratory medicine, providing residents with the skills necessary to practice as clinical biochemists and independently direct a clinical biochemistry laboratory.

The program is structured around a series of hospital-based rotations. Residents meet regularly with their clinical biochemist mentor to discuss progress. The self-directed learning environment is designed to foster the skills needed to become lifelong learners.

Clinical biochemists are responsible for leading change in the laboratory as science and technology evolve. The profession requires individuals who can self-direct and self-assess their own learning in order to drive and implement change in modern clinical laboratories.

Residents are evaluated through direct observation and oral examinations.

Salaries, benefits, and other entitlements are governed by a comprehensive collective agreement between the Professional Association of Residents and Interns of Manitoba (PARIM) and the Winnipeg Regional Health Authority (WRHA). Additional information about benefits can be found on the PARIM website.

Remuneration for residents in the Postgraduate Medical Education program at the University of Manitoba is negotiated by PARIM. Starting salaries for residents in Clinical Chemistry begin at the postgraduate year 2 (PGY-2) level and are equivalent to those of medical residents.

Annual salaries as of July 1, 2023:

• PGY-2: $69,370
• PGY-3: $74,410
• PGY-4: $80,134

The first year of the program is intended to provide the resident with an overview of Clinical Chemistry laboratory operations and a general understanding of human disease. 

By the end of the fist year, residents are expected to demonstrate knowledge (principle, operation, trouble-shooting) of common laboratory instrumentation, routine testing and essential procedures in clinical laboratory. 

Residents expected to participate in quality improvement, analytical or clinical method evaluation projects. Rotations may include (subject to change):

Laboratory operations and processes

Central laboratory processes - comparison of processes across laboratories of differing size and function and hands-on experience - sample labelling and receipt, patient registration, test accessioning, requisitions, referred-in, referred-out, laboratory information systems, test information manuals, lab reports, pre-analytical and post analytical errors, laboratory safety, phlebotomy.

Automated chemistry

Comparison of processes at hospital labs of differing size and hands-on experience: instrumentation (operation, maintenance, troubleshooting), workflow, quality practices, test methodologies & their benefits and limitations, critical results, auto-verification, method protocols, accreditation requirements, specimen archiving, urinalysis, clinical utility of tests.

Method evaluation, laboratory statistics and quality management

Analytical and clinical evaluation of laboratory tests, requirements for method validation and verification, data analysis and statistical techniques, concepts of total quality management in clinical laboratory including quality control practices, quality assurance and improvement.

Hematology and immunology

Investigation of hemoglobinopathies, plasma cell dyscrasias, and other autoimmune diseases. In-depth look at electrophoretic and immunofluorescence methods, along with flow cytometry and routine complete blood counts.

Therapeutic drug monitoring (TDM)

Concepts of pharmacokinetics, indication and clinical utility of TDM, common classes of drugs, overview of preanalytical, analytical and postanalytical considerations.

Pathology

Specimen collection and handling of autopsy samples. Forensic cases will be reviewed from autopsy to the toxicology lab. Immunohistochemistry of common malignancies and inflammatory conditions. Concepts of cancer screening programs (e.g. HPV for cervical cancer) and fine needle aspiration (FNA) biopsy.

The second and third years of the program largely involve clinical rotations and external laboratory rotations that are intended to provide the resident with a comprehensive understanding of clinical disorders related to the field of clinical chemistry and the utilization of laboratory test results in the clinical management of the patient.

Upon completion of these rotations, the resident will have covered all topics outlined in the CACB syllabus for a postgraduate training program in clinical biochemistry and be prepared to direct a small-medium size clinical laboratory.

The trainee is expected to identify cases of interest during these rotations and link them to laboratory testing. Regular presentations of these cases are an expectation.

The coordinator (a clinical chemist or a clinical colleague) for each clinical rotation identifies specific objectives in addition to the objectives outlined in the syllabus, and arranges with clinical staff, wards or clinics to provide exposure to their particular areas.

During these rotations, the resident will become familiar with clinical aspects of disease diagnosis and management along the related utilization of the laboratory. Scheduled clinical rotations include, but are not limited to:

• Cardiology
• Emergency medicine
• Endocrinology
• Gastroenterology
• Genetics and metabolism
• Hematology–Oncology and hemostasis
• Immunology
• Infectious diseases and microbiology
• Intensive care medicine
• Nephrology (including dialysis and transplant units)
• Obstetrics and gynecology
• Pediatric medicine
• Pharmacy (family medicine and intensive care)

In addition to clinical rotations, resident will complete advanced laboratory rotations, such as:

Blood gases, urinalysis and point-of-care testing

Methodology, clinical utility and interpretation, quality considerations, preanalytical, analytical and postanalytical factors, benefits and risks of out-of-lab testing, accreditation requirements.

Special chemistry and toxicology

Allergy testing, hemoglobinopathy investigation, biogenic amine quantitation, cholinesterase phenotyping, thiopurine methyltransferase (TPMT) phenotyping, porphyria investigation, trace element testing, calculi analysis, fluid testing. Instrumental and analytical aspects of clinical, medical, and forensic toxicology. Management and treatment of poisoned patients. Roles of poison-control center, RCMP laboratory, therapeutic drug monitoring.

Molecular and genomics laboratories

Molecular techniques, genetic diseases, and Non-Invasive Prenatal Testing (NIPT). Time will be spent at the CancerCare Manitoba Next Generation Sequencing laboratory (Health Sciences Centre campus).

Biochemical genetics laboratory and newborn screening

Overview of inborn errors of metabolism and role of newborn screening, biochemical testing and interpretation. Time will be spent at Cadham Provincial laboratory (perinatal chemistry section).