ASCP Certification: The Standard of Excellence Investigating Medical Laboratory Practitioners Scope of Practice Donna Surges Tatum, PhD, CAE Kory Ward-Cook, PhD, MT(ASCP), CAE

ASCP Certification: The Standard of Excellence ABSTRACT Job task, or practice, analyses are a vital component of the certification process. They are used to validate examinations by providing a link between job performance and examination content. Before an examination is developed, and every 3-5 years thereafter, a job task analysis must be performed to define or confirm the scope of practice in order to assure appropriateness and relevance of the certification.

ASCP Certification: The Standard of Excellence ABSTRACT (Cont’d) In 2001, ASCP Board of Registry staff visited 22 diverse practice settings and recorded more than 150 observations to create an ethnographic report. This data was used to develop an in-depth Job Task Survey for Medical Technologists (MT), Medical Laboratory Technicians (MLT), and Phlebotomists (PBT), mailed in early The overall 15% response rate is more than sufficient to determine the various scopes of practice and the validity of the certification examinations.

ASCP Certification: The Standard of Excellence ABSTRACT (Cont’d) Results indicate overlapping scope of practice with MTs and MLTs for many tasks. However, MTs perform complex tasks more often than do MLTs. PBTs have defined jobs and do not practice outside clearly defined parameters. Other variables, such as geographic differences, length of time in the profession, practice setting, type of facility, and schedule also are useful for blue printing the examination and validating the examination content. Further, educators can review their curricula in light of practice, and government agencies will have the facts when determining laboratory regulations.

ASCP Certification: The Standard of Excellence OBJECTIVE  Systematically collect quantitative data describing Medical Technologists (MT) and Medical Laboratory Technicians (MLT) and Phlebotomists (PBT).  To relate laboratory practice to the certification examination by determining:  what these practitioners do  how often they do it  under what conditions they do it  what they must know  skills that are necessary to perform the job

ASCP Certification: The Standard of Excellence METHODS The data from the surveys was collected in Teleform using SPSS v11.5 to perform descriptive analyses. Winsteps, which is based on the Rasch model of measurement, was used. to calculate calibrated item measures. The analysis presented here was performed using the MT and MLT data. To investigate DIF (differential item functioning) the measures for the items ( tasks) from each group were compared to determine if the items were functioning differently for the two groups (MT and MLT).

ASCP Certification: The Standard of Excellence METHODS (Cont’d) An independent t-test was calculated comparing the item measures from the MTs and MLTs. The overall significance decision was based on a DIF of.25 and a t-test significant at the.05 level. If both of these criteria were met, the item was considered to be functioning differently for the two groups.

ASCP Certification: The Standard of Excellence RESPONSE SUMMARY Profile of Survey Recipients  All persons who became MT-, MLT-, and PBT-certified from June 1999 to June 2001 (total 9,363)  1000 randomly selected persons from each of the following groups: those who became MT-, MLT-, and PBT-certified in 1996 (total 3,000)  1000 randomly selected persons who became PBT-certified in 1989 (total 1,000)  1000 randomly selected persons from each of the following groups: those who became MT- and MLT-certified in 1986 (total 2,000)  1000 randomly selected persons from each of the following groups: those who became MT- and MLT-certified between (total 2,000)

ASCP Certification: The Standard of Excellence

RESULTS Job Task Maps The Job Task Maps show the calibrated frequency of tasks performed in the laboratory by MTs and MLTs. The scale covers a range of 5.00 to 15.00, with the origin, or balance point at That means a task of “average” frequency has a calibration of about Tasks performed more often have a higher calibration, while those rarely done have a lower calibration. The column on the left graphically shows calibrated tasks performed with equal frequency by both MTs and MLTs. The other two columns demonstrate MT and MLT tasks that have statistically significant different measures of frequency.

ASCP Certification: The Standard of Excellence RESULTS (Cont’d) By examining the Job Task Maps, we can determine overlapping scopes of practice as well as the differences between the Medical Technologist and the Medical Laboratory Technician. We can see the tasks most commonly performed in relation to tasks that are less routine. We can benchmark these tasks and track them to find out how laboratory practice changes over the years.

