-----Original Message-----
From: Louri Caldwell [mailto:louri_c@hotmail.com]
Sent: Tuesday, September 12, 2000 6:13 PM
To: tim9@cdc.gov
Subject: RE: BOR Registry - Clarification


Tim,

It all still comes back to the course content of what is to be completed in
the Associates degree program.  I went to 2 different universities and I can

say that the course content for a general biology class differs
significantly depending on the institution. My 2nd semester biology course
at the first university I attended was a combined zoology/ecology course
(related to the vet field in a broad sense as it was extremely general - but

how is it related to human clinical histology?). Even with that point made,
I don't beleive a couple courses of a general biology class and a couple of
chemistry classes will provide the depth of knowledge that this requirement
is proposed to ensure.

Without strict curriculum requirements in place, the requirement of an
associate degree still accomplishes nothing but to discourage those from
entering the field.  It's sort of the closed door theory "we made it - sorry

you can't" and appears to be an artificial requirement as it again does
nothing to truly improve the quality of our field.  Again - look at the Med
Tech field as an example of how to properly apply an educational standard.

Again, my main concern is the quality of what comes out of these labs
(clinical and research)produce.  Why is that same educational requirement
not being placed on those already in the field?  If education is the concern

as it relates to the more complicated procedures to improve the quality and
status of our field- why not require it of ALL technicians instead of the
few that will come in 5 years from now?

I, for one, welcome the opportunity to further my knowledge base by taking
quality continuing education courses and feel lucky to be at an institution
that offers such.  I just wish it was a requirement.

