Stepping into the Lab

Laboratory medicine is a vital part of healthcare around the world. According to the CDC, 14 billion medical laboratory tests are carried out in the United States every year. To put this into perspective, fourteen billion seconds is 444 years (1). 

To ensure that we are meeting the ever-increasing need for more laboratory testing in medicine we need more workers. However, there is a major barrier to recruitment: the general perception of laboratory medicine as the “hidden profession of medicine.” 

Here’s an example of how this manifests. According to the Bureau of Labor Statistics, we need to recruit 24,200 new medical laboratory scientists (MLS) or medical laboratory technicians (MLT) every year over the next decade (2). But, in 2022, only 7,400 new MLT/MLS graduated (3,4). 

I believe we need to actively negate our “hidden profession” status – and we need to start in our high schools. Here, I share my experience of inspiring high school students to become the next generation of laboratory medicine professionals via in-person work-based learning opportunities with local/regional medical laboratories.

What is work-based learning?
 

According to one definition from New York State, work-based learning is “the umbrella term used to identify activities which collaboratively engage employers and schools in providing structured learning experiences for students. These experiences focus on assisting students develop broad, transferable skills for postsecondary education and the workplace” (5). 

Unfortunately, that definition fails to exemplify what specifically counts as work-based learning. Quality in-person work-based learning opportunities are things like guest speaker presentations with real skill-based activities, interactive field trips, shadowing and internship/co-ops. Each of these provides increasing levels of inspiration for entering the field. 

Now let’s discuss what this approach looks like for laboratory medicine careers.

Work-based learning for medical laboratory careers
 

According to ASCP’s What’s My Next site, there are 11 medical laboratory careers – ranging from phlebotomist and medical laboratory assistant (MLA), through various technician and technologist roles, to pathologist and laboratory director. This presents a wide range of career possibilities that a student may find interesting, depending on how long they want to remain in education, their preferred level of contact with samples, and the skillsets they have. We need to help expose them to these careers while they are in high school and provide them with the opportunity to consider these paths. The goal would be having tens of thousands of high school graduates planning a career in laboratory medicine.

I teach the two-year Medical Laboratory Assisting and Phlebotomy program to high school students through Monroe 2-Orleans BOCES Career and Technical Education, based at WEMOCO CTE Center in Spencerport, New York, USA. Along with theoretical content knowledge and skills for the collegiate level, the program teaches employable skills for work in medical labs, the value of which cannot be overemphasized – it really sets our students up with a deep understanding of the possible career paths. 

The students also gain real experience working in external laboratories, where they can test their new lab skills, as part of 120 hours of co-operative education programs (co-ops). And we arrange guest speakers and industry mentors to help the students create a professional network.

My students leave high school already qualified for industry certifications like phlebotomy and MLA as well as cardiopulmonary resuscitation and automated external defibrillator (CPR/AED). To quote my colleague, Cindy Christensen (BOCES 2 CTE Career Readiness Coordinator), about the potential of work-based learning: “Jim’s extraordinary efforts in fostering industry connections illuminate the path for his high school students, demonstrating that, with dedication and vision, the possibilities for their futures are limitless." 

WBL Level 1: active engagement with guest speakers
 

We need laboratories – or even individual laboratorians – to reach out to local or regional high schools to offer guest speaker presentations. Ideally, this would be during a career day or a biology class. The presentation should provide career information, engaging simulations of laboratory work, and take-home materials. A lot of these materials are provided by ASCP’s Career Ambassador program (see whatsmynext.org for flyers).

Let me provide some great examples of powerful guest speaker presentations that have inspired my students. Hilary Haefner from UR Medicine, presents on the pathologists’ assistant role, then follows up with a hands-on component where the students perform H&E staining, along with permanent cover slipping, on pre-prepared slides. Not only do the students have a blast, but many have gained interest in the tissue preparation and analysis side of the laboratory from her presentation. 

Another example comes from Adam Tegnander from SUNY Cobleskill’s histotechnician program, who likes to bring in his “bucket of guts” to show the students. Through examining a bunch of diseased human organs, the students learn about histotechnology – then they get to try out Adam’s microtome.

These are incredibly powerful experiences for illustrating to students what a medical laboratory career looks like and are great for encouraging them to further investigate the career options.

WBL Level 2: interactive field trips
 

When labs are setting up guest speaker presentations, they should also offer to have students visit their laboratory via a field trip. A great example of a full-day field trip is one we do with Catholic Health Laboratories in Buffalo. Laboratory Director Kenneth Martin III sets up a patient case study that the students can discuss over breakfast. Then they put on lab coats and gloves to tour the laboratory, listening to laboratorians talk about each of their sections of the lab and trying several hands-on stations. They might perform specimen preparation with labeling and organizing tubes, streaking bacterial plates, and adding fake samples to various analyzers. 

