ASCLS Today Volume 32 Number 5

Holly Weinberg, MLS(ASCP)SH, Region Region VIII Director 

The Region VIII Leadership Academy (R8LA) graduated our fifth class of Interns at the ASCLS Annual Meeting in Chicago this summer. Now that we’ve been running for a few years, it’s time to look back and evaluate our program.

First, how did we get here? In 2013, ASLCS Past President Susan Morris, while serving as Region VIII Director, brought the question to the Region VIII Council – what is the feasibility of developing a regional Leadership Academy? One of the original goals of the national Leadership Academy was to begin at the national level and eventually roll it out to the states and regions. The national Academy had then been running for six years; was it time to look at a regional Academy? Susan created a task force in January 2013, chaired by Joni Gilstrap, to research the question. Nine months later, we opened our first R8LA, piggy-backed with the regional conference, Intermountain States Seminar (IMSS) in Jackson, Wyoming.

The academy opens on Monday with sessions running through Wednesday morning prior to the start of IMSS. We rent two condos, one for faculty and one for interns so we can share meals family-style and hold sessions in the faculty condo. The condos are paid for by Region VIII so the interns just need to get to Jackson and lodging is covered. Everyone brings food for pre-determined menus plus extraneous goodies – nobody goes hungry! On Tuesday afternoon we get out of the condos for a group team building activity that is dependent on the weather and the make up of the group.

After those opening sessions in Jackson, we move to video conferencing on six Saturdays between October and December. The Interns also work on a team project that is designed to enhance, augment, and update current processes to help the states in Region VIII move forward. Projects can be focused on an improvement to a regional level process or to state level functions. The Interns are encouraged to share information about the R8LA and their project at their state spring meetings. They present the final project to the Region VIII Council when we convene for our summer meeting in conjunction with the Annual Meeting. After they present their project, we hold a graduation ceremony where they get a certificate and a Region VIII Leadership Academy pin. The goal is for our Interns to attend the Annual Meeting as delegates for their state society.

In the five years of operation we have enrolled 17 Interns; two of those dropped out of the program prior to graduation, and 15 have graduated. All five states in Region VIII have been represented and we average three Interns per class. Interns have ranged from newly graduated students through a 30-plus year MLS. Even though the current class of four interns have not yet graduated, I am including them in the following statistics.

As this table shows, 12 of our 15 graduates/soon to be graduates are active in a leadership role in the region. 13 are still members in ASCLS. The two who are no longer members moved out of state and dropped their memberships the following year.

The faculty is comprised of Region VIII leaders who have many years of leadership experience in ASCLS and in their workplaces. It was critical to have a faculty leader at the inception of the R8LA to set up the curriculum, to get feedback about the process and to keep everyone on the right track. The R8LA would not have been possible without a passionate, dedicated group of individuals to see the initial organization of this new Academy through.

In the first five years of the R8LA, we have learned a lot. We’ve tweaked the curriculum using suggestions from our interns and faculty. We’ve had a lot of fun at the opening sessions in Jackson getting to know our Interns and sharing recipes. The team building activity is always a highlight! We’ve bicycled 13 miles (one-way!) to Moose, Wyoming, for lunch; shopped in Jackson on a very rainy, cold day; took a moderate hike on a gorgeous bluesky autumnal day; trammed to the top of a 10,400 foot mountain (taking the R8LA to new heights!), and survived an escape room challenge pitting the faculty against the interns (ok, the Interns won by two minutes).

The R8LA has been an excellent addition to our Region. When I look at the outcomes, it appears that we are doing something right; we have had the opportunity to get to know exciting new talent in our five states and give them the tools to carry our states forward. Thank you, Susan, for encouraging us to develop the Academy and to our dedicated faculty for making it a success!

Linda Hickok, MLS(ASCP)^CM, Political Action Committee Secretary

The ASCLS/Political Action Committee (PAC) is a voluntary nonprofit organization created to provide financial and educational support for the election campaigns of responsible candidates for Congress. All PACs are legal, ethical, and strictly regulated by federal law, which limits the amount of individual contributions and requires full and regular disclosure.

ASCLS/PAC offers members a simple, convenient way to influence the elections process and actively participate in the federal decision-making process. Through the PAC, ASCLS members can unite together to gain the attention of candidates for national political office.

