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Certification of laboratorians: an update.

Certification of laboratorians: An update

More than a dozen national organizations certify clinical laboratory professionals. As regulations and job descriptions evolve, the debate over certification requirements continues.

Organizations of all kinds recognize competence in their fields by granting certificates to professionals who have met specific criteria. While a single certifying body and one set of standards is sufficient for most occupations, clinical laboratorians have more--far more. The result is that technologists are often confused about where certification is available and which certificates to pursue. This article is intended to help clarify the situation by presenting the full multiplicity of "initials" that can be earned by lab workers and by discussing several other matters pertinent to this topic.

Official certification of clinical laboratory professionals began in 1928 when the American Society of Clinical Pathologists' Board of Registry presented its first certificates to medical technologists. Since then, the number of professional organizations offering certification to phlebotomists, a variety of technologists, and other lab professionals has grown considerably (Figure I).

Through the decades, ambitious laboratorians have often been confused in choosing the credentials that would be most valuable to their careers. They have wondered which credentials best represent excellence in the field and are most widely recognized, how many certifications one person should obtain, and what requirements should make an individual eligible to receive certification. While none of these issues has been completely resolved on a national scale, individual certifying agencies have honed their requirements and philosophies with consistent internal logic. Test formats continue to change and improve. * Reaping benefits. While certification is not legally required for working in a clinical laboratory in many states, a large number of professionals opt to become certified. Passing a certification exam enables newcomers to the field and those with experience to assure employers and the public that they are adequately trained and highly qualified.

In many hiring situations, certified laboratorians have a definite competitive and monetary advantage over their noncertified colleagues. Some employers, for example, will interview only candidates holding certification--and make this clear in their classified advertisements. Employees with certification often earn higher salaries and may be promoted more quickly than those without it.

Passing a certification examination can bring personal rewards as well. Professionals gain a sense of satisfaction and achievement from answering challenging test questions correctly and earning the right to string credentials after their names on business cards, resumes, and bylines. This achievement, they say, demonstrates that they care enough about their careers to go the extra mile.

One desirable advantage of certification would be to help distribute trained lab professionals more evenly throughout the country, explains Michael Bissell, M.D., Ph.D., M.P.H., vice president and medical director of Nichols Institute Reference Laboratories, San Juan Capistrano, Calif. "Certification needs to buy laboratorians something," he says. "Currently certification means nothing in California. Certified individuals who want to work in the state still have to take the licensure exam, which is dissuading many of them from moving here." * Proving proficiency. Many experts in the field believe that all laboratorians, from phlebotomist to lab director, should take a certification examination. "There are capable noncertified professionals working in our labs, but how can anyone be sure without seeing test results?" says Glenda D. Price, Ph.D., dean of the School of Allied Health Professions at the University of Connecticut, Storrs. "In our profession, we can't afford to wait until someone has made a grave error to find out that individual is incompetent."

"The Federal government, or at least employers, should require every laboratorian to demonstrate proficiency in his or her specialty area," notes Annamarie Barros, M.A., CLS(NCA)CLDir, a management consultant and educator who contributes to MLO's Viewpoint column. "It is just as important for laboratory supervisors and directors to prove their management skills as it is for technologists to prove their technical abilities." * Numbers game. How many certifications should an individual pursue? While subspecialists and managers may find it helpful to hold several, that may not be true for generalists who spend their days at the bench.

Lynda L. Hunter, M.S., M.H.S.A., administrative director of laboratory services at Baptist Medical Center, Kansas City, Mo., believes one certification is sufficient. "What can two certifications say about a person that one comprehensive one can't?" she points out. "People obtain many for one simple reason: They don't know which they should have, so they try for them all."

It may not be necessary to acquire more than one certification, but it can't hurt, suggests Dorothy Bergeron, M.S., CLS(NCA), president of the National Certification Agency for Medical Laboratory Personnel (NCA) and assistant professor in the department of medical laboratory science at the University of Massachusetts at Dartmouth. "A professional who takes the time and effort to study and sit for several exams demonstrates initiative and the desire to be the best," she says.

The opposite view holds that multiple certifications often can work against the lab profession. "Laboratorians are in dire need of public unity and support," explains Barbara Castleberry, Ph.D., MT(ASCP), vice president of the ASCP's Board of Registry. "Numerous certifications bewilder employers, other health care practitioners, and the public, detracting from our image."

