Mock Gynecologic Cytology Proficiency Testing as a Training Tool for AP Residents
Darren J Salmi, Bryan D Toth, Christina S Kong. Stanford University, Stanford, CA
Background: The Clinical Laboratory Improvement Amendments (CLIA) of 1988 mandated national proficiency testing for gynecologic cytology. Annual proficiency testing (PT) began in 2006. All pathologists who sign-out Pap tests are required to pass an annual ten-slide PT.
Design: At our institution we introduced mock PT into the cytology curriculum in 2007 as a quantitative measure of anatomic pathology (AP) resident progress in learning gynecologic cytology and to prepare residents for annual PT when they enter practice. AP residents are given three PT sets consisting of 10 slides each of ThinPrep®, Surepath™, and conventional Pap tests. These test sets are administered at three time points: 2nd quarter of PGY1, 4th quarter of PGY1, and 2nd quarter of PGY2, and are scored using the standard PT scoring grid for pathologists. The following parameters are evaluated: 1) performance differences between ThinPrep®, Surepath™, and conventional test sets; 2) performance across test sets; 3) performance before and after the initiation in 2009 of one-on-one teaching sessions with cytotechnologists; and 4) quality of the test slides.
Results: Overall scores did not differ significantly between ThinPrep®, Surepath™, and conventional slide sets (81.38, 80.64, and 79.96 points, respectively). Residents showed a statistically significant improvement in performance between test sets 1 and 3 (76.66 vs. 88.89, p value <0.001), and test sets 2 and 3 (76.53 vs. 88.89, p value <0.001). The average score for the first test set was significantly higher for residents who received formal training by a cytotechnologist as compared with those who did not (80.22 vs. 72.47, p value = 0.004). By the third time point, there was no significant difference in performance between the two groups (88.67 vs. 89.58, p value=0.780). Overall, 16/90 slides were misclassified by 40% or more of residents. 3/16 (19%) had a negative point-biserial correlation coefficient (RPBI) indicative of poor question quality. 8/16 (50%) exhibited glandular abnormalities, including adenocarcinoma undercalled as negative/reactive and benign endometrial cells overcalled as atypical glandular cells/adenocarcinoma.
Conclusions: The mock proficiency tests have confirmed the effectiveness of individual teaching sessions by cytotechnologists. They have also helped to identify an area of gynecologic cytology – glandular cell abnormalities – that residents have difficulty with, thus allowing us to target our teaching curriculum to provide better instruction on this topic.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 58, Tuesday Morning