[Histonet] Practical Exam

Mon Feb 23 09:15:46 CST 2009

Peggy,

You make good, sound points. Thank you.

William (Bill) O'Donnell, HT (ASCP) QIHC 
Lead Histologist
Good Samaritan Hospital
10 East 31st Street
Kearney, NE 68847 

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Lee & Peggy Wenk
Sent: Friday, February 20, 2009 8:13 PM
To: rjbuesa <@t> yahoo.com; 'Victor Tobias'; 'Histonet'; 'Rittman, Barry R'
Subject: RE: [Histonet] Practical Exam

Long answer - skip if not interested. Am responding to several (many) emails, not just to Rene's.

Yes - that was 2 of the reasons (cheating and cost)that the practical exam was dropped. Please realize that I was not on the committee when the decision was made, but afterwards, I talked with ASCP Board of Registry, and with many of the people on the ASCP BOR Histotechnology Committee (of which all of the histotechs are very involved with NSH), and with the NSH representative on the Committee.

ASCP could not guarantee that people were doing their own work. I have talked with people who complained to me about other people in their lab - they were having other people do their sectioning and/or staining. Sometimes it was the supervisor doing this, to make certain their "tech" passed the practical. Sometimes it was other techs, sometimes just to help out, sometimes as ordered by the supervisor or pathologist. I had people call me about this, and approach me at NSH about this, because they were concerned about the cheating. However, they did not want to call ASCP about it, and it would't do any good if I called ASCP. Usually the people did not tell me their name, city, state, or hospital, nor did they tell me the name of the candidate or the people involved in the cheating.

And yes, there was a cost factor. Histotechs, if you remember, ended up paying the same exam fee at medtech, cytotechs, etc. PLUS an additional cost
($75 if I remember) to help cover some of the cost of the practical. The key word being SOME. So for every HT and HTL exam candidate, ASCP lost money.

There were also other factors, such as:
- Automation - Most people were doing their H&E on automated machines. Doing special stains on automated machines.  Using automated coverslippers.
Automated labelers. So it was the machine-work that was being graded.
- Better microtomes and blades - It became very infrequent that someone turned in a slide set that had horrible knife lines or was cut too thick.
- Kits and commercial stains - very few people are making their own hematoxylin or eosin, or most of the special stains. Regardless of whether they are staining by hand or on machine, very few people make stains anymore. So the grade was on commercial solutions, not solutions that the candidates made.

As a result, most candidates could "do" the stain, and make a fairly good section - because of all the automation and kits. In fact,
- from 2001-2004, 70-76% of HT candidates (High school and associate degree
routes) could pass the practical, but only 50-53% could pass the written. 
- When the high school route was dropped, 2005-2007, 90-96% of the candidate could pass the practical, and 55-58% could pass the written (still some high school routes who had failed in 2004 but still had some additional chances to retake the exam). That's 90% could DO the sectioning and the staining!
That wasn't the deciding factor in passing the exam! It was the written part.
- Last year, in 2008, everyone taking the HT exam had an associate degree, and there was no practical, and 64% of candidates passed the written. So the exam is the same, but more people are passing because they have the biology and chemistry background behind them.

This therefore lead to the primary reason for dropping the practical exam.
The written/computer exam was the determining factor in whether someone passed or not. The practical exam was NOT the determining factor. There are
4 ways that people passed/failed the written and practical exams.
1. passed both
2. failed both
3. passed written, failed practical
4. failed written, passed practical

At the time of the decision to drop the practical, about 50% of the applicants passed both parts (#1). That means that the other 50% failed either the written, or the practical, or both.

If they knew their theory fairly well, and could troubleshoot based on the theory, they tended pass both the written and the practical (because they knew what the stain was supposed to look like, and could figure out how to manipulate the stain to make it work right). That's #1. That was 50% of the people. 

It was actually very rare that #3 happened, where they would pass the written (knew the theory) and yet fail the practical (couldn't do the sectioning/staining).

If they didn't know their theory, and didn't pass the written, they also tended to not pass the practical. That's #2.

That leaves #4, where they could DO the sectioning and DO the stain, so they passed the practical. However, they didn't know the theory of WHY or HOW anything worked, and therefore didn't know how to fix it, and therefore failed the written. There were a fair number of these people. But do we, as a profession, want people who can cut and stain when everything is working right, but don't know what "right" is supposed to look like, and therefore don't know when it isn't right, and definitely don't know how to fix it.

So, out of these scenarios, #1 (passed both) & #2 (failed both) had the written exam predicting if the candidate would pass or fail. #3 (passed written, failed practical) rarely happened. #4, (failed the written but passed the practical), though it happened less frequently than #1, and more frequently than #2, is not good for our profession.

