Posted on: Tue 08-09-2020

The relatively new degree, Doctor of Medical Laboratory Science, MLS.D; has been trending on social media in Ghana and Nigeria for the past few days following the above post of female graduates of the program from The University of Development Studies, Ghana. Some observers and stakeholders have raised (valid) questions as to the relevance of this new degree. Here’s my take;

According to literature, 70% of medical decisions on patient care are based on Laboratory test results. The goal of Medical Laboratory testing is unarguably to provide accurate, reliable and maximally utilized test results to aid in diagnostic and therapeutic interventions. For this to happen, there needs to be appropriate structures in place to ensure quality assurance at every step of the Total Testing Process. However, there exists currently a gap in fulfilling this all-important goal. Laboratory test selection and interpretation are key areas of the Diagnostic/Total Testing Process (specifically the Pre- and Post- Analytical phases) that have been neglected to the detriment of the patient and wastage of scarce health resources.

Studies have reported that majority of laboratory errors are due to errors from the extra-analytical phases of the Total Testing Process. Appropriateness of laboratory test selection (part of pre-analytical) and their utilization (part of post-analytical) being part of this all important extra-analytical phases. In many clinical settings across the world, there are no established and functional structures in place to fill this gap. Although many well experienced Medical Laboratory Scientists have taken on this all important advisory and suffice to say consultancy role on their own without further training and or remuneration (structure in place), there still is more to be achieved. It can be argued that here lies part of the role of Clinical Pathologists, and correctly so. However, growing shortages of Clinical Pathologists (you can look up literature on the statistics) have further widened this gap and led to a neglect of these all-important aspects of the Total Testing Process.

 

Instructively, Medical Laboratory Scientists by their training possess broad medical and analytical/technical competence in the Laboratory Sciences which could be exploited on further training to fulfil these established needs in the healthcare continuum. It is also noteworthy that this development is not far removed from the dynamics of modern healthcare practice which favour the integration of the diverse medical and healthcare teams in overall patient management. Diagnostic Mangement Teams (DMT) are a concept that have caught on in countries like the US. Their role includes reviewing decisions on diagnostic and therapeutic approaches with the aim of improving patient outcomes and maximizing every healthcare dollar spent! A typical DMT would include Medical Doctors (relevant specialties), Nurse Practitioners (DNPs/NPs), Dieticians, Pharm.Ds; but hardly a representative from the Laboratory. Odd, given that according to literature, 70% of medical decisions on patient care are based on Laboratory test results! These and many more set the tone and need for the Advanced Practice Doctorate in Medical Laboratory Science. The need for an expert who ’speaks the language of the Laboratory’. Someone to make sense of the reference ranges and limits of sensitivity and specificity, appropriateness of use, sources of interference (e.g. from diet, comorbidity, physical state, drugs etc.,) on laboratory test results; to name a few. This much needed advisory service is many times not available to Physicians who are the major consumers of Medical Laboratory services and consequently lead to under-utilization, particularly in test ordering and interpretation. Laposata and Dighe in their paper; "Pre-pre" and ”post-post" analytical error: highincidence patient safety hazards involving the clinical laboratory will help a curious reader better understand the statement of the problem.

The MLS.D is more clinical oriented with an expanded curriculum (advanced courses in Pathophysiology, Pharmacology, Evidenced Based Medical Practice, Advanced Laboratory Operations (Quality and Management) etc.,). In many African countries where there exists in the current MLS training structure, a pseudospecialisation of sorts at the undergraduate level; the added year as proposed would equally help cover relevant topics in all specialties of Medical Laboratory Sciences compared to the current state were students focus on one speciality (e.g Haematology or Chemical Pathology) in the final 5th year of study. This will undoubtedly contribute to producing better equipped and well-rounded generalist Medical Laboratory Scientists well positioned to make diagnostic sense of the emerging and re-emerging diseases that the world is perpetually burdened with.

The MLS.D will without doubt effectively capacitate the Medical Laboratory Scientist to improve test utilization (improving clinical outcomes and preventing wastage (literature abound on the problem of over-utilization and under-utilization of test results)).

PS Iran had commenced the Doctor of Clinical Laboratory Science degree since 1986!

Dr Brandy Gonsulus MLS (ASCP), DCLS; in her blog; Experiences on my Journey towards the Advanced Practice Doctorate in Clinical Laboratory Science (DCLS) recounts her real-life experiences as the first advanced practice DCLS in the US. She is proving with empirical evidence how the addition of a DCLS to the Diagnostic Management Team at her facility led to better clinical and economic outcomes (with calculated dollar savings from potential ‘over testing’).

This was literally her Doctoral thesis! It was also interesting to read about the support she is getting within the healthcare team, with Nurses inviting her to present seminars on proper sample collection; consultants inviting her on rounds to provide expert advise and how she saves healthcare dollars by reviewing physician test orders to guarantee the appropriateness of test selection etc.

Fantastic blog!

For further reading and background on the subject, I encourage you to read ASCLS Position Papers on Advanced Practice Doctorate in Clinical Laboratory Science

Now more than ever, with the COVID19 pandemic, the import of innovation and integration particularly in healthcare is reinforced; the central role of Laboratory testing in determination of health and diseased state further highlighted. I encourage all relevant education and healthcare stakeholders in Nigeria and elsewhere to assess this degree solely based on its merits and give it the push it deserves so that we can become one step closer to making this world a healthier place!

To conclude, a quote from Socrates; “The secret of change is to focus all of your energy, not on fighting the old, but on building the new.”

About the Author:

Emmanuel Omoviye (B.MLS, AMLSCN) is a Medical Laboratory Scientist and Diagnostics Sales Executive. He writes from Benin City, Nigeria.

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