ASCLS Today Volume 33, Number 5

ASCLSToday Masthead 680

Volume 33, Number 5


Cindy Johnson, MS, MLS(ASCP)CM, 2019-20 ASCLS President

Who would have ever imagined that the extremely shy, youngest member of the “Johnson Bunch” would be your next president of the American Society for Clinical Laboratory Science? I am truly honored to be granted this wonderful opportunity.

The Johnson Bunch grew up in Duluth, Minnesota, which is located on the shores of beautiful Lake Superior and fondly known for two seasons: the 4th of July and winter. With only four years difference between the oldest and youngest of the five Johnson children, our teachers knew our family quite well. And with “Mom” Johnson serving as PTA president in every school we attended, academics was a high priority.

Science interested me at a young age, but it wasn’t until I was a sophomore in high school helping the junior and senior football and hockey players use their microscopes in biology class that my clinical laboratory journey began. I continued to take science and math courses throughout the remainder of my high school years, and my sister encouraged me to pursue my medical technology degree at the College of St. Scholastica.

After working as a generalist in our local hospital laboratory for seven years (primarily on the off shifts), it was time to expand my knowledge and attend graduate school at the University of North Dakota where I earned a master’s degree in clinical laboratory science. During my time in North Dakota I became actively involved in ASCLS.

As a new member to the organization, I was appointed to the Membership Development Committee as a regional representative that led to chairing the national Membership Development Committee a few years later. After serving on a couple other national committees I was encouraged to run for state president. In May of this year I achieved my 30-year anniversary with ASCLS and have been proud to be an active member for those three decades. I am fortunate to have had many mentors along the way which have developed into long-lasting friendships.

The Foundation of ASCLS: Our Constituent Societies

We have heard from numerous constituent societies for several years that “we cannot fill our leadership positions.” The practice of “recycling” our leaders has been a key concern for ASCLS leadership, and recently several steps were taken to address this concern with the work of appointed taskforces.

The foundation of ASCLS is our constituent societies, our grassroots members—all of you. It is imperative that we provide the resources and tools to keep our foundation strong. How do we accomplish this?

The ASCLS Board of Directors spent the past year taking deliberate steps to revise the ASCLS Strategy Map. We first had to address “what is our why” (our purpose) as a laboratory professional organization.

Simultaneously, an expanded group of ASCLS leaders where given the opportunity to participate in our first ASCLS book club with Start with Why, by Simon Sinek. Through five sessions our book club leaders, ASCLS Executive Vice President Jim Flanigan, and ASCLS Region III Director Janelle Chiasera, challenged us to articulate our “Why,” which was not an easy task. We also discussed the other elements of The Golden Circle outlined in the book: Why (Purpose); How (Processes/Methods); and What (Results/Outcomes).

Utilizing resources from ASAE ForesightWorks, ASCLS Executive Board members reviewed 41 key trends driving change within organizations. This information, in addition to the feedback provided by the book club participants, was instrumental in developing our Society’s “Why”—our unique critical objective.

ASCLS exists to advance the expertise of clinical laboratory professionals who, as integral members of interprofessional healthcare teams, deliver quality, consumer-focused, outcomes-oriented clinical laboratory services through all phases of the testing process to prevent, diagnose, monitor, and treat disease.

It became apparent that our purpose (Why) is to advance the expertise of clinical laboratory professionals to deliver quality, consumer-focused, outcomes-orientated clinical laboratory services.

Further discussion by the Board of Directors resulted in identifying three pillars that support our unique critical objective.

ASCLS is a community that supports current and future laboratory professionals as they advance in the profession, and it advocates on behalf of the profession for the good of the public and holds the profession accountable to a Code of Ethics.

Through its governance structure, ASCLS members coordinate efforts to achieve their profession’s goals and provide the resources to support those efforts.

Through membership, the Society develops resources via dues and the development/monetization of programs and assets (e.g., intellectual property).

ASCLS provides a structure for the profession to collaborate with other professions or for the membership to collaborate with other stakeholder groups within the profession.

The Society is a mutual support structure for those working to advance the profession and the Society.

ASCLS defines appropriate professional knowledge and develops and delivers educational programming to assure the profession possesses that knowledge.

