The purpose of this paper is to present a systematic review of the changing dynamics of the skills and competencies of pathology technicians. In order to achieve that aim, the review is based on four specific objectives. The first specific objective is to carry out a review of the factors leading to changes in the demand for the skills and competencies of pathology technicians. The second specific objective is to carry out a review of the current level of skills and competences of pathology technicians. A third of objective is to carry out a review of the required skills and competencies for pathology technicians. Lastly, the paper presents a brief review of the impacts of inadequate skills and competences. The paper follows the structure of the PRISMA model with slight modifications. The findings of the review indicate that recent developments such as increased application of molecular biology in pathology, ICT advancement, increased the need for quality assurance, and the emergence of other important skills are some of the key factors influencing changes in the required skills and competencies for pathology technicians. The required skills and competencies are almost similar in all countries. However, there is a lower level of available skilled and competent pathology technicians than needed. Among other impacts, the issue has contributed to the increased number of errors in pathology laboratories during recent years, and the inability to implement new technology in the laboratories.
Table of Contents
3.2 Inclusion and exclusion Criterion. 7
3.6 Data collection process. 9
3.8 Risk of Bias in Studies. 9
3.9 Planned Analysis Methods. 9
3.10 Risk of Bias across Studies. 9
5.0 Syntheses of the Results. 14
5.1 Recent changes with an impact on skills and competencies. 14
5.2 The Required Pathology Technician Skills and Competencies. 17
5.3 A review of the current level of pathology technicians’ skills and competences. 18
5.4 The impacts of inadequate skills and competences. 19
7.0 Conclusion and Recommendations. 20
List of Tables
Table 1.0 Inclusion and exclusion criteria. 7
Table 3.0 Summary of the characteristics of the studies included. 10
There are various changes that have been taking place in the pathology industry over the last decade that have led to significant changes in the required skills and competencies for the pathology technicians. Also known as pathologist assistant, a pathology technician is a person who works in a pathology laboratory under the supervision and direction of a qualified pathologist. A pathology assistant is qualified to carry out a various autopsy and surgical tasks in a pathology laboratory. One of the major roles of a pathology assistant is to prepare specimen and chemicals needed during pathology testing. Other functions of a pathology assistant include procurement of samples and chemicals, research, training other technicians when needed and to perform other assigned duties such as teaching, supervisory, budgetary and administrative tasks (Rodrigues et al., 2013). Although they are not expected to carry out the diagnosis tests, pathology assistants play a major role in pathology laboratories that influences the quality and quantity of diagnostic tests. As such, they are expected to have adequate skills and competencies in order to carry out their assigned duties effectively.
For more than one and half centuries, there has been constant development in the pathology industry driven by new discoveries, among other factors. At the same time, there has been a constant rise in the demand for health quality care, which is also influenced by the quality of output of the pathology laboratories. In order to enhance the quality of output of pathology laboratories, agencies within and outside the profession have, for a long time, set standards for eligibility into the profession. However, there have been rapid changes taking place during the 21st century, that have more drastic impacts on the skills and competencies needed in the profession. As a result of the changes, the demand for a higher level of skills and competences among the pathology technicians has increased. The issue has influenced many accreditation agencies to revise the minimum requirements for entry into the job. Despite the intervention, the gap between the skills available and the skills needed has been increasing (Rodrigues et al., 2013). The purpose of this paper is to answer the following question; how have the different aspects of pathology technicians’ skills and competencies changed during the recent years?
The main aim of this paper is to examine the changing dynamics of pathology technicians’ skills and competencies. To achieve this objective, the research is based on the following specific objectives:
- To carry out a review of the factors leading to changes in the demand for pathology technicians’ skills and competencies
- To carry out a review of the current level of pathology technicians’ skills and competences
- To carry out a review of the required pathology technician skills and competencies
- To carry out a brief review of the impacts of inadequate skills and competences
A plan for carrying out the research and the inclusion criteria are outlined in the protocol.
