Education of the clinical embryology laboratory professional: development of a novel program delivered in a laboratory medicine department

Abstract

Clinical embryologists are responsible for the handling, evaluation, and care of human gametes and preimplantation embryos within the context of an assisted reproductive technology laboratory. They are integral members of a team of professionals who provide care for fertility patients. Despite the increasing recognition of clinical embryologists as professionals, training requirements, continuing professional development, and appropriate credentialing have lagged in several countries. In many cases, individuals enter the profession with training limited to technical aspects provided by individual laboratory directors through an apprenticeship model. In this article, we present the rationale for rigorous formal training in clinical embryology, introduce CanEMB competencies for practicing professional clinical embryologists that are founded on CanMEDs role principles, and present a nascent Masters of Health Sciences degree program in Laboratory Medicine with a specialization in clinical embryology. This 2-year program has unique features including a Clinical Embryology Skills Development Laboratory, research capstone project, and 200-hour placement within a practicing assisted reproductive technology laboratory. Importantly, this program is delivered through a university-based Department of Laboratory Medicine and Pathobiology in partnership with a Department of Obstetrics and Gynecology. Thus, this program represents a formal acceptance of clinical embryology as a clinical laboratory science. It can be adopted elsewhere to provide a relevant, robust education that will meet current and future needs of the profession.

In narratives describing the Nobel prize–winning journey toward producing the first human conceived through in vitro fertilization (IVF), Robert Edwards regularly emphasized the instrumental role played by Jean Purdy (1, 2). Trained as a registered nurse, Purdy joined the Edwards laboratory in 1968 and was charged with managing the embryo laboratory (1, 3). Although the laboratory was working with animal models before this time, Edwards had just forged his collaboration with Patrick Steptoe, and the trio embarked on an intense research program that culminated in the birth of Louise Brown just 10 years later (4). Purdy is hence widely regarded as the first clinical embryologist, and her resourcefulness and insights contributed to various successes along the way (1).

In the 45 years since Brown’s historic birth, remarkable developments in pharmacology, cell biology, and engineering have directly impacted the field of assisted reproductive technology (ART), resulting in the implementation of new and increasingly challenging laboratory procedures. The growing demands on the expertise and capabilities of clinical embryologists have led to their assuming increasing importance and responsibility within the ART team, perhaps more reflective of Purdy’s role. Continued advances in gene editing (5, 6) and induced pluripotent stem cell biology (7, 8) promise revolutionary changes to the future of infertility care, for which clinical embryologists must be poised to properly implement. Thus, clinical embryologists need rigorous knowledge of reproductive physiology, genetics, theory underlying the techniques to be mastered, and principles to guide ethical dilemmas that regularly emerge in this field. The clinical embryologist has become more of a practitioner and generally provides critical advice and insight that directly impact patient care. The consequences of errors in performance or judgment on the part of the clinical embryologist can lead to serious medical errors with long-term consequences for both the patient and the clinic treating the patient (9).

Concomitant with their ascending importance, the clinical embryologist has advanced to assume roles in communicating health information on gametes and embryos to other health care team members and patients as well. However, the full recognition of clinical embryologists as health care professionals is incomplete, and concomitant regulations regarding the education, training, certification, licensing, and continued professional development remain poorly defined or deficient in several countries, including Canada and the United States (10). The purpose of this article is to present the rationale for rigorous formal training in clinical embryology and considerations in the curriculum development of a novel Masters of Health Sciences (MHSc) degree program in Laboratory Medicine with a specialization in clinical embryology that was recently established to meet this need. This program is delivered through a unique partnership between the Department of Obstetrics and Gynecology and Department of Laboratory Medicine and Pathobiology (LMP) at the University of Toronto.

Educational needs for a career as a clinical embryologist

In several countries, including Canada, governmental regulations regarding training and continuing education of clinical embryologists are nonexistent. To address this void, the embryology special interest groups within national fertility societies, including the Canadian Fertility and Andrology Society, have developed guidelines and examinations for certification (9, 11). Although this is a welcome and important initiative, it must be noted that in most cases, these guidelines are completely voluntary and left to the discretion of individual clinics or individual clinical embryologists because these societies possess neither the legal authority nor the infrastructure required to ensure compliance. However, a critical need is access to appropriately designed training programs to develop and support the ability of individuals to meet these guidelines and prepare clinical embryologists for assimilation of future technological advances.

