Barbara A. Crothers, DO
Sometimes you need to climb up to a peak and view the obstacles on the terrain before you can choose the direction you need to go.
A group of prominent cytopathologists, cytotechnologists, educators, and other stakeholders gathered on Nov. 12, 2009 in Denver at the start of the 57th Annual Scientific Meeting of the American Society of Cytopathology to develop a consensus direction for future education in cytopathology. The Future of Cytopathology Summit was the culmination of nearly eight years of committee work and discussion centering on the skills necessary to support cytopathology services for patients in a changing medical environment, where Pap tests have been in decline thanks to HPV testing and changing algorithms for clinical followup of abnormal results.
Throughout the year leading up to the summit, several groups worked to gather information, ideas, and statistical data. An Educators’ Forum, composed of leaders in cytotechnology education, convened in March to examine potential future roles for cytotechnologists and compile data on the state of cytotechnologist employment. The ASC Resource and Recruitment Committee Work Group fleshed out areas of potential growth and career opportunities. Other organizations and ASC committees provided information, which formed the basis of discussion.
The ASC Multidisciplinary Steering Group organized the event with the assistance of Jean Frankel of Tecker Associates, a facilitator engaged to lead the organization through the process of change. With input from the ASC executive board, the steering group developed a discussion paper centered on the question, What skills will be needed to support the practice of cytopathology in the future, and what kinds of professionals will be best suited to address these needs? Four potential strategic choices arose from the discussions, and the steering group organized task forces to elucidate the advantages and disadvantages of each based on historical and current data. One goal was to provide as much evidence-based information as possible pertaining to each strategy. The steering group proposed four major strategies representing a spectrum of professional complexity. They are as follows:
- Do nothing. This strategy assumes the profession will adapt naturally to current and future needs without implementing changes in training or developing a new profession or professional.
- Optimize the current scope of practice for cytotechnologists. This strategy represents a “career wheel” that optimizes the current practice of cytotechnologists without requiring additional formal education. Examples include on-the-job training of cytotechnologists in histology, molecular testing, and management.
- Expand the cytotechnologist’s skills, with an emphasis on morphology, using novel educational tools. This “career ladder” strategy would require additional training for cytotechnologists, such as a master’s degree, additional certification, or a combination of curricula with clinical laboratory sciences programs.
- Establish a model for the core skills required of a cytopathology assistant. This strategy predicts that growing demands on pathology and practicing pathologists will call for a new model of cytology professional. This would require the development of a new professional with additional training beyond that of the third strategy.
The steering group invited 119 cytopathology experts or individuals representing major stakeholders to attend. Thirty-nine of these participants were selected from a list of applicants representing divergent practices, locations, expertise, and experience in cytopathology. The final summit group of 74 participants (43 pathologists, 31 cytotechnologists) were engaged in discussion before the meeting through the formation of an Internet Google group, and insight from these discussions was added to the white paper.
The ASC invited the presidents of four stakeholder organizations to present their views of the future of laboratory medicine from the perspective of their organizations. The summit opened with short presentations from Jan A. Nowak, PhD, MD, president of the Association for Molecular Pathology; Donald D. Simpson, PhD, MPH, CT(ASCP)CM, president of the American Society for Cytotechnology; Jared N. Schwartz, MD, immediate past president of the CAP; and Mark H. Stoler, MD, president of the American Society for Clinical Pathology. Nick Dudding of the United Kingdom and William Crabtree, SCT(ASCP), and Amber Donnelly, SCT(ASCP), gave impromptu presentations on the Educators’ Forum and the current state of cytotechnology in the U.S. and U.K.
The second day was organized into working groups of 11 tables, each with a facilitator. The participants at each table were chosen to represent diverse practices and locations and include a mix of cytotechnologists, pathologists, and educators. They discussed all strategic options and developed key concepts for each. Two additional options arose from the discussions. The working groups explored the advantages and disadvantages of each strategy. At the meeting’s close, the summit group made a consensus recommendation on the most feasible course of action—expanding the skills of the cytotechnologist through additional education. The final deci-sion rests with the ASC executive board. A new Task Force on the Future of Cytopathology, co-chaired by George Birdsong, MD, and Sue Zaleski, SCT(ASCP), was formed to coordinate action plans with existing ASC committees and sister organizations.
The participant responses to the summit were uniformly positive, with the gathering hailed as a unique opportunity to share opposing views and develop common ground. At the summit’s conclusion, all participants agreed to maintain the following principles on their joint journey into the future:
- Continue a collaborative partnership with sister organizations.
- Leverage the unique morphologic and intellectual skills of the cytotechnologist.
- Improve the image of the laboratory professional (including pathologists) and reaffirm our value to stakeholders, patients, and the public.
- Maintain the mutually and historically supportive relationship between cytotechnologists and pathologists.
Dr. Crothers is vice chair of the CAP Cytopathology Committee, co-chair of the ASC Steering Group on the Future of Cytopathology, and director of cytopathology, Integrated Department of Pathology, Walter Reed Army Medical Center and National Naval Medical Center, Washington, DC.