Written in collaboration with ASCLS and ASCP Board of Certification

Medical laboratory science associations’ blogs, discussion boards, and listserv lists are continually populated with questions concerning what to teach laboratory science students, how to prepare for the American Society for Clinical Pathology (ASCP) Board of Certification (BOC) examination, and what is or isn’t on the certification examination. Both the ASCLS Entry Level Curriculum (ELC) and the ASCP BOC Practice Analysis can provide some answers to these questions and serve as a resource to educators and those preparing to challenge the ASCP BOC certification examination. This article will describe both processes and identify the purpose and intended use of each.

ASCLS Entry Level Curriculum (ELC)

Background and Purpose
The ELC was revised in 2016-2017 and is designed to be a resource for medical laboratory science programs. Entry level is defined as the knowledge and skills that a new graduate at the Medical Laboratory Technician (MLT) or Medical Laboratory Scientist (MLS) level should possess upon entry into the workforce. The first ELC was published in 2002 and created by educators and practitioners using the Body of Knowledge (BOK) published by ASCLS.

The ELC is designed for several purposes which include to:

  • Develop a new program
  • Assist the new instructor/professor with course development
  • Update a current program or course
  • Serve as a resource for clinical faculty
  • Validate what we do as educators
  • Provide guidance to other organizations for entry level expectations
  • Establish entry level expectations

2016-2017 Revision Process
A sub-committee of the ASCLS Education Scientific Assembly (ESA) Committee for Educational Programs and Initiatives (CEPI) was assembled in the fall of 2015 to facilitate the process of updating the ELC. The Committee was charged with two main goals:

  1. Use the recently updated (2014 version) ASCLS BOK and personal expertise in entry level practice to update the curriculum by removing dated topics and adding new items.
  2. Ensure differentiation of the MLT and MLS curriculum based on the level of education required for each.

The ELC committee received comments from MLS and MLT educators who attended the ASCLS Clinical Laboratory Educators’ Conference (CLEC) in 2016 and continued to solicit comments from educators who could not attend. With these comments, another version was created and distributed to all ASCLS members for comments. These comments were used to create a third revision. Consulting each other, ELC committee members finalized all documents by applying the Beck/Moon algorithm introduced at CLEC 2016 and in Clinical Laboratory Science. (Beck and Moon 2017) The algorithm included three basic questions:

  • Is it current practice?
  • Is it entry level?
  • Is it foundational?

In situations where conflicting comments were received, this algorithm provided the criteria for removing dated information from the documents. Upon completion, the third version was submitted to the ASCLS Board of Directors for adoption at the 2016 House of Delegates.

ELC Format
The MLS and MLT entry-level curricula are defined as the knowledge and skills expected of a new graduate upon successful completion of a formal educational program. It assumes no work experience other than that required as part of a clinical education affiliated with the program.

The curriculum format is delineated by discipline area within the MLS and MLT levels. Each discipline area is further delineated by major topics which include a sequence and coordination of concepts, principles and theories, and skills.

The curriculum represents a consensus by reviewers of the minimum knowledge and skills required to be successful in an entry level role. The committee developed the final documents with the understanding that all listed technical items may not be available at each educational institution so that in some programs, only cognitive aspects (state, explain, describe) will be taught and at others the psychomotor may also be taught (perform or observe). The committee also expects that some programs will teach beyond what may be included, based upon regional needs of their graduates and availability of resources.

Taxonomic Levels
The taxonomic levels within the ELC are identified and based upon a simplified version of Bloom’s taxonomic levels as described in Clinical Laboratory Education. (Beck and LeGrys 2014)

The cognitive domain includes:

  • Level 1: Recall of basic knowledge and comprehension
  • Level 2: Application and interpretation of content
  • Level 3: Critical analysis, decision making, and problem solving, which relates to the evaluation and processing of knowledge

The psychomotor domain includes:

  • Level 1: Readiness; an awareness of and ready to perform; observes
  • Level 2: Competence and confidence with performing a task
  • Level 3: Proficiency and adaptation, ability to alter performance successfully when encountering unexpected or new situations

The affective domain includes:

  • Level 1: Awareness of an activity or situation
  • Level 2: Valuing; attachment of worth and beginning to express behaviors demonstrating value of an activity or situation
  • Level 3: Commitment; ability to justify values

Taxonomic levels were included to assist new instructors and new programs.

