Continuing Professional Development Training Needs of Medical laboratory Personnel in Saudi Arabia

Continuing Professional Development Training Needs of Medical laboratory Personnel in Saudi Arabia

Continuing ProfessionalDevelopment Training Needs of Medical laboratory Personnel in SaudiArabia

A study Towards Developingan Educational Program and Improve Performance in Laboratories andPresentation Methodologies in Saudi Arabia: ADissertation

Abstract

This study looked at the continuing professional development trainingneeds of medical laboratory personnel in Saudi Arabia. The mainaspects of a continued development program were Quality Assurance inSaudi Arabia’s pathology laboratories and development of a qualityassurance program to help the practitioners and professional. Acomprehensive literature review established that scholars have givenlittle attention to developing customized training programs to foradoption in particular areas. Regardless, the need for thedevelopment of quality assurance content in continued developmentprograms is resounding. The study adopts the Donabedian model, whichis a linear framework of structure, process, and outcome, designedfor identifying impacts process and process impacts.

The researcher used secondary sources to create a platform forfurther research. For primary data, the researcher used aclosed-ended questionnaire to gather the views of stakeholders in theSaudi’s educational sector as well as the pathology sector. Theresearch variables were the design of quality assurance contentcourse, quality assurance project and pathology (medical) laboratorytechnician’s roles and experience. Additionally, the study deployedan open-ended questionnaire as a primary data collection method forqualitative data. The data collected from the open-endedquestionnaire included demographics, worl experience, ranking oftraining needs and level of agreement to the design of qualityassurance project. The study used qualitative and quantitative datatechniques for collecting information and applied three statisticaltests to analyze the data. The data analysis entailed application ofdescriptive statistics, reliability rests and scaling at 95%confidence interval.

From the results, the study established that as for the design ofquality assurance content, the most important aspect is thedevelopment of a result-oriented approach to learning, which islearning-centered. As for the design of quality assurance project,the most important factor was offering training that prioritizedavailability if personnel centers to provide an opportunity forgrowth and remedial work. Thirdly, the greatest element of pathologylaboratory technicians is offering an opportunity for advancement inclinical practice.

The research showed that the quality assurance content had an indexof 0.987, quality assurance project had 0.982 and role and experienceof pathology lab technician was 0.993. In terms of reliability, rolesand experience of pathology lab technician is the most reliable,followed by quality assurance content and finally the qualityassurance project. The Cronbach’s values are considerably higherthan 0, signifying reliability of the training across the threecategories. On the other hand, the scale tests at 95% confidenceintervals, reflects the significance of the training since the meansare higher than 2.5 or 50% of the scale and provide the means fromwhere the researcher based priority.

The study proposes suggestions that are of significance in thecreation of a Continuous Professional Development program as well asthe development of a Quality Assurance content and Quality AssuranceProject for Saudi Arabia’s laboratories. Quality Assurance contentensures that content provided by an organization meets quantifiedrequirements before publication through a systematic procedure.

Based on the means provided in the findings, the paper concludes themost important training need is the development of a result-orientedapproach to learning that is learning-centered and is crucial ineducating the pathologists. The learning-centered approach is thenfollowed by evidence-based laboratory medicine and safety. Insummary, quality assurance content is the most important part of CPDaligned to the demands of a pathologist. Additionally, CPD is animperative component in the development of pathologists thus, thedevelopment of a systematic CPD.

Table of Contents

Abstract 2

CHAPTER 1: INTRODUCTION 10

1.1. Introduction 10

1.2 Background of the problem 10

1.3 Statement of the problem 14

1.4 Aims and objectives of the study 17

1.5 Methodological framework 18

1.6 Significance of the study 21

1.7 Summary 22

CHAPTER 2: LITERATURE REVIEW 24

2.1 Introduction 24

2.2 Quality control 25

2.2.1 Quality control in pathology 25

2.2.2 Laboratory tests and benefits of quality systems training 26

2.2.3 Quality issues in pathological laboratory tests 28

2.2.4 Statistics concepts of quality in medical laboratories 29

2.2.5 International quality control standard concepts 30

2.2.6 The need to adopt quality control standards in the world 32

2.2.7 State of QA and regulations in different countries 33

2.3 Education and training 35

2.3.1 Elements of good training in pathology 35

2.3.2 Current and urgent issues in training for pathology laboratories 36

2.3.3 Methodologies and training modalities in pathology laboratories 37

2.3.4 Training of clinical scientists – requirements for quality and competence 38

2.3.5 A focus Medical Laboratory Technologists 39

2.4 Continuing professional training 40

2.4.1 Role of continuing professional development 40

2.4.2 Role of continuing professional development 41

2.4.3 Continuing professional development for medical practitioners and pathologists 42

2.4.4 Residency training for pathology 43

2.5 Challenges and prospects in continuing professional development 44

2.6 Summary 45

CHAPTER 3: METHODOLOGY 46

3.1 Secondary data 46

3.2 Qualitative and quantitative methods in research 47

3.3 Primary data 48

3.3.1 Pros and cons of closed-ended questionnaires as quantitative research tools 49

3.4 Research population 50

3.5 Inclusion and exclusion criteria 50

3.6 Reliability and validity 50

3.7 Data analysis 51

3.8 Limitations 52

3.9 General considerations 52

3.10 Ethical considerations 53

3.11 Summary 53

CHAPTER 4: DATA ANALYSIS 55

4.1 Introduction 55

4.2 Data analysis 55

4.3 Descriptive statistics 56

4.4 Reliability tests 57

4.4.1 Cronbach’s alpha 58

4.5 One sample test 60

4.6 Descriptive analysis considerations 61

4.7 Summary 61

CHAPTER 5: RESULTS 63

5.1 Introduction 63

5.2 Quality Assurance Content 63

5.3 Quality Assurance Project 77

5.4 Pathology Technician, role, and experience 86

5.5 Results of open-ended questions 95

5.6 Reliability Statistics 97

5.7 One sample test at 95% confidence level results 100

Means at 95% Confidence Level: Quality Assurance Content 100

One-Sample Test 100

5.8 Summary 109

CHAPTER 6: DISCUSSION 111

6.1 Introduction 111

6.2 Quality Assurance Content of the Course 111

6.2.1 Evidence-based laboratory medicine 111

6.2.2 Result oriented approach in learning 113

6.2.3 Basic knowledge for exploring QA 114

6.2.4 Laboratory safety 114

6.2.5 Parameters accuracy and precision concepts 115

6.2.6 Evaluation and selection of analytical methods and materials 117

6.2.7 Reference ranges 118

6.2.8 Quality achievement techniques 119

6.2.9 Data management, report writing and presentation skills 120

6.2.10 Point-of-Care Testing 120

6.2.11 Statistics in laboratory medicine 121

6.2.12 Specimen management 122

6.2.13 Laboratory and disease surveillance 123

6.2.14 Equipment maintenance 123

6.2.15 Relationship between accuracy and precision concepts and their role in QA 124

6.3 Quality Assurance Project 126

6.3.1 Quality Assurance Project to learners and educators 126

6.3.2 Provision of knowledge on outcome 127

6.3.3 Knowledge on results evaluation and motivation 128

6.3.4 Quality assurance project offers learners self-pacing 129

6.3.5 Repetition of remedial works according to individual need 130

6.3.6 Quality assurance project and special interests in development 130

6.3.7 Fostering of development of self-discipline in study habits 131

6.3.8 Availability of personnel in resource centers for assistance 132

6.3.9 Job satisfaction and improved results 134

6.3.10 Individual attention provision 134

6.4 Pathology Technician, Role, and Experience 135

6.4.1 Critical that Pathology Laboratory Technician communicate effectively with clinicians 136

6.4.2 Technicians must have good judgment 137

6.4.3 Technicians must continually seek out new knowledge and adopt new practices 138

6.4.4 Technician must manage the clinician’s expectations and ensure that they are realistic 139

6.4.5 Clinical experiences in pathology laboratories are primarily working rather than learning experiences 140

6.4.6 Pathology Laboratory Technician program was a positive learning duplicated 141

6.4.7 Pathology Laboratory Technician program was a positive learning experience 142

6.4.8 Working as a Pathology Laboratory Technician provides a sense of accomplishment 143

6.4.9 There are excellent opportunities for advancement in the Medical Laboratory Technician 144

6.4.10 There are good job openings for Pathology Laboratory Technician 145

6.5 Thematic analysis of open-ended questions 146

6.6 Donabedian’s model 146

6.7 Summary 148

CHAPTER 7: CONCLUSION 154

7.1 Introduction 154

7.2 Concluding remarks on the research and recommendations 154

7.3 Summary 162

References 163

Appendices 179

Continuing Professional Development Training Needs of Medicallaboratory Personnel in Saudi Arabia

CHAPTER1: INTRODUCTION

For over one and half a century, the discipline of pathology hasundergone noteworthy changes in line with the evolving technology,human needs, treatment of emerging illnesses and many more factors.The medical research fraternity engrosses in numerous studies tohandle the professional needs as required satisfactorily. This paperis one of such studies, which through a didactic perspective,assesses the need to continue professional development training needsof medical laboratory personnel in Saudi Arabia. This chapterintroduces the scope of the study, the background of the problem,statement of the problem, aims and objectives, theoretical frameworkand significance of the study.

1.2Background of the problem

Laboratory work is one of the core areas of clinical practice, whichis critical in establishing the nature of the ailments that thepatients suffer. As such, the pathologists play a crucial role indefining how to do the work. To be sufficiently depended upon, thepathologists’ work has to be of the highest quality possible,besides being of high standards as required by the profession (Quirkeet al., 2011). To carry out their work efficiently, pathologistsought to have enough knowledge about histology laboratory (HL). HL isone of the most critical components of pathology, which is part ofthe process of making a histopathologic diagnosis. Some of the tasksthat are involved in lab pathology include preparation of blocks byhistotechs, who include a histotechnician (HT) or ahistotechnologists (HTL), processing of information for diagnosis andpresentation of the work for analysis and decision-making.

Giventhe above description, pathological services are some of the mostdemanding in the health facilities’ settings (Gargis et al., 2012).Pathology services include bacteriology, chemical pathology andhematology, all which the specialists have to handle carefully, tocome up with meaningful results. While chemical pathology andhematology have undergone substantial changes over the past fewdecades, facilitated by the introduction of technology intooperations, bacteriology has not experienced radical changes(McPherson &amp Pincus, 2011). Bacteriology, in practice, has madeconsiderable progress in terms of standardization of the processesand introduction of quality controls. However, there is no extensiveintroduction of automation in the practice so far.

Partof the developments in pathology includes evidence-based process andcost-effective laboratory testing, which includes modifiedinterventions that are products of methodological research. Theevidence is useful when it comes to some elements. These include theappropriateness of test selection, sequencing, formulation of designtechnology, acquisition decisions and other population-basedinterventions (Khan et al., 2011 and McPherson &amp Pincus, 2011).Whenever the experts use evidence-based medicine in clinical practiceguidelines, there has to be the use of laboratory information forsupport. Additionally, the information from the laboratories guidesthat patients and practitioners in the decision-making process.Moreover, laboratory testing is an important indicator for theassessment of quality care, especially for some national healthconcerns, such as chronic ailments. Besides improving the quality ofservice offered by the clinics, laboratory data is important insupporting value-based purchasing. Evidence-based medicine attractsgreater support from the medical market and helps the professionalsto regulate the use of tests in clinical practice.

Thetotal testing process defines the prenalysis, analysis andpostanalysis phases of laboratory testing. Additionally, it is thebasis for designing and implementing clinical interventions,restrictions and limits, all which aim to reduce the likeliness oferrors. Despite there being some improvements in these processes overthe last few years, there still are some critical sources of errorthat still exist. The percentage of errors among the prenalyitc,analyutic and postanalytic phases vary (Khan et al., 2011). Whilesome of the errors in the preanalytic phase do not progress into thelatter phases, a good number of them influence the occurrence ofothers in the latter stages.

Poorcommunication, insufficient knowledge of tests and interpretation ofthe results are some of the key issues that reduce the quality ofpathological work. In the clinics, some of the problems are commonerrors associated with anatomy, mishandling of the specimen, markingmistakes and general specimen contamination (Khan et al., 2011).Pathological experts have introduced some interventions to helpreduce the occurrence of mistakes in the pathology laboratories. Someof the interventions include quality control (QC), testreproducibility standards, and performance evaluation. Additionally,there are other technical interventions, such as the QualityManagement Systems (QMS), that experts espouse in ISO 9001:2000 andISO 15198:2003 standards. However, when matched against globalstandards, Saudi Arabia still lags behind in terms of test services,quality control, and quality assurance. This study looks to establishand bridge this technical gap in pathological practice.

Whileimproving the quality of laboratory services in pathology, somefacilities in Saudi Arabia have devised localized solutions. Forinstance, the Al-Riyadh medical services center has a qualityimprovement program, designed to improve the Laboratory QualityManagement System (LQMS). Through a collaborative effort between theQMS Model assist and the department of pathology at the facility, thepractitioners have sounded the need to comply with the accreditationof the related organizations fully, such as the College of AmericanPathologists (CAP), Joint Commission on International Accreditation(KCIA) and the American Association of Blood Banks (AABB). KingAbdul-Aziz Medical City’s QMX model in the pathology departmentdesign follows the recommendations of the Clinical LaboratoryStandards Institute (CLSI) (Ministry of National Guard-HealthAffairs, 2015). According to the recommendations, the practitionershave to adhere to the identification of customer needs and marketstandards as they conduct their business. Most of the healthfacilities in Saudi Arabia look to not only meet the standardrequirements but also to surpass them.

TheQMS of pathological laboratories describes some elements of the pathof workflow. All these relate to the three phases of laboratorypathology, which are the pre-analytical, analytical andpost-analytical processes. One of the most significant element isdocumentation. Each health facility ought to have a documentation andrecord management system whereby information is stored and retrievedwithout problems. A proper document structure is user-friendly and isin line with organizational policies. Secondly, the pathology labattendees have to follow procedures to ensure that the laboratoryequipment in good service and that they meet any accreditationrequirements. These have to be in line with both industry-recommendedand internally structured standards.

Processcontrol is another critical factor in quality pathological serviceprovision. Each facility’s department of pathology has to work withpolicies and processes that support an organized workflow. For themto ensure a smooth transition to work, the management has tocommunicate all process changes to the practitioners promptly. Thisstep highlights the significance of communication links in laboratorypractice. These communication details include the changes tomethodologies, in-house established methods and biological referencesaccording to manufacturers (Khan et al., 2011). At the same time,quality pathology is due to the application of approved methodologiesin handling patient samples in the laboratories, withoutdiscrimination based on the type of examination that is required.

Equallyimportant, it is up to the management of the health facilities toensure that the pathological procedures follow laboratory health andsafety recommendations. There are some areas that the managementneeds to look at from time-to-time, while at the same time, makingnecessary improvements to uphold quality assurance. One of theseareas is emergency preparedness. Given the volatile nature of somelaboratory specimens, a backup plan helps the practitioners toprevent damage to the processes. Additionally, the laboratorymanagement has to factor patient safety when setting up andconducting pathological tests.

1.3Statement of the problem

InSaudi Arabia, there are some persistent problems in the pathologylaboratories, which continue to affect the quality of servicenegatively Raddaoui (2011). Given this, most of the hospitals chooseto send their staff and tests abroad for quality pathology.Additionally, the Saudi culture is one of the obstacles to realizinga sufficient professional workforce to serve the region’s needs, asthe women do not practice at night. The government has also notsufficiently provided enough technical support, as some localhospitals lack the necessary equipment to conduct fruitful laboratorywork.

SaudiArabia still suffers the challenge of inadequate modern automation inpathology laboratories. According to the global standards, healthcareinstitutions ought to have standardized bacteriology laboratoriesthat have a low level of non-discretionary testing (Park et al.,2013). By doing this, the hospitals will be in a position to processspecimen in a timely and standardized manner. As mentioned earlier,a good number of health facilities in Saudi Arabia lack this, meaningthat they have to hinge on foreign states for some pathologicalservices. Moreover, there are factors that limit the quality ofspecimens for use in the health facilities, such as age, state of thespecimen and insufficient clinical detail. These continue to affecthospitals operating in Saudi Arabia. Additionally, it is stillunclear the exact percentage of laboratories that honor preliminarytesting requirements while screening, which is a requirement for fullculture.

In addition to the challenges mentioned above, others emerge asproducts of global trends. These affect the standardization ofpathological services in Saudi Arabia (Mohammed &amp Kharoshah,2014). These trend-necessitated challenges include increasing demandfor pathology services and complying with statutory requirements.Given the increased number of biopsies, the pathologists have to dealwith an expanding client base as they work extra hard to produceresults for diagnosis ailments. As such, the pathologists have toimprove the turnaround time, which is one of the key elements inclinical management. Global health standards present a challenge forpractitioners to give results, which are quality assured, andproduced within laid-out procedures. This challenge is similar tothat of sub-specialization, which requires that pathologists followmore strict outlines while handling the specimen. Additionally, inpathological practice, the explosion of rapidly dynamic techniques isa challenge that affects even some of the most relied-upon facilitiesin Saudi Arabia (Mohammed &amp Kharoshah, 2014). The dynamism of thetechniques is due to the development of high-tech informationtechnology systems and digital operations in the health facilities.

Giventhe status of clinical pathology in Saudi Arabia, specialists havecome up with ways of solving the challenges at the grass-root level.Some of the most serious problems in pathology involve moleculardiagnostics and transfer of digital images from one department toanother. A popular suggestion is that that both an anatomic andclinical pathologists have to eliminate all barriers that separatethem from other technicians. Apparently, most of the Saudi Arabianhealth facilities have not been able to do this. As of present,technical challenges in laboratory procedures, such as moleculardiagnosis, continue to distort the border between the pathologistsand the rest of practitioners in the facilities. Despite the globaldevelopments in molecular and genetic testing, pathological expertsin Saudi Arabia are yet to enjoy the same (El Saghir et al., 2011).This automatically implies that patient care is limited and that theprospects of improvement of pathological services in the regionremain dim.

Asregards to the issue of training pathological practitioners, manyparts of Saudi Arabia lack provision of laboratory services at thecommon level (Sebai, 2014). Most of the infrastructure used to trainthe students in some training facilities is outdated. This setbackmeans that only the high-level hospitals and other privateinstitutions have the ability to provide reasonable laboratoryservices to the clients. One of the most commonly used ways inperformance assessment is customer satisfaction. The region’snational health sector has not adequately provided for theimplementation of satisfaction assessment, and there is a generallack of quality control programs to ensure the accuracy of results.Moreover, a large number of the facilities do not have a constantsupply of latest reagents and kits to help the pathologists toconduct sufficient laboratory examinations. Most of these reagentsand kits come from abroad.

SaudiArabia needs to secure adequate extern sites to help staff theregion’s health facilities. This engagement is in the realizationof the fact that outsourcing of experts is not only expensive butalso detrimental to efforts to building the national health sector.Due to this necessity, the health sector has the responsibility ofspearheading academic and clinical support programs, aimed atproducing highly competent and dependable pathologist. Scholars haveidentified the need to augment resources and workforce to facilitatestandardized pathological services (Bogusz, 2011). According to therecommendation of these scholars, addressing challenges facingclinical pathology need an all-inclusive stakeholder participationin, but not limited to, provision of laboratory equipment andestablishment of a continuous professional development training ofmedical laboratory personnel.

Thefuture of pathology is not easily predictable, because of changes dueto some theoretical and practical aspects, either local or global.However, through research and abstractive studies, scholars predictthat the stakeholders in the health sector have the capacity tocontrol the dynamics and bring balance to practice. A criticalevaluation of the pathological standards in Saudi Arabia is one ofthe ways that the stakeholders can solve the challenges and create afoundation for better quality services. By eliminating errors andinconsistencies in pathological practices, disease diagnosis, andsubsequent treatment is improved.

1.4Aims and objectives of the study

The aim of the study was to develop an educational program andimprove performance in laboratories and presentation methodologiesthat would improve skills for medical technicians working in thepathology laboratories in Saudi Arabia.

Inline with the aim, the following were the objectives for the study:-

  1. To discuss quality control assurance in different departments in pathology laboratories from an educational perspective

  2. To learn the quality control behind all the instruments used in the histology laboratories

  3. To develop a special program in quality assurance for staff medical technologists who work in the laboratories

  4. To design presentation methodology for the presentation of special courses designed to improve the mastery of quality assurance in the pathology laboratories

  5. To test the quality of the developed course program and the presentation methodology by evaluating laboratory performance against baseline values, and to process the results

  6. To recommend a course plan and presentation methodology for implementation by the universities and technicians training to improve performance of clinical pathology laboratories in Saudi Arabia

  7. To recommend a specific role to improve quality control in clinical pathology laboratories in Saudi Arabia

1.5Methodological framework

Thestudy applied the Donabedian model, also known as the MedicalOutcomes Study Model (MOS Model). This model is a linear framework ofstructure, process, and outcome, designed for identifying impactsprocess and process impacts (Rais, 2013). One of the main features ofthe structure is the medical data and information handling, andfacility policies for the maintenance of the records. Othersupportive components of the model are medical record access, such asclient satisfaction with the facility’s data handling mechanismsand practitioner attitude in serving the clients. Below is adiagrammatic presentation of the model:-

Figure 1: Donabedian`s model used in the study.

According to Rais (2013), the model is flexible enough to for use insome situations. The model describes an intuitive relationshipbetween three main related concepts. The first process is thestructures of health. These are the physical and organizationalaspects of a healthcare setting. In is composed of the people,equipment, financial and operational processes that support medicalhealth services. The second concept is the processes of patient care.This aspect is in the middle of the model, largely due to thedependence on resources and mechanisms involved in medical careactivities. Experts define the processes are entities that areperformed to improve the health of the patients, in line with the aimof promoting recovery and achieving patient satisfaction. The finalaspect is the outcome of the health services.

Whileapplying this model to the study, the researcher noted that thequality clinical outcomes are products of the level of medicalprocedures and underlying practitioner characteristics. As such, thestudy focused on the relationship between the controlling factors ofthe pathology practitioners and the effects on outcomes. However, theDonabedian model does not account for the patient, social and otherexternal factors that are not within the healthcare system.Regardless, specialists complement the framework for having theability to influence the coordination of some variables thatcollectively determine the outcome of medical processes.Additionally, the Donabedian model helps medical researchers toidentify failures in the system methodically, besides creating achance to seal in gaps in familiarity, while at the same timefocusing on care coordination. When the experts optimize all aspectsof care adequately, the model gives a chance for them to coordinatemedical procedures for the benefit of all stakeholders, including thepractitioners and the patients.

1.6Significance of the study

By conducting research to develop an educational program towardsquality and performance improvement, the researcher looked to helppathology students and practitioners to make effective clinicaldecisions. The research looked to ensure that the pathologytechnologists, physicians, nurses, and other healthcare providershave access to with procedures and methodologies that aided in theprevention, diagnosis, treatment and management of diseases. Due toshortcomings in quality and continued escalation in laboratoryprocedures costs, healthcare assessment in needed for the purpose ofmaking cognizant verdicts, and redesigning delivery and incentives asneeded. Standardized Pathology laboratory tests are key incontrolling the spread of disease and monitoring breakouts, besidesimproving quality assurance (Bogusz, 2011). Additionally, byrecommendations of globally accredited institutions and councils, itis mandatory for laboratory practices to meet internationalrequirements to achieve desirable outcomes in healthcare.

Developing the educational program towards the improvement ofperformance in laboratories and presentation methodologies will helpSaudi Arabia’s health sector to achieve some objectives. First, thepractitioners will be in a position to improve the quality ofhealthcare through the application of concepts as proposed in thepaper. Secondly, a culture of patient safety and minimal risk ofmedical errors help to ensure that there will be the promotion ofquality service in the region. Additionally, the study will help toimpart optimum healthcare organization to help the practitionersbetter manage the laboratory data and make maximum use of theresources. Finally, there will be increased accountability to thepatients and stakeholders in the region. Consequently, the study,through findings and recommendations, will develop an effectiveeducational program and improve performance in the laboratories, andhelp the practitioners in screening for risk factors, making accurateand timely diagnosis, resolve of disease severity and possibility ofrecovery, selection of monitoring treatment, and evaluation ofpotentially adverse outcomes.