Historically, clinical embryologists in Canada and elsewhere have been informally trained by an IVF laboratory director or manager. The quality of this apprenticeship model of training is variable and largely unregulated. Many entering the field through this route have university baccalaureate degrees but in fields unrelated to embryology. As a result, basic knowledge of physiology, genetics, and molecular and cell biology is inconsistent or incomplete and not adequately provided in an apprenticeship model of training. The knowledge thus obtained does not enable a deep understanding sufficient for today’s dynamic environment of constant innovation, risk management needs, and ever-advancing sophisticated technologies in the IVF laboratory. Consequently, a variety of part-time and distance-learning graduate programs were developed to provide a documented review of history, general knowledge, and applied principles relevant to clinical embryology. Although these programs have filled a significant gap in learning for established clinical embryologists, they are not appropriate for preparing basic science graduates for entry into the discipline. Moreover, a hallmark of a profession, particularly those related to health care, is the completion of a specifically targeted formal degree or training program required for entry into the profession.

With growing recognition of the role of the clinical embryologist in the treatment of infertility, representative clinical embryologists from 20 countries met in Antalya, Turkey, in 2014 with the goal of arriving at a consensus framework to guide fundamental issues in defining the clinical embryologist as a health care professional (Alpha consensus meeting) (11). Chief among these issues was the recommended education and training required to function as a practicing clinical embryologist. The emphasis on practical but informal technical training was acknowledged as a limitation in several training programs, with the members noting “a true understanding of technology requires an understanding of the underlying biologic system, and knowledge of both is critical for effective troubleshooting” (in the article by Alpha Scientists in Reproductive Medicine (11), page 457). The daily tasks completed by clinical embryologists can be generalized to the following: manipulation of gametes and embryos on stereomicroscopes (including oocyte retrieval, embryo transfer, and gamete/embryo freezing and thawing); assessment of gametes and embryos (suitability for use and cryopreservation); and micromanipulation of gametes (intracytoplasmic sperm injection and embryo biopsy). They also participate in quality and risk management procedures and maintain laboratory workflow and sample tracking (i.e., chain of custody). Clinical embryologists are frequently tasked with communicating progress and results with patients and other health care staff and partake in decision-making regarding ongoing care, although these tasks may fall to more senior embryologists or those acting in a leadership capacity.

Advanced clinical embryologists also contribute to ensuring that the laboratory meets legislated clinical laboratory requirements, maintaining equipment, introducing new technologies and products into the laboratory, training of new staff, implementing new procedures, and leading or participating in quality control/improvement or research activities.

Professional competencies for clinical embryologists, CanEMB

On the basis of these collective activities, the consensus document at the 2014 Alpha meeting (11), and the Canadian Fertility and Andrology Society professional competencies (12), we identified 7 roles encompassed by a professional clinical embryologist. Referred to as CanEMBs, these competencies were adopted from the CanMEDs Physician Competency Framework with permission of the Royal College of Physicians and Surgeons of Canada (Copyright © 2015) (13). These competencies include Clinical Embryology Laboratory Expert, Professional, Communicator, Collaborator, Scholar, Advocate, and Leader, which interlace and are strengthened by one another (Fig. 1). The curriculum for a professional clinical embryologist training program should support the development of these competencies and provide the necessary tools for the student to continue to advance in these areas once in the workforce. As with medicine, these competencies can also be useful in developing curriculum for continuing professional development workshops and sessions.

Figure 1.

CanEMB framework for enhancing clinical embryologist training, comprising 7 competencies identified for clinical embryologists that encompass their role as laboratory medicine professionals. This competency model was based on the CanMEDs framework and can be used to inform curriculum development and continuing educational programs for members in the field. These competencies are not independent of each other but instead overlap and are strengthened by one another. Image adapted from the CanMEDs Physician Competency Diagram with permission of the Royal College of Physicians and Surgeons of Canada.

Clinical Laboratory Expert refers to both theoretical and practical knowledge needed for the application of skills for performing laboratory procedures. This includes the ability to determine the most appropriate laboratory procedures and perform them in a skillful and safe manner, the demonstration of a detail-oriented approach in all aspects of laboratory practice, a commitment to quality, and the ability to perform professional duties in the face of multiple competing demands. Recognition of when to seek help is important.

Professional refers to demonstrating honesty and integrity. Moreover, there should be a commitment to excellence and creation of a supportive inclusive environment, recognition and management of ethical issues, knowledge of and adherence to regulatory requirements, and exhibition of professional attributes of transparency and respect.

