Document: Future Directions of Clinical Laboratory Science Education Programs
Classification: Position Paper
Date: July 1987
Status: Approved by ASCLS House of Delegates July, 1987
Changes in the health care delivery system of the United States have occurred in the 1980's as Society has reexamined its allocation of resources to health care in the context of other social, political and economics needs. Federal legislative actions, including the prospective payment system, DRG's, have profoundly affected all of health care, including the clinical laboratory services. The strategy of cost containment through DRG's and other related techniques has created an environment characterized by changing practitioner roles and practice sites, a focus on cost effectiveness as well as quality, and an incentive to organizations and individuals to utilize health care practitioners, including those in the clinical laboratory, at their highest possible level of capability. At the same time, changes in clinical laboratory technology have mandated changes in clinical laboratory practice and practitioner roles
Change of such magnitude inevitably generates uncertainty and concern about actions which must be taken to successfully manage past the understandable turbulence of the moment. Among the issues needing consideration is the education of competent practitioners in the clinical laboratory sciences who can meet the challenges and the opportunities of the new laboratory (1).
Educators in the clinical laboratory sciences have responded to this need by considering issues such as the balance between theory/problem solving skills and technical proficiency, the nature of professions and professionals and the characteristics of professional education, the types of curricula that are congruent with the Scope of Practice of the Clinical Laboratory Sciences (2), and fiscal responsibility issues. Moreover, educators have considered these matters in the context of increasing demand for graduates but declining enrollments in educational programs. The latter is due to many factors in the higher education environment in general as well as to factors of uncertainty about the nature of employment in the new laboratory environment. As consensus about practice roles is achieved (3,4) consensus on educational programs which produce such practitioners must also be achieved. The ASMT position described below represents such consensus.
As referenced above, the American Society for Medical Technology has established that clinical laboratory science is a profession: a) distinct from the practice of medicine; b) characterized by its own, internally-defined Body of Knowledge and Scope of Practice; and c) requiring of its practitioners competency in scientific, technical, managerial and scholarly principles, and high standards of achievement and professional conduct. Further, ASMT has historically asserted that duly qualified practitioners of clinical laboratory science have the right to practice their discipline to the fullest extent of their competence, without unnecessary and unfair constraint.
Among the positions ASMT has taken which are relevant to the educational preparation of practitioners is the Scope of Practice of the Clinical Laboratory Sciences. This document describes in general terms services provided in the clinical laboratory sciences. It states that clinical laboratory personnel, as members of the health care team, are responsible for:
Thus, ASMT defines the profession as encompassing the performance, reporting, interpretation and clinical correlation of clinical laboratory tests for the purpose of promoting health and preventing and treating disease and impairment through the application of scientific principles of biology, chemistry and physics as they relate to physiologic and biochemical processes in the human being. The clinical laboratory science profession also incorporates principles of social science to serve its primary purpose. The profession includes as integral features research, consultation, education, management and administration.
For the considerations described above the American Society for Medical Technology has established the following as its position on the education of practitioners of the clinical laboratory sciences.
The role of the CLT should be that of a technical support professional. In the traditional hospital setting, CLTs should perform routine tests and quality control under the supervision of a Clinical Laboratory Scientist (CLS). In decentralized laboratory settings, CLTs should perform and report results. They will confer with supervisors regarding technical and quality control problems encountered. In any setting, CLTs will conduct themselves in a manner which conveys and promotes the professionalism of clinical laboratory personnel
Clinical Laboratory Scientist (CLS)The role of the CLS is that of a broad-based health professional. In hospitals, large clinics and reference laboratories, the CLS should be able to perform CLT functions; perform the non-routine, more difficult and complex testing; supervise the CLT and other clinical laboratory support personnel; fill diversified roles, usually with additional education, in such areas as education, management, research, home testing, marketing and laboratory administration; serve as a consultant by guiding physicians in test selection, result interpretation, and clinical decision-making; and develop and monitor laboratory utilization and quality assurance protocols. In decentralized laboratory settings, the CLS may perform analyses but may also serve as a consultant. In the consultant role the CLS may guide physicians in test selection, result interpretation and clinical decision-making; offer expertise in the design, implementation and evaluation of a cost effective decentralized laboratory; and monitor the utilization and quality of home laboratory testing. In any setting, CLSs should conduct themselves in a manner which conveys and promotes the professionalism of clinical laboratory personnel. Masters Degree
The masters prepared Clinical Laboratory Scientist should be qualified to assume one or more of the following roles in the profession, depending on the focus of the graduate curriculum completed. Such individuals should be able to serve as a laboratory manager/administrator; serve as faculty in associate degree or baccalaureate level clinical laboratory education programs; conduct clinical/applied research; administer/coordinate CLT and CLS education programs; and serve as a clinical specialist in an area of advanced preparation.
