A garden is a grand teacher. It teaches patience and careful watchfulness; it teaches industry and thrift; above all it teaches entire trust.
— Gertrude Jekyll
We’ve made it through the summer and there has been a lot of growth at the ASC.
Here’s what has taken root and produced results:
The CMS issued a ruling that slides reviewed solely for rapid on-site evaluation (ROSE) for adequacy do not count towards a cytotechnologist’s or pathologist’s workload. This was a collaborative effort through the Clinical Laboratory Improvement Advisory Committee (CLIAC) and our cytology representatives, along with advocacy from the College of American Pathologists. Of note, the time spent at on-site adequacy procedures must be deducted from total time available for screening slides for all cytology personnel involved in that process.
In February, the CMS issued a statement that a BSN is equal to a bachelor’s degree in biological science for high-complexity testing personnel requirements. A last-minute herculean effort from the Government and Regulatory Affairs Committee allowed the ASC and coordinating organizations to craft a succinct response to the CMS’s request for information regarding changes to the personnel qualifications for moderate and high-level laboratory testing. Under the leadership of Dr. Pam Gibson, the committee drafted a cogent argument that a nursing degree did not, of itself, qualify an individual to perform laboratory testing. This draft was modified for the ASC response. The ASC also co-signed, with our sister pathology organizations, a similar petition urging CMS to continue to require specific training and qualification for high-complexity laboratory testing. Clarification from CMS is still pending.
In March, I assisted the Pathology Consultant to the Army Surgeon General on a draft decision paper regarding the relevancy of cytopathology to military force readiness in support of sustaining the 68KM2 cytotechnology specialists. The Cytotechnology Specialty training program was first established in 1967 to meet the demands of increased Pap volumes for new recruits. Military cytotechnologists are tapped for overseas deployment to a war zone in support of anatomic pathology, where they perform grossing, histotechnology and special staining. Interestingly, 93% of all cytotechnologists in the Army Medical Command, both active duty and civilian, have been trained at this school. The Commanding General of the Education and Training Directorate of the Defense Health Agency agreed to maintain the program.
In April, the ASC submitted a statement to the Clinical Laboratory Improvement Advisory Committee (CLIAC) on the status of the cytotechnology workforce in the United States during a public comment period in April. Dr. George Birdsong and Ms. Janie Roberson were cytology representatives and advocates on the committee. The ASC recommended actions in support of our profession to include providing funding and/or grants for cytotechnology and cytopathology training, improve government awareness of the importance of laboratory medical specialties and programs for quality medical care, additions to the Allied Health Programs to STEM funding, and support of current CLIA personnel guidelines and advanced educational requirements for future technologists.
In early June, the ASC Officers met with the International Academy of Cytology and agreed to collaborate on terminology for serous effusions – the International System for Reporting Serous Fluid Cytopathology. Special areas of interest include terminology for mesothelioma, reporting of cellular elements in peritoneal washings, and the use and reporting of ancillary testing for metastases of unknown primary. The ASC also initiated the development of professional videos highlighting the cytopathology and cytotechnology professions to be used as recruitment vehicles for training programs. I initiated discussions with several cytotechnology schools to investigate their status and current unmet education needs.
In July, the ASC Officers had a teleconference with the University of Rhode Island Cytotechnology School to brainstorm future growth and maintenance strategies. This discussion generated several insights into the future of cytology education, as did a subsequent discussion with the University of Nebraska’s School of Cytotechnology and several university deans. Future viability will require sharing resources across programs both within the university and extramurally, with an emphasis on web-based learning. Many programs have difficulty finding clinical education sites. Schedule flexibility is important for remote learners; having the ability to take courses and examinations at their own pace is critical for full-time employees. On a positive note, the concept of a Master’s degree program is widely embraced by education leaders, and employers are enthusiastic about the concept of a multifaceted employee.
In August, the ASC approved two representatives to the American Society of Colposcopic and Cervical Pathology (ASCCP) consensus project for updating the 2012 Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors. This project is co-hosted by the National Cancer Institute with representatives from many pathology and gynecology organizations. The guidelines will be based on patient-risk and tailored to the United States population with an eye towards personalized medicine. Also, the Executive Board voted to approve the Workgroup on Emerging Roles for Cytopathology (WERC), a multiorganizational consortium designed to further progress the transformation of cytotechnology in the workforce. Invited participants include the American Society for Clinical Pathology (ASCP), the American Society of Cytopathology (ASC), the American Society for Cytotechnology (ASCT), the College of American Pathologists (CAP), the Papanicolaou Society of Cytopathology (PSC), and the Cytotechnology Program Review Committee (CPRC).
The United States Preventive Services Task Force (USPSTF) on Cervical Cancer recommendations were released and the ASC won a victory in advocacy- co-testing was retained as an option for screening every 5 years in women ages 30-65. The ASC, in conjunction with other pathology organizations, responded to the USPSTF draft recommendations through the Cytopathology Educational and Technology Consortium (CETC), a powerful voice in support of women’s health.
In September, the Ethics and Conduct Committee, under the leadership of Dr. Hormoz Ehya, drafted an ASC Position Statement warning of the potential for undue industry influence on medical research and development of clinical practice guidelines that we hope will be finalized and approved by November.
By the way, there is an opportunity to really show off this year at the 66th Annual Scientific Meeting in Washington DC, in honor of Dr. Papanicolaou and his work. Get your 100 Years of Color gear and expect to make an entrance at the President’s Gala on Monday night!