Introduction: The serum protein profile remains a very useful test to diagnose, track, monitor and evaluate several inflammatory, nutritional and immune diseases.So his prescription is still limited.the recommandations of good practices in biology Exigences. Depending on our situation, this examination is moderately prescribed by doctors. The objective of this study is to evaluate the prerequisites of internal doctors and residents in pediatric serum protein profile. Method : a descriptive, quantitative and cross-sectional study. The questionnaire consisted of 20 questions, with 4 closed questions, 12 multiple choice questions and 4 closed-ended questions for 59 physicians. This questionnaire assesses the knowledge of residentand internal physicians and their need for trainingon the pediatric serum proteinprofile and their expectations for the servicesof the biochemistry laboratory. Results of the study: The results led to a lack of training in pediatric serum protein profile. Only 3.7% of internal doctors and pediatric residents who received training in this area. 63% of doctors do not consider themselves competent to know the relevanceof the prescription of the targeted proteinprofile. Only 9.3% ensure that the satisfaction of the biochemistry laboratory's performance of the biological council is rather satisfied. Conclusion: Pediatric serum protein profile training has been shown to be very fundamental for all prescribing pediatric doctors in order to reinforce the gains for a highly relevant prescription whose purpose is to accelerate and improve diagnosis.

The knowledgeacquired by physicians in specialty on serum protein profiles is based on the fundamental science of clinical biochemistry, gradually incorporating medicalknowledge. Teachingis based on a spiral methodreinforced with each cycle of acquired knowledge. The objective of this teaching is to acquire clinical and scientific skills that encourage the usefulness and relevance of prescribing serum protein profile testing in different clinical cases. According to the High Health Authority (HAS), the

serum proteinprofile is a frontline test that can identify a monoclonal immunoglobulin. This test is prescribed for various pathologies at the discretion of the physician, thus proving highly useful in guiding and monitoring diagnosis.

Recently, targeted protein profiling can differentiate four types of syndromes: immune, hemolytic, inflammatory, and nutritional. It complements serum protein electrophoresis, taking into account protein values in a given population, gender,age, and their specific

1elevation accordingto immune, nutritional, or inflammatory reactions. Furthermore, serum immunofixation is a prescribed test

monoclonal immunoglobulin.

Given that specialists face complex clinicalcases, they must integrate this theoretical knowledge already acquired to confront the challenge of prescription, where relevance must take into account the patient's clinical record, age, and gender. Moreover, communication between clinicians and biologists should be frequent and based on diligent dialogue. Modern tools such as private computernetworks, intranet, and simplified files containing interpretations of certain syndromic situations are also important.

Additionally, the analytical interpretation of the test result should be accompanied and collaborated on by the biologist throughout all stages, including pre-analytical, analytical, and post-analytical stages, with explicit interpretative reports, emphasizing coordination between the prescribing service and responsetimes.

A study evaluating the knowledge state of specialist physicians in pediatricserum protein profiles,including serum proteinelectrophoresis, immunofixation, and targeted protein profiling, revealedlow prescription rates at the Abderrahim HarouchiChildren's Hospital in Casablanca. The study also aims to assess satisfaction with the communication between prescribers and biologists and the pre-analytical recommendations contained in the biochemistry sampling manual for specialist pediatricians in their clinical practice.

An earlier study in 2017 found a prescription rate of 3.56%. Informal interviews with specialist physicians revealed an alarming observation regarding the prescription rate of this test by pediatricians, with almost a rate not exceeding 7% of requests for serum protein electrophoresis received at the biochemistry laboratory during February 2018.

Our hypothesis is as follows: Does the low prescription rate of serum protein profilesresult from a lack of training and unfamiliarity with the beneficial contribution of this test to a more precise diagnosis?

The objective of this work is to assess the knowledge and training of resident and intern physicians in pediatric serum protein profiles. The aim is to bridge this knowledge gap in the clinical setting to provide tools that facilitate the teaching and provision of laboratory services in biochemistry, emphasizing the necessary communication for the effectiveness and relevance of prescribing pediatricserum protein profiles.