1.7Summary

This chapter introduced the study by defining its scope, intent andobjectivity. While describing the role that pathologists play inmedicine, the chapter identified laboratory work as one of the coreareas of clinical practice. Specialists in the clinical laboratoriesare expected to deliver high quality results from their tests, asthese are used as the foundations of diagnosing and recommendingtreatment for patients. To assure reliable and valid test conducting,the chapter identified the need of improved Quality Assurance, whichis the core measure to preventing mistakes and defects in laboratorywork. Based on this fact, the paper sets upon improving QualityAssurance in Saudi Arabia’s laboratories through recommending aContinued Professional Development program, and the development of aQuality Assurance content for Saudi Arabia’s pathologists. The coreobjective of the study will be to develop a training program toimprove performance in laboratories and presentation methodologiesthat would improve skills for medical technicians working in thepathology laboratories in Saudi Arabia. The following chapterpresents literature that was reviewed in preparation of the research.

CHAPTER2: LITERATURE REVIEW2.1Introduction

This chapter presents findings from the literature reviewed in thebuild-up to obtaining facts and realities regarding the topic. Whileprioritizing usage of peer-reviewed articles, the researcher valuedthe relevance of the information contained in the documents to thisstudy. Given this guideline, the researcher selected articles from apool of scholarly works in different professional journals, includingthose in institutionalized and independent libraries. Additionally,empirical information was of significance in the fact-findingprocess, given the fact that the study is a theoretical and apractical one. In this regards, the body of literature will analyzeresearch studies based on the below facets.

  1. Quality control

  • Quality control pathology

  • Laboratory tests and benefits of quality systems training

  • Quality issues in pathological laboratory tests

  • Statistics concepts of quality in medical laboratories

  • International quality control standards in the world

  • The need to adopt quality control standards

  1. Education and training:

  • Elements of good training in pathology

  • Current and urgent issues in training for pathology laboratories

  • Methodologies and training modalities in pathology laboratories

  • Training of clinical scientists – requirements for quality and competence

  • A focus on medical laboratory technologists (quality management systems, case studies, competency assessment- Role And Experience)

  1. Continuing professional training

  • Role of continuing professional development

  • Continuing professional development for medical practitioners and pathologists

  • Residency training for pathology

  1. Challenges and prospects in continuing professional development

2.2Quality control2.2.1Quality control in pathology

Mitra (2012) defines Quality Control (QC) as a system for verifyingand maintaining a desired level of quality in a given process. Theprocess of QC starts from the moment that a specialist obtains aspecimen from a patient to the moment that they deliver the resultsof the test to a physician. Given this provision, pathologists in thetesting laboratories have to ensure that they uphold systematicmonitoring of quality control results, as an effort to ensure thatall systems and elements are functioning appropriately. Mitra (2012)adds that QC is a coordinated system that entails the detection,control and prevention of the occurrence of errors in thelaboratories. Through this process, the practitioners in the testinglaboratories deliver appropriate results that are useful indiagnosing and treating the patients in the health facilities. Whileprofessional conduct is one of the main determiners of assurance ofQC in the pathology laboratories, personal effort and discipline arealso significant factors.

Some scholars fully support the idea of transforming clinicalpathology services. Gargis et al. (2012) say that the stakeholders,specifically medical experts and pathology practitioners, need tocontribute to the knowledge and expertise to fast track the activity.This effort would help to identify the areas of weaknesses and bringtogether empirical evidence for refining weak links in the fragilepathology laboratory environment. According to Van Krieken et al.(2013), one of the ways of achieving positive development in clinicalpathology QA is surveying the governance structures andorganizational culture. Such investigations would help the experts tocreate a conclusive error report that creates the foundation fordeveloping interventions to improve QA. While at it, Adesina et al.(2013) says that experts cannot ignore the substantial impact thattraining pathology practitioners have on improving QA. He adds thatmanufacturers of the pathology laboratory equipment can work togetherwith trainers to help the practitioners achieve optimum results whenworking with latest reagents and kits, which is part of QC efforts.

Barnes (2014) outlines the need to review the current QC inpathology. According to him, the current pathology QA lacks somecritical factors that determine the overall outcome of laboratoryworks. Some of the leading factors are scrutiny of the processes,effective mechanisms for rewarding and sanctioning, the integrity ofthe personnel and oversight authorities. Adesina et al. (2013) arguethat it is almost impossible to assure the patients and otherpractitioners of quality service without refining these particularaspects of clinical pathology. To add to this, the author criticizesthe broad assurance framework for lacking key assurance indicators,which are necessary for the achievement of evidence quality andsafety of the practice. In conclusion, he is of the opinion thatindeed the pathology discipline has to respond to change and beflexible enough to accommodate requirements that satisfyinternational standards.

2.2.2Laboratory tests and benefits of quality systems training

Tembuyser &amp Dequeker (2015) look at the advantage of having a QAqualified laboratory, as a benefit of quality systems training.According to them, laboratory accreditation gives the facility aformal recognition of competence. This measure consequently helps themanagement and the hospital or research facility in acquiring clientswho identify them for their reliable testing and diagnostics.According to Amukele et al. (2012), maintaining such recognitionneeds a facility to re-evaluate its laboratories regularly, and tokeep a highly competent team of research pathologists. On the otherhand, Tembuyser &amp Dequeker (2015) say that quality systemstraining helps a laboratory to receive accreditation, which is highlyvalued by local and international stakeholders in the field ofpathology. Amukele et al. (2012) observed that big clients, such asinternational organizations and government-affiliated agencies, seekthe services of an accredited laboratory whenever contracting.Tembuyser &amp Dequeker (2015) add that unlike certification to ISO9001, quality systems training help to promote a laboratory’saccredited services to a large base of potential customers.

Fulga(2013) emphasizes that quality systems training allow laboratorymanagement to ascertain whether they are performing their work asneeded. Additionally, it helps them to evaluate the laboratories’adherence to the appropriate practice standards. This is done byproviding a benchmark for maintaining competence at all times.According to Cowie &amp Makkar (2013), a regular assessment,facilitated by quality systems training in laboratories, helps afacility to identify areas of improvement, and where necessary, givesguidelines for follow-up. Wadhwa et al. (2012) say that manycountries have one or more organizations that handle quality systemstraining and accreditation, which has helped them to have a uniformapproach to determining laboratory competence. Besides making itmandatory for laboratories to have quality systems trainingactivities, the accreditation organizations provides technical andmaterial support to help the facilities to uphold internationalstandards in clinical pathology (Ganju &amp Kanga, 2014).

Elsiddig et al. (2014) describe that standard operating procedures(SOPs) are the most important documents in pathology laboratories. AnSOP describes the complete technique for performing tests, which thepathologists ought to adhere to with total strictness. Inmicrobiology and bacteriology alike, SOPs help the pathologists toproduce consistent and reproducible results, which are critical inlater stages of diagnosis and treatment. Elsiddig et al. (2014)provide a few guidelines to help the pathologists to adhere to theSOPs while working on the specimen. First, the experts have to reviewthe document on an annual basis, making corrections and updates wherenecessary. The pathologists also have to ensure that the document ispresent in all tests, and they have to refer to the documentswhenever starting a new procedure (Elsiddig et al., 2014). Some ofthe key topics on the SOPs are safety procedures for variousspecimens, abbreviated administrative structure diagram andinoculation procedures.

2.2.3Quality issues in pathological laboratory tests

Wilson(2014), in the capacity of managing director of the AmericanJournal of Clinical Pathology, looks at the issues in educationand training in pathology and laboratory medicine. According to him,the most fundamental challenge is defining education and training inthe clinical perspective. As thought by Ganju &amp Kanga (2014),experts often used the terms education and training interchangeably.Given this, Wilson (2014) says that the simplest way ofdifferentiating the two is that education imparts knowledge, whereastraining is the actual activity that helps the learners put intopractice the theories that they learn in education.

Thedefinition of education and training, therefore, sets the ground forexperts to assess quality issues in pathological laboratory tests.Green (2013), in a study to identify and eliminate sources of errorin anatomic pathology, says about 70% of pathology errors occur inthe analytic phase. He explains that most pathologists would beshocked to learn that the analytic phase is majorly responsible forsome test failures, which goes against the ‘gold standard’thinking in the profession. One of the problems linked to thisobservation is that the pathologists compound data in the analyticalstage, hence significantly reducing the integrity of the results.Given this, Green (2013) proposes the development of precise riskmanagement approaches in pathology. With insights from continuoustraining, the experts will be in a position to configure thearchitecture of quality management, and purposefully integrate it tocounter the key challenges in laboratory QA.

Hawkins(2012) identifies some local factors that affect the quality ofpathological laboratories in specific countries. For instance, somecountries lack national medical laboratory licensure requirements.One of the best examples is Canada, who are unlike the United States,which has federal laws to establish standard national standards thatall laboratories need to adhere to before being accredited. Accordingto Hawkins (2012), this issue narrows the understanding of quality inpathological tests, meaning that the practitioners are less likely toperform adequately, as far as quality is concerned.

2.2.4Statistics concepts of quality in medical laboratories

Lester et al. (2013) review emerging concepts of QA in clinicallaboratories. According to them, thecurrent shortage of pathologists and scientists in pathologylaboratories is due to recent pressures from the field. The driversof these pressures are emerging concepts of quality in medicallaboratories, which require skilled management and criticalsupervision of all pathological work in the laboratories. The keyelements of a QA system, as identified by Brabd et al. (2015), arethe quality manual, Standard Operating Procedures (SOPs), control ofnonconforming testing, corrective action and record keeping. Theseelements come together to define the modes of internal QC, which arecontrol material, random duplicate sampling and retesting.

To achieve the above, Lester et al. (2013) assert that laboratoryattendants ought to have a comprehensive knowledge of the keystatistical concepts applied in the laboratory. These concepts areaccuracy, precision, specificity and sensitivity. Accuracy is themeasure to which a certain process measures what it is supposed tomeasure. In laboratory application, a test method is accurate whenit, for instance, measures the actual concentration of a substance ina sample. On the other hand, precision is determined when aninstrument of process yields the same results when repeated undersame conditions (Lester et al., 2013). A small amount of randomvariation is a signature of precision.

Wafula et al. (2014) say that in laboratories, specificity andsensitivity are indicators of false negatives and false positives. Anefficient pathologist is in one who can determine any abnormalitiesin a certain process or its results. An example is a pathologist whocan make the extra effort to determine the likelihood of a clienthaving a certain disease, as shown by laboratory results. To make itclear, Wafula et al. (2014) describe specificity as the ability of acertain test to exclude accurately clients who do not a have acertain disease. On the other hand, specificity is the ability of acertain test to identify clients who have a certain disease.Statisticians express specificity and sensitivity in percentages.

2.2.5International quality control standard concepts

Thereare some standard accreditations for medical laboratories, designedby international organizations and through inter-governmentalcollaborations. While there are some standards that are compatiblewith international references, pathologists implement them with theaim of improving QA (Quirke et al., 2012). One of the earlieststandards drafts in the recent times was the UK standards forhealthcare, ISO 15189 (Long et al., 2013). This set of standards wascirculated to other countries, including the U.S and Canada, beforebeing reviewed by these and other countries to fit local andinternational standards. While configuring the requirements of thesets of QA standards, facilities apply QMS for purposes such ascertification and accreditation. Bodies that have the responsibilityof certifying the laboratories are concerned with auditinglaboratories’ QMS, before proposing recommendations andimplementations.

Gargis et al. (2012) identify a lineage of QA that focuses onrequirements for calibrations and testing in the medicallaboratories. Experts developed these standards by using guidelinesprovided by the ISO/IEC. They include the European standard EN45001:1989, ISO/IEC 17025:1999, ISO 15189 and most recently, ISO9001:2000 (Moodliar et al., 2013). International agencies andcontracted practitioners review these standards and make necessarychanges from time to time. According to Moodliar et al. (2013), therevision of the standards has the objective of achieving complianceunequivocally verifiable, besides aligning the practitioners withemerging ISO standards from time to time.

The Clinical Pathology Accreditation (KU) Ltd (CPA) has a set ofstandards, presented in eight major sections (CPA, 2010). These areorganization and QMS, personnel, the environment, equipment andresources, pre-examination process, examination process, postexamination stage and evaluation and QA. All these sections areunique, as they describe various aspects of laboratory QA. Thediagram below represents the eight sections of the CPA.

Figure 2: Laboratory process QA framework

2.2.6The need to adopt quality control standards in the world

Vieth et al. (2012) say that pathology is one of the disciplineswith the highest needs for QA. It is almost impractical to have anaccredited laboratory that is not reinforcing the application of QCstandards by its pathologists. Without these standards, Quirke et al.(2012) says that the rate of laboratory errors would dramaticallyincrease, meaning that its competence and dependability will be atquestion. Antoljak (2013) supports these arguments, saying that dataquality is dependent upon the accuracy, timeliness and consistency ofthe data collection processes, guided by quality control standards.Additionally, Antoljak (2013) asserts that the commercial success ofany given public laboratory is partly due to the compliance torecognized standards, such as the ISO 9001, which quality assurancebodies publish to provide foundation for achieving market andoperational success.

Whileacknowledging the complication of QA systems, Isse et al. (2012)assert that advances in automated technology provide increasingreliability in the field of clinical pathology. By following qualitycontrol standards, the pathologists can ensure accuracy and precisionof test results, which are vital for correct clinical diagnoses.Phelan (2014) adds that quality control standards are devised out ofknowledge accumulated from previous errors, hence providing aguideline for the pathologists to avoid similar mistakes.

Moreover, by following these standards, the pathologists canconfidently reduce operational costs related to erroneous practice.Arnaout et al. (2013) identify the costly nature of errors in theUnited States. In a laboratory test, a small bias error in testing acertain element may result in a big percentage of increase in thecost to diagnose and treat a patient. Given such observations, Arnoutet al. (2013) advises that quality assurance schemes help theclinicians to perform standard tests and generate accurate results.

2.2.7State of QA and regulations in different countries

The United Nations has put in place a number of regulations andstandards to guide QA in all countries. For instance, the Annex 12 ofthe World Health Organization (WHO) has a prequalification of qualitycontrol laboratories. In the technical report series publications,the world health-oversight body has a procedure for accessing theacceptability and principles for use in all countries (WHO, 2011).Leading world economies, such as the United States and England, cometogether to review the status of QA in their countries using therecommendations of the WHO (Dux, 2013). However, due to insufficientresources and time constraints in under-developed and developingcountries, there is lack of coordination between the WHO and thesecountries’ respective health departments in quality assessment andinspection.

Inthe developing countries, Amukele et al. (2012) say that the WHO incollaboration with their respective health departments has put inplace efforts to make medical consultations on the analyticaltechniques and quality assurance. This includes the provision ofreference books and statistical procedures that the pathologists andphysicians use to enhance their laboratories’ QA. Some of theconcepts and element of QA that other countries have adopted tracetheir origins back to the U.S. One of these are the Good LaboratoryPractices (GLP), which is organizational process and conditions underwhich laboratories set up training classes (McCarthy, Borget &ampMihaich, 2012 and Gargis et al., 2015). The GLP further describes theplanning, performance, monitoring, recording and reporting onlaboratory practices.

Atleast all leading countries in terms of laboratory QA have put inplace special training programs to develop their technician’sknowledge and skills further. For instance, in the U.S, Canada,Australia and other parts of Europe, training is an integral part oflaboratory certification process (Levine et al., 2012). This isapplicable to both local and regional practice. Some of theregulations are that all regional officers have to pass appropriatelaboratory certifications courses for either chemistry ormicrobiology. Additionally, all laboratory auditors ought to haveexperienced professionals who are qualified with at least abachelor’s degree in the discipline for which they intend toreceive accreditation. For QA purposes, another major regulationadopted by developed countries is periodic training for at leastevery 5 years to update their knowledge and skills with the latesttrends. These are some of the regulations that leading countriesadopt to ensure that they promote QA for their laboratories.

2.3Education and training2.3.1Elements of good training in pathology

Somescholars have studied the elements of good training in pathology. Oneof the strategic plans of the American College of VeterinaryPathologists (ACVP’s) is ensuring that all training activitiescontain some key elements that are guidelines for success. Accordingto Scott et al. (2012), training should be made consistent across allprograms at the same time ensuring that the trainers providejustification for their methodologies. Based on these remarks,Schrijver et al. (2013) say that the training bodies must ensure thatthe pathology training programs base their content on the knowledgeand skills, which are required to make the pathologists effective inthe diverse field. The ACVP conducted a delineation study as a way ofdefining the scope of knowledge and skills imparted through trainingexercise (Sharkey et al., 2012). One of the findings was thattraining institutes have to ensure the trainers’ proficiency beforehanding them the responsibility to oversee the training activities.According to Schtijver et al. (2013), the tasks that the diplomatshandle are influential in determining the improvement of thetrainees’ techniques. Therefore, before initiating a trainingactivity, the educational bodies have to ensure that they scrutinizethe trainers’ qualifications.

Lauroet al. (2013) say that pathologists encounter new challenges everyday at the laboratory. Given this, during their training programs,they need to acquire knowledge and skills that prepare them to facenot only previously existing problems, but also emerging ones aswell. Sharkey et al. (2012) are of the idea that facility boardscollaborate with training agencies to ensure that the skills andknowledge. Lauro et al. (2013) assert that one of the characteristicsof a good pathological training program is that it provides skillsand knowledge applicable in a variety of fields, such as diagnosticlaboratories, government agencies and even in academics. Such aprogram, according to them, is not only all-inclusive but also opento flexibility, given the dynamic nature of automation in clinicalpathology.

Domenet al. (2015) identify case-based pathology as one of the bestprograms that impart knowledge through independent evaluation ofdisease material. Such a methodology adheres to some technicalprocedures, which some scholars have mentioned in their works (Domenet al., 2015 Lerner et al., 2015). The first one is the performanceof comprehensive procedures while at the same time referring toclassical case studies, found in training books and relateddocuments. Secondly, the trainees, while undergoing knowledgeboosting training, take samples that they independently review andcompare results with their trainers and peers. Tosch et al. (2012)say that some of the scholarly skills required in this nature ofexercise are documentation, recognition and integration of data. Toensure that the trainees are gaining maximum knowledge and skillswhile under the training program, the trainers check to see if theycan demonstrate increasing competence and accountability at the endof each step. According to Gullapalli et al. (2012), these controlsare crucial while preparing evaluation and recommendation reports atthe end of the training sessions, which is part of the finalperformance and competence assessment.

2.3.2Current and urgent issues in training for pathology laboratories

Lewis &amp Klingensmith (2012) say that one of the most pressingissues in training pathologists in the modern times is impartingethics and professionalism. In this regard, scholars assert thatprofessionalism and ethics have taken the central role in thetraining activities that training institutions have designed.Besides, accreditation bodies, such as the Accreditation Council forGraduate Medical Education, have made it mandatory for trainers toincorporate ethics and professionalism into residency training (Lewis&amp Klingensmith, 2012). According to studies conducted by expertsin matters of continued development, formal instructions in ethicsassume an enormous percentage in residency training programs. This isan indication of an emerging trend in continued education training.

There are additional issues that scholars relate to the emergingtrends in pathology training. According to Domen (2014) and Weiss &ampHassell (2014), there is a substantial gap in the pre-residencymastery of basic procedures, such as anatomy and histology, whichenable the practitioners to make relevant clinical decisions. Whilemost trainers are concentrating on imparting average skills, Domen(2014) says that modern training programs have to incorporate skillsthat prepare the trainees to handle high-volume clinical pathology.Given this, the academic and private practice pathologists will be ina position to engage in building the global network of highlyqualified and efficient practitioners.

The American Board of Pathology (ABP) has recently shaped the trendsin pathology training by changing the period of anatomic and clinicalpathology residency training (Caturegli et al., 2015). Previouslybeing around five years, the board proposed a reduction to fouryears, which, however, would be activity intensive. During thisperiod, the training exercise would concentrate on developing sixmain competencies. These are practice-based learning, medicalknowledge, patient care, professionalism, and system-based practiceand communication skills. Given these recommendations, variousorganizations have re-designed their training activities to yieldsimilar results in an almost similar setting as that proposed by theABP.

2.3.3Methodologies and training modalities in pathology laboratories

Garciaet al. (2015) review environmental components and methods forengaging pathology resident in training. According to them, expertshave recently recognized the importance of informatics in pathology,which has created a foundation for integrating better methodologiesand formalizing instructions in the training exercise. Whileimparting knowledge and skills through training, Garcia et al. (2015)say that understanding informatics is critical to practice andapplication. As such, modern trainers integrated their methodologieswith informatics systems, which various information technology firms,in collaboration with pathology experts, have designed. In a similarsentiment, Lois et al. (2015) assert that effective modern trainingmethodologies acknowledge computational pathology, which is along-term effort to improve clinical procedures such as imaging andclinical data. While partners in pathology training institutions makedecisions that influence the distribution of informatics activities,Sinard, Powell &amp Karcher (2014) say that trainers implement theseinitiatives with residency success in mind.

Brook(2014) proposes designers of modern training modalities integrate theactivities with two main approaches, which focus on research andpresentation. According to him, the trainers have to pass knowledgeto the trainees under guidelines proposed by research experts. Thesetrainers can obtain these guidelines from peer-reviewed journals,which can be either retrospective or prospective. Secondly, thetrainees have to present what they have learned in regular meetings.While supporting this, Brook (2014) adds that it is theresponsibility of the training program designers to ensure that themethodologies used in clinical pathology distribution courses areup-to-date with modern trends, not forgetting quality checks.

2.3.4Training of clinical scientists – requirements for quality andcompetence

The Association of Clinical Scientists (ACS) outlinesdiscipline-specific general competence requirements for trainees(Scott et al., 2012). For applicants to register for training asclinical scientists, they have to satisfy the minimum requirementsthat the organization outlines. The applicants have to show anability to specify clinical decisions that a certain interventionwill inform. According to this requirement, Emanuel &amp Fusch(2012) say that the clinical scientists can demonstrate that theyhave the capacity to make informed decisions independently. Thescientist also has to show the ability to make a judgment on theefficiency of procedures used in the laboratory. Additionally,Norcross &amp Wampold (2011) say that showing awareness of evidencethat underpins the use of procedures is a critical requirement foradmission. Similarly, the clinical scientists must be able to adviceon the choice of samples for specific diagnosis. On this point,Emanuel &amp Fusch (2012) say that this demonstrates the scientists’ability to understand the limitation of various elements in clinicaldiagnosis procedures.

In pathology, the clinical scientists have additional requirementsthat they must fulfill to demonstrate their competency in thelaboratory. Padulo et al. (2013) say that the scientists must have anunderstanding of the principles of diagnostic methods thatpractitioners use for various purposes in the laboratory. Theyscientists must also demonstrate a deep understanding ofinvestigative protocols that experts have designed over time,especially those that require skills in automation. Bourbeau &ampLedeboer (2013) add that showing a critical understanding in theintegration of laboratory data with various diagnostic parameters,such as hematological parameters, is a demonstration of sufficientcompetency amongst clinical scientists. At the same time,demonstrating knowledge of clinical methodologies, and theirassociation with evaluation and development measures qualifiesclinical scientists in the modern laboratory environment.

2.3.5A focus Medical Laboratory Technologists

Burtis et al. (2012) discuss theprofessional conduct of medical laboratory technologists, which areaccording to established protocols and guidelines. The guidelineshave numbered codes, outlining various competencies that thetechnologists have to demonstrate. Among the key requirements are theapplication of principles of standard precautions and appropriateinfection control practices. According to Burtis et al. (2012), theguidelines have protocols for reporting errors that help the expertsto respond to field-specific requirements. Medical laboratorytechnologists are also obliged to verify relevant data and ensurethat they use only appropriate specimens in the laboratories.

