Histology Technician Skills, Competencies and Challenges
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Introduction
Histology refers to the study of the anatomy of tissues, cells and organs of plants and animals. The study involves examining organs, tissues and cells by sectioning and staining, and then examining them under a microscope (Mercer, 2012). Among the trained scientists who prepare the samples for use in histology studies are the histology technicians. Precisely, the role of histology technicians in histology laboratories is to prepare samples for use in histopathology. Histopathology is the study of diseased tissues. The samples prepared by histopathology are used for microscopic examination by histopathologists (Mercer, 2012). Histology technicians are employed to work in government agencies laboratories, hospital laboratories, school laboratories, laboratories in industries, veterinary medicine laboratories and research laboratories. They operate precision equipments and use different chemicals to make abnormalities in tissues, organs and cells visible with a microscope. In many countries, histology technicians do not require training for extended period of time. In the US and UK, for instance, histology technicians do not require four-year degree training like the medical laboratory technologists and histopathologists (Mercer, 2012). Rather, training for histology technicians may take much shorter time (even seven months) to get the relevant certification. However, the lack of adequate training presents various challenges to the histology technicians, among other challenges. Despite the presence of challenges, the work environment today requires histology technicians to have certain skills and competencies in order to carry out their tasks effectively (Mercer, 2012). In this regard, the purpose of the current research is to review the skills and competencies that histology technicians should have and to examine the challenges they are facing.
Histology Technician Skills
There are several key skills that histology technicians should have.
Some of the skills and competencies develop from the knowledge gained during formal learning and training, whereas others develop naturally through experience (Ferguson, 2009). Most of the skills and competencies that histology technicians and other laboratory professionals should have are described by regulations in different countries. One of the most important skills that histology technicians should have is the ability to conduct biological experiments. They should have ability to conduct tests on cells, tissues and organs of animals and plants. In order to do so, they should have fundamental knowledge on the tissues, cells and organs of plants and animals and their interactions, interdependencies and functions. In short, they should have fundamental knowledge in biotechnology (Ferguson, 2009).
Secondly, ability to carry out chemical experiments is of utmost importance for histology technicians. They should have ability to use the right chemicals, the correct measures of chemicals and follow the right procedures during experiments. The process of mixing such chemicals is called histochemestry. As such, the histology technicians should have adequate knowledge of chemical properties, structures and composition of substances. In addition, they should be aware of the interactions and uses of chemicals, production techniques, danger signs and disposal methods (Ferguson, 2009). For instance, they are required to have adequate awareness of the common and special stains and their applications. Examples of common laboratory stains are Periodic acid-Schiff stain, Orcein stain, Wright’s stain, Silver stain, Heidenhain’s AZAN trichrome stain, Weigert’s elastic stain Mallory’s trichrome stain, Masson’s trichrome stain, Toluidine blue, Eosin and Haematoxylin. Examples of special laboratory stains are Villanueva Osteochrome Bone Stain, Verhoeff Van Gieson Elastin Stain Kit, TB Fluorostain Kit, Rapid Mucin Stain Kit, Prussian Blue Iron Stain Kit, Periodic Acid Schiff’s Stain, Masson’s Trichrome Stain Kit, Light Green Counterstain Stock Solution and StainRITE® May-Grünwald Stain Solution. Amidst the increased application of molecular diagnosis in histopathology, histology technicians are increasingly required to have skills in molecular biology. Molecular biology involves application of biology and chemistry to analyze interaction between different types of protein biosynthesis, RNA and DNA. One of the areas in histology in which molecular biology skills and laboratory stains are used are used is immunostaining. Immunoistaining refers to the use of antibodies to detect specific proteins in specimens. The process of using antibodies to detect all molecules in general, including lipids, carbohydrates and proteins is called immunohistochemistry. As well, histology technicians should have skills on processes such as fixing, grossing, embedding and sectioning.
All persons working in a medical laboratory should have safety skills. In the US, the safety skills that histology technicians should have are outlined by the College of American Pathologists, whereas in the UK, they are outlined by the United Kingdom National External Quality Assessment Service (Adyanthaya & Jose, 2013). Both sources explain that all persons working in histology laboratories, including technicians should have ability discern and to manage risks involved when operating equipments, strategies and procedures. In this regard, they should have knowledge in equipments and systems, procedures, policies and strategies. In addition, they should be aware of all risks involved when operating equipments, systems, tissues and chemicals. The Occupational Safety and Health Administration outlines the exposure limits for hazards that are permissible (Buesa, 2007b).
