mlt and high complex bb testing

[cclayton]

our lab recently has promoted a mlt(ascp) to be the section supervisor of our blood bank. we were told that this was okay per cap trm rules. what about clia supervisor rule? and any jcaho stds involved with this selection? the person involved has very few years as tech mostly on nights.

title should say testing not esting. sorry <admin comment> fixed

Edited January 12, 2009 by cclayton

[tbostock]

Do you have state department of health regs also? If so, check those. In NY state, you have to be an MT with 7 years experience to qualify as a supervisor.

[Mer]

We don't even hire MLT's where I work. If so, they can just do the simple stuff - yet I worked at another facility, where MT's and MLT's were working side by side, doing the exact same tasks, making different wages...but never, in each place, would an MLT be allowed to be a supervisor - even if they worked there years and years.

Have a good day!

[reidhospbb]

We have used MLT's in blood bank for thirty years. It all depends on their level of training. The ones that were trained at this facility were trained practically to the same level as an MT and were highly recruited by other facilities in the area. We are a clinical site for an MT school and the MLT's are doing the training of the MT's. I know this sounds like heresy, but it goes back to my original point it all depends on their training. MLT's that we have hired that were trained at other facilities do not have the same level of expertise and are not given the same level of responsibility. We have several MLT's that could outperform, physically and mentally, MTs. At this point in time we have no MLT's in a supervisory capacity, but have had in the past. We do have MLTs as lead techs over groups that have MTs with many years of experience. Certifications and titles are important, but look at what you have, not what letters are after their name.

[krichards]

Although I should, I do not know what Texas' requirements are. However, I can tell you what goes on here in the western part of the state.

Our hospital (350+ beds) requires a BS, MT, and 5 years experience. However, many of the smaller nearby hospitals have MLTs as BB supervisors, and there are even a number with MLTs as lab directors. With the shortage of techs, I see this only becoming more common, especially in the more rural areas. In the 10 years that I have lived here, no one has gotten into any sort of trouble because they don't have MTs in these positions...if there are regs, they are not enforced.

Let me also add that I have both an MLT and an MT...and went to school for both. Sad to say, I learned almost everything I know from my MLT program. The MT program added very little, if anything, to my knowledge base. It is the quality of the program, not the number of years it takes to learn it, that makes the tech.

Our lab is staffed almost entirely by MLTs...and that is not an issue, as they are all excellent techs. I have worked with MLTs who knew more about BB than I ever will, and MTs who were incapable of doing the minimal job requirements, and vice versa.

Sorry for the rant; this has been a touchy subject here also.

Karen

[LaraT23]

I also have an MLT but decided to go for a BS in biology rather than the MT program, as I felt most of the material would be redundant. I do know that the MT program near me teaches more management and QA courses than the MLT program I went to did. That would be helpful. I would personally feel a bit strange to be working under an MLT supervisor as I am an MT and soon to take my SBB.

Lara

[Trek Tech]

I also have both an AS, MLT and a BS, MT. Everything I learned in my first 2 years in the MLT program was then pounded into me again in my 4th year internship at a hospital. The third year was management, genetics, virology, mycology, Organic chemistry. There were people who had the chemistry or biology degree who learned ALL of medical technology in one year in their internship... Who is the better tech? Like KRichards said it depends heavily on the person and their training. I also know MLT's I respect more than some MT's.

I believe in Florida you can sit for the Supervisor exam after 6 years experience (but it has been a long time since I checked). We have state licensure and that is a different story.

[cclayton]

Thanks to each of you for your input. I have worked along side MT,MLT, and on-the-job trainees for 40+ years. In almost every instance the techs have performed professionally and were a credit to the lab.

What I was seeking was someone with the knowledge about CAP, CLIA, or JCAHO regulations. CAP says "education and experience equivalent to MT(ASCP)". CLIA calls for at the least a BS for supervisor of high complex testing. JCAHO seems to go alone with CLIA as far as lab regs are concerned.

Maybe someone with these agencies could help with this discussion.

