Tracing our roots: new opportunities and new challenges in clinical laboratory science (1977-1992).

OBJECTIVE: To describe new opportunities and challenges facing clinical laboratory science between 1977 and 1992. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: Between 1977 and 1992 the role of clinical laboratory scientist continued to evolve and expand as new tests and instruments were introduced. Over time, they began to assume greater responsibilities for analyzing and interpreting test results, evaluating and implementing quality assurance programs and new methodologies, and became involved, to a greater extent, in laboratory management and supervision, education, and research. A wide variety of career opportunities were opened to clinical laboratory scientists, providing them with employment opportunities beyond the milieu of the clinical laboratory. Federal regulations aimed at controlling cost of healthcare had a significant effect on the clinical laboratory and clinical laboratory personnel. Stricter guidelines for reimbursement of laboratory services by third-party payees and private insurers forced laboratories to scrutinize their costs and develop creative strategies to attract clients. Attrition, job satisfaction, salaries, and personnel shortages grew in importance during this period as well, prompting research in these areas.

CLS education at a new crossroad.

OBJECTIVE: To provide an overview of the history of CLS education at selected points in time; to describe issues facing CLS education today; and to discuss possible directions for CLS education in the future.

Tracing our roots: the rocky road toward recognition of clinical laboratory science's professional status (1962-1977).

OBJECTIVE: To discuss the progress clinical laboratory science made between 1962 and 1977 toward developing and acquiring characteristics associated with the traditional professions of medicine and law. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted included various books and professional journals. CONCLUSION: Between 1962 and 1977, the field of clinical laboratory science experienced many changes. Medical technologists in supervisory positions became more involved in higher management functions, such as organizing and directing laboratory operations. Clinical laboratory science educators developed graduate programs that would prepare faculty for positions in two- and four-year colleges and in hospital-based programs.

Tracing our roots: a new era in clinical laboratory science education.

OBJECTIVE: To describe the emergence of laboratory personnel at the technician and assistant levels and discuss educational issues that arose between 1962 and 1977. DESIGN: A survey of literature on the history of clinical laboratory science (CLS) was conducted. References consulted include various books and professional journals. CONCLUSION: Advances in scientific and medical knowledge and the development of new technologies created new roles and responsibilities for medical technologists (MTs) in the areas of education, research, and laboratory management. At the same time, the certified laboratory assistant (CLA) category was established as a means of providing competent personnel to work in physician office laboratories and small community hospitals in lieu of a certified MT. The growth in popularity of two-year colleges and the availability of federal funding for the development of allied health programs led to the establishment of yet another category of laboratory personnel: the medical laboratory technician (MLT). These developments prompted educators to modify their CLS curricula, develop educational programs at the CLA and MLT levels, and provide opportunities to CLAs, and MLTs for upward mobility. Furthermore, once the Board of Registry (BOR) established the baccalaureate degree as the prerequisite for MT certification, educators also began to restructure and more closely integrate the academic and clinical components of MT programs.

Tracing our roots: years of turmoil (1962-1977).

OBJECTIVE: To describe the activities of the American Society of Clinical Pathologists and the sequence of events leading to the establishment of the National Accrediting Agency for Clinical Laboratory Science and Medical Laboratory Personnel. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted various books and professional journals. CONCLUSIONS: By virtue of its close association with ASCP, ASMT became drawn into a series of legal actions between 1962 and 1977. Although ASMT was eventually dropped from all law-suits, the association's leadership recognized the need for greater autonomy and independence from ASCP. Clinical laboratory science achieved several victories during this period with respect to certification and mandatory re-registration by the BOR. Responsibility for accreditation of educational programs was shifted from the BOS to NAACLS and the establishment of the National Certification Agency for Medical Laboratory Personnel signified ASMT's commitment to certification by the profession for the profession.

Tracing our roots: a professional identity emerges: 1928 to 1945.

OBJECTIVE: To describe the early years of the American Society of Medical Technology and discuss major issues that led to contention between the American Society of Medical Technology and the Board of Registry. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: Clinical laboratory science began to develop a professional identity of its own, distinct from that of pathology, with the establishment of the American Society of Medical Technology and the publication of the American Journal of Medical Technology. These achievements illustrate clinical laboratory scientists' commitment to developing formal mechanisms to serve their specific interests and needs, independent of pathologists and the Board of Registry. Pathologists were successful, however, in maintaining control over other aspects of clinical laboratory scientists' professional identity, such as certification, accreditation, scope of practice, and code of ethics.