3.2 Inclusion and exclusion Criterion
The following table presents a summary of the criteria that was used to include and exclude studies.
Table 1.0 Inclusion and exclusion criteria
|Inclusion Criteria||Exclusion Criteria|
3.3 Information Sources
Studies were identified through scanning a reference list related to the research topic in the BibMe database. The references identified were then searched in the Medline (1966–Present) and the PubMed database and the Google search engine. Direct searches were also carried out in the Medline database and the Google search engine. The last search was carried on out 14th July 2014.
3.4 Search Terms
The table below presents the terms that were used to search the relevant sources in the databases and the Google search engine;
Table 2.0 Search terms
3.5 Study Selection
The researchers involved two reviewers to assist in the process of screening and determining the eligible studies for inclusion in the review process. In case of any disagreement, the reviewers engaged in close evaluation of the content of the studies.
3.6 Data collection process
The researchers adopted a theoretical approach in extracting the data required for the study. The first reviewer collected data, and the second reviewer checked it. Any disagreement was solved by a third reviewer.
3.7 Data Items
Information was extracted from each source depending on its relevance to a specific research objective.
3.8 Risk of Bias in Studies
In order to identify biases in the studies, the reviewers worked together in evaluating the suitability research designs used and data collection methods and procedures, and the validity and reliability of the data collection instruments.
3.9 Planned Analysis Methods
The researchers applied content analysis method of the content of the studies in order to extract the useful information related to the study topic.
3.10 Risk of Bias across Studies
The cumulative evidence of the studies reviewed may result in biases resulting from factors such as selective reporting and publication bias.
4.1 Study Selection
103 studies were identified for inclusion in the review in both the BibMe, PubMed and Medline databases and the Google search engine. Some studies were older than seven years. After removing them, only 69 studies remained. The remaining studies were screened, and 33 were excluded due to lack of adequate information that would contribute significantly to the current study. The details contained in the remaining 36 studies were assessed for eligibility. 16 studies did not meet the inclusion criteria due to the presence of biases. The biases found included design bias, procedural bias, sampling biases and reporting bias. Only 20 studies were included in the systematic review since they contained information that was relevant to the current study, and they did not have common biases. Figure 1.0 in the appendix gives a summary of the study selection process.
4.2 Study characteristics
The table below summarizes the characteristics of the studies selected
Table 3.0 Summary of the characteristics of the studies included
|Author||Study type||Purpose||The relevant information present|
|Adyanthaya and Jose (2013)||Qualitative analysis||To evaluate quality management system guiding the quality of output of pathology laboratories in the US and UK||Factors leading to changes in the demand for pathology technicians’ skills and competencies
|Alaamern (2012)||Qualitative||To explore the level of training of staff involved radiography in Saudi Arabia||The training level for the laboratory staff including technicians|
|Systematic review||A systematic review of the impacts of accreditation of laboratory staff on quality of output||The impact of accreditation of laboratory technicians on quality|
|Bahaadinbeigy, Yogesan and Wootton (2010)||Quantitative||Investigating the level of application and effectiveness of telemedicine in Australia||Advancement in the use of telemedicine technology in pathology|
|Buesa (2010)||Quantitative and qualitative study||Productivity quality in histopathology laboratories is lower than expected||The current level of pathology technicians’ skills and competences|
|Colebourn, Davies and Becher (2010)||Analysis of case study||Investigating the gap in training for clinical laboratory workers and suggesting ways of bridging the gap||The current level of pathology technicians’ skills and competences|
|Daniel et al. (2011)||Qualitative Analysis||Investigating the applicability of standard digital equipments that produce digital images in pathology laboratories||Factors leading to changes in the demand for pathology technicians’ skills and competencies|
|El-Mahalli, El-Khafif and Al-Qahtani (2012)||Quantitative||Investigating challenges and successes in the application and implementation of telemedicine in Saudi Arabia||The laboratory technician training challenges affecting the implementation and application of telemedicine|
|Ezziane et al. (2012)||Content review||Evaluating ways of enhancing the performance and effectiveness of healthcare workers||Factors leading to changes in the demand for pathology technicians’ skills and competencies|
|Flynn et al. (2014)||Quantitative||The extent to which laboratory staff receive training in the use of molecular biology in diagnosis||Lack of adequate training of pathology technicians in the use of molecular biology in their work|
