For Your Health

News from the University of North Dakota School of Medicine & Health Sciences

The providers behind the providers

UND’s Medical Laboratory Science program celebrates 75 years of behind-the-scenes diagnoses

In honor of the 75th birthday of UND’s Medical Laboratory Science (MLS) program, North Dakota Medicine is running two stories in 2024 that describe the origins and evolution of the often “hidden” practitioners who provide an invaluable service to hospitals, clinics, and public health programs. This first story covers the origins of “medical technology” at UND as a program in 1949 though the turn of the century. A future story will recap the evolution of the standalone Department of Medical Laboratory Science in the twenty-first century.

“Well, you stayed until the pathology reports got mailed out, and if a machine broke down or something happened, you just didn’t leave,” shrugged Cathy Perry from her home in Grand Forks, N.D. “Dr. Wasdahl always said that whatever you’re typing may be the most important thing this person has ever heard – their diagnosis. So he always impressed upon us the importance of what we were doing. Mistakes could not be made.”

So recalled the longtime administrative officer for the UND School of Medicine & Health Sciences Departments of Pathology and Medical Laboratory Science (MLS) of Dr. Walter Wasdahl, who served as pathology chair at UND from 1961 to 1984.

“I remember that during one blizzard he came and picked me up in his truck because he had to go in and read some slides,” continued Perry with a laugh now. “Come hell or high water you went to work and got the reports out.”

Therein lies the value of a too often underappreciated profession, says Perry: providing physicians and other health providers—and their patients—with the biochemical, pathological, and histological information necessary to make an accurate diagnosis and treatment plan.

UND’s nationally renowned MLS program turns a remarkable 75 years old this year.

Shaking her head at the improbability of the anniversary, assistant professor of MLS Mary Coleman smiles at Perry’s memory, adding that what drew her to “medical technology,” as the vocation was once called, and kept her at UND was not only getting to work with folks like Perry and Wasdahl but the adventure of laboratory science.

“I love the pathophysiology—medical lab science is so interesting,” Coleman exclaimed. “Studying diseases and teaching the students about it: This is what you see in the blood smear, these are the chemistry results, this is possibly what the diagnosis is. It’s so fascinating.”

Confessing to having started working for the very program from which she graduated nearly 50 years ago, Coleman said she never really wanted to be anywhere else.

“I stayed here because of the people—they’re just tremendous,” she continued. “It was a fun place to work. It didn’t matter what your position was, you were always treated with respect. You were a valued member of the department, no matter what.”

Medical Laboratory Science: A brief history

Such egalitarianism is all but embedded in the MLS profession, Coleman said. Indeed, the history of medical laboratory science suggests as much.

According to the American Society for Clinical Laboratory Science (ASCLS), epidemics of typhoid, tuberculosis, diphtheria, and influenza around the globe early in the 20th century “created a new need for laboratory testing in patient care.” This increased demand on pathologists led them “to carve out a niche for female scientists,” who were often pathologists’ own spouses. These spouses were put to work determining not so much disease as the cause of death in their husbands’ patients.

So it is that medical technology was one of the first occupations in which “women could find work that was not the conventional low-level clerical role,” says the ASCLS website, adding how one 20th century pathologist tried to keep laboratorians’ salaries low because lab work for these women merely served to “bridge the gap between graduation and marriage.”

As both technology and diagnostic methods—and equity for women—advanced, MLS emerged as its own profession between the previous century’s two World Wars. At that time, medical technologists were typically housed within university and/or hospital departments dedicated to pathology, bacteriology, virology, and public health.

The case was similar at UND whose own technologists—the first in the state—had been firmly embedded with UND’s Department of Bacteriology and Pathology ever since UND President and biologist M.A. Brannon established North Dakota’s then-two-year School of Medicine in 1905.

Part of the combined department’s charge was not only to teach future laboratorians but to partner with the newly established public health laboratory, wrote Louis Geiger in his book on UND’s early history, University of the Northern Plains (1958). As Geiger documents, the first chair of this collection of lab analysts was Dr. Gustav Ruediger, who managed pathological and bacteriological services for the School until 1914.

This arrangement continued until 1949, when North Dakota’s Public Health Laboratory separated from the University, leaving UND’s pathology team, and thus its medical lab scientists, on their own in the university system.

“It was roughly in the 1930s that lab scientists got together to create the laboratory profession,” added Karen Peterson, assistant professor with UND’s Department of Medical Laboratory Science, noting that the first board certification exam came into place in 1938. “It was then that the accreditation piece started. We at UND very much had some of those pieces in place already, but it actually wasn’t until 1949 that our medical technology program was accredited.”

The now-accredited program’s first chair, Jean Holland Saumur, managed what had become by then a Bachelor of Science in Medical Technology (BSMT) degree for an astounding 29 years (1949-78), helping shape a curriculum that trained medical laboratory scientists in everything from phlebotomy and biochemistry to hematology and urinalysis.

Taking such courses in the early 1960s was UND alum Judy Lee, who went on to become a North Dakota State Senator representing West Fargo.

Reminiscing on how a forgettable first quarter at a different North Dakota university prompted her transfer to UND’s medical technology program, Lee praised the exceptional instructors who prepared her and her classmates to perform a variety of biomedical tasks in hospitals, public health clinics, and private labs around the region.

As an example, Lee pointed to her course with SMHS Professor Emeritus Stanley Brumleve, whose “physiology of a sandwich” example Lee will never forget.

