College of American Pathologists
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  Your Pap and nongyn program suggestions


CAP Today




August 2011
Cytopathology And More

Nicole E. Thomas, MPH, CT(ASCP)CM
David A. Hartley, CT(ASCP)CM

The Pap and nongynecologic cytopathology programs provide participants an opportunity to assess their screening and interpretive skills. Every year, more than 10,000 participants enroll in each, making them the largest gynecologic and nongynecologic interlaboratory peer-comparison programs. To understand the participants’ view of and improve the programs, comments are solicited and compiled at the end of each year, some of which are the source of new product ideas. Here are the questions and comments we received in 2010, and our answers.

Claiming CME/CE is too cumbersome. Can you go back to mailing the CME/CE certificates? Self-claiming CME is now a requirement of the American Medical Association. It affords participants the ability to claim credit for the amount of time spent on educational activities. One major advantage of the current process is that you can print or reprint CME certificates at will, rather than have to wait for the CAP to print and send them to you. The CAP processes tens of thousands of CME/CE activities, and self-claim helps streamline its operations.

Provide more clinical history and education feedback. Laboratories across the country donate the cases, and some provide more clinical history than others. That’s due in part to the varying amounts of clinical history reported to the laboratories. When you donate slides to the program, we ask that you provide as much information as possible.

The Cytopathology Committee is committed to improving the nongyn cytologic cases by adding more educational comments specific to the case or diagnosis, or both, but this takes time because there are tens of thousands of cases in the program. We hope you will begin to see more feedback as the cases begin to circulate.

Address ASC-US, AG-US. Atypical squamous cells-undetermined significance and atypical glandular cells-undetermined significance are entities that prove to be difficult to reproduce and for which there is less interobserver agreement. Undoubtedly, these cases would take more time to review when deciding their acceptance into the program and would probably yield a low acceptance rate. At this point, CAP staff do not believe we can offer these interpretations in the glass slide programs. However, ASC-US and AGC interpretations are ones that we usually offer in our online cases for which much more educational content is provided.

Add pediatric NGC cytopathology cases. Pediatric cytopathology cases certainly have education merit, but cases are difficult to acquire. The Cytopathology Committee, after receiving several requests, has decided to make a concerted effort to include these cases in the NGC glass slide program, as well as the online NGC module. The College encourages and accepts slide donations on an ongoing basis for inclusion into these programs.

Improve technical slide quality. Laboratories across the country donate slides to the CAP’s cytopathology programs. This may result in variability in slide preparation and stain quality. Before these slides are accepted into the programs, a cytotechnologist and three board-certified cytopathologists review them. Besides ensuring that the slides contain adequate cells that reflect the reference diagnosis, the committee also tries to make sure the slides are optimally prepared and stained. In this manner, only those slides that are judged to be acceptable are included in the educational programs. Over time, slides may begin to fade or become damaged. The CAP’s cytotechnologist specialists routinely assess these slides and remove those that are considered to be of low quality. Though we have these quality monitors in place, occasionally suboptimal slides find their way into the programs. If you note a particularly bad slide, you can send a note by e-mail to the CAP staff and they will review the slide immediately upon its return to the CAP.

Add more common/uncommon cases. A number of participants have said that NGC and Fine-Needle Aspiration Glass Slide Education Program slide sets have too many uncommon diagnoses, while others say the slide sets include diagnoses they may never see in their careers. One of the objectives of the nongynecologic program is to include a blend of common and rare diagnoses, so that the program serves as an educational tool to keep cytotechnologists’ and pathologists’ diagnostic skills up to date. Including uncommon cases is vital to the educational nature of the programs.

Simplify the Pap proficiency testing process. While Pap proficiency testing is not an educational program, we still receive many comments about it in our education evaluations. There are several pieces to Pap PT that require a great deal of attention on the laboratory’s part: choosing a test date, ensuring the roster is up to date, choosing a proctor and having him or her take the annual exam, and administering the test, to name a few. We receive hundreds of participant calls each year about Pap PT and have posted a list of frequently asked questions and answers for you on the CAP Web site.

Nicole Thomas and David Hartley are cytology technical specialists in the CAP Surveys program, Northfield, Ill.

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