Technologists at Yale Department oflaboratory medicine’s medical laboratory conduct weekly caseconferences, where they present findings from clinical studies(yale.edu, 2015). These case studies include those associated withclinical investigations of known or recurring diseases while theclinical department organizes others to help expand knowledge aboutsome rare diseases. Some of the recent case studies were thepresentation of a 45-year old female for evaluation of ‘easybruisability’ and that of a 53-year old man presented to theemergency room with bleeding and extensive petechiae (yale.edu,2015).

2.4Continuing professional training2.4.1Role of continuing professional development

Poortinga(2015) says that Continued Professional Development (CPD) is one ofthe activities that guarantee competence in the profession. Thisactivity is an ongoing process, which takes place throughout one’sprofessional career. While Boud &amp Hager (2012) identify theimportance of CPD as an individual growth process, the ultimateoutcome of the activity is that it develops the employer,practitioners and the public that benefits from the services. Besidesthis, some scholars have identified a list of benefits that come withCPD. Boud &amp Hager (2012) say that the process help thepractitioners to keep pace with the latest trends in the field.Additionally, CPD helps the practitioners to develop their knowledgeand skills as they engage in the field. While

2.4.2Role of continuing professional development

Ko(2012) says that Continued Professional Development (CPD) is one ofthe activities that guarantee competence in the profession. Thisactivity is an ongoing process, which takes place throughout one’sprofessional career. While Boud &amp Hager (2012) identify theimportance of CPD as an individual growth process, the ultimateoutcome of the activity is that it develops the employer,practitioners and the public that benefits from the services. Besidesthis, some scholars have identified a list of benefits that come withCPD. Ko (2012) says that the process help the practitioners to keeppace with the latest trends in the field. Additionally, CPD helps thepractitioners to develop their knowledge and skills as they engage inthe field.

Ko(2012) says that professionals accept CPD as an integral part ofpathologist education as helps them to continue to higher levels ofcompetency, and helps them to develop new skills each day. Giventhis, he asserts that professionals should not view CPD as anobligatory activity but as part of the entire growth process. Barneset al. (2013) speak about CPD in an all-encompassing perspective,saying that all fields of science are developing at a rapid pace, andas such, should embrace new generations of knowledge. To considerablerates, CPD helps the professionals in the various field of science toacquire skills that replace those they acquired in previousgenerations. CPD, according to Czabanowska et al. (2012), helps thescientists to keep up with relevant and up-to-date knowledge in theirfields. Given this, experts in various field of science are of theview that long serving practitioners should not be reluctant toembrace new forms of skills that are imparted through CPD, even ifthe same means that they have to change their modus operandi(Czabanowska et al. (2012). Similarly, other scholars are of the ideathat CPD should be encouraged among the long-serving practitioners asit helps them to not only learn emerging techniques, but also helpthe younger practitioners to integrate the new era techniques withclassical ones.

2.4.3Continuing professional development for medical practitioners andpathologists

Speakingwhile making a general comparison to other scientific fields, Martinet al. (2015) assert that CPD for medical practitioners, andpathologists in specific, is an almost mandatory requirement forprofessional growth. According to him, almost all people everyone areaware of what he or she learnt about a decade earlier, but there isno guarantee that they are aware of the information pertaining totheir specific fields that have emerged since. Given this, DiMaria-Ghalilio et al. (2014) says that pathologists who escape thereality of dynamism in science run the risk of lagging behind, giventhe pressures that come along with the developments, such asautomation. For instance, pathologists who fail to learn the latestinformation run the risk of dis-accreditation by the relevant bodies.In light of this, Martin et al. (2015) says that urging CPD amongmedical practitioners such as pathologists not only puts them in thesafe side, but also helps them to deliver optimum services thatbenefits them, the clients and other stakeholders in medicine.

Eulert(2014) introduces the term ‘Continuous Medical Education’ (CME),which he says is used almost in the same capacity as CPD. Medicalauthorities that seek to differentiate continuous training in otherfields of science from that of medicine prefer the use of this term.Many published reports have preferred the use this term, which is atrend towards more enforced medical training. While some countrieshave a better-organized professional development curriculum thanothers, there are efforts to ensure that medical practitionersreceive standard training that helps them to develop their competencyto match international requirements (Yamamoto et al. (2015). Forinstance, under the patronage of the European Society of Pathology(ESP), affiliated institutions all over the continent have developedprograms that offer courses for residents, which practicingpathologists also attend. According to Eulert (2014), the bottom lineof the training programs, no matter the framework adopted, is toeducate the practitioners with the objective of helping them toimprove their competence and quality.

2.4.4Residency training for pathology

Hirshet al. (2012) identify the critical role that physicians who did notattend medical schools in the U.S and Canada play. Results fromofficial reports indicate that almost 25% of practitioners in thesetwo countries did not attend the courses. However, because ofsuccessful residency training, which is a prerequisite for licensureby the U.S medical boards, the International Medical Graduates (IMG)makes up a sizeable portion of Physicians that practice today.Additionally, Bjorklund et al. (2011) says that some countries,depending on the societal needs that prevail, offer friendlyresidency programs that positively contributes to the health care andmedical knowledge base. The future of medical practice, includingpathology, relies on identifying the characteristics and specialtytraining needs within a certain region, and developing thepractitioners through residency training and other related programs.

Egolet al. (2012) say that various countries have different demands forqualifications for residency training. For instance, in the UnitedStates, the trainees are required to have their certificatespermanently validated by the relevant bodies, and they have to passsome mandatory tests to assess their language proficiency.Additionally, there is a certain time limit for applicants who wishto undergo residency training. Lebensohn et al. (2014) identify Form246, which details residency placement, which identifies programspecialty, institution address, and personal data. The authoritiessupply residency program information using appropriate communicationchannels. Anakwenze et al. (2013) say that applicants to residencytraining have been increasing over the past few decades. Theconsistent growth of residency trainees has helped the field to fillin critical gaps in the skilled workforce, besides serving a largerclient base.

2.5Challenges and prospects in continuing professional development

Barneset al. (2013) say that conducting CPD varies widely from one facilityto another. As such, the main challenge is defining the framework andpolicies for the procedures that the organization uses. Lack of auniversal definition, as such, is a barrier to the wider acceptanceof the products of the training programs. According to Dillon et al.(2011), because of the emergence of different techniques thattrainers use in various CPD programs, setting a constant pace for useby all trainers and trainees is a technical challenge. Boud &ampHager (2012) say that another major challenge is the way thatdifferent professionals and experts perceive CPD. The trainers oftenperceive CPD as a top-down process that a rigid system of managementruns. This means that independent evaluation of the process islimited, hence closing the loops or creativity and innovativeness.These two elements are important in pathological laboratories, whichcharacterize modern automation.

Reeveset al. (2013) say that the current recommendations for completion ofCPD every three years are most likely to undergo modificationshortly. This is because the level knowledge and skills that passedat the end of this period may need an extension, given the currentrate of automation in the field. Brown &amp Fleisher (2014) notethat attendance at courses and meetings is not the same as learning,and as such, the course designers are most likely to change thetraining frameworks to result in better results in training thepractitioners. Given this, Archibad et al. (2011) say thatlegislature is most likely to factor in, and authorities may passacts to make CPD compulsory for all practitioners. This means thatassessment methods to satisfy the needs of the clients and thepractitioners may crop out of recertification. From historicalevidence, the field of pathology has been undergoing significantchanges and redesigning of CPD may be one of the most outstandingones shortly.

2.6Summary

Thischapter has presented the literature that the researcher reviewed inthe build up to the research. In order to investigate the conceptsapplicable systematically, the researcher reviewed the literaturecategorically. The first category of literature addressed issues inquality control. This was followed by issues in education andtraining, as pertaining to Continued Professional Development. In thethird section, the researcher focused on the concepts of continuingprofessional development, specifically by reviewing the role of CPDin developing medical practitioners and pathologists. Finally, theresearcher appraised literature on challenges and prospects in CPD.From this literature review, the researcher noted that there was agap in knowledge in the concepts of developing customized CPDprograms, as most of the scholars have focused on a broad-spectrumapproach to the study. However, using the concepts obtained from theliterature review, the author embarked upon designing a methodologyto investigate and fulfil the study objective.

CHAPTER3: METHODOLOGY3.1Secondary data

The researcher used secondary data while conducting informationresearch in this study. One of the prerequisites was conducting adetailed description of secondary sources. According to Driver et al.(2013), researchers are supposed to describe how to seek and obtaininformation from secondary sources, especially in the medical fieldof science. Given this guideline, the researcher identified specificinformation from the data sources, before going ahead to verify itsrelevance to the study. The research assistants reviewed hospitalinformation and other health care records based on standard criteria.For better management of the information, specific procedures wereassigned data codes. These codes helped the researcher todifferentiate the academic and technical level of informationrecorded in the secondary sources. Given that some parts of theresearch needed the researcher to use academic abstracts, it wasnecessary to describe main points to avoid mix-up. The researcherfurther ensured that the level of data was sufficient to allow anyreplication, if necessary.

As per the recommendations of Scott (2014), the researcher defendedthe appropriateness of the sources to demonstrate that it capturedhealth care aspects, such as the process of care and patient outcome.Donabedian model, which guides the study methodology, contains this.While identifying acknowledging the purpose of the study, which wasto design a continued learning program for pathology professionals inSaudi Arabia, there was a consideration of some key outcome measures.These included improved functional status in the health facilities,better client satisfaction in the laboratory services and generalproblem solving.

The researcher also used information from internet sources. Over therecent years, scholars have identified the internet as a prospectivesource of secondary data. Many researchers believe that internetsurveying and electronic data are the future of academic research inscience. Recognizing that there is a plethora of secondaryinformation from the internet, the researcher used various tools andresources that contain this information. Perhaps the most promisingsource of secondary information over the internet was Google Scholar.Google Scholar is an academic search engine that helps researchers tolocate peer-reviewed material for supporting their research. With theslogan “standing on the shoulders of the giants”, this tool hashelped several scientist in advancing their studies with ease. Otherinternet resources included Yahoo Informatics and some onlinedatabases, which contained articles with useful research information.

3.2Qualitative and quantitative methods in research

While using the secondary sources, the researcher extracted bothqualitative and quantitative information related to general andsystematic reviews, guidelines, clinical trials, observationalstudies, and other researches from different countries. Thequantitative secondary data relevant to this study included thepathologists’ medical training records, years of theoreticaltraining and clinical practice and job performance statistics. Giventhat this information was easy to obtain and analyze, the researchergreatly depended on them. Besides helping the study to cover a largegeographical area, the secondary data allowed for comparison ofentities such as health facilities and training institutions. On theother hand, the researcher obtained secondary qualitative data fromarchived documents and health service reports. They proved to be richin information that was necessary for referential purposes.

3.3Primary data

The researcher used a detailed closed-ended questionnaire as aquantitative research tool to gather the views of stakeholders in theSaudi’s educational sector, as well as the Saudi pathology sector,especially in the laboratory services. As well, the study used anopen-ended questionnaire to collect independent response for a numberof elements pertaining to the study. This was for qualitative studypurpose. Obtaining the pathologists’ views would help to establishexisting challenges in the laboratory to help in developingeducational and presentation methodologies that can improve theperformance and quality of laboratory tests in the Saudi’spathology laboratories. The researcher precisely decided the items inthe questionnaires in advance.

The participants responded to the questionnaire items, which theresearcher structured with Likert Scale for the open-endedquestionnaires. They had to tick one answer that corresponded totheir view, based on a practical experience with listed statements.Using this the Likert scale, respondents ticked the appropriateanswer, weighed from 1 to 5, where 1 designated that they strongly orintensely disagreed with the item while 5 indicated that theystrongly agreed with the item.

There were three main sections in the closed-ended questionnaire, allthat were part of the effort to rank the participants’ trainingneeds. The drive of the first segment was to investigate the designof Quality Assurance content of the courses that the training bodiesoffered. Some of the key items in this section were evidence-basedlaboratory medicine usage, result-oriented approach to learning andsafety in the laboratories. The second section investigated theQuality Assurance Project. In this section, some of the key itemswere the amount of knowledge that the participants perceivednecessary and the expected outcome of the training exercises. In thethird section, the questionnaire looked to investigate perceived roleand experience of pathology laboratory technicians. On the otherhand, there were four elements in the open-ended questionnaire. Thesewere demographic and general work information, work experience andconversance, ranking of perceived training needs and level ofagreement and disagreement.

3.3.1Pros and cons of closed-ended questionnaires as quantitative researchtools

While some researchers praise the use of close-ended questionnairesin research, others identify some shortcomings associated with thistool. For starters, closed-ended questionnaires are easier andquicker to use, and it is easy to compare answers from differentrespondents. Given the wide array of response possibilities in thefield of medicine, using closed-ended questionnaires helps theresearchers to narrow down options for ease of analysis in laterstages. Additionally, the field of medicine is one of the mostdivergent in term of personal feelings and emotions. As such,researchers who wish to have a response to some critical yetsensitive issues find closed-ended questionnaires quite useful.

However, there are certain shortcomings associated with usingclosed-ended questionnaires, especially in the medical field.Foremost, the respondents are most likely to suggest ideas that theyotherwise would not have, given that they are compelled to give theirresponse under such circumstances. This observation means that theresearcher risked collecting information that would not onlyundermine the integrity of the process but also jeopardize theapplicability of suggestions at the end of the study. Thisshortcoming is closely associated with the possibility of havingupset participants, who may feel offended. According to Driver et al.(2013), another major shortcoming with using closed-ended questionsis that the respondents may misinterpret the questions, which alsomay go unnoticed. At the same time, the respondents may feel that theresearcher compels them to give simplistic responses to otherwisecomplex matters.

3.4Research population

Theresearch participants were pathology practitioners and trainers fromSaudi Arabia. The practitioners included those who had recentlygraduated from the medical schools, and those who had been inpractice for a while. While the time of practice was not a strictconsideration, the researcher looked to collect the feelings andopinions of those who had some experience in the field of pathology.The researcher also obtained data from some experts in the field ofcontinued educational training, who had experience in the field ofpathology and had taken part in previous studies. While identifyingthe participants, the researcher put all measures in place to avoidunnecessary discrimination. At the same time, the researchercollected information from all demographics described within thescope of the research requirements.

3.5Inclusion and exclusion criteria

Hulley et al. (2013) assert that it is mandatory for researchers tospecify the inclusion and exclusion criteria for participants. Bothcriteria describe the characteristics for qualification ordisqualification from participating in a study. The inclusioncriteria were practitioners practicing within Saudi Arabia, andspecializing in pathology. The exclusion criteria were disqualifiedpractitioners and non-English speaking resident practitioners.

3.6Reliability and validity

Reliabilityis the level to which a research instrument produces constant resultsover time (Bryman, 2012). Apart from the literal meaning ofreliability, theoretical reliability is the measure to which theinstrument would yield the same outcomes no matter the number oftimes the researcher used it in a research. To ascertain thereliability of this study’s research instruments, the researcherapplied a test-retest method. This method helped in determining thestability of the research methodology from the researcher begun thedata-collection exercise. The researcher took personal responsibilityto ensure a high degree of stability, which in literal meaning,translated to a high degree of reliability. While the use of thismethod was indispensable in the primary research, it was to a certaindegree applicable to the secondary data collection exercise.

Validityis a measure of the extent to which a certain research methodologycollects the required data (Bryman, 2012). Research experts assertthat attainment of validity is an assurance that the study fulfillsits objectives. To establish the cogency of the research instrument,which was a questionnaire, the researcher revised the items whilevalidating them against the set objective. Additionally, theresearcher contacted research experts and assistants to collect theiropinions on the validity of the items. The final items were thereforeproducts of strict scrutiny and verification, which led to theassumption that the instrument was valid.

3.7Data analysis

The researcher deductively analyzed data and information fromsecondary sources. The purpose of this was to generate generalizedand standard laboratory procedures for pathology learninginstitutions. On the other hand, the researcher used SPSS version10 to analyze primary data, obtained from the questionnaires. Thestudy generated generalized viewed of the participants using SPSSversion 10. It was of importance to ensure that the generalizedconcepts were in line with the majority’s views and opinions. Forthis purpose, the study applied inductive reasoning to thegeneralized secondary information and primary results to come up withthe final report. This report will serve as an educational curriculumtowards quality and performance improvement in the Saudi’spathological laboratories.

3.8Limitations

The researcher identified some study limitations, some that weretechnical. Firstly, there was a heavy reliance on secondary sources.The main shortcoming with this is that the researcher may fail toidentify critical gaps in the knowledge base, hence going ahead toproduce discussions that may already be existing. Secondly, given thelack of a variety of studies with a similar objective as that of thisstudy, the researcher wandered in the unknown, risking the phenomenonof ‘writer’s block’. This phenomenon describes a situationwhere researchers run out of ideas to include in the study. However,the researcher countered this by seeking information from a varietyof sources and integrating them to come up with a sufficientframework to conduct the research. The final challenge was gettingthe respondents to participate objectively without altering theiropinions. While the researcher identified the urge to have therespondents to participate with a free-will, it was felt that someparticipants needed an ideological guide to making the data asobjective as possible.

3.9General considerations

Some general considerations called for the researcher’s attention.According to Bryman (2012), a medical research’s report ought toaddress the assessment of possible random and systematic errors thatthe researcher may encounter in the field. Firstly, the methodologyprocedure described the setting of the population. Pathology is asmall area of the wider medical field of medicine, and as such, it isnecessary for a researcher to guide the reader through the process ofidentifying the study population. This move is to avoidgeneralization and to narrow the scope to specific objectives. Whiledoing this, it was necessary to describe the inclusion and exclusioncriteria. Scott (2014) asserts that researchers have to define therepresentativeness of the sampling frame by identifying the peopleand conditions participation. Carrying out a study without doing thismay lead to errors in the reliability and validity of the data, asthe researcher would have failed to set the optimum conditions forconducting research.

3.10Ethical considerations

While there were no specific ethical concerns associated with thisstudy, the researcher took the necessary precautions as advised formedical research studies. Foremost, the researcher asked theparticipants not to disclose any information that would reveal theiridentity. At the same time, the researcher explained in depth thenature of the research, what the study required of them and thepurpose of the information. Moreover, the researcher assured them ofconfidentiality when it came to analyzing the information. However,the researcher made it clear to the participants that relevantbodies, if necessary, would make the study findings, including theirinput, public through academic publication.

3.11Summary

The researcher applied both quantitative and qualitative scientificresearch methodologies in the research. While using a quantitativeresearch methodology, the researcher created a questionnaire used tocollect the participant’s opinions. The researcher designed aclosed-ended questionnaire, with a Likert scale of one to five tomeasure the weight of the respondent’s opinions on the researchitems. Qualitatively, the researcher conducted an in-depth researchto understand the participant’s feelings about the researchvariables. The researcher used these methods together with secondaryand primary data to collect relevant research information. Themethodologies’ strengthens and limitations were identified, as wellas the rationale for deploying them. While there were no specificethical concerns associated with this study, the researcher took thenecessary precautions as advised for medical research studies.

CHAPTER4: DATA ANALYSIS4.1Introduction

In the previous chapter, the paper described the methods used incollecting study data. The researcher considered every aspect of themethods and research design before embarking on the actual datacollection. Having collected the data, the study set upon analyzingit and producing readable information that the researcher used tocompile findings. This chapter discusses the procedures that theresearcher used to analyze the data from the fieldwork. Whileproviding an independent interpretation of the study researchfindings, the author used some support from literature to back up therationale. It was also of significance to acknowledge the opinionsthat the research participants provided, as they were part of thefoundation of hypothesis creation. Additionally, throughout thediscussion process, the researcher used data analysis principles thatanalysis experts have described in texts.

4.2Data analysis

The researcher obtained data from the quantitative approach by usingquestionnaires. The data from the questionnaires served the purposeof informing the study the key outcomes of the variables applied. Thestudy reached at a research-coded statistics from the methodologyafter formulating a questionnaire to collect the opinions ofpathologists practicing in Saudi Arabia. The questionnaire contained35 items that were spread out categorically to serve the purpose ofinvestigating each variable. The variables were the design of qualityassurance content of the course, the quality assurance project, andthe role and experience of pathology (medical) laboratorytechnicians. The methodology applied a five grade Likert scalemeasuring from “1” strongly disagrees to “5” strongly agreeto the questionnaire.

Uponcompletion of the questionnaires, the participants surrendered themto the research assistants. Apart from the items that the respondentswere required to respond to, the researcher did not need anyadditional information, such as age, sex, and marital status. Asingle Likert scale contained five options. The researcher, in thisregard, required the participants to fill in one of the options.Additionally, apart from the formal introduction to the study’snature and purpose, the researcher needed not to use other extraorientation tools such as pre-interviews. The researcher used SPSSversion 10 for data exploration and arrangement of the outcomes.

4.3Descriptive statistics

Thestudy used descriptive statistics to describe the basic features ofthe field data. The researcher used this approach to provide a simplesummary of the opinions of the participants and the effect of thevariables of the study. Additionally, the researcher aimed atproviding a quantitative description in a manageable form, given thewide scope of the study. Given that there were 35 items beingmeasured on a 5 Likert scale, descriptive analysis was used tosimplify the pool of data and present it in an easily manageable way.While compiling and analyzing the data, the researcher used thistechnique with the aim of making work easy in the data presentationstage.

Frequency

Using this feature of descriptive analysis, the researcher aimed toprovide a summary of the distribution of the individual values forthe items that described each of the three variables. The studyprovided a list of the values of the variables and the number ofrespondents that each item received to simplify the frequencydistribution. While at it, the researcher described every itemsufficiently, besides ensuring that the exact number of responsesthat the items received was included in the calculations. Whileanalyzing the data, the researcher applied valid percent tool toadjust for any missing entries. However, owing to the measures thatwere used to ensure that the data analysis was conducted validly andreliably, there was not any missing data.

The researcher calculated cumulative percentages for the 200respondents. Data analysis use cumulative percent to calculate thepercentage of cumulative frequency within each level (Grbich, 2012).One of the main advantages of this analysis method is that is that itprovided the analyst with an easier way of comparing the sets of datathat applied to the three variables.

The paper number the questionnaire items with respect to each measureof the Likert scale., which is in conformity with the data analysistechnique as described by Agresti &amp Kateri (2011). Additionally,for consistency, the study applied Cronbach’s alpha, describe laterin the chapter, to display scale dependability and describerelations. As such, the researcher mirrored
ed a reasonablemagnitude of consistency throughout, which was necessary to producevalid analyzes. The Likert scale enabled the researcher to confirmthat indeed a good number of the participants had opinions that werein line with the intended research objectives. Additionally,collected data was sufficient to help the researcher make meaningfulinterpretations in later stages.

4.4Reliability tests

Given that the values that the study obtained from the summatedscales acted as predictor components for the objective models, theresearcher prioritized reliability testing. The summated scalespresented the interrelated in terms that helped in measuring theunderlying constructs, meaning that there was a need to determinewhether the same questions would elicit similar responses whenadministered to the same respondents. While using Cronbach’s, alphais an important tool. Alpha is an important numerical reliabilitycoefficient whose computation is dependent on the reliability of thetest in relations to other tests (Agresti &amp Kateri (2011). Theresearcher applied this for the responses obtained for qualityassurance content, quality assurance project and role and experienceof pathology laboratory technician

4.4.1Cronbach’s alpha

In statistics, data analyzer use summated scales in questionnaires toinvestigate underlying constructs, which are of the interest to theresearcher and are important in making meaningful determinations in astudy. Given the fact that summated scales are a collection of itemsthat are associated in a given study, which analyzers also designedto measure underlying constructs, it was important for the researcherto determine the sets of items that would yield similar responsesfrom the participants. This measure was in case the researcher was toprobe the respondents again, as earlier identified.

