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A PROPOSED MODEL BACCALAUREATE PROGRAM IN
MEDICAL LABORATORY SCIENCES FOR NIGERIA
By
STEPHEN OLUFEMI SODEKE
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1983
Copyright 1983
by
Stephen Olufemi Sodeke
Dedicated to my parents, who gave me a good
start, and to my family of friends at
Fellowship in Prayer, Inc. and the world
over. They have been used by God to bless
my life. Each one of them has shared a
unique part of my journey.
ACKNOWLEDGEMENTS
I wish to express my sincere gratitude to Dr. Maggie K. Morgan,
Dr. James Hensel, Dr. Linda Moody, Dr. Ruth Williams and Dr. Phil
Clark, members of my doctoral committee, whose guidance, encouragement,
practical suggestions and invaluable assistance from the beginning to
the end made possible the successful conduct of this research.
Dr. Maggie Morgan, the chairperson of my doctoral committee, has
been a good friend and constructive influence throughout my study at
the University of Florida. Her tireless tenacity has been, for me,
worthy of emulation. I regard her as a mentor in every sense of the
word. She not only worked with me; she also walked with me. The
experience has proved a delightful challenge, and a pleasure. It is an
honor to work with such an uncommon person.
I regard with deep respect Dr. James Hensel, who brainstormed with
me during the initial stage of choosing a topic for this dissertation.
Dr. Phil Clark's ability to get down to the heart of the matter, a
talent he exercised in a gentle and genuinely concerned way, has been a
source of inspiration for me. Dr. Ruth Williams linked the past, the
present, and the future of medical technology in the United States, and
provided invaluable assistance in the organization of the dissertation.
Dr. Linda Moody contributed a knowledge of the health professions as a
whole.
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Other friends and colleagues have offered valuable assistance.
Dr. Rick Bamberg read the manuscripts at the initial stages and offered
valuable suggestions. Mr. J. E. O. Durowoju, Mr. S. O. Osanyintuyi,
Mr. Jide Oyeyinka, Mr. Sola Adeyeye, Mr. D. A. Bamgboye, Mr. Muyiwa
Ogunji, Mr. J. K. Fawcett, and Mr. Oluseyi Phillips and family, all
played a significant part in helping to secure the necessary documents
cited in this work. I am appreciative of the kind and tender support
of Miss Mary Britt, Miss Fran Fisher, and Ms. Beth Perry of the Medical
Technology Department, University of Florida, during the preparation of
the manuscripts. The memories of spring and summer 1983, spent in that
department, will be indelible.
This work would not have been possible without the prayers and
financial support of Fellowship in Prayer, Inc., which sponsored my
doctoral program at the University of Florida.
Finally, I owe a debt of love and gratitude to my wife and friend,
Olufolakemi Olutosin, whose marvelous support and understanding made
the achievement of this lifelong goal a reality. I am also thankful
for the patience and love demonstrated by her, and by my children,
Deborah Toluwalope and Stephannie Olufunmilola, as I worked on this
dissertation.
TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS. .. . . . . . .
LIST OF TABLES . . . . . . . . .
LIST OF FIGURES . . . . . . . . .
ABSTRACT . . . . .
CHAPTER
I. INTRODUCTION . . . .
Statement of the Problem
Purpose of the Study .
Limitations of Study .
Definition of Terms .
Procedures . . . .
Summary . . . . .
ANALYSIS OF BACKGROUND RESOURCES . . . .
Medical Technology Education in the
United States . . . . . . .
Medical Laboratory Sciences Education
in England, Wales and Northern Ireland.
Status of Health Care in Nigeria . . . .
Historical Perspective in Medical Laboratory
Technology Education in Nigeria . . .
Summary . . . . . . . . . .
A PROPOSED MODEL FOR BACCALAUREATE EDUCATION
Conceptual Framework for a Baccalaureate
Program in Medical Laboratory Sciences
for Nigeria . . . . . . . .
Proposed Model . . . . . . . .
Guidelines for Implementation of the Model .
Summary . . . . . . . . . .
Justification of the Curriculum . . . .
A Scenario of Implementation . . . . .
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. . viii
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PAGE
IV. SUMMARY AND CONCLUSIONS . . . . . .. ... 94
Purpose of the Study . . . . . . ... .95
Methodology . . . . . . . . .. ..95
Analysis of Background Resources. ... ... .98
Recommendations and Conclusions . . . ... 102
Model of Medical Laboratory Sciences
Education for Nigeria . . . . .. ... 103
A Final Word . . . . . . . .. ..106
APPENDIXES ...... . . . . . . .. .107
A TRAINING PROGRAMS IN GREAT BRITAIN--ENTRY
REQUIREMENTS AND CURRICULA . . . ... 108
B REGISTRATION AND MEMBERSHIP INFORMATION FOR THE
MEDICAL LABORATORY TECHNOLOGY PROFESSION OF
NIGERIA . . . . . . . .. . . 113
REFERENCES . . . . . . . . .. . . . 120
BIOGRAPHICAL SKETCH . . . . . . . .. . . 126
-vii-
LIST OF TABLES
TABLE PAGE
1. Selected Demographic Data on Nigeria (1950-80) . .. .34
2. Major Reportable Diseases in Nigeria
(thousands of cases reported). . . . . . .36
3. Population per Health Manpower in
Nigeria (1969-1979). . . . . . . .. . 41
4. Medical Manpower in Nigeria: Estimated
Target (1980-1985). ... . . . . . . .43
5. Membership Table (1970-1981) . . . . . .. ... 55
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LIST OF FIGURES
Figures
1. Present model of the medical laboratory
sciences education program in Nigeria-
Flow chart of the curriculum . . . . .. ..49
2. Conceptual framework for the proposed model
for a baccalaureate program in medical
laboratory sciences for Nigeria. . . . . ..62
3. Proposed model for a baccalaureate program
in medical laboratory sciences for Nigeria . .. .67
4. Proposed model for a baccalaureate program
in medical laboratory sciences-Flow chart
and curriculum content . . . . . . ... .68
5. Proposed model for a baccalaureate program
in medical laboratory sciences-Suggested
lower level curriculum . . . . . . ... .69
6. Proposed model for a baccalaureate program
in medical laboratory sciences-Suggested
upper level curriculum . . . . . . .70
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Page
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
A PROPOSED MODEL BACCALAUREATE PROGRAM IN MEDICAL LABORATORY SCIENCES
FOR NIGERIA
By
Stephen Olufemi Sodeke
August 1983
Chairperson: Dr. M. K. Morgan
Major Department: Curriculum and Instruction
The training of Nigerian medical technologists started in 1953 at
the University College Hospital, Ibadan. Students received three years
of instruction in the various aspects of medical technology and spent
an additional year in Britain to complete the training. A 1968 decree
established the Nigerian Institute of Medical Laboratory Technology.
Accordingly, Nigerian training programs were patterned after the
British model with slight modification to fit local needs. Social
changes, students' needs, and present and future needs of the Nigerian
health care system have rendered the programs obsolete.
Unprecedented debates have occurred in the past ten years over the
inadequacy of the present programs. The need for an effective
baccalaureate program has been evident, but to design a college-level
program has remained a problem.
The purpose of this study was to design a model baccalaureate
program in medical laboratory sciences for Nigeria.
The study was descriptive. Data were collected and analyzed
through (1) an intensive examination of available American, British and
Nigerian written resources, (2) visits to selected American
baccalaureate medical technology programs, and (3) interviews with
other American educators and resource persons who have contributed to
the development of medical technology programs in the United States.
Findings indicate that (1) only about 35% of the Nigerian
population is presently covered by any form of health care services;
(2) present and future health plans are focused on reaching 80% of the
population by 1985, and 100% by the year 2000; (3) present medical
technology training programs have not met the staffing needs of the
health care system of Nigeria; (4) effective new programs are needed
to augment the efforts of existing ones; (5) medical technology
training in Nigeria is purely technical--programs are rigorous and the
examination system is thorough, but the orientation is narrow; and (6)
a broad new orientation is essential for producing medical laboratory
scientists with skills adequate for the present and improvable for the
future.
Recommendations include a model that introduces flexibility and
balance, that encourages keeping certain qualities, and corrects
deficiencies in organization, curriculum content, staffing,
instructional methodology and evaluation.
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CHAPTER I
INTRODUCTION
Nigeria has long recognized the need for qualified manpower in
medical laboratory technology in the development of the health care
delivery system. Between 1956 and 1968 Nigeria relied entirely on the
British Institute of Medical Laboratory Sciences for the training of
technologists. In 1968, the Nigerian Military Government Decree No. 56
established the Nigerian Institute of Medical Laboratory Technology to
train medical technologists. With only slight modification of the
contents to suit local needs, Nigeria adopted the British model. The
training is purely technical and rigorous. The examination system is
thorough, but the orientation is narrow. The program emphasizes skill
development, and students specialize in a single area of medical
technology. This professional parochialism produces medical laboratory
scientists who are not well-rounded, and who have a myopic view of
health care. The purpose of this study is to design a model
baccalaureate program to prepare effective medical laboratory personnel
for Nigeria.
In 1956 the profession recruited substantially from a stratum of
ability just below that of those then attending the university. The
primary goal of the training program from its inception has been to
train medical technologists to work in government hospitals as civil
servants. Development of the whole individual was of little concern
For many years the society regarded the medical technology profession
as second best, and considered the membership second rate. A series of
trade disputes beginning in 1968 and a final industrial action in 1976
sensitized both the Nigerian government and the society to the needs of
medical technologists, and to their role in the delivery of health
care.
As the standard of living rose and education--as opposed to
training--for earning a livelihood became more important to society,
the profession began to see "university material" among the growing
number of highly motivated recruits. Furthermore, as higher education
became more accessible, university education became the traditional and
readily identifiable yardstick against which others in the society
measure the worth of the professional. Accordingly, the Nigerian
Institute of Medical Laboratory Technology intensified efforts and
discussions with a number of Nigerian universities concerning
establishment of degree programs in medical laboratory sciences.
Social forces and changes, present and future needs of students,
and needs of the Nigerian health care delivery system have rendered the
present training programs obsolete. At one time--and not too long
ago--only a few people sought medical help when they were ill. Require-
ments of Nigeria's evolving culture and the impact of new knowledge
have changed this. "Health for all by the year 2000" is the current
national slogan, and also the goal of the World Health Organization.
Today only a few people pass through the hospital without laboratory
investigations. Knowledge in medical technology has increased exponen-
tially, the role of the clinical laboratory scientist has changed, the
character of students has changed, and access to higher education has
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become easier. Also, Nigerians have made a large number of changes
relating to curriculum content, and have changed methods and organiza-
tional patterns of curricula. The present Nigerian hospital-based
diploma program in medical laboratory sciences, which served
yesterday's needs, can no longer meet the present or future needs of
students or of the health care system. A reexamination of the tradi-
tional practices and procedures is of vital importance under the above
circumstances.
Statement of the Problem
In the past ten years, unprecedented debates have taken place over
the inadequacy of the Nigerian curriculum for medical laboratory
sciences education. The need for an efficient baccalaureate program
has been evident. Osanyintuyi, in a position paper, described the
standard system of training clinical laboratory scientists in Nigeria.
He said, "The present training system is purely an accident of our
history; it is barely good enough for the present, and certainly bad
for the future" (Osanyintuyi, 1974, p. 5). He alluded to one
resolution after another favoring a baccalaureate program. Since 1972
resolutions have been passed in the annual conferences of the Nigerian
Institute of Medical Laboratory Technology and the Association of
Medical Technologists.
Durowoju (1979) confirmed the shortage of clinical laboratory
scientists in Nigeria and suggested that all available means be used to
increase the number if sufficient impact is to be made on the projected
need. The Office of the Ministry of National Planning expressed a
similar conclusion in the 1981-1985 Fourth National Development Plan
when reviewing the needs of the health care delivery system.
Since to remain in familiar waters is easier than to venture into
uncharted ones, the problem of designing a college-level program in
medical laboratory sciences remains unsolved. In a survey conducted in
northern Nigeria in 1978, E. O. Akintunde (personal communication,
June 29, 1979) noted that no clear-cut recommendations resulted, and
opinions of laboratory practitioners on the issue were mixed. Talks
initiated by representatives of the Institute with two universities
have not yielded any clear and workable solution. This is the
situation even though suggestions abound as to what the nature of such
a program should be. Osanyintuyi (1974) has suggested a four-year
program composed of three years of academic course work and one year of
practical training.
Clearly, a framework is needed, but the curriculum that prepares
society for the present and the future must emphasize the development
of creative individuals who demonstrate qualities of openness,
flexibility, the motivation to make learning a part of self, and the
ability to solve problems. The need for a new pattern of medical
laboratory sciences education sound enough to help the individual
learner fulfill future goals and desires, and designed to prepare
students capable of accomplishing numerous vital tasks in a variety of
health care settings in Nigeria, prompted this study.
Blayney and Truelove (1981) have cautioned that simple transfer of
any American model for the education of allied health professionals to
the educational system of developing countries may be more harmful than
helpful. Sound educational practice calls for intelligent judgment
concerning the curriculum content and design that will enable graduates
to function in a real world.
Purpose of the Study
The purpose of this study was to design an effective model
baccalaureate program in medical laboratory sciences for Nigeria.
Seven research questions were used to achieve the stated purpose:
1. What are the current manpower needs of the Nigerian health
care system?
2. How effective is the present Nigerian medical laboratory
sciences program in meeting the nation's needs?
3. How effective is the present Nigerian medical laboratory
sciences program in providing upward and lateral mobility for
students and staff?
4. What improvements must be made in the present Nigerian
medical laboratory sciences program?
5. What criteria must be considered in developing an effective
model program for Nigeria?
6. What are the future staffing needs for the health care system
of Nigeria?
7. What is the nature of a baccalaureate curriculum in medical
laboratory sciences that would meet the present and future
needs of Nigeria?
