Certification Presentation Ro

Opportunities and Routes for HT Certification and QIHC Qualification

Joelle Weaver MAOM, HTL (ASCP), QIHC

J. Weaver MAOM, HTL (ASCP), QIHC 2012 2

Introduction

• In this presentation I hope to clarify the professional advantages to pursuing ASCP certification as well as talk about the process and the registry exam itself.

• I hope that this will provide some helpful information for anyone contemplating certification but who is not sure what is involved or where to begin.


Learning ObjectivesAt the conclusion of this presentation participants will be able to:1. Identify the mission of the BOC in providing certification.2. Discuss the benefits of certification.3. Differentiate between licensure and certification. 4. Identify vacancy and wage factors affecting employment opportunities in

histology. 5. Identify the routes and the requirements for eligibility for the HT

certification exam and the QIHC qualification.6. Identify the HT exam content, format, and scope.7. Discuss the CMP requirements for histology certifications.8. Identify opportunities and resources for education and training in

histotechnology.


BOC Mission

• The Board of certification mission is to “provide excellence in certification for laboratory professionals”.

• The largest and oldest pathology and laboratory medicine society and is the “gold standard” in certification for laboratory professionals.


History and structure of the BOC Founded in 1928 by the ASCP. To date over 460,000 individuals have

been certified. The ASCP is accredited by the American National Standards Institute (ANSI). The board of Governors of the ASCP BOC consists of 25 members:

• 5 pathologists nominated by ASCP• 5 laboratory professionals nominated by ASCP• 4 representatives from the American Society for Clinical Laboratory

Sciences (ASCLS).• 2 representatives from the Association of Genetic Technologists

(AGT).• 1 other representative from a laboratory society• 1 public mentor


What is certification?• Certification is the process by which a non-governmental

agency grants recognition of competence to an individual who has met certain predetermined qualifications as specified by the granting agency. Having certification is typically offered within an industry to uphold certain standards.

• Licensure is mandated through regulatory or government agencies which define title and scope of practice.

• Certification is generally voluntary, but can be required or part of the licensure process. Licensure is generally a required process necessary to practice within a defined jurisdiction.


Why become certified?

• Certification demonstrates your commitment to the profession.

• Employers prefer and often require certifications. • Demonstrating competency via certification can

provide you a competitive advantage for more job opportunities, higher pay, and increased job security.

• ASCP Survey results show that 69.4% of staff and 91.6% of supervisors in histology departments are certified (2011 ASCP Vacancy Survey of Clinical Laboratories).


Factors & barriers affecting certification

• ASCP policy and elimination of OJT route.• Education and training availability.• Lack of public awareness of histotechnology field.• Lack of knowledge of the certification process,

requirements and steps involved.• Lack of knowledge of benefits to individuals for

becoming certified. • I hope to address most of these topics within this

presentation.


ASCP policy to support recognition has inadvertently created barriers to entry

• In 2005 the ASCP eliminated the high school and OJT and route for HT certification in an effort to increase the professional perception of the field, and attract high quality applicants to the struggling Histotechnology profession.

• While the intention was to raise the status of the profession, this has made some increased obstacles for new candidates for ASCP certification in histology.


DEMAND IS AN OPPORTUNITYHistology is a great profession


Lab Careers- Opportunity Overview• The Bureau of Labor Statistics projects clinical laboratory technician

employment growth of 14.7 percent between 2010 and 2020, adding 23,800 more professionals to the 161,200 jobs currently in this field.

• One of the most appealing aspects of this profession is the relatively easy attainability of the education and training requirements as compared to many other medical professions.

• Most laboratory technicians possess an associate's degree from a community college or junior college program accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). More complex procedures are reserved for clinical laboratory technologists, who must possess a bachelor's degree.

• Those that successfully complete training and certification are in huge demand, and often get placed into jobs very rapidly.


Overview of HT Demand• Nationally, the majority of laboratories filled most positions within six months of

posting an opening, however a statistically significant number of openings take longer than one year to fill .

• Across the nation, vacancy rates were highest for blood banking (11.6%), histology (9.81%), and chemistry (8.62%) departments. The lowest vacancy rates occurred in the departments of cytology (5.14%) and immunology (5.56%).

