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Simulation Training Advocated by Canadian Lab Group to Expand Number of Lab Professionals

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NEW YORK (360Dx) – Faced with increases in lab testing and a shortage of lab personnel, the professional association for Canada's medical lab workers is turning to simulation as a means of training more students for laboratory employment.

The Canadian Society for Medical Laboratory Science is looking to build a library of simulation tools, techniques, and best practices that academic laboratory training programs across the country can use to supplement their curriculums, particularly in areas of laboratory science where training resources are stretched thin.

"We have a system under pressure because nobody wants to orient or onboard staff anymore. They would like them to be ready to graduate on Tuesday and work the night shift on Wednesday," Christine Nielsen, CEO of CSMLS during a presentation at the Clinical Lab Management Association KnowledgeLab conference in Long Beach, California last month.

One key issue, according to Nielsen, is the challenge of providing students with clinical placements, in which they get hands-on training in labs. A survey of educators three years ago found that there has been a consolidation of laboratories into mega labs in Canada, particularly in fields such as clinical microbiology and histopathology, in which specimens have a "fixing" or incubation period, and can incubate on the journey to labs that are farther away. That consolidation of laboratories left fewer spots available for clinical placements for students.

"We were seeing some amalgamation, and that was three years ago, where people were saying we don't know how we are going to begin to give all the students their clinical placements in these disciplines," Nielsen said in a phone interview. "As a national body, we also know that only about 5 percent of our members work in histopathology, but we train 100 percent of them to work there, so that might be an area where a national simulation curriculum could help set expectations for both students and educators."

In addition to the challenges posed by lab consolidation, the laboratory industry faces broader trends that add to employment pressures. In a "backgrounder" on its website explaining the origins of the simulation project, CSMLS notes that in 2010, the Canadian Institute of Health Information estimated that approximately half of all medical laboratory technologists would be eligible to retire within 10 years.

Along with the reduced numbers of lab personnel, the lab industry is also facing more testing and more types of complex testing, according to Nielsen.

"In the province where I'm from, Ontario, we had expected a 2 percent increase in testing, and we have actually seen a 4 percent increase in testing," she said. "Ontario is the most populous province in the country, so even doubling the expected number of new tests has an impact on staff."

The simulation project is somewhat inspired by the National Council of State Boards of Nursing study conducted in the in the US, which randomized incoming nursing students from 10 prelicensure programs into three groups: a control group that offered students the traditional clinical experience, 10 percent of which is spent in simulation; a second group in which students received 25 percent of their clinical hours through simulation; and a third group in which students received 50 percent of their clinical hours through simulation.

"Simulation is only as good as the training of the individual, like any teaching modality, but what they were able to find out after the students finished school, had written the board exams, and started practice was they couldn't tell which students came from which cohort. There was no major difference in satisfaction, performance, and employer opinions, thus leading us to believe this may work for us too," Nielsen said.

CSMLS, which is also the national certifying body for medical laboratory technologists and medical laboratory assistants in Canada, hopes simulation can help increase the number of academic seats by about 400 within Canada to fill current shortages and replace those expected to leave by retirements in coming years, according to Laura Zychla, a CSMLS researcher.

One of the surveys of the laboratory industry that CSMLS conducted from 2015 to 2016 found that the amount of clinical placement hours required by laboratory training programs varies widely, from about 700 hours per student to about 2,000 hours per student, with a median requirement of around 1,225 hours, Zychla said.

"There is great movement that can happen on the top half of those academic programs, where they can reduce their [required] hours through simulation and benchmark themselves against the median number," she said.

The collection of resources that CSMLS will include in its simulation library, or database, will be submitted by the different academic institutions, Neilsen said. The type of simulation content that will eventually be included may include images of hematology slides rather than actual hematology slides, and case studies, or descriptions of how different lab scenarios have been simulated using actors or models.

"We are kind of leaving it up to the partners, who are the educators, to decide what is most important to them. We may have a small lab program in northern British Columbia that doesn't do a lot of immunohistochemistry or flow cytometry — those are newer techniques within the last 20 years. That might be a place where that school needs to simulate that curriculum," she said. "We are hoping different types of content will be made available and accessed on a needs basis."

In addition to providing simulation content in specific lab disciplines, CSMLS expects that the library it is creating could provide tools and techniques for developing the "soft skills" involved in coping with the demands of conducting complex testing in critical situations, Zychla said.

"When that phone rings and someone is asking for an urgent or STAT diagnostic test, how is the student able to handle that? That might not be something that the student is exposed to right away, but the ability to jump in where they have never had that pressure on them before is important to start learning," she said.

CSMLS will not independently evaluate the simulation content included in its library but plans to encourage schools that submit content to provide as much data and evidence to support the content as possible, along with contact information so that those interested in using the content can follow up to receive more information, Zychla said.

"That's not to say that we won't take a scenario that hasn't been validated, but it should be vetted to a certain extent through stakeholders. Someone might still find value in a case study because they can modify it as a means to an end, or they can modify the study for themselves within their own academic program," Zychla said.

For CSMLS, the process toward developing a national body of knowledge on simulation began in 2015 and 2016 when the organization conducted a survey of laboratory medicine programs to assess how their academic and clinical placement programs were structured. That study was followed by a survey of recent college graduates to evaluate how they felt about their clinical placement experiences, Zychla said.

The results of those surveys were shared with academic programs that participated in a forum on the use of simulation in education held in 2016. Following that forum, representatives from 13 academic programs agreed to participate in the CSMLS Simulation Research Network to share ideas on simulation, according to Zychla. In 2017, CSMLS held a forum for employers, to understand what their needs were and better assess the skills that employers expect students to develop through clinical placement, she said.

The board of directors of CSMLS made available C$150,000 ($116,000) to reimburse stakeholders who were interested in participating in the simulation dialog but needed assistance to travel to participate in the forums. The association has also received C$25,000 in seed funding from the University of Ontario Institute of Technology to begin to fund work involved in establishing a database of simulation information, Zychla said.

CSMLS, in conjunction with its Simulation Research Network and with the University of Alberta, is also applying for a government grant from Canada's Social Sciences and Humanities Research Council for funds that would help institutions conduct studies to test different models for simulation and for further funds to support the database that will house the library of simulation resources, according to Zychla.

CSMLS is hoping to have a portal created to house simulation content by the end of March 2019, Zychla said.

One school is already planning to do a small simulation pilot study with only eight students in September that will use simulation to reduce the number of placement hours, Nielsen said, though she declined to name the school. It is using its own funding sources for its pilot study without waiting for funds from the SSHRC grant application, according to Nielsen. Some others schools that are members of the Simulation Research Network already have components of a simulation curriculum that they have indicated they are willing to share with other programs. CSMLS hopes the library it is creating will eventually include a wide variety of simulation content, including content that already exists in addition to content that may be created with the help of government funding.

"They have the curriculum, they just don't have the place to put it, so once we get rolling and have a place to put it, we could have contributions that are even outside the project," Nielsen said.