Chapter 2 Related Literature and Studies This

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CHAPTER 2 RELATED LITERATURE AND STUDIES

This research study cited books, articles and laws, which are relevant to the present present investigati investigation. on. It is composed composed of related literatur literaturee and studies, both local and foreign, foreign, which contain contain facts and information information on the research problem problem at hand. It also provi provides des explan explanati ations ons and logica logicall connect connection ionss between between previo previous us resear researches ches and the present work.

RELATED LITERATURE Foreign

Medical Technology is a profession concerned with providing information based on the performance of analytical tests on human body substances to detect evidence of or prevent disease or impairment and to promote and monitor good health. (Clerc, 1992) The first report on the exercise of Medical Technology has been traced back to 1500 BC by Jean Jean M. Clerc Clerc as intesti intestinal nal parasi parasites tes such as taenia taenia and ascari ascariss were were mentioned mentioned in writings writings of this age. The description description of red blood cells, cells, protozoans protozoans and bacteria given by Anton Van Leeuwenhoek in the early 1700s supports claims that medical technology is one of the oldest allied health professions. The practice of medicine would be impossible without the tests performed in the clinic clinical al labora laborator tory. y.

Labora Laborator tory y measur measureme ements nts and examinat examination ionss provid providee the hard

scientific data used to deal with problems identified by the clinical evaluation and are an

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essential part of the information that contributes to the patient data base (Sanchez, et. al, 1991). Medical technologists may work in all general areas within the laboratory or may spec specia iali lize ze in cert certai ain n area areass like like Clin Clinic ical al Chemi Chemist stry ry,, whic which h is conc concer erne ned d with with the the determination of the presence and quantity of chemical substances in the blood) or in Hematology, which deals with abnormal conditions and diseases affecting the blood. Other areas of specialization include Microbiology, primarily concerned with detection of bacte bacteria ria,, fungi, fungi, viruse viruses, s, and other other organi organisms sms in the body; body; or Parasi Parasitol tology ogy which which is conce concern rned ed with with the the iden identi tifi ficat catio ion n of para parasi site tess in stool stool and and bloo blood d samp sample les; s; and Immuno Immunohem hemato atolog logy y (blood (blood banking banking), ), which which is concer concerned ned with with crossm crossmatc atchin hing g and transfusi transfusing ng blood products products (Clerc, 1992). 1992). With these these various areas of expertise, expertise, the education of medical technologists extends beyond that of medical technicians such that they not only perform laboratory procedures but are also able to correlate, interpret, compare and analyze them (Semrad, 1975). Clin Clinic ical al

labo labora rato tory ry

scie scient ntis ists ts

or

medi medica call

tech techno nolo logi gist sts, s,

have have

seve severa rall

responsibi responsibiliti lities es in the clinical clinical laboratory. laboratory. They may perform supervisor supervisory y or teaching teaching roles or perform perform tests to detect disease disease and may also be involved involved in research. research. They are able to recognize recognize a problem, problem, identify the cause (technical, (technical, instrument instrumental al or physiologi physiologic), c), synthesize synthesize alternati alternatives, ves, and determine determine solutions. solutions. They are able to confirm and verify results through an in-depth knowledge of techniques, principles, and instruments. instruments. They correlate correlate and interpret interpret data based on knowledge knowledge of physiologic physiologic conditions conditions affecting affecting test











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safety safety protocols. protocols. Clinical Clinical laboratory laboratory scientists scientists assume responsibil responsibility ity for and are held accountable for accurate results (Clerc, 1992) In the United States, certain requirements have to be met before one may be considered eligible to practice practice the profession. A clinical laboratory scientist or medical medical technol technologi ogist st general generally ly has a baccal baccalaure aureate ate degree degree in Medica Medicall Technol Technology ogy,, clinica clinicall laboratory laboratory sciences, sciences, or one of the sciences and one of the following: following: (1) Completion Completion of MT or CLS program program accred accredite ited d by the Committe Committeee on Allied Allied Healt Health h Educati Education on and Accreditation (CAHEA); Medical Laboratory Technologist (MLT) or American Society of Clinical Pathologists (ASCP) certification and three years of experience; (4) five years of work-related experience (Clerc, 1992).

