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Clinical Laboratory Science: An Historical Perspective by By Lucy J. Randles, MA, CLS/CLDir Owner, Health Care Advantage

The following historical perspective is provided in order to lay a foundation for the proposed final step in the CLS career ladder, the Clinical Laboratory Practice Doctoral Degree.

1900-1927

In 1919, accreditation standards of the American College of Surgeons required hospitals to have clinical laboratories. Prior to 1930, pathologists did all of the laboratory tests of the time and interpreted the results for doctors. When epidemic outbreaks of typhoid fever, tuberculosis, poliomyelitis, pneumonia and diphtheria occurred, pathologists were unable to keep up with all of the needed laboratory testing, so bacteriologists, the first laboratory technicians, were hired. They worked in hospitals and public health laboratories. Because the work was monotonous, bacteriologists began doing simple blood chemistry plus serological tests and urinalysis.

Since wages were low and opportunities for advancement were few, laboratory work was considered an occupation for women. Dr. John Kolmer noted in 1918 that young women (rather than young men) were more successful performing laboratory work because of "their patience, attention to details, cleanly habits and their ability to concentrate."

During World War 1, the need for clinical laboratories and technicians to work in them increased and the Army and the Navy created medical departments. Bacteriologists and technicians left hospitals and went to military laboratories. This resulted in a shortage of laboratory workers in hospitals. Hospitals responded by expanding opportunities for technicians and training them to do the laboratory procedures specifically performed in their hospitals.

According to a 1927 volume, Occupation for Women, edited by Hatcher, there were two levels of laboratory personnel: (1) the technician who performed simple analyses and reported the results to physicians, scientists or someone in charge, and (2) a higher professional type who had two years of premedical course work. To become a "Chief Laboratory Technician," one was expected to have earned a doctoral degree.

Initial training programs varied according to the needs of the hospitals. There were no standards or minimum educational requirements. As the number of laboratories grew, the numbers of technicians needed to staff them also grew. Hospitals and schools admitted students into three to six month training programs, charged exorbitant tuition, and used students for "cheap labor." Fortunately, because of the need for adequately trained technicians who could work in any hospital laboratory setting, structured educational programs began to emerge. The first Bachelor of Science Degree with a specialization in Medical Technology was awarded in 1922 by the University of Minnesota.

1928-1945

The clinical laboratory science profession grew rapidly between these years and became more widely recognized as an occupation distinct from pathology. The American Society for Clinical Pathology (ASCP) recognized the need to establish standards for training technicians and, in 1928, the ASCP Committee on the Registration of Technicians recommended establishment of the Board of Registry (BOR). That year 350 applicants applied for ASCP BOR certificates, but it wasn't until 1930 that the BOR certified its first Laboratory Technicians. Certificants were required to have a high school diploma, one year of didactic work in the basic sciences, and six months of laboratory experience. Applicants who met the criteria were automatically given a BOR certificate of registration.

The BOR classified laboratory personnel as technicians and technologists. Medical Technologists were required to have earned a university degree with at least one year of basic sciences and one year of practical experience in a recognized laboratory. They also had to demonstrate service to laboratory medicine through research, teaching and devotion to the laboratory technical work. Accepted applicants were elected by the BOR and had to receive a unanimous vote in order to be registered as Medical Technologists.

A 1930 BOR survey of 137 technician training programs identified programs from two months to two years in length that were housed in a variety of settings. This data resulted in specific recommendations to training/education programs. Criteria for hospital programs were much more detailed and difficult than the criteria that applied to colleges and universities.

In 1933 the BOR raised minimum registration requirements for technicians. They became one year of college, which included eight Semester Hours of Biology and Chemistry and 12 consecutive months of clinical training. Registered nurses could substitute their nursing diploma for the college coursework. Applicants were required to take a written and practical exam at their place of employment and meet personal qualifications based upon an interview. The written exam (11 essay questions) counted 25 percent, the oral and practical exam 50 percent, and the assessment of personal and psychological attributes counted 25 percent. The first List of Approved Schools was published by the BOR in 1933. There were 29 technician programs, two colleges that offered degrees, and three post graduate programs. In 1934, the BOR required two years of college. In 1936, the BOR replaced the title, Laboratory Technician with Medical Technologist.

In 1942, the American Medical Association's Council on Medical Education, with hospitals and the ASCP, jointly announced that only training programs in hospitals would be recognized as approved schools and those colleges and universities that had been previously been recognized could only be recognized as academic affiliates of BOR approved schools.

The kinds of things that laboratory technicians did and the competencies they needed were not well defined until after WW II. Because of the requirements of the Army and Navy for recruits to have physical exams and all military personnel to have periodic exams, the number of laboratory test orders increased. Also, war casualties and epidemics among soldiers overseas resulted in civil service jobs for civilians in military hospitals.

In 1932, 25 medical technicians met at a Chicago ASCP meeting to discuss the formation of a professional association that would represent the interests of medical technicians. In 1933, 42 charter members of the association accepted the bylaws of the American Society of Clinical Laboratory Technicians (ASCLT) and the status of laboratory technicians began to improve. Initially, membership required certification by the ASCP BOR. In 1936, ASCLT incorporated in the state of Michigan, and became the American Society for Medical Technology (ASMT). That name change was to project an image of a higher level professional and to more clearly differentiate between technicians and technologists. ASMT held its annual meetings in conjunction with ASCP and AMA meetings to enhance cooperation between physicians and technologists. In 1939, ASMT enabled states to become ASMT affiliate organizations, and Texas was the first state to affiliate.

In 1939, ASCP was unwilling to recognize a group of commercial schools and a group known as the American Medical Technologists (AMT) was developed. Thus an accrediting body, registry and professional association were formed. The AMT copyrighted the designation "MT," and ASCP consequently changed its credential to MT(ASCP)

In 1934, the Bulletin of the American Society of Clinical Laboratory Technicians was first published. Today it is a journal known as Clinical Laboratory Science.

Part 2 of this article will appear in the Volume 91 issue of NAACLS News.

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