Medical laboratory scientist

A medical laboratory scientist (MLS), also referred to as a clinical laboratory scientist, medical laboratory technologist or medical technologist, 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.

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 laboratory medicine. The program must be accredited by the Australian Institute of Medical Scientists (AIMS).^[1]

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.^[2] Many MLTs go on to receive a bachelor of science degree after they are certified, but a few university programs affiliate with a college MLT program to allow students to graduate with both MLT certification and a degree.

New Zealand

In New Zealand, a Medical Laboratory Scientist must complete a bachelor degree in medical laboratory science (or another medical degree) 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. ^[3]

Medical Laboratory Technicians who already hold a bachelor of science or a bachelor of biomedical science degree can enter the field by completing a graduate diploma in science.

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 a masters 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.^[4]

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.^[5]

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^[6]) and some states require a license which can be acquired after completing necessary education and clinical requirements.^[7]

Depending on the state where employment is granted, the job duties between MLS's and MLTs are very similar.

The shorter training time is attractive to many students, but there are disadvantages to this route. MT's, MLS's 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.^[8] 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.

Certification and licensing

A Lab tech uses a microscope for a cell count.

Medical Laboratory Scientists who are certified and in good standing with the approved National Medical Laboratory Science Council or the American Society for Clinical Pathology (ASCP) are entitled to use the credential "MLS" after their names. They are entitled to use the title "Scientist." Formerly before the merger between ASCP and the National Credentialing Agency for Laboratory Personnel (NCA), medical laboratory scientists certified by (ASCP) were entitled to use the credential "MT" (for medical technologist)^[9][10] and if credentialed by (NCA), the credential "CLS" (Clinical Laboratory Scientist) was used.^[11] Those certified by the Department of Health Services (HHS formally HEW), the American Association of Bioanalysts (AAB) and the American Medical Technologists (AMT) are still entitled to use the credential "MT."^[12] Additional certifying agencies include the, National Healthcareer Association, National Phlebotomy Association, the National Center for Competency Testing, and the Accrediting Bureau of Health Education Schools. However the NCA and ASCP have now merged into the major certification agency.^[13]

In the United States, the Clinical Laboratory Improvement Amendments (CLIA '88) define the level of qualification required to perform tests of various complexity.^[14] 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.^[15][16]

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.^[17] 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.^[18]

In the United Kingdom, medical laboratory scientists are known as biomedical scientists and must hold an honours degree from a university accredited by the Institute of Biomedical Science (IBMS) before they can embark upon a period of in-house training of at least one year before being assessed by the IBMS for state registration purposes. The title "biomedical scientist" is a protected title and can only be used by a person registered with the Health and Care Professions Council (HCPC) .

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".^[19] Additional information can be found in the ASCP Procedures for Examination & Certification.^[20]

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.^[21] 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.^[22][23]

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.^[24]

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 clinical laboratory medicine 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.
• 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.

Job duties

MLS in his work environment.

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.^[25]

A 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 then receive the patient specimens, analyze the specimens, interpret 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.

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.^[26]

Job title

Russian MLS prepares the analyses in ELISA laboratory

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 and Medical Laboratory Technicians (MLTs).

In the United States there is a formal distinction between an MLT and an MT/CLS. Both may be certified or registered by one or more nationally-recognized professional organizations, but technicians have a two-year associate degree, and may have less classroom training than other professionals. MTs and CLSs have a bachelor's degree. Scientists and technologists generally earn a higher income than technicians do and have more opportunities for advancement. Much of the confusion could also be from the fact that the NCA and the ASCP certification agencies had different titles in the past (clinical laboratory scientist and medical technologist respectively), but with the merging into a "newer" ASCP and that organization's choice of the name "Medical Laboratory Scientist", it can be said that finally the field has a "unified" title. However, the AMT and AAB still continue to use the title Medical Technologist.

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