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kirkaw

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Greetings,

I am curious to know who out there, is employing MLT's (medical lab technicians) versus MT's (medical technologists. For those places that use both, do you find any difference in the quality of work of the techs? Any difference in the time it takes for orientation and training? 

If you use MLT's do you serve as a site for their clinical rotations? If so, how much time do they spend in your BB/TS and how much do they do (antibody panels? eluates? adsorptions?).

Thanks!

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Hi Kirkaw, there is a topic in the 'Off Topic" section that will answer some of your questions.  http://www.pathlabtalk.com/forum/index.php?/topic/7817-mlt-vs-mls-in-the-blood-bank/

 

In our lab we have mostly MTs but some MLTs.  At this time, all persons who work in BB are MTs.  We have had MLTs in the past and I would say some were a success and some were not.  The time training for us is sometimes longer depending on experience and willingness to learn. 

 

We do take MLT and MT students on clinical rotations.  Typically MLT students are here for only 2 weeks and we cover everything because at our facility, MLT's are expected to function in BB the same as an MT except they cannot be in charge.  We do not cover adsorptions becasue we do not do them here.  Those would go to a reference lab. 

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For decades we hired only MTs, but have had to hire a few MLTs over the last couple of years due to MT shortages. I find the quality of work varies not from the number of college courses they took but the innate ability, initiative and interest of the worker. We train equally and job responsibilities are equal (although the MTLs cannot do some things, like review results etc).

 

I had a MLT generalist on last weekend. He had a patient who got 4 units of blood the week before who now presented with anti-c and a positive DAT, weak mixed field. Pretty classic delayed reaction, except that the eluate reacted with all the panel cells. DAT was negative the week before. He dug into it and tested some more c-negative cells and found that there was also anti-Fya and -Jkb in the eluate (but not in the plasma yet). En route he tested the eluate with ficin-treated cells and PeG and ficin-treated some additional ones himself to help untangle the specificities. I did give him some phone coaching along the way, but it was an excellent job of blood banking. "Just" a MLT, but he really digs BB.

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Dr Pepper has hit the nail on the head - the innate ability, initiative and interest of the worker.  Regardless of education - these are qualities I look for in BB techs, whether MLTs or MTs.  I've worked with SBBs who aren't worth a damn and the best BBer I ever worked with and learned A LOT from was an MLT. 

 

I think there are other recent posts which address this topic somewhere on this site.

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Currently we have both MLTs and MTs in the Blood Bank but we are transitioning to MTs due to changes in NYS licensure concerning the CLIA need for technical supervisors in high complexity testing areas (like BB).

Terri,  I am in NY too.  What changes are you referring to or why could you not use MLTs?  I just want to make sure I do not miss anything!!   I didnt think MTs qualified as a technical supervisor for BB.  Thanks!

 

Shaunna

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Terri,  I am in NY too.  What changes are you referring to or why could you not use MLTs?  I just want to make sure I do not miss anything!!   I didnt think MTs qualified as a technical supervisor for BB.  Thanks!

 

Shaunna

 

§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

( b  ) 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.

...

(q) If the requirements of paragraph ( b  ) of this section are not met and the laboratory performs tests in the specialty of immunohematology, the individual functioning as the technical supervisor must—

(1)(i) Be a doctor of medicine or a 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, osteopathy, or podiatry in the State in which the laboratory is located; and

(ii) Have at least one year of laboratory training or experience, or both, in high complexity testing for the specialty of immunohematology.

Edited by goodchild
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Hi Goodchild, I have seen that standard and I guess my question is why the move away from MLT when an MT can't be a technical supervisor either.  I wasn't sure if there was some aspect I was misunderstanding.  Since my "mom brain" tends to strike often! :abduction:

 

Thank you!

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I think Goodchild's post did not show the entire list of people qualified to be technical supervisor; for CLIA it states that a bachelor's is also acceptable for a Technical Specialist:

Bachelors in medical technology, chemical, physical, or biological science AND 4 years training/experience in high complexity testing in the respective specialty

It's not that you can't have MLTs in the Blood Bank at all, but you have to prove that 24/7, 365 days a year, you have to also have someone qualified as a Technical Supervisor there at all times to directly observe the MLTs. It can't just be a supervisor in another dept if they don't know Blood Bank. This person can also help the department supervisor do some of the more higher level reviews, such as QC review, reviewing antibody ID workups, reviewing exceptions, etc, but only if they also qualify by NYSDOH's standards for a supervisor, which is 6 years working as a licensed technologist.

