TRAINING OF MEDICAL LABORATORY TECHNICIANS

657

analytical

ones.

of the present regulations against the skilled chemistry technician is shown by the fact that, by waste of time and public money, he can register to do chemistry by virtue of training in one or more of these other subjects.

One wonders whether this is due to the

fact that the

patients are being " treated " by 20-year-old occupational therapists in group discussions. R. P. SNAITH. THE PART-TIME TEACHER SIR,-The results of Mr. Sturzaker’s poll

(March 13)

make very interesting reading.

Only 37% of the part-time teachers were excellent so far as punctuality and time spent on teaching were concerned-in other words they were doing properly the jobs they were being paid for. 49% were regarded as satisfactory, and therefore could improve; and about 15% were regarded as unsatisfactory-or dead wood as teachers. This last group have " consultant " immunity (cf. diplomatic) and may plague a medical school for many years until they retire. Surely there must be some way of dealing with this problem, or have we to resort to a medical ombudsman ?

TUTOR.

This registration problem only affects a relatively small number of technicians, but those it effects are important. The National Health Service ought to be able to attract some of the best young people into its technical service. The biochemistry laboratories certainly have need of them. Before the Registration Board could interpret the Act they had, of course, to define what a medical laboratory technician is. It seems that they have defined a technician as he was, and I strongly urge the council to initiate regulations embodying a flexibility which will raise the status of some of the most skilled, and unfortunately most scarce. members of staff of our National Health Service laboratories. ROBERT GADDIE General Hospital,

Birmingham,

4.

Chairman of Council, Association of Clinical Biochemists.

SIR,-Mr. Tapsfield’s defence of his Board of the Supplementary to Medicine is not entirely convincing. It is true that the Act does not define a medical laboratory technician, and Mr. Tapsfield acknowledges that the Board Council for Professions

TRAINING OF MEDICAL LABORATORY TECHNICIANS

SIR,-Mr. Tapsfield’s reply (March 6) to Dr. Grant’s letter (Feb. 27) is factually correct. Dr. Grant wrote as one who has had great difficulty because of registration in holding together a highly competent technical staff working in the field of steroid biochemistry. The regulations under which the Act concerned with the registration of medical laboratory technicians is at present

administered appear to members of the Association of Clinical Biochemists to cater for technicians trained in several subjects and found in the majority of pathology laboratories, and to neglect others. Modern hospital biochemistry laboratories need technicians with more advanced training in the basic sciences than can be obtained at present by the conventional I.M.L.T. training courses and examinations. This is a comparatively recent development not yet accepted by all those concerned with the hospital laboratory service. It is of particular importance in biochemistry at the present time because of the introduction of many new physical methods of analysis which have enormously widened the application of the subject to clinical problems, and of automatic methods and work simplification. These things will surely also become important in other branches of pathology, which, if nothing else, are

becoming increasingly dependent on chemistry. The object of the negotiations between the Association of Clinical Biochemists, the Biochemical Society, and the Royal Institute of Chemistry with the Registration Board, and their due to the desire to ensure that the Act did not prevent suitable and well-trained technicians entering the National Health Service and did not drive others out of the Service, as has happened in Dr. Grant’s laboratory. At the present time these aims have largely been frustrated. The Board has gone some way to meet this situation by recommending that approval for registration should be given to holders of the Higher National Certificate in Chemistry who have had two years’ experience in an. approved clinical laboratory immediately prior to passing an approved examination. This means in practice dropping specialised laboratory work in order to broaden experience. The only examination available is the final examination of the I.M.L.T., and it seems wrong to ask a technician who holds a Higher National Certificate in Chemistry to pass a further examination of a more general standard. Two years’ experience is surely sufficient for a scientifically trained technician of this calibre to become proficient in routine biochemistry techniques. After all, present regulations allow a technician trained in haematology, bacteriology, or histology to register and then proceed to work at once in a biochemistry laboratory. The bias

protracted nature, were

has had to consider a wide range of technicians One wonders how many of this wide range have been registered, other than holders of Institute of Medical Laboratory Technology (I.M.L.T.) diplomas ? For all practical purposes, the Board seems to have chosen to regard " medical laboratory technician " as synonymous with " associate or fellow of the I.M.L.T.", and the existence of 100% of I.M.L.T. members as the technician members who form the majority of the Board, plus an effectively self-perpetuating system of replacing them with other I.M.L.T. members when they retire, means that changes are unlikely to arise from within. The increasing diversity of disciplines involved in hospital laboratory work, and the desirability of attracting and retaining qualified men and women who may not have pursued the I.M.L.T. pattern of training, demands a broader basis for entry to the Register. That the door to further discussion has not been finally closed is largely due to the efforts of the Association of Clinical Biochemists and the Biochemical Society, but one hopes that the Ministry of Health and the medical profession also will realise that the Board’s current policy does not meet with universal approval.

question of which system of training for new should replace the traditional apprenticeship plus is now being discussed in many centres. classes evening In the interim period before better training schemes are introduced, it is important that the Board should not operate so as to drive technicians out of medical laboratory work, as has been happening in biochemical laboratories The

entrants

at

least_ University Department of Chemical Pathology, Foresterhill, Aberdeen.