Louri



>From: "Morken, Tim" <tim9@cdc.gov>
>To: 'Louri Caldwell' <louri_c@hotmail.com>
>Subject: RE: BOR Registry - Clarification
>Date: Tue, 12 Sep 2000 17:20:00 -0400
>
>Louri,
>
>All I can say is it has to start somewhere. We've been working up to this
>for a decade and have fought tooth and nail to get the most basic standards
>in place. Some just don't want to accept that histotechs need to know more,
>now and in the future.
>
>All the courses you list could not possibly be done in an AA degree -
>remember you have to take other courses too - math, writing, etc. What an
>entry level person needs is an introduction to lab science and some math
>and
>writing skills. I disagree completely that taking introductory courses are
>meaningless, unless you think basic chemistry and biology courses are
>meaningless. They are the basis for everything that follows. Yes, some get
>into the field with very basic courses, but at least they have something,
>and in my experience that counts for a lot over people who have absolutely
>no training. Many high-school grads get through with only the most cursory
>science courses - as is evidenced by the nearly complete lack of knowledge
>in the general public about any type of science.
>
>As to specific content,such as sectioning, that is not necessarily the
>need.
>The vast majority of histotechs are lacking in basic theory. Anyone can
>learn to cut sections and follow stain directions. Few will come to
>understand how methods work without an understanding of chemistry and
>biology. That is evidenced in the fact that many who pass the HT practical
>can't pass the written exam - they lack the basic knowledge.
>
>The idea is that an entry level person will have, or will be able to learn
>basic procedures and follow the direction of a supervisor. They should have
>an understanding of the reagents and methods they work with (which requires
>some theoretical knowledge)but will not be expected to develop procedures.
>
>HTL's in most labs are senior techs responsible for developing or
>instituting new methods. They don't necessarily have to run them routinely,
>but they will do research and often take on more advanced duties. Like I
>said, anyone can learn to follow directions, but someone has to work out
>those directions in the first place.
>
>The certification we are talking about is only relevant to ASCP and/or CLIA
>certified laboratories, usually hospitals or reference labs. Other labs,
>such as research or Ag, don't worry about it so much but will certainly
>take
>a certified person if they can get one. So all this is moot if someone is
>interested in working outside the diagnostic medical field.
>
>States are responsible for deciding who should be licensed in a given
>profession. It is up to people in each state to get their representatives
>to
>make laws about this sort of thing. All the ASCP can do is require certain
>standards from the labs they certify.
>
>All new requirements in any field are phased in, not just dumped on people.
>Anyone not certified now has four years to either do it under present
>standards or get an AA, or better, and do it under the new standards. If
>they can't do that then either they aren't serious about it or don't belong
>in this field.
>
>It will be a long, slow change, I know, but that is a fact of life, I'm
>afraid.
>
>Tim
>
>
>
>-----Original Message-----
>From: Louri Caldwell [mailto:louri_c@hotmail.com]
>Sent: Tuesday, September 12, 2000 2:35 PM
>To: tim9@cdc.gov; histonet@pathology.swmed.edu
>Subject: RE: BOR Registry - Clarification
>
>
>Hi Tim -
>
>Thanks for responding to my post, but there still are some things that
>concern me.
>
>First - I agree that an education can only improve the performance of a
>tech
>
>in the lab.  My concern is that even the Associates requirement does not
>adequately specify what courses need to be taken.  I think if ,as you
>suggested, you required Microbiology, Immunology, Cell Biology, Genetics,
>Biochemistry and both Inorganic and Organic Chemistry as part of the
>Associates degree requirement - Then I'll agree that it will "uplift the
>profession" and improve the quality produced by the labs.  Otherwise, just
>requiring so many hours of biology and so many of chemistry is meaningless.
>Does that mean that a semester of ecology (which is a biology class at this
>university) has the same relevence to our profession as an hour of
>microscopic anatomy? Also, most associate programs in general lab
>technology
>
>do not have a rotation in histology - so most of the procedures learned
>will
>
>still be on the job trained.
>
>Second, many have responded that the concern is with those entering the
>field, not the ones already here. I understand that change needs to start
>somewhere, but wouldn't it truly "advance our profession" by requiring only
>an HTL perform certain procedures?  Or at the very minimum require all
>technicians to receive meaninful continuing education credits, IHC
>certification for those performing those procedures, and stricter
>regulatory
>
>standards by those that govern our industry? Why does this higher
>educational standard only apply to those entering the field?  I agree with
>you that EVERY tech should understand the methods, but there are many
>already in the field who do not.  It seems otherwise, this new requirement
>will do very little if anything to improve either part of our profession.
>
>My major concern lies in the regulation of our field.  It truly scares me
