The Epistemological Aspects of Curriculum Development and Implementation for the Medical Laboratory Technology Diploma in Uganda

doi:10.4236/ce.2012.33044

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Creative Education

2012. Vol.3, No.3, 281-289

Published Online June 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.33044

The Epistemological Aspects of Curriculum Development and

Implementation for the Medical Laboratory Technology

Diploma in Uganda

Wilson Rwandembo Mugisha1, Christopher B. Mugimu2

1Ministry of Educat io n an d Sp orts, Param edical Schools, Kampala, Uganda

2Department of Foundatio ns and Curriculum Studies, College of Ed ucation and External Studies,

Makerere University, Kampala, Uganda

Email: [email protected], rwandem bo @yahoo.co.uk

Received March 31st, 20 1 2; revised April 29th, 2012; accepted May 12th, 2012

A study was conducted to investigate the epistemological aspects found in the curriculum, teaching,

learning and practice of Medical Laboratory Technology (MLT) in Uganda. The study involved the analy-

sis of the curriculum document for the diploma in MLT implemented at Mulago Paramedical Schools

(MPS) in Kampala Uganda. It further involved getting the views of learners, educators and clinical super-

visors of the MLT diploma programme. The results of the study revealed that various epistemological as-

pects were applied during the development and implementation of the MLT curriculum as well as during

the practice of MLT in Uganda. Application of these aspects during curriculum development and imple-

mentation led to acquisition of various types of knowledge. It further led to the development of different

and appropriate ways of knowing that is necessary for the training and practice of MLT.

Keywords: Curriculum Development; Implementation; Epistemological Aspects

Introduction

Medical Laboratory Technology (MLT) training in Uganda

has been going on since the late 1920s. This study investigated

whether epistemological curricula issues have been applied in

the training practices and processes as well as professional

MLT practices. Epistemology refers to knowledge generation,

acquisition, and justification. The notion of epistemology is

central in curriculum development and implementation. It is

against this background that this study focused on establishing

whether the epistemological aspects of curriculum exist in the

MLT training in Uganda. This paper presents current research

on epistemology in relation to curriculum development and

implementation. We also present results to highlight how vari-

ous epistemological aspects have been applied in the curricu-

lum development and implementation processes at the school of

MLT at Mulago Paramedical Schools in Uganda. We discuss

the manner in which the different types of knowledge and ways

of knowing have been reflected in the training processes and

practices of MLT, drawing on the Ugandan experience.

The Concept of Epistemology

Epistemology is concerned with the nature of knowledge and

knowing, and the validity of knowledge claims (Zais, 2010).

It also deals with the question of discovering the truth and

authenticity of knowledge as well as limits of knowledge. Re-

cent developments in epistemology have now shifted from the

belief that knowledge is absolute and static to the current post-

modern views, which emphasise its continuous development

and evolutionary nature. Therefore, epistemology and curricu-

lum are interrelated. Figure 1 reflects our conceptualization of

the epistemological aspects of curriculum development and im-

plementation.

Curriculum contents exist in order to transmit knowledge and

to lay a foundation to facilitate knowing or meaning construc-

tion. Ornstein and Levine (1993) consider epistemology to be at

the pillar of curriculum development. Curriculum development

entails decision-making on the nature and the level of content,

level of skills, values and attitudes that learners should acquire

through education (Okello & Ocheng, 1996). Educators’ under-

standing of the various forms of knowledge and patterns of

knowing influence their decisions concerning content selection

and its organization during curriculum design and implementa-

tion. The curriculum implementation processes may include teach-

ing, learning and assessment of learning (Sowell, 2010).

Knowledge

Knowledge is what is perceived to be reality or truth (Higgs

& Smith, 2006; Russell, 1996). Nickols (2000a) argues that

knowledge is a mix of framed experiences, values, contextual

information, and expert insight (pp. 12-2 1). The notion of know-

ledge can be objective, observable and communicable to one

individual and likewise knowledge can be subjective, unique,

and internal to another individual. Figure 1 shows knowledge

as being explicit, implicit, tacit, procedural, declarative, strate-

gic, conceptual, logical-mathematical, physical, automatized,

semantic and social (Ein-Dor, 2008; Kikuchi & Simmons, 1992;

Ree & Urmson, 2005). The term knowledge has various uses

depending on the perspective in which it is used. From this

perspective, when discussing knowledge, it should be done in

context. The critical theory paradigm asserts that truth is cre-

ated and uncreated by human beings. In this context there is no

W. R. MUGISHA, C. B. MUGIMU

Figure 1.

