A STUDY OF PROFESSSONAL At‘éD EDUCATZONAL REQUEREMENTS FSR MEDEGAL TECHNOLOGiST-S IN THE Clflii‘étééNG ARD EVOL‘ ENG ART OF CUMCAL LABORATORY MEDICINE Dissertation for the Degree of Ph. D. MECHIW STATE UNIVERSE“! GLADYS M. ’CHOMAS 1974 This is to certify that the thesis entitled A Study of Professional and Educational Requirements for Medical Technologists in the Changing and Evolving Art of Clinical Laboratory Medicine presented by Gladys M. Thomas has been accepted towards fulfillment of the requirements for Ph.D. degree in Higher Education Major professor 4-25-74 '- --‘__.—-_.,. . a: 4 I Mute—"W _ __ Th technolos technique and adjus was devel. dEtem’line ABSTRACT A STUDY OF PROFESSIONAL AND EDUCATIONAL REQUIREMENTS FOR MEDICAL TECHNOLOGISTS IN THE CHANGING AND EVOLVING ART OF CLINICAL LABORATORY MEDICINE By Gladys M. Thomas This study investigates the present and future needs for medical technology education. An expansion of new and better equipment and techniques in medical services has required new skills, functions and adjustment of work roles of medical personnel. The questionnaire was developed to elicit current thinking about the curriculum, and to determine skills and requirements for future medical laboratory methodology. Population and Sample The sampling population was drawn from five North Central States: namely, Indiana, Illinois, Michigan, Ohio and Wisconsin. There are a total of 190 AMA approved hospital Schools of Medical Technology in these states. The list of AMA approved schools was obtained from the Board of Schools, American Society of Clinical Pathologist (ASCP). A random selection of 35 schools for the study was made from the total number, utilizing standard random tables. The hospital-based programs are chosen to determine if educators, prOSpective employers and students ASP ' of men prepar. (dapart and two utilizir of each . technolot informatic recommenda apflear unde fine P€rcente Square Value (~9- I N ere are ST “1 3“ r h 1” QEDEra] ,. M . The rv "\ N ( Gladys M. Thomas of medical technology have found academic experiences an adequate preparation for entry into the profession. The sample is composed of education coordinators, supervisors (department heads or section chiefs) of clinical laboratory divisions, and two medical technology interns from the selected programs. By utilizing the three groups in existing clinical programs, the reSponses of each grOUp reflect experiences at different levels of the medical technology curriculum. Analysis Procedure The research study is a descriptive analysis which provides information about the strengths and weaknesses of the curriculum and recommendations for change. The presentation and discussion of data appear under the main headings: l. The Medical Technology Curriculum: Present and Future 2. Specialization and the Medical Technology Curriculum 3. Continuing Education and the Medical Technologist The percentage of reSponses appears in contingency tables and the Chi Square values are provided. These values assist in determining if there are significant differences in the reSponses of the three groups. Findings and Conclusions The reSponses to questions concerning the medical technology curriculum such as, basic course requirements and clinical study, in general, conformed to the basic guidelines of the Board of Registry, ASCP. The majority of the reSpondents view medical technology as a .a_,§} “Lil-rug ‘ . -. 1‘ VECOTT‘. icatic but the CUFriCu; method f as the be in the pm resPondent EXISIEG. t EdL medical t C work Obj6ct% aT‘EStn-ct]. an in‘depth SPEClal Gladys_M. Thomas four year curriculum in which three years are allocated to academic study and the fourth year to clinical. The exceptions in course requirements are that biochemistry, genetics,and physics should become requisite courses rather than highly recommended. Immunology and instrumentation are highly recommended as elective courses. Courses in management and commun- ication skills are also recommended as electives. A change in the work roles of medical technologists is recognized but the majority do not agree to Specialization in the undergraduate curriculum. Post graduate education was suggested as the best method for pursuing Specialty education. The majority of subjects viewed continuing education programs as the best means for maintaining an acceptable level of competency in the profession. The continuing education programs offered at the reSpondents' institutions did not either exist or, if these programs existed, the quality ranged from good to poor. These programs were not used as a means of job advancement. Recommendations Education has provided the direction when the professional medical technologist needed a definition of requirements to meet work objectives and goals. The crucial issue is that the curriculum must not emphasize a restrictive and SUperficial kind of professional education, but an in-depth scientific knowledge which can only be provided through Specialization. The information explosion and technical advances '5. .. <— - ' , ,1":ng ‘M‘lt'U" m‘ww'h'h _\ :7. )__~—_—_—___ in m of tf Speci, compet techno ities t Gladys M. Thomas in methodology and instrumentation have not resulted in a removal of the technologist, but are requiring a move toward educating more Specialists earlier in the training process. Association and competition with other professional groups forces the medical technologist to seek quality education which will provide Opportun- ities to meet new challenges more effectively. A STUDY OF PROFESSIONAL AND EDUCATIONAL REQUIREMENTS FOR MEDICAL TECHNOLOGISTS IN THE CHANGING AND EVOLVING ART OF CLINICAL LABORATORY MEDICINE By ( Gladys M? Thomas A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree Of DOCTOR OF PHILOSOPHY Department Of Administration and Higher Education 1974 DEDICATION This thesis is dedicated to my mother, Ruth, my brother, Pompey, and dear friends, Frances and Lucille. You all are a constant source Of strength and encouragement. ii ACKNOWLEDGEMENTS I wish to express my sincere appreciation to Dr. William E. Sweetland for his patience, encouragement and guidance throughout the course of this study. My gratitude is extended to the members of my guidance committee, Dr. Loren L. Hatch, Dr. Vandel C. Johnson and Dr. Harry Perlstadt. A special note of thanks is due to Dr. Lawrence Lezotte for his valuable advice and assistance. I should also like to acknowledge the aid and constructive criticism of my colleagues and friends, Adah Ruth Sutton, Dr. Edith Steward, Dr. Carolyn Teixeira, Shirley Weller, B. J. Schray, Myrtle Yoshinaga and the staff of the Department of Pathology, E. w. Sparrow Hospital. During the course of this study, I was supported in part by the Administration of E. w. Sparrow Hospital. A special thanks is extended to Dr. N. E. Maldonado, Director of the Department of Pathology, for his support. TABLE OF CONTENTS Page LIST OF TABLES . . . . . . . . . . . . . . . . vii LIST OF APPENDICES . . . . . . . . . . . . . . x Chapter I. INTRODUCTION . . . . . . . . . . . . . . l Principle Issues . . . . . . . . . . . . 1 Need for the Study . . . . . . . . . . 4 Purpose of the Study . 6 Statement Of the Problem Description Of Responsibilities of Laboratory Groups . . . . . . . . . . 9 Research Questions . . . . . . . . . . . l0 Methodology . . . . . . . . . . . . . 12; Overview . . . . . . . . . . . . . . 13; II. REVIEW OF THE LITERATURE . . . . . . . . . . 15 Introduction . . . . 15 Historical Development Of Medical TechnOlOgy. . . 16 Educational Requirements for Entry into Medical Technology . . . l8 The Recruitment and Education of Students for Medical Technology . . . . . . . . . . 20 Supportive Personnel . . . . . 23 Impact Of Technology, Legislation, and other Social Trends . . . . . . . . 26 Technology . . . . . . . . . . . . . 26 Legislation . . . . 28 The Junior College and Health Education . . . 29 Equivalency and Proficiency Exams . .. . . . 30 Smmmy. . . . . . . . . . . . . . M III. DESIGN OF THE STUDY . . . . . . . . . . . . 32 Introduction . . . . . . . . . . . . . 32 Population . . . . . . . . . . . . . . 32 Sample . . . . . . . 33 Characteristics of Sample POpulation . . . . . 34 DevelOpment Of Instrument. . . . . . . . . 35 iv Chapter IV. V. Description of Instrument . Data Collection Procedures Design Of the Study . Underlying Assumptions . . . Statistical Analysis of Data . Summary . . . . RESULTS AND DISCUSSION OF THE STUDY Introduction . Underlying Assumptions Of the Study . The Medical Technology Curriculum: Present and Future Medical Technology Curriculum Planning . . Academic and Clinical EducatiOn . . Academic Course Work and the Medical Technology Curriculum . Clinical Study and the Medical Technology Curriculum Curriculum Planning . Summary. . . Specialization and Medical TechnOlogy . Why Specialization? . The Undergraduate and Specialization . . Job Opportunities and Medical Technology . Medical Technologists and Supportive Personnel . . . . . . Swmmy. . Continuing Education and the Medical Technologists . . . Definition of Continuing EducatiOn . Development of Continuing Education Programs for Professionals Smmmy. . The Future of the Medical Technology Curriculum . Core Curriculum . Automation in Medicine . Medical Advances in Patient Care. Types Of Work Roles . Methods Of Teaching . Summary . . . . SUMMARY AND CONCLUSIONS Summary . Findings Conclusions Discussion . lO9 Chapter APPENDIC BIBLIOGR. Chapter Page RECOMMENDATIONS . . . . . . . . . . . . . llO Implications for Future Research . . . . . . . ll4 APPENDICES . . . . . . . . . . . . . . . . . . llS BIBLIOGRAPHY . . . . . . . . . . . . . . . . . T49 vi Table 10. 11. 12. 13. 14. 15. 