Over lunch, the students can discuss the results they found in each section of the laboratory and how that helps to diagnose what is going on with the patient. They love seeing all the analyzers, learning how diseases are diagnosed, and imagining themselves working in the laboratory. Field trips like this have really helped my students solidify their interest in pursuing a medical laboratory career.

WBL Level 3: shadowing (the personal field trip)
 

Having now introduced students to laboratory medicine careers, we need to guide them towards the right career for each individual. Considering the myriad of sights, sounds, and smells in a medical laboratory – they need to know what they can tolerate before spending the time, money, and energy training for the next qualification. 

A shadowing experience should give the opportunity to observe a laboratorian at work while they explain what they are doing and answer the student’s questions. Ideally this experience would total around 8 hours, to increase the students’ chances of finding something cool and interesting. They should come away with a good understanding of a day in the life of a laboratorian, having observed a variety of interesting samples or diseases being diagnosed – maybe even an emergency room patient being saved by a blood banking crossmatch.

An example of this from my class is our pathologists’ assistant shadowing experience. Our students will spend 3 hours in the gross room as tissues come in from surgery, observing the pathologists’ assistant dissect the sample, describe what they are seeing, and select samples that will be turned into slides. Often, as the other pathologists’ assistants receive an interesting sample, they will call my student over to watch them work on the case. 

The student will then spend an hour or so with the histotechnicians and histotechnologists, watching how they create slides and perform IHC testing. After lunch, our students participate in a post autopsy conference, where they hear the discussion of how the patient died at the hospital while seeing the actual organs on the table. This experience has helped some of my students know that a pathologists’ assistant career is for them – and helped one decide that she could not handle the smell and sight of some of the diseased organs. 

Allowing students to be in situ before career decisions are made is extremely important and helps them plan for their next steps to reach their goal.

WBL Level 4: internships/co-ops
 

I believe the best way for students to truly be inspired is to help them develop practical laboratory skills that they can use immediately in their future work or studies. My students learn skills in phlebotomy, microscopy, histology, staining, plating, biochemical techniques, PCR, immunology, clinical chemistry, and urinalysis. To quote Earl Bartz (Rochester Regional Health Lead MT for night shift), “The need for students with this type of education is immense. This program serves as the only access point to laboratory-related fields for this region’s high school students.”

To ensure that students test their skills in the real world and earn national certification in phlebotomy and medical laboratory assisting, we arrange co-ops (aka internships) in local labs. Our students spend 40 hours drawing the blood of actual patients for their medical samples with an UR Medicine or Rochester Regional Health trainer by their side. 

Prior to the co-op, my students had only drawn blood on a phlebotomy training arm that has tubing matching human vasculature. The trainers work with my students to quickly ramp them up to being independent on their blood draws and my students generally have between 80 and 140 successful venipunctures with a 90–99 percent success rate. 

As an example of how skilled they are, one student was initially refused permission to draw blood on a cancer patient. The patient stated they had difficult veins, and they needed this sample for their cancer treatment, so they wanted the trainer to draw their blood. The trainer tried twice and failed twice. The patient then said that my student could have a try, and they were able to get the sample on their first attempt! Our students enter their co-op experience timid and leave very confident that they can get a sample from any patient’s vein. 

Another example of an unpaid training co-op that my students are part of is working in a medical laboratory as an MLA. During this co-op, our students are trained as if they were new hires to the organization – learning accessioning, aliquoting, add-ons, racking, supply chain/stockroom, answering phones, and even how to use the fax machine. 

A number of my former students started working as MLAs immediately after graduation and are now training current students! Several of these MLA graduates are planning on going back to school for MLT or MLS roles after working for a year or more. 

Now at this point, I expect that many of you reading this are wondering how I could possibly have juniors in high school drawing blood from real patients for the medical samples or having seniors training to work as MLAs. Let’s discuss what I had to do to make this happen in Rochester, New York.

Making it possible
 

When I started my public high school medical laboratory program, and started seeking in-person internships for students, there was initially a lot of push back from industry. They just wouldn’t consider training anyone under 18. Since high schoolers are often not 18 until the end of the senior year, if not after, this meant that I could not get my students the external experiences required for certification in phlebotomy or medical laboratory assisting.

Eventually, in March of 2020, I had a breakthrough. My collaborator, Melissa Allen, was promoted to Vice Chair of Administration and Senior Director of Laboratory Services for UR Medicine Laboratories. In partnership with her Director of Education, Vicki Roberts, they were able to leverage the organization’s legal team to make this happen. After several months of work, we had a legal agreement between my district and UR Medicine for my students to do a 40-hour phlebotomy training co-op with their phlebotomy trainers. The agreement included provision for my high school juniors to draw the blood of real patients for the actual medical samples. 