Communicator refers to the sharing of complex information and explanations that are clear, accurate, and timely. This includes the capacity to effectively communicate complex information to patients and their partners and ensuring that all written reports and records are accurate and submitted on time.

Collaborator refers to the capacity to function as a member of a professional team working to provide the best health care for the patient. This includes maintaining positive relationships and communicating clearly with physicians, nurses, social workers, and other health care professionals and negotiating overlapping and shared responsibilities. The clinical embryologist should be able to implement strategies to promote understanding, respect differences, and resolve conflicts in a manner that preserves collegiality.

Scholar refers to the commitment for lifelong self-learning to remain abreast of best evidence-based practices. This includes developing critical thinking skills needed to implement new knowledge appropriately and participate in research activities or quality improvement activities involving laboratory activities or delivery of care. The clinical embryologist should understand the scientific principles of research and scholarly inquiry and its role in providing evidence for health care.

Advocate refers to the ability to promote health equity and inclusivity for all, in particular for those who are most vulnerable. This also includes supporting environmentally responsible practices. The clinical embryologist should be aware of salient ethical issues and dilemmas commonly encountered within the field and how such issues are best resolved.

Leader refers to the ability to engage with others to deliver a vision of a high-quality health care system and assume responsibility for excellence in the laboratory services provided. This includes the ability to apply the science of quality improvement to laboratory services, assessing patient (including gamete and embryo) safety incidents to improve ongoing and future care, and serving as a positive role model for other clinical embryologists and laboratory assistants with a willingness to share special knowledge.

Identifying the ideal academic home for a clinical embryology program

While the Alpha conference was clear on the attributes of a clinical embryologist, they did not provide a mechanism for teaching them. Most scientific and clinical knowledge important for clinical embryologists is embodied in the field of reproductive sciences. In many academic institutions, this expertise resides in or is affiliated with the Department of Obstetrics and Gynecology. Reproductive sciences encompass reproductive endocrinology and physiology, embryo and fetal development, pregnancy and parturition, developmental origins of health and disease, reproductive tract cancers, and genetics. Many graduate degree programs in reproductive sciences are offered globally, with several offering programs relevant to clinical embryologists (14); however, few are geared to the clinical practice of embryology. The laboratories associated with the Departments of Obstetrics and Gynecology and Reproductive Sciences are research laboratories that are not subject to the rigor and regulations essential for the operation of a clinical laboratory. Importantly, in Canada and elsewhere, many ART clinics and laboratories have migrated from university-affiliated hospitals to the private sector. Thus, those with knowledge in clinical embryology do not have the pedagogic skill set, and those in traditional educational institutions do not have the content expertise.

Expertise surrounding the intricacies and reporting requirements of clinical laboratories do reside within the clinical diagnostic departments of laboratory medicine. Thus, combining the expertise within the Department of Obstetrics and Gynecology with that of Clinical Laboratory Medicine would provide ideal support necessary for a comprehensive training program for clinical embryologists. However, to our knowledge, Departments of Clinical Laboratory Medicine have not yet formally recognized clinical embryology as a practice of laboratory medicine, and until now, no educational programs in clinical embryology have been offered through these departments.

Departmental partnership in developing a comprehensive clinical embryology training program

Members of the Division of Reproductive Endocrinology and Infertility within the Department of Obstetrics and Gynecology at the University of Toronto identified an acute and unmet need to have a formal graduate training program in a Canadian university setting to ensure that IVF clinics have clinical embryologists with a solid academic foundation to better meet the current and future demands of this emerging profession. ART laboratory members report to clinic leadership; however, few clinical members of the Deparment of Obstetrics and Gynecology have sufficient understanding of clinical diagnostic laboratory medicine to develop a robust educational program in clinical embryology. In a unique development, members of the Department of Obstetrics and Gynecology at the University of Toronto partnered with the LMP Department to integrate clinical embryology as a field of study within a 2-year full-time professional Master’s graduate program (MHSc degree) in laboratory medicine.

The MHSc Laboratory Medicine program offers education toward 1 of 2 clinical laboratory professions: pathologists’ assistant or clinical embryologist. Pathologists’ assistants work closely with anatomic pathologists and function as extenders of these physicians. These laboratory professionals conduct specimen dissection and prepare tissues for diagnostic procedures within a surgical, autopsy, or forensic pathology laboratory. Although perhaps appearing as an unusual combination at first glance, there is a strong clinical, scientific, and academic basis for combining certain aspects in the training of these 2 laboratory professionals. Both require knowledge of the fundamentals of laboratory management, quality assurance, ethics, molecular biology, critical thinking, and continuous learning. Consequently, there are shared elements within the curriculum. The next sections outline the curriculum, highlight the unique features of this program as it relates to the clinical embryology field, and identify the advantages afforded by this unique departmental partnership.

