Evaluation of the Knowledge Levels of Medical Interns at Suleyman Demirel University Faculty of Medicine Regarding the Pre-Analytical Phase of the Laboratory and Rational Test Ordering

Öz

Objective Since the majority of errors in the medical laboratory testing process occur in the pre-analytical phase and unnecessary test ordering adversely affects patient safety and healthcare system costs, this study aimed to assess the knowledge and awareness levels of sixth-year medical students (medical interns) regard- ing the laboratory pre-analytical phase and rational test ordering, and to contribute to the development of pre-internship training programs based on the findings. Material and Method This cross-sectional survey study included 167 med- ical interns from the 2024–2025 (n = 57) and 2025– 2026 (n = 110) academic years. Data were collected using an online questionnaire. Descriptive statistics are expressed as frequencies, percentages, and mean ± standard deviation. Pearson’s chi-square test was used to compare categorical variables between cohorts. Total pre-analytical knowledge scores and total rational test ordering scores were calculated by summing the correct responses to the relevant items. Statistical significance was set at p < 0.05. Results No statistically significant differences were observed between the 2024–2025 and 2025–2026 cohorts across all knowledge domains (Cramer’s V: 0.01– 0.05). Although nearly all participants reported phle- botomy experience, formal education about pre-an- alytical processes and rational laboratory use was limited, and awareness of national policies was low. Significant deficiencies were identified for technical pre-analytical topics, including order of draw, diur- nal variation, tube handling, and coagulation sample analysis time limits. Knowledge of minimum test rep- etition intervals was generally insufficient, with higher accuracy for HbA1c and lower accuracy for common- ly requested tests such as AST, ALT, TSH, and CRP. Overall knowledge scores indicated low competency, with no differences between cohorts. Conclusion Practical experience alone does not ensure standard- ized knowledge. Structured, compulsory, and sce- nario-based training focused on pre-analytical quality management and evidence-based test repeat inter- vals should be integrated into internship education to improve patient safety and resource utilization.

Anahtar Kelimeler

• Laboratory
• Medical interns
• Pre-analyti- cal phase
• Rational test ordering

Destekleyen Kurum

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for- profit sectors.

Etik Beyan

Ethical approval for this study was obtained from the Suleyman Demirel University Health Sciences Ethics Committee (meeting no:105, decision no:8, approval date: November 3, 2025).

Kaynakça

1. 1. Plebani M. Errors in clinical laboratories or errors in labora- tory medicine? Clinical Chemistry and Laboratory Medicine. 2006;44(6):750-9.
2. 2. Carraro P, Plebani M. Errors in a stat laboratory: types and frequ- encies 10 years later. Clinical Chemistry. 2007;53:1338-42.
3. 3. Lippi G. Unveiling the hidden clinical and economic impact of pre-analytical errors. Turk J Biochem. 2025;50(3):331-8.
4. 4. T.C. Sağlık Bakanlığı. Akılcı laboratuvar kullanımı projesi – akılcı test istemi uygulaması [Internet]. Ankara: T.C. Sağlık Ba- kanlığı; 2024 [cited 2026 Mar 5]. Available from: https://shgm. saglik.gov.tr
5. 5. T.C. Sağlık Bakanlığı. Tıbbi Biyokimya Toplam Test Süreci Reh- beri. Ankara: Sağlık Hizmetleri Genel Müdürlüğü; 2024.
6. 6. Smith BR, Aguero-Rosenfeld M, Anastasi J, et al. Educating medical students in laboratory medicine: a proposed curricu- lum. Am J Clin Pathol. 2010;133(4):533-42
7. 7. Ponnusamy G, Karpaghavalli VG. Basic Laboratory Training Program: A Tool to Reduce Laboratory Errors and Improve Pa- tient Safety. Indian J Med Biochem. 2025;29(2):59–63
8. 8. Yang Y, Tian J, Chen B, et al. Knowledge and attitudes toward clinical laboratory medicine among undergraduate medi- cal interns in China: a cross-sectional survey. Front Med. 2025;12:1671631

9. 9. Dukic L, Jokic A, Kules J, et al. The knowledge and understan- ding of pre-analytical phase among biomedicine students at the University of Zagreb. Biochem Med (Zagreb). 2016;26(1):90-7
10. 10. Smith BR, Kamoun M, Hickner J. Laboratory medicine educa- tion at U.S. medical schools: a 2014 status report. Acad Med. 2016;91(1):107-12.
11. 11. Gardiner FW. Medical stewardship: Pathology evidence-based ordering to reduce inappropriate test ordering in a teaching hospital. J Hosp Adm. 2016;5(1):74-80
12. 12. Küçük A. Türkiye’de kamu hastanelerinde laboratuvar testlerinin kullanımı ve gider analizi. Turk J Clin Lab. 2021;12(3):315-23
13. 13. Arslan FD, Karakoyun I, Isbilen Basok B, et al. The effects of education and training given to phlebotomists for reducing pre-analytical errors. J Med Biochem. 2018;37(2):172-80.
14. 14. Jafri L, Abid MA, Rehman J, et al. Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique. PLoS ONE. 2022;17(4):e0264447.
15. 15. Kılıç E, Tetik BK, Kurt O. Evaluation of Doctors’ Knowledge of Rational Laboratory Use, a Descriptive Study from Turkey. Ko- nuralp Medical Journal. 2021;13(3):614-20.
16. 16. Fidan Y, Öztürk YE, Ayan U, et al. Akılcı laboratuvar kullanı- mı açısından gereksiz tetkik istemlerinin retrospektif analizi: seroloji laboratuvarı örneği. İşletme Bilimi Dergisi (JOBS). 2020;8(2):283-305.
17. 17. Stonys R, Vitkus D. Assessing Non-Laboratory Healthcare Pro- fessionals’ Attitude towards the Importance of Patient Prepara- tion for Laboratory Tests. Healthcare. 2024;12(10):989.
18. 18. Milutinović D, Andrijević I, Ličina M, Andrijević L. Confidence level in venipuncture and knowledge on causes of in vitro he- molysis among healthcare professionals. Biochem Med (Zag- reb). 2015;25(3):401-9.
19. 19. Giavarina D, Lippi G. Blood venous sample collection: Recom- mendations overview and a checklist to improve quality. Clin Biochem. 2017;50(10-11):568-73.
20. 20. Christian RJ, Baccon J, Knollmann-Ritschel B, et al. The Need for Laboratory Medicine in the Undergraduate Medical Educa- tion Curriculum: A White Paper from the Association of Patho- logy Chairs. Med Sci Educ. 2024;34:193-200.
21. 21. Laposata M. Insufficient teaching of laboratory medicine in US medical schools. Acad Pathol. 2016;3:1-2.
22. 22. Guidi GS, Lippi G. Undergraduate education in laboratory me- dicine: a critical review. Clin Chim Acta. 2008;393(1):9-12.