16. LIST OF TABLES Number and Percent of Participants Responding According to Group and Sex . . . . Highest Levels of Educational Attainment Types of Certification Principal Place of Employment Principal Job Classification Work Experience . Total Percentage of Questionnaire Return Required Academic Courses for Certification of Medical Technologists by the Board of Registry Total Time for Post-High School Education Of a Medical Technologist . . . . . Minimum Time for Academic Study Minimum Time for Clinical Study Commencement Of Clinical Education Plan Medical Technology Curriculum as Whole Academic and Clinical . Basic Chemistry and Physical Science Courses which are Considered Desirable as Pre-requisites to or for the Curriculum of Medical Technology Basic Biological Science Courses which are Considered Desirable as Pre-requisites to or for the Curriculum Of Medical Technology . . Recommendations for Future Academic Work vii Page 35 36 37 38 39 4O 44 50 52 53 54 57 58 61 65 66 Table l7. l8. l9. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. Appraisal Of Clinical Programs: Work Study . Appraisal Of Clinical Program: Student Laboratory Appraisal of Clinical Programs: Conventional Clinical Rotation . . . . Medical Technology Curriculum Planning List Of Course Suggestions for Medical Technology Curriculum . . . . . . . . Specialization and Medical Technology Specialization and Medical Technology: Year specialization should commence Need for different curricular emphasis for employment in clinical and non-clincial institutions . List Of Desirable Courses for the Employment in Institutions other than Hospitals . . . Positions and Degree Requirements: Percentage of Total Responses . Supportive Personnel Job Promotion and Educational Background Job Promotion and Technical Excellence Continuing Education and Job Promotion Quality Of Continuing Education Programs at Your Institution . . . Continuing Education and Post Graduate Education . Certification Background of Respondents Denoting Generalist or Specialist . . . . Description of Educational Program Respondents Years of Work Experience . viii Page 67 68 69 72 73 76 77 79 80 81 85 86 87 92 93 94 138 139 140 Table Page 36. Minimum Time for Academic Study . . . . . . . . . 14] 37. Minimum Time for Clinical Study . . . . . . . . . 142 38. Commencement of Clinical Study . . . . . . . . . 143 39. Appraisal Of Clinical Program: Work Study . . . . . 144 40. Appraisal of Clinical Program: Student Laboratory . . . 145 41. Appraisal of Clinical Program: Conventional Clinical Rotation . . . . . . . . . . . . . . . . 145 42. Medical Technology Curriculum Planning . . . . . . 147 43. Specialization and Medical Technology . . . . . . . 148 ix APPENDIX A. APPENDIX 8. APPENDIX C. APPENDIX D. APPENDIX E. LIST OF APPENDICES Letters Of Request for Participation to Sample Population . Questionnaire Follow-up Letter AMA Approved Schools . Tables Of Percentages by Category Page ll5 ll9 l3O l33 136 CHAPTER I INTRODUCTION Principle Issues Health care delivery systems have been criticized and, at times, condemned because of cost and lack of resources available to all members of our society. Medicare, Medicaid and prepaid health insurance plans have provided millions of new customers with an opportunity for health services and have also increased the demand for health personnel. Medical care has expanded in its scope from detection and prevention alone to include rehabilitation. Tne broad spectrum of patient care has forced all practitioners of the health care team to evaluate traditional patterns of patient care and respond to contemporary con- cepts and needs. Technological advances in medicine, such as automated, multiphasic testing instruments and computers, have accelerated the development of comprehensive health care programs for the community. These develop- ments have enhanced the quality and availability of health care by pro— viding physicians with broad data upon which to make a rapid diagnosis resulting in a decreased number of admissions and shortened hospital stays. The objectives of a comprehensive health care program are defined by Margaret Olendzki are: l. Identifying health problems. This procedure must Include In part, epidemiological techniques, discussion 2 of problems with community leaders, provision of medical examinations for people of the community. 2. Bringing the consumers closer to the providers of health care. This is accomplished by steering Clients to appropriate care and by persuading the professionals and para-professionals Of the health care team to become more community - or population oriented. 3. Experimenting or encouraging or facilitating differ- ent models of health care. 4. Solving environmental health hazards. This involves assisting in upgrading housing and occupational health standards. 5. Attempting to improve the whole system of health care delivery. One such modality which can be effectively used fOr patient information and follow- up is the computer. This would enhance the coordina- tion of medical services. 6. Adding to the body of knowledge. Additional medical information is gained for use in treating the whole patient. 7. Educating professionals, para-professionals and allied health personnel. These persons will be needed to provide, improve and develop further approaches to he used in comprehensive medical care.1 A vast increase in biomedical knowledge has led not only to the need for more providers of health care services, but has led to a need for highly trained teams of specialists. Amid the great flux of change, an improvement in the education and utilization of physicians and auxiliary personnel must occur. The complexities of health care delivery cause serious concern for educators Of medical and paramedical personnel to provide maximal training in order to cope with the demands of contem- porary society. 1Margaret Olendzki and Charles H. Goodrich, editors, "A Health Care Plan for East Harlem - Now", Annals of the New York Academy Of Sciences, Vol. 196, Art. 2, April 7, 1972, p. 58. 3 Simmons states that hospital service had become a great enterprise. In 1964 he reported that hospital service ranked sixth or seventh among the country's business investments in capital outlay for plant and equip- ment alone. Such an expansion of new and better equipment and techniques in medical services has required new skills, functions and adjustment Of work roles of medical personnel.2 Laboratory medicine is one specialty area which has demonstrated an enormous growth. Dr. Bradley Copeland writes: Our hospital was changing from 350 beds to 500 beds. Our laboratory was changing, and fast. No sooner had one change begun than several other changes followed in quick succession, giving me a helpless feeling similar to that Of trying to stop a moving automobile at a red traffic light only to find the brakeslnot working. Machines and events were not under my contro . He further states that: While Future Shock is imminent, it is not considered inevitable by Mr. Toffler, who suggests several strategies to prevent or cure the disease: (1) educational reform, (2) reinforcement Of the individual's sense of importance, (3) committee oriented control of future change. TO these, I would like to add two items: (4) identification Of changes which are needed now; (5) the search for existing models to combat Future Shock.3 The major concern of this treatise is the identification Of changes which are needed in medical technology education for the present and future years, and a search for a curriculum which might remain viable in a chameleonic art. .— 2Leo W. Simmons, Ph.D., and Virginia Henderson, R.N., M.A., Nursing Research: A Survey and Assessment, New York, Appleton-Century- Crofts, 1964, p. 284. 3Bradley E. Copeland, M.D., "Future Shock - A Present Reality in Pathology", Ward Burdick Award Speech, American Journal Of Clinical Patholog , Vol. 57, June, 1972, p. 700. Need for the Study Comprehensive health care is the key issue in planning and meet- ing the medical needs Of a community. Those needs may be defined in the following broad categories: 1. Prevention and early detection of disease, 2. Diagnosis of disease, and 3. Treatment of disease. Resources are very important for the achievement of comprehensive health care. Money, plants and equipment are valuable assets, but even more valuable are the involved personnel and their Skills. One area in the community hospital where technological advances have produced opportunities for performing better medicine is the clini- cal laboratory. The development Of automated instruments has made it economically feasible to perform biochemical screening profiles. Physi- cians can diagnose or evaluate therapy without long delays for results of analyses. If the concept of automation is viewed as an extension of intellectual and practical attainment, the future of medical care is expansive. Dr. James Whittico, Jr., states: It is only through such instrumentation, it is only through the modalities of computerization and techniques by which tests, and intricate examinations can be performed on a mass basis .... It is only through these techniques that we will be able to deliver adequate medical care to all people of our nation.4 For increased quality and quantity of laboratory services, these Objectives must he achieved: (1) delivery of uniformly high quality 4Warren Perry, "The Future Of Health Care: Conclusion", American Journal of Medical Technology, Vol. 36, March, 1970. 5 laboratory services to all members Of the community, (2) expansion of automated testing to provide excellent services at low costs, and (3) evaluation and interpretation Of clinical tests for rapid diagnosis 5 In summation, and effective therapy. Technological inventiveness is linked with man's work. It cannot cease unless man in his work ceases to be competitive and no longer tries to find easier and faster ways of performing his tasks. If he manages to take the heaviness out of work, he then feels the need to take the dullness out of it. The inventions that bring satisfac- tion in work are never sufficient to quench the thirst for still more invention to make work still lighter and more productive and the workday still Shorter. Invention makes work increasingly a knowledgeable activity for man and makes the machine more an instrument for his handling.6 The education and training requirements for approximately 22 health occupations range from a few weeks of on-the-job training for a nurse aide to 10 or more years of post-high school education and training for a physician. Many studies and innovations are taking place With respect to the education of health workers. The most serious problem with these studies and innovations is that they are isolated from the mainstream of medical practice and are not evaluated by involved pro- fessionals and employer groups.7 More specifically, the utilization Of 5Thomas D. Kinney, M.D., Chairman, The Mechanization, Automation, and Increased Effectiveness of the Clinical Laboratory, National InstTtutes Of Health, Bethesda, Maryland, DHEW Publication NO. (NIA) 72-145, 1971, p. 76 6Nels Anderson, Dimension of Work, New York, D. McKay Company, 1964, p. 125. 