Edited January 14, 2009 by cclayton

[caj1018]

I've taught blood bank to MT and MLT students. The MT program had 5 weeks of BB clinical training preceeded by 3 weeks of Immunology/Serology which also included significant BB training. The MLT school consisted of 2 weeks of BB training. When I asked for more time the school informed me that the graduates weren't expected to be able to perform BB testing "in the real world". Yet I have a graduate from this school that does work in BB on a regular basis and does a good job. We spent a significant time "in orientation" training her to work in the dept and she is able to work independently. I cannot imagine someone with this training as the Supervisor of the department.

[Eagle Eye]

I do not think I would want MLT as BB supervisor.

Either way as tech working under MLT BB supervisor or A blood bank director who has MLT supervisor running blood bank.

[LaraT23]

I just finished reading through the CLIA regs which state that an MLT can do high complexity testing, provided they are certified and have been trained/working after 1993. Those who were trained prior, have some additional specific course requirements. Here is one for you: Can an MLT be a general night shift supervisor when the only other persons in the building are on the job trained lab assistants?

[NedB]

This is a case of semantics. CAP requires the Lab Director and Technical Supervisor to have the qualifications you state. Most places circumvent having CAP challenge their personnel choices by using terms like Section Head, Team Leader, Coordinator, Lead Tech, etc. With CAP, you will not be asked for qualifications (even in the Blood Bank) if you avoid the term Supervisor. You will have to list the qualifications, but you will not have to defend them. This is not a short-coming of CAP. They are allowing individual facilities elbow room in filling positions. Smaller communities would naturally have fewer MTs to choose from.

[bbbirder]

CLIA regulations are different for a "General Supervisor" and a "Technical Supervisor". According to CLIA, I don't qualify as a Technical supervisor in BB, even though I have BS, MS, MT(ASCP) because only a "doctor" can qualify as the technical supervisor of Immunohematology. For all other subspecialities, MTs qualify. So, on our CLIA certificate, a pathologist is named as the Technical supervisor of Immunohematology.

Go figure! I honestly think that this is the area of the lab where pathologists have the least knowledge (unless you are in a large center with a transfusion medicine specialist pathologist.) (This is not to put down our pathologists! I love ours!)

Link to CLIA regulations:

http://wwwn.cdc.gov/clia/regs/toc.aspx

Linda Frederick

[rurallab]

I'm a MLT(ASCP), MT(HEW/HHS) Bloodbank Section Supervisor in a small hospital. We do limited testing, no antibody identifications,etc and stick to basic transfusion practices. As mentioned in other posts, some MLTs were trained as well and perform as well as MTs. The MLTs and MTs were trained side by side for the same length of time, the same curiculum. I will add, there are not many MTs willing to come here, due to location, pay, on call etc. Sometimes there are no other choices. I have been surveyed in the last seventeen years by JCAHO, IDPH(CLIA) and an FDA visit, none of which made any comments or recommended that a MT should be the section head or that I didn't qualify. Sorry, didn't mean to be so lengthy. One last item, I would NOT accept the same position in a larger hospital that would perform more complex transfusion testing and infusion practices, I would, however, feel comfortable working as a bloodbank tech in one.

[CYGI]

Although I should, I do not know what Texas' requirements are. However, I can tell you what goes on here in the western part of the state.

Our hospital (350+ beds) requires a BS, MT, and 5 years experience. However, many of the smaller nearby hospitals have MLTs as BB supervisors, and there are even a number with MLTs as lab directors. With the shortage of techs, I see this only becoming more common, especially in the more rural areas. In the 10 years that I have lived here, no one has gotten into any sort of trouble because they don't have MTs in these positions...if there are regs, they are not enforced.

Let me also add that I have both an MLT and an MT...and went to school for both. Sad to say, I learned almost everything I know from my MLT program. The MT program added very little, if anything, to my knowledge base. It is the quality of the program, not the number of years it takes to learn it, that makes the tech.

Our lab is staffed almost entirely by MLTs...and that is not an issue, as they are all excellent techs. I have worked with MLTs who knew more about BB than I ever will, and MTs who were incapable of doing the minimal job requirements, and vice versa.

