Across the Universe: May 2012

Updated: 5 Jan. 2019 (Fixed links)

Interested in the process of qualifying to practice in Canada and how long it takes?

Latest: Anyone wanting to come to Canada as a med lab technologist/scientist, please see

Canadian Govt - Immigration & Citizenship
CSMLS Prior Learning Assessment

That said, it's really hard, almost (not quite) impossible, and takes a long wait time of years. Read on for all the gory details and also read the many comments at the blog's end.

NOTE: Comments are closed for this blog.

EARLIER BLOG
See this example of one Canadian province's process:

NEW: College of Medical Laboratory Technologists of Alberta (CMLTA) 2014 Annual Report

CMLTA is the regulatory body in the Canadian province of Alberta. Among other roles, the College protects and serves the public, patients, and its members by setting entrance to practice requirements.

In particular note the middle column on p.17 beginning:

'Registration as an IEMLT in Alberta is a two-step, process which involves the CSMLS and the College. Initially IEMLTs, are directed to the CSMLS to undergo a Prior Learning Assessment (PLA) which involves the submission of supporting, documentation and the assessment of, academic credentials, language proficiency, clinical training, and professional work, experience.'

The Alberta report gives a sense that the process for those internationally educated is lengthy and requires much paperwork and patience. I suspect it's similar in other Canadian provinces.

Dark Daily reports, "Medical laboratory technologists with foreign credentials to get fast-track acceptance in Canada."

Unfortunately, this headline and accompanying article are misleading, at least so far as medical laboratory technologists are concerned (cannot speak to the situation for other health professionals).

If I were asked about foreign-trained technologists from the USA, UK, Australia, and New Zealand, where English as a second language is a non-issue, and where education and training are world class, here's what I'd say:

All the fast-tracking in the world won't help.

USA GRADS
First, besides clinical chemistry, hematology, clinical microbiology, and transfusion science, Canada's general certification exam requires education and a clinical rotation in histotechnology. Thus USA grads do not qualify.

Second, subject certification for USA grads in the other 4 main disciplines is out because Canada offers subject certification only in clinical genetics technology and diagnostic cytology. Reasons that CSMLS does not offer subject certification in other disciplines include

Cost (subject exams are costly to maintain)
Employer need for flexible grads who can work in all disciplines
Fear that employers may use those with subject certification to work in lab sections for which they are untrained

Accordingly, the path to employment in a clinical laboratory for a US-educated and trained medical technologist / clinical laboratory scientist is onerous:

Step 1: Attend an educational institution (Canada or US) and take a course equivalent to a histotechnology course taught at Canadian institutions. For example, see 5 MLS disciplines at the University of Alberta.
Step 2: Convince a potential employer to provide a clinical rotation in histotechnology. In Canada this is ~4 weeks. And it's next to impossible because employers can barely offer clinical rotations to Canadian-trained students.
Step 3: Apply to CSMLS for a 'Prior Learning Assessment'
Step 4: If eligible, arrange to write the CSMLS general certification exam covering the five disciplines specified on the CSMLS website (link above).

Be aware that the CSMLS exam is based on a competency profile.

UK, AUSTRALIA, NEW ZEALAND

Background

In my experience, education and training in the UK and 'Down Under' exceeds that of the typical Canadian graduate, since Canada rejected the BSc as entry-level several years ago.

People who did not support the BSc were employers (private labs and public hospital labs, both govt-funded) and bureaucrats in provincial government departments of health.

Reasons for rejecting the BSc varied. But in my opinion, employer and bureaucrat rationales were biased: they perceived making the BSc entry level for nurses as being credential inflation leading to increased salaries without sufficient return on investment. They were determined to stop this happening in the case of medical laboratory technologists.

Accordingly, employers wanted the cheapest possible medical laboratory technologists, those who could be 'turned out' as quickly as possible and paid as little as possible. In their short-sighted view, with the move to increased laboratory automation and centralized testing, who needed a highly educated technologist whose education and training took 4 years?

Exception

For interest, the only (see correction below) Canadian program that provides both a BSc and professional certification by the CSMLS is the MLS program at the University of Alberta (UA). The first BSc (MLS) degrees were awarded in 1961. MLS also offers a post-diploma BSc.