The researcher used five approaches to provide answers to the
research questions, and to achieve the purpose of the study:
1. Analyzed the past and present status of the health care
delivery system of Nigeria based on data from the Federal
Ministry of Planning. The analysis pointed out the type of
staffing needs that a medical laboratory sciences education
program must meet.
-6-
2. Surveyed past and present medical laboratory sciences educa-
tion in Nigeria. The survey helped to evaluate the
effectiveness of the program in meeting the nation's needs,
in meeting students' needs and interests, in providing
students and staff upward and lateral mobility. The survey
also indicated improvements needed in the present medical
laboratory sciences program of Nigeria.
3. Visited three kinds of baccalaureate medical technology
programs in five universities, and interviewed key American
educators of medical laboratory personnel. The information
gathered helped identify some criteria that were considered
when designing the proposed program.
4. Analyzed approaches to planning medical laboratory sciences
educational programs in the United States and Great Britain.
The analysis identified other criteria that were considered
in developing the proposed program.
5. Designed a model baccalaureate program in medical laboratory
sciences for Nigeria.
Limitations of the Study
The study describes the Nigerian diploma program in medical
laboratory sciences, usually called the Associate of the Institute of
Medical Laboratory Technology program, as it was from 1956 to 1981.
The format of the program has remained unchanged since 1968, while the
country waited for an evolutionary movement in education to meet the
changing needs of the nation and the students.
-7-
The study was subject to four limitations:
1. Methodology. The researcher used a descriptive approach to
the study. The model program built from this approach would be more
credible if the procedure were to be followed by a consensus approach
using the opinions of Nigerian medical laboratory sciences educators.
Securing the opinions of these experts was not feasible.
2. Literature. The literature to which the writer had access
consisted of Decree No. 56, which established the Institute of Medical
Laboratory Technology of Nigeria; the Institute's brochure and sylla-
bus; minutes of the general and annual meetings of the clinical labora-
tory scientists; and two articles from the Nigerian Journal of Medical
Technology.
3. Researcher knowledge gaps and bias. The program and curricu-
lum of each country have their own peculiar characteristics to meet the
country's needs as suggested by Blayney and Truelove (1981). The
researcher used his knowledge of the Nigerian society and of the health
needs of the country, coupled with knowledge of the past and present
professional practice in other countries, and his knowledge of the
content and process of the medical laboratory sciences education. He
also used his judgment to adapt theories and research in program
planning and education to the development of a model program for
Nigeria. The researcher could not avoid or totally exclude his bias or
completely fill all knowledge gaps.
4. Deficiencies in knowledge of curriculum development. The
establishment of a baccalaureate program in and of itself does not
guarantee quality medical laboratory scientists. For instance, a
graduate who does not take advantage of the affective qualities and
people-oriented approach emphasized in the program may not exercise
good interpersonal relationships, and may have difficulty obtaining and
keeping a job. However, in the hands of capable people and responsive
students, a quality program is possible.
Definition of Terms
The following terms are defined as used in this study.
Medical technology--All the sciences that deal with obtaining vital
clinical laboratory data used to monitor health and assess illness.
These may include identification of disease-causing microorganisms,
analysis of chemical makeup of the body, and microscopic examination of
blood and other body fluids. A few United States institutions that
offer programs in the sciences more appropriately refer to the programs
as in medical laboratory sciences. In this study, medical technology
and medical laboratory sciences are used interchangeably.
Medical laboratory sciences--The present preferred name for programs in
medical technology in Britain and Nigeria.
Associate of laboratory science--A degree to be awarded after comple-
tion of the first two years and the clinical practicum of the model
program. Holders will be eligible to take the clinical laboratory
technician examination of the Institute of Medical Laboratory Tech-
nology of Nigeria.
Baccalaureate--A degree to be awarded after completion of the model
program. Holders will be eligible to take the Associate of the Insti-
tute of Medical Laboratory Technology examination.
Program--The entire plan indicating different curricula and their
implementation through direct instruction and other means in an
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educational system to achieve a set of broad objectives.
Curriculum--A plan for providing sets of learning opportunities for
persons to be educated. The plan should be viewed as an intention
rather than a blueprint (Saylor, Alexander and Lewis, 1981, p. 8).
Curriculum domain--A group of learning opportunities planned to achieve
a single set of closely related educational goals and specific objec-
tives (Saylor et al., 1981, p. 32).
Model--A semantic and schematic representation of the program or
curricular structure. It may be used as a prototype for planning.
Decree No. 56--A legislative act from the military government establish-
ing the Institute in 1968.
AIMLT--The acronym for Associate of the Institute of Medical Laboratory
Technology. A diploma is issued for associateship on successful
completion of Parts IIa and IIb examinations of the Institute.
FIMLT--The acronym for Fellowship of the Institute of Medical Labora-
tory Technology. It is a diploma given to individuals who demonstrate
an extension of knowledge in medical laboratory sciences and a widening
of their experience through examination or a defense of an original
scientific thesis related to medical laboratory sciences.
Sandwich degree course--A course in medical laboratory sciences in a
university in which three years of academic studies are interspersed
with one year of employment in a specialist laboratory.
Ordinary members--A professional status granted to members who pass
Part IA and IB examinations of the Nigerian Institute of Medical
Laboratory Technology.
Advisory committee--A number of persons appointed to serve in an
advisory role to the program. These individuals are selected because
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of their experience, positions in the community or other contributory
roles that they may play in establishing and implementing the program.
Procedures
The researcher used a descriptive approach to the study and
followed three methods in collecting data:
1. An intensive examination of available American, British and
Nigerian written resources (primary and secondary).
2. Visits to three kinds of baccalaureate medical technology
programs in five universities in the United States. Three of the
programs have a 2 plus 2 pattern, one has almost completed the process
of changing from a 3 plus 1 to a 2 plus 2 pattern, and one is a
study-work five-year program. Of the three 2 plus 2 programs two are
within a medical school facility, and one is associated with three
affiliating hospitals.
At each site, and in each interview, the researcher investigated
matters concerning the curriculum, the operation of the program,
scheduling of classes, scheduling of clinical experience, instructional
faculty, instructional materials, evaluation procedures and funding.
Discussions also centered on factors that have contributed to the
success of each program, and on failures and problems of the program.
3. Interviews with other American educators and resource persons
who have contributed to the development of medical laboratory sciences
education in the United States.
Most of the data from which the study was made were published; a
few unpublished materials were also used. Preference was given to
primary over secondary resources.
-11-
The chapters on health in the Third and Fourth National
Development Plans (1975-1985) were summarized and interpreted to
determine the past and present status and manpower needs of the health
care delivery system of Nigeria.
Decree No. 56 that established the Institute in 1968, the
Institute's regulation and syllabus, the annual reports of the
Institute (1974-1981), minutes of the general and annual meetings, and
reports of the secretaries of the associations of medical technologists
helped clear and add coherence to the data when describing and
analyzing the status of medical laboratory sciences education in
Nigeria.
Information regarding medical technology educational programs in
the United States and Britain was obtained through a survey of
literature and related research.
All information obtained from written materials and interviews was
checked and cross-checked to ensure accuracy. Where appropriate,
information obtained from interviews was checked against written
resources and, if the two resources were in conflict, written
information was selected over the oral except where written resources
were antiquated.
The study report contains a synthesis of surveys, analyses and
interviews, and makes recommendations for change through a proposed
model program. The model is clarified by a set of guidelines and
scenario for planning and implementing the proposed program.
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Summary
The purpose of the present study was to design an effective
baccalaureate program in medical laboratory sciences for Nigeria. The
study includes seven research questions and a description of five
approaches to answering those questions. It also includes four limita-
tions of the study, functional definitions of the terms used in the
study, and an explanation of the procedures followed by the researcher.
CHAPTER II
ANALYSIS OF BACKGROUND RESOURCES
As Saylor et al. (1981) indicated, curriculum planners can profit
from an understanding of the history of curriculum planning. The
authors contended that, while curriculum workers should not be bound in
their decisions by historical precedent, if they remain ignorant of
such precedent they may repeat errors of the past. In drafting a
proposal for change, and in developing a new curriculum, one must
scrutinize intelligently the history and experience in the medical
technology profession, examine experiments with educational programs,
and learn from successes and mistakes. This approach facilitates sound
decisions about such an educational endeavor.
This chapter surveys the evolution of curricula in medical
technology education in the United States, Great Britain and Nigeria.
Such historical perspective will provide a basis for analyzing the
various approaches that have been used in program planning, and the
analysis will help determine some of the criteria that can be used in
developing a new model program for Nigeria. The chapter also discusses
health care in Nigeria and indicates the kind of staffing needs that
new programs must meet.
-13-
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Medical Technology Education
in the United States
Curriculum Theory
Saylor et al. (1981) indicated the three bases that curriculum
planners need to attend to in planning curriculum. The bases include
the society, the learner, and the nature of knowledge. The authors
hinted at dangers in using one or two bases for the curriculum at the
expense of the others. They warned that appropriate weights should be
assigned to the consideration of each of the bases in planning. They
recommended that weights should shift with the type of learning
opportunities being planned. Tyler (1949) and Haas (1980) suggested
similar guidance in making decisions about curriculum planning, albeit
in slightly different ways.
Hilda Taba (1962) suggested that, in curriculum development,
design should follow function rather than vice versa. Saylor et al.
(1981) reiterated this belief and pointed to five main curriculum
designs: subject matter or discipline, specific competencies or
technology, human traits or processes, social functions or activities,
and individual needs and interests or activities. Since curriculum is
a plan for providing sets of learning opportunities for students, the
authors contended that no single design could be adequate for the total
curriculum plan. They suggested that curriculum planners select
appropriate designs for particular curriculum goals, domains, and
objectives. Program planners in medical technology education must
therefore be knowledgeable about curriculum designs and the design
process in educational programs.
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Early Medical Technology Education in the United States
No examination was required for certification in medical
technology in the United States prior to 1933. From then on, students
were required to have a minimum of 30 semester hours of college credits
including eight semester hours each of chemistry and biology as
prerequisites for hospital training. The need then arose to teach
these subjects to would-be professionals.
The 1936 Survey of Schools for Clinical Laboratory Technicians
conducted by members of the Council for Medical Education and Hospitals
was an early description of the types of educational programs that had
sprung up, and of curriculum planning efforts then in vogue. The two
types of programs the survey identified were the college or university
programs, and the hospital laboratory programs. The university
programs offered standard collegiate courses, the fourth year of which
consisted of instruction and practice training in a hospital department
affiliated with the institution. The hospital laboratory programs
admitted students with backgrounds that ranged from high school
preparation to four years of college course work. All used both
subject-matter design and the apprenticeship approach. Lecturers in
college taught theory and principle with the idea that these would
serve as underlying motives for students' later activities. The
general method of preparation in the hospital laboratories was based on
the principle of learning by doing. The Essentials of an Accredited
Educational Program for the Medical Technologist (1936-1977) were
mainly dictated by the American Medical Association Council on Medical
Education in collaboration with the American Society of Clinical
Pathologists and the American Society for Medical Technologists.
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The major thrust of research in undergraduate program planning for
the decades between 1930 and 1960 was on subject matter rearrangements
and rescheduling. Arnold (1960), in his study of the educational
standards in medical technology, reported that such efforts led to a
revamping of the junior year pre-clinical curriculum of certain
schools, and a reevaluation of some courses offered in the three-year
collegiate programs, courses that were prerequisite to the year of
hospital training.
Program and Curriculum Planning in Medical Technology Education
Six varieties of programs and curriculum planning have been
developed through the years. They can be classified for the purpose of
this research as programs using the "traditional" pattern, the "inte-
grated" pattern, and the "competency-based" pattern.
The traditional pattern. This pattern emphasizes subject matter.
Programs using this approach include high school plus 1, 2 plus 1, 3
plus 1, and 4 plus 1. The first numeral indicates the years of
academic preparation and the second, the period of clinical experience.
Usually, the experience lasts 12 consecutive months in a hospital
laboratory.
In 1933, the requirements for entrance into an approved hospital
training school of medical technology were graduation from an accredit-
ed high school, or equivalent preparation, and a minimum of one year of
college, including course work in chemistry and biology. In 1938,
collegiate requirements were raised to two years. According to the
Essentials published in 1958 and the 31st edition of the information
booklet of Registry of Medical Technologists (1959), the 3 plus 1
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program resulted from efforts of leaders in the field who considered
the purpose of higher education and recognized a real need for a
minimum of three years' college pre-clinical training. The program
came into effect in January 1962. Fagelson (1964) expressed the
sentiments of the leaders of that time when she wrote the following:
The basic purpose of higher education is to educate
the whole individual. A college education provides
more than just the means to earn a livelihood; it also
develops the traits of literacy, judgment and
discretion in both professional and personal life.
The teaching of broad concepts as opposed to
specialized rules lays the foundation for creative
thinking and problem solving. In the final analysis
it is these tools that enable the individual to take
advantage of the scope of the progressive changes in
the laboratory fields, the world of medicine, and the
world around him. It is from the ranks of these
college trained professionals that specialists,
teachers, administrators, and researchers must come.
(p. 50)
Withers (1969) and Fryer (1970) supported this approach because,
as they explained, it produces a well-rounded medical technologist, and
provides a firm foundation for graduate study. However, Williams and
Lindberg (1979) noted a disadvantage of this approach. The authors
observed that since clinical practice were in hospitals that may not
necessarily be in the same geographical area as the university,
students have decreased involvement in campus activities. Students
became literarily divorced from the university, particularly when
distance was a factor and no classes were held on campus.
By 1966, a number of hospital schools admitted students who
already have a degree of Bachelor of Science (or Arts) earned by four
years of collegiate work prior to training. Such students usually have
met the pretechnical requirements of college mathematics, biology and
chemistry. Although affiliation agreements occasionally existed
-18-
between some universities and hospital schools, these agreements were
only to meet the letter of the law. Compliance was perfunctory rather
than active. Affiliating hospitals were recommended to students for
clinical experience, and students were responsible for applying to the
schools in which they wished to receive clinical experience.