Sorry for the rant; this has been a touchy subject here also.

Karen

Karen,

I have to agree with you, I too know MLTs which are knowledgable of different sections and hold just as much pride as MT. Don't worry about ranting i'm right in your corner. We need to stop looking at techs with degrees and help each develop knowledge to a higher lever. I always wonder if the people who complaining, why they do not apply for the positions that are posted. Each tech is an asset to the department if they are giving a chance.

[jcdayaz]

Thanks to each of you for your input. I have worked along side MT,MLT, and on-the-job trainees for 40+ years. In almost every instance the techs have performed professionally and were a credit to the lab.

What I was seeking was someone with the knowledge about CAP, CLIA, or JCAHO regulations. CAP says "education and experience equivalent to MT(ASCP)". CLIA calls for at the least a BS for supervisor of high complex testing. JCAHO seems to go alone with CLIA as far as lab regs are concerned.

Maybe someone with these agencies could help with this discussion.

Wow, talk about a sensitive subject!!

Are there really good MLT's out there? Most certainly. Are there bad MT's out there? Most certainly.

I know it is against at least CLIA regs for an MLT to be a supervisor. And I have a HUGE problem with it!!

[bbnewbie]

Would you be ok with a MLT but also has a BS in Biology, just hasnt sat for the MT exam? What is the difference if trained properly? What gets taught in a MT program has changed over the years and like others were saying much of what they learned was during the MLT portion.

[adiescast]

If you are CAP accredited, the following applies:

TRM.50000

Phase II

N/A YES NO

Does the person in charge of the technical operations of the transfusion medicine section of the laboratory have education or experience equivalent to an MT(ASCP) and at least 4 years experience (one of which is in transfusion medicine) under a qualified laboratory director?

[vilma_mt]

http://www.cap.org/apps/docs/laboratory_accreditation/forms/personnel_requirements_by_testing_complexity.pdf

http://wwwn.cdc.gov/clia/regs/subpart_m.aspx#493.1449 Sec. 493.1449 Standard; Technical supervisor qualifications.

The laboratory must employ one or more individuals who are qualified

by education and either training or experience to provide technical

supervision for each of the specialties and subspecialties of service in

which the laboratory performs high complexity tests or procedures. The

director of a laboratory performing high complexity testing may function

as the technical supervisor provided he or she meets the qualifications

specified in this section.

(a) The technical supervisor must possess a current license issued

by the State in which the laboratory is located, if such licensing is

required; and

( The laboratory may perform anatomic and clinical laboratory

procedures and tests in all specialties and subspecialties of services

except histocompatibility and clinical cytogenetics services provided

the individual functioning as the technical supervisor--

(1) Is a doctor of medicine or doctor of osteopathy licensed to

practice medicine or osteopathy in the State in which the laboratory is

located; and

(2) Is certified in both anatomic and clinical pathology by the

American Board of Pathology or the American Osteopathic Board of

Pathology or Possesses qualifications that are equivalent to those

required for such certification.

© If the requirements of paragraph ( of this section are not met

and the laboratory performs tests in the subspecialty of bacteriology,

the individual functioning as the technical supervisor must--

(1)(i) Be a doctor of medicine or doctor of osteopathy licensed to

practice medicine or osteopathy in the State in which the laboratory is

located; and

(ii) Be certified in clinical pathology by the American Board of

Pathology or the American Osteopathic Board of Pathology or possess

qualifications that are equivalent to those required for such

certification; or

(2)(i) Be a doctor of medicine, doctor of osteopathy, or doctor of

podiatric medicine licensed to practice medicine,

[jcdayaz]

Uggh. You have stricken a cord with me in this post. Please pardon me if I come off sounding harsh.....

I have never before in my 18 years of being a BS MT worked along side MLT's who are turning out results like I am now. Apparently, the way our lab gets around the regulations is that an MT has to review their results. This very often happens the next day or even a couple of days later. There is something in our computer called a "Review Que", but it doesn't always get looked at on a daily basis (workload dependant, of course).