Epistemological aspects of curriculum, development and implementa-

tion.

absolute truth. This paradig m emphasises that kno wledge should

be looked at in a democratic manner. Current reality should be

subjected to constant challenge. Phillip Ein-Dor (2008) in his

chapter on taxonomies of knowledge postulates that knowledge

is multidimensional in nature and can be perceived in different

views; therefore many taxonomies are possible. We provide a

brief description for some of the salient taxonomies of know-

ledge that may be relevant to MLT. However, we are also being

mindful of the fact that it is almost impossible to draw a con-

crete line between these various types of knowledge in a prac-

tical sense.

Explicit knowledge is formal, systematic and codified (Ni-

ckols, 2000a) usually digitized in form of documents such as

books, and reports. Thus, it is articulated in form of text that

may contain specifications and scientific formulas. In labora-

tory practice like in other areas of practice, explicit knowledge

is the most commonly used knowledge. It is used in routine

teaching and learning.

Implicit knowledge is reflected in observable behaviour or

even in performance of tasks. It can be teased out from the

individual’s performance by experts using task analysis. In

MLT practice, this can be seen as positive traits among indi-

vidual professionals as they perform their routine duties.

Tacit knowledge refers to the knowledge that people have

but is not written down. It is thus difficult to articulate and

tends to be shared through interactions, storytelling and discus-

sions with individuals having this knowledge and expertise.

Tacit knowledge is acquired as a result of individuals’ experi-

ence and some individuals may not even be aware that they

have this knowledge. The utility of tacit knowledge is not as

broad as that of explicit knowledge.

Procedural knowledge refers to understanding of how to

carryout procedures normally based on implicit memory or

long-term memory of specific skills and procedures (Nickols,

2000a). It denotes knowledge of how to complete tasks. Reber

and Reber (2001) contend that procedural knowledge is the

understanding of how to control relevant factors for examining

phenomenon, knowing methods of manipulating specific con-

ditions or the technique for implementing tasks. It is obscure,

process-oriented and it is not extendible to other uses. In MLT

practice, procedural knowledge is used while conducting labo-

ratory experiments and designing laboratory protocals.

Declarative knowledge like procedural knowledge, declara-

tive knowledge, refers to the ability to describe, interpret and

explain how to perform certain tasks (Nickols, 2000a). Declara-

tive knowledge helps learners to develop procedural knowledge.

It is easy to validate, identify, transfer, and slow to acquire as it

requires interpretation of its acqui s i tion process.

Strategic knowledge is the ability to perceive the right time

and the right reason for doing things (Nickols, 2000b). It is

used by Laboratory managers in their routine day-to-day activi-

ties as well as in planning. In clinical laboratories, strategic

knowledge is used when making decisions. It helps laboratory

professionals in identifying which operations are of emergency

nature and those that are routine.

Conceptual knowledge refers to the manner in which one

represents major concepts in a system. It explains relationships

an d understandings of a sy stem (Rittle-Johnson & Alibali, 1999).

Conceptual knowledge involves making sensory observations,

logical correlation of data, abstractions, assimilations, problem-

solving, reasonable judgement and understanding of humans.

This is related to operations at work such as making differential

diagnosis in MLT practice. It requires that one knows the facts

that are necessary for one to arrive at solutions and to make

conclusions. Logical-mathematical knowledge involves quan-

tification of observations such as counting, measuring, preci-

sion and accurate communicating of facts (Ree & Urmson,

2005). It is the ability to think about objects or variables and

existing relationships between them. Logical-mathematical

knowledge also entails the ability to demonstrate problem-

solving skills, good understanding of critical issues and sketch-

ing out the way forward in deciding what steps to take. It is

mainly applied in experimental and quantitative research. It is

used in the preparation of reagents, analysis of physiological

samples, in interpretation of results and in communicating re-

sults of the analyses.

Physical knowledge refers to ability to demonstrate a clear

understanding of the physical properties of objects or events.

Lovat (2004) argues that physical knowledge is a good under-

standing of facts and features such as size, shape, texture,

weight, volume, and dimensions. It enhances understanding of

phenomena and predicting emerging phenomena. In MLT,

physical knowledge is used in describing properties of equip-

ment and instruments, characteristics of chemicals, drugs, re-

agents, and clinical laboratory features of diseases and condi-

tions. It is also used in describing features of biological materi-

als and their components such as body cells, tissues and organs.

Automatized knowledge is the knowledge that involves con-

struction and understanding of concepts and analysing issues. It

is acquired without necessarily using rote memory (Wadsworth,

1989). It is used in MLT when new discoveries, trends, proce-

dures and approaches get established.