7Manpower Report of the President, 1970, Manpower Demand and Supply in Professional Occupations, (Reprint), Washington, D.C., Government Printing Office, 1970, p. 177. 6 allied health personnel for new and different clinical settings will demand a Change from traditional roles. The expanding variety of scientific knowledge applicable to health care problems makes it unlikely that traditional academic procedures will produce the needed skills. New concepts for training health specialists must soon be formulated and developed.8 Purpose of the Stgdy Medical laboratory workers are among the top four areas in which manpower requirements will increase very rapidly during the next ten years. Government and private studies predict that white collar jobs will occupy more than half the United States Labor force by 1980. A third of the jobs will call for professional or technical skills. One of the most promising occupations listed is the medical technician.9’10 It is the purpose of this study to define skills and determine requirements for present and future medical laboratory methodology. The following areas will be explored: 1. The educational requirements of the medical technologists due to technological develop- ments and the information explosion. 2. The changing work roles of the medical technolo- gists relative to the growth and deveTOpment Of clinical laboratory medicine. 3. The need for postgraduate and continuing education for horizontal or vertical job advancement. ‘fifi.-- --- . -- ~._.. .- a ,, .— .-.—-—-- --—-—.- 8Kinney, The Mechanization, Automation, and Increased Effectiveness Of the Clinical Laboratory, p. 78. 9Hedley Donovan, editor-in-chief;"JObs for Tomorrow" Time Magazine, February 15, 1971, p. 70. 10Manpower Report of the President, 1970, Manpower Demand and Supply in Professional Occupations, p. 176 7 The trend in medicine shows itself not only in burgeon- ing demand for health care and in shortages of personnel in all traditional categories, but also in the emerging need for skills of new kinds and at new levels of compe- tence. The professional societies concerned with the provision of medical laboratory services have attempted to anticipate and prepare for some of these changes. It is increasingly evident, however, that many of the prob- lems of change confronting the laboratory will demand new approaches to education.1 Dr. Eli Ginzberg best summarizes the purpose Of this study as follows: "It is incumbent upon all leadership groups to make sure that you don't get stuck with the pattern that served you well in the past, but that you develop the flexibility to come out where it makes sense to come out at a decade hence."12 Statement Of the Problem There can be little doubt in the mind of anyone engaged in allied health education that this is a time of change, reassessment and revision. The major efforts Of those involved in training health care specialists have been directed toward improving the required educational and experi- ential training they wish their graduates to have. Curriculum development is important both in preparing students for career entry and in expediting vertical or horizontal career mobility. Perhaps the major problem is the creation of a curriculum which remains functional. This study will investigate present and future needs for 11Carol Kahler, editor, Guide for Program Planning: Medical Labora- tory_Technician. Washington, D.C., American Association of Junior Colleges, 1969, p. 7. 12Eli Ginzberg, Keynote Speech at the Manpower for the Medical Laboratory Conference, October 11-13, 1967. Washington, D.C. 8 medical technology education in the context of the developments in the comprehensive health care framework. Most hospital-based educational programs are approved by the American Medical Association (AMA). The AMA delegates authority to the professional organizations to act as certifying agents. The certifying agent for the certified laboratory assistant, medical laboratory technician and medical technologist is the American Society of Clinical Pathologists (ASCP). and American Society of Medical Technologists (ASMT). The certifying agent for the doctorate degree scientist may vary, such as, the American Board of Clinical Chemistry, American Board of Microbiology, National Registry Of Microbiologists and so on. The certifying agent for the pathologist is the American Board of Pathology. The certification category is dependent upon one's educational background and clinical training. A classification Of clinical laboratory practitioners and the res- pective education requirements for each competency level follows: 1. Certified Laboratory Assistant (CLA) requires one year of technical training beyond high school. The clinical training program is conducted in an accredited hospital laboratory. 2. Medical Laboratory Technician (MLT) requires two years training leading to the Associate of Arts or Associate of Science degree in the community college. 3. Medical Technologist (MT) requires four or five years post high school education. Students may meet the mini- mum requirement Of three years Of collegiate work plus one year of clinical internship. Upon completion Of this program a degree is conferred. Some stu- dents may have a Bachelor's degree and meet required course study then enter a clinical internship. 4. Doctorate Degree Scientist (Ph.D.) may spend vari- able lengths of time obtaining the doctoral degree granted by the university. 5. The Pathologist (M.D.) requires approximately thir- teen years beyond high school. This time is normally divided as follows: four years pre-medical education, four years in medical school for a medical doctor degree, one year of internship and four years resi- dency for specialist requirements. Although this study deals with the education of the medical technologist, the other categories cannot be totally excluded because of vertical mobility, closeness of the disciplines, and objectives of work requirements. Description of Re5ponsibilities of Laboratory Groups CERTIFIED LABORATORY ASSISTANT: Under supervision, performs the more routine serological, bacterio- logical, biochemical, hematological and related tests. Training is required in an accredited hOSpital. MEDICAL LABORATORY TECHNICIAN: Makes routine bacteriological, serological, hematological, biochemi- cal and related examinations; assists in the preparation of pathological specimens for examinations and in other procedures in a hOSpital or 10 health laboratory; performs related work as required in a semi-supervised environment. MEDICAL TECHNOLOGIST: Makes varied or specialized bacteriological, serological, hematologi- cal, biochemical and related examinations; assists in the preparation of pathological specimens for examinations and in other procedures. Works in supervisory, teaching and other related positions. DOCTORATE DEGREE SCIENTIST: Administers and Operates the clinical department of his specialty. Performs research, writes new procedures and teaches students of medical technology and medicine. PATHOLOGIST: Directs a hospital or health laboratory. Interprets, and makes diagnoses observed in disease states. Makes recommendations to clinicians and teaches persons involved in health care. Research Questions Education Of clinical laboratory personnel takes place in two differ- ent institutions, the colleges or universities and hospitals. Types Of clinical education formats in the hospital are: 1. CONVENTIONAL HOSPITAL-BASED LABORATORY: Rotation through clinical laboratories in a hospital where on-the- job clinical training and formal lectures are provided by the pathologists, clinical scientists, education coordinators, supervisors and medical technologists. 11 u’o f. 2. STUDENT CLASSROOM LABORATORY: Clinical education is provided in a student lecture room and labora- tory which is separated from a service laboratory. A service laboratory, such as a hospital laboratory, is used for approximately two months to supplement the program. 3. WORK-STUDY PROGRAM (COOPERATIVE PROGRAM): Academic course study is alternated with a paying clinical labora- tory job for a set period of time. The co-Op program is then followed by a year of clinical education in a hospital-based facility. TO obtain a Bachelor's degree five years instead of four are required. Each institution has its own responsibility in the development Of the student for his chosen career. Therefore, major consideration must be given to the following stages of the training of clinical personnel: 1. Complete education of candidates with recognition of Opportunity for postgraduate education and entry into the medical profession. 2. Technical training from accredited institutions. To effectively bring about innovations in the area of education and successful career or job entry, these questions must be answered: 1. How can students become well-rounded academically and also knowledgeable practitioners of a changing, evolving art? 2. How can the variable periods for training best be used? 3. What goals must be pursued? 4. How can these goals be achieved? 12 The following assumptions are made: 1. Present and future developments in clinical labora- tory medicine demand new approaches in creating a viable curriculum for clinical laboratory practitioners. 