ALBERTA COLLEGE OF
MEDICAL LABORATORY
TECHNOLOGISTS

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Position Statements

The College has developed position statements which establish the College’s viewpoint on medical laboratory science issues.

BRIDGING PROGRAMS FOR INTERNATIONALLY EDUCATED MEDICAL LABORATORY TECHNOLOGISTS (IEMLTs)

The national shortage of Medical Laboratory Technologists (MLTs) has been well documented by the Canadian Society for Medical Laboratory Science (CSMLS) as well as the Alberta College of Medical Laboratory Technologists (College). Alberta is suffering an increasing shortage of qualified Medical Laboratory Technologists due to an aging workforce. The current number of graduates from the training institutions in Alberta is insufficient to replace those who will retire.  

 
IEMLTs are one source of technologists to help alleviate this shortage. The process to achieve national certification is arduous. IEMLTs typically have a much lower success rate when challenging the certification exams as compared to those individuals who have completed a formal training program at an accredited institution in Canada.
 
In recent years, a limited number of bridging programs for internationally trained technologists have been established. To date, graduates from these programs have had a much higher success rate on the national certification exam. The College endorses the concept of bridging programs for internationally trained technologists. Any such program should be flexible enough to meet varying needs of individuals. Workplace related English language proficiency and a clinical practicum are required as essential components of a bridging program. 
 
The College strongly encourages provincial and federal governments to support development and ongoing operational funding of bridging programs for IEMLTs.
 

HUMAN RESOURCES AND WORKPLACE CHALLENGES

The College recognizes there are challenges related to human resources within the health care profession. Due to an aging population the laboratory workload increases while the number of trained technologists declines.

 
The College acknowledges that workplace stresses are increasing and include:
  • loss of experienced staff,
  • insufficient number of qualified replacement staff,
  • shifting ratios of full-time/part-time/casual staff,
  • increasing workload and overtime expectations,
  • inadequately trained staff, 
  • restructuring without adequate re-training,
  • shifting value systems/expectations relative to acceptable life/work balance, and 
  • increasingly stringent safety demands.
The College Standards of Practice (2005) state, “…the setting or environment where medical laboratory technology is practiced should provide the organizational, human support systems, and material resources to enable MLTs to practice in [a] safe, competent, and ethical manner…” 
 
The College supports strategies including the following:
  • Enhanced system capacity for clinical placements.
  • Bridging programs for internationally educated medical laboratory professionals and those wishing to re-enter the workforce.
  • Established systems and processes to recognize graduates of post secondary programs of study in areas specifically related and relevant to a clinical diagnostic laboratory area. 
  • Promotion of regulation of Medical Laboratory Assistants to enhance the pool of consistently trained medical laboratory professionals.
  • Recruitment and retention of qualified professionals. 
The College supports and fosters strong and positive working relationships between employers, government, training institutions, unions, regulated members, regulatory, and certification bodies in order to develop strategies to address workplace challenges in the medical laboratory. An open and collaborative approach is fundamental in achieving a workplace environment that ensures patient safety and public protection.
 

MEDICAL LABORATORY ASSISTANT AREA OF PRACTICE

Medical Laboratory Assistants (MLAs) play a vital role in the provision of laboratory services in Alberta.

As the national certifying body for medical laboratory professionals, the Canadian Society for Medical Laboratory Science has defined the entry level competencies for MLAs.  The MLA competencies concentrate on the pre-analytical phase of laboratory testing, including specimen collection, specimen preparation and data entry.
 
With technological advances and workforce shortages, there is pressure to broaden the MLA area of practice.  It is the position of the College that MLAs must:
  • have formal training in a recognized program that includes both didactic and clinical training to gain the appropriate knowledge, skills, and abilities,
  • meet the Standards of Practice for Medical Laboratory Assistants, and
  • maintain competency in their areas of practice.   
The Health Professions Act states:
46(1) A person must apply for registration if the person . . . 
46(1)(b) intends to provide one or more of the following:
46(1)(b)(ii) . . . [conducting of laboratory tests that are used by other regulated members] to provide professional services directly to the public.
 