Correction (9 May, 2012): The University of Ontario Institute of Technology - now Ontario Tech University - which opened in 2003, offers a Bachelor of Health Science (Hons) in MLS that also provides both a BSc and professional certification by the CSMLS.

All other Canadian programs are 2- or 3-yr diploma programs at technical institutes or community colleges (equivalent of USA 'associate degrees').

Focusing on the UA program where I taught for many years, UA MLS grads are eligible to write the American MT(ASCP)* exams and many have upon completing their degree. [*To change once the ASCP's Board of Registry and NCA merge to form a single US certification agency.]

This allows MLS grads from UA to work in the USA and many did during the mid-90s when laboratory jobs greatly decreased in Canada and many educational programs closed.

As well MLS is the only Canadian program whose grads are eligible to work in NZ without writing exams. They have extensive international mobility, which is how it should be.

NOTES:

1. Although many Canadian diploma holders have a BSc and later obtain a med lab tech diploma (to gain employment more easily), their initial BSc is seldom the equivalent of a BSc in MLS. As one example, few non-MLS BSc degrees inculcate quality assurance and quality system concepts the way that MLS degrees do. And it's tough to grasp quality concepts in short diploma program, especially when introducing so much new knowledge related to transfusion, hematology, etc.

2. An addendum stimulated by one of the blog's comments below ("the trend in Canada to "dumb down" medical science"): Personal reflections on Canada's med lab technology / science scene:

Discussing this topic is cringeworthy but I think it's necessary. Having taught 100s of medical technologists who obtained diplomas or bachelor degrees over the years and worked with dozens more, I must comment on the view that Canada has a 'dumbed down' system, particularly if it is misinterpreted to imply that Canadian clinical labs and all their staff are not world class. They are.

Because the norm in Canada has always been been diploma programs, those wanting to work as medical laboratory technologists attended 2- and 3-yr technical institutes and community colleges.

The professional society (now CSMLS) developed an internal route for laboratory technologists to progress in their careers, certification as 'Advanced Registered Technologists' (ARTs). Because subject certification was then possible in all 5 disciplines, technologists could obtain subject ARTs, as well as a general ART (encompassing 3 disciplines).

Initially, the ART was obtained by a combination of continuing education credits, writing a literature review followed by a research project, writing the paper, and defending it in a oral examination. Latterly, written examination was an option to the research project. In many ways the ART simulated a masters degree.

By tradition, supervisors, managers, and other senior personnel were ideally required to have an ART. However, one big problem existed: Sadly, no one outside the clinical laboratory recognized the ART. Eventually, fewer and fewer candidates applied for ART certification and in 2011 CSMLS began to phase them out, with the last certifications by the end of 2014.

Another issue is how medical laboratory technologists are viewed by other health professionals. Many members of the health care team have bachelor degrees, including nurses (RNs), pharmacists, physiotherapists (where entry level is now a MSc). Since qualification prejudice continues to exist (consider how many physicians think of PhD holders), this affects how some view the credibility of diploma-holding medical laboratory technologists to be full partners on the health team.

Canada's clinical laboratories staffed by a combination of diploma-holding technologists (some with non-MLS degrees), technologists with a BSc in MLS (e.g., UA grads), ART holders, MSc and PhD level scientists, and directed by physicians, are some of the best in the world. Examples:

Sunnybrook in Toronto, developers of the Bloody Easy programs.

University of Alberta Hospital, Edmonton, whose clinical labs are accredited by CAP and AABB.

So, are Canada's labs 'dumbed down'? No.

Would Canadian labs be improved by a stronger mix of more medical technologists with a BSc in MLS and diploma holders? I believe Yes.

Would grads be better served by a BSc than a diploma, a resounding YES. They'd have more career mobility, more international mobility, and be better respected as a profession by other health care workers.

What about job mobility for technologists trained in other English speaking countries besides the USA? Can university educated and trained UK, Oz, and NZ grads easily work in Canada as med lab techs?

