The hidden profession of histotechnology.

Today there are more job openings in the field of histotechnology than there are educated people to fill them, and the U.S. Department of Labor expects employment opportunities for histotechnicians and histotechnologists to grow by 10 to 20 percent over the next eight years. So, what are career tech schools across the nation doing to help fill this growing demand?

Histotechnicians and histotechnologists (HT/HTLs) prepare human or animal tissue samples for microscopic examination. Working in laboratories, the majority being pathology labs, HT/HTLs prepare samples to be used for diagnosing diseases, medical research and even training medical personnel. Sometimes, their work is done while a surgical team stands by awaiting the pathologist's findings, and, with critical minutes ticking by, these highly trained technicians must rely on the care and precision acquired in their training to deliver accurate test results.

Using a variety of methods in their testing, HT/HTLs prepare slides by freezing and cutting sections of tissue, mounting samples onto slides and staining them. Sometimes samples are embedded in wax and then oat into very thin slices using a microtome. Tissue samples may also be studied through the process of dehydration, mounting, fixation sectioning, and decalcification and micro incineration. If it sounds technical, that's because it is. Anyone interested in this type of laboratory work needs to be patient, precise and able to work well under pressure.

In the June 2003 Journal of Histotechnology, in an article titled "The Rise of Histotechnology," Assistant Editor Patsy Ruegg writes, "Although histotechnology has always played a vital role in diagnostic pathology, our field of laboratory science has not always been held in the position of respect we are now enjoying. There are many factors determining the status fields hold in the laboratory science arena. Education requirements for entering the field are certainly among these factors."

Uncovering the Hidden Profession

The 2003-2004 school year marked the inception of the histotechnician program at Arizona's Pima Community College, and it already appears to be successful. Program director Sandra King reports that out of 30 students initially enrolled, 27 students will graduate in December 2004, and there are already another 30 lined up for this fall's program.

The histotechnology field attracts people from all walks of life. "The students vary," notes King. "We have even taught medically discharged veterans from the various armed services. One of them was an Air Force mechanic. He said it was the perfect choice for him, and he is doing great in his grades and experience through the co-op."

Pima has two working lab cooperatives: one to address the research aspect and the other to satisfy the clinical requirement.

"Another student is a mom taking care of her own children and her sister's, plus working, and is still doing a superb job [in the program]," continues King. "Some students are out of high school; we have two physicians from other countries who cannot practice medicine here in the United States and are putting their medical experience to work in the histology field. We have women going back into the workforce. We also have students who have BS degrees in biology who are looking for a career, or at least to get their foot in the door to a profession in biology."

King, who has 31 years of experience as a registered American Society for Clinical Pathology (ASCP)/HT in the histology field, talks with great enthusiasm about Pima's program. "We have two aspects to our program. The first is a certificate of employment. This is for those with previous college and/or lab experience, and you can earn a certificate in one year. We have another program that, once completed, issues an AAS (Associate Applied Science) degree. This is a two-year program. We encourage all of our graduates to take a national test from the ASCP for histotechnology when they are finished with our program. Basically, we teach them the techniques and the knowledge to prepare them for the ASCP [test]."

The ASCP will be changing its requirements for taking the test in 2005, according to King. Those heading down the path to becoming a histotechnician will require more than a high school diploma. A student will either have to complete an accredited histology program or have a degree (AAS or BA) to be eligible to take the test. If the aspiring HT has just a degree, he/she will also need one year of experience working as an HT.

"This test is very thorough in that it has both a didactic or computer element, but it also has a practical element in which you have to send in blocks and slides that you have done," King explains. "This way they will be able to determine that you have both the technical knowledge and the ability to do the slides and blocks."

"This is definitely a hidden profession," says King. "Nationwide, according to the ASCP, there is a 22.2 percent shortage of histologists throughout the United States. And not only is there a shortage now, but a lot of the technicians who are working now are ages 55 to 65 and thinking of retiring. Things could get worse if we don't get some trained histotechs out in the field. Ninety-five percent of the general public does not know about this field. This profession is hidden behind surgery and the morgue."

King believes that the appeal of Pima's program will continue to expand as the word gets around about this not very well known but very much in demand career.

"It is a most interesting profession, and growing like the technology around us," she comments. "You have to keep up with the knowledge as it grows, or you will be left standing. The quality of the work the histotech performs has great effect on the patient and their course of treatment. It is a critical profession. It is someone's life that is in your hands."

King believes that Pima will play an integral role in educating more highly qualified individuals to fill the many openings for HT/HTLs across the nation. "We have to give the student a sense of professionalism, a sense of ethics and confidentiality, and the belief in the need to keep learning and growing with the changes in the profession," she says. "This is a great profession."

