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  Proficiency testing and CME in one program

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October 2005
PAP/NGC Programs Review

Ann T. Moriarty, MD

Proficiency testing in gynecological cytology has taken a front seat in the practice of cytology. Many enhancements have been made this year to the CAP Interlaboratory Comparison Program in Gynecological Cytology. In addition to the traditional gyn challenges, the CAP offered a mock proficiency test as part of the educational slide challenge program. This program allows labs to practice for government-approved proficiency testing, offering a 10-slide challenge that will be graded as if used in proficiency testing. The mock PT portion of the program is not an official PT test; it’s a tool to help labs prepare for their actual proficiency tests. As a result of the change this year in the Pap program configuration, participants will receive three mailings consisting of two educational five-case slide sets and one educational 10-case mock PT slide set.

The CAP has developed a PT program while at the same time calling for federal review of the regulations leading to PT, and the Centers for Medicare and Medicaid Services recently approved the CAP program for 2006. Since 1989, the CAP Cytopathology Committee has been providing the Interlaboratory Comparison Program in Gynecologic Cytology based on the PT requirements of CLIA ’88. For two years, the CAP staff and members of the CAP Cytopathology Committee have worked tirelessly to have the PT program in place when the CAP received CMS approval. For a single annual fee, participants will receive two educational challenges of five slides each as well as a single 10-slide PT. The CAP PT not only conforms to CMS standards for PT, but also will meet the CAP’s more stringent criteria for field validation. For participants in the CAP program, the benefits are a more rigorously validated PT program and an opportunity to receive 12 continuing medical education credits for the educational component. In addition, the educational program fulfills accreditation requirements for an interlaboratory peer-comparison program. Only CAP offers both PT and CME in the same program.

In addition to the CAP’s new PT program, progress has been made in new College programs using the Internet, glass slides, and more traditional efforts. In 2006 a new Web-based gyn and nongyn program will be offered. Using a virtual slide scanning technique, participants will be able to view a slide using their own computers, pick the correct answer, and answer several other challenge questions based on the virtual slide exercise. The Web-based program will make it possible to disseminate more unusual cases to a wider audience. In the classic interlaboratory comparison programs, slides of unusual diseases are difficult to obtain in sufficient volume to distribute them widely to participants. The Web-based design allows more participants the opportunity to see odd or unusual cases incorporating ancillary studies, such as flow cytometry, genetics, and immunological or molecular studies. The new gyn program includes four yearly Web-based challenges as part of the glass slide educational program. Two cases will accompany the first educational glass slide challenge, and two cases will accompany the second glass slide challenge. The new nongyn program will also offer four challenges; two thyroid and two respiratory cases are being offered as an enhancement to the current glass-based program. These new exercises will bring the experts into your office.

More improvements are underway in the glass slide interlaboratory comparison program. Fine-needle aspirates of bone will be catalogued with their radiographs during the course of next year. Participants will be able to obtain computer-based images of the radiographs or other pertinent studies as they evaluate the bone fine-needle aspirates. Similar programs are being evaluated for immunocytochemistries and ancillary flow cytometry studies for various tumors and lymphomas.

Many cytologists still enjoy the feel and visual images in a standard text. Members of the CAP Cytopathology Committee are composing a publication of gynecologic cytology based on the committee’s findings and experiences over the last 16 years. Included in the brief text and atlas are topics of basic morphology, classic differential diagnostic problems in gynecologic cytology, HPV biology—“what you need to know,” management topics, practical discussions of new technology, summary of TBS/ASCCP management guidelines, and quality improvement procedures and policies. This small volume, which you can expect to see within the next year, will be packed with important information arranged in a user-friendly format.

Of course, the CAP will continue to offer the classic glass slide interlaboratory comparison program in nongynecologic cytology as well as the educational challenges for gynecologic cytology. These programs still deliver the best opportunity for learning and growth in cytopathology.


Dr. Moriarty, a member of the CAP Cytopathology Committee, is with AmeriPath, Indianapolis.