Medical Laboratory Science Undergraduate Management Curriculum Development Using Practitioner-reported Job Tasks

INTRODUCTION

A major difference between the undergraduate and graduate degrees is the amount, type, and depth of management-related content in the curriculum. Anecdotal communications to program administration that Bachelor of Science in Medical Laboratory Science (BSMLS) practitioners are promoted to managerial positions without sufficient management-related education, laboratory experience, and available mentoring are cause for concern. This issue is exacerbated by the reported clinical laboratory personnel shortage. The Bureau of Labor Statistics projects a 14% growth in workforce needs for medical laboratory science (MLS) practitioners between 2014 and 2024.¹ Additionally, the American Society for Clinical Pathology (ASCP) reported average clinical laboratory vacancies of 8.7% with a 19.2% expected retirement rate over the next 5 years.²

A Midwestern, 3+1, university-based, MLS program is developing a master’s degree [Master of Medical Laboratory Science (MMLS)] option in addition to its traditional baccalaureate degree program (ie, the BSMLS). To provide a stronger foundation in management education, the MLS program explored the development of an MMLS option with a managerial focus. Program administration and faculty were tasked with determining and articulating the management-related curricular differences between the undergraduate and graduate degree options.

MLS curriculum focuses on the theoretical knowledge and technical skills required to perform diagnostic testing in all clinical laboratory disciplines. In addition, management-related topics must also be taught to prepare the entry-level laboratory professional. When considering MLS program management curriculum content, resources routinely referenced to guide such development do not provide clear direction as to the specific management-related content to include.^3⇓-5 Inconsistent terminology may intensify this ambiguity. The National Association Agency for Clinical Laboratory Science (NAACLS) program accreditation standards require inclusion of the following management-related topics: government regulations and standards, principles and practices of administration, principles and practice of quality assurance/quality improvement, and educational methodologies in MLS curricula.³ The ASCP Board of Certification MLS exam includes questions on quality assessment and troubleshooting, purchasing, inventory control, competency, education and communication, and laboratory information systems.⁴ Examples of management-related areas in the proposed, updated American Society for Clinical Laboratory Science (ASCLS) entry-level curriculum for MLS include health care reform, regulations, general and financial management theory, information systems, and human resources (HR).⁵

The literature also does not communicate clearly defined management-related content to include in MLS curricula. Beck and Doig’s 2002 survey reported that educators, managers, and practitioners all agreed that clinical laboratory scientist (CLS) [MLS]-level staff members need more management and administrative skills in today’s clinical laboratory. Yet, in the same survey, significant differences were found in manager and educator responses to the statement, “Baccalaureate degree CLS/[MLS] programs should focus on the sciences underlying laboratory testing, not on management and education,” with managers disagreeing and educators agreeing with the statement.⁶ A 2007 ASCLS white paper proposing a CLS/MLS levels-of-practice model first mentioned specific management-related practice skills for experienced Bachelor of Science (BS)-prepared practitioners with additional experience that included method evaluation/test development, point-of care oversight, and front-line supervision and training. Compliance/coding/regulatory, quality management, risk/patient safety, and operations/business management were recommended for those with a master’s degree; however, the model assumes that “practitioners at each level are responsible for performing and/or supervising the duties performed at lower levels.” Thus, an entry-level MLS practitioner could be expected to supervise phlebotomy, specimen processing, waived testing, core laboratory automated testing, and/or the additional skills listed for the MLT practitioner.⁷

For educators, making management-related curricular decisions can be ambiguous. To address this issue, current staff-level practitioners were surveyed to answer the primary research question, “What managerial related tasks and at what frequency are staff-level clinical laboratory practitioners performing as part of their non-managerial job duties?” The purpose of this research was to determine how frequently management-related job tasks were performed by staff-level practitioners. The resulting data will help guide management-related curriculum development that differentiates and best prepares the BS-level/entry-level and master’s level practitioner.