In line with recommendations by Agresti &amp Kateri (2011) asregards to using the Cronbach’s alpha, the researcher declared thevariables derived from the questionnaire reliable only when theyprovided constant and reliable responses. Additionally, the studybased the computation of alpha on the reliability of the test, aboutothers with the same items. In this particular study, 35 questionsusing Likert scale (1= strongly disagree 5- strongly agree) wereadministered to 200 respondents, all who were within the inclusivecriteria as described in the methodology chapter. The three variablesin the study were quality assurance content, quality assuranceproject and pathology laboratory technician.

The research applied 35 question Liker scale questionnaire. Uponreceiving the questionnaire forms, the researcher programmed thequestionnaires using measures of SPSS to decide the implication ofthe items to the study. Given this, the study used variables as theexamination factor to make the index of Cronbach’s alphaacceptable. Additionally, the researcher used the alpha to make adetermination on the how any erroneously designated items influencedthe outcome of the study.

According to Agresti &amp Kateri (2011), the Cronbach’s alpha isan efficient pointer of uniformity and dynamism that are usuallyassociated with the items, having been allowed by the exact mark ofthe study’s concept. The study used a Cronbach’s reliabilityindex ranging from 0 to 1. This coefficient described the reliabilityof the factor that the study extracted from the Liker scaledichotomous scale. While conducting the analysis, the underlyingassumption was that a higher score indicated a high reliability ofthe generated scale. The analysis measured the three variablesindependently. The researcher designed the analysis to forpresentation as follows for every variable the Cronbach’s alpha,Cronbach’s alpha based on standardized items and some items. Thequality assurance content had an index of 0.987 the qualityassurance project had 0.982 and role and experience of pathology labtechnician was 0.993. The diagram below presents a tabular form ofthis particular analysis process.

Variables

Coefficient Alpha

Quality Assurance content

0.987

quality assurance project

0.982

Pathology (Medical) Laboratory Technician (Role and Experience)

0.993

Scalingat 95% confidence interval

A confidence interval in statistical analysis is an interval estimatefor a parameter value (Bryman &amp Cramer, 2011). In this study, theresearcher used it to give a proportion of the values to include theunknown variable, then designating this proportion as the confidencelevel. The 9% confidence interval was set as the default value in theSPSS 10 program that the researcher used in the analysis.

4.5One sample test

The researcher used the one-sample test to determine whether thesamples came from a population with a defined mean. The analyzerensured that data fitted the description given by Grbich (2012) inconducting a one-sample test. While applying the one sample test, theresearcher had four assumptions to guide the process. Theseassumptions are required for ensuring that the one sample test gave avalid result. In theory, checking four these assumptions may lead tomore time needed to finish conducting the analysis, however, they ledto better results to aid in the interpretation process. Nevertheless,in the real-world applications, normal research would fail to meetone or two assumptions. This assumption does not mean that theresults will be less valid, as there are more solutions used toadjust the validity check for the data.

The first assumption was that the researcher was going to measure thedependent variables at the interval. The second assumption whileusing the one sample test was that the data in the variables wasindependent. An independent variable means that there were noexternal influences from any of the variables, which would affect theindependence of the data in another. Thirdly, the analyzer ensuredthat there were no significant outliers. Grbich (2012) definesoutliers’ data points within the pool of data that fail to follow adefined pattern. Outliers in data analysis negatively affect theaccuracy of the results by interfering with the one sample test. TheSPSS program has features that the researcher used to identify anysignificant outliers and eliminate them. The final assumption wasthat the dependent variable was normally distributed. Grbich (2012)asserts that the one-sample test is vigorous to violations ofnormality, which means that it requires normally distributed dataonly. However, the nature of this assumption means that most studiescan easily violate it, regardless, without resulting in significantdata distortion.

4.6Descriptive analysis considerations

The research used a central tendency to define the fixed data thatobtained from the quantitative method. This measure established thedominance of the situation of the set statistics. Correlation anddescriptive data analysis, in general, had implications for theresearch. Specifically, the one test sampling technique denoted thenumerical implication of the items that the researcher included inthe questionnaire. Additionally, having a benchmark with Cronbach’salpha and confidence level showed that the principle applied in theresearch will hold. The study grounded reliability and validity onthe positivist model to make meaningful interpretations later. Inthis regard, a dependent concept, cogency, applied to the process ofanalyzing the data, which means that the study’s independent andprofessional perception of the concept of validity determined thedynamism of the entire research. Moreover, as needed of scholars inmodern research work, the researcher upheld numerous ethicalconsiderations to guarantee professionalism and objectivity whilecollecting and analyzing the results.

4.7Summary

Inthe data analysis chapter, the researcher used three statisticaltests. These are descriptive statistics, reliability tests andscaling at 95% confidence interval. From the descriptive statistics,the study evaluated the frequency and cumulative percentages of theresponses. In this case, the variables were each presented in tableswith the analysis done based on some responses on each scale (5 pointLikert Scale). The Likert scale presents the level of agreement ordisagreement towards a certain variable. On the other hand, theresearcher performed reliability tests using the Cronbach’scoefficient, which depicts the reliability of generated scale. Allthe three statistical tests have been crucial in determining theinclusion of the training in the design of quality assurance formedical lab technicians. For instance, while the descriptivestatistics provides the level of agreement, the scaling at 95%confidence gives the means that help in prioritizing the trainingduring the design of the content and project.

CHAPTER5: RESULTS5.1Introduction

The previous chapter described the statistical descriptive analysismethods that the researcher used to analyze the data. These methodswere descriptive statistics, reliability tests and scaling at 95%confidence interval. The first part of the chapter presents theresults of the analysis of the variables, using descriptivestatistics while the second part presents the results of reliabilitytests and one sample test. While analyzing compiling the results, theresearcher referred to parts of the literature that documentedsimilar studies. Scholars have researched the issue of designation ofa quality assurance content by assessing variables such as evidencebased laboratory medicine. Despite the fact that most of thesestudies investigated the variables in a different content, most ofthe implications of the results are almost similar across all formsof related research. Additionally, besides taking a similar approachas that of the studies reviewed in the literature, the researchercomplied the studies in this section in a way that is easy for otherscholars to review and give critique.

5.2Quality Assurance Content

Aresults-oriented approach to learning, which is learning-centered iscrucial in educating pathologists

&nbsp&nbsp&nbsp&nbsp A results-oriented approach to learning, which is learning-centered is crucial in educating pathologists

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

3

1.5

1.5

1.5

Disagree

6

3.0

3.0

4.5

Neither Agree/Disagree

18

9.0

9.0

13.5

Agree

120

60.0

60.0

73.5

Strongly Agree

53

26.5

26.5

100.0

Total

200

100.0

100.0

Fromthe cumulative percent, it can be observed that the greatest numberof respondents, about 86.5% agreed a results-oriented approach tolearning, which is learning-centered, is crucial in educatingpathologists.

Evidence-basedlaboratory medicine

Thetable below presents the results of evidence-based laboratorymedicine.

&nbsp&nbsp&nbsp&nbsp Evidence-based laboratory medicine

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

3

1.5

1.5

1.5

Disagree

13

6.5

6.5

8.0

Neither Agree/Disagree

20

10.0

10.0

18.0

Agree

124

62.0

62.0

80.0

Strongly Agree

40

20.0

20.0

100.0

Total

200

100.0

100.0

Fromthe cumulative percent, it can be observed that the greatest numberof respondents, about 62% agreed the evidence-based laboratorymedicine was necessary for designing the quality assurance content.

Safety

Belowtable presents the results for the responses on the need for safetyin design of quality assurance content

&nbsp&nbsp&nbsp&nbsp Safety

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

3

1.5

1.5

1.5

Disagree

9

4.5

4.5

6.0

Neither Agree/Disagree

21

10.5

10.5

16.5

Agree

93

46.5

46.5

63.0

Strongly Agree

74

37.0

37.0

100.0

Total

200

100.0

100.0

Fromthe cumulative percent, 16.5 percent of the respondents eitherdisagreed or gave no response while the rest agreed that safety wasnecessary, which implies that Safety should be included whiledesigning the quality assurance content.

Learningto name the parameters for measuring accuracy and precision concepts

Thetable below presents the results of responses rearding the inclusionof learning to name the parameters for measuring accuracy andprecision concepts in the design of quality assurance content.

&nbsp&nbsp&nbsp&nbsp Learning to name the parameters for measuring accuracy and precision concepts

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

19

9.5

9.5

9.5

Disagree

8

4.0

4.0

13.5

Neither Agree/Disagree

54

27.0

27.0

40.5

Agree

45

22.5

22.5

63.0

Strongly Agree

74

37.0

37.0

100.0

Total

200

100.0

100.0

Fromthe cumulative percent, 45 percent, disagreed or were undecided onwhether learning to name the parameters for measuring accuracy andprecision concepts was necessary for the design of qualityassurance content. However, 55 percent agreed learning to name theparameters for measuring accuracy and precision concepts wasnecessary.

Qualityachievement techniques

Thetable below presents the results of the need for quality achievementtechniques for the design of quality assurance content.

&nbsp&nbsp&nbsp&nbsp Quality achievement techniques

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

22

11.0

11.0

11.0

Disagree

15

7.5

7.5

18.5

Neither Agree/Disagree

28

14.0

14.0

32.5

Agree

112

56.0

56.0

88.5

Strongly Agree

23

11.5

11.5

100.0

Total

200

100.0

100.0

Inthe cumulative percentages 2.5 percent either disagreed or wereundecided on whether this was necessary, meaning 67.5 percentsupported the idea, hence the need for its inclusion in designing thequality assurance content.

Datamanagement, report writing and presentation skills

Thetable below presents the need for data management, report writing,and presentation skills in the design of quality assurance content.

&nbsp&nbsp&nbsp&nbsp Data management, report writing and presentation skills

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

26

13.0

13.0

13.0

Disagree

30

15.0

15.0

28.0

Neither Agree/Disagree

36

18.0

18.0

46.0

Agree

86

43.0

43.0

89.0

Strongly Agree

22

11.0

11.0

100.0

Total

200

100.0

100.0

Thedecision can be based on cumulative percentages where 46 percent wereeither undecided or disagreed while 54 percent agreed that datamanagement, report writing, and presentation skills were necessaryfor the design of quality assurance content.

Point-of-CareTesting

Thetable below presents the results of point-of-care testing for thedesign of quality assurance content.

&nbsp Point-of-care testing

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

37

18.5

18.5

18.5

Disagree

29

14.5

14.5

33.0

Neither Agree/Disagree

33

16.5

16.5

49.5

Agree

92

46.0

46.0

95.5

Strongly Agree

9

4.5

4.5

100.0

Total

200

100.0

100.0

Fromthe cumulative percentages, it can be observed that 49.5 percent wereeither not in for the idea or were undecided, meaning only 50.5percent agreed that this should be included. This implies the need toreconsider point-of-care testing when designing the quality assurancecontent.

LaboratoryDisease Surveillance

Thetable below presents the results on responses regarding the inclusionof laboratory disease surveillance during the design of qualityassurance content.

&nbsp Laboratory and disease surveillance

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

9

4.5

4.5

4.5

Disagree

10

5.0

5.0

9.5

Neither Agree/Disagree

23

11.5

11.5

21.0

Agree

55

27.5

27.5

48.5

Strongly Agree

103

51.5

51.5

100.0

Total

200

100.0

100.0

Cumulatively,21 percent were either undecided or disagreed with the inclusion oflaboratory disease surveillance in quality content while 79 percentagreed, which implies that the course was necessary and should beconsidered.

SpecimenManagement

Thetable below presents the responses on the need for specimenmanagement in the design of quality assurance content.

&nbsp Specimen management

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

11

5.5

5.5

5.5

Disagree

7

3.5

3.5

9.0

Neither Agree/Disagree

35

17.5

17.5

26.5

Agree

108

54.0

54.0

80.5

Strongly Agree

39

19.5

19.5

100.0

Total

200

100.0

100.0

Cumulatively,26.5 percent were either undecided or disagreed while 73.5 percentagreed. Hence, specimen management should be included in whiledesigning the content.

EquipmentMaintenance

Thetable below presents the results on the need for inclusion ofequipment maintenance for the design of quality assurance content.

&nbsp Equipment maintenance

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

7

3.5

3.5

3.5

Disagree

22

11.0

11.0

14.5

Neither Agree/Disagree

39

19.5

19.5

34.0

Agree

75

37.5

37.5

71.5

Strongly Agree

57

28.5

28.5

100.0

Total

200

100.0

100.0

Thosewho agreed were 66 percent while 34 percent were either undecided ordisagreed, hence the need to reconsider this course when designingthe quality assurance content.

Statisticsin laboratory medicine

Thetable below represents the responses on the need for statistics inlaboratory medicine in the design of quality assurance content.

&nbsp Statistics in laboratory medicine

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

11

5.5

5.5

5.5

Disagree

11

5.5

5.5

11.0

Neither Agree/Disagree

48

24.0

24.0

35.0

Agree

100

50.0

50.0

85.0

Strongly Agree

30

15.0

15.0

100.0

Total

200

100.0

100.0

Fromthe table above, most of the respondents, 100, agreed that thestatistics in laboratory medicine was necessary for the design ofquality assurance content. 11 strongly agreed, 48 neither agreed nordisagreed, 11 disagreed and 11 strongly disagreed. In this regards,35.5 percent of respondents either disagreed or were undecided and 65percent agreed hence need to include the course while designing thequality assurance content.

Expressingthe relationship between accuracy and precision concepts and the roleof these concepts in quality goals

Thetable below presents the results of expressing the relationshipbetween accuracy and precision concepts and the role of theseconcepts in quality goals in the design of quality assurance content.

&nbsp Expressing the relationship between accuracy and precision concepts and the role of these concepts in quality goals

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

23

11.5

11.5

11.5

Disagree

25

12.5

12.5

24.0

Neither Agree/Disagree

21

10.5

10.5

34.5

Agree

111

55.5

55.5

90.0

Strongly Agree

20

10.0

10.0

100.0

Total

200

100.0

100.0

Cumulatively,34.5 percent either disagreed or were undecided while 63.5 percentagreed that the course was necessary, hence the need for itsinclusion when designing the content.

Definition,establishment and use of reference ranges

Thetable below presents the responses on the need for definition,establishment and use of reference ranges in the design of qualityassurance content.

&nbsp&nbsp&nbsp&nbsp Definition, establishment and use of reference ranges

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

20

10.0

10.0

10.0

Disagree

33

16.5

16.5

26.5

Neither Agree/Disagree

28

14.0

14.0

40.5

Agree

91

45.5

45.5

86.0

Strongly Agree

28

14.0

14.0

100.0

Total

200

100.0

100.0

Onecan confirm the results from the cumulative percentages, where 59.5%was in for the idea while 40.5 percent were either undecided ordisagreed.

Assessmentand selection of analytical approaches and instruments

Thetable below presents the responses on the need for evaluation andselection of analytical methods and equipment in the design ofquality assurance content.

&nbsp&nbsp&nbsp&nbsp Assessment and selection of analytical approaches and instruments

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

27

13.5

13.5

13.5

Disagree

30

15.0

15.0

28.5

Neither Agree/Disagree

46

23.0

23.0

51.5

Agree

72

36.0

36.0

87.5

Strongly Agree

25

12.5

12.5

100.0

Total

200

100.0

100.0

Fromthe cumulative percentages, 48.5 percent agreed that this wasnecessary while the rest 51.5 percent were either undecided ordisagreed, which implies the need to review the inclusion indesigning the quality assurance content.

Basicknowledge that will enable analysts to explore the quality assurancediscipline

Beloware the results for the responses on need for basic knowledge thatwill enable analysts to explore the quality assurance discipline indesign of quality assurance content

&nbsp&nbsp&nbsp&nbsp Basic knowledge that will enable analysts to explore the quality assurance discipline

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

8

4.0

4.0

4.0

Disagree

22

11.0

11.0

15.0

Neither Agree/Disagree

85

42.5

42.5

57.5

Agree

80

40.0

40.0

97.5

Strongly Agree

5

2.5

2.5

100.0

Total

200

100.0

100.0

Fromthe cumulative percent, it can be concluded that the highestpercentage neither agreed nor disagreed on the need for basicknowledge in exploring quality assurance discipline. Therefore, thereis need to reconsider incorporating this course in the qualityassurance content.

5.3Quality Assurance Project

Thetable below presents the results on responses regarding the offers ofquality assurance project to the learners and educators.

&nbsp&nbsp&nbsp&nbsp Offers various advantages to the learners and educators as well as to society hence, it should be used in laboratory learning

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

7

3.5

3.5

3.5

Disagree

43

21.5

21.5

25.0

Neither Agree/Disagree

36

18.0

18.0

43.0

Agree

44

22.0

22.0

65.0

Strongly Agree

70

35.0

35.0

100.0

Total

200

100.0

100.0

Cumulatively,this can be translated to 57 percent agreement and 43 percentdisagreement and undecided, which implies that the quality assuranceproject was necessary for both the learners and the society.

The table below presents the responses regarding the qualityassurance project offering the knowledge on the outcome to ensureunderstanding of the materials.

&nbsp&nbsp&nbsp&nbsp Offers knowledge about the outcome so that the reason for studying the material is understood, and the total picture is made clear

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

16

8.0

8.0

8.0

Disagree

31

15.5

15.5

23.5

Neither Agree/Disagree

48

24.0

24.0

47.5

Agree

77

38.5

38.5

86.0

Strongly Agree

28

14.0

14.0

100.0

Total

200

100.0

100.0

Fromthe table above, most of the respondents, 77, agreed that the qualityassurance project offers knowledge on outcome to ensure understandingof the materials. 28 strongly agreed, 48 neither agreed nordisagreed, 31 disagreed and 16 strongly disagreed. 47.5 percenteither disagreed or were undecided and 52.5 percent agreed.

Knowledgeof results evaluation and motivation in to achieve them

Thetable below presents the results on the responses regarding thequality assurance project in providing knowledge on resultsevaluation and motivation in to achieve them.

&nbsp&nbsp&nbsp Offers knowledge about the results of the evaluation and gives the motivation to achieve them

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

20

10.0

10.0

10.0

Disagree

40

20.0

20.0

30.0

Neither Agree/Disagree

44

22.0

22.0

52.0

Agree

82

41.0

41.0

93.0

Strongly Agree

14

7.0

7.0

100.0

Total

200

100.0

100.0

Fromthe cumulative percentage, only 48 percent of the respondents agreed,meaning quality assurance project does not necessary offer results ofthe evaluation and the motivation to achieve them.

Thetable below presents the results of training offering learnersself-spacing to enable them plan their study time to match theirlimitations and abilities.

&nbsp&nbsp&nbsp&nbsp Offers learners self-pacing, so they can plan their study time to match their abilities and limitations

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

17

8.5

8.5

8.5

Disagree

24

12.0

12.0

20.5

Neither Agree/Disagree

62

31.0

31.0

51.5

Agree

61

30.5

30.5

82.0

Strongly Agree

36

18.0

18.0

100.0

Total

200

100.0

100.0

Fromthe table above, most of the respondents, 22, neither agreed nordisagreed that the training learners self-spacing to enable them plantheir study time so as to match their limitations and abilities. 61agreed, 36 strongly agreed, 24 disagreed and 17 strongly disagreed.The findings are reflected by the cumulative percentages where 51.5percent either disagreed or were undecided.

Opportunitiesfor repetition and remedial work based on individual needs

Thetable below presents the results of the training presentingopportunities for repetition and remedial work based on individualneeds

&nbsp&nbsp&nbsp&nbsp Offers opportunities for repetition and remedial work, according to individual needs

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

17

8.5

8.5

8.5

Disagree

32

16.0

16.0

24.5

Neither Agree/Disagree

45

22.5

22.5

47.0

Agree

89

44.5

44.5

91.5

Strongly Agree

17

8.5

8.5

100.0

Total

200

100.0

100.0

Cumulatively,those who agreed were 53 percent while those who either disagreed orwere undecided comprised of 47 percent.

Other results

Strongly disagree

Disagree

Neither Agree/Disagree

Agree

Strongly Agree

Offers the opportunity to study in greater depth if special interest in an aspect is aroused

21

33

41

64

41

Fosters the development of self-discipline in study habits

8

36

38

28

90

Ensures the availability of personnel in resource centres at reasonable times to assist with individual learning difficulties

6

21

48

91

34

Provides educators with greater job satisfaction and a sense of achievement, since learners who study better deliver better results as employees

29

7

54

76

34

Gives educators an opportunity to provide students with individual attention

18

35

35

88

24

5.4Pathology Technician, role, and experience

Thebelow tables presents the responses obtained regarding the needs forthe training in promoting role and experience of the pathology(medical) technician.

&nbsp&nbsp&nbsp&nbsp It is critical that Pathology (Medical) Laboratory Technician communicate effectively with clinicians to verify clinical history, appearance, and requirements

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

5

2.5

2.5

2.5

Disagree

11

5.5

5.5

8.0

Neither Agree/Disagree

20

10.0

10.0

18.0

Agree

52

26.0

26.0

44.0

Strongly Agree

112

56.0

56.0

100.0

Total

200

100.0

100.0

Thegreatest number of respondents 112 strongly agreed and 52 agreed thatcommunication was necessary to verify the clinical history,appearance and requirements. However, 4 strongly disagreed, and 11disagreed while 20 of the respondents neither agreed nor disagreed.This is reflected by the cumulative percentages where 82 percentagreed and 18 percent either disagreed or were undecided.

&nbsp&nbsp&nbsp&nbsp Pathology Laboratory Technician must have good judgment, be conscious of the patient’s welfare and always strive to provide an accurate diagnosis

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

32

16.0

16.0

16.0

Disagree

12

6.0

6.0

22.0

Neither Agree/Disagree

37

18.5

18.5

40.5

Agree

97

48.5

48.5

89.0

Strongly Agree

22

11.0

11.0

100.0

Total

200

100.0

100.0

Fromthe table above, the level of agreement on the need for properjudgment in providing accurate diagnosis was high, 97 agreed and 22strongly agreed. 32 and 12 strongly disagreed and agreedrespectively, while 37 neither agreed nor disagreed. Cumulatively,this is equivalent to 59.5 percent agreement.

&nbsp&nbsp&nbsp&nbsp Pathology (Medical) Laboratory Technician must constantly seek out new knowledge and adopt new practices as they become available

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

22

11.0

11.0

11.0

Disagree

16

8.0

8.0

19.0

Neither Agree/Disagree

12

6.0

6.0

25.0

Agree

149

74.5

74.5

99.5

Strongly Agree

1

.5

.5

100.0

Total

200

100.0

100.0

Thegreatest number of respondents, 149, agreed and 1 strongly agreedthat a medical lab technician must constantly seek knowledge andadopt any new practices based on their availability. On the otherhand, 22 strongly disagreed, and 16 agreed while 12 neither agreednor disagreed. Cumulatively, this is equivalent to 75% agreement.

&nbsp&nbsp&nbsp&nbsp Pathology Laboratory Technician must manage the clinician’s expectations and ensure that they are realistic

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

5

2.5

2.5

2.5

Disagree

30

15.0

15.0

17.5

Neither Agree/Disagree

58

29.0

29.0

46.5

Agree

97

48.5

48.5

95.0

Strongly Agree

10

5.0

5.0

100.0

Total

200

100.0

100.0

Thetable above illustrates that 97 respondents agreed, and 10 stronglyagreed the need to manage the expectations of the clinician to ensurethat they remain realistic. Nevertheless, 35 respondents were opposedto the idea. This translates to the cumulative percent of 53.5%agreement.

&nbsp&nbsp&nbsp&nbsp My clinical experiences in pathology laboratories were primarily working rather than learning experiences

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

31

15.5

15.5

15.5

Disagree

23

11.5

11.5

27.0

Neither Agree/Disagree

16

8.0

8.0

35.0

Agree

62

31.0

31.0

66.0

Strongly Agree

68

34.0

34.0

100.0

Total

200

100.0

100.0

Thetable above shows that 54 respondents believed that working as apathology technician was mostly working instead of being a learningexperience. However, the highest number of respondents, 130, wasopposed to this, and 16 respondents neither agreed nor disagreed.This is equivalent to 65 percent agreement.