Doctoral DegreeIn addition to those roles described for the masters level CLS, doctorally prepared Clinical Laboratory Scientists should be qualified to assume one or more of the following roles. Such individuals should be able to provide leadership for Clinical Laboratory Sciences to be recognized as an academic discipline within college and university settings; serve as faculty for CLS programs at both baccalaureate and graduate levels; conduct both basic and applied research to expand the body of knowledge in the profession; provide service to the profession and community; develop new technologies and methods of testing to improve the quality of patient care and the cost effectiveness of laboratory practice; and direct and control the diagnostic functions of clinical laboratory services.
All curricula should be grounded in the liberal arts to provide breadth and depth to the educational experience and must include both written and verbal communication skills. Educational programs must provide for the development of professional attributes in students. Such development is a socialization process which is nurtured and encouraged in an autonomous environment in which professionals learn to seek and to accept accountability and responsibility for their own body of knowledge, standards of practice and conditions of work.
Educational programs should provide curricula which prepare students for their future roles in multiple laboratory settings. Curricula, therefore, should focus on the Body of Knowledge at the appropriate level, and promote the transferability of skills such as critical thinking and problem solving. They should provide a clinical experience which reflects the diversity of current and future practice. In defining this clinical experience, outcomes met rather than time spent will serve as the criteria. Curricula should also promote responsibility for independent and continued life-long learning.
Educational programs should utilize clinical experiences for the application of knowledge and skills learned in a didactic phase. These will differ for CLTs and CLSs, given the appropriate focus of each level of educational program.
Curricula should be based upon and include the unique Body of Knowledge of Clinical Laboratory Science at the appropriate level as described in the Levels of Practice. Educational programs should be reflective of current "real world" needs as well as anticipated needs for the future as defined and disseminated by the profession.
All curricula at all degree levels should facilitate upward mobility. Students should be aware of their opportunities for mobility through their college as well as professional publications. All programs should emphasize the diversity of career paths open to graduates.
Clinical Laboratory Technician CurriculaCLT curricula should incorporate the core body of knowledge which pertains to Level I (CLT) practice as defined in the Levels of Practice document of the profession. The acquisition of transferable skills in liberal arts courses should be emphasized and should be integrated into the professional curriculum.
Upward mobility should be facilitated by insuring that one full year of credits earned toward the associate degree should be in transferable general education courses such as English, mathematics, social science, natural science and humanities. One full year of credits earned should be in professional/clinical courses.
Clinical Laboratory Scientist CurriculaCLS curricula should build on or incorporate a Level I (CLT) core curriculum and add the body of knowledge which pertains to Level II (CLS) practice as defined in the Levels of Practice document of the profession. Higher order transferable skills, such as critical/analytical thinking and communications skills, should be integrated throughout the four year program. An introduction to principles of management, education, research and contemporary health care issues should be included in the curriculum. Career mobility for CLT students to CLS and for CLS to graduate school in the sciences should be facilitated.
