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Education and training of medical technologists in Italy
Clinica Chimica Acta 393 (2008) 33–35
Contents lists available at ScienceDirect
Clinica Chimica Acta j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c l i n c h i m
Education and training of medical technologists in Italy Gianni Casna ⁎ Polo Universitario delle Professioni Sanitarie, Rovereto, Italy
A R T I C L E
I N F O
Article history: Received 13 March 2008 Accepted 14 March 2008 Available online 27 March 2008 Keywords: Biomedical laboratory technologist Training Education university degree Teaching sectors Core competence
A B S T R A C T The role and figure of biomedical laboratory technologists have undergone important changes over the past decades. The increasingly complex functions and responsibility of biomedical laboratory technologists both require an updated education and training process. Here, we describe the current situation in Italy regarding the education of biomedical laboratory technologists and the results of a survey conducted in 28 universities. A significant variability between the different universities was observed regarding both the teaching subjects and the distribution of credits among the different courses. The results of this survey highlight that a greater uniformity in the distribution of credits and a better balance among teaching sectors might be advisable. © 2008 Published by Elsevier B.V.
1. Introduction The role of the biomedical laboratory technologist has undergone important changes over the past years, and this professional figure is now required to take on increasingly complex functions and responsibilities, that require an adequate body of knowledge and skills, which can only be acquired during the university courses. Training courses for biomedical laboratory technologists were developed at several Italian Universities in the early 1990s, with the former creation of the so-called three-year university diploma, further evolving into the 3-y bachelor's degree course in 2001 [1]. This course is run by the faculty of medicine and surgery and aims to provide students with the necessary knowledge and essential skills to operate in the role corresponding to this specific professional profile [2]. To be admitted on the course, students must have a secondary school diploma (awarded after 5 y of secondary school education) or an equivalent qualification awarded abroad that has been recognized as suitable. The number of places on the course is planned and subjected to students passing an entrance examination consisting in a written test containing questions relating to basic sciences (e.g. biology, chemistry, mathematics and physics), logic and general knowledge. In Italy, there are now 51 degree courses for biomedical laboratory technologists. For the academic year 2007–2008, the Ministry of Education has planned to provide 1250 positions. At the end of the three years, students who have passed all the required examinations and have successfully attended the practical placement (worth 180 credits) are admitted to the final examination. This consists in the discussion of a thesis and demonstration of the technical and practical expertise acquired during the 3-y university course. This final ⁎ Corresponding author. Tel./fax: +39 464 403 140. E-mail address: [email protected]. 0009-8981/$ – see front matter © 2008 Published by Elsevier B.V. doi:10.1016/j.cca.2008.03.026
assessment is valid as a state examination that qualifies successful candidates to practice their profession as biomedical laboratory technologists. Further training after the 3-y degree course includes the opportunity for graduate technologist to access more advanced specialist training in the form of a Masters course or a two-year Laurea Magistrale (postgraduate specialization). The Masters courses aim to further develop the necessary expertise for the biomedical laboratory technologists to practise in their specific roles in the public health organizations, e.g., to take responsibility for coordination, to teach on CPD (continuing professional development) schemes, to act as tutors both in the training setting and in the laboratory for the induction of new employees. Other Masters courses offer the chance of further in depth study in specific diagnostic areas, such as cytodiagnostics and molecular biology. These courses are run by the Universities, which offer different types of training according to local needs. The Masters courses last 1 y, are worth 60 credits and are attended by technologists during the working activity, so that the training courses are generally spread over a period of 15–18 months to facilitate attendance and individual study. The specialist postgraduate courses are worth 120 credits and are provided jointly with other professions in the technical area (medical radiology technologists, neurophysiopathology technologists, audiometrists); the aim of this type of courses is to develop expertise for personnel managing the organizational, training and applied research processes. In this context, the Masters courses and specialist postgraduate courses offer a programmed number of places and are accessed by means of entrance tests; for the academic year 2007–2008, the Ministry established that 350 places should be available on the 16 specialist postgraduate courses run by the different Universities. The Italian national commission that joins the managers of the degree courses for biomedical laboratory technologists has recently
