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Distance education in histotechnology: an innovative instructional model for laboratory education.

INTRODUCTION

Histotechnologists (HTLs) are baccalaureate-prepared laboratory professionals who are responsible for the preparation of human tissue samples for microscopic evaluation by a pathologist. HTLs most often are employed in a clinical laboratory setting where they must possess a high-level and specific skill set to prepare histologic specimens. Troubleshooting technical issues that occur during tissue preparation is critical. The interpretation of histologic specimens by a pathologist determines the course of treatment patients (Wolcott, Schwartz, & Goodman, 2008). As such, it is imperative that HTLs are adequately educated in the theory as well as the practice of histotechnology.

The American Society for Clinical Pathology (ASCP, 2011b) reports a vacancy rate of 9.81% for histotechnologists in the United States. Although at first glance this number may not be alarming, one must consider the landscape of the histotechnology profession. There are currently fewer than 3,000 certified HTLs in the United States and given their integral role in the management of patient care, HTLs have a tremendous responsibility to ensure that pathologists have well-prepared specimens in order for them to render accurate diagnoses. Consider also that there are 5,795 registered hospitals in the United States (American Hospital Association, 2011). Given these numbers, there are hospital laboratories that have no certified histotechnologists, and the need is actually much greater than that depicted by the ASCP survey (V. Della Speranza, personal communication, March, 23, 2011). Furthermore, 40% of laboratory personnel, nationally, are expected to retire within 10 years (Sullivan, 2008), creating an increased shortage.

In addition to the personnel shortage, there are not enough educational programs to meet the demands of training HTLs (Kibak, 2008). On-the-job training has been suggested as an option (O'Neal, 2008). However, because HTLs play such a vital role in the diagnosis of disease, and their job roles are expanding to include more complex testing, on-the-job training may create discrepancies in HTL training and may not be the best approach to fill these positions (Hinds, 2000). HTL training requires more complex didactic education than on-the-job training can provide. This leaves the profession in a situation with a severe shortage of histotechnologists and limited educational opportunities for training new technologists.

The ASCP calls for an increase in the number of HTL education programs (ASCP, 2009), and more flexible educational options have been cited as one way to address the shortage (ASCP, 2007). Of the four HTL education programs in the country, the Medical University of South Carolina (MUSC) Hospital Authority is the only one that offers an option in distance education (DE). The purpose of this article is to provide an overview of the application of DE technology to histotechnology education.

HISTORY OF THE PROGRAM

The Histotechnology Program at MUSC is a hospital-based program that began in 2004 to provide traditional (on-site) training to students who have little to no laboratory background. In 2010, the DE option was added and, while the program is small in scope--just two DE students--the intent is that the program will grow. The traditional education program continues to operate parallel to the DE program.

PROGRAM FOCUS

Currently, the focus of the DE option is to provide didactic instruction to on-the-job trained technologists and other laboratory personnel who are interested in sitting for the ASCP HTL Board of Registry Certification exam. Although certification is not a universal requirement for employment in a histology laboratory, there is an increase in the number of employers who are requiring the certification (V. Della Speranza, personal communication, November 12, 2010). Another incentive for noncertified histology practitioners to become certified is pay increase. On average, certification results in a 14.7% increase in salary (ASCP, 2011a).

PROGRAM STRUCTURE

Program administration includes the program director, who also serves as an instructional technologist, and the education coordinator, who provides content expertise. The education program is operated under the auspices of two service areas within the laboratory, laboratory education services and anatomic pathology.

The program director (lab education services) works closely with the education coordinator (anatomic pathology) to develop and evaluate instructional content for the traditional and the DE students. The education coordinator and the clinical faculty in the MUSC clinical laboratory are responsible for the clinical education of the traditional students. The program director works with the DE clinical faculty to ensure that the clinical education for the DE students is equivalent to that of the traditional students.

Because DE students are currently employed in histology laboratories, the employees' working laboratory provides all the clinical education as required by the National Accrediting Agency for Clinical Laboratory Sciences (2011). Clinical affiliation agreements between the sponsoring laboratory and the MUSC HTL Program outline the responsibilities of each party. The organizational hierarchy can be seen in Figure 1.

[FIGURE 1 OMITTED]

CURRICULUM

The DE option is integrated into the traditional program, and the curricula are identical in terms of the course offerings. All students are required to demonstrate mastery (didactic and clinical) of the knowledge and skills mandated by National Accrediting Agency for Clinical Laboratory Sciences (2011). Although the objective of the two options is the same, preparation for successful completion of the certification exam, the instructional strategies differ. The specific differences will be explored in the discussion of instructional strategies and their corresponding learning theories. In order to understand the differences between traditional HTL students and DE HTL students, distinctions between the two student groups need to be addressed.