Within the context of life-long learning, ASCLS prepares laboratory professionals to fully participate in and lead in an interdisciplinary and dynamic healthcare environment by expanding scientific knowledge and clinical laboratory skills.

ASCLS instills in laboratory professionals the skills to lead and take management or leadership positions within and outside the laboratory and prepares laboratory professionals to understand and speak the languages of quality with other professionals with whom they interface (e.g., nursing, pharmacy, and medicine).

P.A.C.E.®, collaboratively with hundreds of providers, assures that high-quality opportunities for life-long learning are available specifically for laboratory professionals.

ASCLS utilizes a variety of modes and forms to meet the needs of the widest-possible number of laboratory professionals, including virtual and live meetings and other innovative ways, both for credit and to simply deliver knowledge.

As an advocate, ASCLS will actively shape the environment for laboratory professionals to maximize the efficacy of their efforts on positive patient outcomes. Volunteer leadership defines how the Society aims to shape that environment.

In collaboration with other like-minded stakeholders, ASCLS will ensure the public policy environment (both legislative and regulatory) is conducive to laboratory professionals working fully within their scope of practice and working to expand that scope of practice where it will improve patient outcomes. This includes pressing for high standards that include state licensure and stronger rules on certification.

How a profession is perceived by patients, other healthcare providers, and policymakers impacts the capacity for laboratory professionals to achieve their desired purpose to themselves, to other healthcare providers, and to the public. ASCLS will actively shape public perceptions of laboratory professionals and their contributions to the healthcare system.

An Evolving Map
The Strategy Map is a document that is dynamic and will continue to evolve as our committees, forums, councils, and taskforces focus on our purpose to:

1. Advance the expertise of clinical laboratory professionals. It is imperative that we identify and mentor emerging leaders to prepare them for new roles. We can accomplish this by utilizing current resources and developing new ones.

2. We are the voice of the profession. Each of us has the responsibility to tell our story. We are the experts in laboratory medicine and have vast knowledge to share. Become involved, promote our profession—go to local schools, participate in laboratory tours and science fairs, and ask to be part of health fairs. But most importantly be a patient advocate … you do make a difference.

The Rest of My Story
After graduate school, I went back to the laboratory in my hometown and was the general laboratory manager for the next eight years. I had the ideal job as I worked “on the bench” and taught the senior medical laboratory science students laboratory management principles in addition to my other responsibilities.

Twenty years ago, I moved to Central Minnesota to become the laboratory director, and my role continues to evolve as our organization has grown significantly during this time. Through all the changes I have seen in my career I have never regretted the decision to become a laboratory professional back in high school.

I want to challenge you to find your “Why.” It is an honor and a privilege to work with dedicated colleagues who continually strive to advance our profession. Thank you for the difference you make in the lives of others.

Cindy Johnson is senior director of laboratory services at CentraCare Health in St. Cloud, Minnesota.

President Cindy Johnson’s Acceptance Speech at the 2019 House of Delegates Meeting in Charlotte, North Carolina


Roslyn McQueen, PhD, CCRC, ASCLS Past President

It has been a distinct honor for me to serve as the 2018-19 president of the American Society for Clinical Laboratory Science. I believe in ASCLS and recognize it as an essential organization that represents the medical laboratory profession. I can proudly say that I have maintained continuous membership in ASCLS for over 40 years. All my friends and colleagues know about ASCLS and that it is the organization that represents the laboratory profession and professional. I believe that we are each charged with being ambassadors for promoting our profession. Medical laboratory science is a profession, not a job.

I began the 2018-19 ASCLS year with the theme, “ASCEND - Exemplifying Sustainable Excellence in Laboratory Medicine.” Sustainable excellence requires that we identify problems and develop solutions for the challenges affecting the organization. To that aim, the letters in ASCEND represented the six target areas of focus during the year.

A = Association Wellness
S = Sustaining the Strategic Map
C = Communication
E = Educational Excellence
N = Networking
D = Diversity and Leadership Development

This has been a year of challenge, transformation, and possibilities. However, I feel we are on the right path to achieve the sustainable excellence of our Society. I am proud to report that ASCLS is alive and well, primarily due to the support and participation of the ASCLS Board of Directors, committee and forum chairs, constituent societies, and a dedicated staff. I am writing to report on the accomplishments we have achieved over the past year.