34
G. Casna / Clinica Chimica Acta 393 (2008) 33–35
Table 1 Professionalizing subjects taught and credits attributed at 27 universities Subjects taught
Medical genetics Clinical pathology Microbiology Pathological anatomy Technical sciences of laboratory medicine Clinical biochemistry Pharmacology Parasitology
Credits Minimum
Maximum
Mean
2 1.5 4 4 1 1 1 0.5
7 15 25 12.5 22 16 5 3.5
4 7 7 8.5 10 8 3 1.5
conducted an investigation, based on a questionnaire, to analyze the experiences and the teaching plans adopted by the Universities, as well as the formulation of proposals for adjusting the teaching content for a professional training of improved quality [3]. This investigation was conducted with the participation of 35 degree courses held at 28 Universities. The major aim of this investigation was to analyze the students' movements, the organization of the teaching plan and the professional training placement. 2. Principal results The results of the investigation produced a snapshot of the available degree courses for biomedical laboratory technologists, which were analyzed and discussed by a group of educators. The courses were attended by 23 students on average in the first year, 19 in the second year and 17 in the third. An average of 16 students graduate each year from each university. From the analysis of the teaching content, it emerged that 53% of the time is spent on theory (accounting for an average 96/180 credits), and 34% on the training placement (worth an average 61/180 credits), while an average 7/180 credits (4%) is used for the thesis. The optional activities chosen by the student, which correspond to nearly 6% of the whole activity (and are awarded a mean 10/180 credits), require participation in seminars and conferences, further placement experiences, a more extensive study of English language and computer science, and other special courses of interest for the student. These optional studies are assessed by means of certificates of attendance and, in the case of courses, by a final examination. Finally, 3% of the course activity (and a mean 6 credits) is dedicated to the study of computer sciences and language proficiency. Of the total credits reserved for theoretical activity, an average 60% of the credits goes on studies in medical sciences, 25% on biological sciences, 11% on the area of physics, statistics, computer science and linguistics, 3% on the legal and economic sciences, and 1% on the psychosocial sciences. Going into the teaching plan in more details, it appears that some disciplines are not always included in the students' curriculum of studies. For instance, the legal and bioethical issues normally developed within courses of forensic medicine were not included in 7 of the degree courses. Half of the courses contain no legal sciences and only a few of them includes psychosocial teaching. Analyzing the data reported by 27 Universities on the relative weight of the professionalizing scientific subjects summarized in Table 1, a marked variability can be observed. As concerns microbiology, in particular, it is worth mentioning that although the subject is the most strongly represented with the largest number of credits, the weight attributed varies considerably among the 27 Universities' teaching plans (from a minimum of 4 credits to a maximum of 25). There is a similar situation in technical sciences for laboratory medicine; some Universities have attributed only 1 credit, others up to 22, and as many as 4 Universities have planned no training on this topic. The number of integrated courses and examinations averages 20.7, a situation that complies with the recent recommendations included
in the University reform (3-year courses should involve ≤20 examinations), although the differences between the various universities are again remarkable, with some courses including 18 examinations, others as many as 34. As for the arrangements for the practical placements at the 29 Universities providing degree courses for biomedical laboratory technologists who participated in the investigation, an average 61 credits were assigned to this activity over the 3-y period (with a minimum of 50 and a maximum of 80 credits), usually divided between semesters, except for 7 universities where no practical placement in the first semester of the first year is held. The distribution over the 3-y period involves an average 18 credits in the first year, 21 in the second and 22 in the third. As for the evaluation of the practical training activities, the investigation showed that the majority of the degree courses involved an assessment at the end of each of specific working experience. It was also observed that most of the courses included an assessment on field experience in