Scarselletta, Mario. "The infamous lab error: education, skill, and quality in medical technician's work." in Between craft and science: technical work in US settings, edited by Stephen Barley and Julian Orr. Ithaca, NY: ILR Press.

What is skill?

Skill is often seen as an attribute of individuals. It is not just knowledge but the "ability to do something well". Skill almost invariably entails improvisation and is contextual. Since skill is hard to measure people often use "years of schooling" as a proxy for skill possession. But this view can be very misleading.

Productivity is also a poor measurement of skill.

Skill and Policy

Skill as Practice

Education and training do not equal skill -- the are merely indicators of skill. Skill resides in a performance.

Medical Laboratory Technical Work

Technicans in modern labs are now as much monitors as anything else, responsible for the care and feeding of machines. Physicians tend to perceive technicians in chemistry and hematology as semi-skilled, often referring to these techs as "button pushers".

The most educated (Medical Technologists) theoretically should be more skilled than the two other groups (Medical Lab Technicians).

Data and Method of Study

Did an ethnography of a hospital lab.

Errors

Both MT's and MLT's come in with the same propensity to make errors. The extra schooling didn't seem to help much in ability -- just extra pay.

Pre-analytic errors

There are "bad orders", "bad samples",

Analytic errors

This includes machine malfunction. Also the tech can fail to follow procedure or incorrectly identify or classify cells under the microscope.

Post-analytic errors

Errors transferring data to computer files. Typing errors. Physicians misread results.

Managing Error in the Lab

The bulk of errors are pre and post outside of the lab. Most in-lab errors are test results that out of context look normal.

Skills in Controlling Lab Error

Interpretative Skill

Techs would pool interpretive skills in ambiguous results. "...technicians had adopted an informal practice of public humiliation in order to impart and reinforce the importance of teamwork in negotiating the interpretation of ambiguous test results."

Troubleshooting Machine Malfunctions

Improvisation adn Artistry in Histology

Some skills are more based on art and talent. Each tech had rituals for delicate performance. They jealously guarded their own equipment.

Observations on Skill and Practice

Med tech work requires alot of "working knowledge", largely tacit. It's the tacit knowledge that helps them avoid errors, not formal knowledge. While still important, they tap only a small portion of what they actually learn in the classroom. Experience is more important than education.