The HTL traditional students enter the program with little to no experience in the histology laboratory. Traditional students are taught theory in histologic techniques and are required to demonstrate competency in histology technical skills. By contrast, the HTL DE program is designed for practitioners who currently work in a histology lab but do not have the HTL certification. Their entry-level knowledge is greater than that of the traditional students, and they do not necessarily require the clinically intense instruction. The distance education students currently possess the necessary laboratory and technical skills, but they lack the didactic and theoretical teachings of histotechnology.

INSTRUCTIONAL TECHNOLOGY AND INSTRUCTIONAL STRATEGIES

Communication and instruction for the DE students is primarily conducted using asynchronous methods. However, there are some subjects, specifically, laboratory mathematics, that are better suited for synchronous instruction. In cases such as these, Adobe Acrobat Connect Pro provides audio, video, and screen sharing capabilities.

All course material, course syllabi, video presentations, laboratory assignments, discussion boards, and tests are accessed by both groups of students via WebCT. Initial instruction, that is histotechnology curricular content, is provided through assigned readings and videos. One-on-one instruction and communication occurs via e-mail or telephone with the program director, education coordinator, or face-to-face with clinical faculty.

TECHNOLOGY REQUIREMENTS FOR DE STUDENTS

Technology resources are minimal. Each student is required to have adequate Internet access on a computer (PC or Mac) that has audio and video capabilities. Videos are produced as MP4 files and will play on standard video players.

INSTRUCTIONAL STRATEGIES FOR DE AND TRADITIONAL STUDENTS

With the implementation of the DE program, new instructional strategies were implemented to enhance the independent learning styles of the more experienced HTL DE students. DE students have the flexibility to work with their clinical faculty to determine how to best use the instructional activities. Each instructional strategy is based on commonly used learning theories, behaviorism, cognitivism, and constructivism. A description of the instructional strategies follows.

Camtasia Studio is used to record video presentations; videos contain text, images, and motion images. This strategy works well for the traditional students because they have no HTL background, and this strategy, based on cognitive learning theory, is most useful in conveying information to novice learners (Driscoll, 2005). However, it is also useful for DE students who may be unfamiliar with particular concepts in HTL. If a DE student feels comfortable with the information, he or she can choose not to view the video(s), or the student may wish to view the video if he or she needs more information in the subject area. This flexibility allows a DE student to customize his or her education.

Laboratory assignments are completed by the students in the clinical laboratory. Assignments incorporate psychomotor and cognitive skills related to laboratory techniques. This is a hands-on strategy that incorporates elements of behaviorism, cognitivism, and constructivism. Through practice, students are expected to achieve competency in laboratory techniques (behaviorism). Students also rely on information learned through the lectures and readings to perform these tasks (cognitivism). Constructivist learning is more evident towards the end of the curriculum when students can use gained knowledge to troubleshoot laboratory techniques or instrumentation malfunctions. A DE student may choose not to perform a specific assignment if he or she performs that technique as a component of the sponsoring laboratory's workload. In this case, the clinical faculty would attest to that student's mastery of the skill.

Written and practical exams rely on cognitive and constructivist knowledge to demonstrate mastery of the subject material. Written exams incorporate cognitive and constructivist learning because, while students must demonstrate mastery, scenario exam questions are developed that require students to troubleshoot and/or interpret techniques. Practical exams allow students to demonstrate the application of the theory they have learned.

INSTRUCTIONAL STRATEGIES FOR DE STUDENTS

Discussion boards are a mainstay in online distance education as they promote a sense of community and shared knowledge among the students (Puntambekar, 2006). Discussion boards were implemented in the HTL DE program to help lessen the transactional distance between the program director and the DE students. Transactional distance refers to the level of communication within an online distance education course; limited communication results in high transactional distance. Transactional distance is lessened when communication is maximized (Gunawardena & Mclssac, 2004). The program director is available onsite for the traditional students and impromptu discussions and questions occur; a sense of community develops. The discussion boards afford the DE students a similar way to connect. Although it is not identical, it does serve as an equivalent way of communication. Traditional students also have access to the discussion boards through WebCT, and they are encouraged to participate along with the DE students. Traditional students may learn from the more experienced DE students through shared understanding and collaboration, a hallmark of constructivist learning (Steinbronn & Meredith, 2008). This connection among all students also facilitates community.