Another important skill that histology technicians should have is the ability to use scientific methods and rules to solve problems. They should have ability to apply theory into practice. They should be able to identify complex problems, review related information and use it to develop solutions to the problems. Where need be, the histology technicians should be able to use mathematics to solve problems (Chung et al., 2007). Ability to apply mathematical knowledge in practice is also very essential in histology. Histology technicians should be able to apply concepts such as calculus, geometry, algebra, arithmetic and statistics in their work where necessary.
Reading comprehension is an important skill that all histology technicians should posses.
Reading comprehension refers to application of prior knowledge and experience to make meaning of text. In addition to drawing from clues within text, a reader makes meaning of text by referring to prior knowledge and experiences (Tindall & Nisbet, 2010). A person who is able to comprehend text is able to write about what he/she has read and to engage in useful conversations. Reading comprehension skill enables histology technicians to understand the meaning of text in work-relate documents and to engage in higher order thinking.
Histology technicians need to have quality control analysis skills. As Adyanthaya and Jose (2013) explain, histology technicians should have the relevant skills needed to inspect products and conduct tests. They should be able to evaluate the overall quality and performance of processes and services in medical laboratories. They should be able to apply quality control skills during the pre-analytic, analytic and post-analytic stages in order to prevent possibility of erroneous diagnosis.
Ability to make judgments and to make informed decisions is a necessary skill for all histology technicians. Decision-making refers to the ability to select the best choice out of more than one alternative. Effective decision-making process requires the decision-maker to assess all possible solutions, apply prior knowledge and where need be, seek for additional guidance from experts or work-mates (Tindall & Nisbet, 2010). After coming up with the best alternative, a decision-maker should inform all stakeholders involved before implementing the final decision. In histology, technicians encounter situations where they need to make considerations of the benefits and costs of their potential actions (Tindall & Nisbet, 2010). As such, they should have decision-making skills in order to be able to select the most appropriate choices.
Histology technicians should have monitoring skills. They should be able to asses self performance, the performance of workmates and the overall organization (Ortiz, Spalding & Andreasen, 2011). If a histology technician finds that his or her own performance low, he/she should develop strategies to tackle the weaknesses and come up with improvement strategies. If the performance of the workmates is low, a histology technician should encourage them to enhance their performances. Where need be, a histology technician should steer other workers to engage in collective action in order to improve the performance of the overall organization (Ortiz et al. 2011). The ability to monitor operations is one of the most vital abilities. Histology technicians should be able to watch dials, gauges and other indicators to ensure that laboratory equipments are working properly.
Ability to control operations of systems and equipments in a medical laboratory is also important for histology technicians. Histology technicians should be able analyze equipments and systems in order to determine how they work and how changes in the environment, operations and conditions will affect outcomes (Ortiz et al. 2011). They should also be able to determine the equipment that is suitable for a particular job. In addition, they should have ability to maintain systems and equipments. They should be able to determine the kind of maintenance that is needed for specific equipments and systems and perform the maintenance frequently. According to Ortiz et al. (2011), histology technicians should have ability to evaluate systems and determine the actions needed to enhance performance in accordance with the goals of the system. As such, histology technicians should have adequate knowledge of tools, machines and systems, including their uses, designs, repair and maintenance.
Active learning is also very important. Histology technicians encounter new information frequently emanating from new discoveries. As such, they should always be ready to learn the new information and its implications in practice, currently and in the future. They should have ability to use instructional tools, methods and procedures appropriately in order to acquire new information (Gass, 2012).
Writing skills are essential in histology technician profession. According to Gass (2012), writing skill is the ability to write a sequence of letters, symbols or words marked on a surface. Gass (2012) describes writing skill as the ability to compose text for publication. As Gass (2012) explains, writing is the major means of communication within organizations. According to As Gass (2012), almost 30 percent of work time is utilized in written communication. Writing has two major roles in histology: to convey information and to clarify to readers. When a histology technician has problems or is unable to express an idea, writing it down can help the readers understand. Also, writing skills enables histology technicians to convey information to a large group of recipients, which could have taken long time to explain. Histology technician apply writing skills in writing reports, prescriptions, articles, manuals, brochures, letters, emails and legislation (Gass, 2012).
Critical thinking skill is also necessary in the histology technician profession. Critical thinking refers to the use of reasoning and logic when solving problems. When new problems emerge, histology technicians should be in a position to identify possible or alternative solutions. In addition, they should be able to asses the strengths and weaknesses of each option (Chung et al., 2007). A histology technician should have ability to come up with a sound conclusion about the best option, and then come up a suitable approach for solving the problem. Close to the critical thinking skill is troubleshooting skill. Histology technicians should be able to detect operation errors and determine the causes (Chung et al., 2007).