Having one set of credentials would help the profession become more cohesive, say some industry leaders. Yet as long as certifying agencies remain divided on issues such as whether extensive lab experience is equivalent to a four-year degree and whether the Government should administer a new proficiency exam, unity is impossible. (The HHS exam is discussed in "A new bill rekindles an old debate," below.) * Education vs. experience. An issue that continues to pit professional organizations against one another is whether holding a baccalaureate degree is necessary to be a technologist. Mark S. Birenbaum, Ph.D., associate administrator of the American Association of Bioanalysts (AAB) and administrator of the International Society for Clinical Laboratory Technology (ISCLT), strongly asserts that it is not. "Formal education is a plus for anyone," he says, "but people with extensive laboratory experience who were trained in other settings--proprietary schools, the military, or junior colleges--can perform in the field just as well as those who hold a baccalaureate."

Gerard P. Boe, Ph.D., executive director of American Medical Technologists (AMT), agrees. "Many of our people have their master's degrees and doctorates, and we support those working to further their education. A person's behavior and true ability, however, can only be gauged by performance at the bench."

While education is important, says NCA president Dorothy Bergeron, her organization certifies laboratorians who have extensive on-the-job training and meet non-baccalaureate educational requirements as well as those who have four-year degrees. "Professionals with proven tract records are just as deserving of certification as those with a B.S.," she says.

Advocates of more formal education for laboratorians are not convinced. "For certification to be valid," explains Paula Garrott, Ed.M., MT(ASCP), CLS(NCA), director and associate professor of the MT program at Sangamon State University, Springfield, Ill., "it must be a culmination of three components: education, experience, and passing a validated, competency-based exam."

"The role of the medical technologist is rapidly changing," notes Marianne Watters, MT(ASCP), administrative director of pathology at Parkland Memorial Hospital, Dallas, and past president of the Clinical Laboratory Management Association (CLMA). "Becoming a supervisor of technician work teams or a superscientist with extensive knowledge and expertise in biotechnology, this new-era lab professional needs a baccalaureate degree to develop strong communication skills and sharp cognitive and judgmental abilities."

"Technical ability is only the surface," observes Bettina G. Martin, M.S., M.B.A., pathology management associate and professor of medical technology at the State University of New York Health Science Center at Syracuse. "Well-educated individuals learn ethics and theory, the foundation of being a quality laboratorian." Martin, a member of MLO's Editorial Advisory Board, was inducted last month as president of the CLMA.

Birenbaum questions the importance of understanding the theory of laboratory medicine. "If I had car trouble," he says, "would I be better served by consulting an engineer with numerous academic degrees who could explain the theory behind the malfunction or by going to an auto mechanic who could solve the problem?" Adds Boe of the AMT: "Some things can't be taught in the classroom. Attributes such as honesty, reliability, and common sense are polished on the job. Someone with a Ph.D. in chemistry can demonstrate knowledge of lab procedures by passing an exam but may perform poorly at the bench." * Bias toward certificants. On what basis should a laboratorian decide which organization to approach for certification? Personal background has a lot to do with it, as does one's philosophy regarding prerequisites for certification in the laboratory. The medical technologist who believes a four-year college degree is crucial will probably go to an agency that requires a baccalaureate for certification. The laboratorian who has been unable to complete a degree because of financial or logistical snags, family obligations, or lack of interest will look to an organization that promotes experience as highly as formal education.

It has been asserted that bias toward certain certifying agencies is common in the profession and that employers often turn down qualified applicants strictly for lack of certification by a specific group. "Many employers weed out applicants who aren't certified by the agency of choice," notes MLO Editorial Advisory Board member Luci Berte, M.A., MT(ASCP)SBB, director of laboratory quality assurance at Elmhurst (Ill.) Memorial Hospital. "Hiring an ASCP-certified person over an NCA certificant with more experience for a position, for example, might be hard to justify, but it is done nonetheless."

Betty Martin explains that "it's perfectly acceptable to specify |ASCP [certification] preferred.' The facility won't be chastised. Proving that an applicant has been rejected for lacking a certification, rather than a qualification, would be difficult." * Following loyalties. Because the ASCP, established half a century ago, was the first certifying agency for laboratorians in the United States, many professionals consider it the gold standard for measuring excellence. "I wasn't aware other certifying agencies existed when I was in college preparing for certification," recalls Marti Yapit, MT(ASCP), chief technologist of hematology and microscopy at University Hospital, Pennsylvania State University, Hershey, Pa. "I felt comfortable going to the ASCP because everyone else was going there," she says.

"It's natural for people to rely on the familiar," notes Castleberry of the ASCP. "Consumers purchase brand-name products for the same reason. They feel they can depend on them based on past experience."

Newer organizations may simply need more time to establish themselves. "We've only been around since 1976," notes Bergeron of the NCA, "so we're still building our reputation. Regardless, professionals should judge organizations objectively, looking at factors such as how their exams are written and by whom, and whether they have a recertification process in place." (Issues related to recertification are discussed in "Once certified, always certified?," page 32.)

