Developing a Competency Framework for Medical Laboratory Scientists in Taiwan: A Modified Delphi Approach

Developing a Competency Framework for Medical Laboratory Scientists in Taiwan: A Modified Delphi Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Developing a Competency Framework for Medical Laboratory Scientists in Taiwan: A Modified Delphi Approach Hsien-Li Huang, Chi-Wei Lee, Pi-Yueh Chang, Huey-Ling You, Ping Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7370316/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Apr, 2026 Read the published version in BMC Medical Education → Version 1 posted 12 You are reading this latest preprint version Abstract Background Medical Laboratory Scientists (MLS) are essential members of the healthcare team, providing crucial information for patient diagnosis, treatment monitoring, and disease prevention. With the rapid development of laboratory medicine, the competencies required of MLS have significantly increased. While many countries have established frameworks to define MLS competencies, Taiwan currently lacks a comprehensive framework that is both aligned with international standards and specifically tailored to local healthcare needs. Methods This study was conducted from August 2022 to July 2023, employing a multi-stage mixed-methods approach to develop a competency framework for MLS in Taiwan. The process began with a systematic literature review and expert-informed focus group discussions to identify preliminary competencies. Subsequently, a three-round Delphi survey was conducted, involving 39 experts from teaching hospitals across various regions of Taiwan. Iterative modifications were made between each round to refine competency indicators, and the final consensus rate was set at 75%. Results The final framework comprises five core competencies: Technical Skills, Knowledge Base, Communication, Continuous Professional Development, and Professionalism, along with a total of 15 associated sub-competencies. Notably, three competency domain-level revisions were made during the Delphi process to reflect more observable and assessable behaviors. Additionally, six sub-competencies were revised for clarity and alignment with professional practice. Conclusion This study successfully constructed a comprehensive and hierarchically structured competency framework for MLS in Taiwan. The framework is both internationally aligned and deeply localized, providing a robust foundation for curriculum development and competency-based assessments. This framework is expected to significantly support the ongoing modernization of MLS education and enhance the quality of laboratory services in Taiwan. Medical laboratory scientist Competency Delphi Framework Introduction Medical Laboratory Scientists (MLS) play a pivotal and indispensable role in modern healthcare systems, serving as the backbone of accurate diagnosis, effective treatment monitoring, and disease prevention. Their expertise in performing complex laboratory analyses, interpreting results, and ensuring quality assurance has a direct impact on patient care and public health outcomes [1]. In an era characterized by rapid technological advancements, increasing diagnostic complexity, and evolving healthcare demands, the responsibilities and required competencies of MLS are continuously expanding beyond traditional laboratory tasks to include quality management, interprofessional collaboration, digital competencies, and patient-centered care [2–4]. This evolution necessitates a clear and comprehensive definition of the competencies required for MLS to perform effectively and adapt to emerging healthcare challenges [5]. To ensure that health professions education remains responsive to evolving professional demands, the development and implementation of robust competency frameworks has become essential. This shift is globally recognized, exemplified by the emergence of Competency-Based Medical Education (CBME) which aims to develop professionals who are proficient in local healthcare needs [6–8]. Numerous international professional organizations—including the International Federation of Biomedical Laboratory Science (IFBLS), the Centers for Disease Control and Prevention (CDC), the Medical Sciences Council of New Zealand, the Pathology Associations Council of Australia, and national bodies in Japan and Sweden—have established competency standards for MLS or public health laboratory professionals [9–14]. Additionally, the American Society for Clinical Pathology and the Canadian Society for Medical Laboratory Science offer competency-based certification examinations [15–16]. The global trend toward ISO 15189 accreditation further highlights the pressing need to strengthen workforce competencies in medical laboratories [17]. However, these international frameworks often reflect the structure and demands of their respective healthcare systems and may not fully align with the unique regulatory, educational, and clinical environments of other regions [18]. Therefore, this study aimed to develop a comprehensive and hierarchically structured competency framework for MLS in Taiwan. A rigorous multi-stage consensus methodology was adopted, comprising an extensive literature review, a preliminary focus group, and a three-round modified Delphi process. In contrast to the traditional Delphi method, which typically begins with open-ended questions and excludes prior discussion [19]. This study employed a modified Delphi by introducing a preliminary draft competency list based on literature synthesis and stakeholder input from a focus group. This modification was designed to enhance contextual relevance and content comprehensiveness before formal Delphi rounds. Furthermore, in each subsequent round, participants were provided with summarized quantitative results and aggregated qualitative feedback from the previous round. This iterative feedback mechanism enabled participants to reconsider their ratings within a broader context, thereby fostering reflective judgment and facilitating the development of well-informed consensus. The resulting competency framework not only offers a clear and updated blueprint for MLS curriculum development but also supports competency-based assessments and promotes continuing professional development aligned with the specific demands of Taiwan’s healthcare system. Methods Study Design This study employed a three-phase sequential mixed-methods approach to develop a comprehensive competency framework for MLS in Taiwan. This approach involved (1) a systematic literature review to identify an initial pool of relevant competency domains and items, (2) a focus group discussion to refine these preliminary competencies and explore local contextual expectations, and (3) a modified Delphi study to achieve expert consensus on the finalized competency framework. The research was conducted between August 1, 2022, and July 31, 2023, and was approved by the Chang Gung Medical Foundation Institutional Review Board (IRB No. 202200030B0A3). Phase 1: Literature Review A comprehensive literature search was performed using PubMed, Google Scholar, Web of Science, Airiti Library, and dissertation databases, employing keywords such as "competence," "competency," "task," "job," "knowledge," "skill," "attitude," "medical laboratory scientist," "medical technologist," and "clinical laboratory scientist." This also included a systematic review of relevant competency frameworks and clinical guidelines from international and national professional organizations, covering publications up to December 2022. After a rigorous screening process, 18 relevant studies were included for analysis [9-16, 20-28]. During data analysis, two researchers independently extracted and reviewed the competency domains presented in the included literature. Any discrepancies in interpretation were resolved through consensus meetings among the research team to ensure analytical consistency. Through this iterative process, eight major competency domains were synthesized: laboratory technical skills, professional knowledge, safety and risk management, interdisciplinary communication and collaboration, continuous professional development and quality improvement, professional ethics, administrative management, and teaching supervision. These domains reflected broad categories of essential capabilities identified from global frameworks and served as the preliminary structure for subsequent refinement. Phase 2: Focus Group Discussion To validate and refine the preliminary competency framework for local applicability, a focus group discussion was conducted with nine MLS experts. These experts, strategically recruited from the Taiwan Society of Laboratory Medicine (TSLM) and the Taiwan Association of Medical Technologists, possessed recognized expertise in MLS education, professional training, and workforce development, ensuring diverse perspectives from academia, clinical practice, and professional organizations. Over two iterative rounds, the discussion, informed by the Phase 1 preliminary framework, aimed to identify and define core and sub-competencies specific to MLS in Taiwan. Objectives included understanding unique roles, challenges, and demands on MLS within the Taiwanese healthcare context and adapting extracted items and associated sub-competencies for relevance, clarity, and alignment with local demands and international standards. Through this iterative process, the core and sub-competencies for Taiwanese MLS were tentatively defined, forming the basis for the subsequent Delphi study. The initial five core competencies included in the Delphi questionnaire—Technical Skill (TS), Knowledge Base (KB), Team Resource Management (TRM), Continuous Professional Learning, Development and Quality Improvement (CPQ), and Professionalism and Accountability (PA)—were synthesized from the eight domains identified during the literature review. Meanwhile, the 14 initial sub-competencies were developed through thematic synthesis of both literature findings and expert input during the focus group, ensuring alignment with international competency standards and the specific needs of MLS practice in Taiwan. This refinement ensured that the resulting framework remained both comprehensive and contextually appropriate. Table 1 summarizes the mapping between the original competency domains from Literature Review and initial competency structures used in Delphi questionnaire. Phase 3: Delphi Study To validate and refine the proposed competency framework, a three-round Delphi survey was conducted using a structured questionnaire. This instrument, which was specifically developed for this study and had not been previously published, incorporated five core competencies and fourteen sub-competencies that had been iteratively developed through prior phases. The questionnaire featured both closed-ended items—rated on a 5-point Likert scale (1 = very inappropriate to 5 = very appropriate)—and open-ended prompts for qualitative feedback. The English versions of the Round 1–3 questionnaires are provided as Supplementary Files (Additional file 1-3). A total of 39 MLS experts from diverse clinical institutions across Taiwan participated. These participants were recruited through formal invitations sent to teaching hospitals nationwide, targeting laboratory directors or education leaders. This panel size exceeds the typical Delphi recommendation of 15–30 experts [29], enhancing the diversity, representativeness, and reliability of the consensus outcomes [30]. To facilitate engagement, the survey was distributed in both paper and digital formats. Anonymized summaries of quantitative ratings and qualitative comments were provided between rounds to support reflective reassessment. This iterative feedback process allowed participants to refine their evaluations and converge toward consensus across all core and sub-competencies. Consensus Criteria and Data Analysis Competencies were evaluated and retained, modified, or removed based on predefined statistical thresholds. Specifically, items with a mean score (M) 0.5) among expert opinions prompted further discussion and clarification by the research team for subsequent rounds. Consensus for each competency item was defined when the Coefficient of Variation (CV) was ≤ 25% (i.e., (100% - coefficient of variation) ≥ 75%) [30]. The Delphi process was terminated once 95% of the competency indicators met these convergence criteria for consensus across all domains [31]. Results Expert Panel Demographics and Distribution A total of 39 MLS experts participated in the Delphi study (Table 2), maintaining a 100% response rate across all rounds. The panel was nearly gender-balanced (51% female, 49% male), with 72% holding managerial positions and 80% having over 15 years of professional experience. Educational backgrounds included 26% with doctoral degrees, 59% with master’s, and 15% with