Local

History of Medical Technology in the Philippines In the Phili Philippi ppines nes,, Medica Medicall Technol Technology ogy practi practice ce was introd introduced uced by the 26th Medical Laboratory of the 6th US Army. Army. The US Army establ established ished the the first clinica clinicall laboratory in the Philippines at Quiricada Street, Sta. Cruz, and Manila where the Manila Public Health Laboratory Laboratory is presently presently located. The laboratory offered offered training programs to high school graduates as early as February 1944 (Rabor, 1998). The Philippine Union College (PUC) and Medical Sanitarium offered the first four-year B.S. degree in Medical Technology. After two years (1956), PUC PUC graduated its first graduate, Dr. Jesse Umali, who is a successful OB-gynecologist.











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elective to 4th and 5th year B.S. Pharmacy students. Because of the popularity of Medical Technology among Pharmacy students, Rev. Fr. Lorenzo Rodriguez decided to offer it as a course. It was in June 17, 1957 when a temporary permit was issued by the the Department of Education for first to third year students, then in June 1960, the permit for the intern internshi ship p progra program m was issued. issued.

The full recogni recogniti tion on of the 4-year 4-year B.S. Medical Medical

Technology course was given on June 14, 1961. Many schools schools followed followed to offer the the B.S. Medical Technolog Technology y course. Today acco accord rdin ing g to the the reco record rdss of the the Comm Commis issi sion on on High Higher er Educ Educat atio ion, n, ther theree are are approximately 68 colleges and universities offering the course. The University of the Philippines offers a similar course but the degree conferred is B.S. Public Health. Post Postgr grad adua uate te studi studies es are are offe offere red d B.S. B.S. Medi Medica call Techn Technol ology ogy grad gradua uate tes. s. The The University of Sto. Tomas Graduate School and the Philippine Women’s University are offering MS in Medical Technology. In addition, the University of the Philippines is offering a one-year, non-thesis degree in Master in Public Health. The trainin training g of medical medical technolo technologis gists ts has since then been clinical clinical based. based.

It

included theoretical aspects acquired in classrooms and applications of principles in the hospital. With the increasing realization of the contribution contribution of the nurse, the training was deemed elevated as well. The Philippine government, aware of its responsibility to regulate the practice of professions as well as to promote the public health of the people, has created the Medical Tech Technol nolog ogy y Boar Board d in 1969 1969 when when the the Phil Philip ippi pine ne Legi Legisl slat atur uree passe passed d on June June 1969 1969











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a) Admini Administe sterr the provi provisio sions ns of this this Act; Act; b) Administer Administer oath oath in connectio connection n with the admini administrat stration ion of this this Act; c) Issu Issue, e, susp suspend end and revok revokee cert certif ific icat ates es of regi regist stra rati tion on for for the the prac practi tice ce of medical technology; d) Look Look into into condi conditi tion on affe affect ctin ing g the the prac practi tice ce of medi medica call techn technol ology ogy in the the Philippines and, whenever necessary, adopt such measures as may be deemed proper for the maintenance of good ethics and standards in the practice of medical technology; e) Invest Investiga igate te such violati violations ons of this Act or of the rules and regulati regulations ons issued issued thereunder as may come to the knowledge of the Board and, for this purpose issue subpoena and subpoena duces tecum to secure appearance of witnesses and production of documents in connection with charges presented to the Board; and f) Draf Draftt such such rule ruless and and regu regula lati tion onss as may may be nece necess ssar ary y to carr carry y out out the the provisions of this Act; provided, that the same may be issued only after the approval of the Professional Regulation Commission (P.D. 223) g) To pres prescr crib ibee the the quali qualifi ficat catio ion n and and trai traini ning ng of medi medica call tech technol nologi ogist stss as to specia speciall fields fields of the profes professio sion n and superv supervise ise their their specia specialty lty examin examinati ation on condu conduct cted ed by the the prof profes essi sion onal al organ organiz izat atio ion n of medi medical cal tech techno nolo logi gist stss accredited by the Professional Regulation Commission (PD 498). The government’s effort would have been in vain if the academic world remained











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Associ Associati ation on of Medical Medical Technol Technologi ogists sts (PAME (PAMET) T) and the Philip Philippin pinee Associ Associati ation on of Schools of Medical Technology and Public Health (PASMETH) adopted measures to furthe furtherr the develop developmen mentt of the academ academic ic and clinic clinical al train training ing of wouldwould-be be medica medicall technologis technologists. ts.