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W. R. MUGISHA, C. B. MUGIMU

Semantic knowledge refers to highly organised knowledge

found in long-term memory and includes major concepts, vo-

cabulary, facts and relationships (Ree & Urmson, 2005; Wads-

worth, 1989). In MLT semantic knowledge is applied when

results of analyses of patient’s samples are compared with the

results of known standards. It is also applied in new terms,

concepts and facts that are established and integrated into rou-

tine professional use.

Practical-technical knowledge refers to what people know

and can do (Clancey, 1997). It includes the understanding of the

structure of work activities in organizations. It is the knowledge

that individual use when deciding to take some action basing on

their beliefs and values. Practical-technical knowledge is

learned on the job through experience and adaptation to the

working environment. The technical knowledge includes the

ability to demonstrate the expertise while performing the tasks

(de Vries, 2003; Lovat, Holbrook, Bourke, Dally, & Morrison,

2003). It requires technical analytical skills. It helps laboratory

managers to relate with different laboratory departments and

hospitals in general.

Social knowledge involves the enhancement of cultural or

social groups to come to agree by convention. It is based on the

belief that knowledge can be acquired through social interaction

especially when people engage into dialogue, conversation,

copying, practicing, having feelings and establishing connec-

tions and relationships with others. Social knowledge is there-

fore socially mediated and is community bound. It promotes

shared meaning and creation of new knowledge as a result of

agreement between people of different backgrounds. Profe-

ssions are in themselves specialised communities or societies.

The senior professionals influence the young ones who copy

good practices as they grow into the profession.

Figure 1 shows that, curriculum content provides a founda-

tion for the acquisitions of various forms of knowledge and that

through internalization and experiences based on the curricu-

lum implementation processes and strategies, an individual is

able to undergo a state of knowing or constructing their own

meaning.

Knowing

The notion of knowing refers to one’s ability to construct

meaning as a result of internalization and experiences (see Fig-

ure 1). It involves internal mental cognitive changes within the

individual as a result of learning. Knowing emerges through

various forms such as empirical-analytical, interpretive-her-

meneutical, self-awareness, ethical, self-reflective, and aesthe-

tic. Higgs and Smith (2006) argue that empirical-analytical

perspective assumes that knowing is acquired after observation

and documentation of situations in an objective and timely

manner. It is objective, abstract and provides theoretical expla-

nations for phenomena (Kikuchi & Simmons, 1992). It entails

acquisition of factual subject matter in the natural sciences,

biological sciences and human sciences. This way of knowing

is of particular importance in the health sciences in general,

including the medical laboratory sciences. Empirical knowing

informs health professionals in their scientific decisions,

choices, and practices.

On the other hand, the interpretive-hermeneutic perspective

emphasises that knowing is acquired through self-discovery of

the learner. It assumes that it is humans who create knowledge

and understanding; therefore, it is based on knowing of what

has been created by human beings. Furthermore, it entails hav-

ing constructed meanings through the processes of critical in-

terpretation of issues or personal experiences, which often in-

volves interpersonal dialogue. As such, through dialogue indi-

viduals attain insights to convey the underlying meanings that

are inherent in what was studied or experienced (Higgs &

Smith, 2006). Indeed through practices of professionals new

meanings emerge thus acquiring interpretive-hermeneutic ways

of knowing.

The concept of knowing is also linked to moral issues to be

transmitted to learners (Kikuchi & Simmons, 1994). The ethi-

cal perspective assumes that individuals acquire knowledge to

enable them make moral decisions. It is concerned with ques-

tions on what is good, valuable and desirable in society. The

ethical way of knowing entails developing ethical decision-

making skills and ability to resolve ethical dilemmas. The

moral decisions are made as informed choices in accordance

with societal or professional norms and values. To obtain ethi-

cal knowledge, it is necessary to study content that is related to

morality, professional ethical codes, legislation and human

rights. Individuals with ethical knowledge act professionally

and responsibly and become ethically and morally accountable

for their actions. Ethical practice entails demonstrating will-

ingness to doing the right and responsible things and in accor-

dance with the value system of the health professions (Kikuchi

& Simmons, 1994).

Kikuchi and Simmons (1994) argue that personal way of

knowing refers to achieving self-awareness and knowing one-

self, thus, the individual gains self-consciousness. Self-con-

sciousness allows one to discover oneself and to know one’s

own strength and weaknesses. Self-consciousness is acquired

through participation in self-awareness and self-evaluation

activities (Engebretson, 1997; Lovat, 2004). This way of know-

ing is gained through exposure to content and learning experi-

ences through which learners can discover their preconceived

ideas, attitudes and fears. People who possess self-conscious-

ness/self-knowledge are better able to relate with other people.

Thus, educational institutions should develop among learners

an understanding of self and others in order to make them de-

velop practical ways of knowing.