“Dr. Brumleve was a remarkable teacher,” Lee said from her home in West Fargo. “One of his questions was: ‘You’re eating a sandwich for lunch. Tell me about its progress through your body.’ You had to be able to think about all the parts of the body at work as you eat and digest that sandwich. You were expected to understand how the body worked, which I thought was an extraordinarily good way to learn anything.”

As Lee’s comments suggest, the medical technology program at this time was still considered an extension of the pathology and microbiology departments at UND. This meant that students like Lee pursuing the major took undergraduate courses in biology, chemistry, and pathology before transferring to the hospitals to complete their hands-on training in what was known as a “3+1” model.

“We had the same teachers as the med students, and some of the same classes,” Lee noted of her curriculum in 1963-64. “I like it when doctors recognize that they are partners in trying to solve healthcare issues. Then, our fourth year was entirely internship. It was 12 months long – unpaid I should add.”

In other words, despite its university housing and financing, med tech education was “hospital-based” in the 1960s and 1970s insofar as it was within hospitals and alongside physicians and nurses that technologists were trained in the collection of biological samples. And because many clinic and hospital systems did not then have their own in-house laboratories, these technologists – students and professionals – would transport the samples back to the university pathology laboratories, which were hired by the providers to conduct lab analyses.

In the case of Grand Forks, the former St. Michael’s Hospital on Columbia Road (which later became the UND School of Medicine & Health Sciences headquarters) would collect blood, urine, or tissue samples from patients and send these over to UND’s Department of Pathology – Pathology Associates, Ltd. in its commercial capacity – to analyze samples and write the reports that Perry then sent to the hospital.

“I was in Grand Forks – the old Deaconess Hospital and at St. Mike’s,” added Lee. “They sent students to the public health lab and a variety of places so we could have different kinds of experiences. Bacteriology was probably my least favorite subject, but I loved the blood chemistry and hematology part of it.”

Taking her degree with her to St. Francis Hospital in Breckenridge, Minn., when she and her husband Duane moved to Wahpeton, N.D., Lee called UND’s MLS program exceptional, adding that she still keeps up with goings-on at the School.

“We had a phenomenal program, and if you understood the whole concept – per my example with the sandwich – you don’t forget that easily. It’s a pattern of learning and teaching that made us who we are. And the teachers we had – I give them all the credit.”

The White Knight

Under Holland Saumur’s leadership, the program added a master’s degree and certification for cytotechnology by 1975. In 1980, the program was accredited in the training of histotechnology.

But as health providers started to develop their own laboratories and train their own technologists in-house, UND’s program saw a drop in enrollments. So the team needed to get creative.

Enter Wayne Bruce.

“Dr. Bruce had some great ideas,” said Coleman of the former department chair whose license plate used to read “MANBAT” given how his surname reverses a certain superhero’s alias. “He saved our program.”

Chairing the renamed clinical laboratory science program from 1978-2003, Bruce, who passed away in 2023, inaugurated several projects that helped UND’s MLS team not only survive changing healthcare and educational environments but thrive to become one of the largest MLS programs in the United States.

Under Bruce’s leadership, the program saw the initiation of a very productive postgraduate training partnership with Mayo Clinic, the forming of a Western College Alliance for Medical Laboratory Science (WCAMLS), which brought students from twelve midwestern colleges and universities to UND for training in MLS, and the move to what was, in the 1990s, a very basic online training module.

Each of these programs expanded the department’s scope, opening up avenues for students from across the region to become UND MLS students, even if they still lived in Rochester, Minn., Billings, Mont., or Lacrosse, Wis.

Such projects all but ended the chatter about moving the entire program out of UND—a common occurrence a quarter century ago, said Marybeth McGurran.

Both before and especially after the 1997 Red River flood that inundated Grand Forks, that is, the clinical laboratory science program had been slated for possible elimination. Mobilizing his team and their clinical allies, Bruce helped convince the UND administration that the loss of his program would significantly hamper area hospitals, clinics, and public health units—and UND.

This was especially true given that several small hospital-based laboratory training programs in the region had already closed or were scheduled to close around that time.

“Our program was going to be cut a few different times, but Wayne found ways of diversifying the student body,” said McGurran, who served as administrative assistant for the Department from 1986 to 2020, describing what became the program’s “4+1” route for practicing lab professionals whose degrees may have been in biology or chemistry—not MLS— but needed an MLS credential to continue their work. “Wayne knew a lot of people at Mayo and they wanted their people to have an MLS degree, which they got from us. Mayo contacted us and our faculty went down there to teach the lab portion of their lab scientists’ MLS certification.”

“That’s how the master’s and online programs grew—we worked through WCAMLS,” said Coleman. “We had to generate our own revenue, so we did. Wayne worked with our college business manager at the time, Randy Eken, and came up with a plan to save the program, really.”

Entering a new century

Under Wayne’s creative direction, the program solidified both its financial and student base. Even so, as the century turned, the department was feeling the pressure to produce more revenue for the School, add students, and perhaps even become its own standalone department.

“Things change,” concluded McGurran, admitting that as the program evolved students were asked to do more independent work – she was holding fewer hands. “They had to be more responsible because our student numbers did increase greatly with the Western College Alliance when we brought in students from all those other states. Just look at the old pictures—all those women in dresses and nylons? You can’t do that anymore. Safety measures have changed.”

The story of that change – how a program within UND’s Department of Pathology came into its own in the 21st century as the Department of Medical Laboratory Science—will be told in the Summer 2024 issue of North Dakota Medicine.

By Brian James Schill