The same organizatio organizations ns conducted conducted annual conventions conventions to update and

further develop the practicing medical technologists who are both in the academe and in the laboratory. Republic Act no. 5527 also known as the Philippine Medical Technology Act of 1969 1969 defi define ned d the the prac practi tice ce of Medi Medica call Tech Technol nolog ogy y as a prof profes essi sion on whic which h aids aids the the physician in the diagnosis, study and treatment of disease and in promotion of health in general: 1. Examination Examination of tissues, tissues, secreti secretions ons and excretio excretions ns of the human human body and and body fluids fluids by variou variouss electr electroni onic, c, chemic chemical, al, micros microscopi copic, c, bacteri bacteriolo ologic gic,, hemato hematolog logic, ic, serolo serologic gic immunol immunologi ogic, c, nuclea nuclearr and other other labora laborator tory y procedures and techniques other manual or automated; 2. Blood Blood bankin banking g procedu procedures res and and techn techniqu iques; es; 3. Parasitic Parasitic,, Mycologic Mycologic and Microb Microbiologi iologicc procedures procedures and and techniques; techniques; 4. Histop Histopath atholo ologic gic and and Cytote Cytotechno chnolog logy; y; 5. Clin Clinic ical al rese resear arch ch invo involv lvin ing g pati patien ents ts or human human bein beings gs requi requiri ring ng the the use use of and/or application of medical technology knowledge and procedures; 6. Prep Prepar arat atio ion n and and stand standar ardi diza zati tion on of reag reagen ents ts,, stan standa dard rds, s, stai stains ns and othe others rs,, provided such reagents, standards, stains and others are exclusively for













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8. collec collecti tion on and preser preservat vation ion of spec specime imens ns

The same act under section section two defined defined a Medical Medical Technologist Technologist as a person who engages in the work of medical technology under the supervision of a pathologist or licensed physician authorized by the Department of Health in places where there is no pathologist and who having passed a prescribed course (Bachelor of Science in Medical Technology/Bachelor of Science in Hygiene) on training and examination is registered under the provisions of this Act (Rabor, 1998).

Bachelor of Science in Medical Technology (BSMT) Program The four-year course program’s main goal is to contribute objective and accurate labor laborat ator ory y data data that that will will aid aid in the the diag diagno nosi siss of vari variou ouss dise diseas asee proc proces esse ses. s.

As a

paramedical paramedical profession profession,, it includes includes the following areas: areas: Hematology Hematology,, Blood Banking, Immunology Immunology and Serology, Serology, Clinical Clinical Chemistry Chemistry,, Bacteriol Bacteriology, ogy, Parasitol Parasitology, ogy, Clinical Clinical Microscopy and Histopathology. Histopathology. These are designed to develop students’ capabilities in performing laboratory tests designed to help the medical practitioner establish or confirm clinical diagnosis, or aid in making a differential diagnosis that will ultimately influence











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Clinical Chemistry I – Pure Blood Chemistry The course includes the application of basic chemistry principles to the analysis of variou variouss chemic chemical al metabol metabolite itess in blood.

The subject subject deals with basic procedur procedures, es,

principle principless involved, involved, instrument instrumentation ation and interpretat interpretation ion of the basic blood chemistry chemistry pro proce cedu dure res. s.

It also also deal dealss with with the the intr intrin insi sicc and and extr extrin insi sicc fact factor orss affe affect ctin ing g the the

determination. Clinical Chemistry 2 – Endocrinology and Toxicology The course includes the study of clinical enzymes, electrolytes, endocrine glands, hormones and the most common toxins with regard to their specific characteristics, classi classific ficati ations, ons, measur measureme ement nt and factor factorss affect affecting ing enzyme enzyme-re -react action ions, s, their their clinic clinical al significance and the methods used in their determination. Microbiology The subject includes study of microbes, which includes bacteria (Bacteriology), viru viruse sess (Vir (Virol olog ogy) y),, and fungi fungi (Mycol (Mycology ogy). ).