METHODS

Data for this institutional review board–approved study were collected as part of a larger MLS practitioner managerial task performance and self-reported task preparedness online survey. The online survey was administered by a sister campus’s Bureau of Sociological Research (BOSR). The BOSR collaborated with the investigators during question and survey development. When writing survey questions, investigators consulted accreditation and professional organization documents, laboratory management course resources, and personal experience. After beta-testing with a cohort known to the authors, they surveyed a convenience sample of clinical laboratory practitioners over 4 weeks using purchased ASCP and Clinical Laboratory Management Association email databases. Due to additional costs in using the purchased email lists, no reminder emails were sent. In addition to demographic information, participants self-categorized using survey-provided definitions as either a director/manager, supervisor/lead, or staff MLS. This study focused on the staff-level MLS responses. It questioned participants about how often (ie, often, sometimes, never) they had been asked to perform a list of 30 managerial tasks.

RESULTS

Education and Training Tasks

Of the 4 education and training tasks, the most frequently performed was “train laboratory staff” (88%), followed by “train non-laboratory staff” (54%). Most of the respondents never performed the remaining tasks “develop continuing education material” and “present continuing education material” (65% and 59%, respectively). See Figure 1.

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Figure 1.

Managerial task performance (education and training, finance, and human resources).

Finance

The vast majority (86%–97%) of respondents indicated they never perform the 4 finance tasks. For these tasks, 14% of respondents indicated they often or sometimes “perform a cost analysis,” 11% sometimes “determine productivity,” 8% sometimes “negotiate vendor contracts,” and 3% sometimes “prepare a laboratory/department budget.” See Figure 1.

Human Resources

The HR tasks respondents most frequently performed (41% often or sometimes) were “evaluate employee performance” and “resolve conflict.” The majority of respondents identified the remaining tasks, “interview applicants,” “build employee consensus,” “write job descriptions,” and “hire new employees,” as never being performed (73%, 82%, 92%, and 98%, respectively). See Figure 1.

Quality

The majority (50%–65%) of respondents indicated they often or sometimes perform all of the quality tasks with the exception of “perform a SWOT analysis” [strengths, weaknesses, opportunities, and threats analysis (SWOT)]; only 5% of respondents indicated they sometimes perform this task. See Figure 2.

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Figure 2.

Managerial task performance (quality, regulatory, and other duties and equipment acquisition/validation).

Regulatory

The majority (57%–82%) of respondents indicated they often or sometimes perform all the regulatory tasks except for “develop/oversee document management/control system”; 46% indicated they perform this task often or sometimes. See Figure 2.

Other Duties and Equipment Acquisition/Validation

For this study, the tasks “recommend, select, and/or acquire equipment” and “perform or participate in equipment/method validation” are considered equipment acquisition/validation tasks. The remaining 3 tasks are considered as other managerial duties.

The majority (53%–82%) of respondents indicated they often or sometimes perform all the other duties and equipment acquisition/validation tasks except for “maintain/validate the LIS” [laboratory information system (LIS)]; 44% indicated they perform this task often or sometimes. See Figure 2.

DISCUSSION

Staff-level technologists frequently perform managerial tasks as part of their nonmanagerial job duties. Tasks identified by the majority (≥50%) of respondents (self-reported) as being “frequently” performed included “train laboratory staff”; “train non-laboratory staff”; “monitor quality via quality indicators”; “plan, measure, and evaluate process improvement projects”; “investigate SOP/policy deviations” [standard operating procedure (SOP)]; “analyze/monitor test utilization”; “develop competency assessment materials”; “facilitate/oversee competency assessments”; “prepare for/participate in laboratory inspection/assessment”; “revise or write policies and procedures”; “ensure compliance of regulations/standards”; “recommend, select, and/or acquire equipment”; “perform or participate in equipment/method validation”; “participate in interdisciplinary teams”; and “analyze/review inventory data.” Hence, familiarity with/preparation to perform these specific managerial tasks should theoretically occur prior to entrance into the MLS workforce (ie, during completion of an MLS educational program).