Study aids for retraining and updating technologists.
Two basic personnel problems face clinical laboratory managers today: finding medical technologists and technicians to fill vacancies, and insuring that those already on the job are proficient enough to meet the requirements of CLIA '88.
Recruiting, retraining, and rehiring inactive medical technologists will help you fill vacancies. Providing current staff with continuing education (CE) will prepare them for proficiency testing (PT). Both goals may be attained with a structured program that includes self-teaching aids, a time and place to study, and contributions from experts on your staff. The "Listen, Look, and Learn" (LLL) series of audiotape lectures, texts, and matching slides, developed nearly 20 years ago to give full instruction in all specialties of clinical laboratory science, has been brought up to date by Health and Education Resources, a nonprofit organization located in Bethesda, Md. Ordering information is provided in Figure 1.
* Response to shortage. The shortage problem, which we tend to think of as a current issue, is rooted in a general scarcity of health care professionals that developed in the 1960s and 1970s. In response, the American Society of Clinical Pathologists (ASCP), the College of American Pathologists (CAP), and the American Society for Medical Technology (ASMT) through their joint National Committee for Careers in Medical Technology (NCCMT) began to recruit inactive medical technologists who wished to return to work.
Laboratory managers quickly discovered that assessing the varying needs of returnees and providing individual retraining tended to require more time than they conveniently could spare. In projects in California, Georgia, and New Jersey, the NCCMT found that most retrainees already knew the basics and did not need individual training. They were highly motivated; given the material, they would learn it. Thus was born LLL, the first edition of which, issued in 1973, contained 73 lectures matched with 650 slides. The U.S. Department of Labor funded reproduction of the slides, which the NCCMT made available with cassettes in binders with pockets and sleeves. Altogether, 1,500 sets were distributed at cost to medical technology schools and clinical laboratories, where they were used for training, retraining and, increasingly, CE. One set went to a repository in each state for free loan.
The National Committee for Careers in Medical Technology broadened its scope and changed its name to the National Committee for Careers in the Medical Laboratory. in 1973 it was dissolved--but not before its staff organized Health and Education Resources to update LLL with the assistance of the original authors and the American Association of Blood Banks, the American Society for Microbiology, and the American Association for Clinical Chemistry. A special series on AIDS was prepared by experts from the National Institutes of Health, the Armed Forces Institute of Pathology, the Centers for Disease Control, and the Mayo Clinic.
* Retraining. Training medical technologists fresh out of college takes about 12 months, while retraining formerly active workers takes only three to six months. Those who return to the work force after a break tend to stay on the job much longer. In my experience, those returning remain for 10 to 15 years, whereas recent graduates work three to seven years before leaving, often to raise families. Tips on finding and retraining inactives are offered in Figure II.
* Continuing education. The LLL series proved itself long ago by providing CE to small or rural one- and two-person labs. Lab professionals who are on call 24 hours a day or far from medical centers where courses are offered could turn to audiovisual lectures for enrichment and refreshers. LLL remains a reasonable option in an era of shortages and austerity.
* Earning credit. When the Department of Health and Human Services gave proficiency examinations in 1977 and 1978 to laboratory personnel who lacked the educational requirements to qualify under Medicare/Medicaid rules, many of those who passed the tests gave credit to self-study using LLL. In 1980 the Joint Commission on Accreditation of Healthcare Organizations accepted audiovisual self-study to meet its requirement that all hospital labs provide medical technologists with CE regularly.
In 1988, when Florida began to require that medical technologists and technicians have 10 hours of continuing education for biennial renewal of their state licenses, LLL was accepted toward contact hours. The same year, Health and Education Resources began to award CE units (CEUs) based on results of before-and-after examinations administered by the Educational Testing Service (ETS), Princeton, N.J. Clinical chemistry, with 25 lectures and 200 slides, is worth 3.8 CEUs; immunoserology, with seven lectures and 20 slides, is worth 1.5 CEUs.
* New editions. The personnel and regulatory pressures on lab managers make the publication of new editions of LLL even more timely. New or revised editions of slide lecture packages on AIDS, blood banking, clinical chemistry, coagulation, hematology, immunoserology, microbiology, and urinalysis include 92 half-hour audiotaped lectures, 1,035 pages of text, and 1,816 slides. The lectures were prepared by pathologists, clinical chemists, microbiologists, blood banking specialists, and others who were selected by professional societies and who contributed their time and slides. Since the slides were provided by the lecturers--and lecturers traditionally use their best slides--LLL probably has the most comprehensive general collection of good clinical laboratory slides available.
Each lecture is accompanied by a self-study guide with references and questions and answers. This information makes it easy for people with lab backgrounds to study on their own, with access to experts for clarification and demonstration. A series of questions provides lab directors and supervisors with a way to test trainees on their knowledge, give relevant assignments, and measure progress. A summary of new editions follows.
[paragraph] Clinical chemistry. Prepared by specialists selected by the AACC, this greatly expanded package includes 25 half-hour lectures in a 250-page text illustrated with 200 diagrams and tables that also appear as slides. The text is an exhaustive recounting of clinical chemistry aimed at a wide audience, including pathologists and technologists. An introductory lesson is geared to newcomers.
[paragraph] Coagulation. Twenty new slides augment four lectures and a 65-page text. The material includes characteristics of the coagulation factors and effects of factor deficiencies on specific coagulation tests.