We conducted a descriptive, quantitative, exploratory, and cross- sectional studyover a one-month period in March 2018.This study took place at the Abderrahim Harouchi Children's Hospital in Casablanca, involving the followingdepartments: Pediatric Infectious Diseases (P1), GeneralPediatrics (P2, P3, P5), Neonatology (P4), Pediatric Orthopedics and Traumatology (OTP), Pediatric Visceral Surgery (CVP), Pediatric Emergencies (SAUP), and Pediatric Resuscitation (Pediatric Intensive Care Unit).

The study population consistedof internal and resident physicians to identifythe nature of the affectedgammaglobulin during assigned to the pediatric departments. We employed a census sampling approach, meaning that all eligible individuals were included in the study. No specificsampling method was established; instead, we chose to conduct a census of the target population (N = n = 59).

Development of the questionnaire     The questionnaire is based on a conceptual framework derived from the literature review. It consistsof four sections:socio-professional data, trainingreceived on pediatric serum protein electrophoresis/immunofixation and targeted pediatric protein profiling during internship/residency, evaluation of the relevance of prescribing pediatric serum protein profiles including serum protein electrophoresis, immunofixation, and targeted protein profiling, and satisfaction with the servicesprovided by the Biochemistry Laboratory of CHU Ibn Rochd- Casablanca        (serum    proteinelectrophoresis/immunofixation/targetedprotein profiling).

This questionnaire consists of 22 questions, including 4 closed- ended questions, 14 multiple-choice questions, and 4 closed-ended scale questions among 59 physicians (N=59).

The researcher visited all pediatrichospital departments to present the survey to resident and intern physicians and encourage their participation. The questionnaires were distributed in all pediatric departments and made available for one week. It is possible that physicians consulted scientific literature regarding the evaluation of the relevanceof prescribing serum proteinprofiles, sought inputfrom other resources, answered with the assistance of colleagues, or were not the intendedindividuals to respondto the questionnaire. To address this bias, each physician was invited, in the presentation text of the questionnaire, to respond independently without external assistance.

All physicians who wished to collaborate in this study completed the questionnaire anonymously, indicating only the name of thedepartment and theirstatus. The researcher returned to the pediatric departments one week later to collectthe questionnaires

Statistical Method:

The study is of a cross-sectional design with two aspects: an analytical aspect and a descriptive aspect. The data were collected and processed using Sphinx Plus2 software (V5).

For the analytical part, the dependent variable is the quality of trainingin pediatric serum protein profiling, which is a dichotomous variable(poor or good training).

The tests used are the Chi-square test. A p-value < 0>

Out of the 59 distributed questionnaires, 54 were collected(91.5%), with 5 non-responses (8.5%).

The majority of respondents were aged between 21 and 25 years, comprising 27 physicians. There was a predominance of female respondents, accounting for 31 cases, while male respondents numbered only 15 cases (see Table 1).

Table 1: Distribution of participants by age and gender

Regarding training in pediatric serum protein profiling, only 2 out of 54 cases (3.7%) of doctorswho received basic training in

pediatric serum protein profiling (Table 2).

Table 2: Training in Pediatric SerumProtein ProfilE

A comparative analysis was conducted between physician training and the relevance of prescribing pediatrictargeted protein profiles. The analysis yieldeda p-value of 0.019.

The theoretical knowledge of the surveyed physicians regarding serum proteinprofiling showed rates of incorrectresponses ranging from 16.66% for serum protein electrophoresis to 62.96%for targeted proteinprofiling (see Table 3).

Table 3: Evaluationof the relevance of serum protein profileprescription in pediatrics

Regarding the communication servicebetween the biologist and the prescriber, half of the physicians (21/54) reported being not  satisfied at all with this service. Additionally, almost half of the participants (26/54)stated that the pre-analytical recommendations outlined in the biochemistry samplingmanual were rather nsatisfactory 
 

To our knowledge, this study is the first to evaluate the theoretical knowledge of pediatric serum protein profiling. A total of 54 collected questionnaires within a month allowed for the assessment of the knowledge level among residentand intern physicians at the pediatric university hospital. With a predominance of females(31/54), this can be explained by the increased access of females to medical school in recent decades [8].