Tracing our roots: early clinical laboratory scientists and their work--myth and reality.

OBJECTIVE: To describe the 'real' and 'ideal' clinical laboratory scientist according to the perceptions of pathologists, clinical laboratory scientists, and the public during the early years of the profession (1918 to 1942). DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: As early as 1920, young women learned, through career guides, that they were particularly well-suited for performing laboratory work because they possessed a unique set of attributes which were considered to be desirable qualities in a clinical laboratory scientist. In addition, magazine articles published in the popular press in the 1930s and 1940s romanticized laboratory technicians. Although later articles did present a more realistic description of the work of the laboratory technician, they continued to portray the occupation in idealistic terms. Pathologists and laboratory technicians also described the ideal laboratory technician in professional journals, citing those qualities that were essential or especially desirable in a competent laboratory technician. The relationship between the clinical pathologists and the laboratory technician was described as one of mutual interdependence and integration of responsibilities. In reality, pathologists maintained strict supervision and control over the work of laboratory technicians. The 'real' laboratory technician differed markedly from the 'ideal' prototype created by the public, pathologists, and by laboratory technicians, themselves.

Tracing our roots: the beginnings of a profession.

OBJECTIVE: To examine the role of the American Society of Clinical Pathology and the Board of Registry in shaping the field of clinical laboratory science during its formative years. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: The Board of Registry played a significant role in the early development of clinical laboratory science. The Board established standards of competence for entry-level practitioners and a mechanism for assessing competence and developed an accreditation process for educational programs.

Tracing our roots: the first clinical laboratory scientist.

OBJECTIVE: To trace the roots of clinical laboratory science by discussing the development of the role of the "laboratory technician", and describing selected early training programs for clinical laboratory personnel. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: The first clinical laboratory scientists began working in clinical laboratories shortly before World War I. During the war, and in the years that followed, a critical shortage of trained laboratory personnel developed. To alleviate this shortage, pathologists began to hire young women, training them on the job to perform simple laboratory tests. However, there were no established training standards, and few institutions offered a systematic method for instruction. During this same period, three educational programs were established that did offer high quality training that provided systematic instruction to their students.

Tracing our roots: the broadening horizons of clinical laboratory practice (1945-62).

OBJECTIVE: To describe how the field of clinical laboratory science responded to the shortage of qualified laboratory personnel in the 1950s, and to review educators' responses to the changes in clinical laboratory practice. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: Between 1945 and 1962, the demand for certified medical technologists grew as a result of public demand for more health services, including laboratory testing. The shortage of qualified laboratory personnel, coupled with the introduction of new, more complex methods of analysis and the addition of different types of tests gave rise to specialization in each of the clinical laboratory disciplines. These developments also stimulated a renewed interest in creating another class of laboratory worker, the laboratory assistant, who could be assigned to perform simple procedures under the supervision of a certified medical technologist. The broadening horizons of clinical laboratory practice created new opportunities and new challenges for medical technologist educators.

The quest for professional recognition.

OBJECTIVES: To assess the progress clinical laboratory science has made toward achieving professional status. DATA SOURCES: Books, professional journals. STUDY SELECTION: Not applicable. DATA EXTRACTION: Survey of literature. DATA SYNTHESIS: Characteristics of clinical laboratory science as a profession were compared to a model of professionalization developed by Houle to assess the extent to which clinical laboratory science has acquired and refined selected attributes of a profession. CONCLUSION: Although clinical laboratory science has attained some of the characteristics associated with a profession, several critical issues must be addressed before it can achieve full professional status and recognition.

Tracing our roots: origins of clinical laboratory science.

OBJECTIVE: To trace the roots of clinical laboratory science by explaining how women initially gained access to scientific work and to describe the emergence of clinical laboratories. DESIGN: A survey of literature on the history of clinical laboratory science was conducted. References consulted include various books and professional journals. CONCLUSION: The origin of the field of clinical laboratory science can be traced to the early 1900s. Between 1890 and 1910, women were able, for the first time, to pursue careers in scientific professions, clinical laboratories became established in hospitals, and the clinical utility of laboratory tests became more widely recognized by physicians.