>that there are some labs out there that have technicians performing
>complicated testing that directly determines the type of treatment a
>patient
>
>receives (such as breast cancer markers) with virtually no meaningful
>regulation (from either the BOR or CAP).  Some of these techs - as I'm sure
>you have seen - are so unintersted in the procedures they are doing and
>have
>
>so little understanding of the theory that a mistake on their part could
>easily be overlooked. One of the technicians I worked with in the past has
>made me convinced of one thing - if anything like that is required for me
>or
>
>a member of my family - I will have two labs test it!
>
>As I stated previously, there are many areas of histology that do not
>require education beyond a high school diploma.
>
>If the main goal of this new regulation is truly to uplift our field and
>increase the quality of slides produced - then require more education of
>ALL
>
>- including the techs already in the field.  I'm sure this is an unpopular
>view - as there are many subscribers of "the old school" to this list - but
>if the BOR doesn't do that - I truly have to question why this is being
>done.
>
>Louri Caldwell, BS (Microbiology), HTL (ASCP)
>College of Veterinary Medicine
>University of Georgia
>
>
> >From: "Morken, Tim" <tim9@cdc.gov>
> >To: 'Louri Caldwell' <louri_c@hotmail.com>, histonet@pathology.swmed.edu
> >Subject: RE: BOR Registry - Clarification
> >Date: Tue, 12 Sep 2000 13:19:56 -0400
> >
> >Louri wrote,
> >
> ><<Also, you'll have no better influence over the quality of
> >the more complicated procedures produced by labs because you'll still
>have
> >those who are HT grads or who were grandfathered in performing those
> >procedures that supposedly require the additional education put forth by
> >the
> >
> >BOR.>>
> >
> >Did you know that manicurists and barbers have tougher standards of
> >pracatice than histotechs? All manicurists and barbers, by law, have to
>go
> >through training and take a board exam to do their work. The reason is
> >because there are a lot of ways a they can injure people through improper
> >techniques.
> >
> >Doesn't it seem strange that, in most states, a person can go into a
>histo
> >lab in the US with no training at all and be allowed to do the work?
>There
> >are multitudes of people that have done just that. In one hospital I
>worked
> >in we took a dishwasher and made him a histotech. He learned to do the
> >cutting and stains and did well. It happened, however, that he had no
>idea
> >what he was doing; he just followed the directions and managed to get
> >things
> >right (about the AFB control he would say "If the red dots are there,
>it's
> >OK"). No matter how we worked with him he could not grasp chemistry and
> >biology. He certainly is not one that you would want training anyone
>else!
> >
> >That's certainly a worst case scenario but it is what lab administrators
> >will do when there are no requirements, as there are none in histology
>now.
> >Why not? They save money by paying them less and work gets done. You only
> >need certain education to be certified, not to get a job or work. There
>are
> >thousands of uncertified techs working out there and I've seen many that
> >are
> >incompetent to work with modern technologies.
> >
> >Now, just because a person CAN be trained OJT to do these things doesn't
> >mean we should do it that way. There is certainly no rule that says we
>owe
> >it to people to give them a job just because they want one or are
> >interested
> >in a certain field. And why would we want people who don't want to put
>out
> >the effort to meet some minimal standards? We're only cutting our own
> >throats with that line of thinking.
> >
> >Quality control is the province of a lab. It has nothing to do with
> >education reuirements needed to be certified. The fact that most
>histotechs
> >are being trained by old-time techs just shows you thow the system has
> >always worked, which is not to say it is a good system. Yes, many of
>those
> >techs are excellent. But many are not. I doubt many of them would say
>more
> >education is worthless!
> >
> ><<I was only trying to understand the purpose behind the AA
> >requirement, as I do not see how this "advances our profession" as the
> >previous arguements have stated.>>
> >
> >I don't understand why you can't see that taking chemistry, biology,
> >physiology, anatomy and microbiology courses, to name a few, is good for
> >histotechs. It would seem to be obvious how these would help a person do
>a
> >better job!
> >
> >Learning any of these subjects outside of a formal course is very
> >difficult,
> >something only the most dedicated will be able to do. Learning them on
>the
> >job will result in an incomplete education because you will only learn
>what
> >you need to do the job at hand.
> >
> ><<...you'll have no better control of the quality of training
> >received unless you implement strict curriculum guidelines for the
> >certification.>>
> >
> >It's true that at some point most histotechs learn the hands-on methods
>on
> >the job. What they really learn at that time is dependent on who teaches
> >them and how they apply themselves. The inconsistency in this part of the
> >training is all the more reason to require certain formal education
>levels
> >outside of the job.
> >
> >It is certainly true that there are only minimal standards for education