bachelor’s degrees. Affiliations were split between medical centers (49%) and regional hospitals (49%), with only 2% from district hospitals, and were geographically represented in the north (38%), central (26%), south (31%), and east (5%) regions of Taiwan. Refinement and Consensus on Core Competencies The Delphi process refined five preliminary core competencies for MLS. In Round 1, TRM was replaced by Communication (COM). CPQ was refined to Continuous Professional Development (CPD). Finally, PA was simplified to Professionalism (PRO). All five revised core competencies achieved high expert consensus by Round 3 (Table 3). On a 5-point Likert scale, mean scores ranged from 4.87 to 4.95, with consensus rates exceeding 92% across all items. TS demonstrated the highest consensus (Mean = 4.95 ± 0.22; 95% consensus), closely followed by KB (Mean = 4.92 ± 0.27; 95% consensus) and COM (Mean = 4.90 ± 0.31; 94% consensus). Refinement and Consensus on Sub-competencies A total of 14 sub-competencies were evaluated through a three-round Delphi process. Following Round 1, six sub-competencies were revised based on expert feedback to improve clarity and contextual relevance. These revisions, along with structured feedback provided in subsequent rounds, contributed to increasing consensus among participants. By Round 3, 12 sub-competencies achieved consensus levels ≥95%, indicating strong agreement across the expert panel (Table 4). The highest-rated items included Validating and reporting laboratory results accurately and timely (Mean = 4.93 ± 0.10; 98% consensus), Establishing, managing, and maintaining documentation, equipment, laboratory resources, and inventory (Mean = 4.89 ± 0.17; 97% consensus), and communicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality (Mean = 4.89 ± 0.17; 97% consensus). Definition of Core Competency Domains and Sub-competencies Based on expert consensus obtained through three rounds of the Delphi process, a comprehensive competency framework for MLS was established (Table 5). The TS domain encompasses specimen handling, analytical performance, quality control, and accurate reporting. The KB domain integrates understanding of laboratory medicine, use of health information systems, and laboratory safety management. The COM domain emphasizes effective interdisciplinary collaboration as well as the ability to manage and utilize human resources in laboratory settings. CPD reflects the importance of lifelong learning, research competence, and clinical reasoning. Finally, PRO encompasses ethical behavior, legal compliance, and professional conduct. Each of these five core competency domains includes clearly defined sub-competencies to ensure comprehensive coverage of the expected professional roles of MLS. Table 1. Mapping of original competency domains to initial core competency structure Original Competency Domains (from Literature Review) Initial Core Competencies (used in Delphi Questionnaire) Laboratory technical skills Technical Skill (TS) Professional knowledge Knowledge Base (KB) Safety and risk management Merged into Knowledge Base (KB) Interdisciplinary communication and collaboration Team Resource Management (TRM) Continuous professional development and quality improvement Continuous Professional Learning, Development and Quality Improvement (CPQ) Professional ethics Professionalism and Accountability (PA) Administrative management Excluded (role-specific task) teaching supervision Excluded (role-specific task) Table 2. Characteristics of experts participating in the Delphi study (N=39) Position Percent (Number) Management 72% (n= 28) Non-management 28% (n= 11) Gender Female 51% (n= 20) Male 49% (n= 19) Years of work experience 5-15 years 21% (n= 8) 16-25 years 49% (n= 19) >25 years 31% (n= 12) Education level Doctoral degree 26% (n= 10) Master’s degree 59% (n= 23) Bachelor’s degree 15% (n= 6) Hospital level Medical center 49% (n= 19) Regional hospital 49% (n= 19) district hospital 2% (n= 1) Hospital locations Northern 38% (n= 15) Central 26% (n= 10) Southern 31% (n= 12) Eastern 5% (n= 2) Table 3. Refinement and Delphi consensus ratings of core competencies for MLS across three rounds. Core Competencies Round 1 Round 2 Round 3 Before the Delphi Study After the Delphi Study Mean±SD Consensus Level Mean±SD Consensus Level Mean±SD Consensus Level Technical Skill (TS) Technical Skill (TS) 4.82±0.39 92% 4.92±0.27 95% 4.95±0.22 95% Knowledge Base (KB) Knowledge Base (KB) 4.67±0.58 88% 4.87±0.41 92% 4.92±0.27 95% #Team Resource Management (TRM) Communication (COM) 4.59±0.59 87% 4.77±0.43 91% 4.90±0.31 94% #Continuous professional learning, Development and Quality improvement (CPQ) Continuous Professional Development (CPD) 4.69±0.66 86% 4.79±0.52 89% 4.87±0.41 92% #Professionalism and Accountability (PA) Professionalism (PRO) 4.62±0.71 85% 4.85±0.37 92% 4.87±0.34 93% Items marked with "#" indicate sub-competencies that were revised after the first Delphi round based on expert feedback. Table 4. Refinement and Delphi consensus ratings of sub-competencies for MLS across three rounds. Sub-competencies Round 1 Round 2 Round 3 Before the Delphi Study After the Delphi Study Mean±SD Consensus Level Mean±SD Consensus Level Mean±SD Consensus Level #Collecting, preparing, and analyzing clinical specimens Collecting and preparing clinical specimens 4.64±0.68 85% 4.76±0.54 90% 4.83±0.35 93% Performing laboratory analyses and preserving specimens 4.88±0.34 94% 4.91±0.19 96% #Conducting quality control of laboratory tests Applying quality assurance principles to conduct laboratory quality control 4.88±0.31 94% 4.87±0.34 93% 4.89±0.26 95% Validating and reporting laboratory results accurately and timely Validating and reporting laboratory results accurately and timely 4.78±0.41 91% 4.92±0.31 95% 4.93±0.10 98% Applying knowledge of laboratory medicine to support patient care Applying knowledge of laboratory medicine to support patient care 4.77±0.48 90% 4.74±0.54 92% 4.83±0.26 95% Utilizing healthcare information systems or software for documentation, data retrieval, calculation, and analysis Utilizing healthcare information systems or software for documentation, data retrieval, calculation, and analysis 4.64±0.52 89% 4.73±0.51 92% 4.87±0.21 96% #Maintaining documentation, equipment, laboratory resources, and inventory Establishing, managing, and maintaining documentation, equipment, laboratory resources, and inventory 4.69±0.57 88% 4.86±0.58 94% 4.89±0.17 97% Maintaining and promoting safe laboratory practices Maintaining and promoting safe laboratory practices 4.67±0.58 88% 4.79±0.48 93% 4.85±0.23 95% Communicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality Communicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality 4.69±0.69 85% 4.84±0.43 93% 4.89±0.17 97% #Supervising and managing personnel Managing and utilizing human resources effectively in laboratory settings 4.65±0.59 87% 4.32±0.77 82% 4.88±0.18 96% Identifying professional learning needs and participating in continuing education and team training Identifying professional learning needs and participating in continuing education and team training 4.79±0.57 88% 4.87±0.41 92% 4.90±0.38 92% #Participate in research and development activities Demonstrating logical reasoning, scientific inquiry, and research skills 4.59±0.85 81% 4.79±0.41 91% 4.87±0.34 93% Applying critical thinking to solve clinical problems, make informed decisions, and provide laboratory consultation Applying critical thinking to solve clinical problems, make informed decisions, and provide laboratory consultation 4.54±0.81 82% 4.74±0.55 89% 4.88±0.18 96% Understanding and adhering to accreditation standards, assessment regulations, and national laws governing medical laboratories Understanding and adhering to accreditation standards, assessment regulations, and national laws governing medical laboratories 4.77±0.63 87% 4.92±0.27 94% 4.92±0.27 95% Demonstrating professional responsibility, ethical behavior, and integrity in medical laboratory practice Demonstrating professional responsibility, ethical behavior, and integrity in medical laboratory practice 4.41±0.97 78% 4.75±0.45 91% 4.88±0.22 95% Items marked with "#" indicate sub-competencies that were revised after the first Delphi round based on expert feedback. Table 5. Core competencies and supporting sub-competencies in the MLS competency framework Core Competencies Rationale and Definition of Sub-competencies Technical Skill (TS) MLS must provide high-quality, efficient laboratory services centered on patient needs. This includes specimen preparation, analytical procedures, and result interpretation. Effective workflow and risk management are essential to ensure biosafety and minimize laboratory-related errors and hazards. Therefore, the following sub-competencies were identified. TS1：Collecting and preparing clinical specimens TS2：Performing laboratory analyses and preserving specimens TS3：Applying quality assurance principles to conduct laboratory quality control TS4：Validating and reporting laboratory results accurately and timely Knowledge Base (KB) MLS must possess a solid understanding of laboratory medicine and analytical techniques. They are also required to utilize medical information systems, manage documentation and resources, and ensure safety in the laboratory environment. Thus, the following sub-competencies were included. KB1：Applying knowledge of laboratory medicine to support patient care. KB2：Utilizing healthcare information systems or software for documentation, data retrieval, calculation, and analysis. KB3：Establishing, managing, and maintaining documentation, equipment, laboratory resources, and inventory. KB4：Maintaining and promoting safe laboratory practices Communication (COM) MLS should demonstrate effective communication skills. They are expected to collaborate with other healthcare professionals and function as part of an interdisciplinary team. Accordingly, the following sub-competencies were proposed. COM1：Communicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality. COM2：Managing and utilizing human resources effectively in laboratory settings Continuous Professional Development (CPD) MLS are expected to maintain competence and adapt to evolving professional roles. They must engage in lifelong learning, evidence-based research, and critical thinking to meet the demands of modern laboratory medicine. Based on these needs, the following sub-competencies were established. CPD1：Identifying professional learning needs and participating in continuing education and team training CPD2：Demonstrating logical reasoning, scientific inquiry, and research skills CPD3：Applying critical thinking to solve clinical problems, make informed decisions, and provide laboratory consultation Professionalism (PRO) MLS must demonstrate professional responsibility and ethical conduct. They must comply with relevant laws and regulations and ensure patient confidentiality and safety. Accordingly, the following sub-competencies were defined. PRO1：Understanding and adhering to accreditation standards, assessment regulations, and national laws governing medical laboratories. PRO2：Demonstrating professional responsibility, ethical behavior, and integrity in medical laboratory practice. Discussion This study successfully constructed a comprehensive competency framework for MLS in Taiwan. Through a multi-stage process involving literature review, focus group discussions, and the Delphi method, 5 core competencies—TS, KB, COM, CPD, and PRO—along with 15 essential sub-competencies, were identified. Unlike some recent studies on MLS core competencies [13,14] which often lack sub-competencies and focus solely on entry-level professionals, our framework is applicable across various clinical settings and career development stages. Furthermore, the establishment of this clear, hierarchical competency framework provides a robust blueprint for curriculum development in educational institutions, enables more precise assessment of individual competency levels, guides targeted professional development programs, and clarifies expected roles and responsibilities within clinical laboratory settings. While certain items initially received lower levels of consensus, this may have reflected the fact that some competencies—although emphasized in international frameworks—are not yet fully embedded in local MLS practice. Nevertheless, since none of the items scored below the pre-established exclusion threshold (mean score < 3.5), the research team retained all of them for subsequent consideration. In the following Delphi rounds, aggregated quantitative scores and anonymized qualitative feedback were provided to panelists, enabling them to re-evaluate these items within a richer contextual framework. This iterative process facilitated thoughtful convergence and minimized the risk of prematurely excluding potentially valuable competencies that may