How and why was the first biomedical science degree created? The man behind it, Dr Ray Jones, explains all on this landmark anniversary.
This year sees the 40th anniversary of the first UK graduates (pictured, above) who had followed a BSc Honours degree with a significant proportion of biomedical sciences – then known as “medical laboratory science” (MLS) – in its curriculum. The first such degree was at the University of Portsmouth (then Portsmouth Polytechnic) and was instigated by me, ably joined by Professor David Rogers. This was quickly followed by degrees at the universities of Bradford, led by Professor Terry Baker; Ulster, led by Professor Gerry McKenna, and Cardiff Metropolitan University (then Cardiff Institute of Higher Education), led by John Clarke.
There are now more than 50 such qualifications in the UK and honours degrees have become the standard and mandatory requirement for entry to the profession. Here I attempt to summarise the conditions, which facilitated the change to a graduate profession.
The first examinations
One of the principal aims of the IBMS’ precursor, the Pathological and Bacteriological Laboratory Assistants’ Association, established in 1912, was to create a system of qualifying examinations. The first examination was held in 1921 based around “on-the-job” training. Over the decades, the qualification system changed, expanded and became the Institute’s multi-disciplinary “Intermediate” followed by two single-discipline “Final” examinations studied in evening classes.
In 1962 day-release was granted for attendance at courses. In 1968, the system became an Ordinary National Certificate (ONC), followed by the Higher National Certificate (HNC) in Medical Laboratory Sciences. Both contained significantly more basic science than did Institute examinations. There were a few full-time Higher National Diplomas. Courses moved exclusively to colleges and quickly became a significant proportion of part-time science education. Several lecturers with pathology laboratory qualifications and experience were appointed.
The above four centres were the only specialist degree providers for some
years, but gradually other universities added similar degrees to their portfolio, together with more specialist subjects
at Master’s level. All degrees were validated by the professional body and accepted as appropriate by the “licence
to practice” organisation.
Development of degrees
It is considered that three or four main paradigms facilitated the development of the degrees: qualification inflation and academic drift, technical change and professionalisation.
Qualification inflation refers to three interrelated changes in qualifying systems: rises in qualifications for entry level, rises in the level of basic qualifications of the occupation and increases in the time taken to acquire the basic qualification.
For example, in 1970 the minimum entry qualification for chiropody, orthoptists, physiotherapy and radiography was five GCE (General Certificate of Education) passes at Ordinary (O) level.
By 1980, these all required two GCE Advanced (A) passes for entry. Entry requirement for Medical Laboratory Scientific Officers (MLSOs), the then title of the occupation, remained at four O levels. However, there was demand-led qualification inflation with a 75% increase in the recruitment of graduates to the profession between 1975 and 1985. Advertisements for O level entrants ceased in 1982.
Associated with qualification inflation is the phenomenon known as “academic drift” – the act of teaching, the organisation of courses and the writing of curricula tends to push courses to a higher level, both academically and administratively. Further, at that time in Britain, academic pay and conditions became dependent on the level taught. This encouraged academic drift and a move to full-time courses.
This was a time of considerable technical change in hospital laboratories. This is exemplified by a change in emphasis in the Institute examinations with the names of the disciplines being altered, for example: 1921-1959 – “Pathological Technique”; 1960-1969 – “Histopathological Technique” and subsequently “Cellular Pathology”.
There was a substantial increase in the knowledge base required for the occupation with more basic sciences needed and thus, from about 1971, the HNC route became standard.
Cognitive requirement
Prior to their abandonment, an analysis of the cognitive requirements of the Institute examinations, the HNC and undergraduate examinations was made. The analysis was based on Bloom’s Taxonomy of Cognitive Domains – a hierarchy of cognitive requirements that defines six levels of knowledge of varying degrees of difficulty, ranging from Level 1 (knowledge/remembering) to Level 6 (evaluate/create/synthesise).
The HNC was shown to be less demanding in Bloom’s higher categories than both the professional examinations and undergraduate examinations. The IBMS examinations placed a greater emphasis on Bloom’s less intellectually demanding categories, but there were insignificant differences in the higher categories compared with undergraduate courses.
There were fewer differences in the higher categories between the professional and undergraduate examinations than between the HNC and undergraduate examinations. With the professional examinations being set by practitioners and thus being more likely to reflect professional requirements, it was reasonable to posit that the knowledge base of the occupation in the late 1960s and early 1970s was sufficient to sustain a first degree qualification and new entrants to the occupation were intellectually equipped to handle this.
“In terms of the actual work done and levels of responsibility these are no different for MLSOs than they would be for similar graduates in industry. Graduates are more articulate about problems, more logical and in a better position to provide the executive viewpoint. Leaders of the MLSO profession have always been people who in earlier times for social, environmental and cultural reasons did not go to university, but who nowadays would go… High levels of ability with high levels of basic sciences are needed [together with] a high concept of responsibility… even at comparatively low levels, because of the patient at the end.”
(Consultant Pathologist, 1981)
Defining biomedical science
It is surprisingly difficult to define a “profession” as distinct from an “occupation” and some languages do not have separate words. Attention has, therefore, focused on the events and circumstances in which people in an occupation attempt to change it into what is tacitly recognised as a profession, and themselves into professional people. This is known as the “professionalisation process” and is a definite and explicit series of criteria which change an “occupation” into what is generally recognised as a “profession”. At least 13 criteria have been described and include establishment of a qualifying association, a basic qualifying system in universities, a substantial knowledge base, a code of ethics and a work-context that recognises the above. Over the years, biomedical scientists have followed these criteria of professionalisation with remarkable precision and have been formally recognised as a profession since 1960 via the Professions Supplementary to Medicine Act.
The first degrees in Biomedical Sciences were developed in response to the phenomena of qualification inflation, academic drift, technical change and professionalisation. These synergised to provide an appropriate platform for the development of the specialised degree qualifications. The initiatives were successful mainly because of their utility, but partly because they attracted support from other science lecturers at a time when fewer students were being recruited to “traditional” science courses. While the original programmes were unashamedly aimed at the medical laboratory market, employment data from Portsmouth and Bradford show that the graduates were readily accepted into a variety of occupations and Biomedical Science is now a significant and highly regarded component of British higher education.