It is the position of the College that anyone conducting medical laboratory tests must be a regulated health professional.
 
Public protection and safety are paramount. Medical laboratory professionals with appropriate knowledge, skills, and abilities are essential for public protection and safety and for achieving our vision.
 

POINT OF CARE TESTING

Point of Care Testing (POCT) is an alternative to central or core laboratory testing that is performed near the patient, predominantly by non-laboratory healthcare personnel. Potential benefits to POCT include: improved turnaround time, reduced time to diagnosis, treatment and length of stay, improved patient outcomes, and lower overall costs. POCT is made possible by the technological advancements that have produced portable, easy to operate instrumentation that can rapidly deliver high quality test results through the use of whole blood technologies. Effective management of these advancements continues to necessitate the inclusion of Medical Laboratory Technologists in an important leadership role.

Successful POCT programs require thorough planning, implementation and evaluation. The initial step required for implementation is the formation of a multidisciplinary POCT Steering Committee. This collaboration sets the stage for cross-discipline communication and resolution of Point of Care issues. The committee’s role includes the evaluation and determination of:

  • medical necessity for testing
  • potential improvements for patient outcomes
  • standardization and performance verification of available technologies
  • testing frequency and utilization
  • certification and staffing requirements 
  • effective cost management
The POCT Steering Committee must adhere to both the accreditation requirements set forth by the College of Physicians and Surgeons of Alberta 1 and the Alberta Health and Wellness Guidelines established for POCT 2.
 
Clinical laboratories must focus on assuring continuous quality of all laboratory testing. The laboratory must work collaboratively with other healthcare personnel to establish a quality management program that includes:
  • developing, maintaining, and reviewing appropriate training and competency programs 
  • developing written procedure manuals
  • establishing and monitoring appropriate documentation
  • establishing and monitoring quality control practices
  • implementing and auditing internal and external proficiency testing programs
  • ensuring compliance with equipment management protocols
POCT is a unique opportunity for Medical Laboratory Technologists to work collaboratively with a broad scope of healthcare professionals by providing strong clinical laboratory expertise and leadership.
 

RESTRICTED ACTIVITIES

Medical laboratory technology is a distinct area of practice recognized by the Health Professions Act (HPA). Only those health professionals regulated by the HPA can perform restricted activities as outlined in their Regulation. Restricted activities are set out in the Government Organization Act (GOA). 

The Alberta College of Medical Laboratory Technologists (College) regulates approximately 2400 medical laboratory technologists (MLTs) practicing in Alberta. Up to 85% of physician diagnosis and treatment decisions rely directly upon laboratory test results reported by MLTs. 
 
Currently, the MLT Profession Regulation does not encompass restricted activities. Laboratory medicine, like other health disciplines, has become increasingly complex during the 10 years since the restricted activities list was first drafted by government. The College believes that there are areas of laboratory technology that should be recognized as restricted activities with the goal of enhancing the protection of Albertans.
 
The College has identified proposed revisions to the restricted activities as set out in the GOA and the MLT Profession Regulation of the HPA using the following criteria: 
  • Where there is a well documented risk of potential serious harm to the patient, including the risk of debilitating injury or death;
  • Where there is minimal correlation between the laboratory result and the clinical picture to alert other health care providers when a mistake may have occurred;
  • Where the test itself is subjective in nature, requiring unique knowledge, skills, and experience to ensure accurate results.
 
