Certification Presentation Ro

Opportunities and Routes for HT
Certification and QIHC Qualification
Joelle Weaver MAOM, HTL
(ASCP), QIHC

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

Introduction
• In this presentation I hope to clarify the
professional advantages to pursuing ASCP
certification as well as talk about the process
and the registry exam itself.
• I hope that this will provide some helpful
information for anyone contemplating
certification but who is not sure what is
involved or where to begin.


Learning Objectives
At the conclusion of this presentation participants will be able to:
1. Identify the mission of the BOC in providing certification.
2. Discuss the benefits of certification.
3. Differentiate between licensure and certification.
4. Identify vacancy and wage factors affecting employment opportunities in
histology.
5. Identify the routes and the requirements for eligibility for the HT
certification exam and the QIHC qualification.
6. Identify the HT exam content, format, and scope.
7. Discuss the CMP requirements for histology certifications.
8. Identify opportunities and resources for education and training in
histotechnology.


BOC Mission
• The Board of certification mission is to
“provide excellence in certification for
laboratory professionals”.
• The largest and oldest pathology and
laboratory medicine society and is the “gold
standard” in certification for laboratory
professionals.


History and structure of the BOC
Founded in 1928 by the ASCP. To date over 460,000 individuals
have been certified. The ASCP is accredited by the American
National Standards Institute (ANSI). The board of Governors of
the ASCP BOC consists of 25 members:
• 5 pathologists nominated by ASCP
• 5 laboratory professionals nominated by ASCP
• 4 representatives from the American Society for Clinical
Laboratory Sciences (ASCLS).
• 2 representatives from the Association of Genetic
Technologists (AGT).
• 1 other representative from a laboratory society
• 1 public mentor


What is certification?
• Certification is the process by which a non-governmental
agency grants recognition of competence to an individual
who has met certain predetermined qualifications as
specified by the granting agency. Having certification is
typically offered within an industry to uphold certain
standards.
• Licensure is mandated through regulatory or government
agencies which define title and scope of practice.
• Certification is generally voluntary, but can be required or
part of the licensure process. Licensure is generally a
required process necessary to practice within a defined
jurisdiction.


Why become certified?
• Certification demonstrates your commitment to
the profession.
• Employers prefer and often require certifications.
• Demonstrating competency via certification can
provide you a competitive advantage for more
job opportunities, higher pay, and increased job
security.
• ASCP Survey results show that 69.4% of staff and
91.6% of supervisors in histology departments
are certified (2011 ASCP Vacancy Survey of
Clinical Laboratories).

Factors & barriers affecting
certification
• ASCP policy and elimination of OJT route.
• Education and training availability.
• Lack of public awareness of histotechnology field.
• Lack of knowledge of the certification
process, requirements and steps involved.
• Lack of knowledge of benefits to individuals for
becoming certified.
• I hope to address most of these topics within this
presentation.


ASCP policy to support recognition has
inadvertently created barriers to entry
• In 2005 the ASCP eliminated the high school and OJT and
route for HT certification in an effort to increase the
professional perception of the field, and attract high quality
applicants to the struggling Histotechnology profession.

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


Histology is a great profession

DEMAND IS AN OPPORTUNITY


Lab Careers- Opportunity Overview
• The Bureau of Labor Statistics projects clinical laboratory technician
employment growth of 14.7 percent between 2010 and 2020, adding
23,800 more professionals to the 161,200 jobs currently in this field.
• One of the most appealing aspects of this profession is the relatively easy
attainability of the education and training requirements as compared to
many other medical professions.
• Most laboratory technicians possess an associate's degree from a
community college or junior college program accredited by the National
Accrediting Agency for Clinical Laboratory Sciences (NAACLS). More
complex procedures are reserved for clinical laboratory technologists, who
must possess a bachelor's degree.
• Those that successfully complete training and certification are in huge
demand, and often get placed into jobs very rapidly.


Overview of HT Demand
• Nationally, the majority of laboratories filled most positions within six months of
posting an opening, however a statistically significant number of openings take
longer than one year to fill .
• Across the nation, vacancy rates were highest for blood banking (11.6%), histology
(9.81%), and chemistry (8.62%) departments. The lowest vacancy rates occurred in
the departments of cytology (5.14%) and immunology (5.56%).
• There were an estimated 28,400 working histologists as of 2008. However ½ of
those 28,400 will reach retirement age in the next 4 years.
• Consider that an estimated 31,200 new histotechs will be needed by 2015 to
replace retirees and anticipated need by 2015. Since only 477 new HT were
certified as of 2009, then potential there will be a potential deficit of over 29,000
certified HT staff by 2015.
• According the an ASCP report, laboratory managers appear to choose certified
rather than non-certified staff .
• Obtaining certification will ensure that you are competitive in the current job
market and prepared to meet the demand of new testing methods, accreditation
and in many states licensure requirements.

