Evolution of Medical Laboratory Technology in Pakistan

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Evolution of Medical Laboratory Technology in Pakistan

UsmanWaheed, Muhammad Umar14

M.Arshad Malik, Hasan Abbas Zaheer Abstract

Clinical laboratories represent an area of healthcare that has undergone great deal of improvement since its beginning centuries ago. Introduction of a variety of laboratory tests and new diagnostic techniques, in a wake of technological advancements, in the recent past, has given a new perspective to the field of medical laboratory technology. Since the future role of medical laboratory technology is strongly challenged by new technological advancements, it is necessary to get into the detail of evolution of this field of medical science in order to address curriculum and training related issues of the discipline especially in a developing country like Pakistan. There is a need of continuous professional development and highly specialized trainings. The benefits of medical laboratory technology can only be achieved by setting up specialized institutions, updating and standardizing the curriculum and instituting a Pakistan Medical Technology Council. Current reviewhighlights the past of medical laboratory technology in Pakistan and future recommendations which seem imperative for making this important medical profession up to date.

Introduction

Medical laboratory professionals play a critical role in the management of modern health care by assisting in the diagnosis of diseases. Medical laboratory technology is one of the most dynamic and rapidly growing scientific fields. The practice of modern medicine is now incomplete without the role of clinical laboratory [1]. These professionals are considered to be the detectives of healthcare world searching for clues that helps in

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UsmanWaheed (usman.waheed07@gmail.com), Technical Advisor, Safe Blood Transfusion Program, Muhammad Umar, Incharge, Holy Family Hospital, M.Arshad Malik, Assistant Professor, International Islamic University, Hasan A.Zaheer, Professor, Pakistan Institute of Medical Sciences, Pakistan.

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better diagnosis and patient care. Medical Laboratory Technology (MLT) has thus become a very advanced field and the modern hospitals now have very sophisticated and automated diagnostic laboratories where Medical Laboratory Technologists (MLTs) have the options to specialize in the various new sub-specialties. However, in the resource constraint economy, the settingsof diagnostic laboratories are still quite basic and the MLTs working in such set-ups are not usually specialized in this field. In addition, the demand of MLTs in the research laboratorieshas also increased in industries, public health, and medical laboratories; as well as teaching hospitals, colleges and universities.

Each year, the U.S. News and World Report (USNWR) publish analysis of the “50 Best Careers”. In 2011, Medical Technologists (MTs) and/or Clinical Laboratory Scientists (CLSs) were rated among “The 50 Best Careers of the Year” in USNWR’s annual survey of high-demand careers [2]. The future role of the medical laboratory scientists will circle around the phrase “survival of the fittest”, a tailor made solution to fit in the particular work space, science specialty and laboratory type. The medical laboratory scientist has challenges and rewards in the world of medicine and science. Molecular diagnostics is assuming an important role in routine diagnostics in the clinical laboratory. The developments in molecular biology has the potential to change laboratory medicine, the same way as computed tomography and magnetic resonance imaging altered the practice of radiology [3]. Making molecular diagnostics widely available means overcoming obstacles and resolving issues that have surfaced during its development [4]. Initially the proper full-fledged modern clinical laboratory was opened at Johns Hopkins Hospital, USA, in 1896 for the assessment of human body fluids [5]. At that time, the importance of laboratory examination in diagnostics and therapeutics was not recognized and the laboratories consisted of a small setup ancillary to the physician’s office or hospital, wherephysicians themselves performed the tests. Laboratory investigations were considered an expensive luxury and the clinical laboratory science was a poorly understood, vague and ill-defined occupation. Early 1920s marked the emergence of the field of clinical laboratory science as a distinct profession. More recognition of the value of laboratory tests resulted in increased workload on clinical laboratories which prompted the physicians/pathologists to recruit assistants who

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could be trained for performing simple routine laboratory tests. With advancement in clinical laboratory science, the skills and knowledge required by these assistants more clearly defined in order to competently exercise it in their duties [6]. The field grew in terms of the number of practitioners and in the volume and variety of laboratory tests performed. In 1950s, technological

development laid the foundation of advancement in

instrumentation, automation, quality control and quality assurance. These advancements not only enhanced the precision and accuracy of results but also provided more efficient analytical processes. The demand for clinical laboratory staff paved the path to establishing training institutes with numerous programs for laboratory technicians all over the world.