2. Scientific advances, consumer demands, and trends in medicine require early specialization. 3. Opportunities for continuing education must be estab- lished in order to keep up to date in laboratory medicine. Methodology Thirty-five schools of medical technology were randomly selected from the five north central states, namely, Illinois, Indiana, Michigan, Ohio and Wisconsin. A list Of AMA approved schools was obtained from the Board of Schools, ASCP. The schools were assigned numbers from 1 to 190. A table of random numbers was used to select the schools. Schools were not excluded because Of low enrollment. The enrollment varied from 3 to 60. Inferences are not made to all existing medical technology programs. Therefore, proportional allocation is not required. The number of schools chosen for this study is based upon the number required for large sample statistical analysis (N230). The large sample statistic applies when the number of the sampled population is thirty or greater. In the event that some programs were no longer in operation or failed to respond, five schools were chosen in addition to the thirty. Students of medical technology, education coordinators and super- visors (department heads, section chiefs) involved in the clinical 13 programs are the target sample population. These groups are closely associated with the curriculum and work roles of the medical technolo- gist. The medical technology student experiences will provide an appraisal of current educational preparation. The active involvement of the education coordinator in the total medical technology curriculum makes him valuable in determining the directions of curricular changes. The supervisory personnel in the clinical institutions also assess the developments in the world of work and how such developments affect curricular change. All three groups are given the same questionnaire for response. The Chi Square Test of Significance (x2) is used to analyze the data. The calculated Chi Square for the responses to the items is used to determine if there are significant differences among the groups at the .05 level of confidence. Recommendations for change in the medical technology curriculum are based upon these results. The research study is a descriptive analysis of curricular needs for medical technology education. This study should provide some con- cept Of the direction in which the medical technology curriculum should move . Overview An historical review of the relevant literature is contained in Chapter II. This demonstrates the developments which have influenced medical technology education to the present time. The experimental design, assumptions in the study, and statistical methods used for analysis of the data are described in Chapter III. The results, including tables designed to clarify the data, are reported in Chapter IV. Che and imp” relevan‘ 14 IV. Chapter V contains a summary, discussion of findings, conclusions and implications for future research. Appendices contain instruments relevant to the experimental design. science medical pharnac medicin the dev 0f the Decicin Scientj the Qua will be 0T aUtO 09y Edu \ Challe CHAPTER II REVIEW OF THE LITERATURE Introduction Clinical Laboratory Medicine is a conglomerate Of the natural sciences. It is a melding of chemistry, biology, physics and all the medical counterparts, biochemistry, anatomy, physiology, microbiology, pharmacology and immunobiology, to name a few. To practice laboratory medicine, one must be well versed in the basic sciences, and follow the developments within these areas, for they are the building blocks of the clinical laboratory practice. Therefore, the field of laboratory medicine recruits its members from diverse scientific backgrounds. These scientists have the wide range of knowledge and skills needed to provide the quantity, variety and quality Of medical laboratory services which will be required by contemporary medical practices.13 This chapter contains a review Of literature related to medical technology education and the development of the profession. The effects of automation, legislation and general social trends upon medical technol- ogy education are also presented. 13Thomas M. Perry, M.D., "Laboratory Medicine: Careers and Challenges," Laboratory Medicine, Jan., T970, Vol. l, NO. l, p. 32. 15 .flfi... - growth society health and dis contras growth also cc in use medical caPable Importa tion f0 0T Clln In I923 Educatj of the SlSts h Skills . \ The STE Y0] . 47| 16 Historical Development of Medical Technology The growth of medical technology is directly proportional to the growth and development Of the sciences. Other broad changes in our society which have affected not only medical technology, but other health categories are population mobility, shifts in age composition and disease prevalence, scientific orientation to life's issues in contrast to the religiOphilOSOphical concept and the presence and growth of organized pressure groups. Within the health field one must also consider such trends as the vast development of equipment, increase in use of professional and para-professional Specialties, and grOUp medical practice.‘4 At the beginning of the century the pathologist-physician was capable of performing all clinical laboratory procedures, the most important of which was anatomic pathology. The professional organiza- tion for pathologists, ASCP, is just over 50 years old and the specialty Of clinical pathology is only a few years older than the organization. In I928 the registry was established by the ASCP to standardize the educational requirements Of the laboratory workers. Since the beginning of the registry, the educational requirements for the medical technolo- gists have been consistently upgraded to meet the range of knowledge and skills for an expanding health care delivery system.15 *— 14Simmons, Nursing Research: A Survey and Assessment, pp. 279-283. 15Marta Jeanne Henderson, M.S., and Betholene F. Lover, M.S., '"The Status of Medical Technology Education", Journal of Medical Education, V01. 47, June, 1972, p. 479. IN NEC' rapidly to the IL concern ‘ Dr. Kano laborato dards for tory sch: and then 17 Medical technology is a comparatively new profession which has rapidly come of age. From the earliest days of on-the—job training to the present college-hospital programs, pathologists have shown a concern for and interest in the need for qualified workers. In 1928 Dr. Kano Ikeda of St. Paul, Minn. set up a national registry of clinical laboratory technicians. Dr. Ikeda also established educational stan- dards for students. High school graduates were admitted to the labora- tory schools, but the requirements soon changed to one year of college, and then two years were required.16 In 1929 the ASCP began to establish standards and develop hospital schools for educating medical technologists. The cooperation of the Council on Medical Education became an integral part of planning, evalu- ating and establishing criteria for the curriculum of medical technology. In 1933, registered technicians organized the American Society of Clinical Laboratory Technicians and published a journal, The Bulletin of American Society of_Clinical Laborato:y_Technicians. In 1936 the name of the journal was changed to The American Journal of_Medical Technology. With increased educational requirements and better technical training, the term technologist was adopted and the National Society became the American Society of Medical Technologists (ASMT).17 Today, members Of the ASMT cooperate with the ASCP in meeting the growing need for developing model curricula for professional training of ‘. 16Howard M. Vollmer and Donald L. Mills, editors, Professionalization, Prentice Hall, Inc. Englewood Cliffs, New Jersey, 1966, p. 20. 17Ibid., p. 20. medic tinue persc medic effor 1972, teed | Schoo' recogi placec FECOgr t0 ful for Cal PUbIlc Flnal R 'Rwsl r .LN‘J§\ 18 medical technologists.18 Both organizations have recognized and con- tinually demonstrate the growing need for competent clinical laboratory personnel. Their response to the complexities of clinical laboratory medicine has been one of meeting these needs with vigor and concentrated efforts. Educational Requirements for Entry into Medical Technology A requirement for today's medical technology major, as of December, 1972, is that they must either have a baccalaureate degree or be guaran- teed one upon successful completion of their studies. The Board of Schools, ASCP, declares that students of medical technology should be recognized with a diploma for the cost of time, finances and energy 19 placed into the preparation for their profession. There are three recognized pathways a student of medical technology may follow in order to fulfill requirements for professional entrance. 1. The total program: Three years Of collegiate study plus one year of clinical education. A student enrolls in a college and declares medi- cal technology as a major. The minimum require- ment for academic course work is 90 semester hours (l35 quarter hours) which must include appropriate course credit in the essential sub- jects, biology, chemistry, physics, mathematics. The student must then complete l2 months of clinical study at an AMA-approved school of medical tECDOOIOOY- A baccalaureate degree in medical technology is granted after satisfactory completion of the total program. 18The Alabama Pilot Study, Sponsored by the National Committee for Careers in Medical Technology, grant from Cancer Control Program, Public Health Service, U.S. Dept. of Health, Education, and Welfare, Final Report of a Three Year Project, l959-l962. 19American Society of Clinical Pathologists, Board of Schools Newsletter, October l2, l97l. Th univerg role. and p] hinir. resp 91‘01 ailc am do 19 2. Four years of collegiate study plus one year of clinical education. A student may major in biology, chemistry, microbiology. zoology and so on. He must meet the minimum require- ments to enter a hospital-based program for 12 months of clinical study. Upon completion of his studies, he is a medical technologist holding a baccalaureate degree in a science related to medical technology. 