[paragraph] Immunoserology. The current edition of immunoserology, formerly labeled "serology," features diagrams displaying the principles behind the newest technologies in the discipline. Various test kits and methods and their detection levels are presented. Users learn to help select the correct test system for a specific purpose--for example, pre-employment or prenatal screening to evaluate immunity, or the detection of light antibodies to aid in the diagnosis of disease. The impact of DNA probes on the future of immunoserology is explained. QA and QC are covered as well.
[paragraph] Urinalysis. Urinalysis and immunoserology, packaged together at twice the size of the original presentation, contain 11 lectures, 160 pages of text, and 80 slides. New urinalysis material includes a description of methods used in reagent strip analysis and the characteristic features of significant formed elements in urinary sediment. Quality assurance and quality control are important features.
* Success stories. Throughout the history of LLL, clinical laboratories have used the program to bring back laboratorians who had left the workplace. Several schools of medical technology organized short-term courses for these "inactives" while their regular medical technology students underwent clinical training.
During the early to mid-1980s, the program in medical technology at the School of Health Related Professions at the University of Pittsburgh used LLL in 12-week courses that retrained four to eight inactives each spring. The students, ranging in age from the late 30s to early 50s, had been away from lab work for 7 to 20 years.
After slow starts, "it was fantastic the way they learned so much so fast, passing their qualifying exams with higher grades than the full-time med tech students," said program director Ann Albers, Ph.D., MT(ASCP). When the course ended, students were awarded a credit at the University of Pittsburgh and given jobs at local labs at the medical technologist rate of pay. At this writing, a decade later, at least half were still at work.
The first labs to order updated LLL packages have already started retraining programs:
[paragraph] New York. St. Vincent's Medical Center, Staten Island, is using LLL to retrain inactive medical technologists and to provide CE for 130 staff technologists and technicians. The facility purchased the original LLL series in 1973 and was first to order the new series in 1991. Some participants are shown in the upper photograph on page 41.
[paragraph] Pennsylvania. The new editions of clinical chemistry, hematology, immunoserology, and urinalysis will be assigned for in-service CE at Allegheny General Hospital in Pittsburgh.
[paragraph] Wisconsin. The Marshfield Clinic in Marshfield uses the series in teaching programs for MTs and MLTs and to update new hires.
[paragraph] Texas. The VA Medical Center in Houston intends to use LLL in its new school of medical technology (lower photo, page 41).
[paragraph] Worldwide. Over 3,000 "Listen, Look, and Learn" series are now established in medical centers, schools for medical lab personnel, and hospitals throughout the U.S. Many more have been distributed abroad. An instructor at Ife University in Nigeria was shown LLL during a course at Howard University in Washington, D.C., and took it home. Previously, CE available to him had been limited to slides of diseases endemic to his country.
When the Pan American Health Organization (PAHO) ordered 10 sets of LLL to use in regional medical and hospital centers in Central and South America, Dr. Mario Gonzalez Pacheco of PAHO's health technology department and a former professor of microbiology in Mexico noted, "I have not seen anything like it. When I was teaching, we only had texts and had to make our own visual materials." Self-help of that kind is necessary no longer.
Packages available for "Listen, Look, and Learn"
AIDS. Seven audiotaped lectures, 60-page text, 123 slides; $145.
Blood banking. Twelve taped lectures, 100-page text, 228 slides; updated with new section on HIV infections and transfusion-associated AIDS that includes 19 slides; $175.
Clinical chemistry. Twenty-five taped lectures, 210-page text, 200 slides; $585.
Coagulation. Four taped lectures, 65-page text, 20 slides; $116.
Hematology. Nine lectures in a 90-page text matched to 432 slides; $350.
Immunoserology. Seven taped lectures, 80-page text, 20 slides. This is sold with the urinalysis package for $295.
Microbiology. Twenty-four taped lectures, 350-page text, 714 slides; 450.
Urinalysis. Four taped lectures, 80-page text, 60 slides. Sold with the immunoserology package for $295.
When bought all at once, the entire series of 92 half-hour audiotaped lectures, 1,035 pages of text, and 1,816 slides costs $1,905, a saving of $211.
Shipping and handling:
$100 or less $3.50 Health and Education Resources $101-500 7.50 4733 Bethesda Ave. 501-1,000 10.00 Bethesda, MD 20814 More than $1,000 20.00 (301) 656-3178
Tips on finding and retraining inactives
How to lure them
Ask your staff for referrals. Everybody knows or remembers a great laboratorian who might be coaxed back to work--now that the children are grown, for example.
Send an announcement to all the independent laboratories in your area. Let your local pathology and medical technology associations know you will retrain and hire inactive medical technologists. Ask that news of your offer be included in a mailing to members.
Offer free retraining to inactives who will come to your laboratory regularly--for three months, perhaps, or until they have made enough progress to qualify for a job at the regular rate of pay.
How to train them
Provide time and space in the lab for study. You will need a slide projector or viewer and an audiotape player (when applicable) to supplement study from the text,
To determine the educational level of students, give the tests that accompany each lecture. Use the results to assign specific lectures with slides. Consider beginning with hematology, which has seen fewer changes than other specialties and has a new study guide.
Set aside time every week when returnees can ask you and the specialists on your staff for explanations and assistance. Test again at the end of the training period to measure progress.
The author is president of Health and Education Resources, a nonprofit organization for the development of programs and communications in health, education, and social services, Bethesda. Md For 25 years she was executive secretary of the National Committee for Careers in Medical Technology, described in this article.