In MLT education and practice, personal way of knowing is

acquired by learners and professionals in the process of receiv-

ing feedback of their individual contributions, as they work

with colleagues on joint project. The process also applies as

they get the feedback out of their participation in meetings,

seminars and conferences.

The aesthetical perspective assumes that knowing entails

synthesis of acquired knowledge and establishing relationships

in general. The knowledge in this case is intuitive, contextual

and subjective. It enables an individual to intuitively grasp the

meanings inherent in particular clinical situations, and to crea-

tively contribute towards transforming the situation.

Another perspective of knowing is the personal way of

knowing. The aesthetical perspective assumes that knowing

entails synthesis of acquired knowledge and establishing rela-

tionships in general. The knowledge in this case is intuitive,

contextual and subjective. It enables an individual to intuitively

grasp the meanings inherent in particular clinical situations, and

to creatively contribute towards transforming the situation.

Thomasson (2005) contends that aesthetic knowing is char-

acterised by empathetic awareness and morality in interpersonal

relationships, emphasizing humanity and dignity. It is required

W. R. MUGISHA, C. B. MUGIMU

for healthcare professionals in order for them to effectively

practice the art of their professions. Learners acquire aesthetic

knowledge when they participate in activities, which need a

combination of knowledge, experience, intuition and under-

standing (Chinn & Kramer, 1999). This is the corner stone of

the ethical code of conduct practiced in health care delivery of

which MLT practice is part and parcel.

Self-reflective perspective of knowing assumes that knowing

is emancipatory in the sense that one will have appraised the

adequacy of information and evaluated its meaning for oneself.

It entails having moved beyond the conceptual and semantic

product level of the human mind by understanding the universal

patterns underlying what has been taught. Self-reflective in-

volves the critique of ideological “truth” as presented by domi-

nant forces in society. And by doing so, it enhances the ability

to challenge the status quo and acts as an agent of change in the

interest of a more just dispensation (Lovat et al., 2003).

Methods

The study utilized both quantitative and qualitative methods.

Available documents on MLT training and practices were gath-

ered and analyzed for curriculum objectives, implementation

strategies, and teaching methods. This document analysis was

conducted using structured observational checklists in order to

compare the curriculum intentions, content, and strategies in the

curriculum documents. The checklists contained standard de-

scription of the expected status. This was done in reference to

the characteristics of various types of knowledge and knowing

that existed in literature and was relevant to MLT training and

practice. The observations were categorized, described, quanti-

fied, and recorded.

The survey questionnaires were also developed and self-ad-

ministered to different key stakeholders including learners,

educators and supervisors. Each of the survey questionnaire

consisted of 34 closed-ended questions. The questionnaires

probed for views of stakeholders regarding the types of knowl-

edge and knowing that learners encountered/developed as a

result of curriculum implementation processes. The question-

naires were filled and returned. The responses were analyzed

and recorded. The study used 10 educators (100%) (both full-

time and part-time) on the MLT because they are few and

highly specialized in their subjects, 30 clinical supervisors

(100%) who were involved in the supervision of the MLT stu-

dents during practicum attachment as well as individual

learner’s projects and 63 learners (64%) were randomly se-

lected. The learner’s eligibility for inclusion in the study was

such that one should have completed one year of study at the

institution and was not yet in the specialized part of the pro-

gram. Two successive groups of learners at the MPS were in-

cluded.

Focus group discussions for learners, educators and clinical

supervisors were conducted using semi-structured open-ended

interview guides comprised of 25 questions. For purposes of

triangulation, separate focus groups for educators, clinical su-

pervisors and learners were conducted. Focus group discussions

were conducted using 10 learners and 10 clinical supervisors

randomly selected and all the 10 educators participated. The

focus group discussions lasted between one and half hours and

two hours each. The aim of focus group discussions was to get

verbatim responses and explanations of the written responses.

A check list of issues to be covered during the focus group

interview was developed based on issues which had been inves-

tigated in curriculum document analysis and the questionnaire

survey.

Results from Curriculum Document Analysis

and Interpretation

The study found that the MLT curriculum focused on acqui-

sition of various types of knowledge reflected in Table 1. It is

clearly shown that curriculum content provided for the critical

types of knowledge required for the modest learning and prac-

tice o f MLT program.

Results on Types of Knowing

The analysis of implementation strategies, observations, and

purposes of a particular curriculum area based on the curricu-

lum documents are presented in Table 2. From Table 2, it is

clear that the curriculum implementation process had appropri-

ate strategies to make learners acquire different ways of know-

ing. These strategies in addition assessed the acquisition of the

ways of knowing.

