The Medical Laboratory Profession

Woon Sung Thong1, Badarul Zaman b.Abdul Aziz2.

1Sysmex Asia Pacific, 2Allied Health Science Division

Historical Background      

Malaysia as part of the British Commonwealth of nations inherited its educational system from the British when it gained independence in 1957. So did the medical laboratory services.

The first basic laboratory services were available at the IMR since its founding in 1900. Those who worked in the laboratory at that time were simply called laboratory assistants, a generic name that was used to describe anyone who works in a laboratory setting. The laboratory assistants at that time, whether they were in the Ministry of Health (MoH) laboratories or in the army were trained on the job just like their counterparts in UK, Australia, Hong Kong and Singapore. In 1945, more formal training was introduced to train the laboratory assistants in wider job scope. They included diagnostic work as well as community health programs. Then in 1965, a structured training program based on the British system was introduced accompanied with an examination structure (certificate level) to replace the First Departmental Examination.

It was the late Prof Dato’ Dr. Ungku Omar Ahmad, the Director of IMR 1965-1969, who thought it necessary to have a structured course. He then initiated the school for training of Medical and Health Laboratory Technology in 1968. The School of Laboratory Technology which started with 41 students was established with funds from UNICEF to buy the equipments. Following that a 3 year program was offered the following year (1969). The number of students including those from the National Tuberculosis Centre (NTBC), Lembaga Perancang Keluarga Negara (LPKN), Jabatan Orang Asli (JOA), Military, Wildlife Dept. and Universiti Kebangsaan Malaysia (UKM) were increased to 70 in 1971. Three years later enrolment was extended to the state of Sarawak

The training program was taken care of by the Division of Training Management, MoH. Hostel for the trainees was built and it accommodated 74 first year student and 120 second year students. Then in 1975 a new 3 storey block with 4 laboratories and 2 lecture halls was built. This has the capacity to train 120 Laboratory Assistants and 120 Junior Laboratory Assistants. Students from the state of Sabah were enrolled in 1977. In 1980 another milestone was achieved which saw the Post Basic Medical Laboratory Technology examination replacing the Second Departmental Examination. The curriculum was revised in 1990 to a bivalent diploma. In 1995 the name ‘School’ was changed to ‘College’ and the bivalent system was replaced with a polyvalent system to produce multi-skilled graduates.

 A new extension was added to the college infrastructure in 1998. It consists of a 3 storey block with an additional 8 laboratories, 2 lecture halls, 19 lecturer’s room, 1 seminar room and 1 examination hall. Currently the college provides a 3 year diploma course in Medical Laboratory Technology and advance diploma courses in the following disciplines:

  LABORATORY MANAGEMENT
  CYTOLOGY
  TRANSFUSION MEDICINE
  HAEMOSTASIS
  MEDICAL MICROBIOLOGY
  CHEMICAL PATHOLOGY

At around the same time as our independence, our nation embarked on the establishment of its first medical school at the University of Malaya (UM). Owing to the fact that there were not enough trained personnel to manage their laboratories, they set up their own School of Medical Laboratory Technology. MLTs from National University of Malaysia (UKM) earlier batches were trained in UM and MLT School in IMR, until in 1978 UKM trained their own MLTs for their laboratory operation.


Change of nomenclature

An opportunity arose during the Harun Commission when the laboratory assistants in the universities submitted a memorandum to request a change in nomenclature which is in line with international practices to reflect the nature and scope of its work. The Commission fully agreed with its representation and the designation of Laboratory Assistant was changed to Medical Laboratory Technologist. Unfortunately this only applies to those who work in the Universities but not for those who were in the MoH. It was not until 1978 that the MoH agreed to change the nomenclature for its Laboratory Assistants to Medical Laboratory Technologist (MLT).



Shifting trends in international practice

Australia which has the same setup as anyone of us in the Commonwealth, decided in the early 70s to upgrade the training of Medical Laboratory Technicians as they were called then to a degree program. The British quickly followed where the University of Bradford, UK offered a degree program in 1976. With these upgraded qualification, the MLTs professional designations evolves finally to “Medical Scientist” in Australia and “Biomedical Scientist” in UK.