Histology technicians should have skills in clerical work. They should be able to apply knowledge on clerical and administrative systems and procedures into practice. This includes skills in word processing, designing forms, stenography and transcription, managing files and records and other office procedures. During the recent years, computer skills have become important in almost all professions. Histology technicians should have skills to operate computers and electronics and use them to make their work easier. To do so, they need to have basic knowledge of how to use computer hardware and software, chips, processors and chip boards (Chung, Isaacs, & Simons, 2007).
Instructional skills are important in histology. Histology technicians constantly discover or learn new information that fellow workers need to learn. In order to pass the information to the other workmates effectively, they should have instructional skills (Gass, 2012). Interactional skills are very important in every profession. Histology workers should have ability to understand others, understand their reactions and causes and respect them. They should have ability to persuade workmates and other people change their minds (Hoeltke, 2012). The ability to manage personnel resources has become important in all professions during the recent years. Histology technicians should have ability to direct, develop and motivate other people as they work. Those who are given leadership roles should be able to identify workers with adequate skills for particular jobs (Hoeltke, 2012).
Histology Technician Competencies
An important competence that histology technicians should have is integrity. Integrity in this context refers to engaging in actions that are grounded on responsibility, respect, trust, ethics, honesty and fairness. Histology technicians are expected to do work that is grounded on the aforementioned attributes (Davis, 2011). Further, histology technicians should always be attentive to details. The profession deals with numerous details that need careful attention. Some details are very small and require the use of equipments such as microscopes to asses. The results derived from histoloogy laboratories are very sensitive since they are applied in patient diagnosis. For instance, the micro-array based gene expression that is applied in diagnosis of cancer requires close attention to details to ensure that results are accurate. In other words, to ensure that the right care is provided to patients, the results of medical laboratory tests should be as accurate as possible (Davis, 2011). Therefore, the histology technicians should ensure that their tests are as thorough as possible. Thoroughness can only be achieved when the technicians are attentive to details (Davis, 2011).
Histology technicians should be dependable. They should to always fulfill their obligations, they should be responsible and they should always be reliable (Davis, 2011). Further, histology technicians should be stress tolerant. Histology technicians often encounter situations where the need to prepare too many tests within shorter periods than normal. They also face criticisms for their work from the public, despite their hard work. As a result, they frequently encounter stressing situations (Davis, 2011). Sometimes, the stress emanates from the nature of the work. Histology technicians take samples for use from tissues and cells of plants and animals. In some cases, they are required to get specimens from bodies of dead human beings. Dealing with human corpses can cause a lot of stress. To navigate effectively through such situations, histology technicians must be able to deal calmly with the stress (Davis, 2011).
Histology technicians must show independence. In medical laboratories, histology technicians frequently encounter situations where they need to make decisions and solve problems. In addition, they have to follow the fundamental professional, legal and ethical standards that guide the profession (Echaore-McDavid, 2012). Although they are required to follow the standards, they expected to develop their ways of doing things in order to make work more effective. When a worker develops his/her way of doing things and relies less on rules, he/she gets motivated do more work and to improve quality. However, they are expected to follow the fundamental standards with little or no supervision (Echaore-McDavid, 2012). They are expected to depend on themselves to get work done. Histology is a job that requires technicians to work together when conducting experiments. The technicians should, therefore, have preference to work with others, rather than work alone. They have to personally connect with the fellow workers on the job (Echaore-McDavid, 2012).
As well, histology technicians must have ability to cooperate with other people. In the recent years, team working has become very important in all organizations. Team working refers to the ability to form groups and work together while focusing on specific goals (Echaore-McDavid, 2012). In histology, teamwork can help to improve the quantity and quality of output. They should be pleasant with the fellow workers in the job and should display cooperative attitude. In addition, histology technicians should show concerns for others (Echaore-McDavid, 2012). They should be sensitive to the needs and concerns of fellow workers. They should be ready to understand others and to help them carry out tasks.
Histology technicians should have self control. As mentioned earlier, histology technicians often encounter stressing situations, some of which may arouse emotions (Bogusz, 2011). For instance, dealing with human corpses may lead to deep emotions and other difficulties. Some challenges encountered by the histology technicians, such as negative exposure by the media to the public and lack of adequate funding may lead to anger. Working under too much pressure may also lead to anger and aggressive behavior. However, the histology technicians are expected to deal with such stressing situations calmly and to show self control. To deal with such situations, histology technicians must have ability to maintain composure, avoid aggressive behavior, control anger and keep emotions in check, in every stressing or difficult situation (Bogusz, 2011).
