Research articles

By Dr. Sekaran Senthilkumaran , Dr. Arokiyasamy Synthia , Dr. Arumugam Sundhararajan
Corresponding Author Dr. Sekaran Senthilkumaran
Biochemistry,Chennai medical college,Trichirappalli,Tamilnadu,India, DBlock ,L2Shankar abodes,Kumbakonam salai,Thiruvanaikkoil, - India 620005
Submitting Author Dr. Senthil Kumaran
Other Authors Dr. Arokiyasamy Synthia
Department Biochemistry,Chennai medical college Hospital & Research Centre (SRM Group), Trichirappalli,Tamilnadu,India, - India 621105

Dr. Arumugam Sundhararajan
Department Biochemistry,Chennai medical college Hospital & Research Centre (SRM Group), Trichirappalli,Tamilnadu,India, - India 621105


External Quality Assurance, Pre test, Post test, NABL, Technicians, Interpretation

Senthilkumaran S, Synthia A, Sundhararajan A. A study on Awareness and knowledge about external quality assurance among clinical Biochemistry laboratory technicians in a tertiary care hospital. WebmedCentral CLINICAL BIOCHEMISTRY 2014;5(9):WMC004702
doi: 10.9754/journal.wmc.2014.004702

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 24 Sep 2014 04:52:50 AM GMT
Published on: 25 Sep 2014 05:13:59 AM GMT


The clinical laboratory technicians should acquire basic knowledge on analysis and interpretations in external quality assurance for improving the quality of reports. The present study is designed to assess the knowledge and interpretation skills on external quality assurance programme laboratory technicians. The training programme was conducted to 10 clinical biochemistry laboratory technicians.  The study involves pre test on external quality assurance by standard questionnaires, followed by lecture sessions on external quality assurance. A post test was conducted following the lecture and the pre/post test performance was analyzed.  The results shows there was a significant (p< 0.001) increases in the score of the marks among the technicians in post test (13.6±1.2) compared to pre test (5.9±1.7). The present study reflects the suboptimol knowledge on external quality assurance among technicians and recommends enriching the laboratory knowledge for technicians to enhance quality of reports.


In today’s evidence based medicine practice the role of laboratory results is vital for screening, diagnosis and prognosis of the diseases. It is obligatory for laboratory personnel   to issue quality reports. The clinical laboratory technical staffs should have the commitment and passion towards updating the knowledge. At the same time there should be available scientific grounds in all the ways of acquiring and updating a sound knowledge on laboratory practices. Quality system practice in the laboratory can be achieved based on good internal quality control and external quality assurance. External  quality assurance is a system in which the lab performance is assessed periodically  and retrospectively by an independent outside agency to indicate to the laboratory and staff  where there may be shortcomings and hence indicates a need for improving and/or changing the Internal quality control procedures [1-2].

The  basic  knowledge of analysis and interpretation about external quality assurance reports  is quiet essential for clinical laboratory technicians. The resource materials for uplifting their knowledge about  external quality assurance is very limited. It was found that there was a deficiency in learning about the external quality assurance at the curriculum of undergraduate laboratory training courses itself [3]. The practice of external quality assurance will be more accountable if the laboratory technicians following the proceedings have a basic scientific knowledge about proceedings. With this background the present study aims at assessing the basic knowledge and interpretation skill about the external  quality assurance among laboratory technicians and conduct training on the basics of external quality  assurance.


The study was conducted at Chennai medical college hospital and research centre Trichy. Ten laboratory technicians working in the Department of clinical biochemistry were chosen, a pre test was conducted based on the standard questionnaire. Standard questionnaires were prepared based on  definition, terminologies, analysis, interpretations, trouble  shooting, methodology on external  quality assurance programme conducted by Association of clinical biochemist of India, Christian medical college Vellore. The pretest performance was assessed followed by a training programme on external quality assurance. The programme was conducted by clinical Biochemists from the Department of Biochemistry. Following the training a post test was conducted. The data of pretest and post test performance was analyzed using SPSS 19.0 software version.

The questionnaire is as follows,

1. What is EQA?
2. What is the monthly last late for sending EQA’s result to the regional centre (CMC vellore)?
3. How will you reconstitute the external Quality Control sample?
4. How long the QC sample stored after reconstitution?
5. What  is  VIS ?
6. What is  OMVIS ?
7. What is  CV ?
8. What is  SDI ?
9. What is your interpretation if the OMVIS result for external quality assurance of our lab was 65 for the previous month?
10. How will you interpret and proceed if VIS for creatinine is 229 for the previous month.


