CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Diane D. Davey, MD
Christine Noga Booth, MD
Kelly Goodrich, CT(ASCP)
Daniel F.I. Kurtycz, MD
January 2018—Annual proficiency testing is mandated for all cytotechnologists and pathologists who sign out Pap tests. CAP staff frequently receive questions about the PT rules or hear of situations in which there was confusion about the rules, a few of which we will highlight here.
Important to note first is that communication among Pap proficiency testing participants during the testing event is prohibited.
One common question is about trainee participation in PT. Residents, fellows, and other trainees are not required to participate. They are considered free of the requirement until 12 months after their training program ends. This includes newly graduated cytotechnologists who have passed the Board of Certification exam. If new cytotechnologists haven’t passed the BOC exam, they are required to participate in proficiency testing.
CAP staff is often asked if residents, fellows, and other trainees are allowed to review Pap PT slides. The CAP does allow this, but only after all testing has been completed and after the proctor has confirmed receipt of all result forms. Also, all Pap PT slide sets must be returned to the CAP no later than the morning after testing day three or Friday afternoon, whichever comes first, so nonparticipants who wish to review the slides have to do so on this schedule. Participants are never permitted to review slides simultaneously with a trainee at a multiheaded microscope during the testing process. Any review of slides with other staff can take place only after all participants have completed the examination.
All cytotechnologists are considered primary screeners and must receive the slides undotted with no interpretations from others who may have viewed the same slides. Pathologists who test as secondary screeners are permitted to receive pre-dotted slides as well as the answer sheet from the cytotechnologist who reviewed and dotted the slides. No other oral, text, or email communication is permitted. Participants cannot use textbooks related to gynecologic cytopathology or view websites during the exam. The pathologist cannot ask the cytotechnologist questions about which slides were challenging or confusing, and the cytotechnologist cannot adjust answers based on a pathologist’s review.
Each participant is responsible for verifying the completeness of the answer sheet that will be faxed to the CAP, including the clarity of their name and CMS number. While the participant may make notes on the history sheet, only the faxed answer sheet counts for scoring. Sometimes participants insist that they failed to transfer one answer, were not advised by the proctor, and request rescoring. It is not the responsibility of the proctor to review answer sheets and inform participants of errors or omissions. In fact, it is a violation of the rules. Just as cytologists/pathologists are responsible for the ultimate signout of a patient’s case, they are responsible for the answers they submit to the proctor. The examination proctor is responsible for faxing the answer sheets after each participant’s testing event and for verifying that all answer sheets were received.
Once all score sheets have been faxed to the CAP with verification by the proctor, trainees and staff within the laboratory can discuss the slides before shipping the slide sets back, again as long as they’re returned to the CAP no later than the morning after testing day three or Friday afternoon. At this time, slides can be reviewed at a multiheaded microscope so long as no proficiency test slides are imaged. CAP proficiency test challenges are validated slides that are frequently regarded as classic examples, and participants may be tempted to image them for documentation or teaching purposes. However, images of test slides of any kind, including those taken with cell phone cameras, are not acceptable and could result in automatic failure for neglecting to follow established Pap proficiency testing procedures. Since slides are recirculated, imaging of cases is restricted because it could prevent future use of these expensive validated slide sets. Participants who fail the PT examination may rely on their notes and answer sheets if they appeal a result but should never email images of slides to the CAP.
In addition, there are no excuses for participants who are insecure and try to game the system. A score of less than 90 percent is failure. You cannot call the PT provider and indicate what you meant to do after failure, just like you cannot call a patient back after missing an HSIL and tell her what you meant to do. An initial test failure requires reexamination.
Violating the rules of the examination is cheating and is manifestly unfair to those who follow the directions. Unethical behavior would call into question the operation of not only a cytology section but also the entire clinical laboratory. Complaints lodged to the CMS will result in inspections. Laboratory professionals must be fully aware that the CMS’ mission is not educational but patient protection, and the CMS is extremely serious about its mission.
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Dr. Davey is associate dean of graduate medical education, University of Central Florida College of Medicine, Orlando, and practices at the Orlando VA Medical Center. Dr. Booth is an associate professor of pathology, Cleveland Clinic Lerner College of Medicine. Kelly Goodrich is a cytology technical specialist, College of American Pathologists, Northfield, Ill. Dr. Kurtycz is medical director, Wisconsin State Laboratory of Hygiene, and professor, University of Wisconsin School of Medicine and Public Health, Madison. Dr. Booth is chair of the CAP Cytopathology Committee, Drs. Davey and Kurtycz are members of the committee, and Kelly Goodrich is committee staff.