Changes and Challenges—Association Wellness
“Wellness is an active process of becoming aware of, and making choices toward, a healthy and fulfilling life.” This year, with approval of the Board of Directors, we established the Constituent Society Task Force (CSTF). This task force was formed to address the issues identified in the 2018 Root Cause Task Force report. For many years, ASCLS constituent society board reports expressed common concerns related to leadership at the local level. Issues identified by the Root Cause Task Force include societies with decreased numbers of members, inadequate student to professional transition, ineffective production of officers, and recycling of officers, ultimately leading to a lack of programming or development of perceived value of belonging.

The CSTF identified key performance indicators in five parameters that could effectively target a stratified approach to interventions in struggling constituent societies:

  • Financial health
  • Programs and service delivery (e.g., continuing education)
  • Volunteer resources
  • Outreach and advocacy
  • Governance

A preliminary survey was conducted of five states and data presented at the 2019 March Interim Board Meeting. The survey has been refined and will be submitted to all constituent societies this fall to assess overall association wellness. Ultimately, we want to first identify the states experiencing the more significant problems, and then develop an action plan to address and/or solve the problems. We hope to meet these societies where they are and bring the support, leadership development, and mentoring so badly needed and assist them in preparing and training future leaders.

ASCLS Annual Meeting. The foremost major change and challenge facing ASCLS last year was planning and preparing for the 2019 ASCLS Annual Meeting in Charlotte, North Carolina. As stated previously, circumstances forced ASCLS to dissociate from the AACC Scientific Expo. Yet we optimistically faced this as an opportunity, rather than as an obstacle. Fortunately, we were able to build a partnership with the Association of Genetic Technologists (AGT), and together we developed the first joint meeting between ASCLS and AGT. We are confident this meeting will grow to unparalleled dimensions to meet the needs of our members, sponsors, and industry partners.

Sustaining the Strategic Map
The Strategic Map provides the focus and direction for ASCLS committees and forums to pursue their specific charges throughout the year. I am pleased that 100 percent of our committees are functioning, engaged, and reporting as charged.

Our governing documents require constant review and evaluation. During the year, the Position Descriptions, Standard Operating Procedures, and Bylaws were updated and assessed for conformity after the action of the 2018 House of Delegates.

An essential responsibility of our organization is to provide timely, accurate, and essential communication to keep our members informed and involved. We have a diverse membership that requires various forms and methods of communication. Throughout the year, ASCLS has been working hard to enhance and expand modes of communication. As a result, I have observed a tremendous improvement in the level and scope of communication within the organization.

Society News Now. One of my visions was to resume Society News Now, initiated under Susie Zanto’s administration. This was an online communication tool to provide an update to members on the “behind the scenes” activities of ASCLS, including the work of our national committees, important governance information, and other issues of interest to our members. To date, ASCLS has published nine issues of the Society News Now e-newsletter.

ASCLS Today. Cheryl Caskey continues to be the backbone of the ASCLS Today newsletter, which is considered an invaluable membership asset. This year we published seven issues of ASCLS Today and Editor Cheryl Caskey is to be commended.

Marketing and Communications Committee. One of my first official duties as president was to appoint members to the newly established Marketing and Communications Committee. Kyle Riding and Rebecca Rogers served as chair and vice chair, respectively. This committee has been phenomenal and an integral part of furthering the level and quality of communication to our members.

Clinical Laboratory Science. Editor Perry Scanlon and Jim Flanigan have worked continuously with various agencies and platforms to bring this journal back. All articles have been published ahead of print, and issues are being composited. The new website allows data to be deposited in various indexes and more than 1,000 readers are visiting each month.

Educational Excellence
ASCLS prides itself on being a leader in providing quality continuing education for laboratory professionals. The continuing education that ASCLS provides through our national, regional, and constituent society meetings is exceptional. Our P.A.C.E.® program is recognized as the premier system for maintaining high standards of program quality and professional acceptability, and over 200 providers enrolled numerous events during 2018-19.