In another sense, your support and generous contributions to the ASCLS/PAC represents your Positive Action and Commitment.

Our system of government depends on the wisdom and integrity of elected officials. They, in turn, represent us best when they are exposed to and held accountable by an informed and active public. Now more than ever, laboratory professionals must take an active role to see that congressional reforms of American healthcare support cost-effective, high-quality clinical laboratory services. You can help by supporting the ASCLS/PAC. Each dollar you give improves the chances that informed and capable people will be elected to Congress to enact responsible reforms in America’s health service delivery system.

Healthcare in the United States has unfortunately evolved into a complex and intricate network of legislation and regulation. Legislation approved today can vastly change the future course of a profession — our profession. It is the responsibility of the profession itself and its members to keep lawmakers fully informed and cognizant of the key issues that may directly impact us.

To provide the needed information to our lawmakers, it is necessary to gain access and attention. ASCLS/PAC is designed to do just that — to gain access and obtain the attention of lawmakers.

By providing campaign contributions to a carefully selected number of candidates, the ASCLS/PAC helps ensure the re-election of lawmakers who have been attentive to the needs of the clinical laboratory profession. Our support for these candidates guarantees that ASCLS is well represented in Congress.

Established in 1976, the ASCLS/PAC is administered by its own Board of Trustees. Campaign contributions must be approved by the Chair or by the full Board of Trustees. Recommendations for contributions are made by both ASCLS staff and members; decisions are based on a candidate’s past record of performance, understanding of healthcare issues, and likelihood of future support for clinical laboratory science.

Any solicitation for contributions to ASCLS/PAC is intended solely for members of ASCLS, an individual membership organization, for the purposes of the Federal Election Campaign Act of 1976, as amended. ASCLS does not solicit or accept contributions from individuals who are not members of ASCLS.

ASCLS/PAC is supported solely by donations from ASCLS members. Under federal law, these donations must be voluntary, and cannot be listed as a charitable contribution for tax purposes. The PAC files financial reports with the Federal Election Commission on a quarterly basis. Your support of the ASCLS/PAC demonstrates your support of hard-working and responsible candidates for public office. Your contribution decision will in no way affect your rights as a member of ASCLS.

For more information and to make a contribution, visit www.ascls.org/PAC.

Bev McCarron, Rutgers University

The patient, a quadriplegic with an irregular heartbeat, was set to get a pacemaker when a test came back suggesting he had pneumonia, delaying surgery and lengthening his hospital stay.

But when a medical team consulted at his bedside, Brandy Gunsolus, a Rutgers University clinical lab doctoral student and certified medical laboratory scientist, questioned the diagnosis. She noted the man used a breathing tube – and that bacteria found in a test result likely came from the tube, not his lungs. A second test, considered the gold standard in medical care, was clear. The attending physician agreed with her assessment.

“He got his pacemaker the next day, which saved 10 days on intravenous antibiotics, 10 days on a ventilator and $22,000 in hospital costs,” said Gunsolus, who is completing her residency at a Rutgers-affiliated Georgia hospital.

At that moment, Gunsolus felt fully integrated into the health care team. For the past year, the doctoral student has been a pioneer in a new health care model that brings advanced-practice clinical lab scientists to a patient’s bedside to work hand-in-hand with physicians and other health care professionals.

On May 16, Gunsolus became the first graduate of a doctoral program that is the first of its kind in the nation – Rutgers School of Health Professions’ advanced practice doctorate in clinical laboratory science (DCLS). The school launched the program in 2014 to address an ongoing need for greater accuracy and cost efficiency in lab testing.

Gunsolus saw firsthand the need to integrate lab science into the health care system. A medical lab manager in Louisiana, she was frequently asked what lab tests to order and if she could help interpret the results. Her desire to be fully prepared to answer those questions fueled her decision to get a master’s degree in clinical laboratory science at the School of Health Professions in 2013 and then to enroll in the doctoral program.

“There is a gap between practicing physicians and labs not understanding the correct tests to order or how to interpret them. For patient safety, we need to fill this gap,” she said.

In addition to performing rounds at the hospital with the medical team, Gunsolus reviews all laboratory test orders and is part of the hospital’s diagnostic management team as well as a nationally sponsored consumer information response team that answers patient questions about lab tests. During her residency, she documented nearly $700,000 in savings that came from consulting with clinicians and health care providers about lab tests. But what most excites her is being part of the attending health care team.