> >right now. The requirements for college education are spelled out
>according
> >to certain credit hours of chemistry, biology and other courses, not
>whole
> >programs. That is a concern for the future (you may want to see the last
> >ASCP Lab Medicine, which has an article which outlines and "ideal" B.S.
> >program for histotechnology). Right now we need to get people with basic
> >science education in the lab, not dishwashers!
> >
> ><<It just appears that the BOR is trying to "advance the profession"
> >through artificial requirements that in the end do not mean much.>>
> >
> >Sometimes you have to drag people kicking and screaming into the future!
> >You'll only know the  "meaning" of all those requirements after you meet
> >them and use them on the job.
> >
> ><<Again, I do not feel that an HTL is required to perform those more
> >complicated procedures - as I know many HT's that are high school grads
> >with
> >
> >OJT that understand it as fully as those who have a degree.>>
> >
> >Wouldn't you rather have EVERY tech understand the methods, rather than
> >"many", or more likely, only a few?
> >
> ><<I just feel that the AA requirement hurts a lot of very capable people
> >from
> >entering the field, and it's going to be even harder to recruit
>individuals
> >to work.>.
> >
> >Again, in most states anyone can enter the field now. The education
> >requirement is only for certification. If a person is really interesed in
> >making it a profession the AA degree won't be a big hurdle. As I said
> >before, I believe the higher requirements will most likely attract more
> >people to the field.
> >
> >As to being "hurt", how do you think people will feel when they realize
> >they
> >are not going to get promoted beyond a basic bench tech position because
>of
> >their lack of education? Even if an institution is willing to give them a
> >job at the most basic entry level it doesn't mean they will pass them up
> >the
> >ladder just because they can do a certain job. Anybody in any lab can
>tell
> >you that education is the key to advancement. My experience is that those
> >who are willing to get the education they need do the very best work in
>all
> >circumstances. In fact, the good techs I know recognize a certain truth:
> >the
> >more you do in the lab the more you realize how much more education you
> >need.
> >
> >Finally, Louri, I was shocked when I first started working in the
>histolab
> >and found out that only one person had more than a high-school education.
> >Out of five techs, one was really good, but he learned histotechnology in
> >the military. The rest were OJT people and were average or below average
>in
> >their histotech work(by my standards). I quickly realized that histology
> >was
> >the backwater of the lab. Since I had never even heard of the field
>before
> >that (I was in EM) I could not even imagine that people working in a
> >hospital lab would be so uneducated. Even later when we got a couple of
> >bachelor-level people, they had degrees in things like environmental
> >science
> >and had little understanding of biochemistry, physiology or anatomy. They
> >were able to learn much more quickly, however, while the others
>floundered
> >with every new technology that came in.
> >
> >I have done consulting work in many labs to train people for
> >immunochemistry
> >and ISH. I can tell you that there are many, many labs out there that are
> >just hangning on by a thread because the people working in them are just
> >working in the dark. Yes, there is a shortage, but the last thing any
> >respectable lab wants now days is more uneducated people!
> >
> >Tim Morken
> >Atlanta
> >
> >
> >-----Original Message-----
> >From: Louri Caldwell [mailto:louri_c@hotmail.com]
> >Sent: Tuesday, September 12, 2000 8:29 AM
> >To: histonet@pathology.swmed.edu
> >Subject: BOR Registry - Clarification
> >
> >
> >To clarify my opinion as stated in the previous e-mail, I am against the
> >requirement of an AA for an HT - and I was trained by a graduate of a
> >technical school (not a histology program or an Associates Degree
> >Program)who had extensive on-the job training.  She also is the best tech
> >I've ever worked with.
> >
> >However, I was only trying to understand the purpose behind the AA
> >requirement, as I do not see how this "advances our profession" as the
> >previous arguements have stated.
> >
> >First of all - you'll have no better control of the quality of training
> >received unless you implement strict curriculum guidelines for the
> >certification.   Also, you'll have no better influence over the quality
>of
> >the more complicated procedures produced by labs because you'll still
>have
> >those who are HT grads or who were grandfathered in performing those
> >procedures that supposedly require the additional education put forth by
> >the
> >
> >BOR.  It just appears that the BOR is trying to "advance the profession"
> >through artificial requirements that in the end do not mean much.
> >
> >Again, I do not feel that an HTL is required to perform those more
> >complicated procedures - as I know many HT's that are high school grads
> >with
> >
> >OJT that understand it as fully as those who have a degree.
> >
> >I just feel that the AA requirement hurts a lot of very capable people
>from
> >entering the field, and it's going to be even harder to recruit
>individuals
> >to work.  There are not enough of us out there as it is.
> >
> >Louri
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