Clinical Laboratory Educators Conference (CLEC). I had the opportunity to attend my first Clinical Laboratory Educators Conference (CLEC). It was held February 21-23 in Baltimore, and in spite of inclement weather, there were over 500 in attendance. CLEC provides an opportunity to learn new skills and better understand the issues that educators face on a daily basis. Concurrent sessions presented subject matter by experts in the areas of education, certification, and accreditation. Updates by the ASCP Board of Governors and NAACLS provided perspectives for ensuring we have a competent stream of professionals entering the profession. I left the conference feeling recharged, motivated, and inspired.

Constituent Societies’ Annual Meetings. I presented hematology lectures and ASCLS update messages this year at various constituent society annual meetings. I am pleased to report the vast majority of our societies present one-, two-, or three-day annual meetings. These state meetings allow our members to interact with experts in the field or to observe and discuss new products with vendors, experience networking opportunities, and have fun with colleagues. I want to thank all the volunteers who helped ASCLS constituent societies provide annual scientific meetings.

Increasing our Network within the Scientific Associations
Networking continues to provide an opportunity to meet likeminded members from all avenues of our profession. Working interprofessionally, we will improve diagnosis, treatment, disease prevention, and patient safety. Our efforts with the Legislative Symposium, Choosing Wisely, and representation on other allied health agencies are indications of such efforts.

Legislative Symposium. Networking on governance issues with other health profession organizations is essential to make a difference in the political arena. The 2019 Legislative Symposium was well attended with 130 attendees representing the American Medical Technologists (AMT), American Society for Clinical Pathology (ASCP), Association of Genetic Technologists (AGT), Clinical Laboratory Management Association (CLMA), and National Society for Histotechnology (NSH). Workforce shortage remains a common topic for all laboratory professionals.

Choosing Wisely Task Force. The Choosing Wisely Task Force, under the leadership of George Fritsma, presented several recommendations to the ASCLS board to approve to be submitted to the American Board of Internal Medicine (ABIM) for consideration. Testing considerations submitted included:

  • Ferritin: “Avoid using hemoglobin to screen for iron deficiency. Instead use ferritin,” by Dr. Esani.
  • PT and PTT: “Avoid routine prothrombin time (PT) and partial thromboplastin time (PTT, APTT) preoperative screens on unselected patients,” by Professors Fritsma and Miller.
  • RBC Transfusion: “Do not transfuse red blood cells for expansion of circulatory volume unless necessary for patient cases with severe hemorrhage,” by Professor Bostic.
  • “Do not order rapid multiplex molecular assays for microbial infections unless the assays will impact patient management decisions,” Dr. Ebomoyi.
  • “Avoid routine blood typing and screening for low risk surgeries without a clinical indication,” Miller and Fritsma developed.

Representation to other Allied Healthcare Organizations. I truly appreciate the dedication of the ASCLS members who have been appointed to represent our Society on the boards of various organizations. I want to highlight activities of a few of them.

Coalition to Improve Diagnosis: In September 2018, Patient Safety Committee Chair Lezlee Koch championed the effort for ASCLS to become a member organization of the Coalition to Improve Diagnosis. This coalition is a collaboration of more than 50 leading healthcare organizations focused on ensuring that diagnoses are accurate, communicated, and timely. Brandy Gunsolus is our appointed representative.

Coordinating Council for the Clinical Laboratory Workforce (CCCLW): Susie Zanto is the ASCLS representative to CCCLW. A major project this year was the development of a Laboratory Science Careers website, which launched in early December 2018. This was a major project, and the design team included ASCLS members Susie Zanto, Joshua Cannon, and Lezlee Koch, with help from Jim Flanigan and the Orange Wave website contractor. Please visit this website and share it with others.

Health Professions Network (HPN): Daniel Olson has represented ASCLS at the HPN Board of Directors and was elected January 1, as the HPN president. Congratulations, Dan. The HPN continues working to implement a two-pronged consumer awareness campaign: first, to create awareness of the health professions and the career opportunities in these fields; second, to address more fundamental issues, such as lack of clinical sites, shortage of faculty, inadequate program funding, and issues with credentialing and licensure.

Additionally, ASCLS continues to be prominent representatives and take full advantage of our affiliations with NAACLS and the Board of Certification. NAACLS is also seeking membership with the Health Professions Accreditors Collaborative (HPAC), which serves as a platform for discussion, proactive problem solving, and sharing among health professions accreditors.