increase in relevance as the profession evolves. During the three-round Delphi evaluation process, expert panel members proposed several improvements to enhance conceptual clarity and contextual relevance, leading to revisions in the terminology and scope of three core domains. First, Technical Resource Management (TRM) was replaced by COM. Experts emphasized that TRM denotes a training strategy rather than a fundamental competency. In contrast, Communication was deemed a more assessable foundational skill, better reflecting MLS's roles in interacting with healthcare teams and ensuring patient safety. Second, CPQ was revised to CPD for improved clarity and alignment with internationally recognized terminology, emphasizing lifelong learning and competency maintenance throughout one's career. Third, PA was simplified to PRO, acknowledging that accountability is inherently embedded within professional conduct, thereby streamlining the concept without compromising key evaluative elements. In addition to adjustments at the core domain level, six sub-competencies also underwent revision after the first Delphi round to enhance their accuracy, consistency, or alignment with professional practice. For instance, the original item "Collecting, preparing, and analyzing clinical specimens" was split into two distinct sub-competencies—"Collecting and preparing clinical specimens" and "Performing laboratory analyses and specimen preservation"—to delineate tasks during the pre-analytical and analytical phases. Other improvements included changing "Conducting laboratory quality control" to "Applying quality assurance principles to conduct laboratory quality control," and modifying "Supervising and managing personnel" to "Managing and utilizing human resources effectively in laboratory settings." Both revisions underscore an emphasis on principle-based practice and real-world applicability. Given that the roles and responsibilities of MLS vary across countries, competency frameworks consequently differ. In this study, the TS and KB domains largely align with international counterparts such as those from IFBLS, ASCP, and CSMLS, prioritizing laboratory techniques, quality assurance, and laboratory safety. The incorporation of sub-competencies about the integrated application of health information systems within the KB domain indicates a growing recognition among experts of the critical role that informatics competencies play in the context of artificial intelligence. This development underscores Taiwan's proactive commitment to advancing laboratory informatics and enhancing digital readiness. Furthermore, CPD emerged as an independent domain, explicitly defining critical thinking, research capabilities, and emphasizing lifelong learning. The Swedish framework acknowledges language proficiency as a crucial aspect of communication competency [14]. However, this study defines communication more broadly, emphasizing its practical application. Specifically, it highlights the ability of MLS to collaborate within interdisciplinary teams, communicate effectively with patients and colleagues, and manage human interactions in laboratory settings. These sub-competencies were developed to reflect Taiwan’s multilingual and team-oriented healthcare environment, where effective communication plays a pivotal role in ensuring service quality and patient safety. While PRO aligns internationally on ethics and compliance [16], its more explicit articulation at the sub-competency level within this framework likely reflects strengthened local regulatory oversight and ethical scrutiny in clinical laboratories. Furthermore, experts recognized the increasing importance of inventory management, especially considering supply chain disruptions caused by the COVID-19 pandemic and geopolitical conflicts affecting global supply chains; this was consequently integrated into the sub-competencies. In addition to aligning with internationally recognized frameworks, this study incorporated contextual elements unique to Taiwan’s healthcare and professional landscape. For example, the KB domain includes competencies related to the integration of medical information systems and digital transformation, which are essential within Taiwan’s highly digitized healthcare infrastructure. The widespread use of the National Health Insurance (NHI) system and the emerging application of AI-assisted diagnostics underscore the growing importance of informatics in routine laboratory practice. The COM domain reflects the multilingual and culturally diverse environment in which MLS operate in Taiwan. Effective communication across professional disciplines, with patients, and within laboratory teams is essential to maintaining service quality and patient safety in such a setting. In the PRO domain, the inclusion of sub-competencies related to compliance with national regulations and ethical conduct corresponds to Taiwan’s increasing emphasis on clinical laboratory oversight and patient-centered care. Furthermore, the establishment of CPD as an independent core domain responds directly to Taiwan’s licensing requirements, which mandate 120 hours of accredited continuing education every six years for MLS license renewal. This regulatory structure reinforces the importance of lifelong learning and competency maintenance, making CPD not only professionally desirable but also legally essential in Taiwan. While the competency framework developed in this study aligns with international models, it introduces localized refinements reflecting Taiwan’s regulatory context, professional expectations, and evolving MLS roles, supporting both national relevance and international adaptability. Nonetheless, several limitations exist. First, although MLS operates across diverse settings, this framework primarily addresses competencies for clinical practice within hospital-based laboratory medicine or anatomic pathology departments, potentially missing competencies needed in non-clinical or specialized domains. Second, representation from district hospitals was minimal (2%), which may underrepresent perspectives from smaller institutions where MLS often take on broader responsibilities or face resource limitations. Third, although the modified Delphi method offers a systematic approach to consensus building, it remains inherently subjective and may reflect panel-specific biases, potentially leading to the omission of certain relevant competencies. Despite these limitations, the identified competencies provide a robust foundation for developing Entrustable Professional Activities and milestones, advancing competency-based education in medical laboratory science. Conclusions This study employed a multi-stage methodology, culminating in a three-round Delphi process, to construct a comprehensive, hierarchically structured, and consensus-driven competency framework for MLS in Taiwan. This framework encompasses five core competencies and fifteen sub-competencies. While aligned with international competency models in its foundational structure, the framework was further localized to reflect Taiwan’s unique healthcare context, integrating capabilities such as digital adaptability, interprofessional communication, and emerging skills required by the evolving roles of MLS. By offering a clear and contextually relevant blueprint, this framework is positioned to serve as a cornerstone for curriculum development, competency assessment, and continuous professional growth, ultimately supporting the transformation of MLS education and practice and enhancing the quality of laboratory services in Taiwan. Abbreviations MLS: Medical laboratory scientist IFBLS: International Federation of Biomedical Laboratory Science CDC: Centers for Disease Control and Prevention ASCP: American Society for Clinical Pathology CSMLS: Canadian Society for Medical Laboratory Science TS: Technical Skill KB: Knowledge Base TRM: Technical Resource Management CPQ: Continuous Professional Learning, Development and Quality Improvement PA: Professionalism and Accountability COM: Communication CPD: Continuous Professional Development PRO: Professionalism Declarations Ethics approval and consent to participate This study was approved by the Committee on Ethics of the Chang Gung Medical Foundation, Taiwan (IRB number: 202200030B0A3). Written informed consent was obtained from all participants after the purpose and procedures of the study were fully explained. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request. The English versions of the Delphi Round 1–3 questionnaires used in this study are provided as Supplementary Files (Additional file 1-3). Consent for publication All participants signed written informed consent forms prior to participation in this study. Competing interests The authors declare that they have no competing interests. Funding This study was financially supported by National Science and Technology Council of Taiwan (Grant no. 111-2410-H-182A-004 -). Authors and Affiliations Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan Hsien-Li Huang, Huey-Ling You Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan Hsien-Li Huang, Pi-Yueh Chang Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan Chi-Wei Lee Department of Medical Laboratory, Administration Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan Pi-Yueh Chang Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan Huey-Ling You Graduate Institute of Adult Education, National Kaohsiung Normal university, Kaohsiung, Taiwan Ping Yu (adjunct professor) Authors’ contributions Hsien-Li Huang conceived and designed the study, conducted the research, and drafted the initial manuscript. Ping Yu provided overall supervision and was responsible for data analysis and interpretation. Huey-Ling You and Pi-Yueh Chang contributed to the literature review and data organization. Chi-Wei Lee revised and edited the manuscript. All authors reviewed and approved the final version of the manuscript and agreed to its publication. Acknowledgements The authors gratefully acknowledge the time and expertise contributed by all participating experts during the focus group discussions and the Delphi rounds. References Becich MJ. Information management: moving from test results to clinical information. Clinical leadership & management review. Clin Leadership Manag Rev. 2000, 14(6):296-300. Morris S, Otto CN, Golemboski K. Improving patient safety and healthcare quality in the 21st century—competencies required of future medical laboratory science practitioners. Am Soc Clin Lab Sci. 2013, 26(4):200-204. Kummerfeldt VD. Developing the next generation of clinical laboratory scientist supervisors: A study of supervisory competencies in clinical laboratory. Capella University; 2019. Adekoya A, Okezue MA, Menon K. Medical laboratories in healthcare delivery: A systematic review of their roles and impact. Laboratories. 2025, 2(1):8. Badrick T, St John A. Time to redefine the requirements for a medical laboratory scientist. Aust J Med Sci. 2012, 33(3):107-110. Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, , et al. Competency-based medical education: theory to practice. Med Teach. 2010, 32(8):638-645. Zaga FR. Transforming medical education in the 21st century: the role of competency-based medical education. Rev Fac Med Hum. 2024, 24(1):16. ten Cate O. Competency-based medical education and its competency frameworks. In: Competence-based Vocational and Professional Education: Bridging the Worlds of Work and Education. edn.: Springer; 2016: 903-29. The International Federation of Biomedical Laboratory Science (IFBLS). IFBLS guidelines regarding Core Competence and Core Curriculum [Internet]. 2012 [cited 2025 Aug 13]. Available from: http://www.ifbls.org/images/IFBLS_Documents/IFBLS_Guidelines_Core_Competence_and_Core_Curriculum_2016.pdf. Ned-Sykes R, Johnson C, Ridderhof JC, Perlman E, Pollock A, DeBoy JM et al. Competency guidelines for public health laboratory professionals. Mmwr Suppl. 2015, 64(1):1-81. Medical Sciences Council of New Zealand. Competence Standards for Medical Laboratory Science Practitioners in Aotearoa New Zealand [Internet]. 2018 [cited 2025 Aug 13]. Available from: https://www.mscouncil.org.nz/assets_mlsb/Uploads/2018-Nov-V2-MSC-Competence-Standards-MLS.pdf. Merlino J, Palladino S, Sheehan P, Badrick T, Thorburn D, Weinholt L, et al. Competency-based standards for Medical Scientists. Pathol Assoc Council. 2009. Maekawa K, Kotera S, Ohsaki H. Competency for Japanese novice medical laboratory scientists: a Delphi method. BMC Med Educ. 2022, 22(1):875. Stollenwerk MM, Gustafsson A, Edgren G, Gudmundsson P, Lindqvist M, Eriksson T: Core competencies for a biomedical laboratory scientist–a Delphi study. BMC medical education 2022, 22(1):476. The ASCP Board of Certification. U.S. procedures for examination & certification [Internet]. 