“Big Picture” Statistics

Overall % of Histology % of Histology % of Histology
Histology staff certified vacancies staff expected
vacancy rate taking more to retire
than 1 year to within 5 years
fill
9.81% 69.4% 13.7% 15.3%

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


General Correlation of Education & Job Skills to
Earnings


How much do Histologists earn?

SALARY INFORMATION


Wage by Occupational Title in the
Laboratory


Breakdown of national wage level averages
for HT and HTL’s
• Staff level HTs earn an average of $22.68 (SD =
$5.28) per hour.
• Certified staff HTs earns 14.7% more than non-
certified HT staff.
• The average hourly wage for staff HTLs is
$26.00 (SD = $5.83).
• * 2010 ASCP Wage Survey of Clinical
Laboratories


Regional salary variations-2005 data
Regions Cost of living Median Annual Median average salary/position
unit (unit=100) Income ( unit=1000) (unit=$5/hour)

Mean Mean HT HTL
Northeast 141.7 51.4 19.35 23.73
East north 105.5 46.2 18.51 21.15
central

South central 100.6 42.1 18.00 20.82
Atlantic

West south 95.5 38.5 18.72 19.44
central

West north 98.5 43.6 17.08 21.32
central

Far west 117.4 48.3 18.24 22.54
National totals 109.9 45.0 18.47 21.63


How do I begin the steps to get certified?

PROCESS TO CERTIFICATION


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

Experience Requirements
• To fulfill the experience requirement for the Histotechnician examination, you
must have experience, within the last ten years, in the following areas:
• Fixation
• Microtomy
• Processing
• Staining
• Full-time experience is defined as a minimum of thirty-five (35) hours per week.
Individuals who have part-time experience may be permitted to utilize prorated
part-time experience.
• To document your clinical laboratory experience (if required):
• Use experience documentation forms (for the appropriate certification category
and route number) must be downloaded and printed from the ASCP website at
www.ascp.org/certification .


Establishing eligibility
Eligibility to take a certification examination is established by:
1. Meeting the stated minimum requirements for the particular category of
certification
2. Submission of the appropriate application form
3. Payment of the appropriate application fee
4. Submission of all appropriate documentation including official transcripts
indicating the appropriate degree

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


Verification of Academic Education
• If college credits are required for the examination
category, you must
submit an official transcript or transcript evaluation.
• Continuing Education courses are not acceptable in fulfilling
the academic requirements.


Verification of Training
Route 1. NAACLS or CAAHEP Accredited Programs
• If you are currently enrolled in or have completed a NAACLS or CAAHEP accredited
training program within the last five years, the printed application form must
include the program director’s name and the school code number must be
indicated. The education received from a NAACLS or CAAHEP accredited program
is acceptable for a period of five (5) years from the date of completion of that
program.
Route 2:
• You must download the appropriate training documentation form from the ASCP
web site at: www.ascp.org/certification .
• If you are unable to download the form, go to www.aspc.org or fax us at 312-541-
4845 to request printed copies. The training documentation form must be
completed by your program director and attached to a letter, on letterhead, signed
by the program director verifying the accuracy of the information.


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


What can I expect when I sit for the HT registry exam?

ASCP HT EXAMINATION


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


CAT Testing format
Computer Adaptive Testing (CAT) -
1. An examinee’s score on the exam is not influenced by the scores of other examinees
who take the exam.
2. When you answer correctly, the next test question has a slightly higher level of
difficulty.
The difficulty level of the questions presented to the examinee continues to increase
until a question is answered incorrectly. Then a slightly easier question is presented. In
this way the test is tailored to the individual’s ability level.
3. Each question, in the test bank is calibrated for level of difficulty, the weight (value)
given to each question is determined by the level of difficulty.
4. The examinee must answer enough difficult questions to achieve a score above the
pass point.
5. To pass the certification examination, the examinee’s scores must exceed the minimum
pass score.
6. You will have to check in at the testing center with your admission letter, identification
and no calculators allowed.