Diversity and Leadership Development
What makes ASCLS great is the hard-working, committed, and enthusiastic people who volunteer their time and expertise on behalf of our Society. We are a diverse, grassroots, volunteer organization with members who possess different skill sets, abilities, and experiences. But the common element among all members is that we are clinical laboratory scientists, trained, educated, and certified to render service in the healthcare arena

The Diversity Advocacy Council is heralded for championing the causes of our diverse membership. Their newsletter articles are timely, perceptive, and insightful for the diverse patient population we encounter. Last year, we updated the ASCLS motto to include diversity language.

ASCLS is an inclusive, culturally relevant community of people acknowledging their differences and unique characteristics; it is an organization where all persons can engage and participate in a meaningful way empowering everyone to grow and learn.

Sustaining Membership. A significant membership change this year was the introduction of Sustaining Membership. Sustaining Membership is a status, not a class or type of membership. It is an added option to ASCLS memberships for individuals with a desire to provide additional financial support for the Society’s work and mission. Sustaining Members are entitled to additional benefits that visibly recognize Sustaining Membership status and provide minor amenities. This benefit does not impact voting, holding office, or serving in any formal capacity for the Society.

Leadership Academy. The Leadership Academy was on hiatus this year. A Leadership Academy Task Force (LATF) evaluated the national Leadership Academy to determine how it fits in with our overall leadership development needs. Kathy Doig and Alice Hawley served as co-chairs. The LATF made several extensive recommendations that were approved at the 2018 Fall Board Meeting. The underlying theme was the national Leadership Academy should be a more advanced academy; essentially an executive leadership academy that is applicable to the workplace and the profession, not just ASCLS. It should be unique, compared to regional and state academies. This spring the 2019-20 Leadership Academy class was selected and met for the first time at the Joint Annual Meeting in June.

Thank You
In conclusion, my year as ASCLS president has been an extremely rewarding and gratifying experience. I am grateful to the many volunteers that said “yes” to the profession when called upon to serve on committees and forums.

Medical laboratory science is a profession, not a job. The difference between having a JOB vs having a PROFESSION is largely one of education, attitude, ethics, and commitment. Webster defines profession as “a calling requiring specialized knowledge, requiring long academic preparation, usually involving mental rather, than manual work, and conforming to a code of ethics.”

I have worked to perpetuate the profession, empower the membership, mentor the ascending and developing professionals, and instill a philosophy of sustainable excellence about the worth and necessity of our ASCLS membership. I have been encouraged by our members’ commitment to ASCLS.

I have also had a phenomenal Board of Directors who are dedicated and committed to this organization. Everyone without exception has given tirelessly of their time and talents in their respective positions to the advancement of this Society. I am encouraged by the true loyalty, devotion, and allegiance of our ASCLS members who continue to volunteer to work on committees/forums, task forces, and other special projects. Thank you for what you have done and what you continue to do for this organization. I pledge my support and assistance to President Cindy Johnson in her presidential year, and I look forward to joining the ranks of the ASCLS past presidents.

Roslyn McQueen is a research doctor at Hurley Medical Center in Flint, Michigan.


Floyd Josephat, EdD, MT(ASCP)

The clinical education practicum serves as an intricate connector in our journey from the classroom curriculum to real work responsibilities. It has become a key component in both hospital and university-based clinical laboratory science programs. This key component in the curriculum of our profession is sometimes overlooked. However, it is becoming more visible as our profession continues to grow and people begin to recognize the value in what we do.

Clinical laboratory science preceptors work to make sure CLS students get the most current laboratory training experiences that are needed to function in today’s scientific work environment.

Connecting what we are learning in the classroom can be challenging because of the complexity of some subjects, but it is still an important way of integrating classroom learning objectives into real work settings. A clinical practicum can provide the opportunity for students to observe clinicians in practice, apply their classroom knowledge, and develop ethical and moral decision-making skills in providing patient care as they begin to assume their professional identity (Romig, Tucker, Hewitt, and Maillet, 2016).

Clinical Training Overview
Clinical training has also been defined as “the practice of assisting a student to acquire the required knowledge, skills, and attitudes in practice settings, to meet the standards defined by a university degree structure or professional accrediting/licensing board” (Rose & Best, 2005, quoted in Romig et al., 2016, p. 244). While classroom education and controlled laboratory and simulation experiences provide essential background knowledge and basic skills, clinical training or practicum deliver the most value to students and to the hospitals and other clinical settings that will employ them after graduation (Sepples, Goran, & Zimmer-Rankin, 2013).