• There were an estimated 28,400 working histologists as of 2008. However ½ of those 28,400 will reach retirement age in the next 4 years.

• Consider that an estimated 31,200 new histotechs will be needed by 2015 to replace retirees and anticipated need by 2015. Since only 477 new HT were certified as of 2009, then potential there will be a potential deficit of over 29,000 certified HT staff by 2015.

• According the an ASCP report, laboratory managers appear to choose certified rather than non-certified staff .

• Obtaining certification will ensure that you are competitive in the current job market and prepared to meet the demand of new testing methods, accreditation and in many states licensure requirements.


“Big Picture” Statistics

Overall Histology vacancy rate

% of Histology staff certified

% of Histology vacancies taking more than 1 year to fill

% of Histology staff expected to retire within 5 years

9.81% 69.4% 13.7% 15.3%

Data: ASCP 2011 Vacancy Survey of US Laboratories. Lab Medicine. Vol.42. No. 4. pp. 193-256


General Correlation of Education & Job Skills to Earnings


SALARY INFORMATIONHow much do Histologists earn?


Wage by Occupational Title in the Laboratory


Breakdown of national wage level averages for HT and HTL’s

• Staff level HTs earn an average of $22.68 (SD = $5.28) per hour.

• Certified staff HTs earns 14.7% more than non-certified HT staff.

• The average hourly wage for staff HTLs is $26.00 (SD = $5.83).

• * 2010 ASCP Wage Survey of Clinical Laboratories


Regional salary variations-2005 dataRegions Cost of living

unit (unit=100)Median Annual Income ( unit=1000)

Median average salary/position (unit=$5/hour)

Mean Mean HT HTL

Northeast 141.7 51.4 19.35 23.73

East north central

105.5 46.2 18.51 21.15

South central Atlantic

100.6 42.1 18.00 20.82

West south central

95.5 38.5 18.72 19.44

West north central

98.5 43.6 17.08 21.32

Far west 117.4 48.3 18.24 22.54

National totals 109.9 45.0 18.47 21.63


PROCESS TO CERTIFICATIONHow do I begin the steps to get certified?


Routes to HT ASCP certificationTo be eligible for the HT examination category, an applicant must satisfy the requirements of at least one of the following routes:Route 1: Successful completion of a NAACLS accredited Histotechnician program within the last 5 years prior to the date of application for examination; ORRoute 2: At least 60 semester hours (90 quarter hours) of academic credit from a regionally accredited college/university, with a combination of 12 semester hours (18 qtrs) of biology and chemistry (must include credit hours in both), or an associate degree from a regionally accredited college/university, with a combination of 12 semester hours (18 quarter hours)of biology and chemistry (must include credit hours in both), AND one year full time acceptable experience in a histopathology (clinical, veterinary, industry or research) laboratory in the U.S., Canada or an accredited laboratory* within the last ten years. * laboratory accredited by a CMS approved accreditation organization (i.e., AABB, CAP, COLA, DNV, The Joint Commission, etc.).


Experience Requirements• To fulfill the experience requirement for the Histotechnician examination, you

must have experience, within the last ten years, in the following areas:• Fixation

• Microtomy • Processing

• Staining• Full-time experience is defined as a minimum of thirty-five (35) hours per week.

Individuals who have part-time experience may be permitted to utilize prorated part-time experience.

• To document your clinical laboratory experience (if required):• Use experience documentation forms (for the appropriate certification category

and route number) must be downloaded and printed from the ASCP website at www.ascp.org/certification .


http://www.ascp.org/certification

Establishing eligibilityEligibility to take a certification examination is established by:1. Meeting the stated minimum requirements for the particular category of

certification 2. Submission of the appropriate application form3. Payment of the appropriate application fee4. Submission of all appropriate documentation including official transcripts

indicating the appropriate degree

Before your examination eligibility can be determined, you must submit the appropriate documents verifying that you meet the current ASCP Board of Certification requirements before you are eligible to sit for the registry exam.


Verification of Academic Education• If college credits are required for the examination category,

you must submit an official transcript or transcript evaluation.• Continuing Education courses are not acceptable in fulfilling

the academic requirements.