National Scenario

After independence in 1947, Pakistan inherited a rudimentary healthcare services system which had to cater to the needs of some 30 million inhabitants. The hospitals were devoid of any trained Laboratory Technologists and untrained Para-Medical staff performed this role. The first diploma/certificate awarding organization was established in 1957 as the ‘West Pakistan State Medical Faculty’ followed by the establishment of the ‘School of Medical Technology’ in 1961. The establishment of the University Grants Commission (now Higher Education Commission) under The University Grants Commission Act, 1974 further strengthened its foundations. The first School of Medical Technology, founded at the National Health Laboratories (now National Institute of Health) offered a 1-year diploma in Medical Laboratory Technology [7]. This diploma was later upgraded to a 2-year course equivalent to Higher Secondary School Certificate. Subsequently, various paramedical institutes were established to offer MLT diploma/certificate courses. However, opportunities for training were often least available for existing staff who were in desperate need of it, particularly those working in small hospital laboratories were devoid of easy access to training institutions. Rapid advancements in technology and the rising use of automated instruments in the clinical laboratory changed the nature of work of the laboratory technicians. Consequently, the work of the laboratory technicians evolved from the performance of a few, relatively simple procedures to the performance of a variety of

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tests using increasingly complex methodologies and instruments. Cognizant of these developments, the Government of Pakistan initiated a Bachelors’ Degree Program in Medical Laboratory Technology at Jinnah Postgraduate Medical Centre, Karachi, in the early 1970s. That program was discontinued a few years later but again started at the National Institute of Health, Islamabad, and Sheikh Zayed Federal Post Graduate Medical Institute, Lahore in the early 1990s. Laboratory personnel were classified into two groups, Medical Technologists (having bachelor’s degree in laboratory technology) and laboratory technicians (having diploma in laboratory technology), based on their level of education, training, and experience. Currently, over 30 institutes (affiliated with various universities) are offering a BS (Hons) program in

MLT in Pakistan. The diploma/certificate awarding

institutes/educational boards operate under the umbrella of respective Departments of Health through Provincial Medical Faculties, and they are examining bodies for the institutes. All universities are autonomous bodies associated with the Higher Education Commission (HEC) Pakistan. In 2006, University of Health Sciences, Lahore, initiated a Masters program in MLT with a research component in one of the specified fields such as Microbiology, Biochemistry etc.[8]. In 2012, the same university also initiated M.Phil degree in MLT with specialization in one of the above mentioned fields. It is estimated that there are approximately 7,000 qualified MLTs in Pakistan at present. However, it is critical to mention that Baluchistan, Gilgit-Baltistan and the State of Azad Jammu Kashmir do not have a teaching institute for Medical Laboratory Technologists. There is a wide diversity in the standard of the institutes and no regulatory or accreditation system exists. Lack of regulation is however, not a feature of associated professions of the allied health sciences such as medicine, dentistry, nursing and pharmacy, which have organized professional bodies like Pakistan Medical and Dental Council, Pakistan Nursing Council, Pakistan Pharmacy Council with the mandate of registration and licensing of professional institutes and professionals.

In May, 2013, the American Society for Clinical Pathology (ASCP) established an Advisory Board in Pakistan to assist ASCP in promoting International Certification in Pakistan. This is an important development and likely to strengthen the field of MLT in the country.

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Curriculum Revision

As there was no mechanism for providing systematic instruction, each training program established its own educational criteria, curriculum and training standards. Growth of the sector led to a need to develop standardized training programs for laboratory technicians who would include minimum educational pre-requisites and technical qualifications [9]. Diversity of opinion occurs regarding the curriculum revision and standardization. A minority believes that the process of education for laboratory technicians should be based on the same pedagogical principles as in any other educational system. This group recognized that both knowledge and extensive independent judgment were required in the clinical laboratory. Some believed that clinical laboratory practice was a skill that was developed through repetitive drill in laboratory techniques and extensive academic preparation was a waste. However, most individuals connected with the education of laboratory technicians believed that the practice of medical technology was purely mechanical and required little thought. A whole year of practical training, consisting primarily of drill in six to ten routine techniques, was believed to be adequate for preparation of laboratory technicians, and that the length of the training program should be kept to a minimum so that “persons in modest circumstances” could enroll in training programs. The nature of medical laboratory practice has beenevolved and therefore, new roles and expanding responsibilities for medical technologists in the areas of management, supervision, research, and education, are required. The existing curriculum does not adequately addresses the new roles and responsibilities of Medical Technologists. In most cases, this curriculum is out dated as well. The curricula for Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), Bachelor of Science (BS) Nursing, Bachelors of Science (BS) Physiotherapy, D Pharmacy are uniform and standardized across the country. Every institution has to execute the same curricula; however, it is contradictory in case of, NIH, Islamabad which is working in complete isolation. The services provided are of varying standards with a few institutes still offering a 2-year BS in MLT while the rest (> 25) have a 4-year program of BS-MLT. Many centers offering degrees, diplomas, certificates and courses in MLT have mushroomed to fill the gap of human resource in clinical

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laboratories. Revisiting the Medical Laboratory

Technologyprofession and trying to reposition, rejuvenate and restructure its current curriculum to meet and if possible, surpass the currently achieved standard of healthcare services is very crucial and quite indispensable if the country aims at modernizing and achieving the primary goals of the Medical and healthcare profession and aspirations.

It is critical for MLTs to have systematic and organized educational experiences that would assist them in keeping up with advances in knowledge and technical methods throughout their careers. The time has come for educators to re-evaluate and revise the entire educational program so that it would enable MLTs to function effectively in their new roles. They now have to prepare professional MLTs who, not only supervise technical procedures in the laboratory, but could also find it interesting and worthy of research and teaching. The broadening horizons of clinical laboratory practice have created new opportunities for MLT practitioners and are posing new challenges for MLT educators. It is essential to develop the professional cadre for clinical laboratories which needs careful review of the existing curricula from different academic boards and universities, developing a common template which can then be adapted countrywide through the support of HEC, Government of Pakistan which has exercised similar protocol for several professional degrees. HEC needs to play significant role to implement this reform process and the academic institutions should fully embrace the change.