|Hammerling (2012)||Qualitative review||Reviewing the errors occurring in the clinical laboratories and their causes||The impacts of inadequate skills and competences|
|Hawash (2014)||Quantitative||Evaluation of an Algorithm based on immunoassay for identification and screening of Cryptosporidium and Giardia antigens in faecal specimens||Increased application of molecular biology technology in pathology profession|
|Lippi, Plebani and Šimundić (2010)||Qualitative review||Investigating the extent to which theory on quality enhancement is applied in laboratory diagnostics||Factors leading to changes in the demand for pathology technicians’ skills and competencies|
|Morelli et al. (2013)||Qualitative analysis||Investigating the root causes of errors in histology laboratories||The role of lack of adequate training of pathology technicians in increasing number of errors|
|Nichols (2011)||Qualitative Review||Reviewing the effectiveness of the quality control approaches applied in order to reduce risk for low-quality results in clinical laboratories in Saudi
|Rodrigues et al. (2013)||Content review||Examining the application of molecular biology in diagnosis of prostate cancer||Factors leading to changes in the demand for pathology technicians’ skills and competencies, and the impacts of inadequate skills and competences|
|Saikia, Gupta and Saikia (2008)||Qualitative review||Evaluating trends in the modern histopathology
|Factors leading to changes in the demand for pathology technicians’ skills and competencies|
|Salari (2009)||Qualitative review||Investigating disparities between the required and the available skills and competences for medical professionals dealing with personalized care||The current level of pathology technicians’ skills and competences|
|Walz (2013)||Qualitative review||To examine the required training and education for medical laboratory professionals in the US||The required pathology technician skills and competencies|
|Zima (2010)||Qualitative review||To examine the accreditation standards for pathology laboratory staff in different countries||The required pathology technician skills and competencies|
5.0 Syntheses of the Results
5.1 Recent changes with an impact on skills and competencies
The studies examined have pointed out various changes that have occurred in the pathology profession over the last decade. According to Rodrigues et al. (2013), pathology technicians are increasingly faced by work challenges that were not faced by the previous generations. Some of the challenges have a direct impact on the needed skills and competencies in the pathology technician profession. One of the major changes examined by the studies is the increased application of molecular science in diagnosis. According to Hawash (2014), pathology has changed from its initial focus on autopsy only, to an increased focus on molecular biology. A good example is the application of molecular science in the immunotherapy for cancers and the classification of traditional histology (Rodrigues et al., 2013; Hawash, 2014)). According to Flynn et al. (2014), pathology professionals seem to be exploring areas that earlier generations could not have imagined. With the increased application of molecular biology and biotechnology in diagnosis increases, all individuals working in the pathology laboratories are expected to be versed with its application, on top of the traditional pathology testing techniques. Although pathology technicians are not required to have the ability to conduct the complex tests, they are required to be versed with the new methods of preparing samples and instruments used in the molecular tests.
According to Saikia et al. (2008), advancement in information communication technology (ICT) has also had major impacts on the work of the pathology technicians. Telemedicine is one of the main applications of ICT in pathology, a concept that was rare a few years back. Telemedicine involves the exchange of information about patient care from one point to another through electronic gadgets in order to improve patient care. One of the key sub-disciplines of telemedicine is telepathology, which involves “capturing, transmitting, and viewing histological and pathological images through telecommunication channels such as telephone, dedicated satellite or internet, as opposed to the traditional methods of microscopy” (Saikia et al., 2008). According to Daniel et al. (2011), advancement in technology has led to the emergence of telepathology systems that enable pathologists to accurately exchange such information, and hence deliver a quick and accurate diagnosis. Daniel et al. (2011) explain that the emergence of virtual slides has led to the increased significance of telepathology in the pathology laboratories. A virtual slide refers to a digitalized image that emerges after scanning a specimen at a very high resolution. According to Saikia et al (2008), the virtual slide enables pathologists to derive an image at all magnifications or fields of view that a microscope has. The images derived from the different views are stitched together into a single image that multiple pathologists can view at the same time. A good example is the ultra-rapid virtual slide processor (Saikia et al., 2008).