Unfortunately, no. The main reason is that programs in these countries, while providing education in the 5 basic disciplines, do not require clinical rotations in all 5 disciplines.

For example, NZ graduates of university programs are ineligible to work in Canada because they may do a year's rotation in only 2 disciplines, e.g., 6 mth clinical rotations in their 4th year in each of 2 disciplines, e.g., hematology and transfusion science or clinical chemistry and hematology, etc., as at AUT in NZ.

In contrast, a typical Canadian grad may spend 3 mths in a hematology lab and one month in a transfusion service lab, only one-third of the total time spent by NZ grads in these labs, and in the case of transfusion science, one-sixth as much. But NZ MLS grads are not eligible to write the CSMLS general certification exam without obtaining equivalent clinical rotations in all 5 disciplines.

Is this not nuts, given that NZ MLS grads clearly have more extensive basic education than most Canadian grads (diploma holders), as well as more practical experience in at least 2 clinical laboratories?

OZ and UK grads are similarly stymied if they want to work in Canada because graduates of Australia and UK's university programs can specialize. Examples:

Australia: AIMS accredited universities for medical laboratory science
UK: Bradford University's BSc (Hons) in Biomedical Science

Why do these medical laboratory technologists face significant barriers to working in Canada? Is it all about protecting public safety by ensuring medical laboratory professionals meet Canadian standards of education and training? Yes, but it's also about protecting Canadian jobs for Canadians.

If you graduated from one of the above foreign programs and are certified by your county's professional body and have worked in one or more areas of a clinical laboratory (perhaps for for 5-15 years), why do you need to write the CSMLS general certification examination covering all 5 disciplines to work in Canada?

CSMLS CERTIFICATION

For interest, if the educational programs of any foreign-trained technologists include the 5 basic disciplines and rotations in all 5, i.e., are otherwise equivalent to Canadian programs (or better), foreign-trained candidates must write the CSMLS general certification exam to work in almost all Canadian medical laboratories.

Most Canadian provinces (seems now they all do) have regulatory bodies that de facto require that medical laboratory technologists be certified by the CSMLS as a condition of employment in a clinical lab that performs diagnostic tests on patients.

For lab professionals with experience (e.g., those who trained 10-15 yrs ago), and who have likely worked in one discipline (perhaps two) for years, writing an exam covering knowledge and competencies in 5 disciplines is not easy. And getting clinical rotations in Canadian labs is pretty much impossible.

MUSINGS
I personally know NZ-, UK-, and USA-trained lab professionals who are better educated and trained than many Canadian grads, have ample current experience, and would make valuable contributions to Canadian labs and be exemplary employees. But they cannot work here, despite the fast-track BS of our governments.

True fast-tracking would allow

Different routes that don't require candidates to re-learn specific disciplines (e.g., histotechnology), which they never will work in;
Restricted licenses to practice and work only in the area or areas for which you are well qualified.

The situation for those for whom English is a second language:

Besides becoming fluent in English, these technologists often need to upgrade their education and training to Canadian equivalency. As but one example, in transfusion science, the association of the Rh blood group system with severe hemolytic disease of the fetus and newborn would not have been taught in Asian countries where almost everyone is Rh positive.

Upgrading programs are rare but exist. If candidates pass required English language competency tests, successfully complete whatever minimal upgrading is deemed necessary, write and pass the CSMLS general certification exam, they still may not be hired if their English remains weak. That's the reality of today's clinical laboratories where staff are stressed to the max, mainly due to under-staffing.

If asked, I often advise foreign-trained grads to enroll in a Canadian medical laboratory technology program. It's a tough sell because they have to support themselves and their families. But in the end, this route can prevent much grief and frustration.

In total, not a pretty picture, but there it is.

Talk of fast-tracking foreign-trained medical laboratory technologists / medical lab scientists / biomedical scientists is largely smoke and mirrors.

As always, comments are most welcome. Thanks to all for commenting. See below.

Added 3 Dec. 2013
Reply to Anonymous (Zoë) With BSc in Molecular Biology from McGill. My feedback:

1. If you want to work in a clinical/medical laboratory in a hospital or private lab, take a diploma program in Clinical Genetics Technology to obtain CSMLS certification.