Pakistan Medical Technology Council

In Pakistan, the allied health fields have professional bodies since a very long time. The Pakistan Nursing Council was established in 1948; Pakistan Pharmacy Council in 1967; and Pakistan Medical and Dental Council in 1962. There is, however, no such body to protect the interests of the field of medical laboratory technology. With the rapid advancements in the field of Medical Technology and the growth of this sector in Pakistan, there is a need of a professional body to determine a career structure and resolve core issues such as recruitment policy, promotion channel, staffing pattern, job descriptions, continuous medical education, etc in medical laboratory technology field.

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The first national body for Medical Technology was established in 2010 under the title “Pakistan Association of Medical Laboratory Sciences” (PAMLS) [10].In India, a similar body has been in existence since 1970s. PAMLS has, so far, organized two national conferences in 2010 and 2011 with over 500 Medical Technologists and Laboratory Professionals participated actively. However, PAMLS is currently inactive and needs government attention and support. Another organization, Medical Laboratory Technologists Association of Pakistan (MLTAP), has also been set up to promote MLT professional growth and development [11]. It is imperative that these two organizations to join hands and work together for the advancement of this field. These two organizations should also pave path for the establishment of an accreditation body, i.e. Pakistan Medical Technology Council (PMTC), similar to Pakistan Nursing Council or Pakistan Pharmacy Council. This accreditation body should be identical to the National Accrediting

Agency for Clinical Laboratory

Sciences inUSA[12](accredits/sets standards for Medical

Laboratory Training Programs) and the American Society of Clinical Pathologists [13]which certifies individuals upon meeting certain academic, experience and/or training prerequisites and successfully passing the examination. The major objectives of PMTC should include: (1) standardizing the curriculum for the Medical Laboratory Professionals; (2) inspecting and monitoring academic institutions for approval based on established standardsincluding curricula content, minimum classroom and teaching aid facilities, faculty education and experience, etc.; (3) providing licenses to practitioners; (4) acting as an advisory body for MLT at the Federal and Provincial level; and (5) registering and licensing the medical laboratories. PMTC should also help to establish and recognize Medical Laboratory Technology as an entity separate from Pathology, with its own specialists and career structure.

Conclusion

On the verge of the 21st century, laboratory is providing more information about the human condition more rapidly and more accurately than ever. The Government of Pakistan needs to come forward and endorse this vital discipline. It should establish minimum criteria for training programs conducted in paramedical schools, accreditation of these programs and institutes that meet

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the required standards (via establishment of PMTC) and enforce a uniform curriculum across the country, implementing educational reforms in the Medical Laboratory Technology Science. These actions will result in transforming the emerging field of laboratory sciences into an occupation that possesses a defined body of knowledge, a consistent system for training, and objective methods of assessment.

References

American Society for Clinical Pathology. (2013). Accessed on June 2013, available at www.ascp.org

Berger, D. (1999). A Brief History of Medical Diagnosis and the Birth of the Clinical Laboratory, Part 4.Fraud and Abuse, Managed-Care, and Lab Consolidation. MLO Med Lab Obs. Vol. 31(12), pp. 38-42.

Bersch, C. (2006). A Brief History Medical Diagnosis and the Birth of the Clinical Laboratory, Part 5a.The Foundation of Molecular Science and Genetics. MLO Med Lab Obs. Vol. 38(9), pp. 16-21.

Kotlarz, V. R. (1998). Tracing our Roots: Early Clinical

Laboratory Scientists and their Work-Myth and Reality. Clin Lab Sci. Vol. 11(4), pp. 209-213.

Kotlarz, V. R. (1998). Tracing our Roots: the Beginnings of a Profession. Clin Lab Sci. Vol. 11(3), pp. 161-6. Kotlarz, V. R. (1998). Tracing our Roots: Origins of Clinical

Laboratory Science. Clin Lab Sci. Vol. 11(1). Pp. 5–7. Medical Laboratory Technologists Association of Pakistan.

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National Accrediting Agency for Clinical Laboratory

Sciences.(NAACLS). Accessed on June 2013, available at www.naacls.orgUniversity of Health Sciences. (2013). Pakistan. Accessed on June 2013 available at

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National Institute of Health. (2013). Pakistan. Accessed on April 2013 available at www.nih.org.pk/history.asp

Pakistan Association of Medical Laboratory Sciences. (2013). Accessed on June 2013, available at www.pamls.org US News and World Report. (2013). The 50 Best Careers of 2011.

Accessed on January 2013 available at www.usnews.com Waheed, U., Ansari, M. A. and Zaheer H. A. (2013). Phlebotomy

as the Backbone of the Laboratory. Lab Medicine. Vol. 44 (1), pp. 69-71.

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