Further, the studies reviewed have shown that increased demand for quality assurance during recent years has led to significant changes in the skills and competencies needed for pathology technicians. Today, legislation has become strict, and the wrong diagnosis may invite punitive punishment on pathology laboratory professionals. There are national agencies that constantly inspect the quality of pathology laboratory output. In the UK, inspection is carried out by Care Quality Commission, among other programs. In the US, the quality is regulated by agencies such as the College of American Pathologists and the National Accrediting Agency for Clinical Laboratory Sciences (Adyanthaya & Jose, 2013). At the international level, the quality is regulated by organizations such as World Health Organization and the National Standard and Regulatory Agencies (Adyanthaya & Jose, 2013). In Saudi Arabia, quality in pathology laboratories is inspected by the Central Board for Accreditation of Health Institutions (Alkhenizan & Shaw, 2011). Lippi et al (2010) note that additional pressure is exerted by the general public, as people are increasingly demanding for quality healthcare services. As such, there has been an increase in pressure on persons working in pathology laboratories to be accountable for the quality of their work. As part of the pathology laboratory workers, pathology technicians are also accountable for their actions.
According to Ezziane et al. (2012), organizations, including pathology laboratories, have become aware of the fact that they are increasingly operating in constantly changing internal and external environments. In some cases, the changes are unpredictable and may have huge effects on the performance and quality of output. In some cases, the changes may involve uncertainties that may have unfavorable effects to an organization. A good example is a recent shortage in the number of available skilled pathology technicians in countries such as the UK and the US. The problem has contributed to the work overload experienced by many pathology technicians in the two countries during recent years (Ezziane et al., 2012). In order to counter the unfavorable effects, it has become imperative for pathology laboratory managers to come up with proactive strategies to enhance the quality and speed of the reaction to both the predictable and unpredictable changes. Examples of the strategies proposed for organizations to improve their results are teamwork and strategic decision-making. As such, skills that would enhance such strategies in organizations have become very important, although they are not directly related to the basic skills needed in the profession. Examples of the skills that have become important include team working, communication, decision-making and critical-thinking skills (Ezziane et al., 2012).
With the changes observed by various scholars in the pathology industry, it has become important for the accreditation of all individuals working in pathology laboratories, including the laboratory technicians, to be reviewed upwards. In addition, re-accreditation of all the individuals working in the laboratory has become very important (Ezziane et al., 2012).
5.2 The Required Pathology Technician Skills and Competencies
The results of the recent studies have shown that the increased need to achieve quality results and to incorporate higher-complexity testing in pathology laboratories has raised the demand for pathology technicians with higher levels of skills and competencies. As a result of the changes, the skills and competencies needed for pathology technicians in many countries have been reviewed upwards. As noted in the studies reviewed, the required skills in the profession in the UK, US, Canada, Saudi Arabia, Australia, and other countries are almost similar (Walz, 2013; Nichols, 2011). One of the most important basic skills noted in the studies is ability to carry out biological and chemical tests. Secondly, pathology technicians are expected to have the ability to apply safety, mathematical and mechanical knowledge in their work (Zima, 2010). Other important skills mentioned in the studies are active listening, writing, speaking problem solving, critical thinking, reading comprehension, quality control, decision-making, monitoring, operation and control, time management, equipment, and systems maintenance, coordination, service orientation, systems evaluation, and interactional skills. With increased application of computer technology in the pathology profession, the technicians are also required to have computer skills (Walz, 2013). Among the most important competencies examined in the studies include attention to detail, cooperation with fellow workers, dependability, integrity, stress tolerance, self-control, independence, achievement, and persistence.
