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It's time for zero-based lab education planning.

Our educational programs in the clinical laboratory sciences--undergraduate, graduate, and clinical experience--stand in urgent need of drastic remodeling. The alternative is obsolescence. It's time for the agencies that accredit and license these programs to closely reexamine their requirements. I'd like to suggest that they do so on the Zero-based budgeting principle.

In economics, a zero-based approach means looking at every program and activity as if it had just begun. This viewpoint forces us to evaluate activities based on needs and priorities. Too often, we continue to do things a certain way out of tradition, inertia, or habit. When new programs are needed, we simply add them to the existing structure. In medical technology education, this method of operation will become increasingly difficult.

As the tecnology and methodology of our profession have advanced, we have added and expanded curricula to meet the growing demand for knowledge. Now, however, we seem to be reaching the saturation point: In most programs, the schedule has run out of room. Yet new and important developments keep coming at a rapid race. What are laboratory educators to do?

Here are a few suggestions. First, let's stop placing sole responsibility for curriculum development on educators and their institutions. Since laboratory managers and supervisors know the requirements of the job market, they should have significant input into course selection. Staff personnel, particularly new entrants into the laboratory field, are also good information sources, for they quickly discover just how well their skills and knowledge match current demands. And professional associations are an excellent resource, representing a broad base of practitioners.

They key to revamping laboratory education is to identify job needs, now and for the future. It is often said that education lags by some five years behind knowledge needed on the job, but in today's lab, the lag may well be 10 years or more. It seems to take forever to convince academic or hospital programs to make major changes in course content. When asked to add new techniques or subjects, they offer lack of time as an excuse. But they resist dropping any existing courses.

Change won't happen until employers, educators, and practioners look realistically at today's total health care picture and its implications for the future of our profession. For too many years, we accepted a certain number of training hours in chemistry, hematology, immunology, and microbiology as the basic preparation for a generalist technician or technologist.

In California, for example, state regulations delineate the minimum number of weeks to be spent in each subject area--a rigid schedule that provides no creativity or flexibility in light of changing job needs. As a result, many California programs are unable to give students the kind of background that will qualify them for long, successful careers. States without such stringent licensing laws are better equipped to make changes, but educational evolution is a slow-moving process everywhere.

I foresee tomorrow's clinical laboratory in need of two major types of personnel: the generalist technician, serving as the lab's major "doer," and the practitioner who is a specialist, advanced generalist, supervisor, manager, educator or some combination of these roles. The professionals in form the bulk of the lab's actual workload. Rather, they will be the developers, coordinators, and evaluators.

This new generation of professionals will have responsibilities that extend beyond the laboratory into patient care and administrative decisions. Small in number but widely recognized, they will interact with physicians, colleagues, and the public to a greater extent than before. They will need to understand and interpret test results. Moreover, they will have to be sensitive and responsive to the political forces that influence their practice.

The knowledge and skills of tomorrow's mobility-oriented laboratorians will be vital to the total health care team. The career path from a medical technology background will open into other positions like infection control officer, DRG coordinator, in-service education director, or even administrator. New opportunities will arise in the booming ambulatory clinic sector, where versatile technolgists can gain responsibility an authority as valuable assets to the clinician.

Can current technologist education programs develop this kind of practitioner? It's doubtful. There is still too great an emphasis on teaching students how to perform tests, rather than on what test results mean for the patient. Few programs provide any course work in interpersonal relations, government regulations, or professional concerns. And there is little if any emphasis on newer technologies such as immunodiagnositics, in vivo drug monitoring, clinical virology, and computer correlations and interpretations. These topics should be an integral part of every undergraduate and clinical program.

Graduate programs also suffer from short-sightedness. Most provide extensive background in advanced microbiology, chemistry, and other disciplines--that is, the technical competence to become department supervisors, without the needed supervisory skills. Many such programs don't even require a graduate management course. Laboratories now seek supervisors with sharp managerial abilities; they can no longer afford to promote the "best" technologist unless he or she can also make the most of human and material resources. Graduates who lack these skills will find themselves qualified only for research or bench work.

The master's degree in medical techcnology is one program headed toward obsolescence. It produces advanced generalists with extra knowledge in all the scientific areas but no special expertise in any one, let alone in management. These graduates could become medical technology educators, of course, but even here it is doubtful that they have appropriate educational skills.

Closely related is the master's in biological or clinical sciences, another advanced generalist curriculum with a track in one of the disciplines. If management is the major track, or part of a dual track with a scientific area, these graduates will probably qualify for laboratory management or supervisory positions. Sadly, however, several such programs are dropping their management requirements in favor of added scientific courses, an unrealistic step that will take its toll when graduates go job hunting.

A warning, then: Let program directors and curriculum advisors start reevaluating now, using a zero-based approach to analyze the profession's changing needs. Two-year technician programs should be strengthened to produce technical generalists. Baccalaureate and clinical experience programs should deemphasize the "how to's" to concentrate on developing people-oriented clinical and technical specialists. And graduate programs should start developing advanced clinical specialists with a broad base of management and people skills. All education programs should require working knowledge of computers, burgeoning bedside diagnostic and therapeutic procedures, political and professional concerns, and the relevance of laboratory data to DRGs and patient outcomes.

These changes will be impossible unless we part with some traditional components of a lab education. We may even have to begin selecting different, more outgoing types of students who are willing to work outside the conventional clinical laboratory setting. This evolution won't be easy, but it's fast becoming inevitable if the profession is to survive and grow.

Historian James Harvey Robinson described our present plight succinctly: "We like to continue to believe what we have been accustomed to accept as true, and the resentment aroused when doubt is cast upon any of our assumptions leads us to seek every manner of excuse for clinging to them. The result is that most of our so-called reasoning consists in finding arguments for going on believing as we already do."

Those who train our laboratory professionals are running out of arguments. Will we go on as before, or accept this new world and adapt to it?
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Title Annotation:Viewpoint
Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Article Type:column
Date:Aug 1, 1984
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