It deal dealss with with the the basi basicc stru struct ctur uree and and

charac character terist istics ics of microb microbes, es, such such as morpho morpholog logy, y, bioche biochemic mical al and physio physiolog logica icall cha

terist teristics ics

Knowled Knowled

of the classif classifica icatio tio

and medica medicall signif significa ica

to the











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Parasitology The subject emphasizes the study of the biology and ecology of parasites affecting man. man.

It also also incl include udess the the study study of the the morp morpho holo logy gy,, life life cycl cycle, e, phys physio iolo logy gy and

pathogenesis of the parasites affecting man. Hematology This This course course deals with the fundament fundamentals als of blood blood as a tissue tissue,, includ including ing its its physi physical cal characte characteris risti tics. cs.

The mechanism mechanism of coagul coagulati ation on as the underlyi underlying ng basis basis of

understandi understanding ng and properly properly applying applying all laboratory laboratory tests associated associated with coagulation coagulation defects. It also deals with the proper techniques of peripheral blood collection, marrow tissue, splenic and lymph node specimen, also morphology of blood cells and mechanics of hematologic procedures associated with the diseases, abnormalities of red cells and the necessary corrections. Serology and Immunology The course deals with the study of antigen and antibody reactions as applied to the human body in both normal normal and in disease conditions. It also tackles the procedures and methods methods for detection of antibodies, antibodies, antigens, antigens, or antigen-ant antigen-antibody ibody complexes in normal normal individuals and in various diseases.











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of blood donor. donor.

It includes includes blood blood compone component nt preparat preparation ion in order order to meet meet specif specific ic

demands of blood transfusion. transfusion. It emphasizes the selection selection of high quality blood in order to protect the recipients as well as donors. General Pathology and Histotechniques (Histopathology) The course deals with the various factors affecting affecting man on al morphologic morphological al and histologic histological al level. It is also also the laboratory laboratory diagnosi diagnosiss of diseases. diseases. It also involves involves the the different procedures performed in the processing of tissue sections from either biopsy or autopsy, and staining techniques employed and the proper procedures in performing them. Clinical Microscopy The subject deals with the macroscopic, chemical and microscopic study of the different non-blood body fluids and their by products such as urine, feces, sputum, gastric and duodenal duodenal contents, contents, cerebrospina cerebrospinall fluid, fluid, synovial synovial fluid, fluid, transudates transudates,, exudates, exudates, sweat, sweat, seminal seminal fluid, vaginal vaginal fluid and amniotic amniotic fluid.

Macroscopic Macroscopic examinati examination on includes

description of the physical characteristics of different specimens employing basic senses. Chemical examinations involve the detection of the presence of elements not normally nt

abs

of element element

mally mally

t in bod

fluids fluids and their their clinic clinical al











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Medical Technology Laws and Ethics with Laboratory Management The course includes the study of the history of the Medical Technology profession both local and abroad, history of the Philippine Association of Medical Technologists, Phil Philip ippi pine ne laws laws,, Pres Presid iden enti tial al Decr Decree eess in rela relati tion on to the the prac practi tice ce of the the Medi Medica call Technology profession, such as the Medical Technology Law of 1969, R.A. 6138, P.D. 1534, Clinical laboratory law, Blood Banking law, letters of instructions, Administrative Orders from the Ministry of Health, also the study of the Medical Technology Code of Ethics, Ethics, and Laboratory Laboratory management, management, Laboratory Laboratory Operations Operations,, Personnel Personnel Management Management,, Material Management and Professionalism.

Medical Technology Internship Program The Medica Medicall Techno Technolog logy y Intern Internshi ship p Progr Program am provid provides es the traini training ng for the development of medical technologists who possess the knowledge, technical skills and attitude to perform scientific laboratory investigation in aid of diagnosis treatment and research required in health care delivery in the country and the global community (MT Internship Manual AY 2000 – 2001). The internship program strives to fulfill the following objectives:













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3. To provid providee scient scientifi ificc princi principle pless and speciali specialized zed knowledge knowledge to perfor perform m testin testing g procedures in the field of diagnostic laboratory. 4. To instil instilll in the intern internss a high high degree of profess profession ionali alism, sm, love love of learni learning ng and pride in the chosen course.