Bringing it to Light

It was quite by chance that two biology professors from Mt. San Antonio College (Mt. SAC) discovered the future program director for the school's very successful histotechnician program. During their visit to San Antonio Community Hospital in Upland, California, biology professors Cindy Anderson and Lou Shainberg job-shadowed the hospital's pathology manager, Jennifer MacDonald. MacDonald shared with Anderson and Shainberg the need for well-qualified histotechnicians throughout California and across the nation. They discussed how a program to train histotechnicians could benefit their community. And, that was the birth of Mt. SAC's histology program and a new career path for MacDonald.

While teaching is new for MacDonald, she spent 10 years in Canada working as a medical technologist before coming to work in the states as an HT.

"I love histology," says MacDonald. "That actually happens to be part of the med tech program in Canada."

The difference in the training here and the fact that there are less than 30 schools in the U.S. with histotech programs, brought the realization that there was a genuine need for more training in the field. MacDonald's love of histology, coupled with the urgent need to produce qualified HT/HTLs, created the magic formula that brought the program to life.

But MacDonald is quick to give most of the credit to others--the community, local businesses, members of the histotechnology field and the school's administration.

"The histology community has been very supportive of our program," she explains. "Our clinical affiliate work sites provide training to our students, and many of the people at these sites are a part of our advisory committee. We have received many donations from vendors, and our clinical affiliate work sites have been great with our students. Initial startup costs for the program were provided by a large grant from the National Science Foundation. VTEA (the Carl D. Perkins Vocation and Technical Education Act) has provided funds for equipment and training, and the administration here at the college and the biology department faculty have been really supportive of the program."

MacDonald talks about the contributors to Mt. SAC's histology program with great pride. She feels that the donations made through grants and public and private industry are key to the program's success now and in the future. She names almost a dozen organizations that have donated equipment, supplies and even scholarships.

"The community as a whole has provided tremendous support and resources to the program," MacDonald notes. "We have had facilities donate items that they no longer use in their labs. These donations add up, and provide us with supplies that we might not otherwise purchase. The community and industry are really supporting this program."

Mt. SAC has seen two graduating classes move on to their new careers, and next year's graduating class is already taking shape, with three of the four classes offered this fall already filled. There are 24 students enrolled in each of the three classes, and students' names are now being placed on a waitlist. One of Mt. SAC's big plusses is its class size capacity of 24.

An interesting piece of information about Mt. SAC's histotech program is that it falls under the Biology Department. "Most histotech programs are considered allied health and are part of health professions," explains MacDonald. "We are the first vocational program in the Biology Department at Mt. SAC."

The histotech program is an open enrollment program with students taking any or all of the classes and attending part time or full time. However, students must take anatomy, physiology, microbiology and chemistry in addition to general education classes to complete the program. And, in lieu of a post-graduation internship, 240 hours of work experience must be completed before a student can graduate.

"We have clinical affiliates throughout Southern California that students will go to and get on-the-job training," notes MacDonald. "So far, most of the students are hired by the places where they are getting their work experience."

Mt. SAC is also very proud of its state-of-the-art laboratory, which contains 18 microtomes, six embedding centers, two tissue processors and a cryostat. Three of the six histotech classes are held in the lab, allowing a lot of hands-on training for the budding technicians. MacDonald, who teaches six of the classes, says, "Looking out at a sea of faces expecting you to teach them everything about histology can be overwhelming. Speaking in front of a group of people has never been something that I enjoy, but teaching is different. At the very beginning I wondered how I would have something to teach for all of the hours. Now I wonder how I will fit everything in!"

Her experience and enthusiasm for histology create a special chemistry between teacher and student. MacDonald also believes that her experience in various types of labs has also been a benefit, since she can present a more balanced program.

The face of histology is shifting, and the requirements to become certified are shifting with it.

"With immunohistochemistry becoming more and more prevalent, and PCR/DNA becoming incorporated with histology, the expectation of the level of knowledge for histotechnicians has gone up in recent years. It's not the field it used to be," notes MacDonald.

The Art and the Science

The histotechnology (HT) program at Harford Community College (HCC) was created and accredited in the early 1980s. Initially developed to meet the manpower needs of Harford County and the Baltimore metropolitan area, the program has seen some changes over the years. But, as in most HT programs, it contains the three core areas--general education, science and clinical education--and is designed to produce five to seven graduates per year.

Floyd Grimm, professor of biology at HCC, in describing the program's success explains, "First, the HT program enjoys about a 98 percent pass rate on the ASCP HT exam with about a 95 percent pass rate for students taking the exam for the first time. Second, HCC program graduates, in addition to being competent bench technicians, have assumed either supervisory or educational responsibilities."

Becoming more and more aware of the increased need for histotechnicians within the state of Maryland and nationwide, HCC took pause to review its mission and asked the question, "How do we enhance our ability to educate more histotechnicians here and across the nation?"

Their solution to reaching out and teaching additional qualified histotechs is very much in keeping with the technology of today.

"In order to meet the needs for Maryland, HCC developed an online clinical learning experience where the didactic portion of the course is taught using a distance learning venue, and the skills portion is mastered in an approved histology laboratory," says Grimm. "HCC then developed academic affiliations with community colleges throughout Maryland to provide the general education and science portions of the HT curriculum."