the first, second and third years; one University scheduled this assessment only in the third year; and at three Universities it was not contemplated. The methods adopted for these assessments also varied: 7 degree courses included both oral and practical tests, 4 performed only practical test, 3 used written and oral tests, 3 used written, oral and practical tests, 2 used written and practical tests, and only 2 used oral tests. The specific practical activities were involved laboratory services belonging to the Universities' clinics or to general hospitals or other public healthcare structures; private laboratories were involved in 3 cases only. The areas attended by N90% of the students were clinical biochemistry, clinical pathology and microbiology–virology; immunohematology and pathological anatomy services were attended by 86% of the students and only 60–70% of the students attended the genetics and pharmacotoxicology services. 3. Discussion In terms of sectors characterizing the professional expertise of biomedical laboratory technologists, there was evidence of a significant variability between the different Universities, which would suggest the need to review the teaching plans to enable a greater uniformity in the distribution of the credits and a better balance in the contribution of the various teaching subjects. A guiding criterion for decisionmaking concerns the choice of the subjects that characterize the laboratory areas where these professionals are more likely to be involved. There was a general agreement on the importance and the relative weight that some teaching subjects must have in these specific degree courses, as summarized in Table 2. Subjects such as computer science, statistics and linguistics are included in the various teaching plans either as separate courses or integrated in other subjects, from which their aims are unclear. The educators involved in the investigation suggested that an integrated course to be arranged on “Methods for an evidence-based professional practice”, to finalize the teaching of medical statistics, epidemiology, scientific English and research methods. The aim of this integrated Table 2 Minimum credits assigned to the professionalizing teaching subjects Teaching subject
Credits
• Technical sciences of laboratory medicine • Clinical pathology • Clinical biochemistry and clinical molecular biology • Microbiology • Pathological anatomy • Medical genetics • Pharmacology • Molecular biology • Parasitology and parasitic animal diseases
10 8 8 6 6 5 4 2 2
G. Casna / Clinica Chimica Acta 393 (2008) 33–35
course is help developing the elemental expertise for any profession with a scientific background, including the skill to read scientific articles and analyze them critically, know the different types of study design and methodology, interpret a research protocol, consult a database to find information and remain updated, undertake a strict and critical literature review on a given topic. These are essential requisites for public healthcare professionals to orient their professional development and fit their qualifications to the technological and organizational evolution of the laboratory diagnostics. Finally, it would be a good idea to include some lectures in the area of the psychosocial and organizational sciences, because they can help the future professional to acquire skills that the public healthcare services expect, such as capacity to become integrated in the working processes, co-operate and harmonize with other professionals, comply with the service's development and innovation objectives. Regarding the practical activity, it would be advisable to plan a course of studies at all Universities to ensure that the students attend the most important areas of the laboratory. Since we are dealing with professionalizing university qualifications, there is a unanimous consensus concerning the need to implement assessments that include
35
practical tests to ascertain and certify the student's “know-how”. In each laboratory area where students gain their practical experience, there must be supervisors with specific responsibilities to act as tutors. Finally, on a national scale, a priority goal is to develop a core competence that students must have acquired during their three years, shared by the educators and by the laboratory service managers, paying also attention to the future growth of this profession at European level. References [1] Decreto Interministeriale 2 Aprile 2001. Determinazione delle classi delle lauree universitarie delle professioni sanitarie. (Pubblicato nel S.O. n. 136 alla Gazzetta Ufficiale n. 128 del 5 giugno 2001). [2] Decreto Ministeriale 26 Settembre 1994, n.745. Regolamento concernente l’individuazione della figura e del relativo profilo professionale del tecnico sanitario di laboratorio biomedico. (Pubblicato nella Gazzetta Ufficiale 9 gennaio 1995, n. 6). [3] Maria Rosaria Giovagnoli Confronto sui piani di studi dei corsi di laurea in Tecniche di Laboratorio Biomedico: un primo bilancio e proposte. Quaderni delle Conferenze Permanenti delle Facoltà di Medicina e Chirurgia 2007;39:1644–1648.