&nbsp&nbsp&nbsp&nbsp My Pathology (Medical) Laboratory Technician program was a positive learning duplicated

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

5

2.5

2.5

2.5

Disagree

35

17.5

17.5

20.0

Neither Agree/Disagree

38

19.0

19.0

39.0

Agree

111

55.5

55.5

94.5

Strongly Agree

11

5.5

5.5

100.0

Total

200

100.0

100.0

Thetable above shows that most respondents, 122, believed that theprogram was a duplicated positive learning, 40 disagreed while 38neither agreed nor disagreed. This is equivalent to the cumulativepercent of 61 percent agreement.

&nbsp&nbsp&nbsp&nbsp My Pathology(Medical) Laboratory Technician program was a positive learning experience

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

30

15.0

15.0

15.0

Disagree

40

20.0

20.0

35.0

Neither Agree/Disagree

14

7.0

7.0

42.0

Agree

113

56.5

56.5

98.5

Strongly Agree

3

1.5

1.5

100.0

Total

200

100.0

100.0

Thehighest number of respondents, 116, believed that the program was apositive learning experience, 70 disagreed while 14 neither agreednor disagreed. Cumulatively, this is equivalent to 58 percentagreement.

&nbsp&nbsp&nbsp&nbsp Working as a Pathology (Medical) Laboratory Technician provides a sense of accomplishment

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

3

1.5

1.5

1.5

Disagree

4

2.0

2.0

3.5

Neither Agree/Disagree

20

10.0

10.0

13.5

Agree

134

67.0

67.0

80.5

Strongly Agree

39

19.5

19.5

100.0

Total

200

100.0

100.0

Thetable above shows that most people, 173, agreed that working as apathology lab technician gives a sense of accomplishment, 7 disagreedwhile 20 neither agreed nor disagreed. Cumulatively, this isequivalent to 86.5 percent agreement.

&nbsp&nbsp&nbsp&nbsp There are very good opportunities for advancement in the Pathology (Medical) Laboratory Technician

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

3

1.5

1.5

1.5

Disagree

6

3.0

3.0

4.5

Neither Agree/Disagree

18

9.0

9.0

13.5

Agree

120

60.0

60.0

73.5

Strongly Agree

53

26.5

26.5

100.0

Total

200

100.0

100.0

Thegreatest number of respondents, 173, believed that there are goodadvancement in pathology lab technician, 9 disagreed while 18 neitheragreed nor disagreed. Cumulatively, this is equivalent to 86.5percent agreement.

&nbsp There are good job openings for Pathology (Medical) Laboratory Technician

Frequency

Percent

Valid Percent

Cumulative Percent

Valid

Strongly Disagree

3

1.5

1.5

1.5

Disagree

8

4.0

4.0

5.5

Neither Agree/Disagree

21

10.5

10.5

16.0

Agree

93

46.5

46.5

62.5

Strongly Agree

75

37.5

37.5

100.0

Total

200

100.0

100.0

Thetable above shows that 168 respondents agreed that there are good jobopenings for the pathology lab technician, 11 disagreed while 21neither agreed nor disagreed. Cumulatively, the level of agreement is84 percent.

5.5Results of open-ended questions

The research collected qualitative data in non-numerical form,commonly referred as open-ended responses. Thus, for the research toremain consistent, qualitative data analysis was used. The analysisinvolved explanations and clarification of the used data by using athematic analysis. The thematic analysis utilizes a thoughtful andflexible process to capture an in-depth aspect of the qualitativeinformation or data. In the open-ended questions, the researcherasked the participants four questions and then analyzed the answersusing the thematic approach.

Whatare the most important perceived needs in training and tests?

The participants identified quality systems needs in medicallaboratory, application of a quality management system, andidentification of the sources of errors in laboratory processes asthe most significant perceived needs. In order of priority, 75percent and more of the participants perceived they required trainingon quality systems’ needs, application of quality managementsystems, and identification of errors in laboratory processes. Thetable below illustrates the three most perceived needs as viewed bythe participants

Priority 1

≥ 75 percent

Priority 2

65 – 74 percent

Priority 3

55 – 64 percent

Priority 4

≤ 54 percent

Quality systems needs in medical laboratory

Utilization of external quality evaluations to enhance testing processes

Evidence-based laboratory medicine

Professionalism and ethics

Application of a quality management system

Customer care

Disease and laboratory maintenance

Supervision

Identification of the sources of errors in laboratory processes

Specimen management

Monitoring and assessment

Medical coding

Whatare your suggestions to increase Medical Laboratory Technologists’satisfaction and motivation and to make it a better job?

Most participants viewed professional developmentas the most important factor to increase satisfaction and motivation.Employment engagement, incentives, working environment, andappreciation from the administration also featured prominently inorder of priority.

Suggestions to increase satisfaction and motivation

Professional development

88 percent

Employment engagement

74 percent

Incentives

70 percent

Working environment

68 percent

Appreciation from the administration

60 percent

Whatstrategies should educators employ to ensure quality assurancetraining for medical laboratory technologists In the future?

Three approaches featured prominently. Mostparticipants, more than 70 percent viewed continuing professionaldevelopment as the most significant and assistive strategy inensuring quality assurance. Other strategies included systematizedevidence-based training workshops, and virtual assistive approaches

Howdo you view the quality control training for Pathology LaboratoryTechnicians?

Majority of the participants viewed the qualitycontrol training in a negative manner but asserted that if itfollowed a systematized procedure, it would be the highlight of aLaboratory Technician. Issues such as poor controls, lack ofmanagement, non-effectual communication flow, and lack of enough casestudies featured prominently.

5.6Reliability Statistics

QualityAssurance Content

Reliability Statistics

Cronbach`s Alpha

Cronbach`s Alpha Based on Standardized Items

N of Items

.987

.987

15

Thealpha coefficient for 35 items is 0.987, equivalent to 98.7%, whichimplies that that the items to be trained on in the quality assurancecontent have a high degree of internal consistency. Studies show thata reliability coefficient of 70% and more is ‘acceptable’.

Quality Assurance Project

Reliability Statistics

Cronbach`s Alpha

Cronbach`s Alpha Based on Standardized Items

N of Items

.992

.993

10

Thealpha coefficient for 35 items is 0.992, equivalent to 99.2%. Thisimplies that that the items to be trained on in quality assuranceproject have high degree of internal consistency. Studies show that areliability coefficient of 70% and more is ‘acceptable’.

PathologyLaboratory Technician

Reliability Statistics

Cronbach`s Alpha

Cronbach`s Alpha Based on Standardized Items

N of Items

.978

.982

10

Thealpha coefficient for 35 items is 0.995, equivalent to 99.5%, whichimplies that that the roles and experiences of medical labtechnicians have a high degree of internal consistency. Studies showthat a reliability coefficient of 70% and more is ‘acceptable’.

5.7 One sample test at 95% confidence level results Means at 95% Confidence Level: Quality Assurance Content One-Sample Test

Test Value = 0

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

&nbsp&nbsp&nbsp&nbsp Evidence-based laboratory medicine

66.687

199

.000

3.925

3.81

4.04

&nbsp&nbsp&nbsp&nbsp A results-oriented approach to learning, which is learning-centered, is crucial in educating pathologists

73.809

199

.000

4.070

3.96

4.18

&nbsp&nbsp&nbsp&nbsp Basic knowledge that will enable analysts to explore the quality assurance discipline

54.872

199

.000

3.260

3.14

3.38

&nbsp&nbsp&nbsp&nbsp Safety

66.261

199

.000

4.130

4.01

4.25

&nbsp&nbsp&nbsp&nbsp Learning to name the parameters for measuring accuracy and precision concepts

41.854

199

.000

3.735

3.56

3.91

&nbsp&nbsp&nbsp&nbsp Assessment and selection of analytical approaches and instruments

36.574

199

.000

3.190

3.02

3.36

&nbsp&nbsp&nbsp&nbsp Definition, establishment and use of reference ranges

39.574

199

.000

3.370

3.20

3.54

&nbsp&nbsp&nbsp&nbsp Quality achievement techniques

43.409

199

.000

3.495

3.34

3.65

&nbsp&nbsp&nbsp&nbsp Data management, report writing and presentation skills

37.540

199

.000

3.240

3.07

3.41

&nbsp Point-of-care testing

34.684

199

.000

3.035

2.86

3.21

&nbsp Statistics in laboratory medicine

52.017

199

.000

3.635

3.50

3.77

&nbsp Specimen management

54.530

199

.000

3.785

3.65

3.92

&nbsp Laboratory and disease surveillance

53.462

199

.000

4.165

4.01

4.32

&nbsp Equipment maintenance

48.898

199

.000

3.765

3.61

3.92

&nbsp Expressing the relationship between accuracy and precision concepts and the role of these concepts in quality goals

40.829

199

.000

3.400

3.24

3.56

Forquality assurance content, the test value was zero and it can beobserved that the means are greater than the hypothesized ‘0’value, meaning that all the training were critical and should beincluded in design of quality assurance content.

QualityAssurance Project

One-Sample Test

Test Value = 0

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

&nbsp&nbsp&nbsp&nbsp Offers various advantages to the learners and educators as well as to society hence, it should be used in laboratory learning

40.901

199

.000

3.635

3.46

3.81

&nbsp&nbsp&nbsp&nbsp Offers knowledge about the outcome so that the reason for studying the material is understood, and the total picture is made clear

41.488

199

.000

3.350

3.19

3.51

&nbsp&nbsp&nbsp&nbsp Offers knowledge about the results of the evaluation and gives the motivation to achieve them

39.470

199

.000

3.150

2.99

3.31

&nbsp&nbsp&nbsp&nbsp Offers learners self-pacing, so they can plan their study time to match their abilities and limitations

41.062

199

.000

3.375

3.21

3.54

&nbsp&nbsp&nbsp&nbsp Offers opportunities for repetition and remedial work, according to individual needs

42.237

199

.000

3.285

3.13

3.44

&nbsp&nbsp&nbsp&nbsp Offers the chance to study in enhanced depth if special interest in an aspect is aroused

37.428

199

.000

3.355

3.18

3.53

&nbsp&nbsp&nbsp&nbsp Fosters the development of self-discipline in study habits

41.243

199

.000

3.780

3.60

3.96

&nbsp&nbsp&nbsp&nbsp Ensures the availability of personnel in resource centers at reasonable times to assist with individual learning difficulties

52.179

199

.000

3.630

3.49

3.77

&nbsp&nbsp&nbsp&nbsp Provides educators with greater job satisfaction and a sense of achievement, since learners who study better deliver better results as employees

38.859

199

.000

3.395

3.22

3.57

&nbsp Gives educators an opportunity to provide students with individual attention

40.379

199

.000

3.325

3.16

3.49

Forquality assurance project, the test value was zero and it can beobserved that the means are greater than the hypothesized ‘0’value. A mean greater than ‘0’ value means that all the trainingare critical and should be included in design of quality assuranceproject.

PathologyLaboratory Technician

One-Sample Test

Test Value = 0

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

&nbsp&nbsp&nbsp&nbsp It is critical that Pathology (Medical) Laboratory Technician communicate effectively with clinicians to verify clinical history, appearance and requirements

59.440

199

.000

4.275

4.13

4.42

&nbsp&nbsp&nbsp&nbsp Pathology Laboratory Technician must have good judgment, be conscious of the patient’s welfare and always strive to provide an accurate diagnosis

38.053

199

.000

3.325

3.15

3.50

&nbsp&nbsp&nbsp&nbsp Pathology (Medical) Laboratory Technician must constantly seek out new knowledge and adopt new practices as they become available

46.943

199

.000

3.455

3.31

3.60

&nbsp&nbsp&nbsp&nbsp Pathology Laboratory Technician must manage the clinician’s expectations and ensure that they are realistic

53.834

199

.000

3.385

3.26

3.51

&nbsp&nbsp&nbsp&nbsp My clinical experiences in pathology laboratories were primarily working rather than learning experiences

34.822

199

.000

3.565

3.36

3.77

&nbsp&nbsp&nbsp&nbsp My Pathology (Medical) Laboratory Technician program was a positive learning duplicated

52.438

199

.000

3.440

3.31

3.57

&nbsp&nbsp&nbsp&nbsp My Pathology(medical) Laboratory Technician program was a positive learning experience

36.691

199

.000

3.095

2.93

3.26

&nbsp&nbsp&nbsp&nbsp Working as a Pathology (Medical) Laboratory Technician provides a sense of accomplishment

79.219

199

.000

4.010

3.91

4.11

&nbsp&nbsp&nbsp&nbsp There are very good opportunities for advancement in the Pathology (Medical) Laboratory Technician

73.809

199

.000

4.070

3.96

4.18

&nbsp There are good job openings for Pathology (Medical) Laboratory Technician

67.340

199

.000

4.145

4.02

4.27

Figure 1: Quality Assurance Content

Figure 2: QualityAssurance Project

Figure 3: Role and Experience of Pathology LaboratoryTechnician

5.8Summary

Thischapter presented the results of the data analysis process that thestudy described in the previous section. For clarity and simplicity,the author has used tables to present the results of the descriptiveanalysis and reliability tests. The first section includes theresults of the design of quality assurance content of the course, thequality assurance project and the pathology (medical) laboratorytechnician’s roles and experience. The quality assurancecontent had an index of 0.987, quality assurance project had 0.982and role and experience of pathology lab technician was 0.993.Comparing the three in terms of reliability, roles and experience ofpathology lab technician is the most reliable, followed by qualityassurance content and finally the quality assurance project. However,it can be observed that the Cronbach’s values are considerablyhigher than 0 hence, reliability of the training across the threecategories. On the other hand, the scale tests at 95% confidenceintervals, reflects the significance of the training since the meansare higher than 2.5 or 50% of the scale and provide the means fromwhere the researcher based priority. These resultswill form the basis for discussion in the following chapter andconclusion in the last chapter.

Theresults reflect the observations, discussions and conclusions made bysome of the literature that was reviewed in the second chapter. Someof the elements that were reflected in the results that elicitedsimilar opinions from the literature review were the roles ofpathology technicians as per their experience. In the literaturereview section, some authors asserted the need of having a thoroughlyexperienced laboratory staff to enhance quality assurance. Similarly,with a resounding confirmation, the results confirmed the role thatthe technicians play in improving laboratory quality. At the sametime, the results section confirmed that evidence laboratory medicineplayed a critical role in improvement of laboratory quality, same asthe information given in the second section of the chapter. Thedesign and role of the quality assurance project also producedresults that reflected a summary of other authors’ opinions fromthe literature review.

CHAPTER6: DISCUSSION6.1Introduction

This chapter discusses the finding from the data analysis that wasconducted in the previous findings. While providing an independentinterpretation of the study research findings, the author used somesupport from literature to back up the rationale. It was also ofsignificance to acknowledge the opinions that the researchparticipants provided, as they were part of the foundation ofhypothesis creation. Additionally, throughout the discussion process,the author suggests proposals that are of significance in thecreation of a Continuous Professional Development program as well asthe development of a Quality Assurance content and Quality AssuranceProject for Saudi Arabia’s laboratories. While discussing theimplication of the results from the previous chapter, this chapteralso compares other scholars’ opinions that the author reviewed inthe literature review section.

6.2Quality Assurance Content of the Course

Thispart will highlight the findings of the quality assurance content aswell as its importance to CPD. Quality Assurance content ensures thatcontent provided by an organization meets quantified requirementsbefore publication through a systematic procedure. In this regards,it measures the quality of content and ensure that an organizationcompletes the content deliverables on time and with the acceptedlevel of quality. Since the analysis of data regarding qualityassurance content revolved around 15 items, the discussion willillustrate the findings as well as provide an argument on theresults.

6.2.1Evidence-based laboratory medicine

From the data analysis, a majority of the respondents agreed that theevidence-based laboratory medicine ought to be a portion of thestrategy of the QA content. In medical practice, professionals andexperts describe evidence-based laboratory medicine as an approachthat reduces the importance of unsystematic clinical approach(Badrick, 2013). This viewpoint is true because thepathophysiological rationale is not strong enough for clinicaldecision-making. Instead, evidence-based medicine stresses theimportance of having concrete proof while doing medical research.Evidence-based laboratory medicine, having been around since thenineties, several developed countries have practiced it to asuccessful extent. Applying it in the Saudis Arabian system wouldimprove the medical laboratories QA, as it would help thepathologists to explain associations, say, between symptoms andrelated abnormalities.

In designing a CPD program, this paper proposes an approach thatfocuses on five major principles of evidence-based laboratorymedicine. The first one is creating an inquiry content, whichsuffices to ask questions that need answers. The second step islooking up for evidence to support rational thinking, after which thepathologists can evaluate the evidence. The fourth step is theapplication of the evidence, and finally, doing a follow-up toexamine the experience. Following these steps, the implementers canuse evidence-based laboratory testing as a tool to improve patientoutcomes. The diagram below summarizes the key pillars of creatingthe evidence-based laboratory testing procedure.

Figure 3: Proposed evidence-based laboratory medicine procedures for Saudi Arabian pathology laboratories

In general, evidence-based laboratory medicine is important mainlybecause it characterizes intrinsic logic, and all the processesinvolved are well-defined, and as such, boost QA.

6.2.2Result oriented approach in learning

Oneof the assumptions made in the research was that a result-orientedapproach to learning, which is learning-centered, is crucial ineducating the Saudi Arabian pathologists. An 86.5% field approvalrating approved this assumption. In pathology, instructionalperspectives and process approaches are the main dominant features ofteaching innovations. Therefore, by focusing on the main concepts andtheories, the trainers are in a position of communicating knowledgeand abilities in an effectual manner. Moore, Dalley &amp Agur (2013)relate this approach to the use of hands-on activities, which helpthe laboratory practitioners in training to have a betterunderstanding the mechanisms of knowledge acquisition in laboratorymedicine. A result-oriented approach to learning in Saudi Arabiawould assist the pathologists to acquire a variety of skills thatresonate those of international standards.

Whileconducting the study, the researcher noted teaching and learning aremutually exclusive, as they have specific characteristics thatillustrate each. In this regards, the paper suggests that trainingactivities in Saudi Arabia should not undermine either, instead,apply a systematic comparison to consolidate them. Teaching withinthe framework of result-orientation, therefore, puts emphasize onexploring the learners’ motivation, with the aim of encouragingmore participation from them. A quality assured teaching and learningplan, therefore, promotes both theoretical and practical excellencein the laboratory.

6.2.3Basic knowledge for exploring QA

Scholarsthink of basic knowledge as a key tool in helping laboratory analysisto explore the QA discipline (Martensson, Roxa &amp Stensaker,2014). However, after analyzing the data from the field study, it wasestablished that there were mixed feelings regarding theappropriateness of this concept. The researcher concludes that thefindings of the study on this particular issue are highly associatedwith personal preference, which in turn, has a strong relationshipwith improved knowledge, skills and QA issues. In this regard, thelearners demonstrate an eager urge to learn the contribution that QAhas to their personal development. This observation points to thefact that professional development in Saudi Arabia pathologicallaboratories are in its early stages, and regardless that it isprospective enough.

Giventhis, experts designing a professional development program need tointegrate the expectations of the pathologists with the realities onthe ground. The paper, therefore, proposes a more detailed researchto fine-tune the findings of this particular element in QAdevelopment. At the same time, the preliminary results that QA is anintegral part of health care should provide a guideline forresearchers and experts looking to develop a CPD program.

6.2.4Laboratory safety

A QA project needs to take into consideration safety requirements. Assuch, the study, supported by research findings, proposes animplementation of new safety standards for laboratories in SaudiArabia. Besides setting up infrastructure and other technicalities toenhance laboratory safety, the trainers need to prepare thepathologists by teaching them the underlying concepts of safety.While doing this, the pathologists will be able to understand thesafety frameworks that the experts will set up, and in the process,guarantee procedure safety.

Laboratorysafety encompasses the well-being of both the patients and theclinicians. While being detrimental to facility integrity, erroneouslaboratory procedures pose risks of harm to both the patients and theclinicians. As such, while using automated equipment, thepractitioners have to ensure that they do not harm the patients andthat they protect themselves. The standard College of AmericanPathologists (CAP) mean laboratory risk-related error stands at 6.7%(McCormick et al., 2015). However, it is probable that there arecontinuous measures to reduce this figure. Based on this, SaudiArabia’s practitioners should aim to produce fewer errors thanthose stated by the CAP board. This measure is possible byimplementing laboratory QA practices that tract risk-related errorsand initiating programs to train the pathologists to reduce the same.

6.2.5Parameters accuracy and precision concepts

The study included a research item to evaluate the need for thelearners to learn to name the parameters for measuring accuracy andprecision. In the laboratory setting, several instruments emerge fromthe market. Manufacturers design these instruments to improve thereliability and validity of test data. The learners need to have anunderstanding of the basic concepts that guide their calibration touse these instruments with high precision. This knowledge places themin a position of making independent interpretations when using thisequipment in the laboratory.

Additionally, given the variability of test objectives in thepathological laboratories, levels of precision vary from one test toanother. As such, performing a balancing act needs the pathologiststo be highly knowledgeable in matters of calibration and precision.As such, there are some elements that the paper proposes to beincluded in CPD program for the inclusion of two main learningobjectives. The first one is the identification of sources of errorin tests, and the second one is a description of automated equipmentaccuracy and precision. Following these guidelines, the Saudi Arabiapathologists in continued professional training programs will have aninclusive understanding of the notions of meticulousness and accuracyin clinical practice.

The guidelines below should guide a comprehensive precision andaccuracy-training program for Saudi Arabia pathologists.

Table1: Proposes structured precision and accuracy training through threephases

Phase 1 of training

Phase 2 of training

Phase 3 of training

Item/Objective

Understanding concepts of automated equipment precision and accuracy

Distinguishing invasive and non-invasive lab tests

Distinguishing quantitative, qualitative and semi-qualitative lab procedures

Refine reference range and factors affecting it

Define sensitivity and specificity parameters

Identification of potential errors

Identification of patient-specific factors to be considered

Describe rational and independent approaches for assessment

6.2.6Evaluation and selection of analytical methods and materials

QA greatly relies on assessment and selection of some elements, amongthem being methods and materials in research. The laboratorytechnicians, in this sense, have the liberty of choosing specificanalytical methods and materials for the laboratory procedures. Thisdoing means that they have to be equipped with sufficient knowledgeto help them make informed and independent choices. There arespecific elements that are associated with analytical methodchoosing. The first and perhaps most important one is selecting amethod a suitable matrix. Here, the pathologist selects a test methodthat he or she thinks will help him or her in carrying out the testmost efficiently. The other engagements include selecting anappropriate measurement range, eradication of interferences anduser-friendliness.

Method validation is needed to verify to performance parameters anddeciding whether they are adequate for a particular analyticalprocedure or not. The validation is mostly necessary when apre-constituted method is used in a different laboratory, and whenthe pathologists need to demonstrate equivalence between two methods.From the study data analysis, a big percentage of the respondentsfelt that inclusion of evaluation and selection of analytical methodsand materials in training programs would help them improve thequality of their service. Below is a proposed fitness for purposemethod-selection diagram.

Figure 4: Fitness for purpose concept.

6.2.7Reference ranges

A high percentage of the respondents were supportive of the idea toinclude definition, establishment and use of reference ranges in aCPD program. Among the Saudi Arabian students, reference rangestraining will prove to be substantial for the improvement of qualityresults in patient care. Pagana &amp Pagana (2012) say thatestimation methods are quite expensive and hard to implement. Giventhe aim of the study, which was to propose a continued professionaldevelopment program with the objective of streamlining performance inSaudi Arabia, avoiding unnecessary costs and setbacks is imperative.

For training pathologists, the recommended approach focuses ondetermining reference ranges, which is the first step towardsdefining the population that applies to the test. While doing this,the pathologists will be trained methods of testing the populationsbefore working out particular laboratory tests. Intensive training inthis area will help the pathologists to avoid common misconceptionsabout test results and reference ranges, such as assuming thatabnormal test results are signs of medical problems.