Curriculum development for the clinical embryology field of the mhsc in laboratory medicine

In developing the curriculum for this program, the planning committee considered learning objectives and outcomes in 5 categories, as recommended by the Ontario Council of Academic Vice-Presidents, the provincial body providing guidance on educational excellence and academic quality. These categories include the following: depth and breadth of knowledge; research and scholarship; application of knowledge; professional capacity; and communication skills. These categories also address key aspects of the 7 CanEMB competencies identified for clinical embryologists (Fig. 1).

The curriculum is delivered over 6 academic terms and takes 2 full calendar years to complete. The program requires students to complete 9.5 full-course equivalents (FCEs). One FCE equates to a 2-semester course. Several core courses are shared between the pathologists’ assistant and clinical embryologist fields, whereas others are specific to either pathologists’ assistants or clinical embryologists (Table 1). Members of the Divisions of Reproductive Endocrinology and Infertility, Maternal Fetal Medicine, and Reproductive Sciences within the Department of Obstetrics and Gynecology and academic pathologists and basic scientists contribute to the teaching in this program, which is run through the graduate unit of the LMP Department. The name, MHSc in Laboratory Medicine, reflects the nature of the unique program, which incorporates the 2 fields under a laboratory medicine framework. The overall academic goal of the program is to provide education that imparts general core knowledge in laboratory medicine and specific theoretical and applied principles and skills of either anatomic pathology (for pathologist’s assistants) or ART (for clinical embryologists) that will enable them to function as high-quality professional laboratory scientists.

Table 1.

Courses leading to the Masters of Health Sciences in Laboratory Medicine, clinical embryology field

Course category	Course title	Terma	CanEMB competencies addressed
Core courses	Cell and Molecular Biology	1	Scholar, Communicator
	Biomedical Research Methods	1	Scholar, Communicator
	Biostatistics	1	Scholar
	Biomedical Ethics	2	Scholar, Leader, Advocate, Professional, Collaborator
	Capstone Project	4–6	Scholar, Collaborator, Communicator, Leader
	Clinical Laboratory Management	6	Leader, Collaborator, Laboratory Expert
CE field-specific courses	Advanced Reproductive Physiology	1	Scholar, Communicator
	Human Embryology and Teratology	2	Scholar, Communicator, Laboratory Expert
	Reproductive Genetics	2	Scholar, Communicator, Laboratory Expert
	Foundations in ART	2	Laboratory Expert, Professional
	Applied Methods in ART	3	Laboratory Expert, Professional
	Current Topics in Causes and Treatments of Infertility	4	Scholar, Collaborator, Communicator, Advocate
	Innovation in ART	4	Scholar, Laboratory Expert, Advocate, Leader
	Laboratory Skills Development I	4	Laboratory Expert, Leader
	Laboratory Skills Development II	5	Laboratory Expert, Leader
	Applied ART Laboratory Decision Making	5	Leader, Collaborator, Laboratory Expert, Professional
	ART Laboratory Placement	6	Laboratory Expert, Collaborator, Leader, Communicator, Professional

ART = assisted reproductive technology; CE = clinical embryology.

^aThe terms consist of 12-week in-class delivery periods with 3 terms per year: fall; winter; and summer.

Curriculum content for clinical embryologists

The curriculum begins with foundational courses providing depth and breadth of knowledge. This initial content is built on and eventually applied in later courses, creating direct connections between theory and practice through applied learning. An emphasis is placed on student presentations, reviews and reports, simulation laboratory training, and a research capstone project. The emphasis on student presentations and critical analysis provides skills for lifelong learning and contributes to the development of critical thinking.

The courses comprising the program are listed in Table 1, along with the academic term, or sequence, in which they are offered in the program as well as the CanEMB core competencies they address. Core courses are taken by students in both the pathologists’ assistant and clinical embryology fields and represent convergence between the 2 professions. For example, Cell and Molecular Biology provides students with a solid, comprehensive understanding of cell biology and key signaling transduction pathways. This course provides fundamental knowledge that is needed to prepare students for later field-specific courses, including Reproductive Genetics.