Two types of discussions are used--guided and exploratory. Guided discussions are instructor generated and ask for specific information related to a topic. Students are required to provide well-developed responses to questions by utilizing available resources; responses must include more than personal opinion. Exploratory discussions require that students demonstrate problem-solving abilities (Majeski & Stover, 2007). When learners actively participate in discussion topics and respond to one another in a thoughtful manner, they begin to develop a common understanding. By discussing and understanding others' experiences in the laboratory, students can collectively develop a common understanding of the nature of the HTL profession (Puntambekar, 2006).

FUTURE DIRECTIONS

The challenge in developing the DE program was to assess how the resources that were available to MUSC would contribute to this initiative. Initial consideration was given to providing distance education to entry-level students, students with no histology background. As a small, hospital-based program it seemed more feasible to offer the program as described. However, as the program matures and as the faculty's comfort levels with the technology increase, the program administrators will re-evaluate the possibility of making the program more accessible by distance education for students of varying backgrounds.

REFERENCES

American Hospital Association. (2011). Fast facts on US hospitals. Retrieved from http:// www.aha.org/aha/resource-center/Statisticsand-Studies/fast-facts.html

American Society for Clinical Pathology. (2007). ASCP teams up with state pathology society to address the workforce shortage. Retrieved from http://www.ascp.org/HomePageContent/ ePolicyNews/December22007.asp

American Society for Clinical Pathology. (2009). ASCP advocacy efforts focus on developing the workforce. Retrieved from http://www.ascp .org/MainMenu/AboutASCP/Newsroom/ ASCP-Advocacy-Efforts-Focus-onDeveloping-the-Workforce.aspx

American Society for Clinical Pathology. (2011a). Survey finds certified medical laboratory professionals earn more than non-certified personnel. Retrieved from http://www.ascp.org/ MainMenu/AboutASCP/Newsroom /NewsReleases/Survey-Finds-CertifiedMedical-Laboratory-Professionals- EarnMore.aspx

American Society for Clinical Pathology. (2011b). American Society for Clinical Pathology's 2011 vacancy survey of U.S. clinical laboratories. Laboratory Medicine, 42, 199-206. doi: 10.1309/LMZU4JVGH6EO1OXI

Driscoll, M. (2005). Psychology of learning for instruction (3rd ed.). Boston, MA: Allyn & Bacon.

Gunawardena, C., & McIsaac, M. (2004). Distance education. In D. Jonassen, (Ed.), Handbook of research educational communications and technology (pp. 355-395). Mahwah, NJ: Erlbaum.

Hinds, I. (2000). Histotechnology: A new curriculum for current and changing educational needs. Laboratory Medicine, 31(8), 448-452.

Kibak, P (2008). The worsening shortage of lab staff: Whaf s being done to turn it around? Clinical Laboratory News, 34(5), 1-4.

Majeski, R., & Stover, M. (2007). Theoretically based pedagogical strategies leading to deep learning in asynchronous online gerontology courses. Educational Gerontology, 33(3), 171-185.

National Accrediting Agency for Clinical Laboratory Sciences. (2011). NAACLS unique standards and documentation required for accredited HTL programs. Retrieved from http://www.naacls.org/docs/Section3_HTL .pdf

O'Neal, K. (2008, October). Bring back on-the-job training programs [Letter to the editor]. Critical Values, 1(4), 6.

Puntambekar, S (2006). Analyzing collaborative interactions: Divergence, shared understanding and construction of knowledge. Computers & Education, 47, 332-351.

Steinbronn, P., & Meredith, E. (2008) Perceived utility of methods and instructional strategies used in online and face-to-face teaching environments. Innovations in Higher Education, 32(5), 265-278.

Sullivan, E. (Ed.). (2008). Shortage. Critical Values, 1(4), 9.

Wolcott, M., Schwartz, A., & Goodman, C. (2008). Laboratory medicine: A national status report. Atlanta, GA: Centers for Disease Control and Prevention.

Karen Brinker Geils, 165 Ashley Avenue, MSC 908, PO Box 250908, Charleston, SC 29425.

Telephone: (843) 792-4013.

E-mail: brinkerk@musc.edu
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Author:Geils, Karen Brinker
Publication:Distance Learning
Article Type:Statistical data
Geographic Code:1USA
Date:Dec 1, 2011
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