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The clinical scientist in diagnostic pathology.

Having recently returned from the United Kingdom, I had the opportunity to read my first NZIMLS journal for a number of years. I was very interested to see the leading article in the August issue of the NZIMLS journal titled "The clinical scientist in diagnostic pathology" (1). The article contains a number of inaccuracies which I feel should be identified and addressed before the Medical Laboratory Think Tank continues any further with their suggested changes to existing medical laboratory scientist training. Having practised as a Clinical Scientist, registered with the Health Professions Council in the UK for the past 10 years, I feel that I am able to clarify some of the inaccuracies that I have identified.

Unfortunately, this article references documents with regards to the training of clinical scientists in the UK that are outdated. The Department of Health in the UK, who are responsible for overseeing the national training programme, have since introduced a new career structure known as Modernising Scientific Careers (MSC). The first group of trainees entered the MSC programme this year following a successful pilot programme in 2009.

The information provided in the article appears to have been obtained from documents from the Royal College of Pathologists. This perhaps is the reason why the information supplied is outdated - the college is not directly involved with the training of clinical scientists, being more concerned with the training of Pathologists and administering post-registration examinations for registered scientists and is reliant on second-hand information. Training in the UK is generally provided (in the old training scheme that is described in the article) by the Professional Bodies of each discipline, eg. Association for Clinical Cytogenetics for Clinical Cytogenetics.

I would like to clarify some areas:

1. The article states that the biomedical scientist is the equivalent of the New Zealand medical laboratory scientist. This is not entirely true and is dependent on the pathological discipline. Being a New Zealand registered Medical Laboratory Scientist did not exclude me from being registrable as a Clinical Scientist by the HPC. I was not a lone case and know of a number of other New Zealand trained scientists who also hold UK clinical scientist registration obtained through the international applicant route. New Zealand registered scientists currently work as both biomedical scientists and as clinical scientists.

2. Clinical Scientists in what I would now call the "old training scheme" did not usually exit with a PhD. In fact, the Clinical Scientists that I know with PhDs either held them before entering the training scheme or completed them years later post-training; either way Clinical Scientists with PhDs are definitely not the majority. A few lucky scientists are able to complete PhDs with the support of their institutions whilst still practising as Clinical Scientists, however they are a minority. Anyone wishing to pursue a PhD post training has to either resign from their job and apply for a PhD full-time position (as I did) or apply to undertake a PhD part-time which permits them to continue in active employment on a part-time basis.

3. The "old training scheme" that the Think Tank is looking to adopt as mentioned has now been superseded by a new training programme. I quote directly from the UK Department of Health "approximately 200 training posts in Life Sciences (under which the disciplines of Medical Laboratory Science fall), Physics & Engineering or Physiological Sciences to start in October 2011. Successful candidates will join a three-year, fixed term, integrated training programme of workplace-based learning and a Master's degree in their chosen specialism. Trainees will be employed by a single NHS Trust where they will be required to undertake a range of rotations, working in different departments (and possibly different trusts), before specialisation in the last two years of training. After this period of training, successful trainees will be in a position to apply for NHS posts as Healthcare Scientists and to the appropriate professional register."

4. Clinical Scientists do not replace consultants. The title given is more accurately, Clinical Scientist with Consultant equivalence. This title is held, again, by a small number of suitable qualified Clinical Scientists who have usually undertaken the Fellowship examinations of the Royal College of Pathologists and usually involves the management of a large laboratory or a major departmental section. The Consultant Clinical Scientist, as they are sometimes referred to, although equivalent to a Consultant in the medical field by description, is not paid a Medical Consultant salary and generally acts in addition to their managerial role, as an advisor to the Consultants on the ward, which is in fact no different to the role that a head of laboratory or in some instances a head of section currently does in New Zealand. Importantly however, positions of this status are few and far between.

I would strongly suggest that before any major changes are made to the way that medical laboratory scientists are trained in New Zealand, a review of current documentation is undertaken and would direct them to this web address:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH 113275 where the latest information with regards UK-training can be found. I do not particularly endorse either UK training scheme, but do think that it is important that decisions are made with accurate and update to date information.

Reference

(1.) Legge M. The clinical scientist in diagnostic pathology. N Z J Med Lab Sci 2010; 64 (2): 35-7.

Amanda Dixon-McIver, BMLSc MSc PhD, Senior Scientist IGENZ Ltd, PO Box 106 542, Auckland 1010, New Zealand

The author replies

Dear Editor

Thank you for the opportunity to respond to Amanda's letter. I will respond in the order of the points raised in the letter. A general comment first is that the Medical Laboratory Think Tank no longer exists and there is no identifiable structure at present to develop the concept of the Clinical Scientist any further than what the group arrived at during its life time. The Faculty of Science at the Royal College of Pathologists of Australasia (RPCA) has only recently been established and the Faculty Committee is yet to be elected. I would hope that there would be a positive development towards creating Clinical Scientists once the infrastructure has been established. It is not a correct assumption that the information relating to Clinical Scientists was obtained from the Royal College of Pathologists (UK). The acknowledgement to the College in the article was to acknowledge the considerable help they provided in allowing access to their databases to dissect membership and to identify discipline areas College Fellows were qualified in, which was used by the Think Tank. Not to obtain specific information relating to the training of Clinical Scientists in the UK, as this was readily available from the Association of Clinical Scientists as was registration information from the Health Practitioners Council (HPC).