Question taxonomy- levels of question
difficulty
• Taxonomy I (level 1) RECALL
- ability to recognize knowledge from specific facts to
theory.
• Taxonomy II ( level 2) INTERPRETATION
-ability to utilize recalled knowledge to interpret or
apply data.
• Taxonomy III ( level 3) PROBLEM SOLVING
-ability to utilize recalled information and the application
of distinct criteria to resolve problems or make
appropriate decisions.

Question format
• All questions are multiple choice and will
appear on the screen one at a time.
• You must answer one at a time ( can’t skip).
• Color photos, diagrams, charts and other
images may be incorporated and appear on
the screen with the question.


ASCP Exam Statistics for January – December 2011

Exam 1st year Mean # Taking Pass rate 1st Total
Type certified exam attempt certified
pass for (ever)
program
grads

HT 1948 458 772 519 test takers - 327-74% 22,416
67%

HTL 1980 443 283 183 test takers- 100-35% 3,141
65%


How do I prepare for the exam?

SUGGESTIONS FOR STUDY AND
PREPARATION


Study Resources-Foundation Text
• Histotechnology: A Self-Instructional Text
(3rd Edition) ISBN: 9780891895817
• Authors: Freida L. Carson and
Christa Hladik
List Price: $150.00, Member Price: $115.00
• Combo Price!
(Order both the Histotechnology text and the
HistoDeck Flash Cards)
List Price: $195.00
Member Price: $170.00
• Histotechnology: Complete Study Package,
Order # HTPK3, Get the complete
Histotechnology Study package -- textbook,
workbook, and HistoDeck flash cards.
• Available @ ASCP
http://www.ascp.org/ASCPStore/Store/Books
/5817.aspx

Study Guide
• Board of Registry Study Guide:
Histotechnology Examinations (2nd
edition), Order # 473X | ISBN: 089189473X
• Authors: Freida Carson, PhD
Laura Culver Edgar, MT(ASCP)
Donna Surges Tatum, PhD
• The guide includes:
• Guidelines for taking the test
• Information about the
development, content, structure and scoring of
the test
• Practice questions and answers
• Image-based questions
• List Price: $65.00
• Member Price: $50.00
• http://www.ascp.org/Store/Books/Board-
Registry-Study-Guide-Histotechnology-
J. Weaver MAOM,Examinations-2nd-edition.html#StoreList
HTL (ASCP), QIHC 2012 35

From the ASCP website
• Reading lists http://www.ascp.org/PDF/BOC-
PDFs/Bibliography/ReadingListHTL.aspx
• Exam content guidelines http://www.ascp.org/PDF/BOC-
PDFs/Guidelines/ExaminationContentGuidelineHT.aspx
• Online practice tests includes a 90-day online access to the practice
tests, comprehensive diagnostic scores, and discussion boards. If you are an
institutional purchaser that would like to pay by check or purchase order
(minimum of 20 tests to use a check or purchase order), download Order Form
(PDF). http://www.ascp.org/Board-of-Certification/Exam-Preparation/Online-
practice-tests
• BOR Study guide ( shown previously) http://www.ascp.org/Store/Books/Board-
Registry-Study-Guide-Histotechnology-Examinations-2nd-edition.html#StoreList


NSH Study Materials
• The NSH provides many study resources
including texts, self assessments, flash
cards, an on line learning center, and other
study aids offered through the NSH
marketplace.
• Certification study aids page located at :
http://www.nsh.org/content/certification-
exam-study-aids


Study strategy for success
• There is NO substitute for knowing the material.
• You will be able to do well by thorough preparation, and by
use of practice questions to learn how to take this type of test
well.
• Go in knowing the exam format, question types and topics.
• Use a process of elimination for “stumpers” as with all MC
tests .
• Don’t be overly critical of yourself, there has never been a
perfect registry exam score- simply do your best. ( note the
score range is 400-999).
• Make sure you are well rested on exam day!


Using content guidelines
• This is NOT simply a recall examination, so you must strive to learn the
underlying theory and principles and be able to apply them to presented
situations and problems. This replicates actual practical use of knowledge in lab
situations.
• The exam covers ALL of histology practice, so techniques, stains and methods
you may not perform in your job will be topics for questions. The exam
committee designs the test to cover as broad a “scope of practice” as possible.
• I encourage you NOT just to attempt memorization. Not only will this only be
stored in short term memory and quickly forgotten. You will likely do poorly on
application and taxonomy II & III questions if you only memorize.
• I recommend using the content guidelines with the resource texts to fill in and
expand the information on the outline. But flash cards or other study methods
may work well for you.
• Once you have worked through the outline, use practice questions and tests to
determine your weak areas to go back over and devote more study time.