Hovde (1963), Heinemann (1969), and Henderson and Love (1972)
decried the lack of communication between the academic institutions and
the accredited hospital schools. The two institutions operated as two
distinct entities with little or no dialogue, each staying in a shell
of isolationism concerning educational procedures. The 1977 Essentials
published by the National Accrediting Agency for Clinical Laboratory
Sciences offered some direction to correct this state of affairs by
requiring documented evidence of an affiliation agreement and evidence
of cooperative curriculum development and supervision between academic
and clinical facilities.
The integrated pattern. In this pattern educators integrate the
subject matter into logical sequence, expand the applied clinical
courses that combine lecture and structured laboratory experiences, and
provide for expanded but relevant general education courses with some
flexibility in a university setting. Implicit in this kind of pattern
is the concept of producing academically qualified students and
transforming them into professional men and women dedicated to the
service of others through medical technology. It also emphasizes
balance in the theoretical and practical aspects of the program, giving
students opportunities to practice learned skills in a less stressful
environment before they actually become employees.
-19-
The 2 plus 2 program uses the integrated approach. The program
consists of two years of preprofessional college enrollment plus two
years of professional college attendance. The clinical experience is
incorporated within the junior and senior years of college. The
university has an academic department of medical technology. The
department makes use of the humanities, social sciences and biological
sciences faculties to provide the general education and preprofessional
courses. Instructional staff in the department provides instruction in
the principles of clinical procedures, supplemented with simulated
(student) laboratories. The staff also supervises the clinical
experiences in the hospitals affiliated with the university.
Imperatore (1969) pointed out the advantages of this pattern. The
pattern provides the harmonious development of the student in the
chosen profession within the framework of a liberal arts education, and
it provides an opportunity for the hospital and the academic
institutions to become an integrated educational system. Williams and
Lindberg (1979) pointed out another advantage of this pattern:
Students can retain identification with the university, participate in
extracurricular activities on campus, continue social life, and utilize
available opportunities for campus leadership.
The integrated approach and the 2 plus 2 program have received
some criticisms. In some cases the criticism is a natural resistance
to change; in others, it derives from premature judgment being made.
However, Rausch (1974) reported an employer evaluation of performance
and evaluation of performance on a national certification examination
of graduates of the traditional 3 plus 1, and those of the new 2 plus 2
curriculum of the University of Minnesota. Graduates of the 2 plus 2
-20-
were found to be as competent as those of the traditional 3 plus 1.
The performance of the 2 plus 2 graduates was not significantly
different from that of the 3 plus 1 graduates on the certifying
examination. In a 1977 followup study, Rausch confirmed that graduates
of the 2 plus 2 program were as capable of performance and professional
growth as graduates from the 3 plus 1 program.
An obvious disadvantage of the 2 plus 2 pattern is the need for
provision in the budget for more faculty, student laboratory space,
supplies and equipment, and secretarial personnel.
The competency-based pattern. In the competency-based approach,
the professional knowledge, experiences, skills, and attitudes needed
to function at the entry level are defined, organized into
competencies, and sequenced into domains before learning experiences
are designed.
Lindberg, Rodeheaver and Williams (1972) applied the competency-
based approach in developing the Miami-Dade Community College medical
laboratory technician curriculum. The modular-scheduled, competency-
based curriculum was open-ended, taught in a sequence of modules, and
utilized many types of educational media. Time required for mastering
of content was flexible, but content and standard of performance were
kept constant. The curriculum offered upward mobility.
Beard, Sesney, Springham, and McDonald (1974) used the
competency-based approach in developing a medical technology program
implemented at Weber State College, Ogden, Utah. The program includes
an integration of theory with practice, and within it students develop
needed skills under the direction of medical technologists. The
program is said to allow for greater flexibility in timing, scheduling
-21-
of laboratory experiences, and achievement of clearly stated needed
skills. The approach was also reported to be helpful to the clinical
faculty because instructors did not have to spend an exorbitant amount
of time explaining basic principles to students.
Brunner (1978) reported an effort using this approach in a multi-
disciplinary federally funded program developed at the Ohio State
University. Evaluation of the program showed positive results, consid-
ered an indication of its high quality.
Other variants of the basic structure continue to evolve. In a
cooperative education setting, Northeastern University in Boston has a
study-work medical laboratory sciences program. Students in the
program receive two to three quarters of instruction, work in the
clinical laboratory, and then return for further study. The program is
completed in five years.
Procedure of Determining Program or Curriculum Content in Medical
Laboratory Education
Heidgerten (1959) divides the task of curriculum development into
four significant aspects. These include determination of the educa-
tional direction or goals, selection of the curricular experiences that
are likely to lead to the attainment of these desired goals, organiza-
tion of the curricular experiences, and determination and development
of principles and procedures by which changes in the curriculum can be
made, evaluated and sustained.
Review of research in medical technology education reveals that
curriculum development generally follows this approach. However, the
Essentials of an Accredited Educational Program for the Medical
Technologist (1936-1977) often mentions the need for goals for schools
of medical technology, but does not specify just what those goals
-22-
should be. Trumbull (1962) recommended that the goals include the
development of technologists who can perform competently and
expeditiously well the established and ordinarily used technical
procedures of a clinical laboratory, offering training of a quality
comparable to that expected in senior collegiate levels. During the
training the curriculum should inculcate in the student the desire to
develop a curiosity that will carry the learner beyond those needs
ordinarily required simply for learning the theory and technical
procedures being immediately taught. The curriculum should help
students, preferably by example, to develop the proper degree of
compassion for patients, instilling in students the tradition of
medicine whereby the older generation teaches the younger. These goals
must be consistent with those of the college with which the school of
medical technology is affiliated. The majority of these goals are
compatible with what Saylor et al. (1981) considered of great and
future significance--personal development, social competence, continued
learning skills, and specialization.
Once the goals are determined the content of the program or
curriculum is selected. Review of research indicates three main
procedures have been used in medical technology education: The
judgmental, the analytical, and the consensual procedures.
The judgmental procedure. This procedure was, and still is,
widely used by the curriculum worker. Thompson suggested steps that
may be followed in using this procedure. The steps include
identification of the educational and social objectives that should be
accepted, determination of the conditions under which these objectives
are considered desirable and in which they must be realized, and
-23-
selection of subject matter that best satisfies the objectives under
existing conditions (Thompson, 1973, Chapter 8). However, Smith,
Stanley, and Stones (1957) have pointed out that this procedure places
great demands for intellectual honesty upon curriculum planners. The
authors added that if the social perspective of planners is narrow, and
their ideas and prejudices are unaffected by democratic ideals and too
closely identified with interests of special groups, and if they are so
occupied with the past that they cannot appreciate the present nor see
its potential for the future, their judgment will hardly lead to the
best choice of subject matter.
Trumbull (1962) surveyed 44 schools of medical technology and
found that the subjects were those suggested in the guide book prepared
by the Board of Schools on the subjects covered by the Board of Regis-
try in its examination. Such subjects include hematology, chemistry,
microbiology, clinical microscopy, blood banking, serology, histologic
techniques, and radioactive isotopes (American Society of Clinical
Pathologists, Guide book, 1962).
Gleich (1968), in evaluating the medical technology curriculum,
noted that college science prerequisites for admission to a school of
medical technology as required by the Board of Registry have wide
latitude.
The analytical procedure. This procedure has been widely used
recently by researchers for determining curriculum content in medical
technology education. Smith et al. (1957) indicated that the procedure
is that of occupational or task analysis developed by vocational
educators during their participation in World War I training programs.
The procedure includes identification of the abilities and
-24-
understanding needed by medical technologists in occupations involving
knowledge of the field. Data are collected by such techniques as
interviewing, observation, mailed questionnaire, documentary analysis,
and the use of experts or experienced professionals to identify com-
petencies from which the curriculum is developed. The literature
contains no extensive reports of job analysis through observation. The
interview technique is considered superior to the questionnaire since
problems of interpretation, common with the questionnaire, are avoided
using the interviews.
Johnston, Harris, O'Kell, and Baird (1974), for example, reported
the use of the analytical procedure in medical technology. Hospital
representatives gave a brief analysis of the tasks and listed the
concepts and skills needed to perform them in the laboratory. College
representatives described their course content and suggested courses
that could help form the basis for the development of the competencies
needed.
Schumacher, LaDuca, Engel, and Risley (1978) recommended, in the
development of proficiency tests, use of the Professional Performance
Situation Model to identify medical technology competencies from which
a curriculum could be derived.
In order to study laboratory tasks in depth and provide data for
logically restructuring job roles, and to develop a task-oriented
curriculum, Hendrick and Fiene (1975) used the analytical approach.
However, this approach has a number of weaknesses. The validity of the
instrument used to collect data may be suspect. The reliability of
such instruments is also rarely reported. Usually the methodology
improves when experts in the field are polled. Another weakness is
-25-
that random selection, the procedure often used to poll persons who
will furnish information for program and curriculum planning, is not
the most appropriate method. The assumption in using the analytical
procedure is that the competencies are needed for a well trained
worker. Almost invariably this is not the case; entry-level
competencies suffice. On the other hand, the obvious weakness of
settling for such entry-level competencies is that such preparation
cannot prepare trainees for future changes in the profession.
The consensual procedure. The consenual procedure is a way of
collecting peoples' opinions about what they believe the program or
curriculum should be. A jury of experts chosen to validate these
opinions may include educators, practitioners, or representatives of
other groups with a knowledge of the profession. Other forms of
validation procedures may also be used. The responses of the jury of
experts or data from the validation procedure used (e.g., Delphi
technique) are tabulated and interpreted. This information is then
used as a basis on which the curriculum is developed.
Gleich (1968), working with the idea of involving a large number
of people in the profession, an approach Beauchamp suggested in 1961,
used a questionnaire to collect data on opinions of practicing
technologists concerning the usefulness of college science subjects to
them during their hospital training and their professional practice.
Respondents listed courses that were most helpful and these formed the
major part of an undergraduate medical technology curriculum.
Brunner (1978) used opinions of experienced and practicing
technologists to develop competencies from which a competency-based
-26-
curriculum for the Ohio State University School of Medical Technology
was developed.
Crowley (1975) applied the Delphi technique to collect the
perceptions of clinical laboratory educators, other practitioners, and
students in the development of an undergraduate curriculum in medical
technology. This researcher believes that, used alone, the consensual
approach is inadequate.
Medical Laboratory Sciences Education
in England, Wales, and Northern Ireland
Nigeria was a British colony prior to gaining independence in
October 1960. The effects of the long-held allegiance to the British
crown are reflected in the educational system of the country, and in
the medical technology training programs. The training of medical
technologists, which started in 1953, followed the British pattern
until the establishment of the Institute of Medical Laboratory
Technology of Nigeria in 1968. Although Nigeria did not follow the
British schedule after 1970, new programs bear vestiges of the British
model and sentiments and precedent have perpetuated similar modes of
operation. This section presents a brief history of medical laboratory
sciences education in the British Isles.
Fifty years ago medical laboratory technicians were employed to
help pathologists and worked under their supervision. Increased
workload and specialization resulted in the development of separate but
interrelated disciplines in medical laboratory sciences and made the
former pathologist-technician relationship no longer possible. As
years passed, members of the profession were required to act in a more
independent fashion, although working closely with other professional
-21-
groups. Accordingly, training programs with a more academic content
were established to provide an understanding of the nature of disease
processes and investigative methods used (Institute of Medical
Laboratory Sciences (IMLS) Evidence, 1977).
For more than five decades the United Kingdom used part-time
vocational and diploma programs to achieve the stated goal. Presently,
varieties of diploma and degree programs are in vogue. Contact and
exchange of ideas with British experts and educators by the researcher
revealed that England is moving in the direction of baccalaureate
programs to meet more adequately the developmental objectives of the
profession (J. K. Fawcett, personal communication, October 18, 1982).
The often heard and generally accepted reasons were that more recent
applicants and entrants to the profession were university material, and
that more individuals with sound scientific and general education,
which university education provides, were needed to develop the
profession and country rapidly. Dr. Rogers of Portsmouth Polytechnic
in Great Britain, in response to the issue of further progress by
degrees, commented ". . it does seem to be an inescapable fact of
life that most good science is produced by graduate students and that
ultimately the standing of the profession will rest on its academic
position" (IMLS Gazette, August 1978, p. 302).
Review of available literature indicates that importance is
continually being given to college-level education in medical
laboratory sciences in Great Britain. In 1948 only 1% of the medical
laboratory technicians in Great Britain were university graduates; that
figure rose to 20% in 1978 (IMLS Gazette, April 1978). By 1977 both
-28-
four-year, vocationally based degree courses and three-year, full-time
honors degree courses were available (IMLS Evidence, 1977).
The Institute of Medical Laboratory Sciences of London
The professional and educational affairs, and all matters
affecting the working lives of medical laboratory scientists in the
United Kingdom and Ireland, are conducted by two organizations: the
Institute of Medical Laboratory Sciences, founded in 1912, and the
Council for Professions Supplementary to Medicine.
Among the functions of the Institute are determining and
publishing regulations for training medical laboratory scientists in
Great Britain, including prerequisites, academic programs, in-service
experience and examinations; awarding two professional designations--
Associate of the Institute of Medical Laboratory Sciences (AIMLS),
which is state registration level, and Fellow of the Institute of
Medical Laboratory Sciences (FIMLS); the post-registration level;
approving and assessing all courses in medical laboratory subjects
qualifying for AIMLS; preparing and conducting national examinations
for AIMLS and FIMLS, and appointing representatives to regional,
national and international committees whose decisions can affect the
training status and working conditions of medical laboratory scientists
in Great Britain (IMLS Gazette, August 1976; IMLS Evidence, 1977).