The profession of histology technician requires adaptability to change. There are numerous discoveries in science emerging during the recent years, as more scientists engage in research. Some of the discoveries have huge impact on the profession. For instance, researchers often discover more effective equipments to be used by histologists (Bogusz, 2011). A good example of new discoveries in histology is the new telepathology system that has ability to produce more accurate results than the traditional light microscopy. Such new technology may be implemented in a medical laboratory in order to improve the accuracy of results (Osaro & Charles, 2012). The histology technicians must be flexible enough to accept and adapt to the change. In case of need, they should seek for more training in order to deal with the technical change. In some cases, the change may affect organizational culture, rather than the technical details. For instance, the change may involve changing the structure of management (such as replacing bureaucratic structure with work groups) and promoting some workers to higher management ranks. In such situations, the histology technicians should be ready to accept the change and work under the new systems (Bogusz, 2011).
Histology Technician Challenges
There are numerous challenges facing histology technicians. One of the major challenges facing histology technicians is lack of adequate training of histology pathologists to work with most modern equipments. In many countries, histology technicians are not required to take a four-year degree course to qualify in the profession. In some countries, there are training programs that can take even nine months to train histology technicians (Gibson, 2012). Unfortunately, most of the programs providing the training face challenges such as lack of enough funds, time, space and tutors to properly train them. At the same time, there is tendency to assume that the testing personnel in histology laboratories will be able to learn by themselves how to use modern technologies in work settings, to comprehend and use them efficiently. In addition, there is knowledge gap that is emerging; in many countries, histology technicians who are already in the profession are not provided with additional training to understand the new discoveries. As a result, there are only few histology technicians who are able to implement or apply the results of new discoveries. In addition, due to lack of adequate training, there are too few histology technicians who are able to execute complex testing (Gibson, 2012).
Another major challenge that is facing histology technicians is low pay in some parts of the world and inadequate funding of their laboratory work. Low pay is a major challenge that highly affects productivity of histology technicians (Buesa, 2008). In the US, for instance, the average salary for histology technicians is currently lower than most jobs of the same caliber (Vadgama, Peteu, & Thompson, 2013). Since the US government started recruiting immigrants into the profession, the salary offered for the new histology technicians has significantly reduced. The following table presents the recent remuneration trends for the histology technicians in the US.
Figure 2: The recent remuneration trends for the histology technicians in the US
Source: Indeed.com (2014).
The low level of remuneration leads to reduced morale among the histology technicians. In turn, low morale leads to lower quality and size of output (Buesa, 2008). In addition to the low level of remuneration, histology technician profession in many countries suffers from low level of funding (Vadgama et al., 2013). During the recent years, histology and medical laboratories have become part of the targets of the decision makers and administrators during periods of economic challenges. During the recent global economic crisis that peaked in 2008, for instance, medical and histology laboratories became quick targets for funding restrictions by the US federal government (Vadgama et al., 2013). The main reason why they are easy targets is the fact that is possible to reduce the overall cost incurred in medical laboratories introducing new technologies, and automating some of the tasks taking place in medical laboratories. However, the main problem with such a move is that it compromises the quality of the output. Introducing machines and automating tasks undermines the work of histology technicians and distances them from their core role; to ensure that the desired quality medical laboratory output is achieved (Vadgama et al., 2013). Although the quantity of output may increase, automating the tasks carried out by histology technicians may lead to poor quality of results, which eventually leads poor quality patient care. In addition, histology technicians are often allocated fixed amount of funds for a particular period of time, irrespective of the number of tests they are supposed to carry out. In situations where the number of tests is higher than normal, histology technicians usually suffer from insufficient funding, yet they are expected work with the available funds and maintain the desired quality (Vadgama et al., 2013).
Another major challenge is too much pressure experienced by the technicians. One of the causes of the pressure is the shortage of histology technicians in some parts of the world, leading to overload of work. For instance, over the last one decade, the UK has experienced instances of shortages of histology technicians. However, the UK government, through state agencies such as NHS, responded through providing training chances for more specialists in histology (Vadgama et al., 2013). As demonstrated in the following table, the problem of shortage of histology technicians in the UK has been countered.
