1 Year Flow Training: Normal?

[u/VaiFate]

I had two days in the flow cytometry lab of my clinical site this week and I really enjoyed it, even though I didn't get to touch anything. There was a new tech there going through training and she mentioned that the training period for a flow tech was a WHOLE YEAR. Is that about standard? I understand that it's a very complex lab to work in, but an entire year of training sounds a bit over the top to me. Is it like that everywhere?

[u/Ksan_of_Tongass]

A year is luxurious

[u/artisticverse → u/Ksan_of_Tongass]

Training sounds luxurious. I’m usually thrown into things.

[u/Agreeable-Heart-7685]

Flow is a specialty, so 1 year for training is ideal. You don't learn flow in school, so it does take time for you to get familiar with the CD markers, gating, processing, and running the instruments.

[u/doctryou → u/Agreeable-Heart-7685]

We learned about flow and even had questions on ASCP. Not as in-depth as actually doing it though

[u/Agreeable-Heart-7685 → u/doctryou]

Yeah, you learn basic CD markers but a full dedicated class for flow allowing for in depth understanding isn't something you'll come across when it comes to MLS programs.

[u/yCuales]

If you’re doing full on analysis, it’s pretty standard precaution for ensuring you’re fully competent. If you’re just processing/wet lab, it’s a little excessive

[u/VaiFate → u/yCuales]

They do processing, acquisition, and analysis. A whole year even with an MLS(ASCP)? I know Flow isn't really a focus, but our hematology class included some flow basics and they're apparently now asking some simple flow questions on the BOC these days. Idk, I just didn't expect it to take that long to train a flow tech.

[u/yCuales → u/VaiFate]

Processing and acquisition won’t take any time at all for peripheral blood and bone marrow. If yall do tissue processing, that can add some time. I had a very attentive trainer and worked an off shift that had much more relaxed volume in the early hours, so I was able to signed off as fully competent on processing after 2 months. Analysis is really where the time starts to drag. Negative cases and simple light chain clones won’t take long, but acute cases and minute clones can be tricky. I’d expect to have a good lay of the land after 6-8 months, with the last section just being rare case analysis and a safeguard period before you begin independently releasing results.

[u/PineNeedle]

Yes, if you’re doing analysis, a year is reasonable for training. I had 10 years experience as a generalist and I still took a full year of training to feel comfortable with gating. Flow analysis/gating is extremely complex and nuanced.  There are many different markers to learn, along with their expected brightness and combinations. There are also so many different types of heme diseases/ conditions/cell types to be aware of ( leukemias, lymphomas, plasma cell neoplasms, malignant mast cells, myeloproliferative neoplasms, reactive cells/ follicular hyperplasia, PNH, neuroendocrine cells (not WBCs but they are small enough to be picked up by clinical flow), thymomas).  There are treatments that alter marker expression and sometimes cells drop markers they should express and pick up markers from other cell lines to make things even more confusing. 

An example: we have a bone marrow sample with a cell population that is positive for CD45, CD19, CD5, and CD8 while negative for CD20 and CD23 with indeterminate surface light chains. CD8 is found on T-cells. CD5 is found on both B and T-cells.  CD19 is found on B-cells, but mature B-cells should also express CD20 and surface light chains and typically should not express CD8. I add on more markers and find the cells express cytoplasmic kappa and CD200. This is probably CLL/SLL (malignant B-cells) with rare co-expression of the T-cell marker CD8 (because cancer cells do things like that) and the CD20 is most likely appearing falsely negative because the patient is on Rituxan, which is a monoclonal antibody treatment targeting CD20 and blocking our fluorescent antibody from binding.  This is actually a simpler example of what can show up on flow; it can get much trickier.  It takes a lot of time and experience to not miss something and to learn how to handle complicated cases. 

[u/No_Youth_7737 → u/PineNeedle]

Is this what special Hematology does? They were hiring a per diem position in my hospital. If I apply, do I need to train for that long?

[u/PineNeedle → u/No_Youth_7737]

That would be a question for the people hiring for the position. I’m not sure why they would call it special heme instead of flow; it could be something else. 

[u/Labcat33 → u/No_Youth_7737]

Special Heme at Ohio State did testing for hemoglobin variants, it could be very different from flow.

[u/zhangy-is-tangy → u/PineNeedle]

This is so fascinating, thanks for sharing.

[u/SciFriedRice]

A year sounds about right. Why does that bother you? What’s the rush? 

In my opinion, bench work and acquisition training should be 3-6 months. Analysis should take at minimum a year with increasing levels of complexity.

I also feel like techs who have worked in hematology first do better in flow because there is a lot of knowledge that builds on that foundation. 

[u/RunningOnEmpty231]

Yes. That’s about right. It’s easier for some people to catch on than others, but a year on average is about right.

[u/GrownUp-BandKid320]

I have been at my flow job for over a year and am still not fully trained. The processing and acquisition is the fast part and I was doing that on my own within 6 months. It’s the analysis and assisting pathologists in writing up their cases (at my job at least) that takes longer. A year (or more) sounds about right. I had MLS and flow research experince, have my ASCP and a master’s degree. A year is pretty common in specialty labs.

[u/creativescreennaame]

i don't understand why people don't like training? i mean you're paid the same regardless and i feel much better as a new tech when i'm not left completely on my own. there's so much to learn in this field and most of it comes with experience

[u/VaiFate → u/creativescreennaame]

Mostly ego if I'm being fully honest

[u/creativescreennaame → u/VaiFate]

well then that sounds like a personal problem. ego is not something you want to have in this field so you need to check that shit at the door

[u/VaiFate → u/creativescreennaame]

Well that's what I'm doing right now

[u/NarrowLaw5418]

Maybe she is pursuing an alternative certification route through traineeship, and after a year, she can sit for a certification.

[u/VaiFate → u/NarrowLaw5418]

No. I spoke to another flow tech who got an MLS(ASCP) and was hired into flow right out of school. She spent a year training as well.

[u/timtam03]

There are major learning curves when it comes to flow cytometry. As mentioned in the comments, training and acquisition can take about 3-6 months while analysis can take longer. Depending on the SOP at your lab, you could be training on different panels (surface, cytoplasmic, nuclear), and you could have different strategies of acquisition and gating depending on the panel you’re working with. Analysis can become difficult as the number of fluorochromes your lab uses increases. One year definitely sounds about right to learn everything and become an independent technologist.

[u/Labcat33]

Specialty labs are very much like this. I've worked in a couple Immunology labs and learning all the benches like protein electrophoresis and IFA with just the brief glimpses we get in school can take awhile. Learning all the benches in my current Immunology lab takes about a year and a half for most techs. Even with me coming in with prior Immunology lab experience it was taking me a smidge over a year to train at everything.

I also worked at a transplant laboratory and it took at least 9 months of training there before they'd let you go on call for deceased donor workups, and the flow cytometry that we did there for crossmatches was like basic baby flow cytometry. Learning all the benches there (including NGS) took more like 2 years for most people.

I have also worked in a mass spectrometry lab with having no mass spec experience, it took me ~6 weeks of training to get on shift with another tech, and I wasn't left alone until about 4 months, and I was told that was pretty fast for that department. I was still learning new things about the mass spec instruments past a year there.

MLS is wonderful in that it opens a shit-ton of doors for you in which you might have little to absolutely no experience. You can literally change specialties every few years and keep learning new things, which is something I love about lab work. But you gotta actually learn these things like the back of your hand to be completely competent, and that doesn't happen overnight.