6.2.8Quality achievement techniques

All laboratory Quality Improvement Training programs have to addressprocedural, performance and supervisory issues.There are agenciesthat regulate the procedures conducted in the laboratories. Forinstance, in the U.S., the Center for Medicare and Medicaid Services(CMMS) regulate medical diagnostic laboratories (Szanton et al.,2015). Founded on this reflection, the paper proposes a creation ofsuch a board in Saudi Arabia to regulate the performance of itslaboratories. Additionally, there are some tools that the paperidentifies, which are capable of driving quality achievement in themedical laboratories. The tools are-

  1. Maintenance schedules

  2. Calibrations

  3. QA program

  4. Training and quality control

  5. Procedure manuals

The above tools have the capacity to enhance good laboratorypractices, whereby the pathologists will be able to test normal andabnormal controls for daily results. A thorough inclusion andimplementation of the tools mentioned above will help the SaudiArabia technologists to create QC databases, which will form a basisfor future improvements.

6.2.9Data management, report writing and presentation skills

From the literature review, data management, report writing, andpresentation skills were identified as the key elements of QC. Asregards to report-writing, a smooth but swift transition fromtraditional laboratory reports to modernized, IT-intensive techniquesought to be included in the continued professional developmentprograms. The makers of the training programs have the freedom ofcollaborating with IT companies to create a platform for thepathologists to write their reports and present them. At the sametime, developed countries have out-phased traditional data managementprocedures, which are commonly manual file keeping. This sets thepace for Saudi Arabia pathology experts to follow suit and includedata management programs that resonate with those of the developedcountries. The bottom line, as pertains to CPD program in datamanagement, report writing, and presentation skills, is that IT leadsthe way in automation and future practice.

6.2.10Point-of-Care Testing

Scholars have identified some advantages of Point-of-Care testing inlaboratories. The method dates back to the 16th century,most notably among Egyptian practitioners (Yadav et al., 2015). Thegoal of Point-of-Care testing is providing immediate and conventionaldiagnostic testing, aimed at reducing therapeutic turnaround time.Including Point-of-Care testing in the development of QA content inSaudi Arabia will be objective. The main purpose will be to providerapid diagnostic information, which will help the practitioners tomanage critical decisions, which goes a long wait in ensuring patientsafety and treatment.

Point-of-CareTesting will out-phase the traditional centralization of testing inthe laboratory. Developed countries have done away with the lattermethodology, by using automation in testing. In the modern laboratoryequipment market, there are several kits that medical companies havedeveloped that embrace mobility and out-of-office workingenvironments. These environments include hospital bedsides, schools,ambulances and home settings. Point-of-Care testing procedures areproducts of waived testing (Yadav et al., 2015).This technique hascontributed to the improvement patient care in many countries. Aspertains to the purpose of this study, the aim will be to ensure thecreation of high quality and cost effective. The table belowsummarizes the implementation of this particular element of training.

Item

Specification

Point of care testing committee

  • Chaired by a clinical laboratory director

  • Quarterly committee meetings

  • Training of laboratory staff

  • Reviews and reporting of committee progress

Guidelines

  • Proposals to establish decentralization be referred to committee for approval

  • Laboratory attendants to assess technology for decentralization

  • Point of care committee to oversee the assignation of laboratory staff

  • Test procedures to follow standard format

  • Continuous proficiency testing

Figure5: Proposed point-of-care implementation

6.2.11Statistics in laboratory medicine

Laboratory experts mention Statistical Quality Control (SQC) andStatistical Process Control (SPC) while referring to quality controlin modern laboratories. Experts identify SQC as a process that cutsdown the level of variability of a procedure by focusing on revealingany deviations from the defined standards (Miltra, 2012). Improvingthe level of QA in the Saudi laboratories would receive a boost byincluding statistics in laboratory medicine training. This move isderived from an observation that for centuries, manufacturers oflaboratory equipment have attempted to improve their tools bydetecting defects. However, given that they cannot eliminate allmanufacturing errors the last line of measure is a correction of theerrors in the laboratories through statistical methods.

SaudiArabia laboratories need to embrace automation as a trend in clinicallaboratory medicine. In light of this, SQC is a useful tool that canaid the practitioners in medical production. SQC, in the application,is almost similar to the laboratory techniques that practitionersperform using biomedical analyzers. However, the main difference islaboratory determination procedures, which are quite different owingto the major biological difference in human beings. Given this, SQCcomes in handy when dealing with the equipment and analyticalmethods.

6.2.12Specimen management

Standard Operating Procedures (SOPs), as identified in the literaturereview, are one of the shows of commitment to QA. Through this, a QAteam can oversee laboratory procedures and monitor the marketregulations, which are critical factors in adapting to new standards.There are specimen management measures strategies that if included inthe Saudi Arabia laboratory, would help the practitioners to improvethe quality of their services.

Amongthe strategies mentioned above is sample temperature and lightingmonitoring systems. These two aspects are crucial in the managementof delicate samples from different sources. Secondly, compliance andQA, aided by SOPSs, is instrumental in maintaining sample integrityand complying with international standards. The third element ofsample management training is tracking and guaranteeing of sampleretrieval. Given that, many samples are often moved from onelaboratory to another, maintaining integrity in the logistics isimportant in upholding quality. Finally, security and laboratorycontinuity plans are important in specimen management in intensiveactivity laboratories.

6.2.13Laboratory and disease surveillance

Respondents from the research identified the need to includelaboratory and disease surveillance in the design of a QA content. Inmedicine, disease surveillance is a crucial tool for identificationof diseases, especially those with the potential of harming masses.In the proposed QA content, it will be significant to train thecontinuous practitioners a system of capturing reports of notifiablediseases, which will be the baseline for mass surveillance. Also, itwill be crucial to ensuring that the system does not focus only onphysician reporting, as this would greatly minimize the area ofscope. This measure is in the realization that the main competency tothat the trainees will acquire will be the identification of publichealth risks and designing of steps to curb them. The main learningobjectives for the proposed QA content will include epidemiologicalsurveillance and understanding of the concepts of laboratory-basedsurveillance.

6.2.14Equipment maintenance

Correct laboratory maintenance systems not only increase researchefficiency and reduce operating costs but also help laboratoriesadvance the excellence of their services. There are variousapproaches applicable to equipment maintenance in clinicallaboratories. The first one is Run-to-Fail. This approach iscost-oriented, as it requires a structured choice in the replacementof erratic equipment. In training, the learners are taught how toidentify items that are past their depreciation age or frequentlybreak down, to be replaced with better equipment. The second approachis preventive maintenance. By collaborating with manufacturers,laboratories can save a lot and improve QA by utilizing the equipmentin line with a contract signed with the contractor. Finally,Full-service contract approach allows users and laboratory equipmentmanufacturers to sign an agreement for continuous servicing of theequipment. Implementing these approaches will help Saudi Arabia’slaboratories to maintain high standards of quality.

6.2.15Relationship between accuracy and precision concepts and their rolein QA

An overwhelming percentage of research participants were of a strongopinion that the proposed QA content includes skills for expressingthe relationship between accuracy and precision concepts and theirroles in quality goals. Accuracy and precision, per se, involvesrefinement of the processes that applied in the laboratories. On theother hand, QA involves continuous inspection of the same processes.As such, continuous inspection and refinement of laboratory processesare the intrinsic interconnectors of accuracy and precision and QA.The diagram below demonstrates this relationship.

Figure 6: Showing the relationship between accuracy and precision and their role in QA.

6.3Quality Assurance Project

Qualityassurance project highlights the planning, execution, and evaluationprocesses for the desired project, in this case, training ofpathologists. This part presents the discussion on the findings ofQuality Assurance Project variable by illustrating the responses ofparticipants. The presentation of the items reveals some interestingfacts about quality assurance project as seen in the discussion thatfollows.

6.3.1Quality Assurance Project to learners and educators

From the findings of the study, the majority of respondents agreedthat quality assurance project offers numerous recompenses toeducationalists and learners as well as communities. Qualityassurance project forms the foundation for the development,execution, and evaluation processes for projects as well as qualityassurance and control activities thus, an imperative aspect oflaboratory learning. The findings suggest that quality assuranceproject is a ubiquitous aspect that is so enthroned in education.Through quality assurance, scholars have identified frameworks thatpotentially proffer means for laboratory learning: the BenchmarkingFramework as asserted by Dunn,Bottomley, Ali, &amp Walker (2011) and the Quality Frameworkpublished in the works of O’Keefe et al. (2014). These frameworksallow educationists and learners to reap from the aspects of qualityassurance project. By comparing the findings of the study, it isimportant to note that although quality assurance project proffersseveral advantages to learners and educators, it has to meet somepredestined standards to become significant. In this regards, theprovision of quality controls and assessment point to the success ofquality assurance project.

Studies quality assurance project allows learners, educators, andsocieties to fathom the different issues that may arise in alaboratory setting thus, cultivate frameworks to ensure qualitycontrols (Dunn et al., 2011). Pathologists engaging in laboratorysettings have found quality assurance project significant inproviding results, but such results have always hinged onstandardized manageability and assessments. In fact, most systemsrely strongly on quality controls and assessment that establishquality within any setting. Laboratory approaches opine that qualitystandards act as participative instruments for development andorganizational frameworks.

6.3.2Provision of knowledge on outcome

Knowledgemanagement has a strong relationship with quality assurance projectas revealed by the findings of the study. 52.5 percent of theparticipants agreed that quality assurance project proffers knowledgeon outcomes to ensure comprehension of the materials utilized intraining development for medical laboratory personnel. By utilizingquality assurance project, personnel understand the motive behindstudying a material. In fact, quality assurance project instils theappropriate knowledge necessary for quantifying the implications of astudy as well as promoting an understanding of such developments.Phelan (2014) opines that quality assurance allows the development ofa strategic plan for continued development as well as theproliferation of non-numerical data thus, an imperative aspect ofknowledge management. In this regards, quality assurance provides thenecessary information to personnel in comprehending the need forstudies and instruments. By providing the necessary knowledge inregards to laboratory settings and development, quality assuranceprojects allow personnel to understand all the aspects required toascertain the necessary instruments and materials for studies.

Theexploitation of a methodical project management strategy during theprogression of Laboratory quality assurance allows medical personnelto gather the information that helps in best practices and qualitysystem procedures. Participating in quality assurance projects allowpersonnel to anticipate in advance the methods for analysis,interpretation, and dissemination. Also, the findings suggest thatquality assurance project provides the necessary knowledge forapplication in new and shared processes beyond quality controls. Infact, O’Keefe et al. (2014) opine that a systematic quality controlallows the collection of information beyond what is mundane forpatient care thus, personnel can compare different treatments,processes, and interventions. Instilling knowledge during processesor studies allows one to propose ways that can ensure success throughoffering numerous aspects that support a dedicated framework.

6.3.3Knowledge on results evaluation and motivation

Themajority of the respondents strongly agreed that the trainingprovides knowledge on results evaluation and motivation to achievethose results. However, cumulatively, a mere 48 percent agreed, whichmeans that quality assurance project does not essentially provideresults for evaluation. Quality assurance project based on CPDprovides the requisite knowledge on results assessment and motivationto attain the results, but the provision of this knowledge is notnecessarily forthcoming as the findings suggest. Poortinga(2015) suggests that quality assurance project offers numerousways of applying new knowledge and providing personnel with theopportunities for professional development. However, the knowledgeacquired does not extend to results valuation as well as theprovision of motivation to personnel. As suggested earlier qualityassurance project improves knowledge management only to the extent ofbroadening skills and offering different approaches to personnel. Inthis regards, personnel do not enjoy motivation through qualityassurance project, as it does not involve engagement.

Qualityassurance project deals with the control, implementation, andassessment of the desired plan. Thus, it does not allow one toevaluate results in a didactic approach. In addition, the assuranceproject is more virtually than visually thus, any knowledge gatheredis not vital to the provision of motivation or result valuation.Studies on continuous professional development have revealed thatquality assurance project is crucial in offering training needs toprofessional but is does not provide motivation for the continuationof training or the evaluation of the results generated. Against thisbackdrop, it is essential to comprehend that despite the significanceof assurance project, the provision of knowledge on result evaluationand motivation to attain them rests elsewhere.

6.3.4Quality assurance project offerslearners self-pacing

Accordingto the findings, Quality Assurance Project training does not provideself-pacing to learners to allow them plan their study period tomatch their abilities and limitations. The majority (51.5 percent) ofthe respondents were either undecided or disagreed that qualityassurance provides self-pacing to learners. The data agrees tostudies conducted by Dunn et al. (2011) and O’Keefe et al. (2014),which reveals that quality assurance project, does not allow learnersto plan their study period to match their capacities and limitations,as it only deals with assessments and implementation. In addition,the training is not ideal for self-paced instruction where theresponse of the learner is significant thus, learners do not havethe ability to strategize. In this regards, the inclusion of qualityassurance project in training manuals and approaches should notextend to self-pacing instruction.

Accordingto the findings, Quality Assurance Project training does not provideself-pacing to learners to allow them plan their study period tomatch their abilities and limitations. The majority (51.5 percent) ofthe respondents were either undecided or disagreed that qualityassurance provides self-pacing to learners. The data agrees withstudies conducted by Wandersman, Chien &amp Katz (2012), whichreveals that quality assurance project, does little to allow learnersto plan their study period to match their capacities and limitations,as it only deals with assessments and implementation. Also, thetraining is not ideal in a situation where the learners have not beenoriented to the practical setting from previous stages of theirprofessional development.

6.3.5Repetition of remedial works according to individual need

The researcher set to investigate if the training offered theopportunity for repetition and remedial work based on individualneeds. The data analysis established that a majority of thepathologists felt that the quality assurance project substantialimpact on the repetition of remedial works according to individualneeds. One of the core functions of a training exercise is to helpthe trainees to acquire better skills and equip them with emergingconcepts in their field of work. While undergoing training, there isa high possibility that the trainees will be going through thetheoretical material that they covered while they were in theircollege years. These theories are, however, in the training years,put into practice. Additionally, besides giving them an opportunityto revisit the bookwork, the quality assurance project helps them tointerpret the concepts better and apply them sufficiently.

Additionally, while the quality assurance project helps the learnersto gain knowledge and skills using sharing with their peers, itoffers them an opportunity to develop in areas where they areweakest. Development that focuses on individual needs is one of themost objective professional growth strategies. Internationalprofessional development programs standard require that theseprograms include a kind of student retention policy, which addressesindividual development needs. Through this policy, the educationimplementers can evaluate each learner for their academic,professional and personal growth and relate this to the generaltraining objectives. In Saudi Arabia, the quality assurance projectwill address any requirements that the learners may need to help themdevelop according to individual needs.

6.3.6Quality assurance project and special interests in development

The research data analysis and results confirmed that the qualityassurance project offers an opportunity for learners to study ingreater depth if special interests in an aspect are aroused. Inmedicine, the training of skilled practitioners and development oftheir competencies is a key driver of success. Several healthclusters play different parts in bringing strategic vision toinspiring individuals. While some individuals may have alreadyidentified themselves with certain health clusters, some may come tofind out about their potential interests during training. This iswhat has motivated the development of special interest modules. Thesemodules are the additional experience that the pathologist, in thiscontext, competes to help them lead a local cluster of practitionersin clinical networking. A leader of such a group is someone who iswell equipped with knowledge and skills to not only apply to thelaboratories but also lead other pathologists in the same.

Theunderlying objective of a continued professional development programis to bring together researchers who work as contexts forprofessional learning. While doing this, the professionals inspirethe younger generation of practitioners from different theoreticaland methodological backgrounds to come together and identify newlearning opportunities in the quality assurance program. There arecertain elements that a Quality Assurance program ought to include tohelp the trainees to identify their personal interests and pursuethem deeper. Perhaps the most significant is a vocational educationin the training program, which integrates clinical and classroomcontexts. Secondly, the training program has to embrace diversity andencourage each learner on an individual level. It is through suchinitiatives that the learners can benefit from the quality assuranceprogram by identifying new interests and pursuing them further.

6.3.7Fostering of development of self-discipline in study habits

The study established that an overwhelming percentage of respondentsfelt that the quality assurance program indeed helped to promote thedevelopment of self-discipline in study habits. In professionaldevelopment, self-discipline is a kind of self-training and creationof new thoughts that help one to reach their goals. Authors have alsoassociated the concept of self-discipline with task-orientation(Strong et al., 2013). During the training period, the Saudi Arabiapathologists will undergo a process of identifying priorities andplanning for them promptly. Through continued evaluation andassessment, the trainers, in their capacity as mentors, will be in aposition of helping the learners to polish their areas of weaknessesand prepare them for a priority-focused career. Additionally,according to Dany (2014), the key to success in a professional careeris having a long-time perspective, which is integrated with theability to identify weaknesses and develop on them.

Medical practitioners can apply the concept of self-discipline insome situations. For instance, they can use it to explore timemanagement, which over time has proven an overwhelming task thatnegatively affects the quality of work. Additionally, by building ontime management, the practitioners will be able to buildself-confidence, which is positive for quality assurance. Secondly,through self-discipline, the practitioners can schedule their work.In the context of pathology laboratory work, there is much work thatinvolves handling several samples, preparing them, carrying out testsand passing on results to the physicians. All this work needs apathologist who is highly disciplined in terms of scheduling, as ameasure to avoid delays, misplacement and mishandling of the samples,among other things that lower the quality of laboratory work.

6.3.8Availability of personnel in resource centers for assistance

One of the major functions of a training program is to help thetrainees by assisting them with technical support. Additionally, inlaboratory work, most of the technicians get to learn how to use theautomated equipment by applying the knowledge they received incollege and importantly, seeking help from the professionals. This isan indication that a good quality assurance project is one where thelearners have access to the expertise provided by personnel in theresource centers whenever they need them. In the developed countries,there are several developments in the areas of laboratory equipment,occasioned by the growing need of better quality services. Themanufacturers of this equipment select professionals from the majorlaboratories and explain the application of the new automatedequipment. This sets the ground for the development of trainingworkshops, where the junior pathologists and resident practitionersreceive training from the professionals. This model creates astructure of knowledge flow from right at the top to the laboratoryapplication.

In education, a constant underlying assumption is that the learningcapabilities of different people are not the same. There are learnerswho are quick in grasping concept and content while other take alittle more time to achieve the same. This assumption applies to thequality assurance project, whereby the trainers should expect thelearner to understand the concepts at different rates. As such, agood quality assurance project is one, which identifies each’sweaknesses and puts mechanisms in place for such persons to receivespecial attention. Some of the mechanism are separate trainingclasses for these individuals, and peer collaboration to help thelearners share their experiences as they cover the training syllabus.

6.3.9Job satisfaction and improved results

The research established that besides improving the quality of work,quality assurance projects help the practitioners to feel bettersatisfied with their jobs. As an aspect of interest in this study wasinvestigating the evaluation of job satisfaction among trainers, whoare accountable for aiding their students to perform better in theirjobs. Similarly, the study established that the trainers would feelequally satisfied with their jobs if they successfully mentored theirlearner to achieve quality. This observation is associated with thehuman nature of satisfaction through achievement (Aziri, 2011). Inpathology, many successful practitioners have a history ofintensified training, which well-established experts inspire. Aquality assurance program, therefore, sets the platform for renownedpractitioners to pass their skills and knowledge to the youngergenerations, and in the process, helping them to achieve furthersteps in their careers.

Over the past few decades, job satisfaction has received extensiveattention from educational and career experts. It also has subjectiveand attitudinal perspectives. It is subjective in a manner that jobsatisfaction does not only help the learners to improve the qualityof their work but also inspires the trainers to model practitionersthat are more competent. At the same time, job satisfaction isattitudinal in the sense that it motivates the inner ambition in thelearners and the trainers to give out their best. As such, thefindings of the research demonstrate that developing a qualityassurance project for Saudi Arabia’s pathologists will not onlypositively influence the learners’ quality, but also boost thetrainers’ capacity to inspire more competence in the region.

6.3.10Individual attention provision

The research established that a quality assurance program gave thetrainers an opportunity to provide the students with individualattention. Scholars have attempted for a while to establish therelationship between individual attention and performance. Inclinical performance, Miyake &amp Friedman (2012) say that payingindividual attention to the students helps them to build theirpersonal confidence in the laboratory. This is because thecharacteristics of individual attention are concentration,focalization and consciousness of alert. Applying these threeprinciples helps the trainers to assess each`s weaknesses selectivelyand as such, put in place efforts to help them improve.

In quality assurance project, there can be two type of attention,which are focused and divided attention. Neither is inferior to theother, as they have the same capacity to inspire performance amongthe trainees. Trainers in a quality assurance program can give thestudents attention in some ways. For instance, they can publish theirlaboratory results and make them a resource in the classes. This notonly motivates the individuals but also sets the pace for the rest ofthe learners to emulate. Additionally, by paying attention to thelearners, the trainers can practice effective grouping. In education,effective grouping is a staple for experienced instructors. Thetrainers can group the students by ability, interest and using otherparameters, which helps the entire class to improve in all areas oflearning.

6.4Pathology Technician, Role, and Experience

Training of pathologists should be consistent across all programs andtrainers should provide justification for their methodologies. Inthis regards, the training bodies must ensure that the pathologytraining programs base their content on the knowledge and skills,which are required to make the pathologists effective in the diversefield. Pathologists encounter new challenges every day at thelaboratory thus, they need to acquire knowledge and skills thatprepare them to face previously existing problems as well as emergingones. A good pathological training program should provide skills andknowledge applicable in a variety of fields, such as diagnosticlaboratories, government agencies and even in academics. In thisregards, this part discusses the findings of the study about the roleand experience of a technician. The findings revealed that mostpathologists regard their jobs as working experiences rather thanlearning experiences thus, a need for the justification of thisfinding in the ensuing discussion.

6.4.1Critical that Pathology Laboratory Technician communicate effectivelywith clinicians

Effectivecommunication is indispensable in most settings as revealed in thestudy findings. Cumulatively, 82 percent of the respondents agreedthat communication between technicians and clinicians is necessary toverify the appearance, clinical history, and requirements. In thisregards, majority of the respondents believe that technicians cannotmake diagnoses or provide the appropriate tests without effectivecommunication with clinicians. Scottet al. (2012) suggest that it is crucial for pathologists tohave knowledge about patients to provide the appropriate diagnosis,but sometimes due to ineffective communication flow, specimens arrivein the laboratory without indication of what the surgeon desires toknow. In fact, any program should highlight the importance ofeffective communication in a laboratory setting to reduce errors andensure harmonious working relations between clinicians andtechnicians. Today, most laboratories have become sophisticated andcomplex that what most clinicians learned in medical institutions isno longer useable thus, they cannot utilize laboratories in the mostefficient way. In this regards, they may order wrong or outdatedtests thus, it is always necessary for the cultivation of effectivecommunication to understand the best practices.

Effectivecommunication is not only necessary to verify clinical histories,requirements, and appearance, but it is necessary for disseminatingskills and knowledge. CPD programs whether centered on a laboratorytechnician or a clinician should always suggest effectivecommunication approaches to ensure that medical personnel understandrequirements, processes, and approaches. A clinical laboratory is afundamental instrument in a clinician armamentarium thus, personnelwho seek information from laboratory technicians should do so in aneffective and respectful manner.

6.4.2Technicians must have good judgment

59.5of the respondents agreed that Pathology Laboratory Techniciansshould have good judgment in offering an accurate diagnosis as wellas be conscious of patients’ welfare. Laboratory clinicians shouldnever guess wrong in regards to tests, as this can be veryfrustrating to patients and clinicians and in cases where a clinicianorder an unclear test, a technician should cultivate good judgment. Atechnician can only provide an appropriate diagnosis by cultivatinggood judgment and striving to standardize units of measurements andreference ranges. In addition, technicians should understand theexternal setting of laboratories to ensure they provide essentialinformation to clinicians.

