The world has witnessed seismic changes over the past 100 years. Technological innovation and social change have altered the way we work and live in astonishing ways and often, at breathtaking speed. Pathology and laboratory medical education are no exceptions. It was just 100 years ago that a small group of physicians came together to create what would eventually become the American Society of Clinical Pathologists (which later became the American Society for Clinical Pathology, ASCP). If the field’s early pioneers could peek into a current-day laboratory they’d be astonished at what’s changed—and what hasn’t.
Pathologists and medical laboratory scientists are continually tasked with the need to keep up with ever-changing technological advancements, as well as research. The path may be ever changing, but the ultimate goal of meeting patient needs and improving clinical outcomes has not changed.
“The rate of new developments and knowledge is extraordinary. Fifty years ago, if you became a doctor, your training would serve you well until you retire. That is no longer the case,” says Neda Zarrin-Khameh, MD, MPH, a Professor in the Department of Pathology and Immunology at Baylor College of Medicine. Access to readily available information online, and the ability to interface with professionals around the world, has created a dizzying ability for pathology students to solve problems and generate new queries.
In the laboratory, advanced molecular diagnostics and changing technologies, such as PCR testing and massively parallel sequencing, didn’t exist decades ago. “Think about this, when the first laboratory training programs were started, there was no blood banking component. We ‘evolved’ into that training over the years,” explains Nathan Johnson, PhD, FACHE, MASCP, DLM (ASCP), SC, SLS, Chief of the Medical Laboratory Sciences Program at the University of Arkansas.
As anyone in the field will tell you, changes in the lab equate to better patient outcomes and longer lives. “The scientific advancements we see now will often be adapted to meet clinical use. And the lab professional who refuses to adapt will be the easiest to replace,” says Dr. Johnson. “However, much of the core of lab testing has remained consistent. It’s always interesting to teach students that some of the earliest staples of clinical chemistry, such as total serum protein, are still with us today. The technology changes, but the biology does not,” he says.
“Gene sequencing used to be done for research. I work with a lot of cancer patients. As soon as you diagnose them, gene sequencing is done to see if there is a specific, targeted treatment that may be most effective. Cancer patients are living longer now, as a result,” adds Dr. Zarrin-Khameh.
ASCP established the Board of Registry (BOR), now known as the ASCP Board of Certification (BOC), in 1928. This was just 10 years after World War I ended. The Board was needed to register people in the profession but also to make it professional and set standards for competency curriculum and education. “From the very beginning, the majority of people were trained on the job, not in school. WWI had happened, and the field needed people to be trained. Around 80 percent of laboratory professionals were women, because that’s who was available. Today that percentage has declined only slightly, to around 75 percent. In the early years, those trained as Laboratory Technicians with college degrees (one or two years) could be ASCP certified. The BOC (formerly the BOR) was the first certification organization to establish the baccalaureate degree as the minimum requirement for MT certification," says Patricia A. Tanabe, MPA, MLS (ASCP)CM, Executive Director of the ASCP Board of Certification.
Today, changes in educational technology have been established to keep pace with research and innovations in the lab. Teaching takes place in classrooms, laboratories and online. “We need to reach out to learners and teach them the way they like to learn,” explains Susan Graham, MS, MT (ASCP), SHCM, Chair of the ASCP Board of Certification Board of Governors. “In addition to online books and learning management systems like Blackboard, we use resources from the web like YouTube, and other programs. This is a collaborative field, and it is constantly evolving to meet students’ comfort level with technology,” she adds. A benefit of online learning that supports the profession is the ability to reach and access nontraditional learners, including people raising families and those living in rural areas.
As always, the need for hands-on experience in the lab and the teaching of manual methods is paramount. One of the biggest changes in laboratory education is the establishment and use of safety practices. “We used to smoke, eat, and drink in the laboratory. Gloves weren’t required until the late 1980s, when HIV was discovered. Food and specimens were kept in the same refrigerator. Today’s professional looks back at yesterday’s safety standards with horror, for good reason,” says Ms. Graham. Knowledge of chemical hazards was woefully lacking. Laboratory professionals were routinely exposed to a vast array of carcinogens. Mouth pipetting of samples, and no gloves while handling biological specimens, were the norm. Today, laboratory professionals use complete protection and the highest safety standards, especially when dealing with unknowns, such as COVID-19.
Gone are the days when students spent hours in the library, going through card catalogs and reading five-year old journals on microfiche. Internet access allows for fast consumption of hundreds of studies and white papers. Students from around the world routinely share slides with Q&A queries on their Twitter feeds. Dialogue is robust and ongoing.
Teaching techniques changed, even before COVID-19 facilitated the Zoom classroom experience. “In the past, the major teaching format was lectures, which only allowed for achieving knowledge-based objectives. Now, students watch the lectures outside of class. In class, students work more in teams, to answer clinical questions. This approach, known as flipped classroom or team-based learning, allows for the acquisition of both knowledge and skills, under faculty supervision,” explains Richard Haspel, MD, PhD, FASCP, Professor of Pathology at Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston. He feels that medical education has become more of a partnership between student and teacher. He also sees more respect for diversity, equity, and inclusion, regarding how professionals work with students and talk about treating patients. “I was ‘pimped’ all the time during my medical school surgery rotation which is a practice of asking questions of students that are designed to pressure and embarrass them. Today, that approach is frowned upon,” he explains.
Despite the advances of the last 100 years, there are significant challenges facing the field. Many experts are concerned that not enough students are considering pathology. This may be due to the lack of a dedicated rotation in most medical schools. “It is amazing to me how limited the knowledge of pathology is, even among physicians. Today, in medical school, pathology is often available as an elective or you have to join a pathology interest group. Pathology is the base of medicine, yet many students have limited exposure to it,” says Dr. Zarrin-Khameh.
“In medical school, a big part of the second preclinical year used to be a year-long pathology course. Over time, there was a shift to integrate pathology into different system courses, such as cardiology. The result currently is limited exposure. Students don’t create an extended learning relationship with a pathologist. As a result, very few medical students are choosing pathology as a career,” Dr. Haspel explains.
Many existing pathologists and medical laboratory scientists exited the field during the COVID-19 crisis, exacerbating a potential dearth of pathologists and laboratory professionals. Recognition of the field and its career opportunities is a continuing challenge, which may contribute to the lack of potential candidates. “My personal goal for medical laboratory science is that it is recognized as a profession. People think I’m a tech, meaning a technician, without formal training or education. It greatly bothers me that our profession is not valued and consequently, nor is certification. We are responsible for patient care through delivering high quality laboratory testing results, yet no one knows we’re here. The result is a tremendous workforce shortage because of burn-out and retirement as well as inadequate compensation for the profession,” explains Ms. Tanabe.
Generating more diversity among professionals is another significant challenge. “We don’t serve a patient population that is female and white exclusively. There’s lots of effort being done to rectify that. But it’s an uphill battle,” explains Ms. Graham.
Technological innovation in areas such as artificial intelligence will continue to enhance, rather than replace, the ability of pathologists to interpret findings. These innovations will be taught through multiple mediums and shared extensively through robust online platforms. On the educational front, the quest for diversity and ever-enlarging pools of future pathologists and laboratory professionals will be ongoing, and fruitful.
Of course, pathologists and medical laboratory professionals will continue to play an essential and indispensable role in patient healthcare. The medical laboratory, of the future will undoubtedly look different than it does today. As with all things, change will continue to occur. “Despite predictions about the so-called ‘demise’ of the medical laboratory, our ability to provide high quality clinical laboratory support will always be needed,” predicts Dr. Johnson.
Here’s to the next 100 years.