S. C. FRAZER

SIR,-I am grateful to Professor Lendrum and Mr. Pascoe, and to Mr. Tapsfield for some enlightenment, but their comments main issue.

must not

distract your readers from the

The facts remain that there is a most serious shortage of properly trained biochemical technicians, and that the Institute of Medical Laboratory Technology (I.M.L.T.), which has been responsible for the training, has failed to produce them. There can be little argument but that I.M.L.T. training by technicians in busy laboratories, and of tired juniors by tired, more senior technicians in the evening, followed by the internal system of examinations, compares unfavourably with full-day instruction by professional teachers, in approved colleges, and examination

658 the Royal Institute of Chemistry (R.I.C.) and the Ministry Department of Education, for the Higher National Certificate (H.N.C.) in Chemistry. It is my experience that many intelligent young technicians find the unsatisfactory training schemes and the rotation system " of the I.M.L.T. distasteful, and that those with the H.N.C. pick up new and complex biochemical procedures much quicker than those trained by the I.M.L.T. The I.M.L.T. recognises that its training is unsatisfactory. Hence the report of the Watford Working Party, and the correspondence in your columns and the national Press.!

by or

"

Mr. Tapsfield’s comments reveal an extraordinary situation in which the Board of the Council for Professions Supplementary to Medicine is unwilling to accept, without protracted consideration of proposals and counter-proposals, the advice of the R.I.C. and of the Association of Clinical Biochemists (A.C.B.) on the qualifications of biochemical technicians. One would have thought that these are the bodies best suited to say what qualifications are required. Mr. Tapsfield’s comment on the submission of a training scheme is beside the point. I am referring to the acceptance of an existing qualification for technicians who are looking to clinical biochemistry for a career, and who are so badly needed for the National Health Service. The Act of Parliament specifies no particular qualification. With a majority of members of the I.M.L.T. (a body which does " enter the jungle of pay and promotion ") on the Board it is hardly surprising that only I.M.L.T. qualifications are accepted. The H.N.C., which is acknowledged by the and advocated R.I.C., by individual heads of biochemical laboratories and by the A.C.B., is not an accepted qualification even when the holder has worked under a senior member of the A.C.B. in a hospital biochemical laboratory; he may also have had years of valuable experience in an appropriate laboratory outside the N.H.S. Why must the experienced holder of this qualification, backed by the graduate head of the laboratory, be asked to take another examination, which would probably be controlled by the I.M.L.T. ? Can it be that the I.M.L.T. seeks to maintain a closed shop ", in the face of the present crisis, with biochemical laboratories staffed largely by juniors, and with seniors who lack the benefit of a sound training in physical and organic chemistry, and in the use of modern techniques. It is not surprising that no such crisis exists in Scandinavia or Germany or in American medical centres, where the training of those technicians is under the control of the professional biochemists. It appears that there is a good case for an independent board for biochemical technicians. "

It is no concern of the I.M.L.T. or of the Board, but the recruiting of biochemists (science and/or medical graduates) for the N.H.S. is not in a satisfactory state. One factor is the lack of suitably trained biochemical technicians. Good graduate biochemists are unwilling to enter the Service, when they know that they may be called upon to undertake routine analyses which can equally well be done by properly trained technical staff, and which fail to make the best use of their knowledge and skill. Glasgow and West of Scotland Regional Steroid Laboratory, Royal Infirmary, Glasgow, C.4.

reduction in dosage and she was subsequently admitted to hospital in order to exclude any other cause for her hypercalcaemia. Chest X-ray and skeletal survey were normal, serum-protein fractions and electrophoresis showed a reversed albumin-globulin ratio of 3-0/3-9, with a slight increase in a, 1X2, and y globulin. Marrow-examination excluded myelomatosis, and Bence-Jones protein was absent from the urine. After reduction in A.T.10 to 2 ml. daily the serum-calcium level slowly fell to within normal limits, and the patient is now symptom-free and has started to regain weight. She is now receiving a dose equivalent to 30% of her previous

time was 13.2 mg. per 100 ml. to 5 ml. daily the symptoms

Despite a persisted,

daily requirements.

Repeated estimations of the plasma-calcium levels only reliable guide for stabilising each

appear to be the

patient. Guy’s Hospital, London, S.E.1.

S. McH. YOUNG.

CONGENITAL CARDIAC ARRHYTHMIA

Sirhave read your annotationwith interest. In 1963 my co-workers and I reported a remarkably similar case of congenital familial cardiac arrhythmia characterised by syncopal attacks due to ventricular nbrillation and an abnormally long QT interval on electro-

cardiography.22 The patient was a 3-month-old girl who had had severe, frequent syncopal attacks from the age of 2 months. She was referred to our clinic for convulsive seizures. In one of the attacks the electrocardiogram showed ventricular fibrillation. During intervals between the attacks intermittent extrasystolic ventricular activity with very short couplings was shown once only, but changes characterised by a lengthening of the QT interval, broad diphasic T waves, and abnormal alternate complexes were repeatedly shown (see accompanying figure). These electrocardiographic abnormalities (possibly the expression of pronounced disturbances in the repolarisation process) were apparently spontaneous and became more and more evident through an intermediate range (see figure). A mild asymmetry was noted in the electroencephalogram. Two brothers of the patient with identical symptoms died during a syncopal attack at the ages of 44 days and 1. 2.

Lancet, 1964, ii, 26. Romano, C., Gemme, G., Pongiglione, R. Clin. Pediat., Parma, 1963, 45, 656.

J. K. GRANT. A.T.10

SIR,-Dr. Parfitt’s warning2 that difficulty may arise in the control of patients receiving A.T.10 which has been restandardised for dihydrotachysterol content is supported by our experiences with such a patient. This was a 47-year-old woman who had suffered from chronic hypoparathyroidism for 27 years after partial thyroidectomy in 1937. Since 1954, whilst receiving A.T.10, the patient had been symptom-free, and serum-calcium levels had remained within normal limits; from 1958 she had received 6 ml. of A.T.10 daily. In May, 1964, she complained of

anorexia, repeated vomiting, epigastric discomfort, thirst, constipation, and weight-loss; the serum-calcium level at that 1. 2.

Guardian, Jan. 4, 1965. Parfitt, A. M. Lancet, 1964, ii, 643.

Electrocardiogram in patient with congenital cardiac arrhythmia.