The Council for Professions Supplementary to Medicine
The Council for Professions Supplementary to Medicine was
established by an Act of Parliament in 1960 to protect the public by
ensuring a basic standard of practice for qualified practitioners in
paramedical professions, approving all courses in academic institutions
-29-
where the qualification leads to registration, publishing qualifica-
tions from other countries acceptable for British registration, and
recommending disciplinary actions and suspending or restricting the
duties of any practitioner found guilty of professional misconduct
(IMLS Gazette, June, 1978; IMLS Gazette, September, 1978).
Examinations and Certifications
The first Examination Council was set up in 1921. The Council
instituted a system of examinations and certifications whereby separate
examinations were conducted in bacteriology and pathology; chemical
pathology, hematology and blood transfusion, parasitology and virology
were added in succession.
In 1937 an intermediate examination covering all subjects at an
elementary level was introduced. This pattern of examination was
replaced in 1966 by the Ordinary National Certificate/Diploma in
sciences (medical laboratory sciences variant) examination, and finally
terminated in 1970.
The trend toward specialization in industrial Britain in the 1960s
brought a change from the original final examination of the Institute
to the Higher National Certificate examination in 1968. Examinations
were both written and practical in the specialist's subject and in the
"core" subjects of physiology, chemistry and biochemistry. A
successful candidate is awarded the Higher National Certificate in
medical laboratory subjects jointly by the Institute, the Royal College
of Pathologists, and the Department of Education and Science. With
this certificate, and the required in-service experience in an approved
laboratory, the certificant is entitled to become an Associate of the
Institute of Medical Laboratory Sciences (AIMLS), and state
-30-
registerable by the Board of Medical Laboratory Sciences of the Council
for Professions Supplementary to Medicine.
The May 1977 issue of the Gazette noted that the increasing number
of science graduates who worked in medical laboratories and sought
registration when they had acquired sufficient experience made it
necessary for the Medical Laboratory Sciences Board of the Council for
Professions Supplementary to Medicine to design one year of training to
complement the experience gained during a trainee's studies for a basic
science degree. This one-year training is aimed at correcting the
deficiencies such trainees may have. Registration of the graduates
came into effect in June 1978. From this date, holders of science
degrees in acceptable subjects who became employed in medical labora-
tories could gain associateship of the institute by completing 12
months of full-time practical experience in a laboratory approved for
this purpose. However, the degree must have been obtained in Great
Britain.
Several issues of the Gazette from 1976 to date carry a "Scheme 0"
designed as a pathway to associateship for people trained and qualified
overseas. Graduates from approved overseas universities possessing
appropriate science degrees or other qualifications obtained outside
the United Kingdom and the Republic of Ireland complete prescribed
periods of registration with the Institute, train in a laboratory in
the British Isles and take the Higher National Certificate examination
in medical laboratory subjects.
Practitioners of associate grade may advance professionally by
becoming Fellows of the Institute. Fellowship may be gained by passing
the "special" examination, as it is called. A two-year advanced study
of the applicant's major subject at the associate level is required as
preparation for the examination (IMLS Gazette, December 1976).
Fellowship may also be gained by presenting an approved thesis or by
virtue of certain post-graduate degrees obtained in Great Britain (IMLS
Gazette, September 1978).
Training Programs
Training programs exist at the junior and at the senior levels.
Junior level. To begin training, the student must first obtain
employment in an approved laboratory as a Junior Medical Laboratory
Scientific Officer, and then enroll at a college for the junior level
of the training. Programs at the junior level include the Ordinary
National Diploma (OND/ONC) in sciences (medical laboratory sciences
variant), and the Technical Education Council Certificate program (TEC
Cert.) in sciences.
Senior level. The senior level programs build on the experiences
of the junior level. Programs at the senior level include the TEC
Higher Certificate program in medical laboratory subjects, the TEC
Higher Diploma in medical laboratory subjects, the basic sciences
degree holders' program, and the program for people trained and
qualified overseas. Fellowship may be gained by following the
fellowship program.
Degree programs in medical laboratory sciences. Since 1977, 25%
to 30% of new entrants to the profession have basic science degrees;
university degrees in medical laboratory sciences are now available.
Portsmouth Polytechnic offers a three-year, full-time BSc honors
course in medical laboratory sciences within the science degree scheme
of the School of Pharmacy. University of Bradford offers a four-year,
-32-
full-time, sandwich degree course in biomedical sciences with three
years of academic studies interspersed with one year of employment in a
specialist laboratory. Graduates must complete one year of training in
an approved laboratory to be eligible for associateship of the
Institute and for state registration.
The entry requirements and the curricula of the training programs
are presented in some detail in Appendix A.
Status of Health Care in Nigeria
Nigeria, like many other developing countries, has a high infant
and general mortality rate because of insufficient medical and
paramedical personnel, inadequate health care delivery facilities and
poor management of the existing system (King, 1966; Federal Republic of
Nigeria National Development Plans, 1975-1985). The greatest problems
facing health care delivery in Nigeria have been population explosion,
lack of qualified and sufficient medical manpower, and insufficiency of
drugs.
In a series of government-established five-year plans, Nigeria
addresses the major health problems facing the country. In a 1981
article, Okoli reported that the present civilian government, with
assistance from World Health Organization and United Nations
International Children's Emergency Fund, plans to increase the number
of health care facilities (primary, comprehensive, and clinics) in each
local government area. Such an effort will increase the demand for
health professionals and competent laboratory personnel to staff the
facilities. Over the years, the medical technology profession of
Nigeria has played a significant role in providing the health care
-33-
system with medical technologists; however, present documented number
of practicing technologists has not met estimated needs.
Demographic Characteristics and Trends in Nigeria
According to the 1963 census, Nigeria's population is about 80
million. The country has an area of about 941,849 square kilometers.
This represents a population density of about 85 persons per square
kilometer. The population density, however, varies from about 300 to
400 persons per square kilometer in some states to as low as 24 persons
per square kilometer in others. Experts estimate the actual current
population at more than 100 million. The growth rate is believed to be
about 2.8 per cent per annum. This high growth rate has been
attributed to the combined effects of high birth rate (about 49 births
per thousand population per annum), and declining death rate (about 22
deaths per thousand population per year).
Current life expectancy at birth in Nigeria is about 46 years for
males and 49 years for females. The infant mortality rate is still
relatively high (about 187 per thousand live births), and the maternal
mortality rate is about 2.4 per thousand (Federal Republic of Nigeria,
News Bulletin, 1982). In both absolute and relative terms, the above
statistics indicate a poor health status for the country; however, they
reveal significant improvements when compared with earlier periods. As
shown in Table 2-1, life expectancy at birth between 1950 and 1955 was
33.5 years for males and 36.5 for females; by the period 1975-1980 the
situation had improved considerably to 45.9 and 49.2 for the sexes
respectively. There was consistent improvement over three decades.
-34-
TABLE 2-1
Selected Demographic Data on Nigeria 1950-80
(Summarized from: The Federal Republic of Nigeria
Fourth National Development Plan 1981-85)
Crude Birth
Period Rate Per (000)
1950-55
1955-60
1960-65
1965-70
1970-75
1975-80
50.0
49.6
49.3
49.2
Life Expectancy (Years)
Males Females
33.5
36.0
38.5
40.9
43.4
45.9
36.5
39.1
41.6
44.1
46.6
49.2
Crude Death
Rate Per (000)
25.0
24.0
22.7
20.7
The crude death rate which was 25 per thousand from 1960 to 1965,
dropped to 20.7 per thousand in the period 1976-1980.
Nigeria is experiencing a relatively high increase in
urbanization. According to recent estimates, about 65% of the
population live in predominantly small rural settlements, less than 10%
live in towns, while about 15% are urban dwellers. Another aspect of
urbanization is the high rate of growth of cities in Nigeria. These
capital cities are the seats of industrial, commercial and governmental
administrative activities. Accordingly, social amenities, housing,
education and health care facilities are concentrated in these cities.
An estimated 35% of the Nigerian population is covered by some form of
health care services (Federal Republic of Nigeria, Fourth National
Development Plan, 1981-85). Undue emphasis on curative hospital-based
treatment programs with high urban bias has meant that most of the
rural areas, where the bulk of the population live, have remained
unattended. Urbanization has created a lopsided distribution of social
amenities and basic facilities. This relative neglect of the rural
areas in the location of social and basic amenities has made it
difficult to attract an adequate number of health personnel to work in
the areas. When health services are available, they are often
unreliable because communication gaps exist between health workers in
these areas and the community they serve. The community is often not
aware of what is available, and because of poor orientation, health
workers often fail to appreciate the needs of the community.
Past emphasis. The most common diseases in Nigeria are shown in
Table 2-2. The table shows the years for which data are available. A
significant trend is that more cases are being reported. The Nigerian
TABLE 2-2
Major Reportable Diseases in Nigeria
(thousands of cases reported)
(Summarized from: The Federal Republic of Nigeria
Fourth National Development Plan 1981-85)
1968 1973 1977
Malaria 266 724 1,223
Dysentery (All types) 129 227 242
Measles 50 109 283
Pneumonia 28 69 97
Gonorrhea 42 70 65
Whooping Cough 19 21 42
Chicken Pox 10 19 39
Filariasis 7 20 25
Schistosomiasis (All types) 9 25 24
Tuberculosis 9 14 15
culture is evolving, more people are coming to the hospital when they
are ill and the diseases of civilization such as tuberculosis and
alcoholism are becoming increasingly important. The diseases shown in
Table 2-2 are preventable or could be effectively treated if diagnosed
early; however, while past development efforts gave priority to
preventive services, capital budget allocation did not reflect this
emphasis until the 1975-80 plan period.
In the 1960s the main emphasis was on the training of doctors, and
the expansion of old and building of new teaching hospitals. Achieve-
ment, however, did not match expectations because even when hospitals
were completed, the lack of adequate manpower, equipment and drugs
often meant that no services could be provided. Furthermore, these
facilities were mainly for the urban centers with little concern for
community service. This phenomenon persisted through the 1970s and is
still responsible for the long periods of delay between construction
and provision of services.
Another phenomenon observed during the 1975-80 plan period was the
proliferation of private health institutions. While they were needed
to complement government efforts, the standards of most of the private
hospitals were far from satisfactory. These hospitals were crippled
with inadequate physical facilities, irregular services of
overstretched and inexperienced medical practitioners assisted by an
equally inadequate number of ill-trained paramedical personnel. The
situation necessitated the promulgation of the Regulated and Other
Professions Act in 1978. The impact of this problem continues to be
felt in spite of the Act.
-38-
In the Third National Development Plan (1975-80), the Basic Health
Service Scheme (BHSS) was introduced by the Federal Government of
Nigeria. The objective of the scheme was to deliver primary health
care services that will ensure adequate attention to nutrition
education, health education, maternal and child health, family
planning, control of communicable diseases, and environmental
sanitation to a larger proportion of the population, and to redress the
lopsided emphasis on curative services.
In one attempt to implement the BHSS the government disbursed
about one million Naira (1.5 million dollars) for the construction of
20 health clinics, the provision of 84 mobile health clinics in each
state, and the training of auxiliary personnel such as community health
officers, nursing assistants and health aides (Dateline Africa, 1982).
The implementation of the BHSS is being continued in the fourth plan
period of 1981-1985.
Present emphasis. The present emphasis is reflected in the Fourth
National Development Plan (1981-85). The Nigerian government is
pursuing the goal of providing a comprehensive health care that offers
promotional, protective, restorative and rehabilitative services to an
increasing proportion of the population. In order to meet this goal,
the government planned a National Comprehensive Health Care System to
operate at the primary, secondary, and tertiary levels. At the primary
level, basic health services will be delivered in health centers,
clinics and out-patient departments of hospitals in rural, suburban and
urban areas. The secondary health care services will support the
primary services and will be provided in hospitals. The services will
cover referrals from the primary level. The tertiary health services
-39-
are to be provided by the specialist hospitals and other institutions
of health care to support both the primary and secondary levels of
health care.
Okoli (1981) reported that the minister of health, Dr. D. C. Ugwu,
announced that the government, with the assistance of the World Health
Organization and the United Nations International Children's Emergency
Fund, has built 34 thirty-bed comprehensive health clinics, 57
fifty-bed primary health clinics and 452 four-bed community health
clinics. Of the institutions built, only 4 comprehensive, 4 primary,
and 256 community health clinics had been properly equipped and were
functioning. He further added that construction of 9 comprehensive, 44
primary and 123 community health clinics was under way.
The running of community health programs has been entrusted to the
local governments through the state government. The direction of and
the responsibility for the teaching hospitals, immunization programs,
epidemics and several other health hazards, such as leprosy and
malaria, still remain in the hands of the Federal government.
The claims of the herbalists and other traditional medicine men
are being assessed with the view of giving official recognition to
them. The nation may soon witness an unprecedented cooperative effort
between the modern medicine men and the traditional bone-setters, who
sometimes have proved more successful than some of their modern
orthopedic surgeon counterparts.
Major problems. The main problems of the health care delivery
system of Nigeria remain nearly constant although with diminishing
severity. The minister of health, in an interview with Okoli,
explained part of the problems when he said, "The biggest problems
-40-
facing health care delivery in Nigeria have been the population
explosion (Nigeria's population has been estimated at over 100
million); lack of qualified and sufficient medical manpower, and
insufficiency of drugs" (Okoli, 1981, p. 2707). Other problems that
have been highlighted in the Third and Fourth National Development
Plans (1975-1985) include imbalance between curative and preventive
health services, lopsided distribution of health institutions leading
to limited access to health services and inadequate coverage,
inefficient utilization and poor management of health facilities, poor
state of private medical practice, and shortage of health manpower.
