The scenarios in a pathology selection interview are about the moments when the laboratory's work meets patient safety: the result that must reach a clinician now, the specimen that may be the wrong patient's, the report that went out wrong and may have changed a treatment. Panels use them because they test the things a pathology registrar must do from the first week. This guide covers each and the structure that scores.
The critical result
A full blood count shows a white cell count of 150 with blasts. A potassium of 7.5 comes through on a sample. A blood culture grows a gram negative organism at 2 am.
The structure: recognise the result as critical against the laboratory's critical results list. Consider whether it is real: for the potassium, haemolysis, the sample type, the time to separation, a repeat if there is doubt, but without delaying the call if the clinical picture fits. Phone the treating clinician directly, not a message or a report left to be read. State the result plainly, give a recommendation where the laboratory has one (for the blood culture, the organism, the likely sensitivities and the antibiotic implications), and read back. Document the call: who, when, what was said. Escalate to the pathologist for the leukaemia and for any result where the clinician cannot be reached or the laboratory's recommendation is complex. For the 2 am blood culture, know the laboratory's after hours process and that the call is made regardless of the hour.
The probe: the clinician cannot be reached; the ward says the patient has gone home; the result is from a general practice. Each has an answer: escalate up the clinical chain, contact the patient through the practice or the after hours service, and know that the laboratory's responsibility is to make sure the result reaches someone who can act.
The mislabelled specimen
A specimen has been mislabelled and two patients may be affected. Stop and do not issue either result. Identify what is known: the samples, the labels, the collection times, the collectors. Follow the laboratory's procedure for specimen identification failures, which usually means rejecting the sample and requesting recollection rather than guessing. Tell the clinicians of both patients what has happened and what is needed. Report the incident. Say that you would not try to work out which sample was whose from the results, because that is how wrong results get issued.
The probe: one of the samples was a crossmatch. The answer is that transfusion samples are never accepted with any labelling doubt, and the blood bank's rules are absolute.
The report that went out wrong
You notice that a colleague's reporting error has gone out and may have changed a patient's treatment. The patient first: find out whether treatment has been affected and tell the treating clinician now. Tell the pathologist and the colleague, without blame. Issue an amended report. Open disclosure to the patient through the treating team. The incident report and the review, which looks at the system rather than the person. Say what you would do if the colleague asked you not to raise it, and that the answer is that patient safety requires it.
The biopsy with an unexpected malignancy
The pathologist reviews it, the report is clear about the diagnosis and its urgency, the clinician is contacted directly so the patient is not left waiting for a routine appointment, and the result is flagged in the system. Say that the patient is told by their treating clinician, not by the laboratory, and that the laboratory's job is to make sure the clinician knows fast.
The transfusion reaction
The laboratory's role: stop the transfusion is the ward's job, but the laboratory investigates. The samples, the checks on the unit and the patient, the serological investigation, the report to the transfusion service and the haemovigilance system, and the pathologist's involvement. Say that the laboratory's findings go back to the ward quickly because the patient may need more blood.
The test added without consent
A clinician asks you to add a test to a sample without the patient's consent. Most added tests are routine and covered by the original consent for investigation; some, such as genetic tests and HIV, are not. Know the difference, ask what the test is, and decline the ones that need specific consent until it is obtained. Say that you would explain why to the clinician.
What the panels score
Recognition of what is critical, a safe approach to doubtful results, direct and documented communication, refusal to guess with specimens, honesty about errors through the right process, and knowledge of the laboratory's procedures. The common failures are leaving a critical result in the system, working out a mislabelled specimen from the results, and keeping an error quiet.
Preparing
Learn a laboratory's critical results policy, specimen rejection criteria and incident process. Talk each scenario through aloud with the probes. The structure is consistent and the panel is listening for it.