Content Category
• Content area= Staining – know
tissues, procedures, instrumentation, reagents/dyes, & mounting procedures (
following content guideline).
• Subtopic = Histochemical stains
• Stain Group =Carbohydrates = aldehyde or ketone derivatives of alcohols.
Occur as polymerized sugar chains, often combined with proteins or lipids.
CHO categories:
Polysaccharides and Mucopolysaccharides( mucosubstances) including
neutral, acid, sulfated, non-sulfated
(carboxylated), mucoproteins, glycoproteins, Mucolipids .
Some CHO special stain examples:
PAS, PAS-D, Best’s Carmine, Alcian Blue ( pH 1.0, 2.5), Colloidal Iron


Grouping Carbohydrates
• Glycogen- only polysaccharide found in higher
animals as a polymer of glucose.
• Mucopolysaccharides are highly polymerized
disaccharide units divided into acid and
neutral.
• Acid mucopolysaccharides ( mucosubstances)
often called “mucin”.
• Complexes of mucopolysaccharides with
lipids, proteins also.

CHO Category Table & Stains
CHO type Tissue element Histochemical stain

Polysaccharide-glycogen Hepatocytes, muscle PAS-D, Best’s Carmine, AB -,
Coll. Fe-
Neutral Mucosubstances GI epithelium, thyroid colloid, Mucicarmine ( GI
Goblet cells epithelium), PAS +
Acid mucosubstances Many tissues, sublingual AB +
glands, non –sulfated in
synovial membranes
Sulfated mucosubstances Goblet cells(weak sulfated), AB +, Mucicarmine +
duodenal and colonic
Mucoproteins Basement membranes, Weak AB, PAS +, Coll. Fe -
mucoid cells pituitary
Glycoproteins Collagen, reticulin, CT Trichrome, PAS +, Faint AB,
Coll. Fe -
Mucolipids Cerebrosides, nerve tissue PAS +, AB -, Coll. Fe-

Dissecting a special stain
• Technique- Periodic Acid Schiff Reaction
• Application: most often used to demonstrate basement membranes, glycogen and
fungus, and PAS + mucosubstances secreted by epithelium of GI, lung, cervix. Used
to differentiate between secreting adenocarcinomas vs. undifferentiated
squamous cell carcinoma ( PAS-).
• Principle: Tissue is first oxidized by periodic acid. The oxidation results in the
formation of aldehyde groups where CHO are present in tissue elements. The
aldehydes are detected by the application of Schiff’s ( Leucofushin). Sulfurous
rinses follow to remove excess and to prevent false + oxidation by air exposure.
Warm water rinses intensify color.
• Results- PAS + tissue elements are rose to rose- red, counterstain depends on
method. Hematoxylin, light green common; light green typically used with fungus.
• + Control depends on technique used; liver, kidney, fungus containing, cervix.


Example organization for study
• PAS – Periodic Acid Schiff Reaction
• General stain category : Histochemical, CHO stain.
• Used with/for:
• Glycogen- PAS with/without diastase, fungus
• Neutral Mucin-PAS-H
• PAS for fungus
• PAS –basement membranes
• Considered rather non-specific CHO stain, gains specificity for glycogen
with diastase. Mucins are PAS + but also stain with Mucicarmine, which is
much better stain for mucins from epithelium sources. Glycogen may have
diagnostic significance in tumors such as carcinomas, mesotheliomas, and
rhabdomyosarcoma.


PAS Reaction Flow chart
Staining mechanism
↓
Oxidation ( periodic acid)
↓
Chemical reaction ( Schiff’s reagent with aldehydes( CHO)
↓
Recolorization ( water- followed by sulfurous rinse)
↓
Counterstain ( Hematoxylin, light green)

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


Sample Questions
1. The most commonly used stain procedure for demonstration of glycogen is?
A. PAS reaction with and without diastase
B. Alcian Blue-PAS
C. Mucicarmine
D. Aldehyde Fuschin

2. An enzyme employed to increase specificity and identification for glycogen with
PAS staining is?
A. Hyaluronidase
B. Sialidase
C. Diastase
D. Ribonuclease