Students gain theoretical and practical knowledge about the research process in Biomedical Research Methods, Biostatistics, and the Capstone Project. The Biomedical Research Methods course orients students to various research study designs and how they contribute to evidence-based medicine and laboratory best practices. The ability to recognize and minimize research bias and appropriately critique research studies to expose their strengths and limitations is emphasized. Students also gain practical experience in conducting a thorough literature review and construction of a research question. Basic core statistical principles are covered in the Biostatistics course. The material covered highlights the appropriate application of various parametric and nonparametric statistical tests, their interpretation, and their limitations. An understanding of basic statistical principles is essential for adequate evaluation of scientific literature. Students ultimately apply their knowledge of research processes and biostatistics in a capstone research project.

The Capstone Project course is designed to create a research experience in which much of the knowledge in the earlier courses is applied to investigate a biomedical research question important to the field. Students are encouraged to identify a research question through exposures in their courses, seminars, or discussion with various research mentors. Each student is tasked with developing a brief research proposal that presents the research question with the relevant background information, research study design and objectives, outcomes to be measured, and potential impact of the study. On completion, the student prepares a manuscript in accordance with journal guidelines and formally presents their findings to the faculty. Although not a requirement of the program, several of these projects have already been presented at national conferences. As such, the capstone project significantly adds to the academic nature of the program, facilitates networking opportunities, and enhances the ability of our graduates to compete for positions, particularly at clinics involved with research.

The 2 remaining core courses taken along with students enrolled in the pathologists’ assistant field are Biomedical Ethics and Clinical Laboratory Management. The material covered in these courses is germane to both fields. Ethical issues abound in the field of ART as applied to both research and daily clinical care. Knowing how best to approach these issues is a valuable skill for the practicing clinical embryologist and enhances their participation in discussions and the decision-making process. Knowledge of legislated obligations and policies further facilitates these discussions. Legislated responsibilities are also covered in the Clinical Laboratory Management course, which additionally addresses record keeping, quality measures and best laboratory practices, and requirements for clinical laboratory licensure/accreditation.

Foundational courses specific to clinical embryologists include Advanced Reproductive Physiology, Human Embryology and Teratology, and Reproductive Genetics. These courses provide the vast majority of knowledge depth and breadth for the field and integrate didactic lectures with student presentations on advanced topics. The concepts and principles presented in these courses, as well as the core courses, are complimented by field-specific courses focused on ART. Theory underlying the development and application of current andrology and IVF laboratory procedures are covered in Foundations in ART and Applied Methods in ART. In contrast, Innovation in ART introduces a forward-looking perspective, discussing emerging developments and recognized unmet needs that will advance the field in future. Current Topics in Causes and Treatment of Infertility provides an in-depth exploration into the causes of male and female subfertility and infertility and discusses the various approaches that can be considered in their treatment. Information from this group of ART-focused courses is further discussed and considered in the broad context of ART team decision-making in Applied ART Laboratory Decision Making.

Clinical embryology skills development laboratory

The essential core role of the clinical embryologist requires achieving a high level of technical skill. Directed and supervised hands-on experiences with these technical applications are essential to the effective training of clinical embryologists and have formed the framework for the apprenticeship training model widely used. Although trainees can obtain this experience working in ART laboratories, it is provided only when laboratory staff have time and poses risk for patient gametes and embryos to be compromised during early training. Moreover, any damage done to equipment in a practicing laboratory during training could seriously disrupt the ability of the laboratory to maintain ongoing clinical care.

The Clinical Embryology Skills Development Laboratory (CESDL) is a fully equipped, state-of-the-art, simulation laboratory devised to replicate a realistic IVF laboratory environment while providing a safe, low-stakes environment for students to gain initial hands-on experience with basic and intermediate level skills. Students complete a 2-semester (1 FCE) course in the CESDL using gametes and embryos from model organisms and human sperm. The course is divided into modules covering general and specific skills required by the clinical embryologist (setup for the laboratory component of ART cycles, media and dish preparation, semen analysis and processing, oocyte retrieval and embryo transfer, gamete and embryo cryopreservation and thawing/warming, and micromanipulation procedures including intracytoplasmic sperm injection and embryo biopsy). Thus, the CESDL provides a biologic safety containment level 2-compliant environment where students can acquire and hone skills without fear of impacting patient care or interrupting the general operation of a working ART laboratory. Obviously, this course cannot provide the student with sufficient experience to enable them to work immediately as independent, fully technically competent clinical embryologists. All newly minted clinical embryologists will require further experience with documented successes to fully acquire independence and qualify for certification. However, the CESDL experiences provide the foundation to enable the student to move quickly through “in-house” training programs integral to established ART laboratories. The CESDL also offers the opportunity for continued professional development of working clinical embryologists through the ability to deliver workshops and certification courses designed for specific training or practice needs.