2021 [cited 2025 Aug 13]. Available from:https://www.ascp.org/content/docs/default-source/boc-pdfs/exam-content-outlines/ascp-boc-us-procedures-book-web.pdf. Canadian Society for Medical Laboratory Science (CSMLS). CSMLS competency profile general medical laboratory technologist. 2015 [Internet]. 2015 [cited 2025 Aug 13]. Available from: https://go.csmls.org/cert/MLTG_CP.pdf. Nah E-H, Cho S, Kim S, Cho H-I, Stingu C-S, Eschrich K, et al. International organization for standardization (ISO) 15189. Ann Lab Med. 2017, 37(5):365-70. Chou FC, Hsiao C-T, Yang C-W, Frank JR. “Glocalization” in medical education: a framework underlying implementing CBME in a local context. J Formos Med Assoc. 2022, 121(8):1523-31. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol . 2021;11(4):116–129. Badrick T, Willson C. Progressing the Certification of the Medical Science Workforce. Clin Biochem Rev. 2018, 39(1):29-36. Beck S, Doig K. Are new CLS practitioners prepared to stay? Clin Lab Sci. 2007, 20(3):161-71. Beck SJ, Doig K: CLS competencies expected at entry-level and beyond. Clin Lab Sci. 2002, 15(4):220-8. Bishop S, Honeycutt K. Medical laboratory science undergraduate management curriculum development using practitioner reported job tasks. Am Soc Clin Lab Sci. 2020. Jassam N, Lake J, Dabrowska M, Queralto J, Rizos D, Lichtinghagen R, et al. The European Federation of Clinical Chemistry and Laboratory Medicine syllabus for postgraduate education and training for Specialists in Laboratory Medicine: version 5–2018. Clin Chem Lab Med. 2018, 56(11):1846-63. Parikh RP. Competency assessment for medical laboratory practitioners and existing rules and regulations. J Health Occup Educ. 2000, 14(2):6. Valdez AP. Competencies of Career-Entry Medical Technology Graduates of Lyceum of Batangas: Basis for Enhancement of the Internship Training Program. Online Submiss. 2010, 4:16-33. Willson C, Badrick T. A comparison of some certification/registration schemes available for medical laboratory scientists. Aust J Med Sci. 2017, 38(3/4):84-8. Willson C, Bertram K, Badrick T. Pathology laboratory scientific scope of practice and competence-based standards for a certified workforce. Aust J Med Sci. 2018, 39(1/2):32-7. Hohmann E, Cote MP, Brand JC. Research pearls: expert consensus based evidence using the Delphi method. Arthroscopy. 2018, 34(12):3278-82. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021, 11(4):116-129. Tognetto A, Michelazzo MB, Ricciardi W, Federici A, Boccia S. Core competencies in genetics for healthcare professionals: results from a literature review and a Delphi method. BMC Med Educ. 2019, 19(1):19. Kalaian SA, Kasim RM. Terminating sequential Delphi survey data collection. Pract Assess Res Eval. 2012, 17(5):n5. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile.docx Cite Share Download PDF Status: Published Journal Publication published 15 Apr, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 09 Mar, 2026 Reviews received at journal 14 Oct, 2025 Reviews received at journal 02 Oct, 2025 Reviews received at journal 28 Sep, 2025 Reviewers agreed at journal 27 Sep, 2025 Reviewers agreed at journal 25 Sep, 2025 Reviewers agreed at journal 25 Sep, 2025 Reviewers invited by journal 25 Sep, 2025 Editor assigned by journal 23 Sep, 2025 Editor invited by journal 02 Sep, 2025 Submission checks completed at journal 02 Sep, 2025 First submitted to journal 02 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7370316","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525220340,"identity":"9577bda2-dd8b-420a-95f5-684b89c0264d","order_by":0,"name":"Hsien-Li Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDAC+QeJDz5USMjxA9nMROpJeGw444yNsWQDXAtBnYnPpHnb0hINDhCrRb7hcILkDLbDCcbHj1/dXMBgky/vwH9MAp8Wg4NtCQYfeA7nmZ3JKbs9gyHNcuMBZjb8Wph5EhJnSBwuNrvBk3abh+GwgWEDM9sNvA5r4/9wmMfgcOLmGcRqYTjDkNjMk5CWuEGC/RhYizwDAS0GNxiSGWccsDGWOJPDdpvHIM3AgJnZ/Adeh81gSP/x8R8wKtuPP7vNU2FjIN/e+NgAr8MQgAeoEIQOE6keCNgfQOxtIF7LKBgFo2AUjAwAAPhiS6gbjwL7AAAAAElFTkSuQmCC","orcid":"","institution":"Kaohsiung Chang Gung Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hsien-Li","middleName":"","lastName":"Huang","suffix":""},{"id":525220342,"identity":"365357b2-7023-40c2-b15b-9e788f83a133","order_by":1,"name":"Chi-Wei Lee","email":"","orcid":"","institution":"National Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Chi-Wei","middleName":"","lastName":"Lee","suffix":""},{"id":525220345,"identity":"44cb1d30-db6c-495d-8bcf-0664bb251f76","order_by":2,"name":"Pi-Yueh Chang","email":"","orcid":"","institution":"Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pi-Yueh","middleName":"","lastName":"Chang","suffix":""},{"id":525220346,"identity":"50677a73-8e5f-4e80-b9af-6c2430e41755","order_by":3,"name":"Huey-Ling You","email":"","orcid":"","institution":"Kaohsiung Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huey-Ling","middleName":"","lastName":"You","suffix":""},{"id":525220349,"identity":"4e919e6f-6160-41b5-9a33-b9f166347163","order_by":4,"name":"Ping Yu","email":"","orcid":"","institution":"National Kaohsiung Normal University","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2025-08-14 06:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7370316/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7370316/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-026-09191-x","type":"published","date":"2026-04-15T15:59:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93042433,"identity":"62e27c2f-b888-4301-ba98-4ec4d27cca9c","added_by":"auto","created_at":"2025-10-08 12:32:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60044,"visible":true,"origin":"","legend":"","description":"","filename":"2025.9.2modifiedversionofthemanuscriptBMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/5ab9bb2750bfe41aae2230b2.docx"},{"id":93042431,"identity":"d7da2eb8-5939-4c2a-9e01-acb526a65d9d","added_by":"auto","created_at":"2025-10-08 12:32:27","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7710,"visible":true,"origin":"","legend":"","description":"","filename":"d5aa45cb2e834b6c82de9c3295db43d3.json","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/53275420eb53daf9863d50e4.json"},{"id":93043299,"identity":"896471aa-4e1a-4a16-844b-2e0b3c7d8a47","added_by":"auto","created_at":"2025-10-08 12:40:27","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34040,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/e3158e2ad2c46ea9fdd7126a.docx"},{"id":93042430,"identity":"a4543d4d-8560-4069-986d-12ae21ecb7fd","added_by":"auto","created_at":"2025-10-08 12:32:27","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91673,"visible":true,"origin":"","legend":"","description":"","filename":"d5aa45cb2e834b6c82de9c3295db43d31enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/2560edf6ddce7841be6a7a87.xml"},{"id":93042435,"identity":"2503043c-0e00-47a6-87b5-67369c74a563","added_by":"auto","created_at":"2025-10-08 12:32:27","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88797,"visible":true,"origin":"","legend":"","description":"","filename":"d5aa45cb2e834b6c82de9c3295db43d31structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/166ed0622e4bf2a8c61a69fa.xml"},{"id":93042434,"identity":"c78dd5d9-77c7-4b93-9450-ddfad17826ba","added_by":"auto","created_at":"2025-10-08 12:32:27","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96299,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/027c7903b74f08ae3181dc14.html"},{"id":107351849,"identity":"727d179f-63c7-4d98-bef0-d523a3e8f988","added_by":"auto","created_at":"2026-04-20 16:12:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":609979,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/ca835030-86bb-46ed-8869-2035703b03ba.pdf"},{"id":93042429,"identity":"b32e93ae-6354-4c3a-95e9-ef805a53c933","added_by":"auto","created_at":"2025-10-08 12:32:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":34040,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-7370316/v1/47bc335b86e2b89d0a6d9bae.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Developing a Competency Framework for Medical Laboratory Scientists in Taiwan: A Modified Delphi Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedical Laboratory Scientists (MLS) play a pivotal and indispensable role in modern healthcare systems, serving as the backbone of accurate diagnosis, effective treatment monitoring, and disease prevention. Their expertise in performing complex laboratory analyses, interpreting results, and ensuring quality assurance has a direct impact on patient care and public health outcomes [1]. In an era characterized by rapid technological advancements, increasing diagnostic complexity, and evolving healthcare demands, the responsibilities and required competencies of MLS are continuously expanding beyond traditional laboratory tasks to include quality management, interprofessional collaboration, digital competencies, and patient-centered care [2\u0026ndash;4]. This evolution necessitates a clear and comprehensive definition of the competencies required for MLS to perform effectively and adapt to emerging healthcare challenges [5].\u003c/p\u003e\u003cp\u003eTo ensure that health professions education remains responsive to evolving professional demands, the development and implementation of robust competency frameworks has become essential. This shift is globally recognized, exemplified by the emergence of Competency-Based Medical Education (CBME) which aims to develop professionals who are proficient in local healthcare needs [6\u0026ndash;8]. Numerous international professional organizations\u0026mdash;including the International Federation of Biomedical Laboratory Science (IFBLS), the Centers for Disease Control and Prevention (CDC), the Medical Sciences Council of New Zealand, the Pathology Associations Council of Australia, and national bodies in Japan and Sweden\u0026mdash;have established competency standards for MLS or public health laboratory professionals [9\u0026ndash;14]. Additionally, the American Society for Clinical Pathology and the Canadian Society for Medical Laboratory Science offer competency-based certification examinations [15\u0026ndash;16]. The global trend toward ISO 15189 accreditation further highlights the pressing need to strengthen workforce competencies in medical laboratories [17]. However, these international frameworks often reflect the structure and demands of their respective healthcare systems and may not fully align with the unique regulatory, educational, and clinical environments of other regions [18].\u003c/p\u003e\u003cp\u003eTherefore, this study aimed to develop a comprehensive and hierarchically structured competency framework for MLS in Taiwan. A rigorous multi-stage consensus methodology was adopted, comprising an extensive literature review, a preliminary focus group, and a three-round modified Delphi process. In contrast to the traditional Delphi method, which typically begins with open-ended questions and excludes prior discussion [19]. This study employed a modified Delphi by introducing a preliminary draft competency list based on literature synthesis and stakeholder input from a focus group. This modification was designed to enhance contextual relevance and content comprehensiveness before formal Delphi rounds. Furthermore, in each subsequent round, participants were provided with summarized quantitative results and aggregated qualitative feedback from the previous round. This iterative feedback mechanism enabled participants to reconsider their ratings within a broader context, thereby fostering reflective judgment and facilitating the development of well-informed consensus. The resulting competency framework not only offers a clear and updated blueprint for MLS curriculum development but also supports competency-based assessments and promotes continuing professional development aligned with the specific demands of Taiwan\u0026rsquo;s healthcare system.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a three-phase sequential mixed-methods approach to develop a comprehensive competency framework for MLS in Taiwan. This approach involved (1) a systematic literature review to identify an initial pool of relevant competency domains and items, (2) a focus group discussion to refine these preliminary competencies and explore local contextual expectations, and (3) a modified Delphi study to achieve expert consensus on the finalized competency framework. The research was conducted between August 1, 2022, and July 31, 2023, and was approved by the Chang Gung Medical Foundation Institutional Review Board (IRB No. 202200030B0A3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 1: Literature Review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive literature search was performed using PubMed, Google Scholar, Web of Science, Airiti Library, and dissertation databases, employing keywords such as \u0026quot;competence,\u0026quot; \u0026quot;competency,\u0026quot; \u0026quot;task,\u0026quot; \u0026quot;job,\u0026quot; \u0026quot;knowledge,\u0026quot; \u0026quot;skill,\u0026quot; \u0026quot;attitude,\u0026quot; \u0026quot;medical laboratory scientist,\u0026quot; \u0026quot;medical technologist,\u0026quot; and \u0026quot;clinical laboratory scientist.