Sample Questions
3. Glycogen is a carbohydrate that is normally classified as a/an:
A. Acid mucosubstance
B. Mucoprotein
C. Glycoprotein
D. Polysaccharide

4. Parallel sections are stained with PAS, ( with/without). In evaluating the
stain results, the stained section should:
A. Demonstrate acid mucosubstances
B. Show sites of non-staining where glycogen was removed
C. Show sites of non-specific PAS + staining
D. Demonstrate that the procedure is non-specific for Glycogen


Continuing education

MAINTENANCE OF CERTIFICATION


Certification Maintenance Program
(CMP)
• After passing the examination, you will receive a packet of
• information welcoming you as part of the ASCP certified laboratory
• team, including:
• Certificate of Certification suitable for framing, valid for three years
• Certification Maintenance Program (CMP) packet
• This information will be mailed to you approximately 3 – 5 weeks after the
examination scores are mailed. The initials “CM” in superscript must be
used after your certification initials immediately upon receipt of your
certification [i.e., MLS(ASCP)CM].
• In order to maintain your certification, you must complete the
Certification Maintenance
• Program (CMP), as described below, every three years.


CMP credits needed
• HT, HTL, beginning in year 2004 – 36 CMP
points required to include:
• 1 point laboratory or patient safety( i.e.
quality control, quality assurance)
• Remaining points in area(s) of
specialty, management, education or other
related
• laboratory areas of interest
• 1 CMP point= 1 contact hour=1 CMLE credit.

CEU Sources
• Formal continuing education courses—continuing education credits
awarded by AACME accredited programs, ASCP CMLE approved
programs, AACC ACCENT approved programs, ASCLS PACE approved
programs, CE programs sponsored by other professional societies and
courses taken at regionally accredited colleges/universities.
• Employer offered courses (in-service, instrument training, vendor
sponsored)
• Competence assessment from employer (documentation of continued
competency in specific laboratory areas).
• Subscription or online self-instructional courses for which CMLE, ACCENT
or PACE credits are awarded.
• Other educational activities—such as research and preparation for
presenting a workshop or course, authoring journal articles, presenting
posters, etc.

Industry trends in lab careers and
education
• General consensus:
• Not enough programs with new grads to meet
demands
• Lack of awareness of profession


Histology Awareness
• 2007 survey conducted by the Coordinating Council on the Clinical Laboratory Workforce
(CCCLW) found that the sources which led survey respondents to first become interested
in the field ( listed in order of importance) were:

1. A relative or friend
2. A college catalog or college visit
3. A high school science teacher
4. A tour of a medical laboratory
5. Personal research
6. Career fairs
• 76% of these respondents reported that they first became aware of laboratory career
options only after leaving high school. Those of us working in the field need to spread the
word!
• See handout for more detailed data on the state of histology programs nationally.
• See handout for list of NAACLS accredited Histotechnology programs. Link to NSH
Histotechnology program affiliate page with contacts
http://www.nsh.org/content/schools

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

• The best, most concise places to see listings of available training programs
and schools is the NSH or NAACLS listings at.
• NSH program list : http://www.nsh.org/content/schools
• NAACLS approved program search page:
http://www.naacls.org/search/programs.asp
• Both websites list programs by location, instructional delivery
methods, and contacts.


Scholarships
• Example: Siemens and ASCP Award Over 100
Scholarships to Medical Laboratory Students
in 2012
http://finance.boston.com/boston/news/read
?GUID=20884103
• I have a list of other scholarships and awards
available in the handout.


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


What are the advantages of completing a
Qualification?
• Visible recognition of specific skills in a technical area with the Qualification initials
after the ASCP credentials
• Recognition by state licensure—the state of Florida recognizes those individuals
certified and qualified as HT(ASCP)QIHC toward meeting the specialist licensure
requirements for histology
• More job possibilities—career mobility throughout the country
• Professional growth—keeping up with state of the art technology
• Each qualification is a three-year credential that may be renewed by providing
documentation of continuing education activities in the appropriate discipline.
• Qualification will not, in itself, entitle the individual to membership in ASCP.
Individuals must be ASCP certified as a technician, technologist or specialist to be
eligible for ASCP membership.
• Eligibility, routes and experience requirements are listed in the handout.


Thanks!
• Thank you for allowing me to present this
information to you today!
• I hope that I have been able to supply some
useful information, and we can take some
time now to see if anyone has any questions
or comments.
• Note I have included a references page of
resources if you need more information in the
handout

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