Clinical training involves placement of a student at a clinical site under the supervision of a practicing clinician serving as a preceptor. This model provides the student with real-life experiences that work toward developing students into confident and competent practitioners. Some of the goals of clinical training are to help the student:

  • Apply theory and learning to clinical practice,
  • Orient to professional behaviors and attitudes in the clinical workplace,
  • Hone and refine, through observation and repetition, the skills required for clinical practice,
  • Develop communication and collaboration skills to function within an interprofessional healthcare team, and
  • Develop skills in critical thinking, problem-solving, and time management in the fast-paced clinical setting (Romig et al., 2016).

The Role of Site Preceptors
The training of future clinical laboratory science (CLS) students depends heavily upon the availability and expertise of site preceptors. Some of these preceptors are highly trained individuals in specialty areas such as hematology, immunohematology, microbiology, chemistry, coagulation, immunology, and molecular diagnostics. They are also classified as non-faculty but are practicing clinical laboratory scientists at the clinical site.

Their purpose is to provide a one-on-one clinical experience in each of the sub-specialty areas with the student. Students develop clinical skills and competencies that are gained from practical experience working with the preceptors and other members of the healthcare team. These are valuable training experiences that are given to students freely and on a continuous basis. Clinical laboratory science preceptors work tirelessly to make sure that CLS students get the most current laboratory training experiences that are needed to function in today’s scientific work environment.

Some of their responsibilities include developing new clinical practicum experiences, revising existing curriculum, teaching, and serving on various committees. Again, as mentioned earlier, these are additional duties to their day-to-day responsibilities. In addition, clinical preceptors are held at a high standard because of the nature of our profession. Our profession is built on quality and accuracy. Therefore, clinical laboratory science preceptors have to be very competent in their own knowledge of the various clinical laboratory subjects to be able to teach students and to integrate their classroom experience with their clinical rotation.

“Clinical sites must value their preceptors and make every effort to obtain the resources needed to support their clinical laboratory scientists serving in that capacity.”

Professional Development
To be effective as a preceptor, and in the training of clinical laboratory students, it is imperative that preceptors remain current in their laboratory education. One way to remain current is to attend professional conferences. These conferences provide a wealth of educational resources to help develop and sharpen one’s teaching skills. Many individuals who serve as preceptors are motivated by a desire to teach and to prepare the next generation of clinical laboratory scientists. However, precepting students requires both time and resources, especially monetary resources to attend professional development opportunities such as ASCLS or ASCP conferences to improve on their teaching skills.

The current compensation model for preceptors does not include reimbursement for precepting and teaching, or for professional development. Clinical preceptors often rely on their own resources to travel to these various conferences. Clinical sites must value their preceptors and make every effort to obtain the resources needed to support their clinical laboratory scientists serving in that capacity.

The growth of the allied health professions has created challenges in education and training. One major concern is the number and quality of preceptors working with students in community health settings. The supply of preceptors has been shrinking, and this shortage has become a significant issue for health professions schools. Many have reported that preceptors are dropping out, and the schools cannot offer sufficient professional development, recognition, support, or financial rewards to entice them to stay (Beck Dallaghan et al., 2017; Rokusek, 2016).

The clinical laboratory science profession is dependent on these valuable professionals serving as preceptors who are committed and dedicated to training and educating CLS students. Many programs are finding ways and opportunities to identify resources of their own because they recognize the value of the preceptor. Some opportunities may include writing grants to help secure funding to send preceptors to professional development conferences. Also, being an advocate at the clinical placement site for additional incentives and resources that can help send these valuable individuals to conferences and workshops would mean a great deal to them and help retain them as preceptors for years to come.

Lloyd Josephat is program director for Clinical Laboratory Science and Clinical Pathologist Assistant Programs at the University of Alabama at Birmingham.

If you're interested in this topic, join the ASCLS Education Scientific Assembly.