Programs include BCIT's and Michener's.
Or...contact CSMLS to see if you qualify under Prior Learning assessment and can challenge the exam. But be sure to carefully assess CSMLS competencies for Clinical Genetics.

2. As you know, if you want to work in a research lab at a university or biotech company, you do not need CSMLS certification.

But jobs in university research labs are less well paid and the prof could lose funding at any time (research grants are increasingly hard to obtain in Canada), decreasing job stability.
Jobs at biotech companies also tend to be poorly paid with iffy job stability.

3. Try Canadian Blood Services. They're heavily into molecular genetics these days.

Added 6 Jan. 2014
In reply to Chineze Madu, who asked about someone with CSMLS certification working in the USA: My information is outdated and relates to the mid-1990s. I'll check if the same applies currently and update later.

Then, under NAFTA, you needed a Bachelor's degree plus work in a field with shortages in the USA
To work as a clinical/medical lab scientist (as opposed to a clinical/medical lab technician), you needed to qualify (complicated, many paths were possible, the easiest being a BSc in MLS/CLS recognized as equivalent to American education and training)
USA credentialing scene was a bit of a mess, explained here: http://en.wikipedia.org/wiki/Medical_laboratory_scientist
In the past you would write and pass the exams of either ASCP or NCA to get certification. It's changed now. Both general certification and subject certification in some disciplines are possible.

In effect, this meant that in the 1990s when medical laboratory jobs became scarce in Canada due to government cutbacks, graduates of the MLS program at the University of Alberta, who qualified to write ASCP MT exams, and often did at graduation time, could apply for and get jobs in the USA as clinical/medical lab scientists. It was much tougher, almost impossible, for graduates of technical institutes and community colleges to cross into the States for work.

Will update if needed.

Added 20 Jan. 2014
In reply to 'anonymous', Canadian programs that provides both a BSc and professional certification by the CSMLS exist:

MLS at the University of Alberta (UA) since 1961 (they also offer a post-diploma BSc).

University of Ontario Institute of Technology (UOIT), which opened in 2003, offers a Bachelor of Health Science (Hons) in MLS that provides both a BSc and professional certification by CSMLS.

The CSMLS did push for the BSc to be entry level several years ago, but both provincial governments and employers did not support it. My view (no doubt biased) is that they saw it as

Credential inflation, e.g., In teaching the 2-year diploma once needed to become a teacher is now a 4-year BEd. Nursing's diploma is now a 4-yr BSc, physiotherapy and occupational therapy were once undergraduate programs, but now entry level is a masters degree
Salary inflation, costing them more money
Slippery slope, as happened in physiotherapy and occupational therapy

As well, the issue arose when major shortages existed (due to the ill thought out cutback in healthcare and educational institutions in the 1990s, e.g., in Alberta and elsewhere) and employers wanted med lab tech training to be a short as possible.

And technical institutes and community colleges, especially the former, more pronounced if they were 2-yr diploma programs, feared for loss of jobs for their educational staff.

Of course, politics was at work and governments like Alberta's did, and still does, see all education as worthwhile only if explicit job training, even at universities. Perhaps even a smidgen of anti-intellectualism exists in some of the MLAs across the river from UA in Edmonton.

I agree that a BSc as entry level for medical lab technologists (MLTs) would raise the status of the profession in Canada. It's hard for MLTs to participate as equals on health care teams when everyone else on the team has a BSc or higher degree as entry level. And international mobility would also be enhanced.

To me, it's more basic. Every person should be able maximize their potential in life. For example, it's so much easier to get further education if you have an undergraduate degree. And if the bottom ever falls out of your career choice, the degree helps with international mobility.

But that's not what our governments and employer want.

As always, comments are welcome.

Added 20 Jan 2014
Another anonymous comment below notes that this blog fails to mention that MLS programs at many colleges (assume Canadian ones) only accept applicants with a BSc because competition is fierce.

Not sure 'only' applies (would need real evidence) but agree that most applicants to MLT programs at Canadian technical institutes and community colleges have a BSc. The BSc could be in many areas but NOT the traditional disciplines of MLS (clinical chemistry, clinical microbiology, hematology, histotechnology, transfusion science).