Availability
The updated versions of the Entry Level Curriculum for MLS and Entry level Curriculum for MLT can be purchased from the ASCLS Store at www.ascls.org/store.

ASCP BOC MLS and MLT Practice Analyses

Background and Purpose
The purpose of conducting a practice analysis (also known as a job analysis or job task analysis) is to provide the foundation of the certification examination by defining practice in a profession. The practice analysis is administered via surveys which identify the actual tasks that practitioners must be able to perform at the time of certification. The practice analysis provides evidence of content validation. It is required by psychometric standards and is considered best practices for high stakes examination development(Chinn and Hertz 2010). It also ensures the certification examination is fair, valid, job-related, and most importantly, legally defensible. In addition, professional standards used by accreditation agencies (i.e., American National Standards Institute), as well as legal statutes and guidelines, utilize the practice analysis to evaluate the validity of certification programs.

The practice analysis process begins with the development of a comprehensive list of tasks needed for current practice in the field by subject matter experts. This list is placed into survey format along with a rating scale and demographic questions. The practice analysis survey is then distributed to practitioners. The data collected from the surveys is analyzed and the exam committee reviews the results to determine which tasks will be included when developing the content guideline for the certification examination and subsequently the examination question database. All exam questions are linked to a content area on the content guideline.

Process
During the 2015 certification examination committee meetings, the five categorical examination committees (Blood Banking [BB], Chemistry [C], Hematology [H], Microbiology [M], and Molecular Biology [MB]) provided the input and discussion to develop the practice analysis survey for MLS and MLT. Each committee created the sections of the survey corresponding to their respective disciplines. The Joint Generalist Committee, whose membership includes representatives (mainly educators) from each categorical examination committee, reviewed and approved a final version of the survey. The committee members (subject matter experts) collectively discussed all pertinent aspects of their profession to design a concise survey to extract useful feedback from field professionals while maximizing response rate. The survey had two main components: demographics and task inventory with appropriate rating scales for each.

Sampling Procedure
The categorical and Joint Generalist committees determined that the survey should be sent to all current generalists (MT/MLS and MLT certificants) and categorical (BB/C/H/M) certificants in the BOC Personify database.

Demographics
The demographic questions asked about experience, education, gender, age, titles, work shift, type of facility, areas of lab work, work hours, etc. The purpose of these questions was to aid the committee in deciding whether the sample of respondents obtained were representative of the profession in general. The demographic data provides analytic categories that allow refinement of the survey population to utilize only those responses from individuals at the targeted professional level.

Task Inventory – Knowledge and Skill Questions
The survey was broken into two core areas: knowledge and skills. The categorical examination committees and the Joint Generalist committee developed a series of knowledge areas and jobrelated task questions that formed the body of the survey. This survey had eleven major sections: Laboratory Operations, Blood Banking, Microbiology, Chemistry, Hematology/Coagulation, Molecular Biology, Immunology/Serology, Urinalysis, Body Fluids, Point-of-Care Testing, and Management/Supervision. Respondents only rated the tasks within the major sections in which they work. All respondents rated the tasks within the Laboratory Operations section. For example, if a respondent indicated they currently work in Chemistry and Hematology, they rated tasks within those two sections and Laboratory Operations and did not see any other sections of the survey.

Rating Criteria
Different rating scales were used to assess the knowledge and skills on the survey. One rating scale was used for the knowledge-only tasks and asked respondents to assess the significance of having that knowledge to perform their job. The rating scale used for the skill-related tasks assessed whether respondents performed the specific task in their jobs.

Survey Construction
The practice analysis survey was created and delivered through Key Survey, an electronic survey vendor from Highroad Solution. Using an electronic tool allowed survey review and testing via the internet, email tracking of respondents using email addresses, and the ability to send e-mail reminders for completion of the survey.