\u0026quot; This also included a systematic review of relevant competency frameworks and clinical guidelines from international and national professional organizations, covering publications up to December 2022.\u003c/p\u003e\n\u003cp\u003eAfter a rigorous screening process, 18 relevant studies were included for analysis [9-16, 20-28]. During data analysis, two researchers independently extracted and reviewed the competency domains presented in the included literature. Any discrepancies in interpretation were resolved through consensus meetings among the research team to ensure analytical consistency. Through this iterative process, eight major competency domains were synthesized: laboratory technical skills, professional knowledge, safety and risk management, interdisciplinary communication and collaboration, continuous professional development and quality improvement, professional ethics, administrative management, and teaching supervision. These domains reflected broad categories of essential capabilities identified from global frameworks and served as the preliminary structure for subsequent refinement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 2: Focus Group Discussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo validate and refine the preliminary competency framework for local applicability, a focus group discussion was conducted with nine MLS experts. These experts, strategically recruited from the Taiwan Society of Laboratory Medicine (TSLM) and the Taiwan Association of Medical Technologists, possessed recognized expertise in MLS education, professional training, and workforce development, ensuring diverse perspectives from academia, clinical practice, and professional organizations.\u003c/p\u003e\n\u003cp\u003eOver two iterative rounds, the discussion, informed by the Phase 1 preliminary framework, aimed to identify and define core and sub-competencies specific to MLS in Taiwan. Objectives included understanding unique roles, challenges, and demands on MLS within the Taiwanese healthcare context and adapting extracted items and associated sub-competencies for relevance, clarity, and alignment with local demands and international standards. Through this iterative process, the core and sub-competencies for Taiwanese MLS were tentatively defined, forming the basis for the subsequent Delphi study.\u003c/p\u003e\n\u003cp\u003eThe initial five core competencies included in the Delphi questionnaire\u0026mdash;Technical Skill (TS), Knowledge Base (KB), Team Resource Management (TRM), Continuous Professional Learning, Development and Quality Improvement (CPQ), and Professionalism and Accountability (PA)\u0026mdash;were synthesized from the eight domains identified during the literature review. Meanwhile, the 14 initial sub-competencies were developed through thematic synthesis of both literature findings and expert input during the focus group, ensuring alignment with international competency standards and the specific needs of MLS practice in Taiwan. This refinement ensured that the resulting framework remained both comprehensive and contextually appropriate. Table 1 summarizes the mapping between the original competency domains from Literature Review and initial competency structures used in Delphi questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 3: Delphi Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo validate and refine the proposed competency framework, a three-round Delphi survey was conducted using a structured questionnaire. This instrument, which was specifically developed for this study and had not been previously published, incorporated five core competencies and fourteen sub-competencies that had been iteratively developed through prior phases. The questionnaire featured both closed-ended items\u0026mdash;rated on a 5-point Likert scale (1 = very inappropriate to 5 = very appropriate)\u0026mdash;and open-ended prompts for qualitative feedback. The English versions of the Round 1\u0026ndash;3 questionnaires are provided as Supplementary Files (Additional file 1-3).\u003c/p\u003e\n\u003cp\u003eA total of 39 MLS experts from diverse clinical institutions across Taiwan participated. These participants were recruited through formal invitations sent to teaching hospitals nationwide, targeting laboratory directors or education leaders. This panel size exceeds the typical Delphi recommendation of 15\u0026ndash;30 experts [29], enhancing the diversity, representativeness, and reliability of the consensus outcomes [30].\u003c/p\u003e\n\u003cp\u003eTo facilitate engagement, the survey was distributed in both paper and digital formats. Anonymized summaries of quantitative ratings and qualitative comments were provided between rounds to support reflective reassessment. This iterative feedback process allowed participants to refine their evaluations and converge toward consensus across all core and sub-competencies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsensus Criteria and Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompetencies were evaluated and retained, modified, or removed based on predefined statistical thresholds. Specifically, items with a mean score (M) \u0026lt; 3.5 were considered for elimination in subsequent rounds. High variability (standard deviation (SD) \u0026gt; 0.5) among expert opinions prompted further discussion and clarification by the research team for subsequent rounds. Consensus for each competency item was defined when the Coefficient of Variation (CV) was \u0026le; 25% (i.e., (100% - coefficient of variation) \u0026ge; 75%) [30]. The Delphi process was terminated once 95% of the competency indicators met these convergence criteria for consensus across all domains [31].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eExpert Panel Demographics and Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 39 MLS experts participated in the Delphi study (Table 2), maintaining a 100% response rate across all rounds. The panel was nearly gender-balanced (51% female, 49% male), with 72% holding managerial positions and 80% having over 15 years of professional experience. Educational backgrounds included 26% with doctoral degrees, 59% with master\u0026rsquo;s, and 15% with bachelor\u0026rsquo;s degrees. Affiliations were split between medical centers (49%) and regional hospitals (49%), with only 2% from district hospitals, and were geographically represented in the north (38%), central (26%), south (31%), and east (5%) regions of Taiwan.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRefinement and Consensus on Core Competencies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Delphi process refined five preliminary core competencies for MLS. In Round 1, TRM was replaced by Communication (COM). CPQ was refined to Continuous Professional Development (CPD). Finally, PA was simplified to Professionalism (PRO). All five revised core competencies achieved high expert consensus by Round 3 (Table 3). On a 5-point Likert scale, mean scores ranged from 4.87 to 4.95, with consensus rates exceeding 92% across all items. TS demonstrated the highest consensus (Mean = 4.95 \u0026plusmn; 0.22; 95% consensus), closely followed by KB (Mean = 4.92 \u0026plusmn; 0.27; 95% consensus) and COM (Mean = 4.90 \u0026plusmn; 0.31; 94% consensus).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRefinement and Consensus on Sub-competencies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 14 sub-competencies were evaluated through a three-round Delphi process. Following Round 1, six sub-competencies were revised based on expert feedback to improve clarity and contextual relevance. These revisions, along with structured feedback provided in subsequent rounds, contributed to increasing consensus among participants. By Round 3, 12 sub-competencies achieved consensus levels \u0026ge;95%, indicating strong agreement across the expert panel (Table 4). The highest-rated items included Validating and reporting laboratory results accurately and timely (Mean = 4.93 \u0026plusmn; 0.10; 98% consensus), Establishing, managing, and maintaining documentation, equipment, laboratory resources, and inventory (Mean = 4.89 \u0026plusmn; 0.17; 97% consensus), and communicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality (Mean = 4.89 \u0026plusmn; 0.17; 97% consensus).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinition of Core Competency Domains and Sub-competencies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on expert consensus obtained through three rounds of the Delphi process, a comprehensive competency framework for MLS was established (Table 5). The TS domain encompasses specimen handling, analytical performance, quality control, and accurate reporting. The KB domain integrates understanding of laboratory medicine, use of health information systems, and laboratory safety management. The COM domain emphasizes effective interdisciplinary collaboration as well as the ability to manage and utilize human resources in laboratory settings. CPD reflects the importance of lifelong learning, research competence, and clinical reasoning. Finally, PRO encompasses ethical behavior, legal compliance, and professional conduct. Each of these five core competency domains includes clearly defined sub-competencies to ensure comprehensive coverage of the expected professional roles of MLS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Mapping of original competency domains to initial core competency structure\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOriginal Competency Domains\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(from Literature Review)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial Core Competencies\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(used in Delphi Questionnaire)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eLaboratory technical skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eTechnical Skill (TS)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eProfessional knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eKnowledge Base (KB)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eSafety and risk management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMerged into Knowledge Base (KB)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eInterdisciplinary communication and collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eTeam Resource Management (TRM)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eContinuous professional development and quality improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eContinuous Professional Learning, Development and Quality Improvement (CPQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eProfessional ethics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eProfessionalism and Accountability (PA)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eAdministrative management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eExcluded (role-specific task)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eteaching supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eExcluded (role-specific task)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Characteristics of experts participating in the Delphi study (N=39)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePosition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (Number)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eManagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e72% (n= 28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eNon-management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e28% (n= 11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e51% (n= 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e49% (n= 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eYears of work experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e5-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e21% (n= 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e16-25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e49% (n= 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003e\u0026gt;25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e31% (n= 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eDoctoral degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e26% (n= 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e59% (n= 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e15% (n= 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eHospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eMedical center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e49% (n= 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eRegional hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e49% (n= 19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003edistrict hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e2% (n= 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eHospital locations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eNorthern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e38% (n= 15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e26% (n= 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eSouthern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e31% (n= 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 302px;\"\u003e\n \u003cp\u003eEastern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e5% (n= 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Refinement and Delphi consensus ratings of core competencies for MLS across three rounds.