While most counties were upgrading their training to degree level, Malaysia was just laying the foundation for their diploma courses. In other words, we are always a step behind. To rectify the situation, the Malaysian Federation of Medical Laboratory Technologist (MFMLT), the predecessor of MIMLS in its First National Convention in 19891, deliberated the following recommendations:

1.            Defines a practitioner of medical laboratory technology as:
“Persons who perform routine/complex laboratory analyses, fine line discrimination and correction of errors. They are able to recognize the interdependency of tests and have knowledge to confirm physiological conditions affecting test results in order to confirm results and to develop data which may be used by a physician in determining the presence, extent, and, as far as possible, the cause of disease.

The practitioners assume responsibility for, and are held accountable for, accurate results. They establish and monitor quality control programmers and design or modify procedures as necessary. Test and procedures performed or supervised by them in the clinical laboratories centers on major areas such as hematology, serology, medical microbiology, transfusion science, immunology, clinical chemistry, toxicology, cellular pathology, medical parasitology and entomology and includes the in-vivo technologies such as nuclear medicine technology, clinical neurophysiology and electro-encephalography technology, cardio-respiratory function technology, cardio-pulmonary perfusion technology, ultrasonography and renal dialysis technology.

Their place of employment is usually in hospitals, private clinical laboratories, public health centers, research institutions, industrial medical laboratories, environmental control laboratories, pharmaceutical houses, in research programs and teaching in accredited institutions for medical laboratory personnel, medical and dental students. Some may be employed as marketing personnel dealing with medical products and instrumentations”

2.            The need to continuously update the state-of-art of the profession:

To set the “bench mark” of the MLT profession in the country at the Diploma level or its equivalent and progressively upgraded to the level of Bachelor’s degree.

The need for better qualified personnel is important considering that the increased sophistication involving procedures, instrumentation and also expertise that are expected especially in the area of quality systems and patients’ safety.  

3             Propose a National Registration Bill for Paramedic and Ancillaries

Now the Allied Health Profession Bill has been read in Parliament and has since became an act (Act 774) that regulates 23 professions including the lab professionals. It is rather worrisome and confusing to note that this act include so many fragmented professions (biochemist, microbiologists, biomedical scientists, etc) especially when all are working in the same laboratory. It is like the haematologists, histopathologists, cytopathologists, chemical pathologists, each asking for its inclusion instead of just pathologists to register in the Act for the Medical Profession.

This findings and recommendations had been circulated to all the universities and MoH. We are happy to note that some of the recommendations are being implemented.

Evolution of the Medical Laboratory Education programs in Malaysia

When the MFMLT, mooted out the idea in 1987, of an act to regulate the allied health professions (called paramedics in those days), we were also preparing a path for the introduction of a graduate Medical Laboratory Technologists. We were able to convince the academia of the feasibility of a degree program for laboratory professionals that will upgrade the MLTs. The late Professor Terence George Baker from Bradford University of London was engaged to assist in the development of the curriculum. Bradford University was the first university in UK and one of the first in the world to initiate the Biomedical Science degree program and upgrade the medical laboratory technicians to scientist in the 1970s. 

In 1992 National University of Malaysia (UKM) and University of Malaya (UM) started the Baccalaureate degree in Biomedical Science. The first batch for the new program were the MLTs and fresh undergraduates whereby the working MLTS jumped to the second year of the 4 year program. University Putra of Malaysia (UPM), Science University of Malaysia (USM) also started the course and later MARA University of Technology (UiTM) also started a similar program called Bachelor’s degree in Medical Laboratory Technology. With the liberalization of education system, the diploma in Medical Laboratory Technology and Degree in Biomedical Science are some of the popular health sciences programs of the private colleges and universities. 

Unfortunately we were unable to convince the government healthcare top administrators of the need for graduate technologists. On top of that, to our dismay, in 2008 a new profession emerged in the Ministry of Health. This was the Scientific Officer (Biomedical), hence splitting what should be the same profession into two. The career development of the profession which should be a seamless progression has now become an almost impossible task because of the split. The private sectors however were more agreeable and currently employed these degree graduates as MLTs alongside the diploma holders.