From the results figure 1 shows there was a significant (p< .001) increases in the score of the marks of the laboratory technicians in post test (mean 13.6 ±1.2) when compared to pre test (mean 5.9±1.7). There is a significant increase (p< 0.5) was observed in the performance of each individual in the post test when compared to the pretest shown in figure 2. This shows there was a lapse in  basic knowledge of external quality assurance among clinical biochemistry laboratory technicians and  training programme has improve their knowledge about external quality assurance.


Good laboratory practice involves adequately equipping and updating the basic knowledge of technicians [4]. The laboratory technicians are responsible to learn about the laboratory procedures with sound knowledge about the basics and the ability to troubleshoot the issue arising on daily laboratory practice. It is also the duty of chief of the laboratory services and quality managers to update and implement teaching component to the laboratory technicians as an integral part of the laboratory practices [5].

The present study analyses the knowledge of terminologies, basic interpretation, and Technical aspects about the CMC external quality assurance programme. The  present study  shows that  there is lack in basic knowledge about external quality assurance among  biochemistry laboratory  technicians evidenced by the pretest score(5.9±1.7). To address the lacunae found, a training programme was conducted which imparts the knowledge about the basics of external quality assurance with special emphasis on terminologies, need, technical aspects of handling the materials and trouble shooting on outliers on external quality assurance by experts in clinical Biochemistry. Following the training post test was conducted and the results are analyzed. The mean value was found to be13.6 ±1.2. There was a significant improvement on the performance of the technicians when compared to the pretest (p value < .001)

The present study shows that the training session conducted provided scope for betterment of knowledge among the clinical laboratory technicians. The study was conducted at Chennai medical college hospital and research centre, a tertiary care centre equipped with qualified clinical biochemists. So, the technicians have the accessibility of acquiring their knowledge and skills on external quality assurance. The same holds true for those technicians working in the laboratory accredited for NABL, where continual improvement programme is an integral part of the accreditation programme [6]. But the technicians running a private laboratory set up, satellite labs lacks a common parlance for enriching their knowledge, solving their queries and enhancing the trouble shooting skills. The present study reflects the tip of the iceberg about the competency of analyzing the external quality assurance among the laboratory technicians. Further studies and metaanalysis in this aspect should be done on these settings and based on that, recommendations can be formulated, so as to conduct training sessions, targeted on larger group of technicians.

Refreshment courses, workshops, seminars for laboratory technicians about the importance and implications of external quality assurance should be encouraged [7-8]. This strategy will enrich the knowledge of the technicians and enhance issuing of quality reports.


Laboratory technicians should be uplifted in technical and academic wise to troubleshoot problems and issues in laboratory. Training on external quality assurance will enhance their knowledge and  competency skill so as to deliver quality reports.


The authors wish to thank the Management of Chennai Medical College Hospital and Research Centre (SRM Group) for the approval of the present study.

Author Contribution(s)

Dr. Senthilkumaran: Planning, Question formatting, assessment and teaching the technicians 

Dr. Synthia: Execution of the present study

Dr. Sundhararajan: Stastic and Logistic support 


1. Kanagasabapathy S, Swaminathan S, Selvakumar R. Quality control in clinical biochemistry. 1996; 11(1): 17-25 

2. Geethanjalai S, Fleming J, Swaminathan S, and Selvakumar R. External quality assurance—Role of ACBI/CMC scheme. Indian Jr. Clin. Biochemistry. 2006; 21(1): 211–212. 

3. Azhar K, Mumtaz A, Ibrahim M et al. Knowledge, Attitude and Practice of Quality Assurance Among Medical  Laboratory Technologists Working in Laboratories of Lahore. Quality Assurance Among MLTs. Physicians Academy February 2012; 6 (2) 

4. Lewis SM. Quality control: good laboratory practice—an overview of quality assurance. Available at

5. Plebani M. The clinical importance of laboratory reasoning. Clin Chim Acta. 1999; 280(1-2):35-45. 

6. Plebani M. Charting the course of medical laboratories in a changing environment. Clin Chim Acta. 2002; 319(2):87-100.

7. Tan KB, Thamboo TP, Lim YC. Continuing education for pathology laboratory technologists: a needs analysis in a Singapore teaching hospital. Clin. Path. 2007; 60:1273-6.

8. Zinder O. Educating a new generation of clinical laboratory scientists. Clinica Chimica Acta. 2002; 319:149–53.

Source(s) of Funding


Competing Interests


0 reviews posted so far

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)