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"869\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 355px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCore Competencies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eBefore the Delphi Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eAfter the Delphi Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eConsensus Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eConsensus Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eConsensus Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eTechnical Skill (TS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eTechnical Skill (TS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.82\u0026plusmn;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.92\u0026plusmn;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.95\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eKnowledge Base (KB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eKnowledge Base (KB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.67\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.92\u0026plusmn;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e#Team Resource Management (TRM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eCommunication (COM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.59\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e87%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.77\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.90\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e#Continuous professional learning, Development and Quality improvement (CPQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eContinuous Professional Development (CPD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.69\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.79\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e#Professionalism and Accountability (PA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003eProfessionalism (PRO)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.62\u0026plusmn;0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.85\u0026plusmn;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 869px;\"\u003e\n \u003cp\u003eItems marked with \u0026quot;#\u0026quot; indicate sub-competencies that were revised after the first Delphi round based on expert feedback.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Refinement and Delphi consensus ratings of sub-competencies for MLS across three rounds.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"877\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 385px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-competencies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRound 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eBefore the Delphi Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eAfter the Delphi Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eConsensus Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eConsensus Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eConsensus Level\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 193px;\"\u003e\n \u003cp\u003e#Collecting, preparing, and analyzing clinical specimens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eCollecting and preparing clinical specimens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.76\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.83\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003ePerforming laboratory analyses and preserving specimens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.88\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.91\u0026plusmn;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e#Conducting quality control of laboratory tests\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eApplying quality assurance principles to conduct laboratory quality control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.88\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.89\u0026plusmn;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eValidating and reporting laboratory results accurately and timely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eValidating and reporting laboratory results accurately and timely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.78\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.92\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.93\u0026plusmn;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eApplying knowledge of laboratory medicine to support patient care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eApplying knowledge of laboratory medicine to support patient care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.77\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.74\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.83\u0026plusmn;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eUtilizing healthcare information systems or software for documentation, data retrieval, calculation, and analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eUtilizing healthcare information systems or software for documentation, data retrieval, calculation, and analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.73\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e#Maintaining documentation, equipment, laboratory resources, and inventory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eEstablishing, managing, and maintaining documentation, equipment, laboratory resources, and inventory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.69\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.86\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.89\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e97%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eMaintaining and promoting safe laboratory practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eMaintaining and promoting safe laboratory practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.67\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.79\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.85\u0026plusmn;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eCommunicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eCommunicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.69\u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.84\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.89\u0026plusmn;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e97%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e#Supervising and managing personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eManaging and utilizing human resources effectively in laboratory settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.65\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e87%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.32\u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.88\u0026plusmn;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eIdentifying professional learning needs and participating in continuing education and team training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eIdentifying professional learning needs and participating in continuing education and team training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.79\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.90\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e#Participate in research and development activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eDemonstrating logical reasoning, scientific inquiry, and research skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.59\u0026plusmn;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.79\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.87\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eApplying critical thinking to solve clinical problems, make informed decisions, and provide laboratory consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eApplying critical thinking to solve clinical problems, make informed decisions, and provide laboratory consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.54\u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.74\u0026plusmn;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.88\u0026plusmn;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eUnderstanding and adhering to accreditation standards, assessment regulations, and national laws governing medical laboratories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eUnderstanding and adhering to accreditation standards, assessment regulations, and national laws governing medical laboratories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.77\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e87%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.92\u0026plusmn;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.92\u0026plusmn;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eDemonstrating professional responsibility, ethical behavior, and integrity in medical laboratory practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eDemonstrating professional responsibility, ethical behavior, and integrity in medical laboratory practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.41\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.75\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e4.88\u0026plusmn;0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 877px;\"\u003e\n \u003cp\u003eItems marked with \u0026quot;#\u0026quot; indicate sub-competencies that were revised after the first Delphi round based on expert feedback.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Core competencies and supporting sub-competencies in the MLS competency framework\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"867\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCore Competencies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 709px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRationale and Definition of Sub-competencies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eTechnical Skill (TS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003eMLS must provide high-quality, efficient laboratory services centered on patient needs. This includes specimen preparation, analytical procedures, and result interpretation. Effective workflow and risk management are essential to ensure biosafety and minimize laboratory-related errors and hazards. Therefore, the following sub-competencies were identified.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eTS1：Collecting and preparing clinical specimens\u003c/li\u003e\n \u003cli\u003eTS2：Performing laboratory analyses and preserving specimens\u003c/li\u003e\n \u003cli\u003eTS3：Applying quality assurance principles to conduct laboratory quality control\u003c/li\u003e\n \u003cli\u003eTS4：Validating and reporting laboratory results accurately and timely\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eKnowledge Base (KB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003eMLS must possess a solid understanding of laboratory medicine and analytical techniques. They are also required to utilize medical information systems, manage documentation and resources, and ensure safety in the laboratory environment. Thus, the following sub-competencies were included.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eKB1：Applying knowledge of laboratory medicine to support patient care.\u003c/li\u003e\n \u003cli\u003eKB2：Utilizing healthcare information systems or software for documentation, data retrieval, calculation, and analysis.\u003c/li\u003e\n \u003cli\u003eKB3：Establishing, managing, and maintaining documentation, equipment, laboratory resources, and inventory.\u003c/li\u003e\n \u003cli\u003eKB4：Maintaining and promoting safe laboratory practices\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eCommunication (COM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003eMLS should demonstrate effective communication skills. They are expected to collaborate with other healthcare professionals and function as part of an interdisciplinary team. Accordingly, the following sub-competencies were proposed.