Verification of TrainingRoute 1. NAACLS or CAAHEP Accredited Programs• If you are currently enrolled in or have completed a NAACLS or CAAHEP accredited

training program within the last five years, the printed application form must include the program director’s name and the school code number must be indicated. The education received from a NAACLS or CAAHEP accredited program is acceptable for a period of five (5) years from the date of completion of that program.

Route 2: • You must download the appropriate training documentation form from the ASCP

web site at: www.ascp.org/certification .• If you are unable to download the form, go to www.aspc.org or fax us at 312-541-

4845 to request printed copies. The training documentation form must be completed by your program director and attached to a letter, on letterhead, signed by the program director verifying the accuracy of the information.


http://www.ascp.org/certification

http://www.aspc.org/

Application Process

• The steps in the application process are outlined within the handout with links to important forms and contact information.


ASCP HT EXAMINATIONWhat can I expect when I sit for the HT registry exam?


Exam content-Knowledge Areas

• Fixation-10-25%• Processing & embedding 10-14%• Microtomy 10-14%• Staining 40-50%• Laboratory Operations 10-15%


CAT Testing formatComputer Adaptive Testing (CAT) -1. An examinee’s score on the exam is not influenced by the scores of other examinees

who take the exam. 2. When you answer correctly, the next test question has a slightly higher level of

difficulty. The difficulty level of the questions presented to the examinee continues to increase

until a question is answered incorrectly. Then a slightly easier question is presented. In this way the test is tailored to the individual’s ability level.

3. Each question, in the test bank is calibrated for level of difficulty, the weight (value) given to each question is determined by the level of difficulty.

4. The examinee must answer enough difficult questions to achieve a score above the pass point.

5. To pass the certification examination, the examinee’s scores must exceed the minimum pass score.6. You will have to check in at the testing center with your admission letter, identification

and no calculators allowed.


Question taxonomy- levels of question difficulty

• Taxonomy I (level 1) RECALL - ability to recognize knowledge from specific facts to

theory.• Taxonomy II ( level 2) INTERPRETATION -ability to utilize recalled knowledge to interpret or

apply data.• Taxonomy III ( level 3) PROBLEM SOLVING -ability to utilize recalled information and the application

of distinct criteria to resolve problems or make appropriate decisions.


Question format

• All questions are multiple choice and will appear on the screen one at a time.

• You must answer one at a time ( can’t skip). • Color photos, diagrams, charts and other

images may be incorporated and appear on the screen with the question.


ASCP Exam Statistics for January – December 2011

Exam Type

1st year certified

Mean # Taking exam

Pass rate 1st attempt pass for program grads

Total certified (ever)

HT 1948 458 772 519 test takers -67%

327-74% 22,416

HTL 1980 443 283 183 test takers-65%

100-35% 3,141


SUGGESTIONS FOR STUDY AND PREPARATION

How do I prepare for the exam?


Study Resources-Foundation Text• Histotechnology: A Self-Instructional Text

(3rd Edition) ISBN: 9780891895817 • Authors: Freida L. Carson and

Christa Hladik List Price: $150.00, Member Price: $115.00

• Combo Price!(Order both the Histotechnology text and the HistoDeck Flash Cards)List Price: $195.00Member Price: $170.00

• Histotechnology: Complete Study Package, Order # HTPK3, Get the complete Histotechnology Study package -- textbook, workbook, and HistoDeck flash cards.

• Available @ ASCP http://www.ascp.org/ASCPStore/Store/Books/5817.aspx


http://www.ascp.org/ASCPStore/Store/Books/5930.aspx



Study Guide• Board of Registry Study Guide:

Histotechnology Examinations (2nd edition), Order # 473X | ISBN: 089189473X

• Authors: Freida Carson, PhDLaura Culver Edgar, MT(ASCP)Donna Surges Tatum, PhD

• The guide includes:• Guidelines for taking the test • Information about the development, content,

structure and scoring of the test • Practice questions and answers • Image-based questions • List Price: $65.00• Member Price: $50.00• http://www.ascp.org/Store/Books/Board-Regis

try-Study-Guide-Histotechnology-Examinations-2nd-edition.html#StoreList


http://www.ascp.org/Store/Books/Board-Registry-Study-Guide-Histotechnology-Examinations-2nd-edition.html