Contents lists available at ScienceDirect
Clinica Chimica Acta j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c l i n c h i m
Education and training of medical technologists in Italy Gianni Casna ⁎ Polo Universitario delle Professioni Sanitarie, Rovereto, Italy
A R T I C L E
I N F O
Article history: Received 13 March 2008 Accepted 14 March 2008 Available online 27 March 2008 Keywords: Biomedical laboratory technologist Training Education university degree Teaching sectors Core competence
A B S T R A C T The role and figure of biomedical laboratory technologists have undergone important changes over the past decades. The increasingly complex functions and responsibility of biomedical laboratory technologists both require an updated education and training process. Here, we describe the current situation in Italy regarding the education of biomedical laboratory technologists and the results of a survey conducted in 28 universities. A significant variability between the different universities was observed regarding both the teaching subjects and the distribution of credits among the different courses. The results of this survey highlight that a greater uniformity in the distribution of credits and a better balance among teaching sectors might be advisable. © 2008 Published by Elsevier B.V.
1. Introduction The role of the biomedical laboratory technologist has undergone important changes over the past years, and this professional figure is now required to take on increasingly complex functions and responsibilities, that require an adequate body of knowledge and skills, which can only be acquired during the university courses. Training courses for biomedical laboratory technologists were developed at several Italian Universities in the early 1990s, with the former creation of the so-called three-year university diploma, further evolving into the 3-y bachelor's degree course in 2001 [1]. This course is run by the faculty of medicine and surgery and aims to provide students with the necessary knowledge and essential skills to operate in the role corresponding to this specific professional profile [2]. To be admitted on the course, students must have a secondary school diploma (awarded after 5 y of secondary school education) or an equivalent qualification awarded abroad that has been recognized as suitable. The number of places on the course is planned and subjected to students passing an entrance examination consisting in a written test containing questions relating to basic sciences (e.g. biology, chemistry, mathematics and physics), logic and general knowledge. In Italy, there are now 51 degree courses for biomedical laboratory technologists. For the academic year 2007–2008, the Ministry of Education has planned to provide 1250 positions. At the end of the three years, students who have passed all the required examinations and have successfully attended the practical placement (worth 180 credits) are admitted to the final examination. This consists in the discussion of a thesis and demonstration of the technical and practical expertise acquired during the 3-y university course. This final ⁎ Corresponding author. Tel./fax: +39 464 403 140. E-mail address: [email protected]. 0009-8981/$ – see front matter © 2008 Published by Elsevier B.V. doi:10.1016/j.cca.2008.03.026
assessment is valid as a state examination that qualifies successful candidates to practice their profession as biomedical laboratory technologists. Further training after the 3-y degree course includes the opportunity for graduate technologist to access more advanced specialist training in the form of a Masters course or a two-year Laurea Magistrale (postgraduate specialization). The Masters courses aim to further develop the necessary expertise for the biomedical laboratory technologists to practise in their specific roles in the public health organizations, e.g., to take responsibility for coordination, to teach on CPD (continuing professional development) schemes, to act as tutors both in the training setting and in the laboratory for the induction of new employees. Other Masters courses offer the chance of further in depth study in specific diagnostic areas, such as cytodiagnostics and molecular biology. These courses are run by the Universities, which offer different types of training according to local needs. The Masters courses last 1 y, are worth 60 credits and are attended by technologists during the working activity, so that the training courses are generally spread over a period of 15–18 months to facilitate attendance and individual study. The specialist postgraduate courses are worth 120 credits and are provided jointly with other professions in the technical area (medical radiology technologists, neurophysiopathology technologists, audiometrists); the aim of this type of courses is to develop expertise for personnel managing the organizational, training and applied research processes. In this context, the Masters courses and specialist postgraduate courses offer a programmed number of places and are accessed by means of entrance tests; for the academic year 2007–2008, the Ministry established that 350 places should be available on the 16 specialist postgraduate courses run by the different Universities. The Italian national commission that joins the managers of the degree courses for biomedical laboratory technologists has recently