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I think Goodchild's post did not show the entire list of people qualified to be technical supervisor; for CLIA it states that a bachelor's is also acceptable for a Technical Specialist:

Bachelors in medical technology, chemical, physical, or biological science AND 4 years training/experience in high complexity testing in the respective specialty

It's not that you can't have MLTs in the Blood Bank at all, but you have to prove that 24/7, 365 days a year, you have to also have someone qualified as a Technical Supervisor there at all times to directly observe the MLTs. It can't just be a supervisor in another dept if they don't know Blood Bank. This person can also help the department supervisor do some of the more higher level reviews, such as QC review, reviewing antibody ID workups, reviewing exceptions, etc, but only if they also qualify by NYSDOH's standards for a supervisor, which is 6 years working as a licensed technologist.

 

I retrieved that from http://www.ecfr.gov/cgi-bin/text-idx?SID=1248e3189da5e5f936e55315402bc38b&node=pt42.5.493&rgn=div5#se42.5.493_11449

It doesn't show any other acceptable qualifications for technical supervisor for immunohematology laboratories.

 

What you refer to sounds more like a "general supervisor." All qualified testing personnel with two years of experience are qualified to be general supervisors according to CLIA.

 

For moderate complexity laboratories there's also a 'technical consultant.' Where you would need a bachelor's degree and two years of experience.

Edited by goodchild
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I believe Goodchild is correct based on our JC inspection last year. As an MT with many years of experience, I only qualify as the general supervisor and I think I qualify as a technical consultant based on CFR 493.1411, but for high complexity labs, which immunohematology (BB/TS) is always considered, you must have a technical specialist who is an MD.

 

We have crafted our job descriptions, including those for medical directors very carefully. What was confusing to us, was transitioning to the terminology that CLIA uses. The person we call our Lab Director is not really the lab director because of CLIA requirements. The person they call lab director is actually the lab medical director.

 

As for my question about MLT versus MT, I agree that there are many MLT's that are at least as competent as MT's. BUT I have found that some recent graduates from MLT programs are lacking so much theory that their critical thinking skills are poor. It's like I have to re-do their clinical rotation education and that is very time consuming. I think that resources are shrinking and programs are having a hard time finding hospitals that have the time and personnel needed to teach students. Therefore, the quality of the clinical rotation is decreasing, making the initial training/competency needs for these new graduates tremendous. I am worried about the destiny of our profession from that stand-point. 

I was just wondering if other folks had had that experience.

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As for my question about MLT versus MT, I agree that there are many MLT's that are at least as competent as MT's. BUT I have found that some recent graduates from MLT programs are lacking so much theory that their critical thinking skills are poor. It's like I have to re-do their clinical rotation education and that is very time consuming. I think that resources are shrinking and programs are having a hard time finding hospitals that have the time and personnel needed to teach students. Therefore, the quality of the clinical rotation is decreasing, making the initial training/competency needs for these new graduates tremendous. I am worried about the destiny of our profession from that stand-point. 

I was just wondering if other folks had had that experience.

 

With our students we have seen over the last few years, I think that this may what is occurring.  We get students from both 2- and 4- year programs, and I would have to agree that more and more some of the 2 year students do indeed seem to be lacking both with theory and attitude. This does not seem to happen as much with 4-years.  Perhaps it's part maturity, part education?

 

Scott

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We're caught in a catch-22. When we have the staffing available to train MLT students, we don't have open positions. The times that we do have open positions we're either too short-staffed to take on students or we're outside of the graduation timeframe (current students are months out, previous students are already in positions elsewhere). We've actually trained a number of very promising MLTs who I wish we could have hired. Someone in another MLT vs MLS thread said that the most important thing is the person's attitude, I would agree.

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We're caught in a catch-22. When we have the staffing available to train MLT students, we don't have open positions. The times that we do have open positions we're either too short-staffed to take on students or we're outside of the graduation timeframe (current students are months out, previous students are already in positions elsewhere). We've actually trained a number of very promising MLTs who I wish we could have hired. Someone in another MLT vs MLS thread said that the most important thing is the person's attitude, I would agree.