Graduate CurriculaGraduate curricula should serve as a natural extension of professional development for those who desire to serve in leadership roles in management, practice, education and research. Whether graduate education is within the specific discipline of Clinical Laboratory Sciences or in a separate but professionally relevant discipline is important only to the extent that the preparation is applicable to the development of leadership in the profession. At this point in the development of the profession, maximum flexibility is needed in graduate education to encourage the preparation of leaders in all aspects of the profession; however, institutions with the capability and resources to develop graduate programs in CLS, tailored to the development of faculty researchers for the profession, should be encouraged to do so.
Evaluation of educational activities in the clinical laboratory sciences should be based primarily on outcomes rather than process to foster creativity and innovation in program design and implementation. In general, clinical laboratory science programs should enable graduates to qualify for appropriate certification and/or licensure. Peer evaluation of programs by means of programmatic accreditation is essential to assure a continuous flow of high quality graduates into the profession. All programs should demonstrate integration of liberal arts courses, professional courses and clinical practicum throughout the curriculum.
Programs should utilize faculty with appropriate levels of education, experience and professional certification, where relevant, for the courses they teach. Specific criteria for the selection of clinical faculty should be developed and faculty should be assisted in attaining high standards through strong faculty development programs.
Programs should assure that faculty are cognizant of their function as role models and should encourage activity in research, publication, consultation and community service. Faculty should also be strongly encouraged to be involved in their professional organization.
All CLT and CLS program directors must have credentials in clinical laboratory sciences at the CLS level. By the year 2000, the terminal degree in the clinical laboratory science field will be the doctorate. Programs should encourage and assist all faculty in obtaining doctoral degrees.
Clinical Laboratory Technician programs should be based in appropriately accredited educational institutions such as colleges, universities, community and junior colleges and technical institutions authorized to grant associate degrees.
Clinical Laboratory Scientist programs should be based in those institutions which can provide the environment for Clinical Laboratory Science to develop as an academic discipline. As an academic discipline it should encompass the component of education of future practitioners, research for the expansion of the body of knowledge in the field, and service to the profession. The institution must ensure the academic, fiscal and administrative resources necessary to support a comprehensive professional program.
Graduate programs should be based in those colleges and universities which can and do support clinical laboratory science as a professional discipline.
All programs should aggressively seek to enhance those attributes which are consistent with high quality professional programs. These include, but are not limited to the following considerations:
FacultyIn each institution there should be sufficient numbers of faculty who are members of the profession so that mastery of the entire body of knowledge of the clinical laboratory sciences is available collectively and the teaching of transferable skills is emphasized. In addition, because research endeavors can contribute to the existing body of knowledge in the field, each institution should support and promote faculty who contribute to the body of knowledge in the profession through research efforts. In each institution there should be at least one person who, if not actively engaged in research, can teach research design and statistics to students and supervise student research projects.
Development of ProfessionalismIn each institution there should be an environment and faculty which facilitate student understanding that clinical laboratory science is a unique and worthy profession, not a subset of another profession; therefore clinical laboratory scientists should control matters related to their own profession just as other true professionals do.
Planning to Maintain the State-of-the-ArtEach institution should have a variety of mechanisms to maintain" state-of-the-art". These include a variety of clinical sites so that students and faculty can participate in centralized and decentralized laboratory setting; mechanisms for faculty and students to remain current with respect to literature on scientific/technical advances in the field' a variety of mechanisms for students and faculty to stay abreast of professional issues and to actively participate in the professional organization; and a mechanism for students and faculty to gain insight into current issues (political, economic, legal, ethical) affecting the health care industry.
Administrative StructureThe administrative structure of the educational program must allow clinical laboratory scientists to be in charge of their professional education. Although input from other individuals is certainly desirable, clinical laboratory scientists must make final decisions about the scope and content of their own professional curriculum. The institutional environment should promote professionalism by fostering independence (rather than dependence) in decision-making and problem solving situations. To strengthen programs administratively, mergers, cooperative arrangement, consortiums, regional linkages and joint ventures should be explored.