Placement course

Students complete a placement course in their final term to build on experiences gained in the CESDL and provide the opportunity to be fully immersed in the workflow and teamwork of a practicing ART laboratory. In this course, the students spend a minimum of 200 hours over a 7-week period in comprehensive practicing ART laboratories where they gain invaluable experience with the organization, daily workflow, and demands of an active IVF laboratory. Although the majority of their time is spent in the IVF laboratory, they also spend time in the andrology laboratory, which compliments the IVF laboratory in sperm assessment and preparation. During these placements, students are assigned to a preceptor who schedules and ensures that they observe prescribed procedures and gain experience with fundamental tasks that do not infringe on the legal liabilities of the clinic. Preceptors can be the laboratory director, laboratory manager, or supervisor who is normally charged with training new staff and may have an appointment at the university. The preceptors are encouraged to allow students to perform basic laboratory procedures using discarded human gametes and embryos, which they are generally agreeable to given the students experience in the CESDL. Moreover, students assimilate into the laboratory team where they apply their skills in communication and professionalism. These placements have taken place in both university-affiliated and community-based IVF clinics, with only 1 student placed in a given center at a time. Within the placement clinic, preceptors meet regularly with students to discuss their progress, ensure that target criteria are met, and provide constructive feedback as to how improvement may be achieved. Students and preceptors complete daily logs to monitor and track progression. In addition, students and preceptors meet weekly with the directors of the placement course on a virtual platform to discuss progress and opportunities. To improve the student experience, the placement course directors meet regularly with laboratory directors and preceptors to ensure timely progression in the coverage of the prescribed procedures. Furthermore, through these various interactions, both within their assigned clinic and in meetings with preceptors from multiple clinics, students are able to begin to build their professional network.

Experience to date

Although a newly launched program, we have recently graduated our first cohort of students who each rapidly secured employment as practicing clinical embryologists in ART clinics. The program attracts a significant number of applicants that has increased during our first 3 years of offering (the applications for 5 positions received in 2020, 2021, and 2022 were 19, 46, and 70, respectively). In selecting successful candidates, a high level of demonstrated academic excellence is necessary, commensurate with the admissions requirements of the School of Graduate Studies (average of B+ or better during the last 2 years of their 4-year baccalaureate degree from an accredited institution). In addition to intelligence, evidence of personal traits predictive of success in the program and as practitioners is sought, such as perseverance, meticulousness, strong work ethic, dedication, accountability, integrity, and passion for learning (15).

Summary and future prospective

Well-structured and directed academic programs addressing the learning needs for individuals wishing to become clinical embryologists are required for them to be fully accepted as professionals. The academic program described possesses 3 unique features pertaining to the clinical embryology field. First is the formal incorporation of clinical embryology into the overall umbrella of an LMP Department, with several theoretical and practical aspects of the education delivered through the lens of the members of the Department of Obstetrics and Gynecology. This recognition of clinical embryology by the laboratory medicine community provides the field with an appropriate home base but one that includes and requires continued partnership with obstetrics and gynecology. Second is the creation of a CESDL—a state-of-the-art simulation laboratory that is fully equipped to provide a realistic IVF laboratory setting that provides a safe environment for students to acquire initial exposure and hands-on experience with specialized equipment and laboratory procedures. Third is the incorporation of an ART laboratory placement course into the educational program that builds on the experiences learned in the CESDL courses while exposing students to the busy workflow of a functioning ART laboratory.

An important step for this and similar degree programs will be formal academic accreditation of the program as an appropriate curriculum and delivery for clinical embryologists. Accreditation ensures a level of consistency and delivery of a rigorous educational program that fully meets or exceeds the needs of the profession. Consistent with the fledgling nature of clinical embryology training programs and the recognition of clinical embryologists as true professionals, an overarching accrediting agency is not available in Canada. The National Accrediting Agency for Clinical Laboratory Sciences based in the United States provides oversight for training programs in multiple clinical laboratory professions, including pathologist’s assistant programs. This organization has signaled that it plans to extend their laboratory science overview to include clinical embryology in the future.