 

Again, same problem here.  When we really need to retain them, they end up going to work somewhere else.  Sometimes after working here one or two years.  It can be really frustrating.

 

Scott

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Dr Pepper has hit the nail on the head - the innate ability, initiative and interest of the worker.  Regardless of education - these are qualities I look for in BB techs, whether MLTs or MTs.  I've worked with SBBs who aren't worth a damn and the best BBer I ever worked with and learned A LOT from was an MLT. 

 

I think there are other recent posts which address this topic somewhere on this site.

 

I totally agree!  It seems they have the 'same' technical training while maybe the MTs have more of the background/academics like Biochemistry.  I have found that MLTs function the same on the bench as MTs except when running into problem cases.  After a few years, this can even out depending upon how much experience the MLT has had and how willing he/she is to learn the background.  There are MTs that don't 'measure up' ... and, as David stated, there are SBBs that fall way short of expectations.  So, even though MLT/MT/SBB don't start off 'equal', the individual proves him/herself after a while.

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I am fortunate enough to be able to provide the senior seminar in blood banking for a local community college (MLT program).  These students are taught basic blood banking techniques and only receive rudimentary theory.  They rarely know about complement.  I also have been fortunate that they send me their top students for clinical - only 4 weeks (vs 6 for chem, hem and micro).  I have a gruelling program which includes weekly talks to my staff, ab ids out the yinyang and lots of theory.  We have hired 4 of these students based on their performance in my clinical HOWEVER most still refuse to get beyond the basics no matter how hard I try to get them to.  When they were students they did absorptions, elutions, really difficult abids, etc.  Now it is like pulling teeth to get most of them to consider an eluate.  I have even purchased the advanced blood bank surveys from CAP with the carrot of not having to do the routine surveys - only one taker (who was really the best of the lot but now is #2 in chemistry).  It seems this is a pervasive problem with generation X (or whatever it is now - and these students are not all recently out of h.s., in fact at my last seminar everyone had a bachelors degree and there was one PhD, and 2 PhDs in the next year's class).  ??????????????????

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Both MT and MLT students do clinical rotations with us.  They are allowed 14 days total for the BB rotation!  I agree with all the above concerning attitude - both for MT and MLT.  The difference I see is background.  The MLTs are at a disadvantage because they don't get all the theory and most don't have well-equiped student labs.

But some of the worst students were MT - they made it clear they were immediately going on to graduate school and had set their sights on big pharma, so they really only needed to know enough to 'pass'.

I also agree with David - many more BS/BA/PhD students in MLT programs - many from foreign countries.  They cannot find a job in their field and this is a fill-in for them.  They are not invested, and may do well in gen'l lab, but I would hire very few for the BB.  But I also would hire very few of the MT students as well.  I want someone who thinks like a blood banker.  As we all know, we do think and operate differently than the rest of the labs. 

I do have both MT and MLT in my lab - they all do the same thing (even eluates and adsoptions!)

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With all of the various types of analyzers and problems in the "rest" (non-BB) part of our Lab, I am pretty sure we would not want undesirable "don't get the theory" in those areas either.  If all one has to worry about is one area, like BB, well-- I guess you are fortunate.

 

The days of techs working in specific areas and only those areas are long gone, except in specialized areas like Histo and Micro.  It would be nice to have "experts" in all areas of the Lab, but it is just not practical unles you work in a big medical center or reference lab.. 

 

We need good generalists more than anything these days, and yes unfortunately, they are few and far between.  And wiith the general hortage of graduates, the good ones are hard to attract.

 

Scott

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With all of the various types of analyzers and problems in the "rest" (non-BB) part of our Lab, I am pretty sure we would not want undesirable "don't get the theory" in those areas either.  If all one has to worry about is one area, like BB, well-- I guess you are fortunate.

 

The days of techs working in specific areas and only those areas are long gone, except in specialized areas like Histo and Micro.  It would be nice to have "experts" in all areas of the Lab, but it is just not practical unles you work in a big medical center or reference lab.. 

 

We need good generalists more than anything these days, and yes unfortunately, they are few and far between.  And wiith the general hortage of graduates, the good ones are hard to attract.

 

Scott

 

We're in the lucky crowd that considers blood bank too specialized for generalists and I'm very thankful for it, every day.

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