5.3 A review of the current level of pathology technicians’ skills and competences
Despite the fact that the level of skills and competence needed for pathology technicians has increased, recent studies indicate that the demand has not been met. In fact, all the studies examined showed that there is a dire shortage of skilled and competent pathology technicians in many countries (Buesa, 2010). There are several causes of the shortage of well trained and competent pathology technicians cited in the studies. To start with, all the studies reviewed indicate that lack of adequate payment as compared to other jobs has led the pathology technician profession to become less attractive. The studies have shown that salaries for pathology technicians are even significantly lower than the salaries of other pathology laboratory staff. According to the studies, the main cause of the lower salary rate is that the eligibility for entry into the profession is lower than in other laboratory disciplines. The second factor cited in the previous studies is lack of adequate awareness for pathology technician profession among the public. According to Salari (2009), there are also places where the problem has been caused by lack of enough funding to support schools and programs offering pathology technician training. In some cases, individuals lack the required funding to continue with education and acquire the knowledge and training level needed in the new standards. The problem of shortage has been compounded by the fact that the discipline has a high level of the aging workforce, leading to a steady exit. At the same time, the studies indicate that there is a lack of coordinated efforts to provide adequate training to new technicians for replacement. In addition, Salari (2009) noted that the available training programs for pathology technicians do not give adequate focus on the emerging skills in the profession, such as problem-solving, decision-making, communication, critical thinking, and teamwork skills.
Another problem noted by Colebourn et al. (2010) is that many pathology technicians do not seek, or have no access to additional training after entering the profession in order to enable them cope with the changing working environment. According to Salari Colebourn et al. (2010), there is tendency to assume that pathology technicians will learn by themselves any emerging discoveries, and then comprehend and implement them in their work. As a result, only a few histology technicians have ability to execute complex testing. Due to the problem of shortage, there are cases where people who are enrolled into the field do not have defined practical training, or even coordinated theory education. Some of the pathology technicians go for nine-month training to acquire a qualification certificate. As such, the compressed time-frame limits the ability to acquire proper practical training. A study conducted by Alaamer (2012) in Saudi Arabia found that pathology technicians lack adequate knowledge and training in radiography.
5.4 The impacts of inadequate skills and competences
The studies reviewed have shown that the lack of adequate skills and competencies has a major impact in the pathology technician profession. To start with, the problem has contributed to the increased number of errors occurring in the pathology laboratories recently. In fact, the studies have cited the problem as the major cause of pre-analytic, analytic and post-analytic errors occurring in the pathology laboratories (Hammerling, 2012; Morelli et al. 2013). Secondly, the problem has contributed to the inability for pathology laboratories to implement new technologies. For instance, many pathology laboratories have experienced difficulties in implementing molecular biology and automation programs due to lack of adequate knowledge and skills among the staff. A study conducted by El-Mahalli et al. (2012) found a lack of adequate training of technicians and other pathology laboratory staff as a hindrance to successful implementation of telemedicine. Bahaadinbeigy (2010) also found similar results in Australia.
In summary, the studies reviewed studies identified various recent developments that have had an impact on pathology technician’s skills and competencies. The developments identified are increased application of molecular biology in pathology, ICT advancement, increased need for quality assurance, and emergence of other important skills. The studies have also identified various skills and competencies needed in the pathology technician job today. Despite the rise in the entry requirements into the field, there is a lower level of available skilled and competent pathology technicians. The problem has contributed to the increased number of errors in pathology laboratories, and the inability to implement new technology in the laboratories.
7.0 Conclusion and Recommendations
In conclusion, there is an increase in the need for skilled and competent pathology technicians, but the demand has not been met. There is need for intensive training of new and existing pathology technicians in order to bridge the gap. The benefit can only be achieved if issues such as low level of salaries for pathology technicians, lack of funding for the training programs and lack of incentives to provide additional training to existing pathology technicians are addressed.
