A proposed model baccalaureate program in medical laboratory sciences for Nigeria
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 Material Information
Title: A proposed model baccalaureate program in medical laboratory sciences for Nigeria
Physical Description: xi, 126 leaves : ill. ; 28 cm.
Language: English
Creator: Sodeke, Stephen Olufemi, 1948-
Publication Date: 1983
 Subjects
Subjects / Keywords: Medical technologists -- Education   ( lcsh )
Laboratory technicians -- Education -- Nigeria   ( lcsh )
Medical laboratory assistants -- Education -- Nigeria   ( lcsh )
Genre: bibliography   ( marcgt )
theses   ( marcgt )
non-fiction   ( marcgt )
 Notes
Thesis: Thesis (Ph. D.)--University of Florida, 1983.
Bibliography: Includes bibliographical references (leaves 120-125).
Statement of Responsibility: by Stephen Olufemi Sodeke.
General Note: Typescript.
General Note: Vita.
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Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 000503997
notis - ACS4011
oclc - 12153811
System ID: AA00003849:00001

Full Text











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


S x


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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


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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.





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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.





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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.





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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.


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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




-17-


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




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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




-64-


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;





-67-


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




-68-


[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.




-71-


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




-73-


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.




-74-


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




-75-


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.




-76-


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




-77-


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





-79-


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





-80-


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





-81-


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.





-83-


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.




-84-


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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