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National Educator Forum on Simulation and Clinical Placements. Photographer: Cathy Bouwers.

Building consensus to tackle the really big issues

By Christine Nielsen

As an association executive, think of all the “little” things that land on your plate in a given day, like dealing with a member complaint, a governance issue or HR challenges. Then layer on the burning issues of the day, like trying to foster the engagement of your younger members while your baby boomers are retiring in droves, getting delegates out to your events and ensuring you’re providing compelling value for your membership. Tired yet?

These are challenging times for associations and so we often find ourselves focused on the here and now. It’s hard to carve out time to stick your head up and look down the road ahead a year, or five years from now, let alone try to address the issues of the day; we’ve got plenty of those, thank you very much. But as a CEO that IS the job. We have to balance meeting (and hopefully exceeding) the needs of our members today with ensuring we’re making decisions that safeguard our long-term viability. So, occasionally, you have to look down that road a little further. When you do, you may see hazards ahead.

Founded in 1937, the Canadian Society for Medical Laboratory Science (CSMLS) is a member-based association for medical laboratory professionals. We are the scientists that inform your doctor what’s really going on and are critical to the health-care system. As a patient, you need us even if you rarely ever see us. The fact that our numbers are declining is worrisome for health care and especially for an association that relies on dues revenue to operate. You see, that’s the hazard in the road ahead for us.

In 2010, the Canadian Institute for Health Information (CIHI) announced that approximately half of all medical laboratory technologists (our largest member group) would be eligible to retire within 10 years. At the same time, research indicates that the number and complexity of laboratory tests are increasing. Ontario had projected a 1.8 per cent per year increase in lab tests between 2005 and 2010. However, an actual increase of almost four per cent per year was experienced. The harsh reality is that we have a shortage and it’s only going to get worse.

The supply of new professionals is dictated by the educational institutions and their class sizes. We knew we weren’t graduating enough new professionals to meet the labour market needs. Not even close.

Our forecasts demonstrated that Canada requires 992 newly CSMLS-certified MLT graduates per year. The country has only 59 per cent of the graduates required; meaning approximately 400 new MLT student seats must be created immediately to equally offset retirements. This represents the largest increase required by the profession in known history.

The problem is relatively clear and on the surface, the solution seems clear too: increase enrollments. However, obtaining new student seats is complex and can be very political. In addition, all medical laboratory technology students must undertake a clinical placement (internship) as part of their educational program. Programs cannot increase spots without corresponding clinical placements, making this a bottleneck in the system. So we would need to foster greater adoption of simulation-based training to decrease our reliance on those scarce clinical placements.

CSMLS has no direct authority to increase academic seats for any program in Canada. Therefore, it was necessary to have multilevel engagement, opinions, expertise and buy-in from stakeholders who work with students and can implement change at the frontline and through policy.

National Educator Forum on Simulation and Clinical Placements. Photographer: Cathy Bouwers.

To be successful, we would need to build consensus with clinical laboratories, build consensus with academic programs, and change behaviour in both settings. Here’s what we did:

  • An environmental scan was conducted of the MLT academic program’s clinical placement and simulation models.
  • CSMLS hosted a national forum for educators in our profession to discuss the situation and potential solutions.
  • CSMLS created the Research Network, which brought together medical laboratory science programs from across Canada to create simulation and clinical placement research, increase the quality of program curricula through evidence-based information and support employers to increase student placement capacity.
  • The board of directors created a position statement, affirming that clinical hours could be reduced and new education models were required.
  • The initiative was discussed at the annual general meeting and a member open forum.
  • CSMLS hosted a national employer forum, presenting the change evidence collected to date and further building consensus.
  • CSMLS created a letter of commitment that clinical laboratories could sign and indicate they were willing to investigate the potential for new or more students in their lab, which is important for educators seeking more spaces for clinical placements.
  • Grants were created to support enhancing simulation-based learning in the academic programs.

The response to the initiatives was great. Participation at the various forums and events exceeded our expectations. We definitely felt we achieved our goal of building a shared understanding of the challenge as well as potential solutions. The background research and outcomes from the forums and Research Network (still in formation four years later) provided an evidence base for educators to use to advocate for change at their institutions. Several major employers from various regions of Canada signed the letters of commitment and multiple educational institutions have announced they will expand their programming to increase graduates.

Change is happening, slowly. I believe it was the collaborative approach that gave us the traction to get moving. Further collaboration and stakeholder involvement is needed in order keep up the momentum and achieve our ultimate goal — more graduates annually. That hazard in the road ahead is still there. At least now we are actively addressing it. Maybe more importantly, we are rallying a significant portion of our professional community in a concerted effort to solve the problem. What better engagement could there be? While we continue to look at addressing the issues of the day — member recruitment, retention, etc. — we are also showing leadership by tackling the big concerns facing the profession. That’s important for associations. So no matter how pressing the here and now feels, remember to keep your head up and cast your eyes down that road. After all, doing something is better than doing nothing because doing nothing is a great way to become irrelevant. 

Images owned by CSMLS.

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