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Cytopathology in Focus: Closing cytopathology, cytotechnology practice gaps—three years later

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cytopathologyInFocus

Barbara A. Crothers, DO
Janie Roberson, SCT(ASCP)

August 2017—The CAP has focused during the past 10 years on facilitating the transformation of pathology practices from the instrumentation age to the information age, with a concentration on personalized medical care and laboratorians as integral members of the health care team. Hand-in-hand with that effort, the CAP Cytopathology Committee has advocated for the expanded use of cytology specimens in molecular diagnostics and the evolution of the cytotechnology workforce to meet the emerging practice gaps as pathologists become engaged in ever more complex diagnostic processes.

In support of the committee’s effort, the CAP became one of four sponsors (with the American Society of Cytopathology, American Society for Clinical Pathology, and American Society for Cytotechnology) of the Cytotechnology Programs Review Committee (CPRC). This autonomous committee inspects cytotechnology education programs for compliance with accreditation standards and establishes entry-level competencies upon which the curriculum is based.

In 2012, the CPRC, along with its sponsors, began appraising gaps in cytopathology practice, redesigning entry-level competencies for cytotechnology graduates to address current and future needs. The needs were aligned with cytopathologists’ and cytotechnologists’ goals as members of health care teams. The CPRC and its sponsor representatives developed a five-year plan to implement proposed changes in practice standards and guidelines (effective July 1, 2013) and the new cytotechnology curriculum in conjunction with information-gathering to assess emerging market patterns. In this article we provide an update on some of those efforts.

One of the challenges of facilitating transformation has been to understand the level of pathologist delegation of nontraditional tasks to cytotechnologists, particularly in non-academic laboratories, and whether there is a need to train for those skills as cytopathology practice changes. In the past 10 years, many cytotechnology programs have already evolved, with more university-based programs converting to master’s level programs. However, there are only 24 active programs, with an average occupancy rate of 65 percent, threatening the viability of the future workforce. This while the current workforce is shrinking due to retirements. The average age of cytotechnologists today is 46.6 years old, and new certifications are declining annually.

The cytopathology community places high value on and is interested in retaining the morphologic skills of cytotechnologists. For example, many cytopathologists fear that without cytotechnologists they cannot perform primary screening of all gynecologic, nongynecologic, and fine needle aspiration specimens if federal workload restrictions are maintained at 100 slides per day. Increasingly, practices rely on cytotechnologists to be on site for FNA procedures to prepare slides, gather clinical data for triage, and stain and assess for adequacy, thereby saving pathologists time on site. Telepathology has added to the appeal of this process for rapid on-site evaluation. Subsequently, the CAP Cytopathology Committee was tasked with providing online educational modules in emerging practice areas that could augment cytotechnologists’ roles, such as preparing for laboratory inspections, validating digital slides, designing a robust cytopathology quality assurance program, and assisting with biorepository collection and with rapid on-site evaluation for FNA specimen adequacy. These committee-created modules are housed on the American Society of Cytopathology’s website under the banner of the Cytology Education Learning Lab (CELL), which is free to educators who register at the site.

In 2014, two of the CPRC sponsors, the ASC and the ASCP, formed a multidisciplinary workgroup “dedicated to the engagement, contribution to and support for current and future cytoprofessionals by providing trending data that supports education and practice initiatives towards sustaining a workforce which best serves the patient needs.” The workgroup focused on three domains: trending data, education, and practice.

The trending data subgroup was tasked with delivering high-quality data to inform the education and practice domains. Toward that end, a Delphi study of selected experts and laboratory decision-makers was conducted regarding current practice and future needs. In addition, existing data from the ASCP Board of Certification practice analyses conducted in 2009 and 2015 were compared for shifts in practice.

The education domain, tasked with investing in talent through personalized, advanced education, created an annual cytology course, the Advanced Cytopathology Education (ACE) meeting, to address cutting-edge changes to cytology practices. The result is a two-day regional education meeting designed to address needs in the local area for cytotechnologists, pathologists, residents, and fellows who may not have time or funding for larger conferences. Three such meetings have occurred to date. The group is also developing a platform to provide interactive course materials to enhance the skills of practicing cytotechnologists so that they can assume delegated tasks.

Finally, the practice domain facilitated focus groups of cytology professionals at national meetings to take the pulse of current and future practice. They also engaged in a meta-analysis of published literature to review the transformation and development of other advanced practice professions. This adds to the body of information being developed for a future business model. The group will continue to engage stakeholders, including pathology chairs and administrators, in future focus groups.

The work continues on many fronts, and articles with more information about findings will be published in the coming months. Successful, sustainable change to this important profession will require engagement of professionals throughout cytopathology and across all facility types. It is reassuring to know that the evolution of the cytopathology and cytotechnology professions is progressing collaboratively, with all stakeholders invested in guiding the best outcome for patients and practitioners alike.
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Dr. Crothers is a former chair of and now an advisor to the CAP Cytopathology Committee. Janie Roberson, who will become a member of the committee in 2018, is manager of laboratory quality and anatomic pathology, UAB Medicine, Birmingham, Ala.

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