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS ABO/Rh – ABO/Rh Aderse reaction investigation - AdvReacInvest Antibody identification-high incidence - AbIDHigh Antibody identification-low incidence - AbIDLow Antiboy screen - AbScrn Antibody titer - AbTiter Compatibility testing - CompatTest DAT - DAT Elution, absorption - Elution Prepare components - PrepComp Stem cell testing – StemCellTst

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) Chemical inventory – ChemInven Chemical storage – ChemStrg Electrical Safety Audit – ElectricalSafe Ergonomic controls – ErgoControls Fire safety audit – FireSafety Formaldehyde exposure monitoring – FormaldAdt General equipment monitoring – GenEquip General first aid – GenFirstAid Infection control – InfecControl PPE use – PPE Radiation exposure monitoring – Radiation Record retention – RecrdRetention Spill cleanup – SpillCleanUp Waste management – WasteMgmt

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) Data analysis – DataAnalysis Data collection – DataColl Data presentation – DataPresent Problem/complaint investigation – ProbComplaint Proficiency testing – external – ProfTstngExt Proficiency testing – internal – ProfTstngInt Proficiency testing – international – ProfTstngInt’l

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) ANA, anti-DNA – ANA B & T lymphocyte cell count – B&T General viral antibody testing – GenViralAb Hepatitis testing – Hepatitis HIV/HTL/CMV testing – HIV Immunoglobin assays – Immunoglobin Other microbial infectious diseases – Othermicrobial “Rapid” screening for viral or microbial infections – RapdScreen Surface markers/DNA/HCA – SurfaceMrkr Syphillis testing – Syphillis Thyroid antibodies – ThyroidAb

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) Basic metabolic panel – BscMetabolic Blood gases – BldGas Cardiac panel – CariacPnl Comprehensive metabolic panel – MetabPnl Electrophoresis – Electrophoresis Endocrinology/tumor markers – Endocrin Enzymes and other proteins – Enzymes Hepatic panel – Hepatic Lipid panel – Lipd Renal panel – Renal TDM/toxicology – TDM

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) Aerobic organism growth detection – AerobicGrwth Aerobic organism identification – AerobicID Anaerobic organism growth detection – AnaerobicGrwth Anaerobic organism identification – AnaerobicID Biochemical testing – automated – AutoBichem Biochemical testing – manual – ManBiochem Enteric typing – Enteric Fungal organism growth detection - FungGrwthDet Fungal organism identification – FungalOrgID Gram stain – GramStain

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) Mycobacterial growth detection – MycobacGrwthDet Mycobacterial identification – MycobacID Other Stains – OtherStns Ova & Parasites detection – OvaDet Ova & Parasites identification – OvaID Susceptibility testing – Susceptibility Virus growth detection – VirusGrwthDet Virus identification – VirusID

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) Amniotic fluid analysis – Amniotic Brochoalveolar lavage – BroncoLav Cell count – CellCount CSF analysis – CSF Fecal analysis – Fecal Gastric analysis – Gastric Microscopic examination – MicroExam Peritoneal fluid analysis – Peritoneal Pleural/pericardial fluid analysis – Pleural Saliva anlaysis – Saliva Semen Analysis – Semen Sweat analysis – Sweat Synovial fluid analyais – Synovial UA – automated – UAAuto UA – manual - UAMan

ASCP Certification: The Standard of Excellence KEY FOR JOB TASK MAPS (Cont’d) APTT, PT, TT – APTT Blood cell count – automated – AutoBldCllCnt Blood cell count – manual – ManBldCllCnt Bone marrow differential – BMDiff ESR, reticulocyte count – ESR Factor assays – FactorAssay Fibrinogen, FDP, d-dimer – Fibrinogen Morphology and idfferential – automated – AutoMorph Morphology and differential – manual – ManMorph Special stains - SpecialStns

ASCP Certification: The Standard of Excellence

CONCLUSIONS  A Practice Analysis is much more than identifying the tasks performed by laboratory practitioners, it also:  demonstrates relative frequencies of tasks  shows overlapping of responsibilities  determines the knowledge and skills needed to demonstrate and maintain competency  compares these facets at various points in their career.  The Practice Analysis allows BOR Examination Committees to ensure the test certifying competence reflects practice.

ASCP Certification: The Standard of Excellence CONCLUSIONS (Cont’d)  Practice Analysis results are available to Program Directors for guidance in designing educational curricula  Results of the survey will have broad implications to present day laboratory practitioners, as well as future professionals