Responsibility?
Daniel M. Baer, MD
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Or is it a shared responsibility?While most educators and lab-oratory professionals would agree that professional development requires lifelong learning, it is difficult to find statistics that directly bear this out. In the absence of clear statistical correlation, we still know that many of the tests, methods, and instruments used only a few years ago have been replaced by new methods and the old ones discarded. Like professionals in other fields, laboratory pro-fessionals cannot decide to stop learning new skills.
Some new learning is the responsibility of the laboratorian and may even be optional. Learning new areas of competence to broaden one’s opportunities probably falls within that arena. Ed-ucation for new tests or instruments introduced into the labora-tory may be the responsibility of the employer. Regulalabora-tory agencies and accrediting organizations have an interest in ensur-ing that laboratorians receive trainensur-ing to remain competent and to perform their duties safely. Often, the professional’s ambition to add expertise will be at his or her expense, while educating staff in new methods is the employer’s expense—and won’t nec-essarily increase the employee’s earning power.
What Is Continuing Education?
For the purpose of this article, continuing education (CE) includes all educational activities that are pertinent to a person’s professional skills, activities, interests, and growth. It also includes training relevant to the person’s job, such as patient safety, fire and disaster training, and other training required by regulatory and accreditation agencies. A list of some CE cate-gories is given in [T1]. Some regulatory and accreditation agen-cies have more restrictive definitions of continuing education. For some of these, the education must be provided by an accred-ited organization, and the contents must be closely related to the person’s professional activities.
Continuing Education Categories
People engage in continuing education for many reasons. Sometimes it is for the benefit of the employer or to improve job performance. Some continuing education is mandated by regula-tory or accreditation agencies and is oriented toward patient or employee safety. Some educational programs are undertaken to satisfy intellectual curiosity or to enhance professional skills.
Initial Orientation to a Job
When a person starts a new job, the employer usually pro-vides an orientation session to acquaint the new employee with information about the institution, the specific job, and tasks re-quired for the job. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires orientation at 3 lev-els: orientation to the institution and its policies and rules; orien-tation to the department and its work environment; and
orientation to the specific job, equipment, and procedures. Brigg Franklin, MA, is responsible for new employee ori-entation at the Veterans Affairs Medical Center (VAMC) in Portland, OR. He explains that the objective of orientation is “to acquaint the new employees with the work environment, culture, and essential facts about their new place of
employ-ment.” In their orientation, everything from the Medical Cen-ter’s rules and regulations and information about safety to parking information is covered. The Occupational Safety and Health Administration (OSHA) requires that information be provided about infection control, bloodborne pathogens, and other safety matters before employees begin work, and the Equal Employment Opportunity Commission requires that new employees are informed about equal employment oppor-tunity and sexual harassment.
“Our agency, the Department of Veterans Affairs, expects us to tell new employees about human resources issues including rules about leave, retirement, and promotions. We have a cus-tomer service orientation that helps new employees deal with our customers, the veterans, and the public. There is conflict res-olution training, and we inform the employees about the provi-sions of the Whistle Blowers’ Protection Act.” After employees are oriented to the Medical Center, they are oriented to their spe-cific departments and jobs by their supervisors.
Franklin adds, “I recently saw a report that showed that em-ployees who go through a good orientation program become more proficient at their jobs than those who don’t. The reason for this is probably that oriented employees are more confident in doing their work. For this reason alone, it is in our interest to take the time to orient new employees.”
Training for a Specific Task, Test, or Equipment
The employer is responsible for ensuring that whenever an employee takes on a new task, he or she has appropriate train-ing. The vendor usually provides training for new equipment.
Chris Demiris, marketing manager for immunoassay sys-tems at Roche DiagnosticsM, offers industry’s perspective on the vendor’s role in providing training to competently operate new equipment. He says that when a vendor places a new sys-tem at a customer site, it must provide sufficient technical and operational training to the designated laboratory staff. The training can take the form of in-lab training or off-site training at the vendor’s training center. He says that in today’s
Continuing Education Categories
Initial orientation to a job
Training for a specific task, test, or equipment Continuing competency training for work tasks Cross-training for new laboratory tasks Professional growth and career advancement Management skills
Patient safety Personnel safety “Mind stretching”
New developments in career area
Workplace issues such as sexual harassment
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laboratory environment, because of the potential for interrup-tions, in-lab training is less effective than training center–based education. “It is the vendor’s responsibility to train their cus-tomers sufficiently to enable them to use the equipment as in-tended. Generally, the lab will send a senior level staff member or someone with equipment acumen to attend the courses held off site. These individuals are trained to a high level so that upon their return they can function as lab experts or trainers for the remainder of the staff.”