A histotechnician embeds patient tissue into a mold.
Photo credit: Ilka Cole
A histotechnician uses a microtome to cut samples of patient tissue.
Photo credit: Tech Sgt. Liliana Moreno

As medical laboratory professionals, many of us probably work, or have worked, in close proximity to a histology (pathology) lab. You may have wondered, what exactly happens within a histology lab and who works there? I worked as a medical laboratory scientist (MLS) for several years and was unable to answer this question with any clarity or confidence. It was not until I completed a histology program and was certified as a histotechnologist (HTL) that I truly understood and appreciated the field.

This article will introduce the histotechnology profession by describing the general tasks of an HTL or histotechnician (HT) and briefly touch on the current issues within the profession. My goal is to build on the collaboration between the histotechnology and medical laboratory fields, and perhaps initiate a relationship between the histology and medical laboratories within your workplace.

Duties of a Histotechnologist and Histotechnician
Tissues that are analyzed in the pathology lab can range anywhere from large surgical specimens to small biopsies only millimeters in length. Either way, every specimen needs to immediately be placed in a fixative, which is most often a formalin solution. Fixation preserves the architecture of the components within the tissue and is essential for optimal analysis.

Upon specimens entering the laboratory they are assigned an accession number, much like an MLS laboratory specimen. Initially, the specimen is examined and described macroscopically by a trained professional, most often a pathologist or pathologist assistant (this is referred to as grossing). Larger samples are cut into smaller pieces (about the size of a coin) and placed into tissue cassettes for microscopic preparation. At this point, the HTL/HT typically takes over and completes four main tasks: processing, embedding, microtomy, and staining.

Processing involves ultimately removing the water from the fixed tissue and having it infiltrated with a wax which makes it easier to cut in thin slices. To do so, the tissue is moved through a series of chemical solutions. This step is largely automated, but the HTL/HT is responsible for setting the different incubation times, ensuring the chemical solutions are rotated and filled properly, as well as several other maintenance responsibilities.

Once the tissue is processed, the HTL/HT removes them from the cassette and embeds the tissue. At this step, the tissue is placed in a mold, completely filled with a warm wax (liquid form). The wax used most often is paraffin and is the same wax used to infiltrate the specimen during the last step of processing. During this embedding step, it is crucial for HTL/HTs to orient the specimen correctly in the mold. Incorrect orientation will make it difficult or impossible for the pathologist to determine a diagnosis/result.

Once the specimen is properly oriented, the mold is immediately cooled. Consequently, the wax hardens which forms a nice foundation around the tissue making it easier to cut. The excess wax is removed, and the resulting tissue block is then ready for microtomy. The blocks are placed within a specialized tissue slicer, called a microtome. Trained HTL/HTs roughly cut into the tissue and make sure all areas of the tissue are exposed before cutting thinner slices for analysis. Once the tissue has been faced enough, the HTL/HT cuts the tissue at the recommended depth (usually 4 μm), and a ribbon is formed between each slice. The ribbon is placed in a water bath to decompress and then it is placed on a slide. Slides are then allowed to dry and are ready for staining.

Almost every tissue that goes through the histology lab will have a routine hematoxylin and eosin (H&E) stain performed on it. The hematoxylin will stain the nuclei blue whereas the eosin will stain the cytoplasm pink. Other tissue structures will stain different hues of the eosin, making them able to be differentiated as well. The H&E stain provides a nice way to analyze the architecture and layout of the cells within the tissue and usually enables the pathologist to answer the questions he or she needs to make a diagnosis. However, sometimes more testing is needed.

Most histology labs contain several “special stains” to help the pathologist confirm a particular diagnosis. For example, one of the more common special stains performed is a trichrome stain, which can help differentiate between smooth muscle and collagen and helps detect cirrhosis. Some special stains can detect microorganisms like fungi or bacteria. In fact, a Gram stain is one of the special stains that can be performed on fixed tissue. In total, an HTL/HT is trained to understand and troubleshoot up to 50 different special stains.

“[Histology] truly is a good mix of hands-on work, automation, and a lot of troubleshooting. The field is often referred to as both an art and a science.”

This article does not do the histology profession justice by any means, but hopefully you have a better understanding of what an HTL/HT does on a day-to-day basis. It truly is a good mix of hands-on work, automation, and a lot of troubleshooting. The field is often referred to as both an art and a science.