34
G. Casna / Clinica Chimica Acta 393 (2008) 33–35
Table 1 Professionalizing subjects taught and credits attributed at 27 universities Subjects taught
Medical genetics Clinical pathology Microbiology Pathological anatomy Technical sciences of laboratory medicine Clinical biochemistry Pharmacology Parasitology
Credits Minimum
Maximum
Mean
2 1.5 4 4 1 1 1 0.5
7 15 25 12.5 22 16 5 3.5
4 7 7 8.5 10 8 3 1.5
conducted an investigation, based on a questionnaire, to analyze the experiences and the teaching plans adopted by the Universities, as well as the formulation of proposals for adjusting the teaching content for a professional training of improved quality [3]. This investigation was conducted with the participation of 35 degree courses held at 28 Universities. The major aim of this investigation was to analyze the students' movements, the organization of the teaching plan and the professional training placement. 2. Principal results The results of the investigation produced a snapshot of the available degree courses for biomedical laboratory technologists, which were analyzed and discussed by a group of educators. The courses were attended by 23 students on average in the first year, 19 in the second year and 17 in the third. An average of 16 students graduate each year from each university. From the analysis of the teaching content, it emerged that 53% of the time is spent on theory (accounting for an average 96/180 credits), and 34% on the training placement (worth an average 61/180 credits), while an average 7/180 credits (4%) is used for the thesis. The optional activities chosen by the student, which correspond to nearly 6% of the whole activity (and are awarded a mean 10/180 credits), require participation in seminars and conferences, further placement experiences, a more extensive study of English language and computer science, and other special courses of interest for the student. These optional studies are assessed by means of certificates of attendance and, in the case of courses, by a final examination. Finally, 3% of the course activity (and a mean 6 credits) is dedicated to the study of computer sciences and language proficiency. Of the total credits reserved for theoretical activity, an average 60% of the credits goes on studies in medical sciences, 25% on biological sciences, 11% on the area of physics, statistics, computer science and linguistics, 3% on the legal and economic sciences, and 1% on the psychosocial sciences. Going into the teaching plan in more details, it appears that some disciplines are not always included in the students' curriculum of studies. For instance, the legal and bioethical issues normally developed within courses of forensic medicine were not included in 7 of the degree courses. Half of the courses contain no legal sciences and only a few of them includes psychosocial teaching. Analyzing the data reported by 27 Universities on the relative weight of the professionalizing scientific subjects summarized in Table 1, a marked variability can be observed. As concerns microbiology, in particular, it is worth mentioning that although the subject is the most strongly represented with the largest number of credits, the weight attributed varies considerably among the 27 Universities' teaching plans (from a minimum of 4 credits to a maximum of 25). There is a similar situation in technical sciences for laboratory medicine; some Universities have attributed only 1 credit, others up to 22, and as many as 4 Universities have planned no training on this topic. The number of integrated courses and examinations averages 20.7, a situation that complies with the recent recommendations included
in the University reform (3-year courses should involve ≤20 examinations), although the differences between the various universities are again remarkable, with some courses including 18 examinations, others as many as 34. As for the arrangements for the practical placements at the 29 Universities providing degree courses for biomedical laboratory technologists who participated in the investigation, an average 61 credits were assigned to this activity over the 3-y period (with a minimum of 50 and a maximum of 80 credits), usually divided between semesters, except for 7 universities where no practical placement in the first semester of the first year is held. The distribution over the 3-y period involves an average 18 credits in the first year, 21 in the second and 22 in the third. As for the evaluation of the practical training activities, the investigation showed that the majority of the degree courses involved an assessment at the end of each of specific working experience. It was also observed that most of the courses included an assessment on field experience in the first, second and third years; one University