The major limitation face by the reviewers is differences in the quality of the studies examined. Secondly, publication and reporting biases may affect the original findings of the studies, and hence the outcome of the review.
Adyanthaya, S. & Jose, M. (2013). Quality and safety aspects in histopathology laboratory. J
Oral Maxillofac Pathol, 17(3), 402-407
Alaamer, A. S. (2012). Radiography Education and Training in Saudi Arabia. Open Journal of
Radiology, 2, 134-140
Alkhenizan, A. & Shaw, C. (2011). Impact of Accreditation on the Quality of Healthcare
Services: a Systematic Review of the Literature. Ann Saudi Med, 31(4), 407–416
Bahaadinbeigy, K., Yogesan, K. & Wootton, R. (2010). A Survey of the State of Telemedicine in
Western Australia. Journal of Telemedicine and Telecare 16, no. 4, 176–80
Buesa, R. J. (2010). Productivity standards for histology laboratories. Annals of Diagnostic
Pathology, 14, 107–124
Colebourn, C. L., Davies, I. K. G. & Becher, H. (2010). Bridging the gap: training critical care
clinician-echocardiographers through a collaborative curriculum. JICS, 11(1), 13-16=
Daniel, C., Rojo, M. G., Klossa, J., Mea, V. D., Booker, D., Beckwith, B. A., Schrader, T.
(2011). Standardizing the use of whole slide images in digital pathology. Computerized Medical Imaging and Graphics 35 (7-8), 496–505
El-Mahalli, A. A., El-Khafif S. H. & Al-Qahtani, M. F. (2012). Successes and Challenges in the
Implementation and Application of Telemedicine in the Eastern Province of Saudi Arabia. Perspect Health Inf Manag, 9, 1-27
Ezziane, Z., Maruthappu, M., Gawn, L., Thompson, E. A., Athanasiou, T. & Warren, O. J.
(2012). Building effective clinical teams in healthcare. Journal of Health Organization and Management, 26 (4), 428 – 436
Flynn, C. et al. (2014). Integrating molecular diagnostics into histopathology training: the Belfast
model. J Clin Pathol, 67, 632-636
Hammerling, J. A. (2012). A Review of Medical Errors in Laboratory Diagnostics and Where
We Are Today. LabMedicine, 43, 41-44.
Hawash, Y. (2014). Evaluation of an Immunoassay-Based Algorithm for Screening and
Identification of Giardia and Cryptosporidium Antigens in Human Faecal Specimens from Saudi Arabia. Journal of Parasitology Research. 01/2014, ID 213745, DOI: 10.1155/2014/213745
Lippi, G., Plebani, M. & Šimundić, A. M. (2010). Quality in laboratory diagnostics: From
theory to practice. Biochem Med, 20, 126–130
Morelli, P. et al. (2013). Analysis of errors in histology by root cause analysis: a pilot study. J
Prev Med Hyg, 54(2), 90-6.
Nichols, J. H. (2011). Laboratory Quality Control Based on Risk Management. Ann Saudi Med,
Rodrigues, D. N., Butler, L. M., Estelles,, D. L. & de Bono, J. S. (2013). Molecular pathology
and prostate cancer therapeutics: from biology to bedside. The Journal of Pathology, 232 (2), 178-184
Saikia, B., Gupta, K. & Saikia, U. N. (2008). The modern histopathologist: in the changing face
of time. Diagnostic Pathology, 3, 25
Salari, K. (2009). The dawning era of personalized medicine exposes a gap in medical education.
PLoS Med, 6(8), e1000138
Walz, S. E. (2013). Education and training in laboratory medicine in the United States. JIFCC, 24(1), 1-3.
Zima, T. (2010). Accreditation in clinical laboratories. Biochemia Medica, 20 (2), 215–220
Figure 1.0: A summary of the study selection process
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