“At first it was a bit scary. I didn’t know if I’d be accepted, but overwhelmingly there’s been a positive result,” said Gunsolus, who has written a blog about her journey in the Rutgers doctoral program (roadtodcls.com). “I’ve had physicians say, ‘I want you to do the rounds with me every day.’”

She began her paid job on June 1 at the Augusta, Georgia, hospital as the nation’s first doctor of clinical lab science.

“Brandy has become a trailblazer, forging a new clinical career path for medical laboratory scientists and advancing the quality of health care,” said Nadine Fydryszewski, DCLS program director and professor in clinical laboratory science.

Written in collaboration with ASCLS and ASCP Board of Certification

Medical laboratory science associations’ blogs, discussion boards, and listserv lists are continually populated with questions concerning what to teach laboratory science students, how to prepare for the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) examination, and what is or isn’t on the certification examination. Both the ASCLS Entry Level Curriculum (ELC) and the ASCP BOC Practice Analysis can provide some answers to these questions and serve as a resource to educators and those preparing to challenge the ASCP BOC certification examination. This article will describe both processes and identify the purpose and intended use of each.

ASCLS Entry Level Curriculum (ELC)

Background and Purpose
The ELC was revised in 2016-2017 and is designed to be a resource for medical laboratory science programs. Entry level is defined as the knowledge and skills that a new graduate at the Medical Laboratory Technician (MLT) or Medical Laboratory Scientist (MLS) level should possess upon entry into the workforce. The first ELC was published in 2002 and created by educators and practitioners using the Body of Knowledge (BOK) published by ASCLS.

The ELC is designed for several purposes which include to:

• Develop a new program
• Assist the new instructor/professor with course development
• Update a current program or course
• Serve as a resource for clinical faculty
• Validate what we do as educators
• Provide guidance to other organizations for entry level expectations
• Establish entry level expectations

2016-2017 Revision Process
A sub-committee of the ASCLS Education Scientific Assembly (ESA) Committee for Educational Programs and Initiatives (CEPI) was assembled in the fall of 2015 to facilitate the process of updating the ELC. The Committee was charged with two main goals:

1. Use the recently updated (2014 version) ASCLS BOK and personal expertise in entry level practice to update the curriculum by removing dated topics and adding new items.
2. Ensure differentiation of the MLT and MLS curriculum based on the level of education required for each.

The ELC committee received comments from MLS and MLT educators who attended the ASCLS Clinical Laboratory Educators’ Conference (CLEC) in 2016 and continued to solicit comments from educators who could not attend. With these comments, another version was created and distributed to all ASCLS members for comments. These comments were used to create a third revision. Consulting each other, ELC committee members finalized all documents by applying the Beck/Moon algorithm introduced at CLEC 2016 and in Clinical Laboratory Science. (Beck and Moon 2017) The algorithm included three basic questions:

• Is it current practice?
• Is it entry level?
• Is it foundational?

In situations where conflicting comments were received, this algorithm provided the criteria for removing dated information from the documents. Upon completion, the third version was submitted to the ASCLS Board of Directors for adoption at the 2016 House of Delegates.

ELC Format
The MLS and MLT entry-level curricula are defined as the knowledge and skills expected of a new graduate upon successful completion of a formal educational program. It assumes no work experience other than that required as part of a clinical education affiliated with the program.

The curriculum format is delineated by discipline area within the MLS and MLT levels. Each discipline area is further delineated by major topics which include a sequence and coordination of concepts, principles and theories, and skills.

The curriculum represents a consensus by reviewers of the minimum knowledge and skills required to be successful in an entry level role. The committee developed the final documents with the understanding that all listed technical items may not be available at each educational institution so that in some programs, only cognitive aspects (state, explain, describe) will be taught and at others the psychomotor may also be taught (perform or observe). The committee also expects that some programs will teach beyond what may be included, based upon regional needs of their graduates and availability of resources.