3. An integrated four year program. This type Of program is generally observed where a univer- sity and university hospital coexist, e.g., Temple University, Ohio State University, and University of Michigan. A student enrolls in the medical technology curriculum, and fulfills the academic requirements in chemistry, biology, mathematics and physics. Clinical instruction exists as part Of the overall curriculum. Upon completion of the curriculum a baccalaureate degree is granted in medical technology.20,21 The medical technology curriculum is administered by both the university and hospital, with the university playing the predominant role. The university must stress reliability and insist upon excellence and pride in achievement. The hospital educational program must not be minimized, for its responsibility is multifaceted. The hospital has responsibility for providing the student the foundation for professional growth, for providing clinical education which carries college credit, and for nurturing dedication to the goals and objectives Of the hospital and the community which it serves. These responsibilities should induce development of a viable medical technology curriculum which will reflect favorably upon both the university and the hospital. — --~"._.. —.—- 20Carol N. LeCrone, M.S., M.T. (ASCP), "Undergraduate and Graduate Education for the Medical Technologist", Laboratory Medicine, Vol. 4, No. 3, Mar., 1973, pp. 33-36. 21The American Society of Clinical Pathologists, The Registry of Medical Technologists, 1972. 20 The knowledge explosion has made education a lifetime process for all. Therefore, curricula should not be constructed on what is and has 22 Ivor wo0dward writes: been alone, but on what is going to be. How will we train the new technologists? Changes are so rapid that there is no way of teaching today the skills that we must have tomorrow. We must con- centrate on understanding the general principles of those features that will transfer into new situations. Specific skills will be taught and develOped as they are needed. The teaching of these skills will be one of the chief functions in affiliated clinical labora- tories. The corollary is that the student must be so educated that he is never cut off from sources of advanced study. The specifics of technology will need to be updated constantly, and the student of tomorrow23 must be able to advance and update himself as needed. The Recruitment and Education of Students for Medical Technology As the profession of medical technology became visible and the required educational experiences provided the training needed to cope with demanding responsibilities of the profession, the pr0blem of recruiting students in sufficient numbers to meet the demand for gradu- ates was inevitable. Dr. Mary Fried writes, "Every conceivable medium has been employed for telling our story, including pamphlets for high school students, published by the United States Government Printing 24 Office and the Institutes of Health." In 1953, the ASCP, the College of American Pathologists (CAP), and the ASMT established the National 22Darrel J. Mase, Ph.D., ”New Direction(s) for Medical Technology". 139 American Journal of Clinical Pathology, Vol. 50, No. 2, 1968, p. 272. 23Ivor Woodward, Ph.D., "Another Landmark", The American Journal 9f_Clinical Pathology, Vol. 50, No. 2, l968, p. 278. 24Mary Fried, Ph.D., "Is Today's Medical lechnologist Educated?", Lfiflboratory Medicine, Vol. 1, No. 2, February, l970, pp. 27-28. 21 Committee for Careers in Medical Technology. (The name of the committee was changed in 1970 to National Committee for Careers in the Medical Laboratory, NCCML). This organization was originally established to recruit students for study of medical technology. Since the organizations inception it has helped to increase the num- ber of registered technologists from 28,082 in 1952 to 86,915 today.25 Brooks and Blume write that Michigan experienced its first surplus of college medical technology students seeking internships in 1972.26 They have projected that an increased enrollment of medical technology students will be observed through 1975. Dr. George F. Stevenson, Executive Vice President of the ASCP, states that on the national pic- ture the number of applications for medical technology clinical intern- ships has exceeded the number of positions and that a redirection of NCCML activities would take place.27 As the 20 year history of NCCML has unfolded, the activities of the organization have been concerned with other educational matters of medical technology, such as upgrading educational programs, and raising scholarship funds.28 Dr. Fried states that the rush to produce more medical technologists has altered undergraduate training. The scope of the undergraduate 25Thomas M. Peery, M.D., Chairman, National Committee for Careers in the Medical Laboratory. A 20 Year Report - 1953 - 1973. 26Robert A. Brooks, and Christiana S. Blume, "Student Surplus Anticipated: How Much is Too Much?" Cadence, Vol. 4, No. 3, May-June, 1973, p. 33. 27Margaret Howell, editor, "Redirecting NCCML's Activities", Medical Lab, Vol. 9, No. 7, July, 1973, p. 19. 28Ibid., p. 19 pmgn were I dize 1 sumal —‘H —T'—_ ‘ (DID—o.“ Re cerning populat One pro Strongl ments t lS 3150 all hea Qualifi qualify Cerning 22 programs were narrowed to a point where only basic science courses were required, thus, a degree in medical technology tended to jeopar- dize some students' entry into graduate and medical studies. She summarizes this dilemma as follows: Despite the urgent need for more medical technologists, let us not deprive them of their complete education. Let us not allow applied science to take the place of basic science .... Furthermore, let us remember not only that a knowledge of fundamentals is vital to proficiency in every field, but also that a fundamental knowledge of the cultural heritage of the human race is vital to the education of every student.29 Rapid developments in the field of medicine and the philosophy con- cerning the quality and extent of health care services for the total population have raised many questions concerning the educative process. One projector states that continuing education requirements will be strongly emphasized, resulting in enforced continuing education require- ments to update knowledge before granting renewal of certification. It is also projected that a uniform national system for certification of all health services personnel will be established, thereby standardizing qualifications and training so that mobility and distribution of qualified workers are facilitated.30 Questions are being raised con- cerning the advisability of requiring a baccalaureate degree for a medi- cal technologist orior to a clinical internship. ‘ --g —. “”w-» 2829Mary Fried, Ph.D., ”Is Today's Medical Technologist Educated?", p. . . 30Margaret Howell, ed., "Medical Technology in 1980: New Job gltges and More Job Openings", Medical Lab, Vol. 9, No. 2, Feb. 1973, - 8. " 23 Supportive Personnel To become a medical technologist requires at least three years of college and twelve consecutive months in an AMA-approved School of Medical Technology. There were no short cuts to becoming a medical technologist in order to relieve the urgent shortages in the late 1950's and early 1960's. Medical technologists have a thorough scientific training and education which means that they meet professional standards which are recognized by the medical profession. There are serious concerns about those students who are educated in non AMA-approved Schools of Medical Technology. Confusion developed when prospective employers attempted to hire qualified per- sonnel who all claimed to be bona fide medical technologists. The educational background of the broad cross section of medical laboratory personnel varied from training in commercial or private schools of medical technology, to on-the-job training, to Armed Forces Schools, to colleges or universities. A study of a commercial school of medical technology in Minnesota listed the following deficiencies: 1. Because the students have virtually no background in scientific and medical subjects, the curriculum is much too ambitious for the time spent in this type of training. 2. A majority of the regular instructors are not qualified by either training or experience to teach medical tech- nology. 3. The facilities are judged inadequate to properly train students in acceptable laboratory technic. 4. Instructor-student ratio is far below accepted standards. 5. The training offered the student almost no clinical experience. , - 1 i“. H _ :_ . . . J ‘5 n. wumu—n—d It: in Thee Hinge CCTTT‘C peril adeql colll ing' thosl cal, to P1 au5p 24 The evaluation was completed by a committee which was appointed by the Minnesota Department of Education to determine the qualifications of commercial school graduates.31 It was also recognized that the highly educated medical technologist performs a wide range of tasks in which a lesser trained individual could adequately perform. As early as 1958, leaders in the junior and community colleges and professional organizations, ASCP and ASMT, had been discuss- ing the kinds of curricula necessary to prepare students for entry into those health occupations which have been termed subprofessional, paramedi— cal, supportive, semiprofessional and technical.32 This movement was to result in standardized, accredited programs for health occupations. In 1963, a new training program was initiated by the ASCP and ASMT to provide standardized training and national certification under medical auspices for Certified Laboratory Assistant (CLA). In 1969, a joint committee of pathologists, medical technologists and educators conceptual- ized the associate degree Medical Laboratory Technician (MLT) program. In 1971, the Essentials for Approval of Medical Laboratory Technician programs was forwarded to the AMA for sanction.33 During the interim many different patterns of MLT programs had developed. In 1971, 80% of 390 graduates from 51 junior college programs surveyed by the NCCML found jobs.34 The remaining twenty per cent continued their __._. 