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How 1995's instrumentation will impact on the lab.

I recently walked through the clinical laboratory of 1995. My glimpse into the future, gained through a survey of instrument manufacturers, revealed smarter and easier-to-operate analyzers everywhere. Many employees at the controls had lower degrees than today's laboratory staff members and fewer responsibilities for data output.

Such trends are widely forecast at the present time.sup.1-5 This survey of manufacturers furnished clues to the coming extent of automation and computerization and how the technological changes will affect requirements for problem solving, interpretive, and manual skills in each laboratory section. As an educator, I need this information to start planning for changes in the medical technology curriculum.

I selected 53 instrument manufacturers from the list of product suppliers in the 1983 Clinical Laboratory Reference. A cover letter and a one-page questionnaire went out to the vice president of research and development of each company. The letter explained that the intent was not to glean company secrets but to obtain opinions about instrument and operator characteristics in 1995.

Why 1995? It's distant enough to be an unknown, yet close enough to be a target for research and design rather than a stimulus to daydreaming.

Twenty-nine usable questionnaires were returned for a 55 per cent response rate. Manufacturers expressed interests in the following areas: chemistry/special chemistry, 35 responses (manufacturers made no distinction between the two disciplines in the questionnaire, so the responses were grouped together, resulting in a total greater than 29); hematology, 12; microbiology, 12; coagulation, 7; blood baking, 6; home use, 3; and "other," 2 (1 urinalysis and 1 serology instrument manufacturer).

Figures I and II tabulate the instrument and operator characteristics foreseen by manufacturers in the three most frequently cited application areas--chemistry, hematology, and microbiology. Let's look at the characteristics more closely, in all sections of the laboratory.

* Instrument characteristics. More than 80 per cent of the respondents see their instruments automated to some degree by 1995. One maker of chemistry and microbiology instruments predicts "heavy automation" and believes that simplified operator/instrument interfaces requiring only pipetting are "the wave of the future."

Similarly, a manufacturer of chemistry and blood bank instruments states: "The next 10 to 15 years should see a trend toward 'hands off' instrumentation. The introduction of a patient's specimen will most likely be the only manual operation required. Test selection, set performance, data interpretation, and test results will be obtained with a mere push of a button. Computers will be an integral part of such equipment. The addition and/or renewal of reagents will be done by use of self-contained packets with internal computer-read identification and quality control information."

Fifty-six per cent of the responses on chemistry instruments indicated fully automated models in 1995, a quarter semiautomated, and 19 per cent manual. Hematology instruments were split between automation and semiautomation for the most part, as were blood banking instruments, while coagulation and microbiology product lines tended to be only semiautomated.

Chemistry will also be the leader in computer involvement, with over 40 per cent of instruments under complete computer control. Most coagulation, blood banking, and microbiology instruments will be computer-assisted, on the other hand. Here, too, hematology instruments will be divided--between being computer-run and computer-assisted. On average, only 20 per cent of instruments will be provided with an interface to hospital or lab computers.

Respondents believe their instruments will for the most part require only moderate operator dexterity in 1995. A significant portion (20 per cent) will call for minimal dexterity. Overall, this suggests that instruments of the future will be relatively easy to handle.

Contrast these results with respondents' stated requirement of a high or moderate need to follow detailed directions. The interesting conclusion we can tentatively draw is that mental but not manual dexterity will be the norm. This holds for home-use instruments, too, according to manufacturers.

* Operator characteristics. How much education will be needed to work at the bench 10 years from now? Microbiology instrument manufacturers mentioned a bachelor's degree more often (50 per cent) than respondents in any other application area. For most of the other disciplines, an associate of science degree drew the greatest number of responses, and a high school diploma ranked second.

Add to these assessments what the respondents said about needed skills and you get the following profiles of bench employees in 1995:

Chemistry personnel will most likely have an associate degree, use only moderate critical thinking skills, and make very few judgments on data. They will need specific training for each instrument.

In the hematology section, staff members will probably have an associate degree, but a high school diploma may suffice. Interpretation of results won't be an important part of the job; problem solving, even less so. Special training on instruments will probably be helpful but not required.

Coagulation testing specialists will have a bachelor's or associate degree. They will need moderate critical thinking skills. Interpretive skills will be either high or low, depending on the test. Special instrument training will often be required.

Besides a bachelor's degree, microbiology staff members will have to have moderate problem solving and interpretive skills as instrument operators, plus special training.

Blood bank personnel, possessing an associate degree or high school diploma will need special instrument training and moderate problem solving and interpretive skills.

Why will microbiology be an exception to generally lower degree requirements in 1995? One respondent noted that this specialty works with live organisms that change rapidly and are not always typical. While a number of procedures may be automated, data generated are usually obtained through decisions made by the technologist. Manufacturers' comments about moderate problem solving and interpretive skills in microbiology referred to instrument operation, but higher skills are essential for other functions.

I believe the same holds true in blood ranking, where more work is done in the technologist's mind than in any data-producing instrument. Here, instrumentation is used more to handle and process blood products than to judge them compatible with a patient's immune system.

The general move is toward smarter machines and a diminished need for human decision making, and this has been repeatedly cited as a cause of job dissatisfaction among medical technologists.sup.1,4,6-9 If the trend grows more pronounced, as this survey suggests, that discontent will probably intensify.

This pattern of change may result in greater use of medical laboratory technicians (MLTs), with associate rather than bachelor degrees.sup.6 If so, it will most likely occur in lab sections that are already highly automated, such as chemistry and hematology. Remaining technologists will undoubtedly assume different roles unless they want to push buttons.

What might that role be? Several observers of the profession have suggested that more lateral opportunities may open up for technologists in the future and draw on talents that when underused today cause so much frustration. Quality control, method evaluation, continuing education, and broader roles in test interpretation are all possible elements of an expanded practice of medical technology.

Such changes, however, will require alterations in technologists' education. Three alternatives have been recently proposed in the literature. The first recommends that undergraduates receive a more realistic view of the profession.sup.4 It seems so obvious that we would expect it to have been part of MT programs all along.

A second proposal would bring the curriculum itself more in line with actual working conditions.sup.8 Basic electronics, computers, business administration, and statistics would be part of the course work.

Trhid, education and training could be reshaped into a step system.sup.7 Students would first reach the MLT level. After one or two years' work, some might choose to complete a bachelor's degree and take the MT certifying exam. The system would supply many associate-level technicians for routine bench work and fewer, but sufficient, baccalaureates for non-routine work.

The third proposal would make the most sense if clinical laboratories were being invented today. MLT programs would provide basic technical information that many of our survey respondents see as adequate in coming years, and MT training would add advanced courses in business administration and other management topics. This isn't just speculation: Respiratory therapists follow a similar career path.

The second proposal is a more probable development because the bachelor's degree is the norm. We are likely to see a reworking of medical technologist education and placement, not a revolution. Management theory, computers, and statistics are three areas that can be added to college study.

Technologists already at work won't be shielded from change. They will need strong continuing education and retraining to keep abreast, especially as some cross disciplines to meet new staffing demands.

Instruments aren't the only contributor to change in our profession. We need to explore future nontechnological aspects of the field and how they are to be blended into education of new and old technologists.
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Author:Sullivan, Robert J.
Publication:Medical Laboratory Observer
Date:Jan 1, 1985
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