Clearly, the manpower ratios of 1:76,290 for medical technologists,
1:307,140 for dentists, and 1:29,720 for pharmacists as of 1979, as
shown in Table 2-3, are intolerably low and unsatisfactory. The above
problems have remained the bottlenecks hampering health care
development in Nigeria.
Future plans and needs. In a 1982 article, Collins quoted the
Nigerian deputy director-general of World Health Organization,
Dr. Adeoye Lambo, as saying "Health has always been the missing sector
in development planning, and it is this that must change. Only if this
happens could the aim of health for all by the year 2000 be attained"
(Collins, 1982, p. 1506). Accordingly, future plans and needs have
included, among other things, means of removing the bottlenecks that
are hampering development. The government continues to maintain active
interest in the BHSS, although not to the neglect of curative hospital
services. Ways are being sought to improve the training and increase
the number of health workers needed to effectively implement the
scheme. Additional categories of health personnel such as community
-41-
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-42-
health supervisors, community health officers, community health
assistants, and community health aides are to be trained through the
new schools of health technology. Plans are under way to expand and
equip existing teaching hospitals, build new ones, and back these up
with strong diagnostic, nursing, specialist and medical rehabilitative
services to support the network of general hospitals and basic health
centers.
Future plans also include the establishment of adequate methods
for monitoring and evaluating the performance of health institutions
with a view to enhancing effectiveness and achieving optimum resource
allocation. As a part of the effective and efficient health service
development, the government plans to promote the health-team approach
to health manpower development. While government will allow
procurement of needed equipment and machinery, maintenance arrangements
will have to be part of the package from now on to minimize "down time"
of such equipment and guarantee reliable services.
To deal with the problem of drug shortage and lack of essential
equipment, the government plans to establish an effective procurement
system that will ensure local supplies of essential drugs and
equipment. Part of the plan is the promotion and encouragement of drug
manufacturing companies in Nigeria.
The decentralization of the decision-making process in the
management of health services is aimed at involving the local and state
governments, and intended to encourage community participation in the
planning for, provisions for, and organization of health care delivery.
Such an involvement will in the future help in the intensification of
programs of immunization, and others like it.
-43-
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-44-
For the National Comprehensive Health Care System to make the
desired impact, the health institutions should not only expand, but
also be equipped and staffed by an adequate number of well trained
health personnel. The government intends to make an effort to increase
the number of health professionals and technological personnel by at
least 50 percent by 1985. Table 2-4 shows the projected numbers of the
various categories of medical personnel for the period of 1980 to 1985.
In order to ensure a more equitable distribution of doctors and
paramedical personnel, the government plans to effect a combination of
incentive measures to attract the needed personnel to suburban and
rural areas.
Historical Perspective of Medical Laboratory
Technology Education in Nigeria
Clinical diagnosis has evolved from an era in which it required
simple intuition and inspired guesswork to a time of systematic
deduction from amassed clinical and laboratory data. The medical
laboratory technology profession of Nigeria has a significant part to
play in the development of an effective and efficient health care
system by providing the system with educated, versatile and flexible
laboratory scientists able to function effectively as team members, and
able to help physicians in the interpretation of laboratory tests.
The remaining part of this section discusses the historical
perspective of medical laboratory technology education in Nigeria with
the aim of examining its effectiveness in meeting the needs of the
students and staff, and in meeting the nation's health care delivery
system needs.
-45-
Medical Laboratory Technology Education During Colonial Nigeria
The training of medical laboratory technologists started at the
University College Hospital, Ibadan, Nigeria in 1953 (UCH School of
Medical Laboratory Technology, Recruiting Brochure, 1970). Students
were usually sponsored by regional governments. Students received
three years of instruction in the various aspects of medical laboratory
technology in Nigeria, after which they were presented for the old
intermediate examination of the British Institute of Medical Laboratory
Technology established in 1937. The examination covered all aspects of
medical laboratory technology at an elementary level. Successful
candidates received further training for nine months in any one area of
medical laboratory technology. The total program was completed by
undertaking an additional nine months of training, and passing the
associate examination of the British institute in Britain under the
sponsorship of the training hospital. Successful candidates were
awarded the Associate membership of the Institute of Medical Laboratory
Technology (AIMLT), London. This pattern of training was followed by
the School of Medical Laboratory Technology at the University College
Hospital, Ibadan and other training schools that came thereafter.
In 1966, the British institute replaced the intermediate
examination by the Ordinary National Certificate/Diploma in sciences
(medical laboratory sciences variant) examination. Preparation for the
examination took two years, and operated on a one-day and one-evening
per week release system of instruction. The original final examination
of the Institute was changed to the Higher National Certificate
examination in 1968. All these changes made it impossible in terms of
scheduling and economic viability for training hospitals and the
-46-
regional government sponsors in Nigeria to continue to operate the
British schedule. The changes led to the establishment by decree in
1968, of the Institute of Medical Laboratory Technology of Nigeria
(Federal Military Government of Nigeria Decree No. 56, 1968).
Medical Laboratory Technology Education in Nigeria (1968-1981)
The Institute of Medical Laboratory Technology of Nigeria. On
November 21, 1968, the Federal Military Government issued Decree No. 56
to establish the Institute of Medical Laboratory Technology of Nigeria.
The Institute is a corporate body supported in part by contributions
and other funds from members, and by government subventions. Its
functions include determination of the entry requirements, standard of
knowledge and skills that medical laboratory personnel must possess,
and raising of those standards from time to time as circumstances may
permit; establishment and maintenance of a register of technologists,
technicians and assistants; issuing of licenses and awarding of
diplomas to persons qualified to practice medical laboratory
technology; and performing other duties allotted to it by the Council,
such as that of an examining body for all categories of medical
laboratory personnel.
The Council. The Council is the governing body of the Institute.
It is charged with the administration and general management of the
Institute, and therefore has the final say on all matters that concern
the profession. Membership of the Council is representative and is
drawn from all the States of the Federation. The Council is composed
of 24 members, including eight pathologists representing universities
that have medical schools, universities that have faculties of veter-
inary medicine, veterinary establishments, and Federal and state
-47-
Ministries of Health; one technologist from each state; one technolo-
gist from the Federal Ministry of Health, the chief medical advisor (or
the deputy) serving as president; a technologist serving as vice-
president, and the registrar of the Institute serving as secretary to
the Council.
The Council oversees registration of technologists and other
medical laboratory personnel; approves or disapproves training institu-
tions; oversees supervision of instruction and examinations leading to
approved qualifications; has a disciplinary tribunal, and uses an
investigating panel that deals with cases of professional misconduct
and other such offenses, and has power to do anything which in the
opinion of its members is calculated to facilitate the conduct of
activities of the Institute. Almost all tabled matters of the annual
general meetings are referred to the Council for further consideration
(Federal Military Government of Nigeria Decree No. 56, 1968; Minutes of
Annual General Meeting (AGM), 1974-1981).
Registration and membership. Persons who wish to gain access to
the profession must meet certain entry requirements and obtain employ-
ment as student technologists in institute-approved laboratories. They
then apply to begin the training program. Membership categories
include student, ordinary, provisional, associate and fellow. The
details of registration, such as entry requirements and other require-
ments for the different membership categories, are presented in
Appendix B.
Training programs. In its earliest days (the 1950s) laboratory
education in Nigeria was an apprenticeship program. Training programs
were hospital based and learners were employed as student technologists
-48-
in the training hospitals. Strong educational background was of little
concern. In fact, for many years, the profession recruited from a
stratum of ability below the level of those then attending the univer-
sity. Educational programs did slowly improve by becoming more formal.
With the establishment of the Institute in 1968, specific types of
educational background necessary for admission to training schools were
stipulated. Today, laboratory education is still functional, and the
apprenticeship system is still in use.
Between 1970 and 1976, 13 hospitals and one veterinary department
were approved for training. By 1978, two more clinical laboratories
and one virus research laboratory were added to the list of training
institutions (Institute of Medical Laboratory Technology (IMLT) of
Nigeria, Annual report, 1978-1979).
The current curriculum. Until 1970 Nigeria followed the five-year
British syllabus; thereafter, the duration of training became four
years. Although Nigeria no longer felt compelled to fit into the
British schedule after 1970, the four-year diploma program developed
later was patterned after the British model with only slight modifica-
tions to fit local needs. Figure 2-1 shows the model and the flow
chart of the curriculum that has been in use since 1970.
The curriculum is in two segments: Part I and Part II. Each part
lasts two years, and is further divided into two sections, namely Part
IA and Part IB; Part IIA and Part IIB. Movement from Part I to Part II
is not automatic. Students begin each section as they successfully
complete a preceding one.
The A sections last six months each. Students study the basic
sciences at participating universities or colleges of technology.
-49-
Students enter PART IA physics/math/statistics
program in an 6 months biology
approved training---- full-time chemistry
institution with study of general applied sciences
approved subjects basic sciences
PART IA EXAM Pass Fail-
theoretical & practical
training in elementary
PART IB bacteriology
18 months hematology
part-time blood transfusion
study of Medical parasitology
Laboratory histopathology
Sciences chemical pathology
PART IB EXAM Pass Fail
PART IIA biochemistry
6 months organic chemistry
full-time study physiology
of Basic Sciences general microbiology
PART IIA EXAM Pass Fail
students elect to take
PART IIB combined medical lab-
18 months __ oratory sciences or
part-time study special medical labor-
of Laboratory atory science in one of
Sciences the subjects below*
PART IIB EXAM Pass Fail
(Resit)
GRADUATES
EXIT PROGRAM
*Histopathology
Chemical Pathology
Medical Microbiology
Virology
Hematology & Blood Transfusion
Parasitology
Figure 2-1. Present model of the medical laboratory sciences
education program in Nigeria Flow chart of the
curriculum
-50-
Students in Part IA complete 180 hours of physics/math/statistics, 180
hours of biology, 180 hours of chemistry, and 120 hours of general
applied sciences. For Part IIA, students complete 300 hours of
biochemistry and organic chemistry, 120 hours of physical chemistry,
120 hours of physiology,.and 120 hours of general microbiology.
Examinations. Students are examined in the subjects at the end of the
six months of full-time studies. There is one written and one
practical examination for each subject, except for math and statistics
where only a written examination is given. Written papers are divided
into two sections. Section A, which is compulsory, consists of
objective questions. Section B consists of essay type questions. Each
examination lasts three hours. The pass mark for each examination is
40%.
Students who fail in one subject are allowed to resit the
examination in that subject. Students who fail in two subjects resit
the whole examination. Students who fail in three consecutive attempts
are asked to withdraw from the course. Successful students proceed to
section B.
The B sections last 18 months each, and participation is part
time. Students study medical laboratory sciences at the training
schools. In Part IB, theoretical and practical courses in bacteri-
ology, hematology and blood transfusion, chemical pathology, parasi-
tology, and histopathology are studied at an elementary level. In Part
IIB, theoretical and practical courses are offered in hematology and
blood tranfusion, parasitology, histopathology, chemical pathology,
medical microbiology, virology, and in laboratory procedure and organiza-
tion for each of the courses. Students elect to study
-51-
either combined medical laboratory sciences or special medical
laboratory science. When students elect to study the former, they
undergo training in all the subjects; those who elect to study a
special medical laboratory science receive training in only one of the
subjects. Students rarely select the combined medical laboratory
sciences option; the special medical laboratory science option has been
the more common of the two over the years.
Examinations. Students are examined in their chosen areas at the
end of 18 months of part-time studies. In addition to passing the
written and practical examinations, students must also pass a 20-30
minute oral examination. The pass mark is 50%. Successful students in
the Part IB examinations proceed to Part IIA, while successful Part IIB
candidates are awarded the associateship of the Institute of Medical
Laboratory Technology of Nigeria (AIMLT). Due to popular demand, the
Institute has recently been considering a resit process for candidates
who fail Part IIB examinations (IMLT Annual report, 1981).
Problems in the Present Nigerian Medical Laboratory Sciences Education
Skill development has been the emphasis of the program, and this
is reflected in the nature of the programs and the total curriculum.
The majority of those who teach are products of the same type of
program, and the knowledge they have to share is limited to the skills
and techniques they learned. Seniority, rather than ability to teach,
has been the main criterion for teaching role assignment. Most
teachers regard teaching as a perfunctory role. Unavailability of
textbooks that fit the reading level of students forces some teachers
to muddle through by presenting to students notes taken some 10 to 15
years back. The lecture method of instruction is over-used to the
-52-
neglect of other effective methods, and repetitive learning is re-
warded. The result of these instructional practices and problems is a
markedly high failure rate in the professional examinations. Students
who fail, but who are not necessarily mediocre, sometimes give up to
try something else. While it may be argued that such students may not
have been "cut out" for medical technology, an equally tenable argument
is that potentially good students may be lost through ineffective
teaching. Other students, who consider leaving, too late, stay in the
system as ordinary members on reaching that level, and are counted year
after year along with other members of the Institute.
The system is fraught with attrition. The literature contains no
concrete evidence of the causes for the failures. Too often, the
reason for failures has been dismissed as merely the fault of the
students and the schools. In the 1981 annual report of the Institute,
the registrar made a note of the downward trend of the performances in
the professional examinations through the years, and urged both the
schools and students to improve (IMLT Annual report, 1981). The review
of literature indicated no effort to improve the status and educational
background of teachers, yet there is a direct relationship between the
quality of teachers and teaching, and the quality and performance of
graduates.
In fairness, credit must be given for the high standard of the
extended practical experience, but this is usually at the expense of
cognitive learning. Although the syllabus of the Institute presents an
impressive and extensive coverage of the technical subject matter, the
extent and depth of its coverage in the schools is suspect. In the
annual general meeting of May 1975, a concerned member made an
-53-
observation concerning past examinations: ". what the diploma
board expects from candidates is not actually what is taught during
training" (IMLT Minutes of the AGM, 1975, p. 23). The chairman of the
meeting responded by appealing to training institutions to keep to the
Institute's syllabus. One thing is clear: A discrepancy exists
between what is taught and what is expected. While the rigor of the
program leaves graduates with confidence in the performance of
technical skills in the laboratory, graduates emerge scarred with a
survivor mentality. Most develop a nonchalant attitude toward the
schools and their programs, the profession and its future, and society.
