fu+ 6to.w4øun rtffi ll I ilril I llll llll lllllllil lllil TIM EVOLUTION OF BIOMEDICAL SCIENCES IN ET]ROPE: HISTORICAL EXPLANATION AI\D X'[]TURE PROSPECTS by Robert lanMunro A thesis submitted for the degree of Doctor of Philosophy, University of Wales December 2001 J DECLARATION This work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidatr¡re for any degree. Siped Lg (candidate) Date &.c* STATEMENT 1 This thesis is the result of my own investigations, except where otherwise stated. Other sourc,es are acknorvledgd by footnotes giving explicit references. A bibliography is appended. Sigred Qs (candidate) Date ...........àÍ. î *y*.. fut STATEMENT2 I hereby give consent for my thesis, if accepted, to be available for photocoplng and for inta-library loan, and for the title and summary to be made available to outside organisations. Sigred (g.,.**. (candidate) Date ..........Ð{T ..8.**...¿ør. VOLUME I ABSTRACT This work seeks to identifi those factors that have influenced the development of the professional group ofworkers associated with medical laboratory sciences. It has also examined the features that have both encouraged and impeded the trend towards European harmonisation within the profession. The study concentrates on the evolution of this occupational category with respect to four Ewopean Nations - the UIÇ Germany, Greece and Sweden. These countries have been selected on the basis that they have different furancial systems for the delivery of health care. The thesis begins with an assessment ofthe significance of emergent medical sciences during the Renaissance and their impact on diagnostic pathology. This is followed by a consideration of the contribution of Twentieth Century medical advances, set against the background of the Industrial Revolution and the demands emanating from global conflict. The role of scientific and technological developments are seen as the most significant influences in forging European harmonisation within those professions concerned with biomedical sciences. The next consideration concerns the aftitude of medical laboratory technologists towards the notion of 'þrofession", together with their ability to identify the characteristics of such a concept. Results indicate that the ability of practitioners in such respect is not significantly different from that of other members of the professions allied to medicine, or the learned professions. The influence of health ca¡e systems on medical laboratory sciences is examined by identiting the political, economic, social ant technological factors shaping health care delivery in the above cor:ntries. In all cases, diagnostic pathology services are financed by a mixtr¡re of public and private provision. The thesis also assesses the relationship between the various professional bodies and licensing authorities. Although practitioners in all four countries require some form of licensure (i.e. ate "regulated professions"), only those in the UK undergo State Registration on an annual basis. The views of practitioners towards the mutual recognition of European professional qualifications has been sought using semi-structured interviews. There is some support for such a principle, but in practice little activity is taking place. A comparison has also been made of the views of undergraduates and tutors towards European exchange schemes such as SOCRATES. This is achieved using questionnaires aimed at assessing participation rates, identification of barriers to student mobility, levels of awa¡eness regarding European current affairs, and language competencies. Student participation is relatively low and the main barrier to study in other European countries has been identifred as lack of finance. Comparisons have been made with respect to curriculum content, student assessment strategies, course fees and other aspects of education. There is a requirement to increase levels of provision with respect to European studies and students need to be better informed regarding opportunities available to them. The influence of European Union policy on academic and professional harmonisation is assessed by considering aspects of student and staff exchange schemes, together with the possible affects of the Sorbonne and Bologna Decla¡ations. The work concludes with some recommendations for increasing the role of education and training with respect to achieving closer European integration. These include a re-assessment of the af[ects of replacing Inter-University Collaborative Programmes with Institutional Contracts. There is also a need for greater tutor advocacy and further EU investment in student grant aid. ll To myfamily 111 Acknowledgements I acknowledge my gratitude to the following: Professor Morton Warner, Director of