The Progression of Academic Standards in CLS/MT

Summary of ASCP requirements for MT(ASCP) –which was the ONLY level of practice certified until 1967 (see below) – based on series Tracing our Roots by Virginia Kotlarz in CLS journal, 1998-2000.

Research has not determined the exact year in which the BS became required but it is suggested that it was 1967.  Once 3 years of college was required, many people were earning the BS in 3+1 programs.  This is not documented, but it is possible that ASCP was actually behind the trend, changing to BS only after it had become standard in the profession. 

 These changes to increase academic requirements were always implemented by ASCP BOR based on the feeling that additional education was needed to perform the job.  Early on this was also an effort to discourage/eliminate the AMT proprietary programs and even academic programs, maintaining just hospital-based programs under pathologist control.  By enhancing the role of MTs, pathologists also enhanced their own role as someone supervisory to such highly educated people.

 When the 3-year requirement was first implemented, the addition of the year of clinical did not always result in a BS.  It took some time for 3+1 programs resulting in BS to emerge.  Academic institutions had to be convinced of the college-equivalency of the clinical experience and indeed, up-grading of those experiences was needed.

 It is important to note, that the close relationship of BOR to ASMT throughout this time, and with ASMT representation on BOR even after ASMT split off from ASCP, the upgrading of credentials occurred with representation of the professional organization.  And of course, ASCP has always felt it could speak for medical technologists anyway.

 ALSO note that there were always programs with requirements higher than what the certifying body required.  Minnesota has been granting a BS for more than 75 years.

Other Levels of Practice

 1. Clinical Laboratory Assistant – emerging in the early 1960s.  Training programs were already in existence in the 1950s.  Model training program established by ASCP-ASMT (remember ASMT was an off-shoot of ASCP and not yet fully separate) in 1962.  In 1963, BOR recognized graduates of that program.  Certification examination implemented in 1967.

2. Medical Laboratory Technician – arose from federal funding to junior colleges in the 1960s to promote allied health occupations.  American Association of Junior Colleges (AAJC) approached ASCP-ASMT for help in developing technician programs.  Program planning guide published in 1969 and first MLT exam offered that same year.  An MLT committee established in 1971 to define this level of practice and make recommendations to the Board of Schools and the Board of Registry.  In 1973, an ASMT position paper defined the 3 levels of practice.

Other professions

Histotechnology

 (The following is from Frieda Carson who has been a leader in HT.)

 I believe that the first HTL examination was given in 1980 and was initiated primarily at the request of the Histotechnology Committee of the Board of Registry.  A lot a homework was done by the committee justifying the two levels.  As you know there was a 3 year grandfather for this exam allowing those individuals without a degree and with 8 years of experience to take the exam.  Since then only individuals with a Baccalaureate can take the exam.

The NSH has wanted the educational level for the Histotechnician to be an associate degree for a long time.  In 1978, the BOD of the NSH adopted a position paper on phasing out "on-the-job" training, but of course we never got enough schools to make that possible.  In 1988, the BOD adopted a position paper "Recommended Educational Guidelines" recommending an associate degree with course work in chemistry, biology, and math.  In 1993, NSH began strategic planning, and the first goal adopted was to "Approach the BOR requesting that the high-school route and 2 years of experience" be phased out.  As you know we did that in 1999 and were successful.  Some of the reasons given to the Board of Registry were:

1) the increasing complexity of the field and the fact that many HTs were expected to perform these more complex tests in many laboratories,

2) High school graduates frequently do not have the science background to understand the theory of these more complex tests and to effectively problem solve.

3) CLIA permits HTs with an associate degree to

perform gross dissection provided they are appropriately trained.  It is not fair to certify individuals who cannot perform all tasks falling within the purview of a HT, nor is it fair to future employers that might want a histotechnician to perform those tasks.

4) There is a significant statistical difference in the pass/fail rate of the high school +2 years of experience route examinee and the examinees coming by either of the other routes.  This probably means that the majority of high school plus 2 years of experience candidates are not adequately prepared for even the more routine tasks in the laboratory.

 5) The certification exam was 51 years old (first given in 1948) and the requirements had not changed in that time, while those in other fields such as clinical laboratory science/medical technology and cytotechnology changed to reflect the changes in laboratory medicine.

 Remember we are talking about career entry and what is needed to be minimally competent at career entry and not after years of experience, or what an employer should expect of someone just entering the field.

 Note:  Assuming a certifying exam is job-related (i.e. based on job analysis), then the failure of individuals with lower level credentials compared to those with higher level credentials would seem to be a nice objective way to determine what credential is needed.

 Pharmacology

The upgrading to PharmD has been a 50 year process.  Notably, the bodies supporting it have been the professional association and the association of schools of pharmacy (we have no analogous organization in CLS/MT).  These put pressure on the certifying board and accrediting agency.  So, the impetus came from the profession.

 Additional Historical Note

Another Kotlarz article describes a personnel shortage after WWII. (CLS 11(6): 339-345,1998)

 In asking the question of the impetus and process by which the educational requirements rose over the years, the article cites BOR and ASMT surveys in the 1950s that demonstrated substantial support (e.g. 77% in one survey) from certified MTs, pathologists medical directors, and ASMT members (all of whom were ASCP certificants) for raising the college requirements to 3 years.

 The BOR and ASMT had to go to the AMA for approval to raise the requirement and they did so in 1958. However, it was not in effect until 1962, nearly ten years after the BOR survey first supported the increase.

 One may conclude that the pertinent issues are 1) the professionals supported the change and 2) the professional association supported the change and BOR implemented it, but only after many educational programs were already implementing it.

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