Recent graduates and recent and present students have been more
aggressive, more assertive, and had more opportunities than their
predecessors. They are feeling and expressing the need to become truly
educated. Easier access to higher education has triggered their
interests in continuing their education. In a truly Rogerian sense,
they are demanding to be treated worthy, expressive, separate, and
intelligent. But when these graduates, with associate membership of
the Institute, attempt to seek high education in Nigerian and British
universities, they are often denied admission for lack of or inadequate
foundational educational preparation. Some persistent and desperate
few have been able to secure admissions to institutions of high
learning only after gaining the fellowship status of the Institute.
Science graduates who enter the profession are considered better
prepared for higher studies, have felt more secure and have had more
options from which to choose than have medical laboratory sciences
graduates. This kind of frustrating experience of graduates and
students has motivated the debates over the inadequacy of the present
-54-
curriculum, and has generated renewed interest in and a press for an
effective baccalaureate program in medical laboratory sciences.
Clearly, the needs of students have changed, the roles of clinical
laboratory scientists have changed; new knowledge in medical
technology, new developments in organizational structure of curricula
and instructional methodology, and new national emphasis on health,
make present programs outdated. More effective programs that will
cater for the above needs are needed.
Achievements of the Medical Laboratory Technology Training Programs
The medical laboratory technology profession in Nigeria is
relatively young, but it has come a long way. Table 2-5 shows the
membership from 1970 to 1981. In 1970 only 202 members were recorded;
within a decade that number increased to 5,697. The figures are more
significant when examined by membership categories. All categories
have increased in number, with student members ranking highest, and
provisional members ranking lowest. However, while membership was on
the increase, 60% were students who could work only in the training
institution, and 12% were ordinary members who, in the majority of
cases, face a similar situation. The figures reflect a high attrition
rate and this may be responsible at least in part for the shortage of
technologists in Nigeria. Thus, the medical laboratory technology
education programs did not meet the 1975-80 estimated needs of the
health care system of Nigeria; they will not meet the 1981-85 estimated
needs or future needs unless measures are taken to improve present
programs and develop more effective ones.
On the positive side, the diminished supply referred to above has
brought increased recognition of the need for medical technologists,
-55-
TABLE 2-5
Membership Table (1970-1981)
(Adapted from The Institute of Medical Laboratory
Technology of Nigeria Annual Report for 1981)
Associate
76
137
150
212
222
289
277
432
498
763
775
1141
Provisional
13
32
37
40
41
46
32
38
40
88
109
250
2 5
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
Fellow
24
42
46
57
63
78
95
116
153
198
199
255
Ordinary
Member
19
109
177
240
245
269
357
291
490
664
732
729
Student
70
215
258
270
283
384
515
520
621
749
2588
3422
Total
202
535
678
819
854
1066
1210
1463
1801
2462
4403
5697
Rank 4
3 1
-56-
and a willingness to reward professionals with the status,
opportunities, and earning power they deserve. In a 1979 article,
Durowoju discussed the shortage of medical laboratory scientists in
Nigeria and suggested that all available means be used to increase the
number if sufficient impact is to be made on the projected need. A
similar conclusion was reached by the Federal Ministry of National
Planning in 1980. While number is of major national concern, this
writer suggests that quality be part of that concern as well.
Effective programs are needed that will offer not just more education,
but a different kind of education.
Advantages to Preserve and Improvements to Make
The present medical laboratory technology education program has
certain characteristics that make it appropriate to the educational
system of Nigeria. However, some improvements are needed in the light
of the findings from the literature.
1. The purpose of the program from its inception was
functionalism. That message and the functional nature of the
program should be preserved. However, the narrow orientation
characteristic of this approach does not produce a
well-rounded clinical laboratory scientist. This has
implications for a balanced curriculum with technical,
liberal arts, and generalist focuses.
2. The Nigerian society is familiar with examination in the
evaluation of student achievement. An educational program
that does not include a thorough examination system may cause
the graduates to be looked down upon. The system should be
preserved with some modifications. A more objective system
-57-
for the written examination should be adopted. The insti-
tution should develop objective tests. Well developed items
test not only knowledge, but also the more subtle qualities
of discrimination, judgment, and reasoning (Hubbard and
Clemans, 1968). Providing both practical and written examina-
tions is still the more desirable approach, but economic
realities may force the Institute to adopt more creative and
yet effective ways of asking practical questions in written
papers instead of conducting separate practical and oral
examinations. Pencil and paper simulations used in some
medical schools and some allied health programs can be an
excellent means of testing for knowledge, judgment and
problem-solving ability. It will be a good investment for
the Institute to encourage medical technology educators to
develop expertise in testing.
3. The professional courses are an important aspect of the total
program and should be preserved with revisions, modifica-
tions, and improvements in the methods of presentations of
instruction. Instructional strategies employed should be
selected, taking into consideration the learning needs of the
student. When this happens, the student is more motivated to
learn and may experience better success. The responsibility
of learning needs to shift from teachers to learners at this
level. Learners cannot assume responsibility for their own
learning until they become self-directed. This has implica-
tions for a teacher education program.
-58-
The nature of learning and knowledge and of human
development suggests that basic knowledge be taught first.
Teaching the basic sciences first will provide students with
the foundational knowledge and continuity which will make for
easier launching into, and comprehension of the medical
laboratory sciences.
Accountability must take on a new meaning in the
schools. Teachers must not only be held accountable for the
performance of students in the standardized examinations of
the Institute; they should feel responsible for the students'
success. When the Institute begins to require a minimum
percentage of passes in the examinations for continual
accreditation of schools, both the sponsors of programs and
the faculty may reconsider the seriousness of the situation.
Degree Programs in Medical Laboratory Technology
The University of Ibadan started a degree program in medical
laboratory technology in 1965. The program flowered for four years,
but was suspended indefinitely. The literature contains no clear
reason for the action of the university. The program was probably
introduced before the entire membership was ready for it; it was a
victim of apathy. Recent efforts by representatives of the Institute
to get the university to resuscitate the program have so far been
fruitless (IMLT Annual report, 1981).
In 1973, Professor Grillo of the University of Ife, Nigeria,
initiated talks with the Institute on the possibility of starting a
degree program in medical laboratory technology at the University of
-59-
Ife. Dialogues have continued till the time of this writing, and
decisions reached at meetings did not materialize even after seven
years of negotiations and promises. The report of the Medical
Education Working Party of the Nigerian universities was in direct
opposition to the aspiration of the medical technology profession. The
information in the report dampened the enthusiasm of the universities
concerned and created enough financial and administrative problems to
discourage them. Even the University of Ibadan, which accepted "in
principle" the concept of a degree program and was considering
resuscitating the suspended program, has continuously "dragged its
feet." This academic issue has been plagued by politics. However, the
proposals of two universities--the Rivers State University of Science
and Technology, and the University of Calabar--have received the
blessings of the Institute and programs may soon start (IMLT Annual
report, 1981).
Summary
Medical technology discipline is a phenomenon of the twentieth
century. In the thirties, more structure was introduced into medical
technology education in the United States; a similar situation occurred
in laboratory education in Great Britain beginning in 1937. Nigeria
did not experience formal laboratory education until the early fifties.
Nigeria has profited from the British pattern of training for many
years. Present programs, developed in the sixties, are technical,
heavy in practice, cumbersome, and adequate for that time in history.
The programs have not met and will not meet present or future needs
unless they are improved, and more effective programs developed. The
-60-
evolving Nigerian society has new needs; present medical laboratory
sciences students and staff now have needs that are different from
those of earlier times, and new emphasis of the national health care
delivery system suggests a different, broader orientation and a more
people-oriented curriculum. The genetic flaws that characterize
present programs must be corrected; otherwise programs will continue to
prepare graduates for a world that no longer exists.
In any developing health care system, quality laboratory
practitioners will continually be needed. An educational program with
a career ladder approach creates room at the "top" for technicians to
work toward, and frees the "bottom" for newcomers.
CHAPTER III
A PROPOSED MODEL FOR BACCALAUREATE EDUCATION
Findings from literature and the personal experiences of the
writer indicate that improvements are warranted in the medical labora-
tory technology training program of Nigeria. This change is justified
by the social needs of the times, the needs of the learner, and old and
new knowledge accruing in medical technology. This chapter includes
recommendations in the form of a potentially effective model program in
medical laboratory sciences for Nigeria.
Conceptual Framework for Baccalaureate Program
in Medical Laboratory Sciences for Nigeria
Closely related to the proposed model is the conceptual frame of
reference upon which the writer based the model program. Figure 3-1
illustrates the conceptual framework representing the professional and
professional activities. As findings from the literature indicate,
what the Nigerian health care system and the society need today are
responsible, caring, knowledgeable, flexible, and productive profes-
sionals. However, being knowledgeable and being productive without
being responsible and caring are not consistent with professionalism or
professional practice. Responsibility and productivity without
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-62-
Learner
Laboratory
technician
Laboratory
scientist
Problem-solver
Educator
Researcher
Manager
Assess
Organize
Plan
Implement
Advise
(Laboratory personnel)
Responsible
Knowledgeable
Productive
(Environment)
Self
Others
Institutions
Figure 3-1.
Conceptual framework for the proposed model
baccalaureate program in medical laboratory sciences for
Nigeria.
-63-
appropriate use of knowledge is incompetence. As Brown suggested in
1978, competence is the essence of professionalism and results from an
integration of many abilities.
In rendering service and accepting responsibility for it
professionals demonstrate what they know and value.
Rogers (1961), in On Becoming a Person, demonstrates that the self
has needs too. The self is aware and is treated as worthy, expressive,
caring, separate, accepting, sensitive and becoming--a person. The
self does not exist in isolation. The self exists only in relation to
the environment consisting of others, who are also in the process of
becoming. The self, others, and institutions together make the
society. The double-headed arrows indicate the dynamic relationship
that exists among the self, the activities, and the society. The self
understands the needs of the society and is sensitive to those needs;
the society understands the needs of the self and is sensitive to those
needs. As the environment or society (self, others, institutions) and
its needs change, the knowledge needed to render appropriate services
also changes.
On a less abstract level, when serving others, the laboratory
practitioner, working with other health professionals, functions as
clinical laboratory technician or clinical laboratory scientist. The
laboratory practitioner must therefore be knowledgeable about disci-
plines related to human nature, structure, functions and activities--
psychological, physiological, metaphysical, and sociological. When
serving institutions, the clinical laboratory scientist may function as
a manager and therefore needs to acquire management skills. When
serving a client, laboratory personnel must understand and value
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the client whether the client is self, others or institutions. This
justifies the need for an awareness of self and societal values and
needs.
Figure 3-1 indicates that specific functions relate to each role
and a common function relates to all, but a clinical laboratory
scientist may tap all functions in each role. For example, in the
educator/learner role, the clinical laboratory scientist plans,
implements and evaluates learning; the clinical laboratory
technician/scientist/researcher obtains, assesses and evaluates data;
the manager plans and evaluates services.
The activities of the laboratory practitioner are many, their
performance complex. The practitioner moves in and out of various
roles. When this complexity is added to the changing roles and the
changing needs of becoming a person in a changing society, the
specialized professional knowledge of laboratory practitioners requires
a broad, integrated, and future orientation that addresses the
development of the critical skills needed for efficient and effective
functioning of graduates.
Sponsors of programs, faculty, administration, and students must
understand and subscribe to this conceptual frame of reference for it
allows an accurate, new, and different view of clinical laboratory
personnel.
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Background and Assumptions
The following assumptions were made in designing the proposed
model:
1. Nigeria's need for this caliber of health personnel is
demonstrated by its health needs. The estimated health needs
call for more, but effective programs.
2. New emphasis on preventive medicine and new concentration of
efforts on reaching the underserved areas necessitate
preparing graduates who have broad orientation and
flexibility.
3. The health-team approach suggests that not just more
education, but a different kind of education, is needed for
future health personnel, particularly medical technologists.
As the trends indicate, problem solving, creativity and
lifelong learning are vital to the professional of tomorrow.
4. The medical technology profession of Nigeria has the respon-
sibility to provide every interested and capable person the
opportunity to develop to full potential and to become an
effective citizen.
5. There is a need for a career ladder approach in the medical
technology education of Nigeria.
6. The university administration and the teachers will assume
the major responsibility of implementing the model program.
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Proposed Model
Keeping in mind the conceptual framework, and considering the
above assumptions, the model program illustrated in Figure 3-2 is
proposed. The model has the following features:
1. The total program offers four years of baccalaureate degree
preparation in medical laboratory sciences.
2. Clinical laboratory technicians with Associate of Science
degrees, having recommendation of their employer or the
recommendation of the institution from which each was
graduated, are accepted into the third year of the program.
Goals and purpose of the program
The goals and the purpose of the program are:
1. to provide experiences that will lead to self-realization and
self-direction such that students can develop to their full
potential with skills for solving future, as yet unknown,
problems;
2. to produce academically qualified students and transform them
into professional men and women dedicated to the service of
others through clinical laboratory sciences;
3. to provide learning experiences for both educational and
professional career mobility by satisfying the requirements
necessary for further formal graduate work or informal
continuing education;
4. to develop competencies needed by persons preparing to engage
in the practice of medical technology;
5. to meet the health manpower needs of the country;
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FIRST YEAR
+Awareness of self and environmental needs
+Exploration of self, environment and the
world of work
+Basic common knowledge of environment,
science and the health care system
+Self-direction
Evaluation
SECOND YEAR
(Lower-level Pro-
fessional Phase)
Decision
+Evaluation E( Point
+Clinical Rotation
+Exit 1 (Associate of
Science (AS) degree,
CLT diploma)
THIRD YEAR
(Upper-level Pro-
fessional Phase)
+Advanced Professional Knowledge
+Laboratory Management
+Personal/Professional Development
Evaluation
FOURTH YEAR
(Upper-level Pro-
fessional Phase)
Figure 3-2.
