The field of clinical laboratory science took a big step forward in 2018 when Brandy Gunsolus, DCLS, MLS(ASCP)CM, graduated from Rutgers School of Health Professions with her doctorate in clinical laboratory science (DCLS). As clinical lab testing becomes more complex, this new degree has been instrumental in bringing lab medicine out of hospital basements to patients’ bedsides.
The development of the DCLS program started in 2005 when American Society for Clinical Laboratory Science (ASCLS) President Susan Morris convened the first workgroup to begin setting the groundwork for the development of the degree program. The group worked to prove the need for the degree, develop the curriculum for the proposed degree plan, and ensure certification and licensure standards were met.
"DCLS can help reduce diagnostic error by clearing up confusion related to lab procedure ordering, analysis, and interpretation."
Over the next six years, the workgroup would undergo a number of name and initiative changes until Rutgers University enrolled its first student in the program in 2012. Rutgers became the first university to produce a DCLS graduate in the spring of 2018, and the University of Texas Medical Branch in Galveston wasn’t far behind when their first cohort graduated in the summer of 2019.
The need for the DCLS
The DCLS was developed after research showed that the majority of medical laboratory scientists spend time answering questions from physicians about laboratory results and explaining what the results mean for a specific patient, without necessarily having the background or education to feel comfortable doing so. With the increasing number of pathology openings across the country, there is also a gap in the clinical knowledge available to laboratory professionals. Not every laboratory has access to a credentialed clinical pathologist, let alone a specialized clinical chemist or clinical microbiologist with the experience needed to answer questions from physicians about laboratory results. Pathologists have also stated that with increasing case workloads, they don’t have the time to answer questions from physicians about laboratory results.
What does DCLS training include?
This is where the DCLS comes into play. A student in a DCLS program goes through a rigorous course load, including clinical lab-based courses, such as advanced clinical chemistry, advanced immunology, and advanced molecular techniques, while also completing additional coursework in pathophysiology of disease, pharmacology, and research to allow them to help support pathologists.
"A student in a DCLS program goes through a rigorous course load, including clinical lab-based courses."
With this knowledge set, the DCLS students are also provided hands-on experience at a clinical location, which varies in length and time depending on the program. Clinical education at these sites includes rounding on the floor with patient care teams on a variety of medical services (internal medicine, infectious disease, hematology oncology, etc.), starting and running diagnostic management teams, educating physicians and patients about laboratory ordering and results, and performing translational research to help improve patient outcomes.
In total, a DCLS student will spend a minimum of three years completing the degree. The three-year time frame is for students who enroll full time in one of the three programs currently available (Rutgers, UTMB-Galveston, and University of Kansas-Kansas City). However, since many laboratory professionals continue to work at the bench while gaining advanced degrees, the programs can be completed either full- or part-time. Most students complete their degree within four to five years of acceptance into the program.
Can DCLS grads be high complexity lab directors?
This past summer, the Centers for Medicare and Medicaid Services (CMS) put out a request for comment to amend the Clinical Laboratory Improvements Act of 1988 (CLIA’88) requirements for a high complexity laboratory director (HCLD) to include the DCLS degree. Many professional organizations, including the American Society for Clinical Chemists (AACC) and the American Society for Microbiology (ASM), have stated that they do not support adding the DCLS to the HCLD qualifications, because they feel that the educational requirements for DCLS students are not as stringent as current MD and PhD candidates eligible for HCLD.
Unfortunately, many of the comments made have been based on inaccurate notions that the DCLS is more like continuing education requirements for bachelors and masters prepared professionals, and not graduate level education as demonstrated by the course work.
“Laboratory utilization is one of the largest areas of practice for the DCLS.”
DCLS and HCLD as complementary roles
According to practicing DCLS graduates, a DCLS professional is capable of filling in as a HCLD in places where a board-certified clinical pathologist, clinical chemist, or clinical microbiologist is not available—these are not the main responsibilities for the DCLS. The DCLS will be able to enhance the practice of these clinical professionals by working on laboratory test utilization and physician and patient education of laboratory tests and results, while the HCLD can focus on their role as clinical laboratory leader.
Laboratory utilization is one of the largest areas of practice for the DCLS, as there has been a significant increase in laboratory testing menus over the last 50 years, without an increase in educational requirements in medical school for laboratory medicine. This leads to physicians and other health care providers ordering tests that they may not be familiar with, furthering confusion when results are abnormal.
Having a DCLS on staff who is able to review laboratory orders, determine clinical need through chart review for the patient, and consult with physicians about laboratory testing results can reduce unnecessary health care costs for both the health care network and the patient, as well as reduce diagnostic error.
In a 2015 report by the Institutes of Medicine, diagnostic error was shown to account for potentially 6–17 percent of adverse events in hospitals. DCLS professionals can help reduce diagnostic error by clearing up confusion related to lab procedure ordering, analysis, and interpretation.
A bright future
The DCLS is a relatively new profession that will continue to face uphill challenges in gaining recognition and respect in the health care field as a whole. However, over time, the increased presence of DCLS professionals will help reduce laboratory errors to improve the rate of diagnostic error and help elevate the role of the clinical lab in patient care.