The analysis of the results revealed that almost all physicians (52/54) reported not having receivedbasic or continued training in serumprotein profiling during their medicaleducation. Furthermore, the majority of them do not consider this trainingvery important, indicating that physicians in specialties may not fully appreciate the significance of serum proteinprofiling in medical diagnosis. This finding is consistent with a study by Barrier,which showed that physicians have not receivedsufficiently consolidated training inserum protein profiling to understand its diagnostic utility[9].

It appears that training in serum protein profiling was received during the undergraduate medical curriculum. However, during residency and internship, specialty physicians did not update their knowledge in serum proteinprofiling.

No statistical difference between the two profiles(intern physicians or resident physicians) was highlighted. There is a lack

of knowledge regarding serum protein profiling, whether in the intern or resident specialty.

We observeda perceived deficitin theoretical knowledgeof serum protein profiling. This may be explained by the complexity of the definition of serum proteinprofiling. Moreover, a significant portionof specialty physicians demonstrated relatively low knowledge of targeted serum protein profiling, with a false response rate of 62.97%. It is worth noting that targeted protein profiling is useful for diagnosing inflammatory, immune, or nutritional conditions. However, studies have revealed the utility of targeted protein profiling, as it provides a precise examination and contains a reduced number of serum proteins, facilitating the monitoring and evolution of proteins contributing to various pathological syndromes, such as malnutrition, inflammation, intravascular or extravascular hemolysis, immune deficiency, or polyclonal or monoclonal immunoglobulin increases [10].

In our context,we observed deficiencies in the trainingof specialty physicians regarding serum proteinprofiling in generaland targeted protein profiling in particular. Additionally, observations in the field have shown that this examination is moderately known or almost unknown in the university hospital, indicating a perceived lack of training. Furthermore, the comparative analysis was statistically significant (p=0.019) between the lack of training and the relevance of prescribing targetedprotein profiling.

The studyhas highlighted deficiencies in the theoretical knowledge of pediatric serum protein profiling among intern and resident physicians. This recognized lack is evident as a significant portion of participants acknowledge the need for further training. Hence, there is a call to strengthen initial training and fill the gap through continuous education. Introducing innovative teaching methods supported by e-learning is essential, especially with the recent measures taken due to the coronavirus crisis, which necessitate a shift towards online learning. Therefore, we suggest creating a website to enhance serum protein profiling education, containing detailed courses with synoptic reports of various serum protein profiles, illustrated with visuals, and referring to recommendations for good practices in medical biology. This will help motivate students dedicated to physicians duringtheir training.

Current State of Knowledgeon the Subject

• Basic examination in medical biochemistry
• Examination for the diagnosis of certain inflammatory, immune, and nutritional diseases and the identification of monoclonal immunoglobulins

Deficiency in the relevance of prescribing serum protein profiling examinations

Contribution of Our Study to Knowledge

• Importance of training in serum protein profiling for relevant prescription and targeted interpretation of serum proteinprofiles
• Importance of communication between prescriber and biologist for accuratediagnosis.

Conflict of Interest

All authors declare that they have no conflicts of interest. Authors' Contributions

• Safaa Hadrach: Conception and writing of the article
• Naima Khlil: Reading of the article
• Imane Benazzouz: Conception of the study and reading of the article
• Nabiha Kamal: Head of the laboratory service, involved in the article's revision

All authors contributed to the realization of this work. They also declare having read and approvedthe final versionof the manuscript.

Tables and Figures

• Table 1: Distribution of participants according to age and sex
• Table 2: Trainingreceived in pediatric serum protein profiling
• Table 3: Evaluation of the relevance of pediatric serum protein profile prescription
• Figure 1: Satisfaction with the communication service between biologist and clinician at the biochemistry laboratory for pediatric serumprotein profiling.

Figure 2: Satisfaction with pre-analytical recomendations at the biochemistry laboratory for pediatric serum protein profiling