Pilot Testing and Revision
The Joint Generalist Committee tested a pilot version of the survey. They commented and revised different aspects of the survey (e.g., information correctness, grammar/spelling errors, electronic glitches, correct survey branching, etc.). The pilot testing comments and edits informed the final version of the survey.

Survey Distribution
The survey was open for a five-week period. It was e-mailed to all current generalist (MT/MLS and MLT) and categorical (BB/C/H/M) certificants. ASCP BOC staff also directly emailed the survey to the categorical examination committees and encouraged the committee membership to disseminate the survey to their colleagues. Additionally, links were posted on social media sites (e.g., Facebook and Twitter).

To garner more responses from individuals working in blood centers, BOC staff also reached out to the Qualification in Apheresis (QIA) work group and the AABB. These contacts were able to get the survey link distributed to several blood centers and placed in an AABB newsletter.

Survey Analysis
The responses to the survey were analyzed. Responses from individuals performing higher-level supervisory tasks were not appropriate for an entry-level exam and thus excluded. Any individuals not currently practicing (e.g., retired, unemployed, or simply not working as a laboratory professional) were also removed from survey analysis.

Task Analysis
The tasks were divided amongst eleven major sections (Laboratory Operations, Blood Banking, Microbiology, Chemistry, Hematology/Coagulation, Molecular Biology, Immunology/Serology, Urinalysis, Body Fluids, Point-of-Care Testing, and Management/Supervision). All respondents saw the Laboratory Operations category. Because respondents only rated the tasks within the major categories in which that they perform testing, the number of respondents vary for each section.

Committee Review and Decision
During the following year’s exam committee meetings, the Blood Banking, Chemistry, Hematology, and Microbiology Committees reviewed the practice analysis results. They agreed that the demographic results accurately reflect the MLS and MLT population. Each committee reviewed the tasks within their area of expertise. Tasks performed by a low percentage of survey respondents were further reviewed by the committee members to determine whether they should be kept or removed as potential exam topics. Because only a small percentage of the MLS population reported performing management/supervisory tasks, the Management/Supervisory section did not provide useful data. The Joint Generalist Committee then reviewed the decisions made by the aforementioned committees and produced a final determination of the inclusion of the task on the examination.

Exam Content Guideline and Exam Database Publication
The committee reviewed the exam content area percentages and decided where to set the content area percentages for the new exam database based on the results of the practice analysis. The committee revised the content guideline to reflect the practice analysis results. The exam committee continuously reviews the exam database according to the new content guideline. Questions are deleted or revised accordingly. New questions are written to fulfill the new content guideline. The items in the database will be reclassified according to the new guideline. After this work is completed, a new exam database will be published and a new standard for the exam will be set.

Availability
The MLT/MLS practice analysis report with draft content guidelines is available on the ASCP BOC website at About the BOC.

Summary
The ASCLS ELC defines the knowledge and skills that new MLT or MLS graduates should possess upon entry into the workforce, with no prior work experience. It is designed to assist educators to develop curriculum or update courses. The ASCP BOC MLT and MLS Practice Analyses are used to validate the content of the certification exams by defining the tasks that practitioners perform at entry level. Educators can use the tasks identified on the practice analysis reports and the exam content guideline (derived from the practice analysis) to validate what they are teaching in their MLT and MLS courses. Examinees and educators can use the practice analysis report and the exam content guideline for certification examination preparation. The information within the ELC and the practice analysis report are similar, but each document is developed for a unique purpose.

Both the ELC and the BOC practice analysis will be updated every five years. During the next ELC revision cycle, the outcomes of the recent BOC practice analysis will be considered. A new practice analysis cycle results in revisions to the content guidelines and examination databases and the setting of new standards for passing the examinations.

REFERENCES

  1. Beck, S., and T.C. Moon. 2017. “An Algorithm for Curriculum Decisions in Medical Laboratory Science Education.” Clinical Laboratory Science 105-111.
  2. Beck, Susan J., and Vicky A. LeGrys. 2014. Clinical Laboratory Education. 3rd. Westminster.
  3. Chinn, R.N., and N.R. Hertz. 2010. Job Analysis: A Guide for Credentialing Organizations. Lexington: Council on Licensure, Enforcement and Regulation (CLEAR).