Alpha Consensus Meeting on the Professional Status of Clinical Embryologists

7–8 May 2014 — Antalya, Turkey

Despite the expansion of accreditation schemes for ART centres, increasing government regulation of ART and the licensing of clinics and the staff working in them, is making it ever more apparent that the key role of the clinical embryologist, and effective direction and management of ART labs, are not being properly recognized / or managed optimally by some regulatory authorities and professional associations in many places/countries around the world.

Many ART laboratory professionals consider that Clinical Embryologists do not “fit” into the traditional categories of lab workers such as technician, technologist or biologist (in this case a scientist specializing in the area of reproductive biology), but rather that they are in fact “practitioners”. Beyond the high degree of technical skill and experience that typify Clinical Embryologists, they usually make many of the routine decisions that guide, even directly affect, patients’ treatment. Although operating within frameworks where the Medical Director has ultimate responsibility for each patient’s treatment, crucial decisions are made many times each day by the Clinical Embryologists within the context of stated (but not always documented) clinic policies authorized by the Medical Director. Clearly this is a very different situation to the vast majority of other “medical laboratories”, which are directed by a physician who has specialist training in specific areas of laboratory medicine and employ technicians and technologists – the Clinical Embryologist fills a very different role.

This has led to many questions being raised regarding the professional status of Clinical Embryologists, such as:

  • Is the Clinical Embryologist a technician, a technologist or a biologist (a scientist specializing in this area of biology)?

  • Who can work as a Clinical Embryologist?

  • What are the necessary educational requirements for people who want to become Clinical Embryologists?

  • What training is required for someone to work as a clinical embryologist?

  • What are the necessary competencies required to be able to work as a Clinical Embryologist?

  • As new professional frameworks are developed, how are those already working in the field protected and maintain a career path?

  • Who should decide each of these questions?

  • How can the profession establish its own guidelines/rules, best practice recommendations, certification scheme(s), CPD / continuing education system, for the benefit of its own members (and patients); and what is the best way for the profession to interact with other related professional groups (e.g. Clinical Practitioners and professional regulators).

Consequently, the Alpha Executive decided in 2012 that the topic for Alpha’s third global consensus meeting would be to establish the minimum expectations for the professional status of the Clinical Embryologist. In doing this Alpha is not trying to dictate to regulators, but is certainly seeking to educate them in what makes clinical embryology a special profession – and how we must protect the interests of infertile patients around the world and strive towards ensuring they have equitable access to the best possible care and treatment. As with the already published reports from Alpha’s two previous consensus meetings, our goal is to establish and expand the minimum requirements for safe and effective ART lab operation, while providing a framework for achieving quality and excellence.

The Consensus Process

Planning a consensus meeting is no easy task and requires achieving the proper balance between several sometimes conflicting aspects:

  • The meeting needs to be sufficiently small so that reaching consensus will be possible, and the event affordable;

  • The meeting must involve sufficient recognized experts to give the consensus its credibility;

  • The consensus process must have sought, analyzed, integrated, and included in its deliberations, widespread input from professional bodies and individuals alike (so as not to exclude anyone from voicing their opinion or providing pertinent input);

  • Individuals representing larger entities (e.g. national societies) must present the opinion of those entities free from personal bias (although not to the exclusion of their personal opinions, which are still valid input within the forum);

  • The consensus points reached need to cover all aspects of the topic and consider, without bias, relevant differences that exist (e.g. geographic, religious or moral), they must also have been reached free from bias that might be introduced by strong-minded individuals;

  • The whole event must be kept within the budget available, funding having been sought from a broad base of supporters while not exposing the consensus process to inappropriate external influence.

Reaching consensus involves consideration of all input information and material, and interaction between all participants. Meaningful success can only be achieved if everyone is willing to listen, think, and reach compromises. If there was a “right answer” then there would be no need to have a consensus meeting – and expecting to reach unanimous agreement on everything is also unrealistic! Reaching consensus requires a lot of give and take, and accepting that the group will not totally agree on everything – but the great majority of participants will be comfortable with the consensus points, and willing to accept them for the greater good of the profession.

Consensus Meeting Structure

Building on the successful format used in our first two consensus meetings, the meeting will run over two full days, each day comprising 4 × 2-hr sessions. Each session will be moderated by a Chairperson whose primary function will be to facilitate discussion to identify the major points of importance and relevance to the topic of that session, while keeping everyone on message.

  • During the morning of Day 1 (2 × 2-hr sessions) there will be five Overview presentations that succinctly and objectively summarize and synthesize all the submitted information. The five summary areas are:

  - National regulations

  - Required academic qualifications

  - Training and education programmes

  - Continuing professional development requirements

  - Roles and responsibilities

  • Five 2-hr sessions over the rest of Day 1 and most of Day 2 will follow the typical consensus format. For each topic there will be an authoritative Presentation that builds on the information presented during the Overviews, followed by an Open Discussion involving all meeting participants, and ending with a moderated Consensus Discussion during which the specific consensus points will be identified, refined, and consensus statements crafted. Each session will also be overseen by a Chairperson to facilitate free discussion and keep the session on track. The five topics are:

  - Role of the Clinical Embryologist (duties and responsibilities)

  - Educational and academic requirements

  - Training expectations / requirements

  - Defining and assessing competence

  - Continuing professional development

  • The final 2-hr session will include time to consider any particularly tricky points that might have been left in the “parking lot”, and for everyone to review again all the consensus points reached over the preceding 5 sessions.

All presentations will have been made available to all meeting participants well ahead of the meeting, allowing time for everyone to have studied all the background information. All participants will therefore be well-prepared for, and able to engage fully in, the Open Discussions.

The Consensus Report

Immediately following the meeting, based on the summary texts to be provided by the presenters, discussion summaries, and the agreed consensus points, a Consensus Report will be prepared and, following oversight review by the Alpha Executive, published under the authorship of Alpha (with the names of all participants listed in the text) in the Society’s official journal Reproductive Biomedicine Online.

Practical Organizational Matters

Finite financial resources will limit the support available to Alpha for this meeting, and we will clearly not be able to invite every national society to participate face-to-face at the Consensus Meeting. However, the organizers have expended great effort contacting as many national societies as possible to solicit their input in terms not only of information but also to identify the key participants for the Consensus Meeting itself. 

The opinions and ideas of individual professionals working all around the world as Clinical Embryologists are also being sought through a web-based questionnaire (URL link here), giving everyone the opportunity to contribute. A broad-based response to this questionnaire will maximize inclusiveness, and minimize isolationism and bias. Please join with the group of dedicated individuals who are working to enhance the profession of Clinical Embryology for all its current and future members – and for the good of those who we help every day in our professional lives.

The deadline for open questionnaire responses will be 30 November 2013, allowing necessary time for the compilation and analysis of responses, and their integration into the Overview presentations that must be distributed to meeting participants by mid-April 2014. 

We look forward to hearing from as many practising Clinical Embryologists as possible, but it needs to be soon so that we can move forward with the detailed planning of this third consensus meeting. Please address any questions, or requests for clarification on any points, to the Alpha Office, c/o Yasemin Dervisoglu <[email protected]>, and they will be responded to promptly.

PLEASE DOWNLOAD THE QUESTIONNAIRE AS THE ATTACHEMENT BELOW