The Internship Program entails actual exposure of the Medical Technology inters at the Angeles University Foundation Medical Center, laboratory Department and other accredited laboratories in Medical Centers where affiliation is established. The interns undergo twelve (12) months of comprehensive rigorous hands-on training training in the various sections sections of the clinical clinical laboratory. laboratory. They rotate rotate in the different different sections of the laboratory for a prescribed period of time, where they perform actual labo labora rato tory ry work work unde underr the the supe superv rvis isio ion n of lice licens nsed ed and and expe experi rien ence ced d Medi Medica call











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Internship 1 It is the first phase (first six months) of internship training for 4 th year Medical Medical Technology Technology students. students. Rotation Rotation in the differ different ent sections sections namely: namely: Hematology Hematology,, Blood Bankin Banking, g,

Clinic Clinical al

Chemis Chemistry try,,

Microb Microbiol iology ogy,,

Clinic Clinical al

Micros Microscop copy, y, Parasi Parasitol tology ogy,,

Histopathology, and ECG, EEG, is undertaken by the interns within a prescribed period of time. time.

During During the rotation rotation,, they they are made to do actual actual laborator laboratory y work work under under the

supervision of licensed and experienced experienced Medical Technologists. The actual performance performance of laboratory tests will develop and perfect their technical skills in the field of Clinical Laboratory. Community service is also rendered by the interns to develop awareness of their responsibilities towards society.

Internship 2











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Lectures are conducted every last Saturday of the month by Resource Speakers who are highly specialized in their respective fields. This is done to update and review the interns on their theoretical and clinical knowledge in the various laboratory sections. Comprehensive examinations are given after every seminar and is complemented by the continu continuing ing lectur lectures, es, quizze quizzes, s, oral oral and practi practical cal examina examinatio tions ns given given by the clinic clinical al Internship Coordinators during weekly visits to the Affiliation Centers.

Seminar 2 Lectures are conducted every last Saturday of the month by another set of invited Resource Speakers to update and review the interns on their theoretical and clinical knowledge in the different laboratory laboratory sections. Comprehensive examinations are given after every seminar and is also supplemented by the continuing lectures, quizzes, oral and











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Arti Articl clee I Sect Sectio ion n 2 of Reso Resolu luti tion on no. no. 338 338 seri series es of 1994 1994 stat states es that that the the examination should test whether a candidate merits the minimum standard of technical compet competence ence expected expected of a newly newly qualifie qualified d member member of the profess profession ion..

A relati relativel vely y

uniform standard should be established and consistently followed to ensure the reliability of examination results. Sections two and three of the above-mentioned above-mentioned resolution sets the nature nature and diffic difficult ulty y of board board examina examinatio tion n questi questions ons..

It emphasize emphasized d that that techni technical cal

knowled knowledge ge that that is curren currently tly releva relevant nt to the profes professio sion n concern concerned, ed, and adequa adequatel tely y discussed in textbooks textbooks and other professional professional literature. Trivial, outdated, unsettled, unsettled, and controversial questions should be avoided. Section three of the resolution mentioned mentioned that the examination should measure technical competence at the level of new entrants to the profe professi ssion. on.

Questi Questions ons should should neithe neitherr be too easy easy nor too diffic difficult ult.. Betwee Between n two

extremes, a “ difficulty scale” should be adopted so that there is a suitable mixture of











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To meet such objectives the Board of Medical Technology, a regulatory board under under the Profes Professio sional nal Regula Regulatio tion n Commis Commissio sion, n, shall shall jointl jointly y have have charge charge over over the conduct of the examinations given by former according to the rules and regulations stipulated under Section 19 Article III of P.D. 223. The same board in January 17, 1994, resolved to revise Board Resolution No. 02, S. 1994 by adopting the revisions and/or changes incorporated and indicated by the underscored or underlined topics or items including the weight in percent in the revised guidelines guidelines appended appended to the Resolution Resolution no. 15 series series 1996 as Annex A. The resolution resolution indicated the weight of following board subjects: subjects: Hematology = 20%; Microbiology and Parasitology = 20%; Clinical Chemistry = 20%; Blood Banking and Serology = 20%; Clin Clinic ical al Micr Micros osco copy py = 10%; 10%; and Hist Histop opat atho holo logi gicc Techn Techniq iques ues & MTLE MTLE = 10%. 10%. Combined subjects like Microbiology and Parasitology shall constitute 70% and 30%













