NSH, since its inception in 1973, has been the leading provider of histology focused education, serving as a conduit for knowledge sharing and fellowship among the histology community. It is not, however, the administrator of the histology certification exam; the American Society for Clinical Pathology is.
The ASCP was founded in 1922, with the ASCP Board of Registry soon to follow, in 1928. The purpose of the Board was to “develop standards and procedures for individuals to enter, continue and advance in the medical laboratory, and to certify and register those individuals who meet the required level of competence”. Exams were introduced in 1933 for the certifications then available, Medical Technician (MT) and Laboratory Technician (LT). These original exams were 50% oral/practical, 25% written, and 25% personal/psychological, with an exam fee of $10 (equal to about $198 in 2020).
The HT certification doesn’t come on the scene until 20 years after the creation of the Board, in 1948. At this time, they also drop the essay portion of the exam, opting instead for only true/false and multiple-choice questions for the written portion. Over the next two decades additional certifications are introduced including the Cytotechnologist (CT) and the Medical Laboratory Technologist (MLT). It isn’t until 1980 that the HTL is introduced. It is also in 1980 that the test grading changes from norm-referenced (comparing your score to the standard score of comparable test takers), to an absolute standard pass-fail determination.
The grading method would again change in 1994 as the BOR entered the digital age and implemented CAT. Computer-adaptive-testing means that when you answer a question correctly, the next question will be harder. If you get a question wrong, the next question will be easier. CAT sets a minimum competency standard that a test taker must maintain in order to pass. Since the questions get harder as you go along (assuming you’re getting them right), many test takers felt the exam had become harder, but it was simply a matter of the changed nature of the test. The Computer Adaptive Testing method is still used for today’s test. (Learn more about CAT in a post blog post.)
1994 would also see the creation of the QIHC (Qualification in Immunohistochemistry). Though IHC had been around in many labs since the late 1970s it was a manual process that was time consuming and expensive. As technology developed, IHC expanded, growing into one of the largest specialties in today’s laboratory.
As the profession grew more complex, standards began to change. As anyone certified after 2004 can tell you, the CMP (Certification Maintenance Program), made continuing education a certification necessity in the 2000’s. Soon after, in 2005, the high school education route was dropped from eligible education experience for the HT. This move came as a result of a request from the NSH Board of Directors in 1999, which asked ASCP to move towards this change. The Board saw new technologies requiring future histotechnologists to have a greater academic foundation in order to successfully perform the job. The change put histology technician education standards on the same level as medical laboratory technicians.
In 2009 the Board of Registry merged with the NCA to form the Board of Certification (BOC) we know today.