31Robert M. Cunningham, Jr., editor, " cmmcrcial Med Tech Schools“, Ihe Modern Hospital, Vol. 97, No. 6, 1961, p. 103. 32’33Dallas Johnson, "Laboratory Training in Junior Colleges: 100 Programs Today, 200 More Tomorrow", The Modern Hospital, Vol. 117, Dec., 1971, pp. 81-82. 34Dallas Johnson, "Research Needed to Find out What Technicians Really Must Know to do Laboratory Work", The Modern Hospital, Vol. 117, Dec., 1971, p. 82. 25 education. This appears to demonstrate the need for an MLT curriculum which is sufficiently flexible to prepare its graduates for immediate entry into the field or into additional formal training.35 Vested interests, tradition, reluctance to change, are but a few factors which have inhibited opportunities for vertical and horizontal job mobility through the establishment of such a curriculum. An unanswered question which needs to be carefully studied is the question of what tasks should be assigned to the supportive personnel. Until that question is answered, it will be extremely difficult, if not impossible to develop appropriate curricula for various levels of training. In summary, the previously cited developments in medical technology education requirements demonstrate the need for constant planning and implementing of newer concepts in the curriculum. Ivor Woodward has stated the problem very succinctly: It is a myth that the inclusion of subordinate classifi- cations in medical technology will undermine the technology; quite the contrary, it will strengthen the profession. The skilled and competent will be advanced to a higher status and will be freed from the large amount of routine operations. Furthermore, the approximately 60% of laboratory workers who are without specific formal training or skills can be mobil- ized into competent, well-defined groups with specific roles. The present ratio of medical technologists to total labora- tory workers is likely to decrease, not increase. He further states: Judging by the history of the manpower situation in this country, miscellaneous untrained personnel are going to fill the vacancies in laboratories in order to keep them running. The organization of subordinate occupational ’. --—_— 35Ina L. Roe, editor, "ASMT Position Paper: Differentiation Among MT, MLT and CLA Expected Capabilities at Career Entry", American Journal of Medical Technology, Vol. 39, September, 1973, pp. 362-364. ,géu...m— Tecl tota less of sl concl opera Stand.- thn g 26 classifications is a wise preparation also in that many of the simple operations are done better by individuals with less training, pro- vided that the proper controls and supervision are instituted. The highly trained individual is likely to become quite bored with sgch tasks and consequently quite careless. 5 Impact of Technology, Legislation, and other Social Trends Technology Technology involves change. The nature of this change is almost totally unidirectional, that is, the alteration in one's work involves less physical labor. The impact of automation on the variety of jobs of a medical technologist has been viewed as an alteration in the type of skills and knowledge which is required. Some major findings and conclusions concerning the impact of automation on clinical laboratory operations come from a study conducted for the Division of Medical Care Standards, Community Health Service, U.S. Department of Health, Educa- tion and Welfare by Auerbach Associates, Inc. These findings are: l. A surevy of 400 hOSpital laboratories and 450 independent laboratories, with a total response rate of Sl per cent, showed that 55 per cent of the laboratories used some kind of automated equipment. 2. Essentially all of the automation, as defined by the study, was found in clinical chemistry and hematology. 3. The study showed that there are legitimate roles in automated laboratories for equipment operators who do not have formal technologist qualifications. 36Woodward, "Another Landmark", p. 277. 27 4. The study stated that technologists' skills and understanding are needed in an automated environ- ment to supervise calibration and quality control, to trouble shggt equipment problems and to review test results. Arvo W. Schoen writes: Traditionally, medicine has insisted on longer incuba- tion periods prior to accepting new technology than most other scientific disciplines. In the last decade, an acceleration has become evident, and the time between introduction and acceptance is likely to shorten in the future, if for no other reason than that the lifetime of new technology is shortening and the demand for higher levels of technology is increasing. He further states: Historically, the health professional has relied upon the physical and engineering sciences to develop the instrumentation and sensors used in the clinical environ- ment. Unless dramatic changes are forthcoming, this reliance will very much continue in the future. However, with an increasing demand for sophistication in medical measurements, closer cooperation between the medical and engineering sciences will become more essential; and in the application of information gathering and process- ing develOpments, the health professional will have to establish a more prominent role.38 The classical medical technologist's education does not thoroughly cover all facets of automation. For example, some phases of automation, such as maintenance or repair of automated equipment are limited if present in the curriculum. The Department of Health, Education and Welfare study on automation states that automation creates a role in the laboratory for a technician-level individual.39 This further supports 37S. E. Gould, M.D., D.Sc., editor, "Automation and the Medical Tech- nologist", Laboratory Medicine, Vol. 4, No. 9, August, 1973, p. 20. 38Automation in Medicine, sponsored by Cedars of Lebanon Hospital, Miami, Florida, Futura Publishing Company, Inc., Mt. Kisco, N.Y., 1973, p. 40. 39Gould, ”Automation and the Medical Technologist", p. 41. 28 the need for a re-evaluation of the present approach to medical tech- nology education and the current work roles. Legislation A very slow, less-visible movement which greatly influences health care is legislation. Kenneth M. Myers states that seven per cent of the gross national product is now spent for health in the United States. He does not foresee additional spending as the solution to improving the nation's health, but the solution is more likely to be observed in increased productivity and distribution of available health resources.40 The rate, intensity and pace of change in medical care is very much affected by legislation. Some observable effects are: (1) increased numbers of standards for accreditation of hospitals, (2) required changes in physical plant and staffing structure, (3) requirement for each hos- pital to become involved in area-wide (community) planning, and (4) reim- bursement formula from insurance companies such as Blue Cross, which causes some effect on hospital financing, accounting and cost.41 An example of this legislation is observed in the Medicare-Medicaid and the Child Health Law, Title V. Formal budgets and plans for three years in advance must be submitted to the administration of hospitals. These budgets are not reviewed by the Government for substance, but this requirement is an effort to get administrators and Boards of Trustees more concerned and involved in the business activities of the hospital. 40Automation in Medicine, p. 33. 411bid., pp. 8-11. n.| t'W‘l ”if _.,_ ”a V3,: $01 en. be leg duu wri Norm, 29 Some health care legislation is pending and many health laws have been enacted. The present and future health care delivery system is slowly being restructured by the government. The goals of state and national legislatures are to bring about better and meaningful innovative proce- dures in the health care delivery system.42 The Junior College and Health Education The most viably active curriculum in the junior college education- al inventory is the health technology field. Richard C. Richardson, Jr. writes: The field of occupational education represents a topic that is both promising and perplexing. It is promis- ing because of the tremendous need for technically trained personnel in a society involved in the throes of accelerating technological revolution. It is promis- ing because of the desire of the rapidly growing junior college movement to share in the responsibility for meeting the needs of an automated society. At the same time, it is perplexing because many junior colleges are experiencing difficulties in initiating new programs, and in maintaining those already4§n existence at an appropriate level of efficiency. Norman C. Harris states: If the junior college belongs to any era, it is to the span of the next three decades. The past has seen the infancy of the junior college; the present views its growth with surprise, and perhaps even a little alarm in some quarters; and the future's vision is as yet44 unknown as we look toward the twenty-first century. The challenge of the health care system is being met by innovative curriculum planning in which the junior colleges are initiating and 421pm., p. 10 43Emphasis: Occgpational Education in the Two-Year College, American ASsociation of Junior Colleges, l966, p. IV. 44Norman C. Harris, Emphasis: Occupational Education in the Two Year College, ibid., p. 40. 