Figure. 1. Anticipated number of trained histology technicians in the UK
Sources; (RC Path census, 2007)
To counter the shortage of histology technicians in the US, the federal government has been recruiting skilled immigrants from other countries in the profession (Buesa, 2010). Despite the intervention of national governments, the pressure emanating from overload has not been fully countered. This is mainly due to the fact that there are instances where too many requests for tests are made within short periods of time (Vadgama et al., 2013). In such circumstances, histology technicians work under pressure to try to conduct all the tests within a short timeframes. In some cases, the need to determine duplicate and inappropriate requests increases the pressure.
Another major challenge experienced by histology technicians is inability to implement some of the new discoveries in their work. In particular, there are numerous discoveries that are emerging from researches that aim to solve problems in areas such as such as micro array technologies, amplification technologies, blotting technologies, probe technologies, electrophoretic technologies and restriction fragment-length polymorphism (RFLP) analysis. A good example of a recent discovery in histology is the new telepathology system that has been introduced to replace the traditional light microscopy (Osaro & Charles, 2012). Another example is the new novel array microscope, which stitches multiple digital images together in one image that can be viewed by many technicians (Osaro & Charles, 2012).
Despite the presence of such discoveries, some histology technicians have not been able to use them, yet their tests are required to meet the current national and world quality standards. The main reason for the lack of implementation of the new technologies is the high cost of the new technologies (Osaro & Charles, 2012). As a result, some of the small medical laboratories in community hospitals are unable to acquire them. In some cases, the problem is compounded by the presence of prohibitive bureaucratic procedures in the health and regulatory agencies. In the US, for instance, agencies such as the, institutional review boards Health Insurance Portability and Accountability Act may limit the ability to acquire new equipments. In addition, some of the newly invented equipments cannot be applied in some circumstances Osaro & Charles, 2012). For instance, although modern equipments such as novel array microscope produce digital images, primary diagnosis cannot be developed using such images. In addition, the use of digital technology in histology laboratories faces obstacles due to the lack of standardization of instruments. As well, there is lack of standardization of techniques for preparation. For instance, when using antibodies to detect or to visualize lipids, carbohydrates and proteins, histopathotholigts may use immunohistochemistry, immunofluorescence or nonradioactive process, in combination with immunohistochemistry and immunofluorescence (Buesa, 2007a). The presence of different preparation methods (Such as fixing, embedding, sectioning and staining) also presents some difficulties to the technicians. Further, histology technicians use different tissues, namely Connective Tissue, Epithelium, Muscle and Nervous Tissue (Buesa, 2007a). Sometimes, they experience difficulties in differentiating the tissues. The following diagram demonstrates the fact that there is lack of standardization of the instruments used in histology laboratories.
Figure 3: Different instruments used in histology laboratories.
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BCL-2 ONCOPROTEIN QC slides supplied by a newcomer that are used to verify n reagent reactivity and histological techniques
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Hepatitis C Positive Control Slide for IHC supplied by a newcomer, which is available in 10 or 98 sets.
Summary/ Conclusion
In conclusion, histology technology profession requires a wide range of skills. Ability to carry out biological and chemical tests is the most important skill in histology laboratory. In addition, histology technicians need to have ability to apply medical knowledge in treating human diseases, diseases and injuries. Ability to apply mathematical, computer, mechanical and safety knowledge in work setting is very essential for histology technicians. Other important skills are active listening, speaking, writing, critical thinking, reading comprehension, quality control, decision-making, monitoring, problem-solving, operation and control, monitoring, coordination, time management, service orientation, equipments and systems maintenance, systems evaluation and interactional skills. On top of the above skills, histology technicians are required to have various competencies. Among the most important competences include attention to detail, cooperation with fellow workers, integrity, dependability, stress tolerance, independence, self control, persistence and achievement.
Despite the need for such skills and competencies in the profession, histology technicians encounter various challenges that hinder their ability to provide optimal output. One of the major challenges facing the histology technicians is the lack of adequate training. Due to lack of adequate training, many histology technicians are unable to perform complex tests and to use complex modern equipments. Secondly, histology technicians face a major challenge emanating from low level of salaries in comparison to other laboratory workers, such as medical laboratory technicians. In addition, they lack adequate funding for their job by health planners. Lastly, histology technicians face a major challenge resulting from inability to implement some of the new scientific discoveries in their job. The impact of the challenges is that they affect the size and quality of output of medical laboratory laboratories. To counter the challenges, it is essential to provide schools and programs that provide education and training to histology technicians with modern equipments and adequate funding. Histology laboratories should be supported with adequate funding and the technicians should be given satisfactory remuneration. Training to histology technicians should be made continuous, even to those who are already in the profession.
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Chung, L.