+Advanced Professional Knowledge
+Project in MLS +Educational Management
+Personal Development +Clinical Rotation
+Evaluation
+Exit 2 (Bachelor of Science (BSc)
degree, AIMLS diploma)
Proposed model for a baccalaureate program in medical
laboratory technology (sciences)
+Personal Development
+Basic Professional Knowledge
+Awareness and exploration of
work in the medical laboratory
+Professional responsibilities
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[ENTRY I -First Year
Student with + General Education Courses
university + Basic Sciences
requisite + Electives
courses en- + Introduction to Health Care
ters program + Orientation to Medical Laboratory Sciences
+ Evaluation
Second Year (Lower-level Professional Phase)
+ Basic Medical Laboratory Sciences
+ Professional Aspects of Medical Laboratory
Technology
+ World of Work Awareness (WWA)
+ Introduction to Literature of
Medical Laboratory Sciences
+ Evaluation
DECISION POINT
+ Associate of Science Degree?
+ Clinical Laboratory Technician Certificate?
es + Clinical Practicum (36 wks)
No + A.S. degree
+ CLT (IMLS) Examination
--------~~-- EXIT II
ENTRY II --- Third Year
Candidates with (Upper-level Professional Phase)
A.S. degree or
equivalent + Advanced Medical Laboratory Sciences
qualification + Laboratory Management
enter program + Elective
+ Evaluation
Fourth Year (Upper-level Professional Phase)
+ Advanced Medical Laboratory Sciences
+ Educational Management
+ Research in Medical Laboratory Sciences
+ Clinical Practicum (36 weeks)
+ Elective
+ Evaluation
+ BSc Med. Lab Sciences
degree
+ Associateship (IMLS) exam
EXITT III
Figure 3-3.
Proposed model for a baccalaureate program in medical
laboratory technology (sciences) Flow chart and
curriculum content.
r
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FIRST YEAR
FIRST SEMESTER
Fundamentals of Mathematics or
Functional and Basic Calculus
General Physics
General Chemistry
Freshman Writing (Communication)
Dynamics of Health Care System
Economics
SECOND SEMESTER
Organic Chemistry/Biochemistry
Human Physiology
General Microbiology
Quantitative Analysis
or Analytical Chemistry
Social Science
SUMMER SEMESTER
Statistics
Genetics
Orientation to Medical Laboratory Sciences
Psychology
African History/Nigerian History
SECOND YEAR
FIRST SEMESTER
SECOND SEMESTER
*Basic MLS (Urinalysis)
Basic MLS (Hematology I)
Basic MLS (Clinical Chemistry I/
Instrumentation)
Basic MLS (Immunohematology I)
Basic MLS (Bacteriology)
Elective Anthropology
Basic
Basic
Basic
Basic
MLS
MLS
MLS
MLS
Basic MLS
(Hematology II)
(Medical Parasitology)
(Histopathology)
(Clinical Chemistry
II/Instrumentation)
(Mycology, Virology)
SUMMER SEMESTER
Clinical Immunology
Professional Aspects of Medical Technology
Introduction to Medical Laboratory
Sciences Literature
Group Dynamics
Social Science or Nigerian Government
World of Work Awareness Assignment
(Last four weeks of semester)
*All MLS have laboratory sessions
Figure 3-4.
Proposed model for a baccalaureate program in medical
laboratory technology (sciences) Suggested lower-level
curriculum.
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THIRD YEAR
FIRST SEMESTER
SECOND SEMESTER
*Advanced MLS
Advanced MLS
Advanced MLS
Advanced MLS
Social Scienc
Laboratory Ma
(Hematology I)
(Clinical Chemistry I/
Instrumentation)
(Immunohematology I)
(Bacteriology )
e
nagement
Advanced MLS (Hematology II)
Advanced MLS (Clinical
Chemistry II/Instrumen-
tation)
Advanced MLS (Immunohematol-
ogy II)
Elective Philosophy
Economics
Group Dynamics
FOURTH YEAR
FIRST SEMESTER
*Advanced MLS (Mycology)
Advanced MLS (Parasitology)
Educational Management (Seminar)
Project in Medical Laboratory
Sciences
SECOND SEMESTER
Project in Medical Labora-
tory Sciences
Clinical Correlations
(Seminar)
Clinical Practicum
(36 weeks)
CLINICAL PRACTICUM (36 weeks rotation)
Applied
Applied
Applied
Applied
Applied
Applied
Applied
Applied
Hematology
Clinical Microbiology
Immunohematology
Clinical Chemistry
Parasitology
Histopathology
Immunology/Serology
Virology
*All MLS have laboratory sessions
FIGURE 3-5.
Proposed model for a baccalaureate program in medical
laboratory technology (sciences) Suggested upper-level
curriculum.
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6. to develop the abilities in human relations essential in
functioning in a team to provide better health care for the
community in which graduates may have the privilege of
serving, and
7. to provide learning experiences that will help develop
abilities needed to exercise leadership in fulfilling
occupational, social and civic responsibilities.
The goals and purposes stated above are consistent with the
objectives of the National Educational Policy of the present
government. They are complex, and so is the design of the educational
experiences needed to achieve them. The flow chart of the curriculum
is shown in Figure 3-3. Figures 3-4 and 3-5 illustrate the suggested
lower and upper levels of the curriculum respectively.
Organization
The lower level. The curriculum domains to be addressed at the
lower level include awareness of self and environmental needs,
exploration of self, the environment and the world of work, basic
knowledge of science and the health care system, self-direction, and
the basics of medical laboratory technology.
The humanities, the social sciences, and the basic sciences
provide experiences in critical thinking, personal development,
development of vital human traits, the prerequisite and sound
foundation necessary for further graduate work, and for comfortable
movement through the professional courses.
The organization of courses follows the general outline suggested
in Figures 3-4 and 3-5. This approach provides a curriculum that
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endeavors to maintain educational balance between the humanities and
the sciences. This has a two-fold advantage. First, it enables
students majoring in medical laboratory sciences to take the same level
of courses required of students majoring in biology or chemistry.
Second, it provides an opportunity for both educational and
professional career mobility by satisfying the requirements necessary
for further graduate work.
All of the science courses taken during the first year are a
preparation for the medical laboratory sciences courses beginning in
the first semester of the second year. For example, the chemistry
sequence begins in the first semester of the first year with general
chemistry, continues in the second semester with organic chemistry,
biochemistry, and quantitative analysis or analytical chemistry. These
are prerequisites for clinical chemistry I introduced in the first
semester of the year.
The general physics begun in the first semester of the first year
consists of a discussion of mechanics, heat, electricity, magnetism and
optics, and is prerequisite for instrumentation taught along with
clinical chemistry in the professional courses.
The biology sequence begins in the first semester with general
biology, continues in the second semester with general microbiology
taken concurrently with human physiology, and ends with genetics in the
summer semester. These are prerequisites for the biological profes-
sional courses pursued in the second year.
In order to generate high motivation, medical laboratory sciences
students are integrated with students majoring in these other
departments and are instructed by professors, who are specialists in
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the various disciplines, and who have either the doctor of philosophy
or a master's degree.
The lower-level professional courses. The lower-level profes-
sional courses (Figure 3-4) provide for the basic competencies needed
to function at the clinical laboratory technician level. Courses are
taught with appropriate simulated (student) laboratories.
World of Work Awareness (WWA) assignment is scheduled in the last
four weeks of the lower level professional courses. After the WWA
assignment, the student decides to continue or to exit the program. If
the decision is to exit, a 36-weeks clinical practicum is scheduled and
completed. The student is awarded the Associate of Science degree by
the university upon successful completion of the clinical practicum,
and becomes eligible to take the licensure examination of the
Institute. If the decision is to continue the program, the student
begins the third year and enters the upper professional phase of the
curriculum. Persons with associate of science degrees may enter the
program at this point upon recommendation from their employers or from
the schools from which they were graduated.
Student laboratories. The student laboratories simulate the
clinical laboratories as closely as resources and ingenuity of the
instructors at the university department of medical laboratory sciences
will permit. This is where students are introduced to the skills
needed to function in the clinical laboratory. It is also a place
where students get the chance to develop such skills in a
non-threatening, pressure-free environment before they experience
real-life laboratory situations.
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World of Work Awareness. This structured experience introduces
the student to the realities of medical technology as practiced in the
community. It brings the student in contact with the community to be
served upon completion of the program. The student begins to
understand and appreciate the needs of the community while working
among the people and other members of the health team. The student
begins to formulate ideas of how to serve such a community effectively.
The upper-level professional courses. The upper-level profession-
al curriculum illustrated in Figure 3-5 further prepares the student
according to ability, needs and interests, and the needs of the commun-
ity by providing advanced medical laboratory sciences courses. This
level provides the competencies needed to function at the clinical
laboratory scientist level. Graduates of the upper-level curriculum
receive the BSc degree in medical laboratory sciences and are eligible
to take the associateship examination of the Institute after completing
the clinical practicum. The clinical practicum is an integral part of
the fourth year of the program and must be completed successfully.
Clinical practicum. The clinical practicum, whether done after
completion of the lower-level professional courses and the WWA
assignment or after completion of the upper level courses, is nine
months long. It consists of supervised and documented learning
experiences in all the areas of medical technology. Students rotate
through each area, spending time as may be prearranged. This is where
skills developed in the student laboratories of the university
department of medical technology are practiced and perfected under the
supervision of experienced laboratory practitioners. This phase also
gives students an additional chance to experience the real-life
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situations and pressures associated with work in the medical technology
field. Since students are already well prepared in the theories,
explanation of principles and practice of procedures can be
comprehended easily, and interpretation becomes less cumbersome.
The preparation of the clinical laboratory technician is different
from that of the clinical laboratory scientist in terms of depth of
knowledge and managerial and interpretive skills; therefore, the
expectations are different both in the practicum and on the job.
Clinical performances are evaluated by written, oral and/or practical
work. The development of cognitive, affective and psychomotor
behaviors is monitored, rather than the ability to regurgitate facts
when given an appropriate cue.
Flexibility and continuity of education. This is a vital quality
of the program. The flexibility of the program is provided by the
option of exiting at the clinical laboratory technical level and at the
clinical laboratory scientist level. In either option students receive
recognition for their achievements. Flexibility is also provided by
the curriculum content directed toward students' needs and interests,
and community needs. Students, regardless of their ultimate decision,
receive the same courses until they arrive at a decision point when
academic performance, ability and interest, or circumstances beyond the
control of the student play a significant part in the decision-making
process. Such common preparation provides for flexible connection and
continuity between the lower and upper levels of the curriculum, and
makes it possible for graduates of the lower level and others
considered eligible to join the upper level or at a later date to pick
up where they left off, should they decide to do so.
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Adaptability. The program is adaptable, progressive and open to
revision and change. It is formal, and its very formality prevents its
becoming out of date or redundant, for the formula can be filled with
some specific assumption of substance as will meet changing students'
and societal needs.
Balance. The program is balanced in that it uses a combination of
designs. It focuses on individual needs and interests, and community
needs and problems. These are the factors that must be considered by
the advisory committee for curriculum, and in determining curriculum
content emphasis (Figure 3-3). The model program focuses on the
subject matter in the general education, basic sciences, and
professional courses. It also focuses on specific competencies in the
professional courses, student laboratories, and clinical practice
(Figures 3-3, 3-4 and 3-5).
The program is balanced in that the general education courses,
including the humanities, focus on communication, literary and artistic
expressions, the individual and society, and continuing learning
skills. The basic sciences provide a sound foundation for
understanding the technical and professional subjects, and for later
formal or informal graduate education. The professional courses
provide the technical and leadership skills needed. All these help the
personal development of would-be professionals, and give them better
options in life.
The program takes into consideration human development process.
Students are guided step by step from an awareness of man's total
environment and their place in it, through how they can forge through
life harmoniously equipped with developmental skills, into basic
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knowledge and skills required of all persons planning careers in
medical laboratory technology, to a further advanced, yet broad
curriculum according to their abilities, needs and interests (Figure
3-2).
The program takes into consideration the nature of learning and
knowledge. While the number of years needed to complete the medical
technology training program has not changed, time for apprenticeship is
less (36 weeks), and emphasis on replicative use of knowledge is
reduced accordingly. Students will actually have more time to assimi-
late information and practice interpretive and applicative use of
knowledge in the university student laboratories before they enter the
clinical phase of the program.
Guidelines for Implementation of the Model
Recognizing that the greatest challenge will be the problem of
implementing the proposed model program--the problem of achieving a
match between the planned and the experienced curriculum--the following
guidelines for implementation are suggested.
Curriculum Content
The goals of the program should be addressed by including the
humanities, social sciences, basic sciences, introductory or elementary
professional courses, and upper-level professional courses to provide
appropriate learning experiences.
A judgmental approach may be suitable in determining the depth and
breadth of the knowledge required in the humanities, social sciences,
and basic sciences, yet these subjects in and of themselves cannot be
depended upon to function automatically. It takes expertise and
-78-
concern to help young people reach deeper levels of understanding of
the cultural, social, political, economic and scientific heritage
without losing the learners in excessive details. The American edu-
cator, Ralph Tyler, advised that while the aid of subject matter
specialists must be sought, the right questions must be asked of them.
In putting together a general education curriculum, Tyler suggested
that subject specialists be asked, "What can your subject contribute to
the education of young people who are not going to be specialists in
your own field?" (Tyler, 1949, p. 26). He added that if subject
specialists can present answers to this question, they can make an
important contribution because, presumably, they have considerable
knowledge of the specialized field and many of them have had opportuni-
ties to see what the subjects have done for them and those with whom
they work.