30 expanding programs for the paramedical fields. It is throUgh imagina- tive planning and a sensitivity for genuine needs that the junior colleges are helping to meet manpower needs. Such programs as radiology and cardiopulmonary technicians and dental hygiene are but a few inno- vative programs which appear as part of the community college curricula. The junior college movement demonstrates a vigorous growth. Its impact on issues of the times, especially health care, will be determined per- haps in the next decade. Equivalency and Proficiency Exams Traditional methods for career entry are being challenged. There are numerous requests from individuals with non-traditional educational backgrounds or on-the-job training wishing to enter the para-professional or professional ranks. To assist them in achieving their goals, equiva- lency and proficiency examinations have been established.45 "Equiva- lency testing equates learning gained outside of formal training programs with requirements of courses that constitute recognized formal training programs. Proficiency testing assesses an individual's knowledge and skills related to the actual demands of an occupational specialty or a specific job."46 Testing does not exactly present a complete evaluation of the applicant but it does play a significant part in making a provision for the utilization of people who are well qualified but are excluded by lack of formal academic training. 45American Society of Clinical Pathologists, Board of Schools News- letter, June, 1971. 46Equivalency and Proficiency Testipg, Division of Allied Health Manpower, Bureau of Health Manpower Education, Public Health Service, U.S. Department of Health, Education, and Welfare. guy soc est futl reQL deve kind clini l Summar In considering some of the facets of health care delivery, and the social trends, the educators, medical technologists and employers must establish some guidelines for determining curricular needs for the future. Graduate medical technologists must be exposed to the knowledge required by the employers. Curricular content must keep pace with developments in medicine. This can be achieved only by defining the kind of educational objectives and goals which must be accomplished for clinical laboratory medicine. . II ”In“? ls IHHE H «why. ”4‘ . fl . . r‘mb .\ t . CHAPTER III DESIGN OF THE STUDY Introduction The status of medical technology education is under constant appraisal. This continual evaluation of the curriculum is directly related to the increased demand for the utilization of clinical laboratory medicine. As clinical laboratory medicine emerged as a discipline, the need for quality educational programs for workers was also recognized in order to achieve the goals of a comprehensive health care delivery system. This chapter contains (l) a description of the population and sample, (2) development and description of the instrument, (3) data collection procedures, (4) design of the study, (5) statement of the underlying assumptions, (6) statistical analysis of the data, and (7) summary. Population The sampling population was drawn from the five North Central states, namely Indiana, Illinois, Michigan, Ohio, and Wisconsin. There are a total of 190 AMA approved hospital schools of medical technology in these states. The hospital based programs are chosen to determine if the educators, prospective employers and students of medical technology have found the academic experiences an adequate preparation for entry 32 33 into the profession. The enrollment in the schools ranges from three medical technolgy interns to 60. No schools were excluded due to size, because the purpose of the survey is to elicit current thinking concerning future curricular needs. Therefore, inferences will not be made to all existing medical technology programs and proportional or optimal allocation within a strata to isolate the atypical respondent is not needed. A random selection of 35 schools for the study was made from the total number of 190; utilizing standard random number tables. (See Appendix D). The list of AMA approved schools was obtained from the Board of Schools, ASCP. The number of schools chosen for this study is based upon the criterion for large sample statistical analysis (N330). The large sample statistic applies when the number of the sampled population is thirty or greater. In the event that some programs were no longer in operation, or failed to respond. five schools were chosen in addition to the thirty. Sample The sample was composed of education coordinators, supervisors (department heads or section chiefs) of clinical laboratory sections, namely chemistry, hematology, blood bank and microbiology, and two medical technology interns from the selected programs. The interns were chosen by the education coordinator, who was requested to give the questionnaires to any two students who had completed at least four months or more of the clinical program. A postal card was enclosed so that the education coordinator might send the names of the two students to the 34 researcher. This assisted the researcher in the follow-up if no response was received. Two hundred and forty-five questionnaires were mailed. Each school of medical technology received seven questionnaires which were distributed as follows: one questionnaire to the education coordinator, one questionnaire to the supervisor of each clinical department, and one questionnaire each to two medical technology interns enrolled in the program. By utilizing interns, educators, supervisors or administrators of existing clinical programs, the responses of these events reflect experiences at different levels of the medical technology curriculum. Greater experience and knowledge about the profession of medical technology may give the respondent an opportunity to assess the past and present events in clinical laboratory medicine; and, on the basis of these recommend measures for future trends. 0n the basis of recent exposure to the academic part of the curriculum, the intern may have insight which more experienced individuals might overlook. Characteristics of Sample Egpulation Sex, educational background and types of certification are a few characteristics which might affect an individual's response (See Tables l, 2, 3, 4, 5, and 6). The researcher does not use this infor- mation unless there is a significant correlation to the way a Specific group responded to an item(s). An example of such a pattern is: all medical technology interns may react to the need for a shortened period for clinical study whereas the education coordinators may feel strongly that the period for clinical study remain at one year. Perhaps the 35 experiences of the education coordinators give them insights upon which the differences are based. These findings will be presented in Chapter IV with the pertinent discussion. Development of Instrument The questionnaire was designed to examine the current status of the curriculum and to seek ideas and recommendations of the persons responding. The recommendations deal with changes that would be desirable to improve the present quality of the curriculum and to arrive ‘ . , 47 at future requ1rements based upon technological developments. TABLE l.--Number and Percent of Participants Responding According to Group and Sex. Female - Male Total N % N % N % Education Coordinator 23 16.79 3 2.19 26 18.98 Medical Technology Intern 35 25.55 9 6.57 44 32.12 Supervisor (Department Head, Section Chief) 50 36.50 17 12.41 67 48.91 Total: 108 78.83 29 21.17 137 100 47 Walter R. Borg, Educational Research,iAn Introduction, David McKay Company, Inc., New York, 1967, p. 205. No.00, NmF m¢.F N um.m m ¢¢.m m. om.¢o mm om.¢_ . 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I I I’ll. -I-II.I|I -lllll .mucmwcmaxm xcozii.o m4mcmazm N_.Nm cc mo.w PP mo.NN Fm oe.~ N i i i l l - :cmucH amo_occome Pouwumz mm.m~ oN mo.m m oo.¢~ ON 1 l - i - . mN.o _ cepmcwvsoou cowpmusnm N z N z N z N z N z N z N z Nowow mcem> m mcem> q mcmm> m msmm> N sem> _ mmcoammm .ui- lie .1 l- hem-l.i .umwmoroccume _eu_nmz m mo cowpmuzum _oogum gmwzipmoa cow meek quoell.m mmmqe 53 ._o>op mo. ago ea peeoceeemem eoz mew.m_ n seesaw ego oo.oo_ Nm_ mN.o _ mm.Nm me om.om mo ~¢.NP NF mm.o F Nm.N a ”Fopoe _m.m¢ No i . oo.o_ NN mN.oN om em.m w i - mN.o _ Ammwco cowuumm . .umm: pcmEpcmamov cemw>cmaam N_.Nm we mN.o P NN.o_ «F mm.m~ FN __.m N mN.o P i . ccmucH amo_occume Feuwumz mm.m~ oN . . Nm.o m mN.m N_ mq._ N i - mN.N m couocNucoou cowumuzum N z N z N z N z N z N z N 2 Fave» mcem> m mcem> q mcom> m mcom> N ceo> _ mmcoammm oz .Nesem oesoeeo< cow oe_e Eseeeez--.o_ msmqe 54 ._o>o_ mo. ago we demoeceem_m ooz eem.w_ n seesaw ego oo.oo_ NNP mm.o_ my wm.oN mo_ ww.m m Nm.N w m_.N m ow.p N u_opoe Fm.mw No mm.w o wm.Nw mm ow._ N i i - . mN.o _ Ammwcu cowuomm .umm: Newspcmamov cemw>cmqgm N_.Nm ww mm.w m om.MN Nm m_.N m ow._ N mN.o P i . :cmch Nae—oczume Fewucmz mm.w_ 0N m_.N m mm.o_ my o_.N m ow._ N ow.P N mm.o _ commcwucoou cowpouaum N z N z N z N z N z N z N z _epoe memes: w_ memes: N_ meeeoz m meeeoz w memes: m omeoamom oz .Nesem _eoeew_u toe meme Eseeeee--.__ msmwe 55 Academic and Clinical Education The medical technology curriculum is criticized for the chasm between academic and clinical studies. These criticisms are directed toward (1) the lack of integration between theoretical materials and applicability,49(2) the absence of early clinical exposure in the curriculum which results in students' unawareness of what is medical technology,50and (3) a need for affiliation agreements between colleges or universities and the clinical institutions or hospitals to insure equal educational experiences.51 When asked where should the commencement of clinical education occur, forty-eight (35.04%) stated during the senior year and eighteen (13.1 %) stated post-senior year. A total of sixty eight (49.64%) of the subjects Specified that clinical studies should be introduced at either freshman year, sophomore year or junior year (See Table 12). Early introduction of clinical instruction into the curriculum is believed by some to dilute out the concentration in the basic science prerequisites and reduce the curriculum to a level of technical experiences only. In the emergence of medical technology as a profession, the following criteria have been manifested: 49Hamstra, Roger 0., "Medical Technology Education - A Program with Maximum Use of Student Classroom - Laboratory Facilities", American Journal of Medical Technology, Vol. 39, June, 1973, p. 245. 