Results of th e Que st ionnaire Survey

The results in the Table 3 show that most of the items tested

had compliance at 100 percent, even for the item which ranked

low had a high percentage of 90. Table 3 results also indicate

that the curriculum was epistemologically relevant because it

followed established principles of curriculum development and

development of content.

They further show that professional issues were considered

as a relevant curriculum antecedent. The results in Table 4

indicate that most of the tested items showed high compliance

between 82 and 100 percent. Table 5 shows that there was a

reliable assessment process which was recommended at the

design stage and followed during the curriculum implementa-

tion. The educators and clinical supervisors as a category of

respondents rated the following assessment recommendations at

90 percent. It further shows that the assessment process had

institutional administrative support. The respondents rated it at

100 percent. Epistemologically assessment is an important

component of curriculum because it checks to establish whether

teaching led to acquisition of knowledge and knowing.

Results of the Focus Group D iscuss ion

The educators during focus group discussions described dif-

ferent health facilities where they sent their learners for attach-

ment to acquire the different types of knowledge and knowing.

Educators also revealed that the health care organization struc-

ture in Uganda helps them in making learners acquire necessary

knowledge and knowing needed for practice at each level of

health care delivery thus making training relevant. The quota-

tions that follow indicate opinions of respondents:

The structure of the Health Care System in Uganda makes it

easy to relevantly attach learners. The procedures and equip-

ment increases in complexity as one goes up in the structure.

(Educator 1)

The caliber of clinical supervisors and the quality of learning

can be predicated depending of the level of the health facility.

(Educator 2)

As indicated in the quotations above, it is quite clear that

284

W. R. MUGISHA, C. B. MUGIMU

Table 1.

Shows types of knowledge as analysed from different documents.

Type of knowledge Observatio ns Documents analysed

Explicit knowle dge Content for making learners know how to use formulae an d

writing reports. MLT Curriculum document (2006)

Implicit kn ow ledge In practical attachment senior professionals record unique

potential of each learner. Learners pra ctical attachment books/log books (2006)

Procedural knowledge Laboratory attachmen ts o f learners was planned to develop

the practical skills and experience of learners.

Curriculum document (2006),

Learners’ practical record books (Log books),

Standard laboratory operation procedure manuals (2002)

Social knowledge

The content had ethical pro f essional, skills development,

social and community issues.

Learners also participated in community activities while

conducting surveillance of diseases a nd blood donor

recruitment.

Curriculum, log books (2006)

Standard operation Procedure manuals (2002)

Strategic knowledge Curriculum content contained management instructions Curriculum document (2006)

Conceptual knowledge

Implementation strategies aimed at making learners analyse

and interpret results of laboratory analyses.

Individual Learner projects allowed them to generate ideas

and critique the existin g on es.

Curriculum document (2006)

Practical-technical knowledge

The learners rotated in labor atories where different new

laboratory procedures were a pp li ed in diagno s i s of current

syndromes like AIDS.

The learne r s were also rotated in specialised laboratories

where modern diagnostic procedures Polymerase Cha i n

Reaction (PC R) procedures were u sed for diagnosis and

confirm ation of various pathogens including HI V.

Curriculum, learners’ practical record books

(Log books) (2006)

Table 2.

Shows strategies, evidence/observations and purposes of the strateg ies.

Curriculum area Strategy Observations Purpose

Assessme nt of learning Assessme nt of learning Done by se eing learners carry out of

experiments. To assess ac quisition of em pirical and

aesthetical ways of knowing.

Impleme ntation process Development of analytical and

decision m aking skills

Learners allowed to make decisions during

analysis and reporting of results of samples

from patients. Acquisition of ethical knowing.

Impleme ntation process Learners were made to work with

colleagues o n study proj ects and

carry out individual pr ojects

Learners compare with their colleagues and

rate themselves. Acquisition of social and personal

ways of knowing.

Impleme ntation process Learners’ are attachment to

practicum sites

Learners a ppl y learnt knowledge in different

contexts, a broad environment, interface with

and get supervised by experts.

Acquire de eper unders tanding and develop

new meaning.

Acquisition of separate, connected,

ethical, social, aesthetical and critical

(self-reflective) ways of knowing.

Development of aesthetical and

interpretive-hermeneutical ways of

knowing.

Table 3.

Shows how established curriculum principles were followed curriculum.

Items for established curriculum

development pri n c iple No of statements

per item Full compliance

% Partially

comply % Cumulative

compliance % Does not

comply % Total

Following curriculum d es i gn p rinciples 7 86 14 100 00 100

Following principals lea di n g to ca reer path 20 85 5 90 10 100

Developing relevant Curriculum content 34 76 24 100 00 100

W. R. MUGISHA, C. B. MUGIMU

Table 4.