scheduled this assessment only in the third year; and at three Universities it was not contemplated. The methods adopted for these assessments also varied: 7 degree courses included both oral and practical tests, 4 performed only practical test, 3 used written and oral tests, 3 used written, oral and practical tests, 2 used written and practical tests, and only 2 used oral tests. The specific practical activities were involved laboratory services belonging to the Universities' clinics or to general hospitals or other public healthcare structures; private laboratories were involved in 3 cases only. The areas attended by N90% of the students were clinical biochemistry, clinical pathology and microbiology–virology; immunohematology and pathological anatomy services were attended by 86% of the students and only 60–70% of the students attended the genetics and pharmacotoxicology services. 3. Discussion In terms of sectors characterizing the professional expertise of biomedical laboratory technologists, there was evidence of a significant variability between the different Universities, which would suggest the need to review the teaching plans to enable a greater uniformity in the distribution of the credits and a better balance in the contribution of the various teaching subjects. A guiding criterion for decisionmaking concerns the choice of the subjects that characterize the laboratory areas where these professionals are more likely to be involved. There was a general agreement on the importance and the relative weight that some teaching subjects must have in these specific degree courses, as summarized in Table 2. Subjects such as computer science, statistics and linguistics are included in the various teaching plans either as separate courses or integrated in other subjects, from which their aims are unclear. The educators involved in the investigation suggested that an integrated course to be arranged on “Methods for an evidence-based professional practice”, to finalize the teaching of medical statistics, epidemiology, scientific English and research methods. The aim of this integrated Table 2 Minimum credits assigned to the professionalizing teaching subjects Teaching subject
Credits
• Technical sciences of laboratory medicine • Clinical pathology • Clinical biochemistry and clinical molecular biology • Microbiology • Pathological anatomy • Medical genetics • Pharmacology • Molecular biology • Parasitology and parasitic animal diseases
10 8 8 6 6 5 4 2 2
G. Casna / Clinica Chimica Acta 393 (2008) 33–35
course is help developing the elemental expertise for any profession with a scientific background, including the skill to read scientific articles and analyze them critically, know the different types of study design and methodology, interpret a research protocol, consult a database to find information and remain updated, undertake a strict and critical literature review on a given topic. These are essential requisites for public healthcare professionals to orient their professional development and fit their qualifications to the technological and organizational evolution of the laboratory diagnostics. Finally, it would be a good idea to include some lectures in the area of the psychosocial and organizational sciences, because they can help the future professional to acquire skills that the public healthcare services expect, such as capacity to become integrated in the working processes, co-operate and harmonize with other professionals, comply with the service's development and innovation objectives. Regarding the practical activity, it would be advisable to plan a course of studies at all Universities to ensure that the students attend the most important areas of the laboratory. Since we are dealing with professionalizing university qualifications, there is a unanimous consensus concerning the need to implement assessments that include
35
practical tests to ascertain and certify the student's “know-how”. In each laboratory area where students gain their practical experience, there must be supervisors with specific responsibilities to act as tutors. Finally, on a national scale, a priority goal is to develop a core competence that students must have acquired during their three years, shared by the educators and by the laboratory service managers, paying also attention to the future growth of this profession at European level. References [1] Decreto Interministeriale 2 Aprile 2001. Determinazione delle classi delle lauree universitarie delle professioni sanitarie. (Pubblicato nel S.O. n. 136 alla Gazzetta Ufficiale n. 128 del 5 giugno 2001). [2] Decreto Ministeriale 26 Settembre 1994, n.745. Regolamento concernente l’individuazione della figura e del relativo profilo professionale del tecnico sanitario di laboratorio biomedico. (Pubblicato nella Gazzetta Ufficiale 9 gennaio 1995, n. 6). [3] Maria Rosaria Giovagnoli Confronto sui piani di studi dei corsi di laurea in Tecniche di Laboratorio Biomedico: un primo bilancio e proposte. Quaderni delle Conferenze Permanenti delle Facoltà di Medicina e Chirurgia 2007;39:1644–1648.