We then leveraged that experience to gain agreement for our students to work in UR Medicine’s laboratory as MLAs through a similar but much faster process. 

I was then able to take this process to Rochester Regional Health and ask if they wanted to support our students similarly. They were able to make the legal agreements work in only 6 weeks! 

With the help of these forward-thinking labs, the students have gained confidence in themselves and their skills and confirmed laboratory work as an appealing career. I cannot explain how thankful I am to UR Medicine and Rochester Regional Health for taking a chance and putting the hours in to make this happen.

What are the benefits for laboratories?
 

The lab employees who are supervising the students are benefiting from the personal development – and satisfaction – that comes with training and mentoring. Meanwhile, labs are building a reputation with the student that, if positive, is more likely to have the student come back from their college program wanting to work for the lab that they trained with. Finally, by having students train with the lab’s staff, the labs essentially have a 40-hour “try before you buy” period to assess a candidate’s employability. 

Imagine the benefits of hiring a ready-trained employee! Kenneth Martin III (Catholic Health Laboratories Director) said that he “would not hesitate to hire anyone who has completed the program. The clinical laboratory industry needs more programs like this one to champion the field and provide a highly educated and motivated workforce to serve the needs of our patients.”

My students are regularly offered both phlebotomy and MLA jobs directly out of high school as a result of their co-op experience. Sara, one of my first phlebotomy co-op students, successfully drew blood from 103 patients, with 74 being geriatric patients, and earned her American Medical Technologists (AMT) certification as a registered phlebotomy technician. She returned to work for UR Medicine after graduation as a phlebotomist and eventually became a phlebotomy trainer. 

Jordan was one of the first students to benefit from the MLA co-op, earning her certification from AMT as a MLA. She then was immediately hired by UR Medicine as a laboratory support technician II – which usually requires a 2-year college degree – and rose to a laboratory support technician III after some additional training. She now teaches my MLA co-op students and has become a young leader in the laboratory. 

Her friend, CeCe, initially went to school for vet tech but, after a few months, realized she missed the laboratory. She came back to UR Medicine to work as a laboratory support technician II and is now going to college for MLT. 

These young women had positive experiences with their co-ops at UR Medicine and felt they had proven their skills, so this is a role they wanted to follow. To quote Colleen Moran (Rochester Regional Health Supervisor for Training and Education) about their co-op for phlebotomy, “The curriculum and expectations that James has put in place for his students sets a higher standard. Our team has noticed that his students perform at a much higher level of knowledge, skill, and professionalism than you would expect from high school students.”

What are the benefits for college programs?
 

CeCe’s experience demonstrates the power of a positive work-based learning opportunity to cement in the mind a strong desire to work in a laboratory. And it follows that college programs should see that those students doing medical laboratory work-based learning are a step above typical entrants.

Over the last 15 years, we have built a strong reputation with colleges throughout my region of New York State as a premier program for developing new medical laboratory professionals. I have expanded my reach to downstate New York and even to other areas of the country, such as Florida. My students, due to their extensive knowledge and skills, are more likely to be selected for programs because colleges know that they are more likely to stay and graduate. 

Matthew Schoell (Nazareth College’s CLS Program Director) said of our program, “What their program has done to contribute to solving this problem is so fundamentally necessary. They help the students see themselves in these careers, and that vision of themselves is so critical to whether students enter the field.”

I have one student that I love to brag about when I am speaking about how college programs (and employers) can benefit. Rachel entered my program planning on being a radiology tech. She listened to a guest speaker – Earl Bartz of Rochester Regional Health – about MLT/MLS, and immediately fell in love with laboratory careers. A field trip to the medical laboratory sealed the deal – she went to Nazareth College’s CLS program and did wonderfully. 

Four years later, Rachel graduated and earned her ASCP MLS certification – and ended up working for Bartz at Rochester Regional Health.

Call to action!
 

In the last 15 years, our program has drastically changed the perception of local employers, laboratory leaders and colleges. Numerous CEOs of the major medical laboratory organizations and hospitals now regard young people as one part of the equation for solving the workforce shortage. 

We all know that everyone learns best from doing. It is my opinion that we need as many students as possible to be immersed in the laboratory environment to see if this is where they belong, so they enter college or employment with a more informed decision. At a minimum, students should be shadowing in labs and, ideally, following an extensive laboratory training program like my public high school MLA and Phlebotomy program. The more laboratory experience they have, the stronger is their drive to be successful. 

I think that Vicki Roberts (UR Medicine Labs Director of Education) says it best: “Providing training for the BOCES 2 CTE students in our laboratories is very rewarding. They arrive excited to be here, well prepared, and engaged in the process. Our staff have indicated that training the students is a bright spot in their workday. We have also hired some graduates of the program and find them to be well prepared to work in these roles.”

I will end with a question…how will you make this a reality in your area?