Exam Success: IBMS Advanced Specialist Diploma (ASD) in Cervical Cytology

Both Mark and I started out in cytology over 20 years ago (Mark: nearly 30 for me!), for myself this hadn’t been my intention – two things I did not want to be working in a career in the NHS or looking down a microscope! Mark started out in Southampton, moving onto Nottingham before taking the role as Senior BMS in Norwich in 2011. I started out in Colchester, then moved to Southend for the Senior BMS role there before hedging my bets around the potential centralization of the cervical screening service – and an element of fate – and joined Mark as a Senior BMS in Norwich in 2017 (despite having withdrawn my application!). Mark: I also fell into cytology accidently – in my first interview for a cytology trainee position I didn’t really know what cytology was (I pre-date the internet!). I had fortunately read a newspaper article about the screening programme before my second cytology interview in Southampton.

My gamble paid off and in 2019 the cytology lab at the Norfolk and Norwich University Hospital (NNUH) won the tender to provide cervical screening and HPV testing for the East of England. This brought with it an increase in our annual workload from around 75000 samples to around 420000.

With a view to future proofing the East of England Cervical Screening Service Mark and I were encouraged to apply for new ‘Acting Pathway Manager’ roles at NNUH. These posts were a good foundation on which to build knowledge and understanding of the wider cervical screening programme. We were allocated a sector of the East of England and were the main point of contact for service users for that area. This included reporting into NHSE Programme Boards, Trust business meetings, coordination of invasive cervical cancer audit reviews and liaising with the Screening Quality Assurance Service, and managing screening incidents which occurred within that area. This is alongside our senior checking roles and an expectation to endeavour to complete the ASD portfolio and sitting the examination.

Mark had previously started the ASD in late 2020, initially with a view to submit his portfolio and sit the exam in 2022 but due to illness, didn’t make the deadline and so submitted his portfolio in 2023. This was successfully assessed and so he sat the written exam that year. Unfortunately, along with 50% of the candidates sitting the written paper that year he was not successful. Of the 50% that were successful that year there were no candidates successful in passing the practical element, only adding to my fear of the impending 2024 ASD exam!

Mark resubmitted his portfolio in 2024 and was again successful. And so was I, so we both sat the written exam and were both successful. The best part about this was knowing I could have my life back – no more sitting on a lap top every night and weekend! Mark: go into this process with your eyes open – as Kate says, lots of evenings, weekends (and the occasional holiday to Spain) will have to be sacrificed, but the opportunity to sit for this qualification should be regarded as a privilege. 

In July, along with eight others, we sat the microscopy element of the exam. There were only two of us sitting it for the first time – which made the experience even more daunting – for me at least! But I am very pleased and relieved to say that we both passed.

Completion of the portfolio was all-consuming. It’s comprised of a log of cases reported in conjunction with a qualified consultant, a series of more in-depth cases studies, audits and evidence of attendance and reflective learning for colposcopy multidisciplinary team meetings (MDTs), and visits to colposcopy units. There were also 7 bullet point elements that must be covered - all extremely broad but with an overall word count of 2500. Keeping the word count down was challenging – especially since my original drafts were over 5000 words each! Mark: I found this element the most difficult, this could easily have become a 10000 word essay, so to keep within the word limit, and not lose too much context was a massive ask. This is perhaps something the Conjoint board could reflect on.

The biggest challenge during the training period was that we both held substantive, demanding positions, meaning that the portfolio work and preparation for exams had to be done in evenings and weekends, whilst still maintaining some sort of home and social life and for me squeezing in some parenting as well. Mark: fortunately my cat was quite self-reliant!

Weirdly, I found the post-exam period quite strange – readjusting to not having to study in any available free time and trying to remember the things I liked doing before.

The Acting Pathway Manager posts we held stated that we would progress to Consultant BMS/Pathway Manager following successful completion of the Advanced Specialist Diploma qualification. This was arranged without delay and we became Consultant BMS and Pathway Managers along with our pay uplift. To begin with we were supported with double reporting to ensure our reporting was in line with our peers as we settled into reporting the abnormal cases. Also, we now complete invasive cancer audits independently and provide cytology reviews and cover colposcopy MDTs. This has helped to take the pressure off the other three Consultant BMS’s in the department - as a department we have input into around twenty such MDTs each month.

Having two candidates in one department pass is not just a reflection on Mark and my efforts but also demonstrates the quality of the training and support provided here from the other Consultant BMS’s and Pathologists. Mark: I would entirely echo this and would like to thank all of my colleagues, especially those at consultant level for their support and encouragement over the last few years. We are both lucky to work with an excellent team where the support has continued as we have moved into our new posts.

If I were to try to think of some advice or tips for anyone looking to complete the portfolio and sit the ASD exam it would be…..

Definitely attend the pre-exam course at North of England Pathology and Screening Education Centre (NEPSEC). We both attended this at least twice. I went not long after starting working towards the portfolio and then just prior to sitting the exam. Having attended the first time I had a much better idea of the expectations and requirements and the second course definitely made me feel more confident about sitting the actual exam. Mark: the opportunity to talk to others in the same situation and to tap into course leaders was invaluable – this would be 2 days well spent.

Attend one or more colposcopy clinics – especially if you refer patients to more than one colposcopy unit. All clinics work very differently and it’s good to have a rounded view.

Attend as many colposcopy MDTs as you can – this really helped get to grips with the management algorithms and the different factors that need to be considered. Mark: This really helped me (as a non-clinician) to understand the challenges our clinical colleagues face when seeing the patients we have referred. You may hear some pragmatic solutions to various situations, but remember in the exam national guidance and policies are key!

Take advantage of all on line CPD sessions that are offered. Also ensure you keep an eye on the latest publications – there’s a lot out there happening.

Practice lots of different example exam questions – make sure you know the advantages and disadvantages of everything – from different management pathways to new technologies.

And question everything! I love Cyres - the system we use to produce screener performance statistics and to look at colposcopy and histology outcomes against our cytology results for patients - and so I was constantly pulling data to analyse it and to see if we, as a lab, fit with the published data.

Know your differentials – in all elements even if you come to a specific conclusion, it helps to show you are aware of the alternatives and have actively considered them.

We were given conflicting advice on referencing during the exam and you may wish to seek more specific advice from the Conjoint Board but my recommendation would be to get some key references in your mind and be able to quote them.

For anyone currently working towards the qualification or anyone considering it – it isn’t unobtainable, as I was beginning to believe – as long as you put the work in and have the support of the reporting team in your laboratory you can definitely achieve it. So, keep going and good luck!