Many students seeking guidance on certification rely on the recommendations of their program directors. Individual preference then reigns. Some advisors encourage sitting for several exams; others steer their students toward a favored organization. "A number of my new employees were advised by their program directors--who are staunch ASCP advocates--to take other exams |for practice' after graduation," says Luci Berte.

"The issue isn't who is the best, but who is more popular," notes Boe of the AMT. "Who has stronger public relations programs? How much influence do the certifying boards have over the profession? Fraternity members stick together, sending people to the agency where they were certified and hiring their own." * Shopping around. Each certifying agency establishes criteria that professionals must satisfy before being considered eligible to take its exam. Some offer study materials. More information on these and other matters is available from the organizations themselves (Figure II).

* Prescreening procedures. Organizations contacted in researching this article require candidates to fill out an application on which they supply background information. In most cases, a letter of reference from the individual's current employer and/or referrals from former supervisors or program instructors are necessary to document performance, experience, or education.

* Foreign credentials. While organizations typically certify lab professionals trained in the United States and Canada, some agencies will accept foreign credentials under certain circumstances. First, however, the applicant's records may be sent to an institution that evaluates and converts foreign credits into U.S. equivalents. A Ph.D. from a less scientifically advanced country, for example, may be equivalent to a B.S. in the United States.

* Chances at bat. Certifying agencies often allow those who fail an examination to take it again. Most of these organizations require additional schooling after a certain number of tries and set a cap on how many times an applicant may try again after that.

* Study aids. Some credentialing agencies publish manuals to assist laboratorians in preparing for certification exams and to inform credentialed individuals who wish to keep abreast of changes in the field. The ASCP's latest study guide, which provides 1,600 practice questions for medical technologists and technicians, includes a diskette that simulates a computer-adaptive exam. (The organization's experience with the computerized format, first administered in July of this year, is described in "Putting technology to the test," page 35.)

NCA offers a self-assessment exam to prospective test takers who want to measure and improve their performance on the clinical laboratory scientist examination. The questions, "retired" from use, follow the format and length of the actual test. Four weeks after mailing back the exam, participants are sent a computerized analysis of performance. They receive a grade, a summary of results identifying weak and strong areas, and an explanation of all answers. * Expectations. One constructive result of the certification process would be to strengthen the profession. Yet that has not been the case. "We keep shooting each other, and ourselves, in the foot," laments Paula Garrott. "Rather than putting our heads together to decide how to use certification productively to assure competence, competing groups use their energies to promote their individual agendas."

"Our professionals need to reach common ground," says Betty Martin. "As long as we remain divided on basic certification issues, our field will never obtain the financial support and national recognition it needs from other professions and the public to do what we are in the business to do: provide total quality health care." [Figure I and II Omitted]

A new bill rekindles an old debate

Clinical laboratories in rural and urban areas, hit especially hard by the personnel shortage and likely to be hit even harder if rigid CLIA |88 personnel requirements remain, may gain reinforcements if a bill now in Congress is passed.

The Rural Clinical Laboratory Personnel Shortage Act (HR2405) was introduced into the U.S. House of Representatives on May 20, 1991, by Jim Slattery (D-Kan.) and 42 original consponsors under Title VII, the Health Professions Education Act. When Congress failed to vote on the bill before its summer recess, the bill was scheduled for consideration this fall. Still pending at press time, the bill would set the following in motion:

* Laboratorians, primarily technicians and technologists, who agreed to work in rural and other underserved areas for at least two years after graduation would receive education loans of up to $7,500 a year.

* Schools that recruited laboratorians to work in rural and other underserved areas would receive special grants to run related programs.

* The Department of Health and Human Services (HHS) would develop and administer a new competency-based proficiency examination, which would enable practicing medical technologists who failed to meet education requirements under CLIA or Medicare rules to qualify at the technologist level. Testing would begin six months after passage of the bill and be offered annually thereafter for two years.

* During that period, the secretary of HHS would establish national certification standards and approve private certification agencies, at which point the Government exam would cease to be given. * Of any value? Laboratory professionals have strong opinions about the Government's past and possible future exams. Those in favor believe it would provide an immediate solution to prevailing problems in the field, especially the personnel shortage. Those against say the exam would not bring more professionals into the lab, would be unreliable, and would discourage laboratorians from furthering their education. Also under debate is whether the Government has the right or expertise to decide which clinical laboratorians to certify.

Some feel the exam would make the shortage worse "Lowering education standards for technologists will deplete the field of MTs who are truly qualified," notes Marianne Watters, administrative director of pathology at Parkland Memorial Hospital, Dallas.

