A medical laboratory scientist (MLS), also traditionally referred to as a medical technologist (MT), or a clinical laboratory scientist (CLS), is a healthcare professional who performs chemical, hematological, immunologic, histopathological, cytopathological, microscopic, and bacteriological diagnostic analyses on body fluids such as blood, urine, sputum, stool, cerebrospinal fluid (CSF), peritoneal fluid, pericardial fluid, and synovial fluid, as well as other specimens. Medical laboratory scientists work in clinical laboratories at hospitals, reference labs, biotechnology labs and non-clinical industrial labs.
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Educational requirements
Educational and licensing requirements vary by country due to differing scopes of practice and legislative differences.
Australia
In Australia, medical laboratory scientists complete a three- to four-year undergraduate degree in either medical laboratory science or biology or chemistry . The program can be accredited by the Australian Institute of Medical Scientists (AIMS).
Canada
In Canada, three-year college or technical school programs are offered that include seven semesters, two of them comprising an unpaid internship. The student graduates before taking a standard examination (such as the Canadian Society for Medical Laboratory Science, or CSMLS, exam) to be qualified as a medical laboratory technologist. Many MLTs go on to receive a bachelor of science degree after they are certified, but a few university programs affiliated with a college MLT program to allow students to graduate with both MLT certification and a degree such as the University of New Brunswick's Bachelor of Medical Laboratory Sciences program.
New Zealand
In New Zealand, a medical laboratory scientist must complete a bachelor's degree in medical laboratory science or biological or chemical science recognized by the Medical Sciences Council of New Zealand. Once they graduate they must have worked at least six months under supervision, be registered with the Medical Sciences Counsel of New Zealand, and hold a current Annual Practicing Certificate.
Ghana
In the Ghana, a doctor of medical laboratory science (MLS.D) is a professional with six (6) years professional doctorate degree in medical laboratory science, the medical laboratory scientist (MLS) has four (4) years bachelor's degree in medical laboratory science and the technicians has three (3) years diploma in medical laboratory science.
The curriculum for the programme include clinical rotations, where the students get hands-on experiences in each discipline of the laboratory and performs diagnostic testing in a functioning laboratory under supervision.
United States
In the United States, a medical laboratory scientist (MLS), medical technologist (MT), or a clinical laboratory scientist (CLS) typically earns a bachelor's degree in medical laboratory science, clinical laboratory science, medical technology, biomedical science or in a life / biological science (biology, biochemistry, microbiology, etc.), in which case certification from an accredited training program is also required in some states.
Medical laboratory scientist degree programs are set up in a few different ways.
- In 3+1 programs, the student attends classroom courses for three years and complete a clinical rotation their final year of study.
- In 2+2 programs, students have already completed their lower division coursework and return to complete their last two years of study in a CLS program.
- In 4+1 program, students who have already completed an undergraduate program return to complete a year of medical laboratory training. The training is typically completed at a clinical site rather than a college.
The core curriculum in medical technology generally comprises 20 credits in clinical chemistry, 20 credits in hematology, and 20 credits in clinical microbiology.
During clinical rotations, the student experiences hands-on learning in each discipline of the laboratory and performs diagnostic testing in a functioning laboratory under supervision. With limited or no compensation, a student in the clinical phase of training usually works 40 hours per week for 20 to 52 weeks. A few programs in the United States had the number of weeks students spend completing their clinical rotation due to staffing shortages at many healthcare organizations. In 2015, the MLS program at the University of Minnesota reduced the clinical rotation portion of the program from 22 weeks to 12 weeks.
In the United States, a similar two-year degree (or certificate) qualifies the graduate to work as a medical laboratory technician (MLT). MLTs receive training more exclusively in laboratory sciences without basic science coursework often required by MLS programs; however, there are many MLT training programs that require substantial basic didactic science course work prior to entry into a clinical practicum.
Although the didactic coursework may be less for the MLT, the clinical practicum, in many cases, is longer than the MLS student's. This equates to MLTs who are well equipped to enter the work force with relevant and knowledge based practical application.