From the ASCP website• Reading lists

http://www.ascp.org/PDF/BOC-PDFs/Bibliography/ReadingListHTL.aspx• Exam content guidelines

http://www.ascp.org/PDF/BOC-PDFs/Guidelines/ExaminationContentGuidelineHT.aspx

• Online practice tests includes a 90-day online access to the practice tests, comprehensive diagnostic scores, and discussion boards. If you are an institutional purchaser that would like to pay by check or purchase order (minimum of 20 tests to use a check or purchase order), download Order Form (PDF). http://www.ascp.org/Board-of-Certification/Exam-Preparation/Online-practice-tests

• BOR Study guide ( shown previously) http://www.ascp.org/Store/Books/Board-Registry-Study-Guide-Histotechnology-Examinations-2nd-edition.html#StoreList


http://www.ascp.org/PDF/BOC-PDFs/Bibliography/ReadingListHTL.aspx



http://www.starttest.com/6.5.0.0/programs/ASCP/ASCP%20Practice%20Tests%20Online%20Order%20Form.pdf

http://www.ascp.org/Board-of-Certification/Exam-Preparation/Online-practice-tests

http://www.ascp.org/Board-of-Certification/Exam-Preparation/Online-practice-tests



NSH Study Materials

• The NSH provides many study resources including texts, self assessments, flash cards, an on line learning center, and other study aids offered through the NSH marketplace.

• Certification study aids page located at : http://www.nsh.org/content/certification-exam-study-aids


http://www.nsh.org/content/certification-exam-study-aids

http://www.nsh.org/content/certification-exam-study-aids

Study strategy for success• There is NO substitute for knowing the material. • You will be able to do well by thorough preparation, and by

use of practice questions to learn how to take this type of test well.

• Go in knowing the exam format, question types and topics.• Use a process of elimination for “stumpers” as with all MC

tests .• Don’t be overly critical of yourself, there has never been a

perfect registry exam score- simply do your best. ( note the score range is 400-999).

• Make sure you are well rested on exam day!


Using content guidelines• This is NOT simply a recall examination, so you must strive to learn the

underlying theory and principles and be able to apply them to presented situations and problems. This replicates actual practical use of knowledge in lab situations.

• The exam covers ALL of histology practice, so techniques, stains and methods you may not perform in your job will be topics for questions. The exam committee designs the test to cover as broad a “scope of practice” as possible.

• I encourage you NOT just to attempt memorization. Not only will this only be stored in short term memory and quickly forgotten. You will likely do poorly on application and taxonomy II & III questions if you only memorize.

• I recommend using the content guidelines with the resource texts to fill in and expand the information on the outline. But flash cards or other study methods may work well for you.

• Once you have worked through the outline, use practice questions and tests to determine your weak areas to go back over and devote more study time.


Content Category• Content area= Staining – know tissues, procedures, instrumentation,

reagents/dyes, & mounting procedures ( following content guideline). • Subtopic = Histochemical stains• Stain Group =Carbohydrates = aldehyde or ketone derivatives of alcohols.

Occur as polymerized sugar chains, often combined with proteins or lipids. CHO categories: Polysaccharides and Mucopolysaccharides( mucosubstances) including neutral,

acid, sulfated, non-sulfated (carboxylated), mucoproteins, glycoproteins, Mucolipids .

Some CHO special stain examples: PAS, PAS-D, Best’s Carmine, Alcian Blue ( pH 1.0, 2.5), Colloidal Iron


Grouping Carbohydrates• Glycogen- only polysaccharide found in higher

animals as a polymer of glucose.• Mucopolysaccharides are highly polymerized

disaccharide units divided into acid and neutral.

• Acid mucopolysaccharides ( mucosubstances) often called “mucin”.

• Complexes of mucopolysaccharides with lipids, proteins also.


