Advancing the laboratorian’s role on the healthcare team and in patient centered care.
The doctorate in clinical laboratory science (DCLS), the flagship degree of the profession, was created to address gaps in quality diagnostic and therapeutic services generated by movement toward a value-based, consumer-focused healthcare system.1,2 The goal of DCLS daily practice is to provide information to consumers and healthcare providers that makes a difference in clinical decisions. Consultation is the foundation of the DCLS degree, as well as the associated practice, and represents an entirely new rung in the professional career ladder dedicated to delivery of safe, effective, patient-centered, timely, efficient and equitable healthcare envisioned by the Institute of Medicine (IOM).3 This DCLS evidence-based practice is designed to demonstrate a measureable improvement in clinical care.4
The new consultative DCLS practitioner will liaise among healthcare providers external and internal to the clinical laboratory and will integrate consumer information provided by all practice levels of laboratory professionals. The resulting individual care paths will then be acted on under DCLS guidance with documentation in the health record and to the consumer directly. DCLS practitioners will enrich the practices of other laboratory practitioners by providing a conduit for assessment of the clinical utility of laboratory information-that is, by providing a professionally certified and formally credentialed healthcare provider to answer questions like, “So, what do these lab values mean?”
Understanding the impact of and barriers to the introduction of the DCLS practitioner into the healthcare team, evidence-based curriculum and position descriptions have been developed that represent knowledge areas that will address the gaps in quality services delivery.5
One Institution’s DCLS Program Model
Since 2005, the American Society for Clinical Laboratory Science (ASCLS) has promoted the advanced practice doctorate (DCLS) through the ASCLS DCLS Oversight Committee. This Committee has developed program and course models with competencies to guide universities in establishing DCLS programs. The first nationally, Rutgers University DCLS program, offered through the department of clinical laboratory sciences, offers the flagship degree option as the culmination of a complete career ladder that spans the professional program spectrum, including a phlebotomy certificate program (NAACLS approved); BSMLS (NAACLS accredited); and a graduate certificate in CLS, MSCLS, and the DCLS.
This career ladder offers options and opportunities for certified medical laboratory scientists to continue their career development through a curriculum that builds on increasingly complex and comprehensive competency requirements.
The Rutgers DCLS program is 80 credits beyond the baccalaureate degree, consisting of four core components: advanced clinical laboratory science, professional, research and clinical practice. Full- and part-time options are available for the theoretical potion of the program, providing students the opportunity to balance professional, personal and educational responsibilities.
The year-long clinical residency is full time. Course content is based on DCLS competencies established by the ASCLS DCLS oversight committee, accepted by the graduate task force of the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) and guided by IOM aims. Curriculum is further categorized into four main organizational areas: patient care, interprofessional and communication skills, professionalism, outreach and continuous practice improvements. This curriculum offers an innovative educational experience, utilizing blended pedagogy, distance education and clinical experience-creating an academic and clinical educational environment that values interdisciplinary education and practice, supports growth of scholarship and research and increases opportunities for interdisciplinary and collaborative research.
Further, the Rutgers DCLS program was designed to educate and embed DCLS practitioners over the expanse of the nation and in every care setting and strives to admit candidates who can truly make a difference in healthcare delivery in their regions by accomplishing their clinical internships in their localities.6 Additionally, several other universities are close to the launch of their own programs-with others, still, in earlier planning stages.
A Student’s Point of View
In 2009, Brandy Gunsolus, MS, MLS(ASCP)CM, started the Master’s program at Rutgers University. The program expanded on her previous MLS training exponentially, giving her the knowledge base necessary to continue with the DCLS degree program. In the DCLS program, she has taken courses in disease overview and treatment, pharmacology, evidence-based medicine, laboratory utilization in healthcare and others. With just one semester of didactic coursework remaining, she is on track to graduate Spring 2018 and will begin her year of clinical residency.
In her current position as the laboratory manager of a five-physician family practice clinic, the physicians have allowed her to develop a consultative role with clients and healthcare practitioners in addition to her managerial responsibilities. The advanced practice responsibilities include reviewing patient-specific antibiograms for effectiveness, ensuring appropriate ordering of laboratory tests, assisting physicians in the interpretation of laboratory tests and consulting on difficult to diagnose cases. She also assists in managing all Coumadin patients and educates both nurses and patients in appropriate laboratory test utilization and proper interpretation of results.
Brandy stated that she is most often presented with some fairly simple questions, such as those regarding the interpretation of a negative influenza test, why a physician would order a hepatitis panel for elevated liver functions or why insurance will not cover a vitamin D test for screening. However, at least once a day, she is presented with more challenging questions like explaining to other healthcare providers why hemoglobinopathies interfere with hemoglobin A1c testing, what extensive metabolizer results on CYP2C19 testing mean for a patient or why evidence from literature is needed to evaluate denial of a urine culture given a negative screen (i.e., when the only abnormality on the urinalysis with microscopic is 0-2 RBCs/hpf).
Brandy also noted that the threaded curriculum through the MS-CLS and DCLS programs at Rutgers have helped tremendously to prepare her for this role. Since she has added her consultative responsibilities, nursing and laboratory relations have significantly improved, patient satisfaction has appeared anecdotally to improve and physicians have expressed their appreciation to have her available as a resource.
- Porter, M. E. A strategy for health reform – toward a value-based system. N Engl J Med 2009; 361: 109-12.
- Porter, M. E. What is value in health care? N Engl J Med 2010; 363(26): 2477-2481.
- Leibach, E. K. Evidence based practice in CLS education. Clin Lab Sci 2010; 23(3)Suppl: 2.
- Leibach, E. K. Redefining patient safety in the clinical laboratory. Clin Lab Sci 2013; 26(4)Suppl:198-199.
- Jorgenson, D., Dalton, D., Farrell, B., Tsuyuki, R. T., Dolovich, L., (2013). Guidelines for Pharmacists Integrating into Primary Care Teams. CPJ/RPC 2013; 146(6): 342-352. DOI: 10.1177/1715163513504528
- Fydryszewski, NA, Keohane, EM. Cost Effective Implementation of a Doctorate in Clinical Laboratory Science Program. Clinical Laboratory Science, 28:2, 99-105, 2015.