Please don't misinterpret my statements, I have worked with, and do work with several very good MLT's. It is the lack of knowledge base that scares me. It is hard to train, educate, etc on a base that doesn't exist in the first place!

Unfortunately, apparently in our area MLT's are the most readily available for hire. The MT college programs have been closed down. So, I guess we sort of modified our standards to accomodate the availability of employees.

YUCK!!!!

[bbnewbie]

I did fail to mention that I am currently in a MLT to MT program and am VERY frusterated because so far I have not learned much that I didnt get from my MLT training in the military. I only did this since many people wont give me a second look because I dont have the paper stating what I know. I am in my last semester of the program and had I known then how poor it actually is I never would have taken it. Somehow with my "lack" of knowledge I happen to be the one everyone goes to for the answers. Some people can learn just as much from others as from a book that doesnt have much real world applications.

I fill a MT position due to my MLT and my BS in Biology. Last time I checked the biology degree doesnt really prepare you for the lab.

[vilma_mt]

@bbnewbie....i think with your BS Biology and Lab experience ASCP will allow you to take the MT test. There is no doubt there are a lot of MLTs who are qualified/knowldgeable specially those who have good experience. Unfortunately, workplaces and accreditation agencies would not know that until they see you 'work in the bench'. Since you have chosen that route to work in the lab...you pretty much have to 'prove yourself' compared to us who went to the program and pass the test.

[jcdayaz]

I did fail to mention that I am currently in a MLT to MT program and am VERY frusterated because so far I have not learned much that I didnt get from my MLT training in the military. I only did this since many people wont give me a second look because I dont have the paper stating what I know. I am in my last semester of the program and had I known then how poor it actually is I never would have taken it. Somehow with my "lack" of knowledge I happen to be the one everyone goes to for the answers. Some people can learn just as much from others as from a book that doesnt have much real world applications.

I fill a MT position due to my MLT and my BS in Biology. Last time I checked the biology degree doesnt really prepare you for the lab.

I presume this is your respnse to my post? If not, please disregard.

No, Your BS in Biology most assuredly does not prepare you for working in the lab any more than my dual Bachelor of Science degrees in Chemistry and Clinical Science prepared me. However, I was extremely well prepared AFTER my year and a half of extra internship at 6 various hospitals required by my college to get the Bachelor's of Clinical Science. Yep, that's right, total of almost 6 years of college. So, you can get "uppity " if you choose, but there is a difference. Always has been, always will be.

I stated very plainly that I have worked with some VERY good MLT's. ( Matter of fact, I'm training one right now that I think will be great!) Maybe you are one of those..I certainly don't know. I also very clearly stated I have worked with some VERY BAD MT's.

Unfortunately, your "military training" comment sent shivers down my spine. The "military trained" MLT's seem to be the ones I have the most problem with. You sound to be an exception to that "rule". I applaud you for that.

[bbnewbie]

#1 dont think I was being "uppity" just dont agree that a MLT cant be taught the same things a MT does. It all comes down to the clinical training not some college degree. Bookwork is NOT real world, especially with all the new technology these days. Times change and from what I see much of the learning experience is done after school. Second, dont know where you did your degree but the program I am currently in only requires 18 weeks of clinical rotations and much of that time is not actually doing any hands on testing but merely observation. To say that military trained MLT's are among the worst says a lot about you. It is the same coursework and the clinical portions are done by civilian MT's many with 20+ years experiance. I bet hour for hour the military school spends more time but it is compressed into longer days. The military labs I worked in are much more organized than civilian labs I have seen. Yes I do have to prove myself everywhere I go but doesnt everyone? I hope you would not assume soneone is a good tech without seeing their work just because they have a piece of paper.

[tbostock]

For many years I have worked with both MLTs and MTs in the Blood Bank...some good, some bad for each type. I've learned that the best indicator of future success in this biz is the willingness to always be learning new things. I've had employees that don't want to advance their degree, obtain a certification, even attend a Blood Bank conference, because "I have my degree, I'm done".

So, for me, when I interview, I look for someone (regardless of their degree or title) who feels that they are never finished learning, that are interested enough in the field to want to learn something new every day. They usually make great techs.