In the United States, the term medical laboratory technician (MLT) may apply to persons who are trained to operate equipment and perform tests, usually under the supervision of the certified medical technologist or laboratory scientist in their departments. The entry-level for most medical laboratory technicians is an associate degree (60 credit certificate programs exist through military training programs; such as the U.S. Army's 68K military occupational specialty) and some states require a license which can be acquired after completing necessary education and clinical requirements.
Depending on the state where employment is granted, the job duties between MLSs and MLTs may or may not be similar. For example, in Florida, an MLT may only perform highly complex testing while under the direct supervision of a clinical laboratory technologist, a clinical laboratory supervisor, or a clinical laboratory director. This may make it impractical for an MLT to lawfully work in a Florida blood bank. California has similar restrictions on MLTs. To accommodate California's restrictions, the American Association of Bioanalysts (AAB) developed a separate certification examination for California licensure. This exam does not include material covering immunohematology or microscopy.
The shorter training time is attractive to many students, but there are disadvantages to this route. MTs, MLSs and CLSs usually earn higher salaries than MLTs. In 2014, medical laboratory assistants earned an average salary of $40,750 while medical laboratory scientists earned a salary of $60,560. An added disadvantage is some institutions will not employ MLTs. That practice is starting to change due to recent changes in healthcare legislation, cost reduction, and staffing shortages. Additionally, the associate in applied science degree received by the MLT can be utilized as a stepping stone for their future pursuit of a bachelor of a science degree.
Due to several factors, including boomer retirement, and inadequate recruitment and retention efforts, the medical laboratory workforce has been having increasing problems with shortages. For the decade 2010-2020, workforce needs are expected to grow by 13%. This translates into about 11,300 positions per year that will need to be filled, with only about 5000 new graduates per year coming out of various programs.
United Kingdom
In the United Kingdom (UK) there are two varieties of registered healthcare scientist in hospitals - Clinical Scientists and Biomedical Scientists (BMS). There is a strict and formal post graduate training programme for both careers followed by statutory registration for each with the Health & Care Professions Council UK (HCPC):[1], for the safety and assurance of the customers - the patients. They are two similar but distinct careers with parallel but different training paths and different entry requirements.
The role of Clinical Scientists is to improve the health and well-being of patients and the public by practising alongside doctors, nurses, and other health and social care professionals in the delivery of healthcare. Their aim is to provide expert scientific and clinical advice to clinician colleagues, to aid in the diagnosis, treatment and management of patient care.
Examples of the type of work they undertake include:
- Advising, diagnosing, interpreting, and treating patients.
- Advising health and social care professionals in the diagnosis and treatment of patients.
- Researching the science, technology, and practise used in healthcare to innovate and improve services.
- Designing, building, and operating technology for diagnosing and treating patients.
- Ensuring the safety and reliability of tests and equipment used in healthcare.
Trainee Clinical Scientist posts are advertised nationally, usually between November and February on the Clinical Scientists Recruitment webpages where application forms may be obtained and electronic submission of applications can be made. These posts are for the approved Pre-registration Training Programme, designed to prepare entrants for higher professional qualifications, further clinical training and eventual Consultant responsibility.
Clinical Scientist training involves enrolment of graduates (1st or 2nd class honours degree or better is essential due to the high competition for limited training places) into an intensive 3-year training scheme leading to certification and eventual registration before starting the higher career structure. The basic qualification for becoming a Clinical Biochemist, Clinical Immunologist or Clinical Microbiologist is a good Honours degree in an appropriate subject: for Clinical Biochemistry, that subject might be Biochemistry or Chemistry (or another life science subject which contains a substantial Biochemistry component); for Clinical Immunology, that subject might be any life science degree with an immunology component; for Clinical Microbiology that subject might be any life science degree with a microbiology component.
Although not essential, some candidates will apply with higher degrees in an to attempt to improve their chances of selection for training and several universities currently offer MSc courses in Clinical Biochemistry, Immunology and Microbiology which have been approved by the ACB or the AHCS. Full-time and 'sandwich' courses are available, and further information may be obtained from individual programmes, although the level of financial support provided varies, and should be clarified at interview. Some entrants to the profession will already have obtained a PhD, and the training and research experience that this provides is invaluable to the work of the Clinical Scientist. In larger Departments, there may be opportunities to study for a research degree after entering the profession and acquiring registration, but since this has to be fitted in with other responsibilities, it may take some years to complete. It should be clearly understood that the major role of the profession is patient care and that research, management and all the other aspects will come as side issues and not be the predominating factor in the career path. The work of Biomedical Scientists and Clinical Scientists have impact on the diagnosis and treatment of almost every patient admitted to hospitals in the United Kingdom.