He adds that vendors who are highly customer-focused provide additional training via local and national meeting seminars that offer the opportunity for CE credits. Such ses-sions involve lectures on current uses of the product, new technologies, and emerging clinical practices. “Training and CE support is one criterion that a lab should use for selecting new systems,” says Demiris.
Demiris describes the reasons vendors provide training. “It makes good business sense to train customers on a vendor’s systems. Service calls are reduced, satisfaction with products increases, and overall costs to serve the market are lower. Cus-tomers can better implement their new systems and provide better patient care. Customers are placing increasing demands upon their vendors for training to assist in dealing with staff shortages and turnover.”
Continuing Competence
Employers are required to assess employee competence. When there are deficiencies in employee competence, employers are required to provide remedial training to correct the deficiencies.
Asked how priorities are set for required CE topics, Kathy Smith, RN, clinical educator in the education division at Portland VAMC, says, “Our department is concerned about education that is related to staff competence and ability to perform their duties. Obviously, our educational resources are limited, so it is important to put our education funds where they will do the most good.”
She says that her department first determines if there are any new guidelines, procedures, or performance standards that staff must know. Then they do a formal needs assessment using written questionnaires with job-related questions. Be-cause the questionnaires are anonymous, those completing them do not feel at risk. The data from these questionnaires and from incident reports are then carefully evaluated. “We look for any information that indicates a problem or lack of knowledge. Our intent is to identify levels of knowledge and skill so we can plan educational activities to address them,” Smith says.
Finally, they use focus groups to help decide on the most important educational efforts for the year. These groups are made up of an assortment of employees in the target group, which provides many perspectives on needs. “The information we get from focus groups is excellent. The process itself can be time-consuming, but this grouping of participants allows for quicker data collection.”
Patient and Personnel Safety
A number of regulatory and accreditation agencies such as JCAHO and OSHA require annual training for all employees in topics such as bloodborne pathogens, chemical hygiene, and fire and disaster preparedness.
Employer-Required Workplace Topics
Employers frequently have training topics that are required for their employees. Such topics might include a discussion of workplace issues such as diversity training or training to prevent sexual harassment or workplace violence.
Employee-Initiated Education
Laboratorians often want to learn about new
developments in their field, management training, and educa-tion for professional growth and career advancement; such education might include exposure to a new area to “stretch the mind.” Juanita Petersen, MBA, MT(ASCP), manager of the core laboratory at Oregon Health Sciences University Hospital in Portland, OR, was able to earn an MBA with much of the tuition paid by her employer. She evaluates her education this way: “My curiosity in getting additional edu-cation was fueled by my interest in learning something be-yond the laboratory.” Petersen wanted to explore job opportunities available to medical technologists and thought that business classes would expand her knowledge and give her an advantage. Another strong motivator was the opportu-nity available from her employer that enabled her to take graduate-level classes at a significantly reduced rate. She was not, however, initially convinced that her additional education would benefit her laboratory career. Petersen says, “But the more classes I took, the more I was able to see how business principles applied to the laboratory. I cannot claim that my additional education helped me secure any particular
position. However, I gained more confidence in my ability to take on new assignments, I increased my understanding of the forces that have an impact on the laboratory, and became a stronger, more effective employee.”
Types of Continuing Education Programs Available
Continuing education can take many forms [T2]. Although some of these can be undertaken by an individual as a self-study activity, others are group activities or, because of their cost, could not be easily paid for by an individual laboratorian.
Many laboratories have in-service conferences. These are usually conducted during daytime work hours and because of work schedules can only reach a portion of the staff. Because of reductions in staff that have become necessary with reduced budgets, this kind of training is less available than it once was.
On-the-job training is frequently a one-to-one training activ-ity. Although an employee might be able to independently re-view an equipment manual or test procedure, much of this kind of training takes place with an experienced employee demon-strating and explaining procedures.
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Workshops and courses usually require the laboratory pro-fessional to take time away from work and may involve travel to another city. Because of the time loss and tuition and travel ex-pense involved, it is difficult for many technologists to take ad-vantage of this kind of continuing education.