I believe that if NSH or any organization tried to set up their own HT/HTL national certification exam, they would run into the same problems - cheating, automation, expense, and having the practical not really predict who is a good tech (90%+ were passing at the end, remember?).

Also, remember that histotechs were the ONLY lab techs that had to take a practical. Med techs don't have to prove they can plate microorganism on a petri dish, phlebotimists don't have to prove they can hit a vein, all of the specialists in med tech don't have to prove they can run the equipment (flow, PCR, etc.), cytotechs don't have to prove they can adjust the Koehler illumination on a microscope. They do just a written exam. It is then up to the institution that hires them, to decide if they can really PHYSICALLY DO the task.

If you want to know if someone you are interviewing can really section or stain, set them down at a microtome during the interview process, and watch them. Have them embed tissue. Have them evaluate some slides at the microscope, and answer questions as to what the stain is and what's wrong with a bad stain, and suggest a substitute if you run out of a stain or a chemical. 

And USE the 3-6 months probation time. If someone can't do the job - get rid of them. If someone has a bad attitude, get rid of them. You owe it to yourself and your other employees, to have GOOD histotechs, not a body that is doing bad work and ruining the mood in the lab.

It is OK to use our "powers" of being a supervisor, to FIRE someone, if it isn't working out. I know there is a shortage. I know you have to train people from scratch. I know we all bend over backwards to help everyone. But we all know within a short amount of time of hiring someone, whether someone is going to work out or not. That probation allows you to fire someone without all the documentation. USE IT! And get someone who is capable of learning, eager to learn, excited to have a job, willing to work hard, and gets along with everyone.

One of the reasons that the high school route was dropped, was that only 40% could pass, after a minimum of 2 years experience. Yet 60% of candidates with the associate degree will pass, after a minimum of 1 year experience.
So hire someone with an associate degree in biology. Trust me, there are NO jobs out there for people with associate degrees in biology. They would love to get a job in a lab. They have the background theory, so you won't have to spend so much time teaching. And, if they end up not being a good hire, for whatever reason (attitude, ability, drugs, whatever) - then fire them.

Peggy A. Wenk, HTL(ASCP)SLS
Beaumont Hospital
Royal Oak, MI 48073

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Friday, February 20, 2009 9:01 AM
To: Victor Tobias; Histonet; Rittman, Barry R
Subject: RE: [Histonet] Practical Exam

There were 2 fundamental reasons why ASCP eliminated the practical part of the examination:
1- they got to the conclusion that there was no way to determine if the person sending the slides was the one who really made them, and
2- it was getting too costly to send the slides to review or to gather the reviewers to qualify the sections, so they decided to eliminate the practical and made the changes we have now (renewal and CEU).
René J.

--- On Thu, 2/19/09, Rittman, Barry R <Barry.R.Rittman <@t> uth.tmc.edu> wrote:

From: Rittman, Barry R <Barry.R.Rittman <@t> uth.tmc.edu>
Subject: RE: [Histonet] Practical Exam
To: "Victor Tobias" <victor <@t> pathology.washington.edu>, "Histonet"
<Histonet <@t> lists.utsouthwestern.edu>
Date: Thursday, February 19, 2009, 6:30 PM

Victor
I cannot believe that you have said this.
Although I did not think that the practical examination was the ultimate test of skill ,  it did at least provide some uniformity.
With an extension of the logic that you use it is just as easy to allow the pathologist to certify that the technician is qualified even without a written examination. 
Without a somewhat standardized practical there is no guarantee that the technician will have any practical knowledge outside their individual laboratory.
Didactic without adequate practical knowledge is, as far as I am concerned, useless.
What is really needed is a national standardized written and practical test that is administered by NSH.
I am not holding my breath that this will happen.
Barry 

________________________________________
From: histonet-bounces <@t> lists.utsouthwestern.edu
[histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Victor Tobias [victor <@t> pathology.washington.edu]
Sent: Thursday, February 19, 2009 5:03 PM
To: Histonet
Subject: [Histonet] Practical Exam

There has been discussion regarding the removal of the practical exam.
To me it has not been removed, but the responsibility has shifted to whomever signs off on the student. In the case of OJT, the pathologist has verified that this student can cut and stain. Of course what is acceptable to one pathologist may not be to another. Do they get tested in the art of troubleshooting...... As far as the schools go, they shouldn't be graduating anyone that can't cut, stain and troubleshoot.
So I don't really see a problem with the absence of the practical. It is Friday somewhere.

Victor

--
Victor Tobias
Clinical Applications Analyst
University of Washington Medical Center
Dept of Pathology Room BB220
1959 NE Pacific
Seattle, WA 98195
victor <@t> pathology.washington.edu
206-598-2792
206-598-7659 Fax
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