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Certification and licensing
UNITED STATES OF AMERICA
There are currently three major certification agencies in the United States of America for clinical laboratory scientists. They are the American Association of Bioanalysts (AAB), the American Medical Technologists (AMT), and the American Society for Clinical Pathology (ASCP). All three national accrediting agencies will certify scientists in the clinical laboratory as generalist (chemistry, hematology, immunology, immunohematology/blood bank, and microbiology). The American Association of Bioanalysts and the American Medical Technologists certifications continue to use the traditional designation Medical Technologist (MT), while the American Society for Clinical Pathology has adopted the designation of Medical Laboratory Scientist (MLS). Regardless of terminology, these highly qualified individuals serve as scientists in the clinical laboratory.
There are two other organizations that have previously provided proficiency examinations to clinical laboratory scientist. The first, is the US Department of Health and Human Services. The second, is the National Credentialing Agency for Laboratory Personnel (NCA). The NCA was absorbed by the American Society for Clinical Pathology in 2009 and promptly dissolved.
In the United States, the Clinical Laboratory Improvement Amendments (CLIA '88) define the level of qualification required to perform tests of various complexity. Clinical Laboratory Scientists, Medical Technologists and Medical Laboratory Scientists are near the highest level of qualification among general testing personnel and are usually qualified to perform the most complex clinical testing including HLA testing (also known as tissue typing) and blood type reference testing. Provider Performed Microscopy, or PPM (doctorate or master's level health provider) and Cytology have additional requirements.
In addition to the national certification, 12 states (California, Florida, Georgia, Hawaii, Louisiana, Montana, Nevada, North Dakota, Rhode Island, Tennessee, West Virginia and New York) and Puerto Rico also require a state license. Puerto Rico, in order to provide the state license, requires either a local board certification with a state examination, or any of both the ASCP and the NCA. Minnesota, Texas, Illinois, Massachusetts, Michigan, Vermont, Washington, New Jersey, Iowa, Utah, Ohio, South Carolina, Wyoming, Pennsylvania, Virginia, South Dakota, Delaware, Missouri, and Alaska are currently attempting to obtain licensure. All states require documentation from a professional certification agency before issuing a state certification. A person applying for state certification may also be expected to submit fingerprints, education and training records, and competency certification. Some states also require completion of a specified number of continuing education contact hours prior to issuing or renewing a license.
Some states recognize another state's license if it is equal or more stringent, but currently California does not recognize any other state license.
UNITED KINGDOM
In the United Kingdom all clinical scientists and biomedical scientists have had to be registered with the Health & Care Professions Council (HCPC) in order to work unsupervised, to develop through the careers grades of their profession and to use the protected titles of "Clinical Scientist" or "Biomedical Scientist". The HCPC registers nearly 200,000 healthcare professionals[3] and while success in an approved degree course from an accredited University is sufficient for all other professions, both clinical scientists and biomedical scientists have post graduate training and no approved degree courses. Autonomous assessment of applicants in these two professions with subsequent certification for successful ones, is the only approved UK route to registration for them.
"Clinical Scientist", just as "Biomedical Scientist", is a protected title under the law (there is a £5000 fine for transgressors who fraudulently use the title without being registered by the state). The HCPC can strike people off the register for malpractice in just the same way as for doctors with the General Medical Council (GMC).
Those who are working in "Trainee" positions in the profession are permitted to use the title with an appropriate caveat, for example - "Pre-registration Clinical Scientist", Trainee Clinical Scientist, etc. Alternatively some may use titles specific to the discipline they train in, such as Trainee Clinical Biochemist", "Clinical Immunologist in Training" or " Pre-Registrant Clinical Microbiologist" which is also perfectly acceptable since it is not implying the protected "Clinical Scientist" title of fully qualified and registered practitioners. It is against the law to formally work with the title of "Clinical Scientist" without professional registration[4].