Taxonomic Levels
The taxonomic levels within the ELC are identified and based upon a simplified version of Bloom’s taxonomic levels as described in Clinical Laboratory Education. (Beck and LeGrys 2014)

The cognitive domain includes:

• Level 1: Recall of basic knowledge and comprehension
• Level 2: Application and interpretation of content
• Level 3: Critical analysis, decision making, and problem solving, which relates to the evaluation and processing of knowledge

The psychomotor domain includes:

• Level 1: Readiness; an awareness of and ready to perform; observes
• Level 2: Competence and confidence with performing a task
• Level 3: Proficiency and adaptation, ability to alter performance successfully when encountering unexpected or new situations

The affective domain includes:

• Level 1: Awareness of an activity or situation
• Level 2: Valuing; attachment of worth and beginning to express behaviors demonstrating value of an activity or situation
• Level 3: Commitment; ability to justify values

Taxonomic levels were included to assist new instructors and new programs.

Availability
The updated versions of the Entry Level Curriculum for MLS and Entry level Curriculum for MLT can be purchased from the ASCLS Store at www.ascls.org/store.

ASCP BOC MLS and MLT Practice Analyses

Background and Purpose
The purpose of conducting a practice analysis (also known as a job analysis or job task analysis) is to provide the foundation of the certification examination by defining practice in a profession. The practice analysis is administered via surveys which identify the actual tasks that practitioners must be able to perform at the time of certification. The practice analysis provides evidence of content validation. It is required by psychometric standards and is considered best practices for high stakes examination development(Chinn and Hertz 2010). It also ensures the certification examination is fair, valid, job-related, and most importantly, legally defensible. In addition, professional standards used by accreditation agencies (i.e., American National Standards Institute), as well as legal statutes and guidelines, utilize the practice analysis to evaluate the validity of certification programs.

The practice analysis process begins with the development of a comprehensive list of tasks needed for current practice in the field by subject matter experts. This list is placed into survey format along with a rating scale and demographic questions. The practice analysis survey is then distributed to practitioners. The data collected from the surveys is analyzed and the exam committee reviews the results to determine which tasks will be included when developing the content guideline for the certification examination and subsequently the examination question database. All exam questions are linked to a content area on the content guideline.

Process
During the 2015 certification examination committee meetings, the five categorical examination committees (Blood Banking [BB], Chemistry [C], Hematology [H], Microbiology [M], and Molecular Biology [MB]) provided the input and discussion to develop the practice analysis survey for MLS and MLT. Each committee created the sections of the survey corresponding to their respective disciplines. The Joint Generalist Committee, whose membership includes representatives (mainly educators) from each categorical examination committee, reviewed and approved a final version of the survey. The committee members (subject matter experts) collectively discussed all pertinent aspects of their profession to design a concise survey to extract useful feedback from field professionals while maximizing response rate. The survey had two main components: demographics and task inventory with appropriate rating scales for each.

Sampling Procedure
The categorical and Joint Generalist committees determined that the survey should be sent to all current generalists (MT/MLS and MLT certificants) and categorical (BB/C/H/M) certificants in the BOC Personify database.

Demographics
The demographic questions asked about experience, education, gender, age, titles, work shift, type of facility, areas of lab work, work hours, etc. The purpose of these questions was to aid the committee in deciding whether the sample of respondents obtained were representative of the profession in general. The demographic data provides analytic categories that allow refinement of the survey population to utilize only those responses from individuals at the targeted professional level.

Task Inventory – Knowledge and Skill Questions
The survey was broken into two core areas: knowledge and skills. The categorical examination committees and the Joint Generalist committee developed a series of knowledge areas and jobrelated task questions that formed the body of the survey. This survey had eleven major sections: Laboratory Operations, Blood Banking, Microbiology, Chemistry, Hematology/Coagulation, Molecular Biology, Immunology/Serology, Urinalysis, Body Fluids, Point-of-Care Testing, and Management/Supervision. Respondents only rated the tasks within the major sections in which they work. All respondents rated the tasks within the Laboratory Operations section. For example, if a respondent indicated they currently work in Chemistry and Hematology, they rated tasks within those two sections and Laboratory Operations and did not see any other sections of the survey.

Rating Criteria
Different rating scales were used to assess the knowledge and skills on the survey. One rating scale was used for the knowledge-only tasks and asked respondents to assess the significance of having that knowledge to perform their job. The rating scale used for the skill-related tasks assessed whether respondents performed the specific task in their jobs.

Survey Construction
The practice analysis survey was created and delivered through Key Survey, an electronic survey vendor from Highroad Solution. Using an electronic tool allowed survey review and testing via the internet, email tracking of respondents using email addresses, and the ability to send e-mail reminders for completion of the survey.