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cognit cognitive ive level; level; memory memory;; compre comprehen hensio sion, n, interp interpret retati ation, on, comput computati ation, on, applica applicatio tion, n, analysis, problem solving, and other high order thinking skills or abilities; (4) knowledge and proficiency level; and (5) question types – objective, essay, problem solving, or design/drawing – shall have four four (4) items for the choice of one (1) (1) correct answer. The questions questions for each category must must be represented represented of the mass. Every question question shall shall be fully fully edited edited to avoid clerica clericall error. error.

A test test constr construct uction ion expert expert shall shall appraise appraise it, if

necessary, as to to clarity, objectivity, validity, validity, relevance, reliability, reliability, and effectiveness. It











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Hema Hemato tolo logy gy are are given given duri during ng the the firs firstt day day of the the exam exam in the the same same order order whil whilee Serology/Blood Banking, Clinical Chemistry and Histopathology/MTLE are scheduled on the last day of the examination ex amination in the same order as presented in this text. Medical Medical technologis technologists ts have earned a baccalaureat baccalaureatee degree program from college or university recognized by the Commission on Higher Education, including clinical internship in a training laboratory accredited by the Bureau of Research and laboratories of the Department of Health and have passed the licensure examination administered by











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predictors predictors”. ”. They suggest that the usual psychological psychological measures measures of motivation motivation interest interest and personality of student nurse contribute little to the predictor of success or failure. Myers as quoted by Dela Cruz (1999), considers school attainment of works by the pupils as an important measure measure of pupils’ intelligenc intelligence. e. The results results of this study on nursing students reveal a positive correlation between the two variables of attitude or mental ability and achievement. Voh (1970), determined the validity of the college qualification test as a predictor











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and and ’97: ’97: Impl Implic icati ation on to AUF AUF PT Educ Educat atio ion. n.”” Thei Theirr stud study y show showed ed that that acad academ emic ic performance was found to be a significant determinant in the Board Examination of Batch ’96 and ’97. The researchers recommended that a greater emphasis be placed on the academic performance and pre-board examination preparations. The group found out that that clin clinic ical al perf perfor orma manc ncee is a sign signif ific ican antt deter determi minan nantt in the the boar board d exam examin inat atio ion n performance; thus, the internship program must be enhanced to facilitate continuation of the learning process.











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not conside considerr achiev achieveme ement nt tests tests of gradua graduates tes as a determ determina inant nt of board board examina examinatio tion n performance but rather focused on academic, ac ademic, clinical and seminar ratings. Domingo Fontanilla as referred to by Gaddi conducted a study at the University of Santo Tomas, College of Nursing for the School Year 1971-1972. The objective of the study was to determine the correlation between the college freshmen’s mental ability, aptitude for nursing to their academic success. The study showed significant correlation betwe between en colleg collegee freshm freshman an grade grade averag averagee and the follow following ing:: 1) aptitu aptitude de for nursin nursing g













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semina seminarr rating ratingss on the board board examina examinati tion on perfor performan mance ce of the Medica Medicall Techno Technolog logy y graduates of Angeles University Foundation. Cruz, Rustico (1986) compared the academic achievement and National Entrance











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of Nursing graduates while the present study attempted to determine the predictive values of academ academic, ic, clinic clinical al and semina seminarr rating ratingss on the board board examina examinatio tion n perfor performan mance ce of Medical Technology graduates.











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with a mean rating rating of 77.5%. Assuming Assuming equal variances, variances, the T-test T-test for independent independent samples showed that the second group composed of MT graduates of 1999 & 2000 did not perform as well as the other group who took the examination from l995 to l998. This

Chapter 2 Related Literature and Studies This

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