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eCOM1：Communicating effectively with colleagues, patients, families, caregivers, and healthcare team members to improve service quality.\u003c/li\u003e\n \u003cli\u003eCOM2：Managing and utilizing human resources effectively in laboratory settings\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eContinuous Professional Development (CPD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003eMLS are expected to maintain competence and adapt to evolving professional roles. They must engage in lifelong learning, evidence-based research, and critical thinking to meet the demands of modern laboratory medicine. Based on these needs, the following sub-competencies were established.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eCPD1：Identifying professional learning needs and participating in continuing education and team training\u003c/li\u003e\n \u003cli\u003eCPD2：Demonstrating logical reasoning, scientific inquiry, and research skills\u003c/li\u003e\n \u003cli\u003eCPD3：Applying critical thinking to solve clinical problems, make informed decisions, and provide laboratory consultation\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eProfessionalism (PRO)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 709px;\"\u003e\n \u003cp\u003eMLS must demonstrate professional responsibility and ethical conduct. They must comply with relevant laws and regulations and ensure patient confidentiality and safety. Accordingly, the following sub-competencies were defined.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003ePRO1：Understanding and adhering to accreditation standards, assessment regulations, and national laws governing medical laboratories.\u003c/li\u003e\n \u003cli\u003ePRO2：Demonstrating professional responsibility, ethical behavior, and integrity in medical laboratory practice.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study successfully constructed a comprehensive competency framework for MLS in Taiwan. Through a multi-stage process involving literature review, focus group discussions, and the Delphi method, 5 core competencies\u0026mdash;TS, KB, COM, CPD, and PRO\u0026mdash;along with 15 essential sub-competencies, were identified. Unlike some recent studies on MLS core competencies [13,14] which often lack sub-competencies and focus solely on entry-level professionals, our framework is applicable across various clinical settings and career development stages. Furthermore, the establishment of this clear, hierarchical competency framework provides a robust blueprint for curriculum development in educational institutions, enables more precise assessment of individual competency levels, guides targeted professional development programs, and clarifies expected roles and responsibilities within clinical laboratory settings.\u003c/p\u003e\u003cp\u003eWhile certain items initially received lower levels of consensus, this may have reflected the fact that some competencies\u0026mdash;although emphasized in international frameworks\u0026mdash;are not yet fully embedded in local MLS practice. Nevertheless, since none of the items scored below the pre-established exclusion threshold (mean score\u0026thinsp;\u0026lt;\u0026thinsp;3.5), the research team retained all of them for subsequent consideration. In the following Delphi rounds, aggregated quantitative scores and anonymized qualitative feedback were provided to panelists, enabling them to re-evaluate these items within a richer contextual framework. This iterative process facilitated thoughtful convergence and minimized the risk of prematurely excluding potentially valuable competencies that may increase in relevance as the profession evolves.\u003c/p\u003e\u003cp\u003eDuring the three-round Delphi evaluation process, expert panel members proposed several improvements to enhance conceptual clarity and contextual relevance, leading to revisions in the terminology and scope of three core domains. First, Technical Resource Management (TRM) was replaced by COM. Experts emphasized that TRM denotes a training strategy rather than a fundamental competency. In contrast, Communication was deemed a more assessable foundational skill, better reflecting MLS's roles in interacting with healthcare teams and ensuring patient safety. Second, CPQ was revised to CPD for improved clarity and alignment with internationally recognized terminology, emphasizing lifelong learning and competency maintenance throughout one's career. Third, PA was simplified to PRO, acknowledging that accountability is inherently embedded within professional conduct, thereby streamlining the concept without compromising key evaluative elements.\u003c/p\u003e\u003cp\u003eIn addition to adjustments at the core domain level, six sub-competencies also underwent revision after the first Delphi round to enhance their accuracy, consistency, or alignment with professional practice. For instance, the original item \"Collecting, preparing, and analyzing clinical specimens\" was split into two distinct sub-competencies\u0026mdash;\"Collecting and preparing clinical specimens\" and \"Performing laboratory analyses and specimen preservation\"\u0026mdash;to delineate tasks during the pre-analytical and analytical phases. Other improvements included changing \"Conducting laboratory quality control\" to \"Applying quality assurance principles to conduct laboratory quality control,\" and modifying \"Supervising and managing personnel\" to \"Managing and utilizing human resources effectively in laboratory settings.\" Both revisions underscore an emphasis on principle-based practice and real-world applicability.\u003c/p\u003e\u003cp\u003eGiven that the roles and responsibilities of MLS vary across countries, competency frameworks consequently differ. In this study, the TS and KB domains largely align with international counterparts such as those from IFBLS, ASCP, and CSMLS, prioritizing laboratory techniques, quality assurance, and laboratory safety. The incorporation of sub-competencies about the integrated application of health information systems within the KB domain indicates a growing recognition among experts of the critical role that informatics competencies play in the context of artificial intelligence. This development underscores Taiwan's proactive commitment to advancing laboratory informatics and enhancing digital readiness. Furthermore, CPD emerged as an independent domain, explicitly defining critical thinking, research capabilities, and emphasizing lifelong learning.\u003c/p\u003e\u003cp\u003eThe Swedish framework acknowledges language proficiency as a crucial aspect of communication competency [14]. However, this study defines communication more broadly, emphasizing its practical application. Specifically, it highlights the ability of MLS to collaborate within interdisciplinary teams, communicate effectively with patients and colleagues, and manage human interactions in laboratory settings. These sub-competencies were developed to reflect Taiwan\u0026rsquo;s multilingual and team-oriented healthcare environment, where effective communication plays a pivotal role in ensuring service quality and patient safety. While PRO aligns internationally on ethics and compliance [16], its more explicit articulation at the sub-competency level within this framework likely reflects strengthened local regulatory oversight and ethical scrutiny in clinical laboratories. Furthermore, experts recognized the increasing importance of inventory management, especially considering supply chain disruptions caused by the COVID-19 pandemic and geopolitical conflicts affecting global supply chains; this was consequently integrated into the sub-competencies.\u003c/p\u003e\u003cp\u003eIn addition to aligning with internationally recognized frameworks, this study incorporated contextual elements unique to Taiwan\u0026rsquo;s healthcare and professional landscape. For example, the KB domain includes competencies related to the integration of medical information systems and digital transformation, which are essential within Taiwan\u0026rsquo;s highly digitized healthcare infrastructure. The widespread use of the National Health Insurance (NHI) system and the emerging application of AI-assisted diagnostics underscore the growing importance of informatics in routine laboratory practice. The COM domain reflects the multilingual and culturally diverse environment in which MLS operate in Taiwan. Effective communication across professional disciplines, with patients, and within laboratory teams is essential to maintaining service quality and patient safety in such a setting. In the PRO domain, the inclusion of sub-competencies related to compliance with national regulations and ethical conduct corresponds to Taiwan\u0026rsquo;s increasing emphasis on clinical laboratory oversight and patient-centered care. Furthermore, the establishment of CPD as an independent core domain responds directly to Taiwan\u0026rsquo;s licensing requirements, which mandate 120 hours of accredited continuing education every six years for MLS license renewal. This regulatory structure reinforces the importance of lifelong learning and competency maintenance, making CPD not only professionally desirable but also legally essential in Taiwan.\u003c/p\u003e\u003cp\u003eWhile the competency framework developed in this study aligns with international models, it introduces localized refinements reflecting Taiwan\u0026rsquo;s regulatory context, professional expectations, and evolving MLS roles, supporting both national relevance and international adaptability. Nonetheless, several limitations exist. First, although MLS operates across diverse settings, this framework primarily addresses competencies for clinical practice within hospital-based laboratory medicine or anatomic pathology departments, potentially missing competencies needed in non-clinical or specialized domains. Second, representation from district hospitals was minimal (2%), which may underrepresent perspectives from smaller institutions where MLS often take on broader responsibilities or face resource limitations. Third, although the modified Delphi method offers a systematic approach to consensus building, it remains inherently subjective and may reflect panel-specific biases, potentially leading to the omission of certain relevant competencies. Despite these limitations, the identified competencies provide a robust foundation for developing Entrustable Professional Activities and milestones, advancing competency-based education in medical laboratory science.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study employed a multi-stage methodology, culminating in a three-round Delphi process, to construct a comprehensive, hierarchically structured, and consensus-driven competency framework for MLS in Taiwan. This framework encompasses five core competencies and fifteen sub-competencies. While aligned with international competency models in its foundational structure, the framework was further localized to reflect Taiwan\u0026rsquo;s unique healthcare context, integrating capabilities such as digital adaptability, interprofessional communication, and emerging skills required by the evolving roles of MLS. By offering a clear and contextually relevant blueprint, this framework is positioned to serve as a cornerstone for curriculum development, competency assessment, and continuous professional growth, ultimately supporting the transformation of MLS education and practice and enhancing the quality of laboratory services in Taiwan.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMLS: Medical laboratory scientist\u003c/p\u003e\n\u003cp\u003eIFBLS: International Federation of Biomedical Laboratory Science\u003c/p\u003e\n\u003cp\u003eCDC: Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003eASCP: American Society for Clinical Pathology\u003c/p\u003e\n\u003cp\u003eCSMLS: Canadian Society for Medical Laboratory Science\u003c/p\u003e\n\u003cp\u003eTS: Technical Skill\u003c/p\u003e\n\u003cp\u003eKB: Knowledge Base\u003c/p\u003e\n\u003cp\u003eTRM: Technical Resource Management\u003c/p\u003e\n\u003cp\u003eCPQ: Continuous Professional Learning, Development and Quality Improvement\u003c/p\u003e\n\u003cp\u003ePA: Professionalism and Accountability\u003c/p\u003e\n\u003cp\u003eCOM: Communication\u003c/p\u003e\n\u003cp\u003eCPD: Continuous Professional Development\u003c/p\u003e\n\u003cp\u003ePRO: Professionalism\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Committee on Ethics of the Chang Gung Medical Foundation, Taiwan (IRB number: 202200030B0A3). Written informed consent was obtained from all participants after the purpose and procedures of the study were fully explained. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request. The English versions of the Delphi Round 1\u0026ndash;3 questionnaires used in this study are provided as Supplementary Files (Additional file 1-3).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants signed written informed consent forms prior to participation in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financially supported by National Science and Technology Council of Taiwan (Grant no. 111-2410-H-182A-004 -).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan\u003c/p\u003e\n\u003cp\u003eHsien-Li Huang, Huey-Ling You\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan\u003c/p\u003e\n\u003cp\u003eHsien-Li Huang, Pi-Yueh Chang\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInstitute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan\u003c/p\u003e\n\u003cp\u003eChi-Wei Lee\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Medical Laboratory, Administration Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan\u003c/p\u003e\n\u003cp\u003ePi-Yueh Chang\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan\u003c/p\u003e\n\u003cp\u003eHuey-Ling You\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGraduate Institute of Adult Education, National Kaohsiung Normal university, Kaohsiung, Taiwan\u003c/p\u003e\n\u003cp\u003ePing Yu (adjunct professor)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHsien-Li Huang conceived and designed the study, conducted the research, and drafted the initial manuscript. Ping Yu provided overall supervision and was responsible for data analysis and interpretation. Huey-Ling You and Pi-Yueh Chang contributed to the literature review and data organization. Chi-Wei Lee revised and edited the manuscript. All authors reviewed and approved the final version of the manuscript and agreed to its publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the time and expertise contributed by all participating experts during the focus group discussions and the Delphi rounds.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBecich MJ. Information management: moving from test results to clinical information. Clinical leadership \u0026amp; management review. Clin Leadership Manag Rev. 2000, 14(6):296-300.\u003c/li\u003e\n\u003cli\u003eMorris S, Otto CN, Golemboski K. Improving patient safety and healthcare quality in the 21st century\u0026mdash;competencies required of future medical laboratory science practitioners. Am Soc Clin Lab Sci. 2013, 26(4):200-204.\u003c/li\u003e\n\u003cli\u003eKummerfeldt VD. Developing the next generation of clinical laboratory scientist supervisors: A study of supervisory competencies in clinical laboratory. Capella University; 2019.\u003c/li\u003e\n\u003cli\u003eAdekoya A, Okezue MA, Menon K. Medical laboratories in healthcare delivery: A systematic review of their roles and impact. Laboratories. 2025, 2(1):8.\u003c/li\u003e\n\u003cli\u003eBadrick T, St John A. Time to redefine the requirements for a medical laboratory scientist. Aust J Med Sci. 2012, 33(3):107-110.\u003c/li\u003e\n\u003cli\u003eFrank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, , et al. Competency-based medical education: theory to practice. Med Teach. 2010, 32(8):638-645.\u003c/li\u003e\n\u003cli\u003eZaga FR. Transforming medical education in the 21st century: the role of competency-based medical education. Rev Fac Med Hum. 2024, 24(1):16.\u003c/li\u003e\n\u003cli\u003eten Cate O. Competency-based medical education and its competency frameworks. In: Competence-based Vocational and Professional Education: Bridging the Worlds of Work and Education. edn.: Springer; 2016: 903-29.\u003c/li\u003e\n\u003cli\u003eThe International Federation of Biomedical Laboratory Science (IFBLS). IFBLS guidelines regarding Core Competence and Core Curriculum [Internet]. 2012 [cited 2025 Aug 13]. Available from: http://www.ifbls.org/images/IFBLS_Documents/IFBLS_Guidelines_Core_Competence_and_Core_Curriculum_2016.pdf.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"10\"\u003e\n\u003cli\u003eNed-Sykes R, Johnson C, Ridderhof JC, Perlman E, Pollock A, DeBoy JM et al. Competency guidelines for public health laboratory professionals. Mmwr Suppl. 2015, 64(1):1-81.\u003c/li\u003e\n\u003cli\u003eMedical Sciences Council of New Zealand. Competence Standards for Medical Laboratory Science Practitioners in Aotearoa New Zealand [Internet]. 2018 [cited 2025 Aug 13]. Available from: https://www.mscouncil.org.nz/assets_mlsb/Uploads/2018-Nov-V2-MSC-Competence-Standards-MLS.pdf.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"12\"\u003e\n\u003cli\u003eMerlino J, Palladino S, Sheehan P, Badrick T, Thorburn D, Weinholt L, et al. Competency-based standards for Medical Scientists. Pathol Assoc Council. 2009.\u003c/li\u003e\n\u003cli\u003eMaekawa K, Kotera S, Ohsaki H. Competency for Japanese novice medical laboratory scientists: a Delphi method. BMC Med Educ. 2022, 22(1):875.\u003c/li\u003e\n\u003cli\u003eStollenwerk MM, Gustafsson A, Edgren G, Gudmundsson P, Lindqvist M, Eriksson T: Core competencies for a biomedical laboratory scientist\u0026ndash;a Delphi study. BMC medical education 2022, 22(1):476.\u003c/li\u003e\n\u003cli\u003eThe ASCP Board of Certification. U.S. procedures for examination \u0026amp; certification [Internet]. 2021 [cited 2025 Aug 13]. Available from:https://www.ascp.org/content/docs/default-source/boc-pdfs/exam-content-outlines/ascp-boc-us-procedures-book-web.pdf.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"16\"\u003e\n\u003cli\u003eCanadian Society for Medical Laboratory Science (CSMLS). CSMLS competency profile general medical laboratory technologist. 2015 [Internet]. 2015 [cited 2025 Aug 13]. Available from: https://go.csmls.org/cert/MLTG_CP.pdf.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"17\"\u003e\n\u003cli\u003eNah E-H, Cho S, Kim S, Cho H-I, Stingu C-S, Eschrich K, et al. International organization for standardization (ISO) 15189. Ann Lab Med. 2017, 37(5):365-70.\u003c/li\u003e\n\u003cli\u003eChou FC, Hsiao C-T, Yang C-W, Frank JR. \u0026ldquo;Glocalization\u0026rdquo; in medical education: a framework underlying implementing CBME in a local context. J Formos Med Assoc. 2022, 121(8):1523-31.\u003c/li\u003e\n\u003cli\u003eNasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. \u003cem\u003eWorld J Methodol\u003c/em\u003e. 2021;11(4):116\u0026ndash;129.\u003c/li\u003e\n\u003cli\u003eBadrick T, Willson C. Progressing the Certification of the Medical Science Workforce. Clin Biochem Rev. 2018, 39(1):29-36.\u003c/li\u003e\n\u003cli\u003eBeck S, Doig K. Are new CLS practitioners prepared to stay? Clin Lab Sci. 2007, 20(3):161-71.\u003c/li\u003e\n\u003cli\u003eBeck SJ, Doig K: CLS competencies expected at entry-level and beyond. Clin Lab Sci. 2002, 15(4):220-8.\u003c/li\u003e\n\u003cli\u003eBishop S, Honeycutt K. Medical laboratory science undergraduate management curriculum development using practitioner reported job tasks. Am Soc Clin Lab Sci. 2020.\u003c/li\u003e\n\u003cli\u003eJassam N, Lake J, Dabrowska M, Queralto J, Rizos D, Lichtinghagen R, et al. The European Federation of Clinical Chemistry and Laboratory Medicine syllabus for postgraduate education and training for Specialists in Laboratory Medicine: version 5\u0026ndash;2018. Clin Chem Lab Med. 2018, 56(11):1846-63.\u003c/li\u003e\n\u003cli\u003eParikh RP. Competency assessment for medical laboratory practitioners and existing rules and regulations. J Health Occup Educ. 2000, 14(2):6.\u003c/li\u003e\n\u003cli\u003eValdez AP. Competencies of Career-Entry Medical Technology Graduates of Lyceum of Batangas: Basis for Enhancement of the Internship Training Program. Online Submiss. 2010, 4:16-33.\u003c/li\u003e\n\u003cli\u003eWillson C, Badrick T. A comparison of some certification/registration schemes available for medical laboratory scientists. Aust J Med Sci. 2017, 38(3/4):84-8.\u003c/li\u003e\n\u003cli\u003eWillson C, Bertram K, Badrick T. Pathology laboratory scientific scope of practice and competence-based standards for a certified workforce. Aust J Med Sci. 2018, 39(1/2):32-7.\u003c/li\u003e\n\u003cli\u003eHohmann E, Cote MP, Brand JC. Research pearls: expert consensus based evidence using the Delphi method. Arthroscopy. 2018, 34(12):3278-82.\u003c/li\u003e\n\u003cli\u003eNasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021, 11(4):116-129.\u003c/li\u003e\n\u003cli\u003eTognetto A, Michelazzo MB, Ricciardi W, Federici A, Boccia S. Core competencies in genetics for healthcare professionals: results from a literature review and a Delphi method. BMC Med Educ. 2019, 19(1):19.\u003c/li\u003e\n\u003cli\u003eKalaian SA, Kasim RM. Terminating sequential Delphi survey data collection. Pract Assess Res Eval. 2012, 17(5):n5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical laboratory scientist, Competency, Delphi, Framework","lastPublishedDoi":"10.21203/rs.3.rs-7370316/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7370316/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMedical Laboratory Scientists (MLS) are essential members of the healthcare team, providing crucial information for patient diagnosis, treatment monitoring, and disease prevention. With the rapid development of laboratory medicine, the competencies required of MLS have significantly increased. While many countries have established frameworks to define MLS competencies, Taiwan currently lacks a comprehensive framework that is both aligned with international standards and specifically tailored to local healthcare needs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study was conducted from August 2022 to July 2023, employing a multi-stage mixed-methods approach to develop a competency framework for MLS in Taiwan. The process began with a systematic literature review and expert-informed focus group discussions to identify preliminary competencies. Subsequently, a three-round Delphi survey was conducted, involving 39 experts from teaching hospitals across various regions of Taiwan. Iterative modifications were made between each round to refine competency indicators, and the final consensus rate was set at 75%.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe final framework comprises five core competencies: Technical Skills, Knowledge Base, Communication, Continuous Professional Development, and Professionalism, along with a total of 15 associated sub-competencies. Notably, three competency domain-level revisions were made during the Delphi process to reflect more observable and assessable behaviors. Additionally, six sub-competencies were revised for clarity and alignment with professional practice.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study successfully constructed a comprehensive and hierarchically structured competency framework for MLS in Taiwan. The framework is both internationally aligned and deeply localized, providing a robust foundation for curriculum development and competency-based assessments. This framework is expected to significantly support the ongoing modernization of MLS education and enhance the quality of laboratory services in Taiwan.\u003c/p\u003e","manuscriptTitle":"Developing a Competency Framework for Medical Laboratory Scientists in Taiwan: A Modified Delphi Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 12:32:23","doi":"10.21203/rs.3.rs-7370316/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T12:15:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T20:45:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T19:41:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-29T03:42:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139670416304892690417592087583235214125","date":"2025-09-27T22:13:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38824060073451900803729359821420600608","date":"2025-09-25T23:27:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184314378263473026040725033937230621651","date":"2025-09-25T19:58:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-25T12:03:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T11:37:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-02T05:57:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-02T04:27:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-09-02T04:24:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff363a11-c467-43cd-8d9b-ab11785ae84c","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:09:39+00:00","versionOfRecord":{"articleIdentity":"rs-7370316","link":"https://doi.org/10.1186/s12909-026-09191-x","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-04-15 15:59:36","publishedOnDateReadable":"April 15th, 2026"},"versionCreatedAt":"2025-10-08 12:32:23","video":"","vorDoi":"10.1186/s12909-026-09191-x","vorDoiUrl":"https://doi.org/10.1186/s12909-026-09191-x","workflowStages":[]},"version":"v1","identity":"rs-7370316","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7370316","identity":"rs-7370316","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}