50Margaret Howell, Editor, ”A Real World Approach to M.T. Education", Medical Lab, Vol. 8, January, 1972, pp. 12-13. 51Board of Schools (ASCP), Accreditation Workshop, Chicago, Illinois, October 19-20, 1973. 56 (l) A basis of systematic theory, (2) authority recognized by the clientele of the professional group, (3) broader community sanction and approval of this authority, (4) a code of ethics regulating relations of professional persons with clients and with colleagues, and (5) a professional culture sustained by formal professional associations.52 Trolio writes: “The justification for professionalism is that the worker has competence to deal with a given process, structure or sit— uation which is important to the community but potentially dangerous in the hands of the unqualified. Because of the supposed competence involved, control over the profession should be in the hands of pro- fessionals. The three most important aspects of control are training the new member, regulating the quality of practice of the members; and certifying the competence of those allowed to practice."53 Those who state that clinical studies should occur during the senior or post- senior years perhaps see the increased need for concentrated basic science backgrounds which might produce a more flexible medical technologist in a very changeable field. Also, increased educational levels conceivably may assist in maintaining professional status. The majority of the subjects either strongly agree (63; 45.99%) or agree (54; 39.42%) that the medical technology curriculum should be planned as a whole academic and clinical. Ten (7.30%) disagree alld one (0.73%) strongly disagree with this question. (See Table \13). ‘ 52Vollmer, Howard M., and Mills, Donald L., ed., Profession- alization, Prentice-Hall, Inc., Englewood Cliffs, New Jersey, 1966, p. 9. 53Trolio, William M., "Medical Technology: A Profession in Turmoil” flgdical Lab, Vol. 10, January, 1974, p. 18. 57 .Po>o_ mo. ago ea eeeoeceemem eoz oNe.m n seesaw Neg oo.oo_ Nmp w—.m_ NP wo.mm ww oo.om Nw Nw.N_ NP Nm.m m mN.N m ”NMNON _m.mw No wm.m m mm.m_ PN mN.©N MN om.N op m—.N m mw.~ N Ammwcu co_pumm .com: acmEpceamov Lemw>emazm N_.Nm ww N_.m N Fw.N_ NF 0N.w NF mm.w o ow.N N - . :cmucH xmo_o:;ume Nmuwumz mm.mN mN mN.N m om.N ON P_.m N mN.o _ Nm.N w mN.o _ Lopmcwucoou :oNpmuavN N z N z N z N z N z N z N z Noyce cummw com> cem> com» smm> mmcoammm emow sowcmm coNcaw mcoeocaom coacmmcd oz I IIII'II I .cowwmusbm quwcwpu we “CwEmucmEEOUII.N— m4mcooom NN.Nm ww . . oN.N m i . oo.oN NN Nm.mN mN . . :coch amoNoczooN NooNooz wo.wN oN mN.o N mN.N m oN.N m wm.m m mo.m NN . u copocNoLoou rem :oEoooom N z N z N z N z N z N . z N z NopoN oocoomNo oocmomNo Nocpooz ooco< ooem< omcoomom NNmoocum NNocosum oz .NooNcNNu oco UNEoooo< oNocz mo EoNooNecou NmoNoczooN NooNooz coNoil.mN momeN mo. ago we eeeoNNNeone omo. ooN NmN - i i l - - - - i . ooN NmN cozpo ewom.NN ooN NmN . . mo.w NN Nw.mN om No.mw om oN.oN mN mo.m m monNco NmN.m ooN NmN . i - . om.N oN om.Nm mw Nm.No ww . . :oNoopcoEocuch NNN.m ooN NmN mN.o N oN.oN MN om.Nm Nm mN.oN om mo.oN mN om.N oN NcpmNEozo Noon>;o eme.mN ooN NmN . . mN.o N mm.w o oo.om Nw MN.wo mm . . 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M.S., Ph.D., D.P.H.* M.D. P Hospital Epidemiologist Computer Coordinator Other (Please Specify) *M.P.H. = Master's of Public Health *D.P.H. = Doctor of Public Health 27) Should particular attention be given in the curriculum for the positions listed in item 26 at the undergraduate level? Course emphasis: (Please list) 28) Should Specialization in one phase of medical technology take place at the undergraduate level? Yes No If yes, what type of specialization? When should specialization begin? lst year ____“ 2nd year 3rd year 4th year After 4th year 29) The medical technology curriculum prepares students for easy entry into the job market. strongly agree ____ agree neutral disagree __ strongly disagree 30) 31) 32) 33) 34) 35) 36) 37) 38) 129 In clinical laboratory medicine job promotion is based upon educational background. strongly agree agree neutral disagree _ strongly disagree In clinical laboratory medicine job promotion is based upon technical excellence. strongly agree agree neutral disagree strongly disagree The relationship of supportive personnel (medical laboratory technician and certified laboratory assistant) to medical technologists must be defined. strongly agree agree neutral disagree strongly disagree Conflict among professional organizations, accrediting agencies and institu- tions are factors which inhibit job promotion. strongly agree __"h_agree ‘____ neutral _____disagree .____strongly disagree The MT curriculum should prepare students as: specialists generalists Preoccupation with routine methods or ways of performing duties often delays the acceptance of new ideas and developments. strongly agree _. agree neutral disagree strongly disagree Are continuing education programs offered as a means of job promotion at your insitution? Yes No How do you rate these programs according to quality? excellent very good good satisfactory poor Do you view continuing education programs as the best method for post graduate education? Yes No 130 39) The future of the medical technology curriculum is directly related to future developments in medicine. Briefly state what present and future effects the following would have on curriculum planning: Development of core curriculum for MLT, MT, Medical students. Automation in Medicine. Medical Advances in Patient Care. Types of Work Roles. Methods of Teaching. Other Areas (Please Specify). APPENDIX C FOLLOW-UP LETTER l3l MICHIGAN STATE UNIVERSITY EAST LANSING 'MICHIGAN 48823 COLLEGE OF EDUCATION ' DEPARTMENT OF ADMINISTRATION AND HIGHER EDUCATION ERICKSON HALL 1 October 1973 Dear Department Head: A few weeks ago you received a questionnaire concerning medical technology education. I would appreciate your returning the questionnaire by 1 December 1973. I hope you will take the time to fill out the questionnaire, as your answers will have significant bearing on the outcome of the study. Thank you for your time and consideration. Sincerely, ‘ Jfl/j/ [/2/3 - 55727;..c -;,.. = Gladys M. Thomas c/o Dr. William Sweetland 424 Erickson Hall Michigan State University East Lansing, Michigan 48823 GMT/sew I32 APPENDIX D ANA APPROVED SCHOOLS 134 I35 PANDOMLY SELECTIU APPROVED SCHOOLS OF HFDICPL 'ECHVPLOBY Minimal Student Length of Intern- §£sts liaec..9L-I:stnei Entrance Rm” recent fangsifix S.ll_lP..P.".°£l_":’fll_ -_ Illinois Burnhan City Hospital 3 years college 4 12 months Grant Hospital of Chicago 3 years college 6 12 months Northwestern University 2 vcars college --* 24 months Medical School and Passa- 3 years college 13 12 months vent Memorial Hospital 4 years college" -- 27 months Evanston H.5pital 3 years college 13 12 months Lutheran General Hospital 3 years college 12 12 months St. Mary Hospital 3 years college 8 12 months Swedish-American Hospital 3 years college 12 12 months Indiana St. Francis Hospital Center 3 years college 6 12 months St. Mary Percy Hospital 3 years college 16 12 months St. Margaret Hospital 3 years college 10 12 months Snuth Bend Medical Foundation 3 years college 20 12 months Michigan Grace Hospital 3 years college 10 12 months Henry Ford Hospital Degree 25 21 months Mount (armel Mercy Hospital 3 years college 12 12 months Sinai Hospital of Detroit 3 years college 6 12 months McLaren General Hospital 3 years college 8 12 months w. A. Foote Memorial Hospital 3 years college 4 12 months Borgess Hospital 3 years college 8 12 months Hackley Hospital 3 years college 12 12 months Providence Hospital 3 years college 12 12 months Ohio Barberton Citizens Hospital 3 years college 6 12 months Cleveland Clinic Educational Foundation 3 years college 12 12 months * No Student Capacity Listed **Master's Degree Granted 136 Minimal Student Length of Intern- §£§£§. Hgme of School_ Entrance Requirement Capagity ship Program Ohio Ohio State University 3 years college 60 15 months St. Elizabeth Medical Center 3 years college 20 12 months Mansfield General Hospital 3 years college 3 12 months Licking County Memorial Hospital 3 years college 4 24 months Mercy Hospital 3 years college 9 12 months St. Elizabeth Hospital Degree 12 12 months Wisconsin St. Agnes Hospital 3 years college 8 12 months St. Francis Hospital 3 years college 10 12 months iadison General Hospital 3 years collece 16 12 months St. Mary's Hosoital 3 years college 10 12 months Deaconess Hospital 3 years college IO 12 months Milwaukee County General Hospital 3 years college 16 12 months St. Luke's Memorial Hospital 3 years college 9 12 months APPENDIX E TABLES 0F PERCENTAGES BY CATEGORY 137 138 .ucoammc no: u_u mLOmw>cmasm Axum.mv q * smo.mm *mm mm.mm mm NN.om mm Ammwcu cowuomm .umm; pcmspcmamov comw>cmazm oo_ «a - . oop «a ccmch amopoczow» Facaumz cop om mw.m _ m_.©m mm Lopm:_ucooo cowpmuzum & 2 R z x z Pooch Am=o_oauwcwpcau tango __mm LemF>cmazm FNm¢.FV mcoee £03328 FSEFFU 93 mo Em 93 um «5.6% 9.832. a 23:8 5.23 $5303 5 3m mcgmucF amoFocnoma FmoFume msF .mmmcmmu umucm>um chz mcomcma mew aaocm chp :F mm>Fpmpcmmmcqmme **Fm.mm ««om N¢.mF FF Fm.FF NF FN.wm mm . - FFszo conumm .vmm: acmEucmamov comF>cmasm ooF we mm.¢ N mm.Fm «F om.¢o mm . . :cmch amoFoccumF quFumz ooF om mm.m F Fm.N¢ FF Fm.N¢ FF cm.FF m coumcFugooo :onmuzum & z N 2 F 2 R 2 F 2 FmpoF egmspo F + .g» e F + .L> m F + .L» N .mpcmucoammm Emcmoca choFumoacm Fo :oFuaFcommouu.¢m MAmcqum FRmm.Nv Ne *_o.Rm amo Fm.Nm mm om.oa RN F¢.m_ mF Fem_;u cowpaam .umm: “coaucmamov LomF>cmnam ooF «a n u u . ooF we ccmch xmoFocgumF quFuwz ooF mm mm.mo RF mo.mm m «m.FF m cogmcFucoou :onmuzum R 2 R 2 R 2 R z FmpoF mcoe Lo FF oF . m m i o .mucmFLmaxm xcoz mo mcwm>nu.mm mummm mcomF>cmazm FRm¢.FV F as .ucoammc we: uFu mcoumcFucoou :onwuaum Fme.FFv m * 1 um*«Fm.mm ««oo . ¢N.Nm NN mm.mm om am.FF m u - FFmFgo conomm .uwm: acmEpcmamov comF>cmasm ooF «a RN.N Nm.Fm ¢F MR.R¢ FN Fm.mF R RN.N F ccmch AmoFocgomF Fmonmz ¥o¢.mw RMN . 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