Onthe other hand, sensibility in regards to the welfare of patients isa fundamental aspect in any clinical setting. Dunn et al. (2011)asserts that in numerous scenarios, some laboratory policiesinterfere with the welfare and care of patients thus, it is theresponsibility of a Technician to remain cognizant of patients’welfare. The welfare of patients rests with all medical personnel andcannot be left in the hands of an individual so, it is the right allpersonnel to work in harmony to maximize the safety and care ofpatients. The analytical aspect in a laboratory is complex as itinvolves the analysis procedures, and technicians should avoid errorsand strive to subject reports to the necessary processes as well asimplement processes that align to patients care. In fact, everytechnician should strive to implement a functional procedure tailoredto the needs of a patient.

&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy&shy6.4.3 Technicians must continually seek out new knowledge and adoptnew practices

The majority of the respondents, 75% agreed that laboratorytechnicians should continually seek out new knowledge and adopt newpractices. Due to technological changes, medical knowledge andtreatment are under constant change. Consequently, laboratoryclinicians should always seek for new information and knowledge toupdate their skills to become compatible with the upcomingtechnology. As new laboratory technicians are hired, they should haveregular training to enhance their clinical practices. According toKasvosve et al. (2014) andTembuyser &amp Dequeker (2015), the constant training oflaboratory personnel ensures that they acquire the latest skills andexpertise that is required to ensure efficiency and reliability oftheir day-to-day activities. Clinicians working in hospitallaboratories are encouraged to cultivate a positive attitude towardslearning and training since their work is dynamic and requiresinnovation in terms of skills and practices.

Seeking out new knowledge and adoption of new methods does not onlyenhance the professionalism of the laboratory technicians but alsoenhances the overall organization performance of medicalinstitutions. New and more challenging diseases are coming up eachday. For clinicians to correctly and accurately determine thediagnosis and correct treatment of such diseases, they need to wellinformed and equipped with up to date knowledge. By seeking out newinformation, laboratory technicians will invent new and betterpractices to manage the complexities associated with their workeffectively. Kasvosve etal. (2014) argue that laboratory clinicians need to embrace the habitof seeking information and adopting new practices to get accustomedto various changes associated with their work. They further assertthat that, the professionals should not only seek new information butmost significant share it with colleagues and put it into practice.Such a practice will lead to the adoption of evidence-basedlaboratory practices that are in high demand in our today`s healthcare institutions (Badrick, 2013).

6.4.4Technician must manage the clinician’s expectations and ensure thatthey are realistic

Over half of the participants (53.5%) agreed that it is the have theresponsibility of the laboratory technicians in managing clinician`sexpectations to ensure they are realistic. It is good for a clinicianto have expectations for their organizations and patient outcomes.However, the most important factor is not to have high expectations,but rather having the strategies to achieve the expectations. Havingthe expertise and skills on the outcomes of various illness andconditions, the laboratory technicians should ensure that theexpectations set by the clinicians are achievable. In the clinicalsetting, there is a great need for professionals to draw a linebetween realistic and unrealistic expectations. Some technicians willdisagree with the arguments on the basis that high expectations are asource of motivations for the healthcare professionals and thepatients as well. However, there are grievous consequences associatedwith unrealistic expectations.

Due to increased competition in today`s healthcare sector, manyclinicians tend to force their organization`s long-term goals to beachieved overnight. It is impractical to change an organizationovernight, and this creates a need for technicians to get involved indecision-making and goal setting. According to Tugend (2012),technicians should work hand in hand with the clinicians to make surethe sound decisions and setting of realistic expectations.Unrealistic expectations significantly affect the morale andself-drive of the health care personnel and the clinician. In fact,giving patients, unrealistic expectations leads to brokenpatient-doctor relations. It also tarnishes the corporate image ofthe health care organization. There is, therefore, a great need fortechnicians to continually review the clinician`s expectations andmake necessary alterations to ensure they are realistic beforereaching the other personnel and patients.

6.4.5Clinical experiences in pathology laboratories are primarily workingrather than learning experiences

The majority of the participants amounting to 65% agreed thatclinical experiences in pathology laboratories are primarily hands-onexperiences rather than learning encounters. Laboratory techniciansare trained to acquire skills to conduct medical research aimed atexploring new and enhanced health care practices. According to Rhode(2014), laboratory technicians may work behind scenes in health caresettings but they are the pillars of many health care organizations.The primary function of Laboratory Technician is to accurate conductlab test hence, determine the quality of patient`s health care.Their daily routine involves practical handling of human body fluids,tissue samples, and other specimens to make accurate diagnoses. Thehealth professionals execute their work using equipment such asmicroscopes, computers, and other computerized laboratory machines.Therefore, being a laboratory technician as a career is more ofhands-on oriented professional rather than a theory-orientedprofession.

Rhode (2014) argues that laboratory technicians undergo somelearning as part of their course. However, most of their learningexperiences and profession is practical in nature. As a laboratorytechnician, one is supposed to use theory to learn new practices andimplement them practically. Working in a laboratory involvespractical procedures such as operating computerized machines toidentify abnormal cells, determining the type of bacteria or virus inblood specimen among others. Laboratory technicians need t sharpentheir skills in dealing with the changing trends in diseasedevelopment. The professionals can only achieve this through constanthands-on experience to ensure accuracy and efficiency, leading toimprovement in the quality of health care.

6.4.6 Pathology Laboratory Technician program was a positive learning duplicated

The results indicate that 122 respondents (61%) agree that PathologyLaboratory Technician Program was a replication of a positivelearning experience. Pathology laboratory course itself offers apositive learning experience. Before qualifying as a technician, aperson has to undergo training to acquire the skills that are neededto execute the complex duties related to the profession. Rhode (2014)argues that laboratory technician is a profession behind curtains,but it is one of the most exciting careers in health care settings.It involves exploring new ways to diagnose the rising diseases andidentifying abnormalities in blood cells and other types of thespecimen. The wide variety of practical applications offers apositive learning experience to a laboratory technician.

Therefore enrolling in a pathology technician program gives atechnician a second chance to enjoy a positive learning experience.Such programs encompass practical activities similar to the usual,daily practices of a laboratory technician. Therefore, an individualparticipating in the program gets a chance to fresh the practiceslearned under training, making the program a duplicate of a positivelearning experience. Despite the fact, many of the respondentspointed out that the program was a duplicate of a learningexperience it does not mean it is a waste of resources and time. Theplacation aspect of the program is beneficial since it offers therespondents the chance to update their skills and expertise to tacklethe complexities associated with their profession.

6.4.7Pathology Laboratory Technician program was a positive learningexperience

58% of the respondents agreed that the pathology laboratorytechnician program was a positive learning experience. As explainedearlier, a Pathology Laboratory Technician Program encompassesexciting tasks such as experimenting with automated machines,detecting abnormalities in blood cells, determining safe bloodtransfusion, among others. Participating in such a program does notonly offer a person a positive learning experience but also gives onea chance to acquire more skills and knowledge. Some of therespondents (50%) may have disagreed for some obvious reasons. Someprofessionals have a negative attitude towards learning and training.Therefore, such an attitude will hinder them from viewing a PathologyLaboratory Technician Program being beneficial.

There is a great need for frequent and constant pathologytechnician programs because they do not only offer professional withpositive learning experience but most important keep them updated onthe current clinical practices. To improve the quality of healthcare, technicians need to cultivate a culture that embraces trainingprograms because they are exciting, beneficial and leads t higherperformance. To ensure technicians and other health careprofessionals develop a positive attitude towards training programs,they should be educated on the importance of the programs to theirprofession. Through the creation of awareness among technicians onthe on the importance of such programs, they will learn to embraceand view pathology technician programs as positive learningexperiences and significantly benefit from them.

6.4.8Working as a Pathology Laboratory Technician provides a sense ofaccomplishment

&nbspMostof the respondents (86.5%) agreed that pathology laboratorytechnician is a profession that provides an individual with a feelingof accomplishment. According to Rhode (2014), laboratory technicianis a job with a working environment that changes often. Therefore, atechnician should keep up to date with the changes in technologythrough constant learning and practices. The search for knowledge anddesire to keep up with technological advancement some of the factorsthat provides a sense of accomplishment to technicians. Rhode arguesthat a laboratory technician derives pleasure and a sense ofaccomplishment in acquiring the skills and expertise required intheir profession. Of more importance is the fact the technician putthe skills into practice through operating automated machine incarrying out the various laboratory procedures such as bloodtransfusion. The experience an individual gets from a pathologylaboratory offers a sense of achievement in enhancing people`s lives.

Despite the fact that clinicallaboratory is a high volume setting in terms of procedures and work,it is a workplace characterized by low error. It means that inpathology laboratories, issues to deal with error resolutions aregiven the priority. Working in such an environment with the highestlevel of accuracy affecting human lives gives a technician a sense ofaccomplishment. The primary work of a laboratory technician is todetermine with certainty the causes of various diseases hence assistin efficient diagnosis and treatment. A breakthrough in theidentification of the cause of a new illness or health condition doesnot only offer a technician a sense of accomplishment but alsosatisfaction. It is this feeling of accomplishment provided by thisprofession that makes many laboratory technicians passionate andproud of their work.

6.4.9There are excellent opportunities for advancement in the MedicalLaboratory Technician

86.5% of the respondents agreed that medical laboratory technicianas a profession has several excellent opportunities for advancement.According to an article published by HealthCare Pathway.com on 2015,a medical practitioner is a field with unlimited advancementprospects. The field has a variety of positions from laboratoryassistant going up to a level of a laboratory scientist. However, toprogress in this area requires formal education and training. Througheducation, an individual a level of an associate technician cangraduate to a pathology laboratory technician. The article reportsthat according to the latest health care salary report, a clinicallaboratory scientist earns a far much better salary compared to aclinical technician. However, when one wants to advance, there is aneed for a laboratory technician to seek information on the variouslegal requirements enacted by his or her state, or the state whereone wants to practice. In more than 12 States, a clinical laboratoryis a licensed profession hence any advancement or practice in thisfield in such countries should be accompanied by legal certification.

Medical laboratory technician can also advance their career throughqualifying for certification. Enrolling in pathology technicianprograms gives an individual a chance to be certified. Research hasargued that there is a positive correlation between certification andprecision of lab test results. The training and learning programs,therefore, provide opportunities to the technician to advance theirskills and expertise. Technicians also have the chance to participatein professional training programs. Through the programs, techniciansacquire skills and knowledge required for supervisory roles such aslaboratory managers among others. Another aspect of advancement thatmany technicians overlook in their profession is businessopportunities. Laboratory technicians are licensed to own their ownand run their laboratories in many states. The profession offers onethe chance to develop skills and expertise that is needed to become asuccessful healthcare entrepreneur in laboratory equipment andservice delivery.

6.4.10There are good job openings for Pathology Laboratory Technician

168 respondents equivalent to 84% agreed that laboratory technicianis a profession with several excellent employment opportunities. Amedical laboratory technician has several good job openings. Almostall health care institutions such as laboratories, public and privateinstitutions, medical center and local clinics require a MedicalLaboratory Technicians. There are varieties of areas offering goodjob openings for laboratory technicians. The first department isanatomical pathology where technicians are employed to process asample of tissue extracted from the body through surgical procedurest assist in the accurate diagnosis of a disease or health condition.A laboratory technician can get a job as a biochemist in hospitals orlaboratories to test blood and other body fluids with computerizedequipment to determine abnormalities

As technology advances, laboratory technician as a career providesmore and better job openings. Today, it is possible to identify therisks of a person to develop cancer, through a process referred to ascytology. This is done using advanced technology and equipment.Cytology is another area that presents several and well-paying jobopenings to laboratory technicians. Laboratory technicians aretrained, and qualified medical personnel that are can openhealth-care oriented businesses and run them smoothly. Apart frombeing employed by healthcare institutions such as hospitals, theprofession has a high potential for business growth. Laboratorytechnicians with adequate resources and capital can employ themselvesand even provide job openings for their colleagues.

6.5Thematic analysis of open-ended questions

Theparticipants identified quality systems needs in medical laboratory,application of a quality management system, and identification of thesources of errors in laboratory processes as the most significantperceived needs. In order of priority, 75 percent and more of theparticipants perceived they required training on quality systems’needs, application of quality management systems, and identificationof errors in laboratory processes. Mostparticipants viewed professional development as the most importantfactor to increase satisfaction and motivation. Employmentengagement, incentives, working environment, and appreciation fromthe administration also featured prominently in order of priority.Most participants identified the application of a quality managementsystem as the most perceived need. This view supports the findings ofquantitative data where the research illustrated that toachieve consistent high levels of quality in laboratory medicine,healthcare organizations need to apply comprehensive qualitymanagement systems. Extensive quality control and achievementscoupled with systematized standards will bridge the existing gap inSaudi Arabia and help producing qualified and competent pathologists.

Asseen in other studies, quality systems’ needs and quality systemapproaches remain the most perceived needs by Laboratory Technicians.The assertions further support the quantative data employed in theresearch. On the other hand, the participants viewed professionaldevelopment, employment engagement, benefits, and support from theadministration as the most important suggestions to enhancemotivation and satisfaction. Most employees across differentorganizations have identified professional development, employmentengagement, and benefits as the most imperative aspects that increasemotivation and satisfaction.

6.6Donabedian’s model

As earlier stated, the study adopted the Donabedian’s model toevaluate the structure, processes and outcomes of pathologistpractitioner service. For data collection, the researcher used openended and closed ended questionnaires. The stakeholder surveyanalysis involved (N=200) included a detailed investigation ofelements associated with quality assurance and the development needsof Saudi Arabia’s pathologists. Additionally, through literaturereview and examination of some texts, the researcher established themost relevant information about the development of training contentfor the pathologists.

From the process described above, the study identified that adequateand detailed structuring of a quality content is essential forsuccessful implementation of quality assurance for Saudi Arabia’spathologists. Among the most important elements for the design of aquality assurance program were evidence-based medicine andresult-oriented approach to learning. As for the quality assuranceproject, the study established categorical need for focusing onoutcomes and evaluation. Finally, Saudi Arabia’s pathologists’role and experience plays a key role in the development of qualitylaboratories.

Using the Donabedian’s framework, the study assessed the structureof the current practise in Saudi Arabia, the process of designing aquality assurance program and outcomes of the same in clinialapplicaton. All these have been discussed using the information fromthe results sectio of the paper. additionally, the author identified,through the qualitative and quantitative approaches, elements thatinfluence the quaily if service in laboratories. This model furthervalidates the findings from the literature review, results anddiscussion in the paper. Furthermore, by using the Donabedian model,the study demonstrates and understanding of the structure andprocesses for establishing pathology services in Saudi Arabia, whichlay the foundation for formulation of an effective quality assuredpractise in the in Saudi Arabia.

Thediagram below is a representation of the study using the Donabedianmodel.

Figure 1: Donabedian`s model results.

The broad approach that the researcher applied entailed structures ofquality assurance, which include the pathologists’ personal skillsand experience, structural setting of the laboratories and qualityassurance regulations set by various bodies. The structure of thesystem influence the process of laboratory work. The structure inthis particular study was the actual laboratory environment. Thelevel of automation, standards that the pathologists apply andcoordination of laboratory processes influence this. The outcomes, oreffects, are the eventual continued development program and qualityassurance. Broad approaches, using the information from the discussedresults, and coordination of quality assurance are products of theentire research, as guided by the Donabedian’s model. For thepurpose of this study, the strength of the model includes itsfamiliarity to the health care quality research, and basis for thespecific measures that it utilizes. These measures are the structure,process and outcome. However, the model does not satisfactorilymirror the complexities associated with this kind of research, anddoes not acknowledge the need for tailored interventions to fit thearea of study.

6.7Summary

Pathology,a fundamental field in contemporary diagnosis and medicine,encompasses an imperative constituent of the causative study ofdisease. It involves the exploration of diseases by integrating anextensive range of bioscience study areas and medical aspects. Inthis regards, pathologists unlock medical mysteries by conductingstudies using instruments and approaches of laboratory science. Foreasier understanding, a pathologist is a general practitioner whoexplores tissues, checks the accurateness of lab checks and deducesresults to simplify the patient’s diagnosis and cure. Thus,pathologists play a significant role in guiding diagnosis, qualityassurance and making sure that the final product meets adequatestandards. The explosion and extension of genomic study and easy hastransformed the practice of medicine worldwide, which has givenpathologists a critical role to play. In fact, pathologists’ workof guiding clinicians to handpick suitable diagnostic test has becomefundamental in the evolving healthcare setting. Consequently,pathologists should become cognizant of the fundamental differencesbetween the histology laboratory and other areas of the medicallaboratory in departments of pathology. Emerging trends have alsobecome more complex, which means pathologists have to engage in CPDto obtain knowledge and skills.

As pointed out in the discussion, pathologists’ work is importantthus, the need for a CPD that incorporates all aspects of Medicallaboratory and one that considers the welfare of patients. Thediscussion has revealed that CPD is an important aspect in thedevelopment of a pathologist as it enables him or her to attain thehighest level of performance. The role and experience of apathologist coupled with quality assurance content and projecthighlights that training is a significant component in any field. Inthis regards, it essential to highlight the discourse in a summarizedmanner to quantify the most important items to a systematic andeffective CPD.

While conducting the literature review, the author reviewed issues inquality control in laboratory work. The study established that theprocess of QC begins from the moment that specialists obtain specimenfrom patients to the moment they delivered the results to thephysician. This set the basis for investigation of a number ofelements that influenced the quality of work conducted in thelaboratory, such as the role and experience of the pathologists andorganizational factors including the selection of procedures foroperations. The results in the fifth chapter, which guided thediscussion process, confirmed observations and opinions made by theauthors whose work that the study appraised in the literature review.For instance, the questionnaire items that were used to gather datafor analysis and discussion confirmed that the determiners ofassurance of QC in the pathology laboratories are professionalconduct, personal effort, process flow and quality checks.

QualityAssurance content

Based on the means provided in the findings, one can conclude that inthe order of the most important training need is the development of aresult-oriented approach to learning that is learning-centered and iscrucial in educating the pathologists. The learning-centered approachis then followed by evidence-based laboratory medicine and safety.Basic knowledge that will enhance the analysis to explore qualityassurance discipline should follow, then specimen management,laboratory and disease surveillance, statistics in laboratorymedicine, equipment maintenance, quality achievement techniques,learning to name the parameters for measuring accuracy and precisionconcepts, expressing the relationship between accuracy and precisionconcepts and the role of these concepts in quality goals. Definition,establishment and use of reference material, data management,presentation skills and report writing, evaluation and selection ofanalytical methods and equipment should follow these, and finally,the point-of-care testing should be designed as the last item. As thediscussion has highlighted, quality assurance content is the mostimportant part of CPD aligned to the demands of a pthologist.

Quality assurance project

The design of quality assurance content should be based on thefollowing items, based on their significance in a medical laboratoryenvironment. First, the training should ensure the availability ofpersonnel centers, offer the opportunity for repetition and remedialwork, offer knowledge on the outcome to enhance understanding, andenhance self-discipline in study habits. In addition, it should offerthe learners self-pacing to enable them plan their study time,enhance attention of educators to their students, offer knowledge onevaluation and motivates the students to achieve them, enhance jobsatisfaction to the educators. Finally, the quality assurance projectshould arouse the need for further study and expansion of in-depthknowledge as presented in the figure

PathologyLab technicians

According to the respondents, the highest level of confidence in thisarea is that working as a pathologists offers the greatest sense ofaccomplishment and this is followed by the availability ofopportunities for advancement in pathology laboratory technician. This was followed by students’ feeling that there are goodopportunities for the pathology laboratory technician, communicationand management of the expectations to ensure that they remainrealistic. A greater number believed that the program duplicated thepositive learning experience and noted that medical laboratorytechnicians must constantly look for ways of adopting new technology.In conclusion, it can be noted from the findings that pathology labtechnicians should consider their experience as learning experiencesrather than working.

Thisis presented in the table below 3 below, which shows the role andexperience of pathology laboratory technician.

CHAPTER 7: CONCLUSION

7.1 Introduction

CPD involves management, didactic activities,team building, responsibility, proficiency, training, interpersonalcommunication, and capacity building. In this regards, the paper hashighlighted the best practices and processes that enhance effectiveCPD as well as the development of pathologists. In addition, it hasemphasized the guidelines and philosophies defined by specialists,accredited world organizations, and professional societies asfundamental actions that enhance effective lifelong learning andworking experience. In fact, the research has asserted that personallearning plan aligned to an effective CPD is a core area of qualityassurance project thus, it enhances the capacities and knowledge ofprofessionals. In this regards, this chapter highlights the need fora systematic and an all-inclusive CPD assessment and certification.In addition, the chapter concludes the findings of the research aswell as provides recommendations for the best practices. However, therecommendations extend beyond the findings of the research as theytake into consideration the arguments of specialists in the field.

7.2 Concluding remarks on the research andrecommendations

From the findings presented in the study as well as discussionsprovided, it is imperative to note that continuous professionaldevelopment programs offer great importance to pathology settings. Infact, the existing emerging and re-emerging diseases providesconsideration for precise and rapid clinical and laboratorydiagnosis. In addition, the acknowledgment of new contagious agents,the international occurrence of antimicrobial resistance and theprobability of acts of bioterrorism stress the want for the incessantdevelopment of laboratory personnel’s awareness. In this regards,laboratory setting will continue to play fundamental and complexroles in core areas of clinical practice. However, persistentproblems in the pathology laboratories exist across Saudi Arabia,which continue to affect the quality of service negatively.Furthermore, the Saudi culture acts as an obstacle to realizing anadequate specialized workforce to serve the area’s needs, as thewomen folk do not practice at night. International trends and thegovernment’s failure to provide enough technical support, as somelocal hospitals lack the necessary equipment to conduct fruitfullaboratory work have also contributed to the current situation.

Despite the problems that the country faces, it has cultivatedsignificant approaches, which have contributed to the multifaceteddevelopment of pathological aspects. In fact, specialists haveasserted that continued professional development is critical for thedevelopment and enhancement of the quality of healthcare services(Dunn et al., 2011).&nbspSimilarly, the research has found out thatthe training and development of healthcare workforces is animperative inspiring factor and linked with the enhanced performanceof clinical procedures.&nbspCPD for pathologists is an almostmandatory requirement for professional growth since the field hasseen a proliferation of new practices. In fact, without adopting newpractices and knowledge as they become available, pathologists cannotmanage to provide an appropriate diagnosis as well as communicateeffective and necessary information to other medical practitioners.Pathologists who escape the realism of dynamism in science run thethreat of lagging behind especially with the new developments andpractices today. In this regards, the cultivation of CPD amongmedical practitioners such as pathologists puts them on the safe sideand aids them to deliver optimal services that benefit patients,communities and themselves.

CPD training is significant for betterperformance as specialists recognize it as a fundamental means bywhich staffs obtain the essential knowledge, capacities, and skill toadvance institutional performance and accomplish the goals of anorganization. &nbspIn addition, thestudy has illustrated that healthcare facilities should conduct CPDregularly and involve diverse categories of employees so that theirabilities contribute to the accomplishment of the structuralobjectives. However, despite the identification by variouslaboratories across Saudi Arabia on the significance of training anddevelopment, most of the laboratories have not attained theseobjectives. In fact, the research has illustrated that mostpathologists consider their work as a work experience rather than alearning experience, which points to the minimal success of CPD. Onthe other hand, the research has revealed that most specialists havenot fathomed the extent, focus areas, and type of training consistentwith the demands of health care and patients’ welfare. However, thestudy has addressed the numerous gaps existing in Saudi Arabia and indoing so has highlighted the system most consistent with CPD andcurrent practices.