Specialty areas
Most Medical Laboratory Scientists are generalists, skilled in all areas of the clinical laboratory. However some are specialists, qualified by unique undergraduate education or additional training to perform more complex analyses than usual within a specific field. Specialties include clinical biochemistry, hematology, coagulation, microbiology, bacteriology, toxicology, virology, parasitology, mycology, immunology, immunohematology (blood bank), histopathology, histocompatibility, cytopathology, genetics, cytogenetics, electron microscopy, and IVF labs. Medical Technologists specialty may use additional credentials, such as "SBB" (Specialist in Blood Banking) from the American Association of Blood Banks, "SM" (Specialist in Microbiology) from the American Society for Microbiology, "SC" (Specialist in Chemistry) from the American Association for Clinical Chemistry, or "SH" (Specialist in Hematology) from the American Society for Clinical Pathology (ASCP). These additional notations may be appended to the base credential, for example, "MLS(ASCP)SBB". Additional information can be found in the ASCP Procedures for Examination & Certification.
Andrology Laboratory Scientist, Embryology Laboratory Scientist, and Molecular Diagnostics Technologist certifications are provided by the American Association of Bioanalysts; those with the certifications are classified as ALS(AAB), ELS(AAB), and MDxT(AAB) respectively. Certified Histocompatibility Associate, Certified Histocompatibility Technologist, Certified Histocompatibility Specialist, and Diplomate of the ABHI are titles granted by the American Board of Hisocompatibility and Immunogenetics after meeting education and experience requirements and passing the required examination; those individuals would hold the credentials CHA(ABHI), CHT(ABHI), CHS(AHBI), and D(ABHI) upon passing the corresponding examination.
In the United States, Medical Laboratory Scientists can be certified and employed in infection control. These professionals monitor and report infectious disease findings to help limit iatrogenic and nosocomial infections. They may also educate other healthcare workers about such problems and ways to minimize them.
In the United Kingdom the number of Clinical Scientists in a pathology discipline are typically greater, where less medically qualified pathologists train as consultants. Clinical Biochemistry, Clinical Immunology and Genomic Medicine are specialities with an abundance of UK Clinical Scientists, and where the role is well established. Infection services in the United Kingdom are generally undertaken by medically qualified Microbiologists, who may have overall responsibility for laboratory services in addition to Infection Prevention and Control responsibilities, and may be required to contribute to ward rounds and patient clinics. Therefore, the Royal College of Pathologists and Royal College of Physicians have developed Combined Infection Training[10], that medical trainees gain a much more patient focused experience, and undertake Physician examinations in addition to Pathology training. The end result of this is that several regional medical deaneries no longer permit Medical Doctors to train in Microbiology or Virology as single disciplines, and instead advocate dual-specialisation as Infectious Disease/Microbiology or Infectious Disease/Virology [11]. Simultaneously the expansion of higher specialist scientist trainees in microbiology mean that many of the laboratory and scientific responsibilities of medical doctors may be taken on my Clinical Scientists, and medical doctors will instead be expected to perform a much more patient facing role. The exception in Microbiology is the sub-discipline of Virology, which is well suited to the expertise of clinical scientists due to reliance on cutting edge scientific methods, increasing use of specialised genetic technologies, and a technical understanding of virus biology, with a reduced emphasis on patient management compared with Microbiology as a whole[12].
It is therefore likely that many patients in UK hospitals may come into contact with Clinical Scientists working in a patient facing speciality, who may be confused with medical doctors due to the complex nature of their role.
Further education
A Medical Laboratory Scientist may pursue higher education to advance or further specialize in their career.
- Master of Science, Master of Business Administration, Master of Health Administration, Doctor of medical laboratory science for specialization, education and management roles.
- Pathologists' assistant
- Doctor of Philosophy for management and directorship roles in the clinical laboratory as well as for academic research and professorship. Doctors of Philosophy holding a degree in a biological science, and who are board certified by a CLIA-approved entity, are qualified as a medical laboratory director.
- Doctor of Medicine or Doctor of clinical laboratory Science - this is the position that qualifies an individual to oversee or direct almost all types of clinical laboratories. Under U.S. CLIA laws, a requirement of at least year of clinical laboratory experience (any MD) or pathology residency must be met.