Standard International Curricula

It is important to note that medical science in general, is moving towards globalization. For instance, education systems of physicians and nurses had been brought up to international standards since international health and education related organizations like WHO and UNESCO showed their concern over world-wide health problems. The reason that there should be an international unified structure of laboratory personnel having the same core competencies is based on the justification that diagnosis and the management of diseases should be globally standardised. 

Standardised Core Competencies and curriculum study had been carried out by the International Federation of Biomedical Laboratory Science (IFBLS) previously known as the International Association of Medical Laboratory Technologists (IAMLT). The study had been carried out to seek a unified core curriculum in the education and training of medical laboratory professionals. The findings will be submitted to interested governments for their review and implementation.

As such we wish to point out that it has never been our intention to exclude anyone working in the laboratory but to have a unified laboratory career for all involved in the provision of laboratory services. In fact we recommend that all the laboratory practitioners should be a degree graduate. A system should be formulated to gradually upgrade the diploma holders to degree as it had been done in UK in the 1970’s and now has an all degree practitioners for the past 20 years.

Currently, Japan, Korea, Thailand2, Brunei, Philippines, Hong Kong3, Taiwan4, and Australia5 , just to name a few, employs Medical Technologists with degrees only. 

Core Competencies of the profession

The concept of applying core competencies to the practice of biomedical laboratory science will ensure that certain minimum standards are achieved and most importantly that the practitioners must be able to work on their own (autonomously). They must be fully aware that their role as part of the healthcare team, is to provide accurate, reliable results which at the same time will ensure patient safety. It is also acknowledged that 70-80% of patient’s diagnosis is based on laboratory investigations.

What are these core competencies? They are basic biomedical laboratory science skills, scientific reasoning skills, analytical assessment skills, communication skills, information literacy skills, financial and management skills.

The basic biomedical laboratory science skills should encompass the disciplines of clinical chemistry, clinical microbiology, hematology, immunology, transfusion medicine, physiology, computer science and laboratory instrumentations.

Propose Scheme of Service

There should be one unified profession in the medical laboratory service to be called Medical Laboratory Scientists (MLS)

To achieve a unified service, MLS should be seen as a spine where entry to the profession is by either 

i) a recognized Diploma in Medical Laboratory Technology or the equivalent.

ii) a degree in Biomedical Science, Medical Laboratory Technology  or the equivalent.


The salary enumeration should not create any problem, the diploma entry will be placed at grade U29–U40 and the degree holders at U41–U54 and salaries will be paid accordingly.

The classification of biochemist, microbiologist should be replaced and streamlined with MLS and can be denoted by their specialties such as MLS (Clinical Chemistry). Having too many designations only serves to create confusion especially for the public.

This scheme provides opportunities for career advancement as can be seen from those who had diplomas moving upward in countries like UK and Australia. The other advantage of this setup is to have an all degree entry eventually.

The attempt by MoH to merge these segregated professions in the laboratory service had met with fierce resistance by many individuals from both sides of the divide perhaps due to ignorance, arrogance or misguided protectionism. Hence the move has been shelved indefinitely and this setback has maintained the status quo.   If it had been successful, we believe that this would be the birth of a new era for the laboratory profession and no doubt will improve the quality in the delivery of the medical laboratory service and finally catch up with our colleagues in other parts of the world.

References:

1.   Findings and recommendations of the First National Convention of the Malaysian Federation of Medical laboratory Technology, 1989
2           International Directory of Medical Laboratory Science Education by The International Federation of Biomedical laboratory Sciences Pg 230 -234
3         International Directory of Medical Laboratory Science Education by The International Federation of Biomedical laboratory Sciences Pg78 -95
4          International Directory of Medical Laboratory Science Education by The International Federation of Biomedical laboratory Sciences Pg 222-229
5           International Directory of Medical Laboratory Science Education by The International Federation of Biomedical laboratory Sciences Pg 3-11


*Note: The view of the authors in this article does not necessarily mean it represent the view of the institute.

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