Giving comps between practicum and certification - comprehensive examinations for medical technology students

Medical Laboratory Observer, Nov, 1989 by Wendy K. Kiehn, Kenneth T. Maehara

Giving comps between practicum and certification

This school's medical technology students take comprehensive examinations after their clinical training and before taking certification exams. The change has helped them in many ways.

Classroom study provides future practitioners of clinical laboratory science with an understanding of the theoretical knowledge that forms the basis of their chosen career. Hands-on experience that supplements classroom training gives university students actual practice in performing lab techniques, exposes them to a true clinical setting with sophisticated tests and equipment, helps them integrate knowledge acquired in class, and assists them in learning to organize and complete large volumes of work.

In the four-year integrated medical technology program at the University of Nevada at Reno (UNR), juniors and seniors who have chosen a concentration in lab work take lecture and laboratory courses covering all major areas of clinical laboratory science. They then spend an additional six months rotating through all sections of the laboratories at one or more affiliated hospitals.

No formal teaching other than on-site instruction is required during the clinical practicum. Some hospitals provide our students with lectures and seminars; others do not. Each laboratory teaching supervisor may decide whether to give written or practical exams. Students working hard at learning practical tasks often forget much of the theory they learned at the university.

The faculty of the UNR medical technology program suspected that students' level of theoretical knowledge was actually decreasing during the clinical practicum--a situation that became more evident as the time since their last formal lessons lengthened. A preliminary study to examine the issue showed that students who had taken a comprehensive examination before beginning the clinical practicum scored higher than those who had just completed the practicum. We recognized that this situation left students less well prepared for a national certification exam than they might have been before completing their clinical rotations.

Consequently, we decided to add a new requirement to our program: that each student pass a comprehensive exam at the end of his or her practicum. Being awarded a B.S. degree in medical technology now requires not only successful completion of the coursework and hospital rotations but also a passing grade on a written examination. * Our objectives. We instituted the comprehensive examination with the following goals in mind:

To encourage students to review their course materials as they rotate through the laboratory sections, thus enhancing their ability to correlate theoretical with practical knowledge;

To improve student performance during the clinical practicum, with the expectation that studying related content would help them function better in the laboratory; and

To improve student performance on national certifying examinations by indicating areas of weakness that require additional study.

In preparing the examination, we were concerned that students would feel a tremendous amount of pressure to learn or relearn a great deal of material in order to pass. To alleviate some of the stress, we established the following ground rules.

All students must attain passing grades in four major content areas--chemistry, hematology, immunology/immunohematology, and microbiology--and in two minor areas, urinalysis and laboratory calculations. The passing level is set at 60 per cent, lower than the 70 per cent expected of students taking major clinical laboratory science courses at the university. A student who fails any section of the exam is given two more chances to retake the section or sections failed. A third failure in any of the six sections would earn an incomplete grade in the clinical practicum. The student would not receive a degree at that time, but would be urged to do additional work in the subject failed. The student would be permitted to take the test section again only after following a course of review designed specifically for him or her. If the student never passed that section, he or she would not graduate. Fortunately, we have never had to enforce this last contingency. In the 11 years since the comprehensive exam was instituted, not one of the 106 students who have taken it has failed any section more than twice or has had to delay being allowed to sit for a national certifying exam. * Evaluating the program. The goals for which success has been most difficult to evaluate are encouraging students to review course materials in order to better correlate theory with practice and improving student performance in the clinical laboratory. One indication that these goals are being met is the frequent observation by students' clinical supervisors that their preparation and knowledge have improved noticeably.

Performance on the national certification exam is easier to measure. We did so after the program had been in operation for eight years, comparing test scores of the 86 students who had taken a certification exam before we required the comprehensives with scores of the 73 students who had been required to take the comps first. The proportion of UNR students who passed the national certification exam on the first try increased by 11.6 per cent (Table I). Although changes in instructors and curriculum had occurred, the faculty considered the comprehensive exam a major factor accounting for the improved performance.