In developing the content of the lower-level professional cur-
riculum, not only should there be concern for the content of the
elementary professional courses, but the subject matter and experiences
to be offered in all the professional phases of the program should be
determined by the analytical rather than judgmental approach. As
Whooley and Klun (1979) suggested, this approach ensures that education
in these phases is tied directly to the tasks in the work place. The
use of the integrated and competency-based patterns described earlier
in the analysis of background resources and later in the scenario must
be considered here.
Curriculum Development
Individual needs and interests, and community needs and problems
should be the basis for emphasizing certain units in the curriculum
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content. The advisory committee can be helpful in defining community
needs and in finding and using resources that may be needed in meeting
those needs. The advisory committee should therefore be involved in
curriculum development. Membership should include representatives from
the student association, community leaders, state and regional associa-
tions for clinical laboratory scientists, the Institute of Medical
Laboratory Technology of Nigeria and health-related businesses.
The assumption underlying this kind of group constitution is that both
wisdom and expertise are important in making decisions about educa-
tional endeavors, and this heterogeneous group can provide these. The
advisory committee makes recommendations to the curriculum council
consistent with the goals of the program. The entire program should
follow the pattern illustrated in Figure 3-2 (awareness, exploration,
basic scientific knowledge, basic professional knowledge, advanced
professional knowledge).
Staffing Patterns and Instructional Methodology
The faculty must consist of two groups: the curriculum council
and the teaching staff. The curriculum council consists of curriculum
design specialists, specialists in research, logistics, guidance,
counseling and testing, and subject matter specialists. The curriculum
council works with the director of the program, educational coordina-
tor, principal or other appropriate administrator to develop curriculum
materials. The individual guides the instructors and coordinates their
work as they teach the entire discipline.
A team approach should be used in teaching to allow for greater
flexibility and coordination. The team should consist of faculty
members from the humanities and sciences. The writer recommends that
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there be hospital appointments for all university-based medical labora-
tory sciences faculty, and university appointments for the principal
instructors in the clinical institutions. Where this is not feasible,
clinical instructors should be recognized by giving honorary appoint-
ments that do not involve monetary exchange. Teachers in the medical
laboratory sciences department are responsible for classroom and
student laboratory instructions and the coordination of the world of
work awareness and clinical practicum. Clinical instructors should be
responsible only for teaching bench techniques and evaluating and
documenting the clinical experiences.
Sponsors of programs must remember that the primary missions of
colleges, universities and hospitals are different. Colleges and
universities exist solely for educational purposes and their philoso-
phies, goals and objectives reflect this. The primary mission of
hospitals is to serve the sick. The proposed program suggests a
working relationship between universities or colleges and hospitals to
give students a variety of experiences. Before entering into a working
relationship, both institutions should carefully examine each other's
philosophy, goals and objectives that relate to their programs and the
broad educational policies established to achieve these goals. They
must find themselves in basic agreement and put definite commitments in
writing because each shares the responsibility for ensuring an educa-
tional program of acceptable quality. An affiliation agreement is
recommended to ensure that each party knows its responsibilities.
Cooperative planning is essential. Affiliating hospitals and
educational institutions must also agree upon an organization plan that
provides for coordination of activities and a system of communication
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whereby information, recommendations, policy interpretation,
evaluation, and plans for development may be exchanged readily
(Davidson and Cronenberger, 1982).
The teaching team should use the lecture method selectively. A
variety of teaching techniques like discussion, demonstration, reports,
project planning, research papers, mastery learning, modular learning,
and programmed instructions must be considered, structured well, and
used effectively. Effective use of such methods helps shift the
responsibility for learning from teachers to learners. Teachers must
help learners become self-directed.
Evaluation
The writer suggests the use of the process skills approach to
evaluation of clinical competence developed by Snyder and Wilson (1980)
because it facilitates the incorporation of the affective domain when
specific behavioral objectives are identified and correlated with
evaluation items. However, effective use of this instrument will
necessitate in-service training for users. Other evaluation
instruments abound. What is important is to choose and use one that
fits the faculty organization and level of sophistication (Gleich,
1978). In addition, any evaluation instrument used should have input
from the clinical instructors and teachers at the school.
The Institute, as well as the professional schools, must consider
using objective and short-answer test items in evaluating cognitive,
affective and manipulative skills to assure objectivity. Objective
questions force the test writer to be objective. While objective
questions may not measure a student's ability to write, organize,
-82-
integrate or synthesize, objective questions can test more subtle
qualities of discrimination, judgment, and reasoning, as can testing
approaches like clinical simulations, situation analysis and case study
(Hubbard and Clemers, 1968).
Essay questions are not easy to grade and objectivity is often
sacrificed (Holcomb, 1976). However, when essay items are used to
assess higher order learning they must not constitute a major portion
of the examination as is the present practice. Higher order learning
and intellectual development are better developed and tested through
written reports, research papers, project planning and the like, for
these involve inquiry and problem solving. Waiting until examination
time to test with essay questions the ability to synthesize, analyze
and evaluate is sadistic at the least, and may be more harmful than
helpful.
Oral examinations should be restricted to the clinical years when
they are most useful to the student in the development of critical
thinking. The present 20- to 30- minute oral examination should be
discontinued. In a study of oral examination procedures McGuire (1966)
concluded that when the high cost of the oral examination in terms of
professional time and energy is weighed against the observational
records of its reliability and validity as a measure of professional
competence, inevitably a question is raised as to the value of the
dividend of this enormous investment.
Standardized tests must be developed to cover every aspect of the
program content, and examples of such tests must be made public.
Publishing examples of test items will help teachers in the instruction
program and may enhance students' learning.
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Degrees should be awarded on student achievement at school, and
professional recognition and licensure granted on successful
performance at the Institute examinations. Close supervision of
testing must continue to ensure quality, but the format must change as
suggested above. The Institute must continue to conduct the
professional examinations with the above suggestions incorporated to
ensure objectivity, improve success rates, and use its meager resources
effectively.
Recruitment and Admission
Evidence of current and future manpower needs suggests that the
manpower constellations that were in use 30 years ago can no longer be
used. If that were to continue, Nigeria would have a health service
many times more deficient than the present one. Evidence suggests a
diminished supply which has brought increased recognition and willing-
ness to reward clinical laboratory practitioners with the status,
opportunity, and earning power they deserve. So, requiring students to
obtain employment before they are admitted to programs is no longer
defensible. Increased efforts in disseminating information on medical
technology as a career to the public in general, and high schools and
universities in particular is a necessity.
Admission to the university is a prerequisite to acceptance to the
program. The program director should work closely with the admissions
office of the university to ensure that interested persons with
appropriate educational background and qualities are counseled into the
program. The education requirements should be consistent with
university policy and guidelines of the Institute of Medical Laboratory
Technology of Nigeria.
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Placement
As students file an intention-to-graduate form they should be
requested to complete a placement file at the School of Medical
Technology office. Documents on file should include letters of
recommendation, transcripts, a curriculum vitae, and an individual
profile. Questionnaires seeking information concerning availability
for work, area or areas of particular interest, geographical
preference, salary range, and desired position should be on file.
Known job openings within the university should be registered with
the placement secretary. Other job offers obtained from outside
employment agencies, professional journals and employment referrals
should be listed and matched with student profiles. Students who match
the job offers should be notified. Such advertisements should then be
posted on the Job Offer Board. The advertisements on the board should
be kept current, and so should the student profiles. At the least,
this shows concern for graduates' well-being, and at best may leave
pleasant, lasting memories.
Followup
While informal feedback from graduates concerning program
effectiveness should be encouraged, followup studies should be
conducted, six months, one year, and three years after students
graduate, to collect information that will aid in evaluating the
program. Questionnaires sent to graduates and employers should include
items designed to obtain information that will help to improve the
total program.
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Summary
The focus of this study was the design of a model baccalaureate
program in medical laboratory sciences in which the needs of the
learner, the nature of knowledge, and societal needs are considered.
The proposed curriculum is formulated from a frame of reference.
The frame allows a better perspective of the relationship between the
society and the laboratorian, the clinical laboratory activities and
attendant knowledge needed by the practitioner for efficient function-
ing. Goals and purpose give direction to the development of the
curriculum, identification of competencies and delineation of ap-
propriate curriculum content.
The uniqueness and advantages of the proposed curriculum include
its balance and capability to respond to change, malleability and
provision of planned experiences that prepare the student for responsi-
bilities and challenges beyond the immediate technical professional
practice.
Justification of the Curriculum
Present clinical laboratory practitioners, students and faculty
all suffer from problems of identity and image, and a lack of recogni-
tion and visibility. Not many people are aware of what the medical
technologist or technician does or of the important contributions these
practitioners make to health care delivery. A dynamic public relations
program is needed to increase recognition and visibility of the
clinical laboratory practitioner, but perhaps the most important factor
that contributes to the status of a professional group is the individ-
uals of which the group is composed. Individuals, who have a higher
education and broader orientation can work for improved image,
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identity, and recognition of the professional status of medical
laboratory scientists in Nigeria. The proposed curriculum provides for
a sound foundation for future educational aspirations of the learner.
Jobs that will become available in the Nigerian health care system
will require clinical laboratory technicians and scientists with
entirely different roles in nontraditional settings, or similar roles
in different settings. While technical skills are important, these
alone will not fully equip practitioners. Preparation and competence
in communication skills, both written and verbal, the psychology of
interpersonal and organizational behaviors, the principles of finance
and management, and educational methodology are also vital to an
effective curriculum in medical laboratory sciences. The proposed
curriculum provides for these learning experiences.
The proposed curriculum is a source of continuing education for
all laboratory personnel regardless of level. For example, clinical
instructors, through teaching clinical laboratory technicians or
scientist during the clinical practicum, are motivated to keep up to
date in knowledge and skill, thereby maintaining high-quality
laboratory performance.
Finally, the proposed curriculum, by design, will provide the best
source of employees for the nation's clinical laboratories, and the
opportunity to ensure their quality. In these "economic hard times"
Nigeria could conserve her foreign exchange if students could take
advantage of the educational program described instead of an overseas
training.
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Cost
Apart from administrative, instructional and other curricular
concerns, of equal importance is adequate financing of new programs.
Admittedly, new programs should be cost effective, there must be
adequate provision for the basic needs of the programs. Ideally, the
proposed program should be implemented by a university within a medical
school facility to be cost effective. Facilities of the medical school
may be shared with the university department of medical technology--an
arrangement which offsets additional cost of space and other equipment.
Universities without medical schools can still implement the program
but will need student laboratory space in addition to provision for
more faculty and secretarial help.
Nigerian economy is presently in a gloomy state, to say the least.
Ten years ago the nation took pride in the large revenue coming from
its crude oil. The global depression of the Western nations reduced
demand for oil with adverse consequences on prices. Nigeria was forced
to "cut down" on output with a resultant decline in the contribution of
the oil sector to the gross national product. Recently, Nigeria had to
borrow from the International Monetary Fund to pay some of its long-
standing debts.
In any part of the globe experiencing situations similar to the
one described above, the needs of the people and their education
suffer. The investment in a program of the type described here will
not be small; however, when the long-range effects of such a program on
the students, staff, the medical technology profession and society are
considered, it is a worthy investment. The ends should justify the
means.
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A Scenario of Implementation
The purpose of the new curriculum is to provide opportunities for
the student to benefit maximally from participation in the medical
laboratory sciences educational program. Part of the problem of any
forward notion of this nature is that if the right leadership is not
provided, the best laid plans come to naught. Loo (1974) alluded to
the need for strong teacher and administrative support if a curriculum
plan is to be effectively implemented. Effective implementation would
therefore depend on the emergence of good leaders from the ranks of
administrators, teachers, and participatory citizen groups. These
groups form influential forces which positively catalyze the provision
of an environment where the learner can become an educated citizen.
Clark and Stefurak (1975) pointed out that if these groups can identify
with the goals of the curriculum and assume a contributing role in
achieving the goals, the process of change would be even smoother.
The ideas espoused here are revolutionary, cannot be superimposed
on the existing system, and require change. Change is painful. People
naturally ignore, resist or accept change. Resisting change is more
probable, particularly when it is imposed. The proposed change will
not happen overnight, it may not even happen in another few years. An
evolutionary rather than a cataclysmic change is anticipated and
intended. As capable leadership emerges, as funds become available and
as the Institute, faculty, the entire medical technology profession of
Nigeria, and students are ready to accept and support change, the
proposed model program may be implemented by using a pilot-study
approach in one or two settings where individuals indicate the willing-
ness and commitment to experiment with the program.
An important aspect of change is that the problems be seen as
"real," and the proposed change be considered as part of the logical
solutions. The researcher intends to assist the people to be affected
by the change in identifying and outlining the problems, in defining
possible solutions, and in facilitating the process of putting the
solutions into action. If the proposed program becomes a part of the
action plans, the implications and implementation are clarified; the
risks, understood in terms of benefits.
The implementation of the proposed model program involves five
stages: reorientation, planning, organizing, directing and monitoring,
and evaluating. This scenario demonstrates the linking of the stages,
and suggests how the various aspects of the proposed model are attended
to and integrated in the process of implementation.
Reorientation
Effective implementation of the model is contingent upon a
reorientation of the Institute, including program officials,
administration and faculty because all are responsible for the
implementation. Unless these leaders are helped to understand what is
to be done and why, and are committed collectively to getting it done,
the implementation will fail. Reorientation involves discussing the
conceptual framework and the model program built from it; soliciting
responses--objections, agreement, consensus--from all those concerned
with implementation; and modifying the program as needed. The discus-
sion of the conceptual framework provides a common ground of under-
standing for all concerned, and helps build support for the program.
The goals of the program are delineated, and the consistency
between the goals and those of the National Education Policy of the
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