CHO Category Table & StainsCHO type Tissue element Histochemical stain

Polysaccharide-glycogen Hepatocytes, muscle PAS-D, Best’s Carmine, AB -, Coll. Fe-

Neutral Mucosubstances GI epithelium, thyroid colloid, Goblet cells

Mucicarmine ( GI epithelium), PAS +

Acid mucosubstances Many tissues, sublingual glands, non –sulfated in synovial membranes

AB +

Sulfated mucosubstances Goblet cells(weak sulfated), duodenal and colonic

AB +, Mucicarmine +

Mucoproteins Basement membranes, mucoid cells pituitary

Weak AB, PAS +, Coll. Fe -

Glycoproteins Collagen, reticulin, CT Trichrome, PAS +, Faint AB, Coll. Fe -

Mucolipids Cerebrosides, nerve tissue PAS +, AB -, Coll. Fe-J. Weaver MAOM, HTL (ASCP), QIHC 2012 42

Dissecting a special stain• Technique- Periodic Acid Schiff Reaction• Application: most often used to demonstrate basement membranes, glycogen and

fungus, and PAS + mucosubstances secreted by epithelium of GI, lung, cervix. Used to differentiate between secreting adenocarcinomas vs. undifferentiated squamous cell carcinoma ( PAS-).

• Principle: Tissue is first oxidized by periodic acid. The oxidation results in the formation of aldehyde groups where CHO are present in tissue elements. The aldehydes are detected by the application of Schiff’s ( Leucofushin). Sulfurous rinses follow to remove excess and to prevent false + oxidation by air exposure. Warm water rinses intensify color.

• Results- PAS + tissue elements are rose to rose- red, counterstain depends on method. Hematoxylin, light green common; light green typically used with fungus.

• + Control depends on technique used; liver, kidney, fungus containing, cervix.


Example organization for study• PAS – Periodic Acid Schiff Reaction• General stain category : Histochemical, CHO stain. • Used with/for:• Glycogen- PAS with/without diastase, fungus• Neutral Mucin-PAS-H• PAS for fungus• PAS –basement membranes• Considered rather non-specific CHO stain, gains specificity for glycogen

with diastase. Mucins are PAS + but also stain with Mucicarmine, which is much better stain for mucins from epithelium sources. Glycogen may have diagnostic significance in tumors such as carcinomas, mesotheliomas, and rhabdomyosarcoma.


PAS Reaction Flow chartStaining mechanism

↓ Oxidation ( periodic acid)

↓ Chemical reaction ( Schiff’s reagent with aldehydes( CHO)

↓Recolorization ( water- followed by sulfurous rinse)

↓Counterstain ( Hematoxylin, light green)

Note controls needed for technique, and that parallel control sections used with PAS- Diastase for Glycogen.


Sample Questions1. The most commonly used stain procedure for demonstration of glycogen is? A. PAS reaction with and without diastaseB. Alcian Blue-PASC. MucicarmineD. Aldehyde Fuschin

2. An enzyme employed to increase specificity and identification for glycogen with PAS staining is?

A. HyaluronidaseB. SialidaseC. DiastaseD. Ribonuclease


Sample Questions3. Glycogen is a carbohydrate that is normally classified as a/an:A. Acid mucosubstanceB. MucoproteinC. GlycoproteinD. Polysaccharide

4. Parallel sections are stained with PAS, ( with/without). In evaluating the stain results, the stained section should:

A. Demonstrate acid mucosubstancesB. Show sites of non-staining where glycogen was removedC. Show sites of non-specific PAS + stainingD. Demonstrate that the procedure is non-specific for Glycogen


MAINTENANCE OF CERTIFICATIONContinuing education


Certification Maintenance Program (CMP)

• After passing the examination, you will receive a packet of• information welcoming you as part of the ASCP certified laboratory• team, including:• Certificate of Certification suitable for framing, valid for three years• Certification Maintenance Program (CMP) packet• This information will be mailed to you approximately 3 – 5 weeks after the

examination scores are mailed. The initials “CM” in superscript must be used after your certification initials immediately upon receipt of your certification [i.e., MLS(ASCP)CM].

• In order to maintain your certification, you must complete the Certification Maintenance

• Program (CMP), as described below, every three years.


CMP credits needed

• HT, HTL, beginning in year 2004 – 36 CMP points required to include:

• 1 point laboratory or patient safety( i.e. quality control, quality assurance)

• Remaining points in area(s) of specialty, management, education or other related

• laboratory areas of interest• 1 CMP point= 1 contact hour=1 CMLE credit.