In the United Kingdom The Modernising Scientific Careers (MSC) programme sets out for the first time a comprehensive training and career framework for the whole healthcare science workforce inclusive of the more than 50 different scientific professional specialisms. In its conception it aimed to provide a coherent framework that was accessible, affordable and designed specifically to both capture scientific and technological advances and to provide improved outcomes for patients, the service and professionals. A key aspect of the framework from the start was the formalisation of training to develop talented clinical scientists to undertake quality assured Higher Specialist Scientist Training (HSST) programmes to prepare them for roles as Consultant Clinical Scientists. It is envisaged that Consultant Clinical Scientists will work synergistically and in partnership with their medical colleagues and within multiprofessional clinical teams to support clinical scientific practice aimed at quality improvement, innovation and world-class outcomes for patients. This scientific expertise and leadership will provide important benefits and added value to patients and to the service as it moves forward through the 21st century. This will bring to fruition the vision of science and realise the potential of scientific and technological advances for both translational and personalised medicine.
Training through the Higher Specialist Scientist Training pathway is discipline specific. For life science disciplines (Immunology, Microbiology, Virology, Haematology, Biochemistry) the training curriculum and formal examinations are administered by the Royal College of Pathologists. The life science training pathway for Clinical Scientists follows a similar pathway to that undertaken by medically qualified specialist registrars in pathology. Clinical Scientists are therefore the only discipline of non-medical healthcare professionals examined by a Medical Royal College. Clinical Scientists who attain both part 1 examination certification and part 2 certification are awarded Fellowship of the Royal College of Pathologists (FRCPath) and are deemed to have the knowledge and expertise expected of a consultant level scientist. Consultant Clinical Scientist posts generally require candidates to have completed FRCPath qualification to be eligible.
All Clinical Scientists regardless of seniority or specialisation may have other responsibilities including academic appointments, responsibilities as clinical lead for a pathology service, or may have wider hospital responsibilities such as Directorship of Infection Prevention and Control, or responsibility for the hospital's Research and Development strategy. Junior clinical scientists may become involved in academic research, working towards award of a Ph.D. or DClinSci
Job duties
Medical laboratory scientists work in all areas of the clinical laboratory, including blood banking, chemistry, hematology, immunology, histology and microbiology. They perform a full range of laboratory tests - from simple prenatal blood tests to more complex tests to uncover diseases such as HIV/AIDS, diabetes, and cancer. They are also responsible for confirming the accuracy of test results, and reporting laboratory findings to pathologists and other physicians. The information that a medical laboratory scientist gives to the doctor influences the medical treatment a patient will receive. Medical laboratory scientists operate complex electronic equipment, computers, and precision instruments costing millions of dollars.
Medical Laboratory Scientist analyzes human fluid samples using techniques available to the clinical laboratory, such as manual white blood cell differentials/counts, bone marrow counts, analysis via microscopy, and advanced analytical equipment. Medical laboratory scientists assist doctors and nurses in choosing the correct lab tests and ensure proper collection methods. Medical laboratory scientists receive the patient specimens, analyze the specimens and report results. A pathologist may confirm a diagnostic result, but often the medical laboratory scientist is responsible for interpreting and communicating critical patient results to the physician.
Medical laboratory scientists must recognize anomalies in their test results and know how to correct problems with the instrumentation. They monitor, screen, and troubleshoot analyzers featuring the latest technology available on the market. The MLS performs equipment validations, calibrations, quality controls, "STAT" or run-by-run assessment, statistical control of observed data, and recording normal operations. To maintain the integrity of the laboratory process, the medical laboratory scientist recognizes factors that could introduce error and rejects contaminated or sub-standard specimens, as well as investigates discrepant results.
Common tests performed by medical laboratory scientists are complete blood count (CBC), comprehensive metabolic panel (CMP), electrolyte panel, liver function tests (LFT), renal function tests (RFT), thyroid function test (TFT), urinalysis, coagulation profile, lipid profile, blood type, semen analysis (for fertility and post-vasectomy studies), serological studies and routine cultures. In some facilities that have few phlebotomists, or none at all, (such as in rural areas) medical laboratory scientists may perform phlebotomy on patients, as this skill is part of the clinical training.