Teleconferences and subscription programs such as Check-Sample, TechCheck-Sample, and CheckPath usually involve a group of laboratorians in a single laboratory. The teleconference requires participants to meet at a specific time in a meeting room to listen to the conference. Subscription programs with printed materials can be read at any time. These programs, however, may be too expensive for an individual technologist.
Most of the professional societies publish journals that contain educational material. Reading journal articles conforms with most groups’ definition of continuing education. Some journals, such as
Laboratory Medicine, offer some articles with CE credits that will
be recognized by accreditation or regulatory agencies.
A variety of self-study programs are available for the labo-ratorian. These come in a wide range of forms: printed materials, videotapes, CD-ROMs, and the Internet.
Regulation and Accreditation
Regulatory and accreditation requirements drive much con-tinuing education. At the national level, Clinical Laboratory Im-provement Amendments (CLIA) ‘88 have placed the
responsibility for an adequately trained staff in the hands of the laboratory director by stating that the laboratory director must “ensure that policies and procedures are established for monitor-ing individuals who conduct preanalytical, analytical, and post-analytical phases of testing to assure that they are competent and maintain their competency to process specimens, perform test procedures, and report test results promptly and proficiently, and whenever necessary, identify needs for remedial training or con-tinuing education to improve skills.”1
If there is any doubt as to whether the laboratory or the em-ployee is responsible, the rule states that the technical consultant (as defined in the CLIA rule, a technical consultant is a
desig-nated technologist, pathologist, or doctoral scientist) is responsi-ble for “identifying training needs and assuring that each indi-vidual performing tests receives regular in-service training and education appropriate for the type and complexity of the labora-tory services performed.”2There are other CLIA references to
training provided by the laboratory.
JCAHO makes it clear that institutions that it accredits must provide employees with training and continuing education related to their duties and patient and personnel safety.3OSHA requires
train-ing of staff who are exposed to workplace health hazards about bloodborne pathogens4and chemical hazards.5
At the state level, 9 states that license medical technolo-gists have CE requirements [T3], and 37 physician licensing states and territories require continuing education for each li-cense renewal period.
Some employers have developed their own CE requirements for employees. The Department of Veterans Affairs, the nation’s largest health care organization, requires that each employee have 40 hours of continuing education annually. Half of the training hours must focus on patient and work safety. The em-ployee can receive this education through a variety of means,
Types of Continuing Education (CE) Programs Available
Employer-provided in-service or on-the-job training Workshops and courses
Professional society and educational organizations Manufacturer/vendor
Teleconferences
Subscription programs (eg, CheckSample) Self-study courses
Publications with CE credit Journals and books
T2
The Continuing Education (CE) Hours Required by the Nine States That Require CE for Medical Technologists
State Hours Required
California 12 Annually
Florida 24 Biennially
Louisiana 12 Annually
Montana 14 Annually
Nevada 20 Biennially
North Dakota 20 Biennially
Puerto Rico 36 Triennially
Rhode Island 30 Biennially
West Virginia 10 Annually
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including self-study and reading. Some of the required training topics are prescribed, such as fire, disaster, and workplace health hazards. Other CE topics are the employee’s choice.
Some credentialing organizations have developed CE requirements for their members and diplomates. The National Credentialing Agency (NCA) requires 36 hours of continuing education every 3 years for recredentialing of clinical laboratory scientists. The considerations for continuing education include the following:
쐽 Choice of the educational content
쐽 Selection of training methods, instructors, and training mate-rials
쐽 Documentation of training
쐽 Ensuring that employees comply with regulatory require-ments
쐽 Competency compliance and remediation 쐽 Providing time to receive training
쐽 Providing facilities for training 쐽 Providing funding for training
So Whose Responsibility Is It? Employer
The employer, and specifically the employee’s supervi-sor, is responsible for ensuring that employees are competent and able to perform their duties safely. CLIA and the
accredi-tation agencies maintain that the employer is responsible for continuing education to maintain competency and safety. Some employers have policies that require them to provide education on certain subjects. It is to the employer’s benefit to have a well-trained, proficient, and up-to-date workforce. Many employers believe that providing continuing education opportunities to staff is a good investment. This ensures that there is a pool of qualified employees available when there are positions of higher responsibility to fill. Continuing edu-cation, provided at the employer’s cost, is also a powerful recruiting and retention tool in a tight labor market.