Turning to the more specific points raised in the letter:

1. The New Zealand BMLSc is regarded by the Institute of Biomedical Science (IBMS) as equivalent to the Biomedical Science degree in the UK. The UK biomedical science degree is a protected title and can only be used by biomedical scientists, the UK equivalent of medical laboratory scientists here. Whereas the biomedical science degrees offered by New Zealand Universities do not qualify a person as a medical laboratory scientist. I did not say that holders of a BMLSc from New Zealand could not qualify as Clinical Scientists; I was drawing the distinction between the two occupational groups in the UK. There are a number of biomedical scientists in the IBMS and the Association of Clinical Scientists as well as holding Fellowships of the Royal College of Pathologists. I have discussed this issue of equivalence with the President and CEO of the IBMS when I have met with them and they were comfortable with the BMLSc and HPC registration as biomedical scientists. I would add that with a four year BMLSc degree, New Zealand graduates have also had success in obtaining the equivalent of UK Honours for further postgraduate study and salary progression.

2. I cannot understand the comment about the PhD issue, for which there seems to be some confusion. My comment relating to qualifying with a PhD related to the structure provided by the Royal College of Pathologists (UK) when non-medical scientists study for Fellowship. Over the period of time to qualify with Fellowship, completing a PhD may also undertaken. Obviously not all scientists will undertake a PhD and others will undertake Fellowship with a PhD already awarded. From the College database, 70% of those qualifying for Fellowship hold a PhD. The mechanism of how the PhD is achieved I have not discussed, although for Fellowship there is a requirement for records of continuous training. The increasing option of obtaining a professional doctorate whilst still working has been encouraged by the UK government and these graduates have been retained in the workforce.

3. I think we are looking at the same UK qualification route; however, there seems to be some confusion about the role of the "Think Tank". Before its demise the members put forward a proposal to the RPCA for a possible training model for New Zealand should the Clinical Scientist role be developed. This was based on the concept of the UK system i.e. training to MSc level in a discipline with in-house discipline training (similar to registrar training). However, the group recognized that the scale of training and numbers would not be similar to the UK and that funding the model had also to be considered. In addition to these considerations there was the important issue of qualification transportability, especially in Australia, hence the direct involvement with the RPCA. AIMS were kept updated on these developments also as there were similar discussions going on in Australia with an interdisciplinary committee considering the same issue.

4. I did not say that Clinical Scientists replace medical consultants, my wording (in the context of the Fellowship of the Royal College of Pathologists) was: "The qualified clinical scientist is required to be registered with the HPC and can practise independently either at the consultant level or under the guidance of a consultant clinical scientist or medical practitioner in the specific discipline". As I indicated in the article The Royal College of Pathologists recognises that attainment of consultant status will be medical consultant equivalents. The Clinical Pathology Accreditation (UK) agency, who are responsible for pathology accreditation, clearly states in its standards for laboratory accreditation that: "Each discipline shall be professionally directed by a consultant pathologist or a clinical scientist of equivalent status". In the reports considered by the 'Think Tank' there were clear divisions of responsibilities for both clinical scientists and pathologists which were recognized in working through the development of a possible training programme. In the "Modernising of Scientific Careers", which Amanda mentions in her letter, the 'caps' on salary scales have been removed allowing the possibility of a non-medical scientist to reach and be paid at medical consultant level acknowledging special responsibilities and skills, which may be different to those of the medical consultant eg patient care. It is evident however not all scientists will achieve this which is no different to any career structure in any profession. I did mention in the article the necessity of 'stopping off points' in any career development and used the IBMS model of Extended and Expert Practice qualifications as an example to be considered. This would have to be structured in a different way for New Zealand, but offers an option for various levels of training and competencies.

In conclusion, we wait to see what the RPCA might decide on an option for New Zealand and Australia. The 'Think Tank' made excellent progress given the time and resources at its disposal and has made a solid, practical suggestion of extending the role of Medical Laboratory Scientists in the pathology workforce which would enhance the delivery of diagnostic pathology. The UK "Modernising Scientific Careers" has been a working concept for some time in various guises, commencing in 2008 with "Modernising Scientific Careers: The UK Way Forward", and is still a very 'fluid' concept and it is early days in the implementation. This is highlighted with a comment from the IBMS CEO in December 2010 that the professions still have to sort out what the issues are relating to this and has been a specific area for discussion at recent IBMS conferences.

Mike Legge, FIBMS FNZIMLS PhD, Associate Professor & Director Medical Laboratory Science Programme

Department of Pathology, University of Otago, Dunedin
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Author:Dixon-McIver, Amanda
Publication:New Zealand Journal of Medical Laboratory Science
Article Type:Letter to the editor
Geographic Code:4EUUK
Date:Apr 1, 2011
Words:2082
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