Because medical laboratory scientists are skilled in diverse scientific disciplines, employment outside of the medical laboratory is common. Many MLS are employed in government positions such as the FDA, USDA, non-medical industrial laboratories, and manufacturing. The practical experience required to obtain the bachelor's degree in medical technology give the MLS a unique understanding of the inter-relationship between microbiological and chemical testing and the resulting clinical manifestations in clinical, scientific, and industrial settings.
In the United Kingdom and the United States, senior laboratory scientists, who are typically post-doctoral scientists, take on significantly greater clinical responsibilities in the laboratory. In the United States these scientists may function in the role of clinical laboratory directors, while in the United Kingdom they are known as consultant clinical scientists.
Though clinical scientists have existed in the UK National Health Service for ~60 years, the introduction of formally trained and accredited consultant level clinical scientists is relatively new, and was introduced as part of the new Modernising Scientific Careers framework.
Consultant clinical scientists are expected to provide expert scientific and clinical leadership alongside and, at the same level as, medical consultant colleagues. While specialists in healthcare science will follow protocols, procedures and clinical guidelines, consultant clinical scientists will help shape future guidelines and the implementation of new and emerging technologies to help advance patient care.
Role in the healthcare process
A Medical Laboratory Scientist's role is to provide accurate laboratory results in a timely manner. An estimated 70 percent of all decisions regarding a patient's diagnosis and treatment, hospital admission and discharge are based on laboratory test results.
in the United Kingdom, Healthcare Scientists including Clinical Scientists may intervene throughout entire care pathways from diagnostic tests to therapeutic treatments and rehabilitation and although this workforce comprises approximately 5% of the healthcare workforce in the UK, their work underpins 80% of all diagnoses and clinical decisions made[2].
Job title
The informal abbreviations of job titles may be a source of confusion. Medical Laboratory Scientist (ASCP) and Medical Technologists (AMT) or (AAB) are often called "med techs" (based on the era in which they were known as "medical technologists"), but this shorthand term is shared by other healthcare employees, including pharmacy techs, Radiographers (also known as Radiologic Technologists), Respiratory therapists.
In the United States there is a formal distinction between an MLT and a MT/MLS. Often, MT/MLS have at least a bachelor's degree, while MLT have an associate degree. However, due to grandfathering rules and certification requirements between the boards of registry, some MT/MLS may only have an associate degree. Due to increasing standards in the field, the ability for a person with an associate degree to become an MT is increasingly difficult. Scientists and technologists generally earn a higher income than technicians do and have more opportunities for advancement.
In the United Kingdom, there are defined training pathways leading to professional registration as either a Clinical Scientist, or as a Biomedical Scientist. The role descriptions for these healthcare scientists are very different, where clinical scientists generally undertake non-routine research and development, as well as improving and providing clinical service using scientific expertise. Biomedical Scientists in the United Kingdom are similar to the role of MLT and MT/CLS described above, and have similar regulatory requirements for professional regulation. Clinical Scientists in the United Kingdom may struggle with a lack of professional recognition. This is in part due to the myriad job titles used to describe them including Clinical Physiologists, Medical Physicists, Clinical Biochemists, which generally mean the public and other healthcare workers assume Clinical Scientists to be medically qualified doctors, due to the sometimes complex nature of the role.
See also
External links
- Canadian Society for medical Laboratory Science
- U.S. Department of Labor information on Clinical Laboratory Technologists and Technicians
- American Association for Clinical Chemistry
- American Society of Clinical Pathology
- American Society of Clinical Laboratory Science
- National Credentialing Agency for Laboratory Personnel
- National Accrediting Agency for Clinical Laboratory Science
- Medical Technologist Continuing Education
- AIMS: Australian Institute of Medical Scientists
- New Zealand Institute of Medical Laboratory Science
- Greek Association of Medical Laboratory Technologists
- Clinical Laboratory Scientists at Work
References
- http://www.cms.hhs.gov/CLIA/10_Categorization_of_Tests.asp#TopOfPage
- http://dhi.health.state.nm.us/CLIA/index.php
- http://www.naacls.org/docs/guide_dcls.pdf
Source of article : Wikipedia
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