Based upon the above criteria, the College supports the proposed amendments to the GOA that would define the following activities as restricted to qualified health care professionals:
  • Drawing venous blood;
  • Reporting an ABO blood grouping for the purposes of transfusion or transplantation;
  • Performing and reporting manual cell identification of fixed cell samples and cerebral spinal fluid samples;
  • Selecting appropriate or representative tissue or cell samples for investigation;
  • Reporting antibiotic susceptibility;
  • Adding a definition for reporting (to release a test result verbally, electronically, or in writing to another health care professional for the purposes of patient diagnosis or treatment)
Additionally, the College supports proposed amendments to the current MLT Regulation because there are activities that MLTs perform within the course of their regular duties that align with the existing restricted activities listed below. 
  • To cut a body tissue (capillary blood collection). . .  below the dermis; or other invasive procedure on body tissue
  • To prescribe, compound, or administer blood or blood products.1
These amendments will enhance the protection of Albertans by restricting the performance of the activity to regulated, qualified professionals who have met the requirements of their regulatory College in the performance of that activity. 
 

REGULATION OF MEDICAL LABORATORY ASSISTANTS (MLAs)

Medical Laboratory Assistants (MLAs) play a crucial role in the present health care industry. MLAs work in a variety of front line clinical laboratory settings (hospital, private, and research laboratories) and assist in a number of disciplines, which makes the nature of their work very distinct and diversified.

The Health Professions Act (HPA) legislation was enacted to ensure public protection and safety in the health sector. This legislation mandates health professionals recognized under the HPA to demonstrate continuing competence and empowers the College to take disciplinary action against its regulated members if their practice has been deemed incompetent.

MLAs comprise approximately 40% of Alberta’s laboratory workforce. Since MLAs are not recognized under the HPA, neither the College nor any other regulatory body has jurisdiction to ensure minimum standards of training, competence, or ethical practice.

MLAs possess a body of knowledge, skills, abilities, attitudes, and expertise that is unique to their practice and, moreover, one that continues to increase in breadth and depth in large part due to the following requirements:

  • Skills and abilities related to invasive procedures performed on the public involving risk of physical harm.
  • A minimum skill set for the performance of a variety of pre and post analytical tasks, critical for sample integrity and in ensuring accurate and reliable test results being reported in a timely manner. Performance of limited analytical testing.

College Council values the contribution of MLAs to laboratory service delivery and appreciates the significance of the MLA practice on patient outcomes. As such, the College supports the recognition of MLAs as a professional technical support group under the HPA. It is anticipated that the demand for MLAs in Alberta will continue to grow and that their practice will further evolve. Recognition of MLAs under provincial legislation and self- regulation will ensure adherence to the HPA mandate of “Public Protection”.

SAFE PRACTICE

There is growing recognition of the impact of unsafe acts and medical errors on the health and well-being of the public. Various organizations support the creation of a culture of patient safety within all sectors of the healthcare field.

Medical laboratory practice is integral to the healthcare of the public. Medical laboratory professionals employ strategies to manage and enhance safe practice, protecting members of the public and healthcare professionals.

Quality systems for infection prevention, infection control, and safety are essential elements of the medical laboratory professional’s knowledge and skill requirements for competent practice. Through the College Code of Ethics and Standards of Practice, medical laboratory professionals commit to a culture of patient and workplace safety.

SUPERVISION

The College regulates medical laboratory professionals with public protection and patient safety as its guiding principles.

Medical Laboratory Technologists are subject to the following legislation:

  • Health Professions Act
  • Medical Laboratory Technologist Profession Regulation
  • Government Organization Act

Conditions may be applied to a regulated member’s practice permit by the Registrar or the Registration Committee, in accordance with current legislation.

Practice permits may be subject to conditions, one of which may be supervision. Supervision is defined as:

  • Direct supervision – regulated member with an appropriate practice permit is physically present and available to assist and/or consult.
  • Indirect supervision with reasonable access – regulated member with an appropriate practice permit is available for consultation and is able to return to the worksite within a reasonable time to assist.
  • Indirect supervision – regulated member with an appropriate practice permit is available for consultation.

Laboratory test results have a direct impact on the diagnosis of disease and on patient treatment and follow-up. The College recognizes the need for supervision in appropriate circumstances to ensure patient safety and public protection.

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