Mark Birenbaum, administrator of the ISCLT, believes a renewed HHS exam would bring more people into the field. "Our industry needs a competency standard that is flexible," he says. "Qualified technicians who were trained in the military, for example, should be given a way to enter the field and become technologists without having to go to college for three or four more years."

According to Barbara Castleberry, vice president of the ASCP Board of Registry, the proficiency exam would leave the personnel shortage virtually untouched. "Most trained professionals already have jobs, regardless of whether they are certified," she says. * Federal aid. Laboratory leaders opposed to a new HHS exam express dismay at the prospect of having the Federal government step in, thus setting a dangerous precedent. "Once the Government plays Big Brother with us," says Watters, "what will stop legislators from regulating the qualifications of pharmacists, respiratory therapists, and other health care groups?"

Advocates of the HHS exam look at Government involvement differently. "The field is in desperate need of national standards, which would be established if Slattery's bill was passed," says Michael Bissell, M.D., Ph.D., M.P.H., vice president and medical director of Nichols Institute Reference Laboratories, San Juan Capistrano, Calif. "Our profession is continually criticized for lacking uniformity, and for good reason. Something has to be done, or the quality of health care will suffer."

"People are always unhappy when they have to rely on a Federal regulation to do their police work for them," says Dorothy Bergeron, president of the NCA, "but this exam would be designed differently from the old one, which didn't assess abilities accurately." * Reliability. Would the exam be valid? "No good exam can be developed in 180 days," the time frame delineated in the bill, says Castleberry. "Before any reliable test can be written, its developers must survey technologists in the field to find out what they do. Such a task analysis takes several months alone."

Gerard Boe, executive director of AMT, is confident the exam would be reliable "if it is criteria-referenced and competency-based, and developed according to guidelines laid down by lab personnel with many years' experience."

If the test's eligibility requirements match those of two decades ago, says Luci Berte, director of laboratory quality assurance at Elmhurst (Ill.) Memorial Hospital, "the exam would not be dependable. Foreign professionals who are medical technologists in other countries were eligible to take the last test; however, they aren't necessarily generalists based on U.S. standards." * Education. The existence of an HHS exam would dissuade many from furthering their education, some say. "If there is more opportunity for someone without a degree to be certified, fewer people will believe it is necessary to invest four years of time and money in schooling," observes CLMA president Betty Martin.

Dr. Bissell feels the Government's initiative would merely inspire those with four-year degrees to work toward bigger and better things. "Professionals with a B.S. in science are the laboratorians of the future, regardless of where certification requirements are detined," he says. "Technologists are already beginning to gravitate toward management positions."

According to some laboratory experts interviewed for this article, the proficiency exam would shortchange college graduates. "Lab personnel with four-year degrees would be left holding the short end of the stick," says Berte. "Paying the same salary to an HHS-certified person as to someone with a baccalaureate because they do the same work is demoralizing for the degreed professional."

Others view the situation in a more positive light. "The law dictates equal pay for equal work," Bergeron notes. "I would rather see someone actively working toward a higher level than being a warm body in the lab or grandfathered in without having to show competency."

Still, it has been argued that allowing more laboratorians with less education to enter the lab would depress salaries even further. "Employers will pay lower wages to people without a degree," predicts Betty Martin. "This will lower the pay scale for all generalists."

"The question isn't whether a new Government exam should be reinstated, but if it is, who will take it?" adds Lynda Hunter, director of laboratory services at Baptist Medical Center, Kansas City, Mo. "Until HHS can provide sufficient information on the methodology used to. validate its exam, the perceived value of the people who pass it will be different." * Amendments. Still under discussion at press time were possible amendments that would address concerns regarding the exam's content and administration:

* A minimum education requirement would be established at the post-secondary level.

* The exam would be designed to measure professionals' scientific knowledge, including application and problem-solving skills.

* Before administering the exam, the Secretary of HHS would validate it and establish a criterion-referenced passing score.

* Security provisions would be set up to insure the integrity of the examination process.

PHOTO : Gerard P. Boe American Medical Technologists

PHOTO : Mark S. Birenbaum International Society for Clinical Laboratory Technology

PHOTO : Dorothy Bergeron National Certification Agency for Medical Laboratory Personnel

PHOTO : Barbara Castleberry American Society of Clinical Pathologists
COPYRIGHT 1991 Nelson Publishing
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes related articles; certification requirements for clinical laboratory professionals
Author:Trotto, Nancy E.
Publication:Medical Laboratory Observer
Date:Oct 1, 1991
Previous Article:JCAHO to allow Ph.D. lab directors.
Next Article:The making of a new certification exam.

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