Shows compliance to various curriculum strategies/facilities.

Strategy No of statementsFull compliance

% Partial

compliance %Cumulative

compliance % No compliance Total %

Using out comes that lead to skills development 25 80 20 100 00 100

Applying established educational Strategies 11 73 9 82 18 100

Using existing facilities clinical exposure 12 100 00 100 00 100

Table 5.

Shows percentage compliance of the administration to curriculum recommendations.

Complies Partially complies Total compliance Does not comply Total

n % n % n % n % n %

Assessment process 26 85 1 5 27 90 3 10 30 100

Assessment administrative support 26 86 4 14 30 100 00 0 30 100

Note: n = Number of respondents.

educators were greatly concerned about the quality of training

they provide to their students. In fact, during focus group dis-

cussions educators, however, indicated their dissatisfaction of

the fact that technological advances were too frequent to cope

with. They were also in total agreement with the clinical super-

visors’ view that some of the equipment found in clinical areas

is yet to be captured by the official curriculum. Knowledge on

how to prepare learners to learn from the equipment was a

challenge to classroom teachers. This is reflected in the quota-

tions obtained from respondents in focus groups:

It often catches us by surprise, when we find new models of

equipment in our clinical area. Learners in such cases will not

have been adequately prepared for the attachment. (Educator

I have learnt through experience that clinical practice is al-

ways ahead of teaching as far as innovations in equipment and

procedures are concerned. This is why learners should be

taught when they are on attachment. (Supervisor 1)

Learners, during the focus group discussions also indicated

that their daily routines in work places were not exactly the

same as conceived while in theoretical class teaching. Most of

the learners in focus groups felt that it was the responsibility of

their teachers to prepare them for such experiences. This is

reflected in the following quotations:

When we go for our practicum in various clinical areas we

need to have relevant knowledge. At each level of attachment,

we can be able to appreciate the relevancy of our attachment

experiences. (Supervisor 2)

So far, I have felt very comfortable during my last practicum

because I have realized that I had the relevant content, know-

ledge, and skills I needed in the field. (Supervisor 3)

The focus groups of educators revealed that they thought that

relevant curriculum content and appropriate teaching methods

were being used at SMLT. This is reflected in the quotations

that follow:

We use many approaches during the implementation of the

MLT curriculum. For instance, the teaching of theoretical con-

tent involves lecturing, and we also encourage students’ dis-

cussion with moderation of educators. The laboratory teaching

includes demonstration of procedures to learners. It further

involves supervision and moderation of class experiments.

(Educator 4)

This means that the implementation of the MLT curriculum

ensured acquisition of various forms of knowledge and differ-

ent ways of knowing as a result of using a variety of teaching

approaches and procedures.

On a day-to-day basis clinical supervisors see how learners

communicate with patients, and how they handle them (pa-

tients). The supervisors interact with and oversee the learners

as they handle samples, equipment, chemicals, reagents and

supplies. As an educator, I cannot dare to examine any learner

who does not have a certificate of due performance. (Educator

5) Educators, from this quotation emphasize the practical rele-

vancy of the MLT practice. Curriculum implementation is

shared between educators and clinical supervisors. Both parties

demonstrated trust in each other’s role. Educators seem to sug-

gest that attachment experience is an important component of

the MLT training and it is indispensable. Educators also felt

that the due performance of learners during clinical attachment

was extremely important in determining their professionalism

and was a good way to demonstrate application of theory to

practice. This is reflected in the following quotations:

It is through the performance of individual learners in prac-

ticum sites that shows what kind of professional the learner is

likely to be. (Supervisor 2) This means that MLT training led to

the development of skills as a result of continuous supervised

practice of learners in practicum sites.

Unless one has a certificate of due performance endorsed by

clinical supervisors, one does not get registered for semester

examinations. (Supervisor 3)

Passing can only be granted when one passes practical ex-

aminations. (Supervisor 1)

This suggests that there is a common understanding between

the educators, supervisors and learners about the importance of

skills development as part of MLT training.

In summary, all focus groups were in agreement that:

 The MLT diploma curriculum had relevant theoretical con-

tent;

 There was application of a variety of teaching methods

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W. R. MUGISHA, C. B. MUGIMU

during curriculum implementation which enhanced devel-

opment of different ways of knowing;

 That clinical attachments followed theoretical teaching and

classroom laboratory experiments which facilitated devel-

opment of connected knowing;

 Learning in the clinical attachment was guided and super-

vised by senior MLT professionals which leads to devel-

opment of separate knowing.