Employee
One strong characteristic that differentiates professionals from other workers is the professionals’ responsibility for self-improvement and keeping up-to-date in their technical and professional knowledge. It is the responsibility of profes-sionals to seek out educational opportunities that enhance their professional growth and career advancement. If avail-able, laboratorians should also take advantage of education provided by their employers.
Both Employer and Employee
Offering a unique perspective on the relative responsibili-ties of employers and employees is Deborah Burton, PhD, RN, director of education at Portland VAMC and president of the Oregon State Board of Nursing. “Accountability for assessing and maintaining competency of all staff rests squarely with the
Continuing Education (CE) Responsibilities Responsibility
Choice of the educational content
Selection of training methods, instructors, and training materials
Documentation of training
Ensuring that employees comply with regulatory requirements
Competency compliance and remediation
Providing time to receive training
Providing facilities for training Providing funding for training
Employer
Assigns training mandated by regula-tory and accreditation agencies; assigns training needed to do job Provided when employer arranges for training program
Required to document mandatory training; may also choose to docu-ment all education taken by employee Must document education required by regulatory agencies
Must assess job competence and provide remedial education, if neces-sary
Provides paid time for required training; may choose to provide paid time for other CE
Supplies facilities for mandatory training
Mandatory training or CE performed at the request of the employer is done at no expense to the employee; many employers cover all or part of the expense of CE requested by employees
Employee
Selects education topics to enhance job knowledge, advance career, or satisfy intellectual curiosity Selected when employee chooses educational program
Must give employer documentation of mandatory training; employer may request documentation of all educa-tion
Must give employer required docu-mentation
Must demonstrate job competence and attend necessary remedial educa-tional programs
Employees engaging in CE often do so during nonpaid time
Employees engaging in CE often do so away from the job
Employees often pay all or some of the cost of CE engaged in at their request
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employer, particularly for the hospital-based laboratory when the hospital is accredited by JCAHO.” She adds, however, that responsibility for professional continuing education is shared by the employer and the employee, with support from CE de-partments. Professional laboratory staff holding licenses or cre-dentials from external organizations such as ASCP or NCA have legal and ethical obligations to maintain competency, irre-spective of where they work or their specific job title.
“Balancing ongoing competency with the imperative to continually improve operations, bring new equipment and serv-ices, and develop staff to their full potential is challenging, but can also create healthy partnerships for supervisors and educa-tors. In the end, these partnerships can produce improved, effi-cient, state-of-the art patient care while also maintaining a high degree of job satisfaction for professional, technical, and ad-ministrative laboratory personnel,” says Burton.
Responsibility for continuing education, thus, is a shared responsibility. Although the employer should plan and provide time and funding for mandatory training required by the regu-latory and credentialing agencies and training directly related to job tasks, the employee also has educational responsibilities [T4]. Many employers have policies that provide some paid time and tuition reimbursement for continuing education. But it is reasonable for employees to engage in CE activities during
nonduty hours and to pay some of the cost of their continuing education. This is especially true when this education is for the purpose of career advancement, promotion, or exploration of new fields. For the sake of competent personnel performing duties safely and competently, each party must share in the re-sponsibility for continuing education.
1. Code of Federal Regulations, CLIA Final Rule, 42 CFR 493.1445 (e) (13). Available at: www.vh.org/Providers/CME/CLIA/SearchCLIA.html. 2. Code of Federal Regulations, CLIA Final Rule, 42 CFR 493.1413 (b) (7).
Available at: www.vh.org/Providers/CME/CLIA/SearchCLIA.html.
3. Joint Commission on Accreditation of Healthcare Organizations. 2001 Hospital Accreditation Standards. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2001. (Standards LD.2.8, EC.1.5, EC.2.9.2)
4. Code of Federal Regulations, Bloodborne Pathogens Regulatory Text, 29 CFR 1910.1030 (g)(2)(ii)(C). Available at:
www.osha-slc.gov/OshStd_data/1910_1030.html.
5. Code of Federal Regulations, Occupational Exposure to Hazardous Chemicals in Laboratories, 29 CFR 1910.1450 (f)(1). Available at: www.osha-slc.gov/OshStd_toc/OSHA_Std_toc.html.