The combined coursework at affiliated colleges with the online clinical experience gives any student at a Maryland community college the opportunity to graduate from HCC's HT program.

"The college also became concerned about the pass rate of Route 3 applicants on the ASCP HT exam," notes Grimm. Route 3 refers to those histotechnicians who are on-the-job trained. Many HTs working in laboratories today have a high school education with two years of training on the job and have had no other education or training in the field other than what they learned in the lab under a pathologist. This "route" to becoming an HT will no longer be available after January 2005.

"Reports indicated that these applicants generally passed the practical portion of the exam but had a significant failure rate on the written (multiple choice question) portion of the exam," explains Grimm. "Based on the assumption that Route 3 applicants could benefit from a course that helped them organize their understanding of histologic techniques, the college developed the 'Preparing for the HT Exam' course."

Grimm reports that since its inception in 2002, the course has enrolled more than 100 students across the nation, and based on voluntary reports, there is a 100 percent pass rate for course graduates. Because Route 3 for the ASCP HT exam will end in 2005, the college is considering converting the course into a more diverse continuing education opportunity for all histotechnologists.

Observing the success of the online venue, HCC launched an online HT certificate program in 2003.

"This program focuses on the online clinical experience of the AAS program enhanced with lessons in histology, communications, mathematics and chemistry," says Grimm. "The major advantage to this 10-month program is that it has flexible starting dates, so that the laboratory can hire a trainee at anytime, and they can start the program immediately."

HCC has paved the way by being the first and only online program in the area of histotechnology. HCC's HT program is an evolving, expanding and exciting ride into the future.

"What I see," Grimm predicts, "is the whole profession continuing to move towards a blend of artistry and pure science. I think today histologists need to have a strong science background and also appreciate the artistry in the slides they produce."

Perhaps it is the ability to see the beauty in the histotechnicians' work that draws more and more students to this hidden profession.

"When you look at properly prepared slides, they really are pieces of art," says Grimm. "Now, we use them for diagnoses, but the technician who develops them has to have a feeling for both the tissue and the stain employed."

The world of histology is just now coming to light for many people, and there are even a few successful television shows based on the skills of such laboratory technicians.

Schools such as Pima Community College, Mt. San Antonio College and Harford Community College already have a role in their own real-life histology productions--and they are looking forward to a long run.

RELATED ARTICLE: Starting a histology program.

According to the Wage and Vacancy Survey published by the American Society for Clinical Pathology (ASCP) in September 2003, 9.1 percent of U.S. hospitals were reporting shortages of histotechnicians, and 10.9 percent were reporting shortages of histotechnologists.

With the level of shortages, and the fact that most laboratories are doing more work with fewer people, there is very little time to adequately train a histotech via on-the-job training. And yet, most hospitals have neither the money nor the personnel to set up a training program accredited by the National Accrediting Agency for Clinical Laboratory Services (NAACLS). That is why, in the past few years, the majority of the histotechnology programs that have been started have been in colleges or technical schools. These programs can then be affiliated with several (sometimes up to 20) hospitals. The students can learn all the theory and techniques of histotechnology at the college/technical school and then spend only a couple of months at a hospital laboratory perfecting their skills. In this manner, the college/technical school can spread the students out to many hospitals. The hospital histology laboratory benefits by receiving students who are already trained in histotechniques, and the laboratory only needs to take one or two students, as there are other hospitals also taking students.

So how do colleges/technical schools/hospital laboratories get information on how to start an NAACLS-accredited laboratory?

Contacting NAACLS (www.naacls.org) is one way. A packet of information listing the standards and requirements will be sent. The National Society for Histotechnology (www.nsh.org) also has handouts available about how to write exam questions or what to study for the ASCP certification exams.

At its Symposium/Convention for the last six years, NSH has held a three-hour workshop on "How to Start an Accredited Histotech Program in a Hospital or in a College/University." Peggy A. Wenk, BA, BS, HTL(ASCP)SLS is the presenter. She started this workshop due to the number of people calling her and asking what it would take to start a program. The preliminary conversation was one hour, followed by several more lengthy conversations--just for people to obtain the preliminary information to take back to their administrators.

This workshop combines information from NAACLS, ASCP, NSH, Wenk's experience, as well as a survey of other HT/HTL programs.

This workshop has been attended by 15 to 40 people each year and has included histotechs, supervisors, lab managers, pathologists, college instructors and college deans. NSH is committed to helping people start more HT and HTL accredited programs across the country and plans on offering this workshop each September for the next several years.

Several NAACLS-accredited HT and HTL programs have been established in the past four years, many of which had a participant at this workshop.

This information was provided by Peggy A. Wenk, BA, BS, HTL(ASCP)SLS, who a program director of both a histotechnologist and histotechnician hospital-based program at William Beaumont Hospital, Royal Oak, Michigan.