Beware of Ethical Violations in Laboratory Professional Certifications

The American Society for Clinical Pathology (ASCP) has a proud history of promoting quality in the profession of the clinical laboratory sciences. The mission of the Society is to provide excellence in education, certification, and advocacy on behalf of patients, pathologists and laboratory professionals. The ASCP Board of Certification (BOC) is the gold standard in global certification for all laboratory professionals and has certified more than 590,000 individuals. Since its inception in 1928, the BOC continues to set a high standard for quality and continuing competency. This article will delineate the scope of ASCP’s work in ensuring laboratory professionals are well qualified to conduct work that is critical to patient’s safety, and describe the alarming ethical violations that undermine the credentialing process.

Maintaining a committment to professionalism

Laboratory testing is integral to the diagnosis and management of our patients and therefore having a skilled laboratory workforce is critical for our healthcare system. However, the laboratory is still often seen as a “black box,” with many patients lacking knowledge about the sophisticated training required for laboratory professionals. The ASCP BOC offers credentials for 31 different laboratory professions and specialty areas. Most ASCP-certified laboratory professionals are medical laboratory scientists (MLS) and medical laboratory technicians (MLT), who collectively perform laboratory testing in blood bank, chemistry, hematology, microbiology, and molecular biology departments throughout hospitals, physician clinics, and public health and reference laboratories. Other popular ASCP-certification exams include phlebotomy technicians (PBT), who perform venipuncture (drawing blood) and process laboratory specimens, cytotechnologists (CT), who prepare and evaluate human cellular samples from all body sites, under the direction of a pathologist, to detect pre-cancerous changes, cancer, benign tumors, infectious agents, and inflammatory processes, and histotechnicians and histotechnologists (HT and HTL), who process biopsy and tissue specimens into stained-glass slides for microscope review and diagnosis by a pathologist. Many hospital laboratories require ASCP certification for employment. In some licensure states (states that have enacted laws that regulate practice), certification is a requirement for employment.

In addition to a commitment to professional competence, the ASCP BOC holds high expectations for the demonstration of professional ethics in the field. The National Ethics Project (NEP), a consortium of researchers, educators, and practitioners from different disciplines and a variety of higher education institutions state that, “Ethics provides the framework and tools to understand and enact responsible human stewardship for our world. Ethics is increasingly recognized by educators and employers as the pathway to individual and collective integrity, responsibility, and success in society and the workplace.”1 These are simple concepts that any profession should use as a guide in ensuring its certificants meet the demands of being a “professional.”

Laboratory professionals are held to a universal code of conduct because of their chosen profession. The ASCP BOC “Certification Guidelines for Ethical Behavior for Certificants” addresses everything from patient care to relationships with other colleagues. These guidelines suggest/recommend that laboratory professionals:

• Treat patients with respect, care, and thoughtfulness.
• Develop cooperative and respectful relationships with colleagues to ensure a high standard of patient care.
• Perform duties in an accurate, precise, timely, and responsible manner.
• Safeguard patient information and test results as confidential, except as required by law.
• Advocate the delivery of quality laboratory services in a cost-effective manner.
• Strive to maintain a reputation of honesty, integrity, and reliability.
• Comply with laws and regulations and strive to disclose illegal or improper behavior to the appropriate authorities.
• Continue to study, apply, and advance medical laboratory knowledge and skills; and share such with other members of the health care community and the public.
• Render quality services and care regardless of patients’ age, gender, race, religion, national origin, disability, marital status, sexual orientation, political, social, health, or economic status.

The BOC states that certificants will “strive to maintain a reputation of honesty, integrity, and reliability.” Yet, the BOC has encountered a growing number of violations of professional ethics in recent years. Specifically, and alarmingly, there are increased incidents of misrepresentation of credentials via alterations of certificates and documentation. The increasing availability of technology has enabled individuals to produce authentic-looking documentation in the form of ASCP BOC certificates, certification score reports and screenshots of an individual’s ASCP record showing valid (unexpired) certification. Instances of fraud have been traced back to individuals who posted their ASCP BOC certificate and other personal documents (ie, college transcripts) on social media. Unfortunately, individuals who post this type of personal information are at risk for identity theft as well as providing an opportunity for others to commit certification fraud. Thus, copies of wall certificates or other documentation are unreliable. This has unfortunately led to individuals holding laboratory positions for which they are unqualified and potentially endangering patients.

The ethical challenges facing the clinical laboratory profession, in particular with misrepresentation of ASCP BOC certification, are deeply concerning, although not unique to the clinical laboratory professions.2 However, when professionals' actions have a critical impact on patients' health and well-being, it’s importance is paramount. These dishonest practices have the potential for affecting patient safety. Patients rightly expect the highest level of competence and professional practice from those who perform laboratory testing and interpret data about their medical conditions for physicians. Unethical behavior undermines the integrity and reputation of the profession.

The ASCP BOC is reaching out to laboratory managers and human resource personnel for assistance in identifying violations and to ensure that laboratory personnel are hiring and retaining only certified individuals. The only definitive way to verify ASCP BOC certification is through primary source verification. Verification results regarding an individual’s credential status will include the category, credential number (if applicable) and credential validation period. The following steps can assist the ASCP BOC in taking action against violation of certification:

• Verify all ASCP credentials through primary source verification: www.ascp.org/verification
• Forward copies of misrepresentations of credentials to the BOC: verification@ascp.org

We thank you for your assistance in helping the ASCP BOC maintain the highest standards of excellence among laboratory personnel and protecting the health and safety of patients.

References

1. National Ethics Project. Accessed February 5, 2021. https://nationalethicsproject.org
2. McKelvey S. (2015). Catch me if you can: dealing with fraudulent misrepresentation of qualifications or credentials in the workplace. Lexology March 5, 2015. Accessed March 10, 2021. https://www.lexology.com/library/detail.aspx?g=a70b5bbe-9e02-4c66-8164-ed3e33c3d046