Researcl¡ for his patience, inspiration, academic guidance and good humour. Dr Maureen Bower¡ Second Supervisor and Head of School of Applied Sciences, UWIC, for providing financial support, granting of study leave and her help in so many other respects. Professor David Rogers, Second Supervisor - his advice regarding professional issues, expertise on typographical and editorial matters and general encouragement have been much appreciated. Keith Morris, for his assistance relating to statistical methods, his patience and willingness to engage in debate and for helping to alleviate the teaching burden during my period of research. Betty Walker, for her help with respect to Information Technology, photocopying and a multitude of other tasks. Dr Peter Watkins, for readily agreeing to take over my administrative responsibilities during the period ofthis research. IV Joanne Grimley, whose expertise in formatting the thesis, her patience and understanding and her ability to resist any temptation to panic have been an invaluable asset. Lorraine McMullan, for her good humour and general encouragement. The staffand students of colleges within the UK Germany, Greece and Sweden, for their co-operation in completing questionnaires and answering many of my queries with patience and understanding. My colleagues within the Centre for Biomedical Sciences, UWIC, for their encouragement, patience and support. Gareth and Lena Morgar¡ for providing a fellow Welshman with much advice and information regarding Swedish issues. Professor Panagiotis Soubilis, Department of Medical Laboratories, Technical Educational Institution, Athens for his input relating to the Greek perspective. Dr. Bodil Person for providing her insight into the history of medical laboratory sciences in Sweden. Katrina Eck, for having the courage to spearhead the German responses to my quefles. Those respondents who readily agreed to participate in the interviews included in Chapter 7. My son Andrew - for proof reading sections of the text and for his philosophical approach - "I've done it - so why can't you?' My son Christopher - for his sense of humour, IT assistance and fote-bearance with respect to his "old man". My parents - for having faith in my abilities. And most importantly of all - my wife Lynda - where does one begin? vr CONTENTS Page Abstract I Dedication llt Acknowledgements iv Contents vii List of Tables, Figures and Pl¡tes xiii List of Abbreviations xxi Introduction 1 SECTION A SCIENCE AND TECHNOLOGY _ AGENCIES X'OR HOMOGENEITY 8 chapter I Pre-Twentieth century Advances in Diagnostic Patholory 9 Introduction 11 Renaissance Medicine ll The Influence of the Pure Sciences t6 The Birth of Medical Laboratory Sciences 23 The Foundations of Histopathology 24 The Advent of Medical Microbiology 28 The Emergence of Immunology 35 Early Attempts at Blood Transfusion 36 The Foundations of Haematology 37 Clinical Chemistry-The Early Years 40 Non- Scientific Influences 42 Conclusions 45 Notes 56 vll References 63 Chapter 2 Diagnostic Pathology in the Twentieth Century 67 Introduction 68 Histopathology-The Process of Modernisation 68 Microbiology and the Advent of Antibiotics 73 Immunology-the Emergence of a Dichotomous Science 78 Gtobal Conflict and the Impetus for Developments in Blood Transfusion 88 Simple Microscopy to Advanced Automation-The Study of Blood Disorders 93 The Transformation from Chemical Physiology to Clinical Chemistry 99 The Emergence ofNew DisciPlines 103 Conclusions 110 Notes 113 References l2t Chapter 3 Medicat Laboratory Sciences-The Problem of Definition 127 Introduction 128 The Emergence of a New Group of Scientific Workers 128 Problems ofDefinition 136 The Issue of Profession 138 Task Related Autonomy 145 The Concept of '?rofession"-Occupational Differences t52 (a). Method 153 (b). Results r55 (c). Statistical Analysis r65 (d). Discussion 166 Conclusions t7t vlll Notes References SECTION B FOUNDATIONS X'OR THE MODERN ERA. Chapter 4 The Influence of Health Care Systems on Medical Laboratory Sciences Introduction Biomedical Sciences in the Context of Health Services in Europe Developments within the UK The UKNational Health Service and the Expansion of Medical Laboratory Sciences The Health Care Systems in Germany, Greece and Sweden (a). Germany (b). Greece (c). Sweden Conclusions Notes References Chapter 5 The Professional Bodies and Licensing Authorities Introduction The UK State Registration Education and Training Po st-Basic Qualifications Heads of University Centres of B iomedical Sciences (HUCBMS) Continuing Professional Development (CPD) Business and Technology Education Council (BTEC) IX National Vocational Qualifications (NVQs) 263 Germany 265 Greece 269 Sweden 271 Conclusions 275 Notes 279 References 288