CEU Sources• Formal continuing education courses—continuing education credits

awarded by AACME accredited programs, ASCP CMLE approved programs, AACC ACCENT approved programs, ASCLS PACE approved programs, CE programs sponsored by other professional societies and courses taken at regionally accredited colleges/universities.

• Employer offered courses (in-service, instrument training, vendor sponsored)

• Competence assessment from employer (documentation of continued competency in specific laboratory areas).

• Subscription or online self-instructional courses for which CMLE, ACCENT or PACE credits are awarded.

• Other educational activities—such as research and preparation for presenting a workshop or course, authoring journal articles, presenting posters, etc.


Industry trends in lab careers and education

• General consensus:• Not enough programs with new grads to meet

demands• Lack of awareness of profession


Histology Awareness• 2007 survey conducted by the Coordinating Council on the Clinical Laboratory Workforce

(CCCLW) found that the sources which led survey respondents to first become interested in the field ( listed in order of importance) were:

1. A relative or friend2. A college catalog or college visit3. A high school science teacher4. A tour of a medical laboratory5. Personal research6. Career fairs• 76% of these respondents reported that they first became aware of laboratory career

options only after leaving high school. Those of us working in the field need to spread the word!

• See handout for more detailed data on the state of histology programs nationally.• See handout for list of NAACLS accredited Histotechnology programs. Link to NSH

Histotechnology program affiliate page with contacts http://www.nsh.org/content/schools


http://www.nsh.org/content/schools

Where can I find out about Histotechnology Education & Training Opportunities?

• The best, most concise places to see listings of available training programs and schools is the NSH or NAACLS listings at.

• NSH program list : http://www.nsh.org/content/schools• NAACLS approved program search page:

http://www.naacls.org/search/programs.asp• Both websites list programs by location, instructional delivery methods,

and contacts.


http://www.nsh.org/content/schools

http://www.naacls.org/search/programs.asp

Scholarships

• Example: Siemens and ASCP Award Over 100 Scholarships to Medical Laboratory Students in 2012 http://finance.boston.com/boston/news/read?GUID=20884103

• I have a list of other scholarships and awards available in the handout.


http://finance.boston.com/boston/news/read?GUID=20884103

http://finance.boston.com/boston/news/read?GUID=20884103

ASCP qualification opportunities

• Qualification in Cytometry, QCYM• Qualification in Immunohistochemistry, QIHC• Qualification in Laboratory Informatics, QLI• Qualification in Laboratory Safety, QLSFor each qualification category, you’ll find a choice of routes that you can take to verify your eligibility for the qualification, depending on the education and training you’ve completed. http://www.ascp.org/Board-of-Certification/Qualification#tabs-1


http://www.ascp.org/Board-of-Certification/Qualification/Step-1/Qualification-in-Cytometry-QCYM.html

http://www.ascp.org/Board-of-Certification/Qualification/Step-1/Qualification-in-Immunohistochemistry-QIHC.html

http://www.ascp.org/Board-of-Certification/Qualification/Step-1/Qualification-in-Laboratory-Informatics-QLI.html

http://www.ascp.org/Board-of-Certification/Qualification/Step-1/Qualification-in-Laboratory-Safety-QLS.html

http://www.ascp.org/Board-of-Certification/Qualification

What are the advantages of completing a Qualification?

• Visible recognition of specific skills in a technical area with the Qualification initials after the ASCP credentials

• Recognition by state licensure—the state of Florida recognizes those individuals certified and qualified as HT(ASCP)QIHC toward meeting the specialist licensure requirements for histology

• More job possibilities—career mobility throughout the country • Professional growth—keeping up with state of the art technology • Each qualification is a three-year credential that may be renewed by providing

documentation of continuing education activities in the appropriate discipline.• Qualification will not, in itself, entitle the individual to membership in ASCP.

Individuals must be ASCP certified as a technician, technologist or specialist to be eligible for ASCP membership.

• Eligibility, routes and experience requirements are listed in the handout.


Thanks!

• Thank you for allowing me to present this information to you today!

• I hope that I have been able to supply some useful information, and we can take some time now to see if anyone has any questions or comments.

• Note I have included a references page of resources if you need more information in the handout


Documents

Certification Presentation Ro