Fixation on Histology

The Importance of Cross-Training

Collaborating CoworkersAs a proud member of the New York State Laboratory Leadership Consortium, consisting of senior laboratory leadership and management of the academic health systems of New York State, the top priority at this time is: the laboratory workforce shortage: What can we do?  The consortium has coined such phrases as “Make Some Noise!” and “We have run out of runway.”  These might be catchy phrases, but the workforce issue is a scary topic.  How can we, as health care leaders, address this issue both for our own institutions, and for our region? Statistics gathered from NSH’s January 2022 Histotechnician Shortages Webinar, Sharon Kneebone reviewed data from the National Accrediting Agency for Clinical Laboratory Science (NAACLS) HT and HTL programs.

What Sharon came up with, in short, is that we are not educating enough histologists to fill the current shortages resulting from increased retirements and professionals exiting the field throughout the pandemic. In taking this down to a micro level, we need to ask what we can do within our own institutions to address the workplace shortage.

One solution that Memorial Sloan Kettering (MSKCC) enacted is the creation of a cross-training program within the departments of pathology and dermatology. Developing collaboration between these two departments is essential to beginning a cross-training program. When a new student enters the workforce within the Mohs Micrographic Surgery Division (MMS), which is housed under dermatology, the student begins a clinical rotation through Mohs and Histology. To develop a more robust program, the institution addressed issues the other departments were facing with the workforce shortage, and added cytology prep into the rotation. As the program developed, the managers within pathology met to discuss collaboration and the need to cross-train individuals entering this profession.

So where to begin? The first thing needed is to create an action plan and present this to the institutions’ senior leadership and faculty. Such an action plan could include speaking to the technical teams and forming a partnership between the different departments where the cross-training will be utilized, creating a mentorship plan and establishing the role of coach/mentor to assist new hires.

Through a strong and robust mentorship program, bonds are formed between mentor and mentee (Krych et al, 2005). Mentorship can benefit the mentor as much as the mentee. As such, this partnership can create a professional and highly productive work environment (Maruta, Rotz, & Peter 2013). Collegiality is formed amongst staff members within the departments that are involved during this process.

The next steps are to create a training checklist and choose the facilitator of this program who will be the liaison between the coaches/mentors and the new technicians. The facilitator needs to check in with all parties involved in the cross-training program. The communication skills and levels exchanged among the mentor and mentee are beneficial.

Begin the process by having the new technician start working in one of the labs to establish a strong foundation. At our institution, I began the process within surgical pathology (histology). I chose this order because the new hires were graduates from a histology program. Working on skill sets to match didactic training is a good place to begin the cross-training process. So, let’s say for about a month’s time the new hire would begin working within the department of histology. After about a month the student then begins the cross-training process and slowly crosses over to the Mohs laboratory. A review of the workflow process needs to be established so that  it can be reviewed by the facilitator on a weekly, biweekly, or monthly basis.

The workforce shortage has turned into a workforce crisis, institutions need to begin thinking out of the box. The cross-training program that was created at MSKCC currently brought us two solid full-time employees, and the process and program continue to grow.


Written by Camille McKay, M.Ed., BSHCA, HTL(ASCP), CLT





11-30-2022 02:47

Thank you for sharing this.

I believe cross training is vital to keeping the profession afloat, in addition to recruiting new techs. 

As a tech I find it beneficial to me as well as to the any institution that employs me when I am able to help in different areas when needed.  For me, this is one  of the benefits about this profession because it keeps me from getting bored and my day goes faster.  I personally love it, and I consider it a win win.  A win for me and a win for the company.

However, not all techs are onboard with this idea of cross training.  Some techs prefer to stay embedding or stay cutting or stay grossing all day, and I think this is okay because labs also need techs who stay doing the one thing. 

I suggest that leaders listen to their staff to find 2 or 3 techs who actually enjoy floating to areas when needed.  It is best to cross train willing techs.  New techs might be more willing to cross train.  Senior techs might not be so willing to start learning new things.

In the presentation about the workforce shortage presented by the NSH, I believe it was mentioned that senior staff, on the brink of retirement are unwilling to train or to share what they know.  I have witnessed it and it is sad because someone took the time to train these techs, but they are unwilling to share what they know.

In this case, labs might have to bring in consultants to teach or train the newer staff.  For example, you could bring in a consultant to do a training about your processing instruments or you could bring in a consultant to do a training about your Ventana instruments. 

10-07-2022 14:03

Thank you Camille McKay, 
I am very glad to read the phrases of “Make Some Noise!” and  “We have run out of runway.” Your article really addressed the problem. I am also completely agree on preparing the checklist.  However; will you plan to conduct a pilot study prior to the actual action?