Pilot Testing and Revision
The Joint Generalist Committee tested a pilot version of the survey. They commented and revised different aspects of the survey (e.g., information correctness, grammar/spelling errors, electronic glitches, correct survey branching, etc.). The pilot testing comments and edits informed the final version of the survey.

Survey Distribution
The survey was open for a five-week period. It was e-mailed to all current generalist (MT/MLS and MLT) and categorical (BB/C/H/M) certificants. ASCP BOC staff also directly emailed the survey to the categorical examination committees and encouraged the committee membership to disseminate the survey to their colleagues. Additionally, links were posted on social media sites (e.g., Facebook and Twitter).

To garner more responses from individuals working in blood centers, BOC staff also reached out to the Qualification in Apheresis (QIA) work group and the AABB. These contacts were able to get the survey link distributed to several blood centers and placed in an AABB newsletter.

Survey Analysis
The responses to the survey were analyzed. Responses from individuals performing higher-level supervisory tasks were not appropriate for an entry-level exam and thus excluded. Any individuals not currently practicing (e.g., retired, unemployed, or simply not working as a laboratory professional) were also removed from survey analysis.

Task Analysis
The tasks were divided amongst eleven major sections (Laboratory Operations, Blood Banking, Microbiology, Chemistry, Hematology/Coagulation, Molecular Biology, Immunology/Serology, Urinalysis, Body Fluids, Point-of-Care Testing, and Management/Supervision). All respondents saw the Laboratory Operations category. Because respondents only rated the tasks within the major categories in which that they perform testing, the number of respondents vary for each section.

Committee Review and Decision
During the following year’s exam committee meetings, the Blood Banking, Chemistry, Hematology, and Microbiology Committees reviewed the practice analysis results. They agreed that the demographic results accurately reflect the MLS and MLT population. Each committee reviewed the tasks within their area of expertise. Tasks performed by a low percentage of survey respondents were further reviewed by the committee members to determine whether they should be kept or removed as potential exam topics. Because only a small percentage of the MLS population reported performing management/supervisory tasks, the Management/Supervisory section did not provide useful data. The Joint Generalist Committee then reviewed the decisions made by the aforementioned committees and produced a final determination of the inclusion of the task on the examination.

Exam Content Guideline and Exam Database Publication
The committee reviewed the exam content area percentages and decided where to set the content area percentages for the new exam database based on the results of the practice analysis. The committee revised the content guideline to reflect the practice analysis results. The exam committee continuously reviews the exam database according to the new content guideline. Questions are deleted or revised accordingly. New questions are written to fulfill the new content guideline. The items in the database will be reclassified according to the new guideline. After this work is completed, a new exam database will be published and a new standard for the exam will be set.

Availability
The MLT/MLS practice analysis report with draft content guidelines is available on the ASCP BOC website at About the BOC.

Summary
The ASCLS ELC defines the knowledge and skills that new MLT or MLS graduates should possess upon entry into the workforce, with no prior work experience. It is designed to assist educators to develop curriculum or update courses. The ASCP BOC MLT and MLS Practice Analyses are used to validate the content of the certification exams by defining the tasks that practitioners perform at entry level. Educators can use the tasks identified on the practice analysis reports and the exam content guideline (derived from the practice analysis) to validate what they are teaching in their MLT and MLS courses. Examinees and educators can use the practice analysis report and the exam content guideline for certification examination preparation. The information within the ELC and the practice analysis report are similar, but each document is developed for a unique purpose.

Both the ELC and the BOC practice analysis will be updated every five years. During the next ELC revision cycle, the outcomes of the recent BOC practice analysis will be considered. A new practice analysis cycle results in revisions to the content guidelines and examination databases and the setting of new standards for passing the examinations.

REFERENCES

1. Beck, S., and T.C. Moon. 2017. “An Algorithm for Curriculum Decisions in Medical Laboratory Science Education.” Clinical Laboratory Science 105-111.
2. Beck, Susan J., and Vicky A. LeGrys. 2014. Clinical Laboratory Education. 3rd. Westminster.
3. Chinn, R.N., and N.R. Hertz. 2010. Job Analysis: A Guide for Credentialing Organizations. Lexington: Council on Licensure, Enforcement and Regulation (CLEAR).