[Histonet] Practical - 2nd try

[Lee & Peggy Wenk]

Trying to send again. Didn’t seem to go to HistoNet the first time, from what I can see. If you’ve seen it already, hit deleted fast.

The reason the practical exam was dropped was NOT due to ASCP only having MT's. There were lots of HT/HTL associated with NSH that would be invited to grade, along with pathologists, many of whom also present at NSH.

I wrote the following (after the *****), and posted it on HistoNet on March 14, 2006. So if you are not interested, hit delete now.

If someone comes out of a NAACLS HT/HT program, and cannot cut or section, then it is the fault of the program. Complain to the program. Complain to the accrediting agency www.NAACLS.org  

I'm sure my students think I trained in the same Navy facility, as I demand perfection. My students still have to turn in a practical exam - HT being somewhat different than HTL in terms of some tissues, some sizes, some stains, numbers.
- HT - 1 H&E from 23 different tissues, 7 special stains (each student gets different special stains on different tissues. Maybe they all have a PAS, but one is on sm. intestine, one on colon, one on fungus)
- HTL - 1 H&E from 31 different tissues, 9 special stains, 2 IHC

I have check sheets
- 1 point for perfect block and slide (label, embedding, coverslipping, full face, not cut through, etc.) - if anything wronge = 0 points.
- 2 points for sectioning - any cutting artifact = 0 points
- 1 point misc (fixation ppt, over processing, bone dust, etc.) – any problems = 0 points
- 6-4-2-0 points for staining. (perfect, good, poor, bad)

If they have on a slide with a knife line, and 2 tone eosin, that's 1-0-1-4 = 6 points. They need to have 75% overall to pass the practical. The practical is worth 10% of their grade. They have the entire practicum to work on it (7 months for the HT, 11.5 months for HTL). It's a competency based program, so failing any part (exam, homework, practical, rotations) means they don't pass, even if their overall grade is above the 75%.

If people are interested in my practical grading sheets, email me directly (NOT through HistoNet), and I'll email. Specify HT (no enzymes, no IHC) or HTL (enzymes, IHC, more special stains).

Below are the reasons for that the practical was dropped, that I wrote in 2006. The only thing I would add now is, if you can't "test" them for competency of sectioning, coverslipping, etc. during the interview, then USE the 3 months probation option. If they said during the interview that they knew how to microtomy, and you find once they start working that they can't - they lied - then FIRE them! BE the supervisor! Don't allow yourself to be stuck with any employee who can't do the work, won't do the work, is bad for your lab, is bad for the patient, etc.
************
Yes, the HT and HTL practical exams are being discontinued starting in 2007. In other words, 2006 is the last year it will be required.

(If you're not interested, please hit "delete" at this point, as I'm going to get wordy.)

There was information on the ASCP Board of Registry (BOR) web page. However, ASCP recently redid their entire web page, and this information is in queue to be put back up on the new pages. (In other words, they didn't drop it, it just hasn't been put back up.)

I'll fill you in on what I know, learned by reading an email sent to all HT/HTL program directors about 2 months ago, and what was talked about at educator's forum at the 2005 NSH meeting in Florida. Also, I talked with Dr. Blair Holladay (head of ASCP BOR) when the email first came out, and with Gerri Piscorski (exam manager) (312-541-4887), after that, to get more information.

Histotechs were the only category still required to do a practical. Med techs don't have to prove they can make a blood smear or can do a Gram stain or can streak an agar plate. Cytotechs don't have to prove they can make a FNA smear or do a Pap stain. Phlebotomists don't have to prove they can get blood from someone with collapsed veins, or do a heel stick on a newborn.All other categories are tested by just a written exam.

The majority of histotechs pass the practical portion. Of those that don't pass the practical, the majority of these also did not pass the written portion. In other words, very few people pass the written but fail the practical. Most either pass the practical/fail the written, or they fail both parts, or they pass both parts. So the written portion of the HT/HTL exam was a better indicator of who would pass/fail both parts, than the practical exam.

The cost of the grading of the practical exams was very high - flying histotechs and pathologists into Chicago from all over the country, putting them up in hotels for the weekend, feeding them. The graders were not being extravagent - pizza for lunch, sharing cabs to the grading center, etc. The number of slides was reduced from 15 to 9, in part to reduce the number of graders needed, thus reducing the cost. (By statistically picking the right combination of tissues and stains, 9 slides were giving the same pass/fail rate as the previous 15 slides.) The fee charged to the HT/HTL candidates did not cover the cost of grading the practical exam. Not even when an additional $75 fee was added. So ASCP BOR was losing money with each practical exam.

Due to concerns about HIPAA, confidentiality, shipping, etc., many candidates were having difficult times obtaining tissue (especially students in college based histotech programs, that were doing rotations in hospital labs for, say, 2 months).

This idea of dropping the practical exam has been around for quite a few years. Reducing the number of slides on the practical from 15 to 9 was a compromise, a stepping stone if you would.

The people on the ASCP BOR Histotechnology Exam Committee have been taking pictures of poor staining and sectioning artifacts. These will be incorporated into future written exams as troubleshooting and problem-solving questions. What are the causes and how to correct thick/thin sections, wrinkles, folds, splits, microchatter, etc. So the exam is being re-written to incorporate more staining and sectioning problems.

Remember, the ASCP BOR Histology Exam Committee with histotechs very involved with NSH, were involved in this discussion/decision. NSH Board has a representative on the Histology Exam Committee/ASCP Board of Governors, who was involved with this topic. ASCP BOR also talked with program directors of HT/HTL schools about this at the NSH convention, asking their 
opinion. And this topic has been discussed at various committees that I've been on, for the past several years. So it's been coming, slowly, for somewhere over the last 6 years, maybe closer to 10 years, that I'm aware of.

Now, some questions you may be having
- What is going to happen to the people who didn't pass the practical last year or the year before (2005, 2004)?
Each one has been sent a letter, informing them at they must take and pass the practical in 2006 (this year). If they don't pass the practical this year, then they will not have passed their HT or HTL exam.

- What about the people taking the HT/HTL exam for the first time this year (2006), who don't pass?
They will be given one more year (2007) to take the "make up" practical, in order to pass their HT/HTL exam. So, for just these few people, they will be allowed to take the practical in 2007. But no one else.

- How will I know if someone I'm thinking about hiring can really cut or stain, if they don't have to do a practical exam for ASCP?
My suggestion - having them do a "practical exam" as part of their interview with you. Hand them 6 blocks, put them in front of a microtome, and give them 20 minutes to section. Then interview them more (to use up time during the drying), and have them load the H&E stainer. While the slides are staining, have a folder of slides for them to look at - some H&E, some special stains. Ask them to identify the stains or the tissue or what's wrong with a poorly stained slide. As long as you use the same type of tissues in the blocks, and the same stained slides, and have EVERY candidate do the test - this is perfectly acceptable way to assess someone you are interviewing for a position. By this time, the H&Es are done. Have them coverslip them


Peggy Wenk