In the practicum attachment, learning involved interactions

between learners and supervisors. This led to the development

of separate knowing. Focus groups also indicated that progres-

sive and final semester course assessments emphasized per-

formance on both theory and practical skills, which facilitated

the development of Empirical-analytical, Interpretative-her-

meneutical, Self-reflective (critical), aesthetical and ethical ways

of knowing. This type of training orients students to a variety of

knowledge strategies and experiences that sets them apart as

solid future professionals and competent products of the MLT.

Discussion

Professionals are advised to analyze the types of knowledge

applicable to their professional practice in order to improve the

training and practice in their subject discipline. Professionals’

character and practices are influenced by the different types of

knowledge and the nature of knowing they have experienced.

People may not know what type of knowledge they have and

how it influences their behavior. They may also not know the

type of knowledge they lack and the effect it has on their output.

It is therefore important for professionals to know the different

types of knowledge that exist and how they can be applied.

Curricula for developing professionals who are responsible for

delivery of health care should be analyzed to find out if it is

able to make learners acquire the relevant types of knowledge

and knowing required for developing balanced and competent

professionals. This is what will help future professionals to

understand the rapidly developing and changing knowledge and

associated phenomena in this dynamic world.

Teaching the MLT diploma theoretical curriculum content

exposed learners to appropriate concepts, vocabulary and facts.

It further helped them to internalize the relationships that exist

within the different subject discipline. The MLT diploma cur-

riculum implementation was also found to be consistent with

the manner in which explicit knowledge is taught as described

in literature (Nickols, 2000a).

As part of learning, learners carried out experiments. This

exposed them to various skills such as the use of variables,

quantification of observations and making deductions and

analyses of the relationships between variables. It also led them

to making measurements and communicating results of analy-

ses and interpretations of experimental observations. This is in

line with approaches of acquiring implicit knowledge as dis-

cussed by Nickols (2000). This is also in the context of declara-

tive knowledge, logical mathematics knowledge and empiri-

cal-analytical knowing as expressed by several authors (Lovat

et al., 2003). In laboratories, declarative knowledge is used

during the reading, analysis and interpreting of results of ex-

periments.

Furthermore, learners as they performed experiments were

observed by experts who made record of the unique qualities

exhibited by each learner. This was in the content of developing

explicit knowledge Nickols (2000). In laboratory practice it is

important to critically observe professional behavior and prac-

tice of individuals in order to detect and articulate not only their

implicit knowledge but also tacit knowledge in order to use it in

improving practices and behavior of other professionals. More

often than not, this type of knowledge goes unnoticed and yet it

needs to be noticed and used to benefit humanity. This study

revealed that the design and implementation processes of the

MLT diploma curriculum had provisions for assessing and

documenting aspects of explicit knowledge exhibited in the

performance of learners. This was also endorsed by the focus

group as indicated in the following quotation that: The learners

log books allow one to document the novel qualities and pat-

terns in their performance of procedures. I have now come to

know that learners bring out some new things without being

cautious of them. One needs to be extremely observant as

learners perform their routines during their practicum attach-

ment. (Supervisor 6)

From the above quotation, it is clear that the curriculum im-

plementation made learners to know properties, maintenance

and procedures for using various laboratory equipment and

instruments. This facilitated learners to read, analyze and inter-

pret readings of the observations made from the equipment and

instruments. This enabled them learn how to professionally

handle the equipment and strategically plan for their regular

purchase and maintenance. This in incense was the develop-

ment of the procedural, tacit and physical knowledge types.

Continuous application of procedures leads to development of

procedural knowledge. Procedural Knowledge is indeed most

prevalent in this era where many new methods, new equipment

and new approaches are on the increase. The design and im-

plementation strategies of the MLT curriculum offered provi-

sions for development and assessment of acquisition of these

types of knowledge.

Implementation of practical attachment and inclusion of the

professional content on ethics in the MLT diploma curriculum

led to the teaching of social and practical knowledge. The

learners interacted with each other and senior professionals,

developed new meanings as a result of sharing and agreeing on

the meanings, in this process new knowledge emerges. The

shared agreement brings about new rules, laws, morals, values,

ethics, and language systems. This allows further opportunities

for new knowledge to emerge.

The teaching of social and practical knowledge entrenches

the professional and ethical culture which is a basis of profes-

sional development and growth. Practical attachment further

leads individuals in acquiring the practical know-how of fol-

lowing performance procedures of tasks. During practicum

attachments, the curriculum provides opportunities for studying

of the laboratory ethical code of conduct, make linkages that

exist within health services and collaboration of data from

laboratory analyses. This helped learners to acquire vital con-

cepts within the MLT subject discipline and relationships that

exist between MLT practice and other health sciences. This

way the MLT diploma curriculum and its implementation en-

abled learners acquire automatized knowledge. This leads to

development of major concept, new vocabulary, facts and dis-

covering new relationships. Furthermore, learners also learn to

be thoughtful, reflective and analytical about existing relation-

ships in the systems in which they practice in order to under-

stand the systems clearly and develop appropriate concepts.