Throughout the research, it has become clearthat pathologists must ensure that they maintain and advance skills,capacities, and knowledge of their specialized competence andpractice. In addition, all laboratories and bodies overseeing thepractice of pathologists must require CPD records from pathologistsas well as conduct appraisal processes to ensure that pathologistsconduct themselves in the most professional manner. In fact, ashighlighted in the quality assurance content, quality assuranceproject, and pathology experience and skills variables, CPD is anindividual obligation and medical personnel should take it as acontinuous progression of competence and capacities. In this regards,professionals should undertake CPD as a means of improving andbroadening skills and knowledge as well as enhancing individualqualities. In fact, through CPD professionals realize their bestcompetencies and skills thus, it helps them to practice safetypractices. A normal CPD as highlighted in the literature reviewshould take into consideration the demands of the field, emergingissues in diagnosis, emerging diseases, connections betweenlaboratories and other clinical settings, and the existing skills. Byconsidering fundamental aspects, CPD should include practicaltraining, audit activity, mentoring, research, work-basedobservation, and assessment. In addition, workplace chores such ascase studies, conferences, and workshops should count as CPDactivities as they reflect on what pathologists learn in theirworkplace. In this regards, the design of a CPD program shouldfocus on five major principles of evidence-based laboratory medicineas highlighted in the discussion: the creation of an enquiry contentand looking up for evidence to support rational thinking, after whichthe pathologists can evaluate the evidence. In addition, the programshould take into consideration the application of the developedevidence and doing a follow-up to scrutinize the experience.Following these steps, the implementers can use evidence-basedlaboratory testing as a tool to improve patient outcomes.

Increasing educational program towards the enhancement of performancein laboratories and presentation procedures will help Saudi Arabia’shealth segment to attain some objectives. As highlighted in thefindings of the research, the practitioners will improve the qualityof healthcare through the presentation of concepts proposed in thepaper. In addition, an ethos of patient safety and nominal risk ofmedical inaccuracies help to guarantee the promotion of qualityservice in the region. On the other hand, education programs alignedto studies will help to impart optimum healthcare organization to aidthe practitioners better manage information and make optimum use ofthe resources.

However, shepherdingCPD contrastswidely from one facility to another. Inthis regards, the foremostchallenge is defining the contextand strategiesof theprocessesthat the organization utilizes.Without a systematic and a recognizedprocess or approach, the organization cannot manage to oversee CPD oroffer to train to employees. In fact, the lackof a universal definition or system isa barrier to the wider approvalof the products of the training programs. Reeveset al. (2013) assert that the developmentof diversetechniques used by trainersin various CPD programs has complicatedthe setting ofa constant pace for use by trainers andtrainees. In addition, different expertsor professionals view CPD differently, which hinders the developmentof training systems across Saudi Arabia. Mosttrainers often perceive CPD as a top-down process that anunyieldingsystem of administrationruns, which meansthat independent assessmentof the process is limited. A limitedprocess cannot create innovation or creativity thus, automation ofpathological laboratories becomes a problem.

Currently, professionals have set therecommended completion period of CPD everythree years, but going with the currentpractices and trends, the period is too long. Reeves et al. (2013)maintains that the level knowledge andcapacities realized at the completion ofthe CPD may need an extensiondue to the existingrate of automation as well as complexemerging issues. Learning and training do not associate withattendance, workshops, or meetings thus, professionals need to alterthe training frameworks to enablepractitioners realize better results.The discussion part of the research hasillustrated that CPD is an important part of pathologists’development and capacity building, so organizations need to work inharmony with the government to pass laws that might makeCPD compulsory for all practitioners. Sucha development means that valuationmethods to contentthe needs of the clients and the specialistsmay crop out of recertification. Studies,information, gathered in the research, and the body of literaturehighlighted in the paper shows that thefield of pathology has seensignificant changes thus, redesigningof CPD should be the foremost step.

Complacent training cannot assist in transforming CPD hence, theneed for valuation of laboratory staff and laboratory processes,which might help in customizing quality assurance content andquality. By developing assessments and appraisals coupled withconstant CPD, pathologists will manage to generate information usingdisease surveillance and notification systems. As observed in thestudy, management`s input in training packages should be significantand directed towards improved service delivery. In addition, themanagement should tailor the training sought and attained to thedefinite needs of the time. As revealed in the study, many parts ofSaudi Arabia lack provision of laboratory services at the commonlevel, which has hindered the development of CPD as well ascomplicated in-house training. In addition, even with the revealedlevel of training currently sought some infrastructures used to trainstudents are outdated or unspecific to the needs of learners. Such asituation means that only the high-level hospitals and most privateinstitutions have the capacity to provide the requisite andreasonable laboratory services to learners. Any training directed tolearners translate to increased patients’ satisfaction hence, theneed for the development of the necessary infrastructures to aid inthe development of knowledge and skills among learners.

On the other hand, most organizations use customer satisfaction asthe yardstick for performance assessment, but Saudi Arabia and itsneighboring countries lag behind European countries in the provisionof adequate patients’ satisfaction. For example, the region’snational health sector has not provided for the implementation ofsatisfaction assessment adequately as well as it has lagged behind inthe provision of quality control programs to ensure the accuracy ofresults. In addition, most facilities in the region do not have acontinuous stock of latest reagents and kits to help the pathologiststo conduct satisfactory laboratory examinations. However, given thecurrent situation, specialists have come up with ways of unravelingthe challenges at the grass-root level. For instance, most severeproblems in pathology encompass molecular diagnostics andtransmission of digital images from one department to another. Inthis regards, specialists have suggested that an anatomic andquantifiable pathologists have to eradicate all obstructions thatisolate them from other technicians.

However, Saudi Arabia needs to secure passable extern sites to aidstaff the region’s health facilities. The engagement is in theawareness of the fact that subcontracting or outsourcing of expertsis both expensive and detrimental to efforts to building the nationalhealth sector. Because of this necessity, the health sector has theaccountability of directing academic and clinical support programs,aimed at creating highly knowledgeable and dependable pathologist. In this regards, addressing challenges facing clinical pathology needan all-inclusive stakeholder participation in the provision oflaboratory equipment and formation of a CPD training of medicallaboratory personnel.

The findings of the research highlighted other important aspects ofCPD such as learning experience and quality assurance. The findingsof the study support what most scholars have recommended as means ofsupporting the enhancement of CPD. According to Gargis et al. 2012)most scholars support the idea of transforming clinical pathologyservices fully. In addition, medical professionals specificallypathology practitioners, need to contribute to the knowledge andexpertise to fast track the activity. Such an effort would help toascertain the areas of faults and bring together experientialevidence for sanitizing weak links in the fragile pathologylaboratory environment. Surveying the governance structures andorganizational culture is a significant means of attaining positiveenhancement in clinical pathology especially in areas of qualityassurance. Such examinations would aid experts to create anirrefutable error report that generates the foundation for evolvinginterventions to improve quality assurance.

However, even with improving quality assurance and supporting aharmonious relationship between manufacturers and learners, thecurrent pathology QA lacks some critical factors that determine theoverall outcome of laboratory works. These leading factors encompassanalysis of the processes, operational mechanisms for rewarding andsanctioning, the integrity of the personnel and oversightauthorities. As mentioned in the body of literature, it is almostintolerable to assure the patients and other practitioners of qualityservice without sanitizing these particular aspects of clinicalpathology. Furthermore, the current system of CPD lacks fundamentalassurance indicators capable of transforming the pathology sector inSaudi Arabia. In fact, without a dedicated and effective system,professionals in the field cannot attain the necessary for theaccomplishment of evidence quality and safety of the practice. Inthis regards, the sector must respond to the illustrated changes andrecommendations. One cannot easily predict the future of pathologybecause of changes in theoretical and practical aspects globally andlocally. However, through research and abstractive studies, scholarsforecast that the stakeholders in the health sector have thecapability to regulate the dynamics and bring balance to practice. Acritical assessment of the pathological criterions and practices inSaudi Arabia is one of the ways that the stakeholders can unravel thechallenges and generate a foundation for better quality services. Inaddition, by eliminating errors and discrepancies in pathologicalpractices, professionals can improve disease diagnosis and subsequenttreatment.

Leading issues affecting quality include poor communication andinsufficient knowledge of tests that occur mostly during testselection/ordering and interpretation of results. Common errors inclinical and anatomic pathology involve patient and/or specimenmisidentification, specimen collection errors, and specimencontamination. Most specialists often cite test turnaround time andnotification of critical values for ratings of below average to poorin customer satisfaction surveys. Education and training have becomethe most important highlights of the development of pathologistsgiven the low levels of knowledge and pitiable communication flow. Inthe realms of CPD, Kasvosveet al. (2014) assert that the development of a consistent body ofknowledge depends on the systematized training.

Quality control, performance evaluation, and test reproducibilitystandards to diminish diagnostic inconsistencies and inaccuracieshave been better defined and applied in clinical pathology than inanatomic pathology. In this regards, Kasvosve et al. (2014) opinethat organizations should develop quality control, performanceevaluation, and test reproducibility for anatomic pathology. Toachieve consistent high levels of quality in laboratory medicine,healthcare organizations need to move beyond stand-alone,analytic-focused, quality control, quality assurance, and proficiencytesting (PT) activities. It requires more comprehensive qualitymanagement systems (QMS), such as those espoused in ISO 9001:2000 andISO 15189:2003 standards. Extensive quality control and achievementscoupled with systematized standards will bridge the existing gap inSaudi Arabia and help producing qualified and competent pathologists

7.3Summary

This chapter introduced and discussed the highlights of the studywith a comprehensive analysis on CPD. While describing the findingsof the study, the chapter identified laboratory work as one of thecore areas of clinical practice as well as illustrated the importanceof training in the development of pathologists. The chapteridentified the need of enhanced Quality Assurance and developed atraining program capable of improving performance in laboratories toensure reliable and valid test conducting. The chapter addressedissues in quality control, education, and training, as aboutContinued Professional Development. It also focused on the conceptsof continuing professional development by reviewing the role of CPDin developing medical practitioners and pathologists. Consequently,the study, through findings and recommendations developed aneffective educational program that will improve performance in thelaboratories, and help the practitioners in screening risk factors.Professionals and stakeholders can use the study to understand thevarious components of CPD and improve the current processes oflearning and development.

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Appendices

SURVEY QUESTIONNAIRE

Ranking of Your Training Needs

Inthis section, we are seeking information from you about your TrainingNeeds. For each statement complete the box that best describes yourpersonal view.

Tick one answer that corresponds to your view, based on practical experience with the listed statements.

(1)

Strongly Disagree

(2)

Disagree

(3)

Neither Agree nor Disagree

(4)

Agree

(5)

Strongly Agree

Design of Quality Assurance content of the course

  1. Evidence-based laboratory medicine

1

2

3

4

5

  1. A results-oriented approach to learning, which is learning-centred, is crucial in educating pathologists.

1

2

3

4

5

  1. Basic knowledge that will enable analysts to explore the quality assurance discipline

1

2

3

4

5

  1. Safety

1

2

3

4

5

  1. Learning to name the parameters for measuring accuracy and precision concepts

1

2

3

4

5

  1. Evaluation and selection of analytical methods and equipment

1

2

3

4

5

  1. Definition, establishment and use of reference ranges

1

2

3

4

5

  1. Quality achievement techniques

1

2

3

4

5

  1. Data management, report writing and presentation skills

1

2

3

4

5

  1. Point-of-care testing

1

2

3

4

5

  1. Statistics in laboratory medicine

1

2

3

4

5

  1. Specimen management

1

2

3

4

5

  1. Laboratory and disease surveillance

1

2

3

4

5

  1. Equipment maintenance

1

2

3

4

5

  1. Expressing the relationship between accuracy and precision concepts and the role of these concepts in quality goals.

1

2

3

4

5

: TICK YOUR LEVEL OFAGREEMENT/DISAGREEMNT

Circle one answer which corresponds to the level of your view based on practical experience with the listed statements.

(1)

Strongly Disagree

(2)

Disagree

(3)

Neither Agree nor Disagree

(4)

Agree

(5)

Strongly Agree

The Quality Assurance Project

  1. Offers various advantages to the learners and educators as well as to society hence, it should be used in laboratory learning.

1

2

3

4

5

  1. Offers knowledge about the outcome so that the reason for studying the material is understood, and the total picture is made clear.

1

2

3

4

5

  1. Offers knowledge about the results of the evaluation and gives the motivation to achieve them.

1

2

3

4

5

  1. Offers learners self-pacing, so they can plan their study time to match their abilities and limitations.

1

2

3

4

5

  1. Offers opportunities for repetition and remedial work, according to individual needs.

1

2

3

4

5

  1. Offers the opportunity to study in greater depth if special interest in an aspect is aroused.

1

2

3

4

5

  1. Fosters the development of self-discipline in study habits.

1

2

3

4

5

  1. Ensures the availability of personnel in resource centres at reasonable times to assist with individual learning difficulties.

1

2

3

4

5

  1. Provides educators with greater job satisfaction and a sense of achievement, since learners who study better deliver better results as employees.

1

2

3

4

5

  1. Gives educators an opportunity to provide students with individual attention.

1

2

3

4

5

  1. Gives educators the time and opportunity to plan, design, evaluate, re-plan and re-design modules on a continual basis, which enables quality-learning services.

1

2

3

4

5

Pathology(Medical) Laboratory Technician ( Role And Experience)

  1. It is critical that Pathology (Medical) Laboratory Technician communicate effectively with clinicians to verify clinical history, appearance and requirements.

1

2

3

4

5

  1. Pathology Laboratory Technician must have good judgment, be conscious of the patient’s welfare and always strive to provide an accurate diagnosis.

1

2

3

4

5

  1. Pathology (medical) Laboratory Technician must constantly seek out new knowledge and adopt new practices as they become available.

1

2

3

4

5

  1. Pathology Laboratory Technician must manage the clinician’s expectations and ensure that they are realistic.

1

2

3

4

5

  1. My clinical experiences in pathology laboratories were primarily working rather than learning experiences.

1

2

3

4

5

  1. My Pathology (medical) Laboratory Technician program was a positive learning duplicated.

1

2

3

4

5

  1. My Pathology(medical) Laboratory Technician program was a positive learning experience

1

2

3

4

5

  1. Working as a Pathology (medical) Laboratory Technician provides a sense of accomplishment.

1

2

3

4

5

  1. There are very good opportunities for advancement in the Pathology (medical) Laboratory Technician.

1

2

3

4

5

  1. There are good job openings for Pathology (medical) Laboratory Technician.

1

2

3

4

5

Participants`responses

N=200 Person

Training needs

Strongly Disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly Agree

Evidence-based laboratory medicine

3

14

20

124

39

A results-oriented approach to learning, which is learning-centred.

3

6

18

120

53

Basic knowledge that will enable analysts to explore the quality assurance discipline

8

22

85

80

32

Safety

3

8

21

93

75

Learning to name the parameters for measuring accuracy and precision concepts

19

8

54

94

25

Evaluation and selection of analytical methods and equipment

27

30

46

73

24

Definition, establishment and use of reference ranges

20

33

28

91

28

Quality achievement techniques

22

15

28

112

23

Data management, report writing and presentation skills

26

30

36

86

22

Point-of-care testing

37

29

33

92

9

Statistics in laboratory medicine

11

11

48

100

30

Specimen management

11

7

35

108

39

Laboratory and disease surveillance

9

10

23

55

103

Equipment maintenance

7

22

39

75

57

Expressing the relationship between accuracy and precision concepts and the role of these concepts in quality goals.

23

25

21

111

20

Design of Quality Assurancecontent of the coursethe qUALITY aSSURANCE pROJECt

Strongly Disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly Agree

Offers various advantages to the learners and educators as well as to society hence, it should be used in laboratory learning.

7

43

36

44

70

Offers knowledge about the outcome so that the reason for studying the material is understood, and the total picture is made clear.

16

31

48

77

28

Offers knowledge about the results of the evaluation and gives the motivation to achieve them.

20

40

44

82

14

Offers learners self-pacing, so they can plan their study time to match their abilities and limitations.

17

24

57

66

36

Offers opportunities for repetition and remedial work, according to individual needs.

17

32

45

89

17

Offers the opportunity to study in greater depth if special interest in an aspect is aroused.

21

33

41

64

41

Fosters the development of self-discipline in study habits.

8

36

38

28

90

Ensures the availability of personnel in resource centres at reasonable times to assist with individual learning difficulties.

6

21

48

91

34

Provides educators with greater job satisfaction and a sense of achievement, since learners who study better deliver better results as employees.

29

7

54

76

34

Gives educators an opportunity to provide students with individual attention.

18

35

35

88

24

Gives educators the time and opportunity to plan, design, evaluate, re-plan and re-design modules on a continual basis, which enables quality-learning services.

32

12

37

97

22

Pathology(Medical)Laboratory Technician (Role And Experience)

level of your view based on practical

Strongly Disagree

Disagree

Neither Agree nor Disagree

Agree

Strongly Agree

It is critical that Pathology (Medical) Laboratory Technician communicate effectively with clinicians to verify clinical history, appearance and requirements.

5

11

20

52

112

Pathology (medical) Laboratory Technician must constantly seek out new knowledge and adopt new practices as they become available.

22

16

12

149

1

Pathology Laboratory Technician must manage the clinician’s expectations and ensure that they are realistic.

5

35

58

92

10

My clinical experiences in pathology laboratories were primarily working rather than learning experiences.

31

23

16

62

68

My Pathology (medical) Laboratory Technician program was a positive learning duplicated.

5

35

38

111

11

My Pathology(medical) Laboratory Technician program was a positive learning experience

30

40

14

113

3

Working as a Pathology (medical) Laboratory Technician provides a sense of accomplishment.

3

4

20

134

39

There are very good opportunities for advancement in the Pathology (medical) Laboratory Technician.

3

6

18

120

53

There are good job openings for Pathology (medical) Laboratory Technician.

3

8

21

93

75

Section 2: Open-ended questions

What are the three most important perceived needsin training and tests?

………………………………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………..

2. What are your suggestions to increase MedicalLaboratory Technologists’ satisfaction and motivation and to makeit a better job?

………………………………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………..

3. What strategies should educators employ toensure quality assurance training for medical laboratorytechnologists In the future?

………………………………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………..

4. How do you view the quality control trainingfor PathologyLaboratory Technicians?

………………………………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………..

QualityAssurance Content

Reliability Statistics

Cronbach`s Alpha

Cronbach`s Alpha Based on Standardized Items

N of Items

.987

.987

15

QualityAssurance Project

Reliability Statistics

Cronbach`s Alpha

Cronbach`s Alpha Based on Standardized Items

N of Items

.992

.993

10

PathologyLaboratory Technician

Reliability Statistics

Cronbach`s Alpha

Cronbach`s Alpha Based on Standardized Items

N of Items

.978

.982

10

Means at 95% Confidence Level: Quality Assurance Content

One-Sample Test

Test Value = 0

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

&nbsp&nbsp&nbsp&nbsp Evidence-based laboratory medicine

66.687

199

.000

3.925

3.81

4.04

&nbsp&nbsp&nbsp&nbsp A results-oriented approach to learning, which is learning-centered, is crucial in educating pathologists

73.809

199

.000

4.070

3.96

4.18

&nbsp&nbsp&nbsp&nbsp Basic knowledge that will enable analysts to explore the quality assurance discipline

54.872

199

.000

3.260

3.14

3.38

&nbsp&nbsp&nbsp&nbsp Safety

66.261

199

.000

4.130

4.01

4.25

&nbsp&nbsp&nbsp&nbsp Learning to name the parameters for measuring accuracy and precision concepts

41.854

199

.000

3.735

3.56

3.91

&nbsp&nbsp&nbsp&nbsp Assessment and selection of analytical approaches and instruments

36.574

199

.000

3.190

3.02

3.36

&nbsp&nbsp&nbsp&nbsp Definition, establishment and use of reference ranges

39.574

199

.000

3.370

3.20

3.54

&nbsp&nbsp&nbsp&nbsp Quality achievement techniques

43.409

199

.000

3.495

3.34

3.65

&nbsp&nbsp&nbsp&nbsp Data management, report writing and presentation skills

37.540

199

.000

3.240

3.07

3.41

&nbsp Point-of-care testing

34.684

199

.000

3.035

2.86

3.21

&nbsp Statistics in laboratory medicine

52.017

199

.000

3.635

3.50

3.77

&nbsp Specimen management

54.530

199

.000

3.785

3.65

3.92

&nbsp Laboratory and disease surveillance

53.462

199

.000

4.165

4.01

4.32

&nbsp Equipment maintenance

48.898

199

.000

3.765

3.61

3.92

&nbsp Expressing the relationship between accuracy and precision concepts and the role of these concepts in quality goals

40.829

199

.000

3.400

3.24

3.56

QualityAssurance Project

One-Sample Test

Test Value = 0

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

&nbsp&nbsp&nbsp&nbsp Offers various advantages to the learners and educators as well as to society hence, it should be used in laboratory learning

40.901

199

.000

3.635

3.46

3.81

&nbsp&nbsp&nbsp&nbsp Offers knowledge about the outcome so that the reason for studying the material is understood, and the total picture is made clear

41.488

199

.000

3.350

3.19

3.51

&nbsp&nbsp&nbsp&nbsp Offers knowledge about the results of the evaluation and gives the motivation to achieve them

39.470

199

.000

3.150

2.99

3.31

&nbsp&nbsp&nbsp&nbsp Offers learners self-pacing, so they can plan their study time to match their abilities and limitations

41.062

199

.000

3.375

3.21

3.54

&nbsp&nbsp&nbsp&nbsp Offers opportunities for repetition and remedial work, according to individual needs

42.237

199

.000

3.285

3.13

3.44

&nbsp&nbsp&nbsp&nbsp Offers the opportunity to study in greater depth if special interest in an aspect is aroused

37.428

199

.000

3.355

3.18

3.53

&nbsp&nbsp&nbsp&nbsp Fosters the development of self-discipline in study habits

41.243

199

.000

3.780

3.60

3.96

&nbsp&nbsp&nbsp&nbsp Ensures the availability of personnel in resource centers at reasonable times to assist with individual learning difficulties

52.179

199

.000

3.630

3.49

3.77

&nbsp&nbsp&nbsp&nbsp Provides educators with greater job satisfaction and a sense of achievement, since learners who study better deliver better results as employees

38.859

199

.000

3.395

3.22

3.57

&nbsp Gives educators an opportunity to provide students with individual attention

40.379

199

.000

3.325

3.16

3.49

PathologyLaboratory Technician

One-Sample Test

Test Value = 0

t

df

Sig. (2-tailed)

Mean Difference

95% Confidence Interval of the Difference

Lower

Upper

&nbsp&nbsp&nbsp&nbsp It is critical that Pathology (Medical) Laboratory Technician communicate effectively with clinicians to verify clinical history, appearance and requirements

59.440

199

.000

4.275

4.13

4.42

&nbsp&nbsp&nbsp&nbsp Pathology Laboratory Technician must have good judgment, be conscious of the patient’s welfare and always strive to provide an accurate diagnosis

38.053

199

.000

3.325

3.15

3.50

&nbsp&nbsp&nbsp&nbsp Pathology (medical) Laboratory Technician must constantly seek out new knowledge and adopt new practices as they become available

46.943

199

.000

3.455

3.31

3.60

&nbsp&nbsp&nbsp&nbsp Pathology Laboratory Technician must manage the clinician’s expectations and ensure that they are realistic

53.834

199

.000

3.385

3.26

3.51

&nbsp&nbsp&nbsp&nbsp My clinical experiences in pathology laboratories were primarily working rather than learning experiences

34.822

199

.000

3.565

3.36

3.77

&nbsp&nbsp&nbsp&nbsp My Pathology (medical) Laboratory Technician program was a positive learning duplicated

52.438

199

.000

3.440

3.31

3.57

&nbsp&nbsp&nbsp&nbsp My Pathology(medical) Laboratory Technician program was a positive learning experience

36.691

199

.000

3.095

2.93

3.26

&nbsp&nbsp&nbsp&nbsp Working as a Pathology (medical) Laboratory Technician provides a sense of accomplishment

79.219

199

.000

4.010

3.91

4.11

&nbsp&nbsp&nbsp&nbsp There are very good opportunities for advancement in the Pathology (medical) Laboratory Technician

73.809

199

.000

4.070

3.96

4.18

&nbsp There are good job openings for Pathology (medical) Laboratory Technician

67.340

199

.000

4.145

4.02

4.27

Designof Quality Assurance Content

Quality Assurance Content

Designof Quality Assurance Project

.

Quality Assurance Project

PathologyLab technicians

Role and Experience of Pathology Laboratory Technician