It's been true for years now, mainly because the BSc holders want the jobs that CSMLS certification all but guarantees and a university degree does not.

To me, this situation is an incredible waste of taxpayer money. Not a good bang for the buck. Not efficient of student time, cost, and effort.Why you ask? Here's why:

Assume a BSc takes 4 years and training at a technical institute takes 2 years, perhaps 2+years, and at a community college 2-3 years. Canadian taxpayers subsidize a minimum of 6 years of education to turn out a BSc grad with a diploma and CSMLS certification.
Believe me, it's subsidized because students pay only a fraction of the actual cost of their diplomas and degrees. To say nothing of the cost of their rotations in clinical labs.
Instead, if they enrolled in an MLS program like the one at the University of Alberta, they'd spent 4 years and obtain the same qualifications, indeed a better one because the UA BSc is one in MLS (all disciplines).
Moreover, UA MLS grads are eligible to write ASCP (MT) exams in the USA and many do, immediately post-graduation.

So, yes, when CSMLS promoted the BSc as entry level, governments and employers nixed it. Now they pay for that shortsighted decision by subsidizing 2+ years of education for BSc holders chasing a job. And the grads are less qualified than true MLS BSc holders.

Added 14 Apr. 2014
Anonymous below asks if Canada is the best place for the profession of med lab technology / science.

About global med lab technology and Canada's relative place in it, who knows. On one level Canada is a great place to live and work in any profession. We are truly blessed with an overall fantastic quality of life, regardless of job.

On another level, for a long time trends in clinical labs in Canada, the USA, and probably globally are towards cutting costs, which means regionalization, central testing facilities (think mega-lab assembly lines as in car manufacturing), and hiring the cheapest person for the job, i.e., those with less well educated who are trained on the job for specific tasks and don't need to know much else except when to ask for help.

In the end life is what we make of it, regardless of location and there is much more to life than our careers. Think I'll stop on that note.

Added 6 May 2014
I hope this update gives key, definitive answers to those who trained outside of Canada and want to work here as a medical laboratory technologist.

1. You must have a prior learning assessment by CSMLS.
2. Key point: If you're a general medical lab technologist, you must be competent in five disciplines: clinical chemistry, clinical microbiology, hematology, histotechnology (histopathology), and transfusion science (transfusion medicine, blood banking).
3. Assuming you qualify, you must write the CSMLS General Certification exam.

This pretty much excludes candidates from Australia, NZ, UK and USA applicants because their educational system does not require a clinical rotation in all five disciplines (or any training in histotechnology for USA grads).

Personally, I think this is nuts because it prevents exceptionally qualified foreigners from working in Canada. It also hinders international mobility of skilled workers, who's perspective could bring much needed creativity. But that's the route CSMLS has chosen to go.

For interest, I know Canadian grads of MLS at the University of Alberta who can work in NZ and the UK with having their education and training assessed but do NOT need to write certification exams in those countries.

Added 21 July2014
In reply to Riti:

In general, you can't work temporarily as a med lab tech in Canada without Canadian certification. Contact CSMLS or the provincial regulatory body for where you will likely reside, e .g., in Alberta. They will have the latest information.

You're correct, as a USA grad you'll need a histotechnology course and clinical rotation.

Other options: Working as a lab assistant for less pay (short programs are available) or, from Dec. 2013 (see main blog above):

For research lab at a university or biotech company, you do not need CSMLS certification. But jobs in university research labs are less well paid and the prof could lose funding at any time, decreasing job stability. Jobs at biotech companies also tend to be poorly paid with iffy job stability.

You could also try working in industry and govt: food and water testing labs. Two examples:

Added 16 August 2014
As mentioned earlier Michener Institute in Toronto has a 16 week bridging program. Have no idea how successful graduates are on CSMLS exams

Wednesday, May 30, 2012

Amazing women (Winnifred Paktong of Winnipeg, Canada)

Thursday, May 17, 2012

Chelsea has the 'right stuff' to win in Munich

Thursday, May 03, 2012

Want to work in Canada as a medical technologist? Forget it!

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