This helps them to make appropriate judgment and choices of

action from the existing options. By providing these types of

W. R. MUGISHA, C. B. MUGIMU

knowledge, the MLT diploma curriculum taught learners how

to construct knowledge.

The findings of this study also revealed that laboratory train-

ing in the practicum sites involves learning how to meet daily

and periodic targets. We also found that the practicum sites

training aims at making learners internalize the strategic focus

of MLT practice in the Health Care System. This learning

therefore gave learners strategic knowledge. In one of focus

groups, indicated that “It became evident that learners were

making strategic requisition of supplies, planning their work

well ahead of time. While discussing with them, it became clear

that they were developing a forward looking approach in the

work.” (Supervisor 6)

MLT curriculum thus ensured that the teaching of various

subject disciplines was comprehensive and hence practice of

the MLT was consistent with established literature to the effect

that strategic knowledge is about knowing right time and the

right reason for doing things (Nickols, 2000).

The findings of this study also revealed that MLT curriculum

focused on teaching essentially the knowledge of principles,

steps, rationale and interpretation of results of analyses per-

formed during routine laboratory practice. Implying that MLT

teaching in this respect, gives learners mainly declarative

knowledge. A curriculum that fosters acquisition of declarative

knowledge is consistent with Nickols’ (2000) view. Further-

more, declarative knowledge is about following procedures,

using high quality data and making interpretations. This type of

knowledge is essential in the common practice of MLT. App-

lying basic principles is important in ethical practice as well as

in practicing scientific skills. All developments in science and

technology are based on the knowledge of basic principles.

Knowing the necessary steps and principles of carrying out

analyses, on the other hand, is consistent with development of

procedural knowledge and knowing as described in literature

(De Vries, 1994; Reber & Reber, 2001). Having knowledge to

interpret results of analysis is in conformity that learners ac-

quire the interpretative-hermeneutical way of knowing at MLT,

which is part of Haberma’s ways of knowing discussed in lit-

erature (Higgs & Smith, 2005).

From the results of the focus group discussions with educa-

tors and supervisors, it was clear that the practical part of MLT

curriculum was being implemented at different levels of the

health care system. The health care system is designed in such a

way that the higher one goes in the system the more one meets

complex approaches to health care delivery. Learners were

attached at each level for a specified period. This helped learn-

ers acquire different types of knowledge and knowing. This was

consistent with the focus group responses reflected in the quo-

tations that follow: Learners at different levels of their learning

require different facilities for their practicum attachment. It

takes deliberate effort to prepare learners for different levels of

practicum attachment. It requires different scopes of knowledge

and understanding. (Educator 8)

Mentoring senior learners is comparatively easy. You can

see them progressively getting closer to you in performance.

One can confidently delegate some functions to them at differ-

ent levels of the health care system. Senior students in their

final year of study can safely man sections of the clinical labo-

ratories, (Supervisor 7) From these quotations, it is clear that as

learners progress in the training, they gain proficiency and sen-

ior professionals progressively trust them.

Learner focus groups revealed that when they worked in

practicum sites they developed better understanding of the

learnt knowledge. They in addition appreciated the fact that

practicum sites were not all alike. This broadened their knowl-

edge and knowing. This is reflected in the quotation that fol-

lows: In practice some situations look different from the way

they are taught in theory. If one misses practicum attachment,

one cannot easily comprehend MLT knowledge and practice.

All the knowledge is rooted in the practice in clinical areas.

(Learner 3)

Conclusion

From the results of this study and the discussions in the pre-

vious section it is clear that different types of knowledge con-

tribute to development of MLT professionals. The MLT di-

ploma curriculum provided a supportive environment for ac-

quisition of various types of knowledge and knowing in order

to make learners develop the required attributes through their

educational experiences. The curriculum therefore catered for

the relevant epistemological issues of MLT training and educa-

tion. It is evident that the curriculum was ideal for development

of quality competent MLT professionals. What comes out

clearly is the fact that a good understanding of relevant and

appropriate curriculum content as well as curriculum imple-

mentation processes is critical on the part of educators to ensure

the quality of their products.

Recommendations

1) As different professional training programs aim at provid-

ing different traits in learners, it is important that educators

attempt to study and know the types of knowledge and knowing

that may lead to the development of the needed traits;

2) Educators need to evaluate their curricula in order to as-

certain whether their design and implementation have provi-

sions to make learners acquire knowledge and knowing.

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