To become an HTL/HT, one can become certified as a histotechnologist (HTL) or a histotechnician (HT). The HTL, similar to the MLS, would be the four-year degree; the HT, similar to the MLT, would be the two-year degree. Certification through ASCP can be obtained either by going through a National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)-accredited program or one year of on-the-job training with the proper amount of academic background.

Staff-shortages, lack of recognition, licensure … sound familiar? The issues within the histology lab are pretty much identical to the medical laboratory field. Vacancy rates are increasing and are currently at about 8.5 percent.1 Licensure and required certification remain a struggle within the histology profession. Currently, only four states have licensure requirements for HTL/HTs. There are several other states that are trying to get licensure approval.2

Given the similarities of their professional issues, it only makes sense for histology and medical laboratory fields to collaborate. In 2018, the National Society of Histotechnology (NSH) joined ASCLS and several other lab organizations at the annual Legislative Symposium for the first time. This is a great way to initiate a stronger relationship between these two fields and organizations. Hopefully this can initiate collaboration at the state and local levels. I encourage ASCLS leaders to reach out to their nearby NSH state and regional chapters.2 Most importantly, in your workplace, don’t be afraid to simply stop by the histology lab and say hello.


  1. Garcia E, et al. The American Society of Clinical Pathology’s 2018 Vacancy Survey of Medical Laboratories in the United States; American Journal of Clinical Pathology 2019; 152(2): pp 155-168
  2. National Society of Histotechnology

Zac Lunak is assistant professor, medical laboratory science, at the University of North Dakota School of Medicine & Health Sciences in Grand Forks.


Joshua J. Cannon, MS, MLS(ASCP)CM, ASCLS-PA President

This redesigned website serves as a resource for students or recent graduates who are interested in, but know very little about, careers in the laboratory sciences.

Have you visited the new and improved Beginning in March of 2018, I had the pleasure of working with two ASCLS colleagues—Lezlee Koch and Susie Zanto—to redesign, a website housed under the Coordinating Council on the Clinical Laboratory Workforce. This website was initially created to serve as a resource for high school students who were interested in, but knew very little about, careers in the laboratory sciences. We are happy to announce that the new and improved (LSC) is live!

Promoting All Laboratory Professions and Recruiting New Laboratorians
LSC is not only a resource for careers in clinical pathology (e.g., medical laboratory scientist) but also anatomic pathology (e.g., cytotechnologist, histotechnician). It also covers lesser known careers, such as a laboratory information systems administrator, and provides information for careers in public health, industry, research, and education.

Questions such as, “What is laboratory science?” and, “Is laboratory science right for me?” are answered. Although the website originally had a target audience of high school students, we felt there should also be information for college students who are undeclared or students who may be graduating with a general health or science degree and want to know what opportunities are available to them.

The important role laboratory professionals play in healthcare is discussed, along with a brief history of laboratory science. Students learn some of the personality traits and skills that are helpful when working in the laboratory sciences, and the site details next steps to take if they believe a laboratory science career is the right fit for them. Students are encouraged to meet with their guidance counselor, science teacher, or health professions advisor; find a personal or professional mentor; and ask for a tour of the laboratory facilities at their local hospitals.

Education pathways, certification, and licensure are discussed, and students are able to easily search for programs they’re interested in that are accredited by the National Accrediting Agency for Clinical Laboratory Sciences or Commission on Accreditation of Allied Health Education Programs.

“We ask that you send [] to guidance counselors at your local high school and advisors at the program you graduated from or are currently enrolled in. And share the site with friends and family who may have an interest in or know someone who may be interested in laboratory science career opportunities.”

Looking for Personal Stories
There are many medical laboratory professionals featured on LSC who share their journey to becoming a medical laboratory professional. We are currently looking to feature individuals outside of the clinical laboratory who showcase diversity in the laboratory sciences. If you know someone who may be a good fit, please contact me at

We ask that you send LSC to guidance counselors at your local high school and advisors at the program you graduated from or are currently enrolled in. And share the site with friends and family who may have an interest in or know someone who may be interested in laboratory science career opportunities.

Please visit to learn more. If you have any suggestions, feel free to contact me.

Joshua J. Cannon is instructor and education coordinator in the Department of Medical Laboratory Sciences & Biotechnology at Thomas Jefferson University in Philadelphia.