The current challenges of training in cervical cytopathology

From left to right, Georgina Wong, Dorotheea Ivan, Ambriene Irshad

Introduction

Around 20 years ago, you would find a cytology laboratory in most hospitals, where cervical and diagnostic cytology samples were processed, and there was quite often someone in a training post, whether a trainee cytoscreener or a trainee BMS role.

Obviously, the landscape of cervical cytology has changed massively since then, with the use of liquid-based cytology, HPV testing and vaccination leading to a significant reduction in the number of samples requiring morphological assessment. As a result, little investment in trainee roles was deemed necessary, and it was assumed that the existing workforce would see out the need for cervical cytology.

Fast forward, and there are now just 8 cervical screening laboratories in England. The reconfiguration process has led to the loss of many qualified staff from the workforce, and the remaining labs are now in need of screening staff again to replace staff lost to retirement and meet the increased workload.

This is not a quick fix - the training process for cervical cytology requires a minimum of 18 months for biomedical scientists and a requirement to have looked at 5000 samples, alongside formal training course attendance at one of the 4 approved cytology training schools. At the end of this training period, a written and practical microscopy examination is undertaken.

This blog looks at the training experience from three different perspectives.

The Training Officer – Ambriene Irshad

My background is in Cervical and Diagnostic CytoPathology. I did my original training in Conventional Cytology and then went on to do the ThinPrep and SurePath Liquid based Cytology training. I started my training in 2004, training as both Cytoscreener and Biomedical Scientist at the same time.

The main bulk of my training was fulfilled by the Cervical Cytology Introductory course and as a trainee, we were then left to get on with completing the portfolio and the 5000 training slides.

Manchester Cytology Centre currently have 3 Trainee Cytoscreeners/Trainee Biomedical scientists (BMS) and 1 Trainee Cytoscreener who is already a registered BMS. The registered BMS is about 2/3rds into her training and will be ready for her exam in October 2024. The other 3 are still in the early part of their training and are progressing through consistently.

I have found most trainees struggle with getting their screening numbers as it is difficult to build up speed of screening especially at the beginning. This is something we can all relate to from our training.

I began my role as the training officer over a year and a half ago and one of the main things I have noted is that the paperwork is very time consuming. I have had to put together the portfolios for all the trainees at the beginning which took up a great amount of my time. Maybe a folder, with everything ready to go could be provided.

I feel like a shared library of resources would also be very helpful for the training officers as putting together things like test sets is again time consuming.

I feel some of the questions in the portfolio could also be worded better. Some have word counts and others don’t which makes it difficult for the trainee as they always want guidance. If the same thing is done for all questions then there is no confusion.

As I have to fulfil my routine screening duties and do my other training duties I do find time very difficult to manage and I have often had to take assignments to complete at home in my own time which can be very frustrating.

I do multi-header sessions with the trainees after test sets and have also explained they can bring slides for me to go through if they want. But I feel they need more structured and regular sessions which they have now set up with the Consultant BMS.

All being said, I have a great set of trainees in the department at the moment who have been a pleasure to work with and train and I wish them all the success in their training. They have been very patient and understanding, as I also find my feet in my new role as the training officer. I have no doubts they will all make great cytoscreeners and BMS in the future.

The Trainee Cytoscreener (Registered Biomedical Scientist) – Dorotheea Ivan

Upon securing the position as a Biomedical Scientist specialising in Cervical Cytology I wasn’t sure what to expect. I was informed that I would have to attend a course and that there would be a portfolio I would need to complete. Initially I thought it would be something resembling the registration portfolio, given my limited experience working in cytology.

Fast forward to now; I am almost finished with my portfolio and the mandatory 5000 slides. Alongside the cytoscreening training, I also have other duties such as looking on LIMS into holds for samples that have been booked in; helping out with ensuring each patient has the appropriate history on LIMS; zero tolerance and, more recently, I have started working on my specialist portfolio as well. I am grateful for the opportunity to be able to learn new things and that I have been allocated the necessary time to complete my NHSCSP portfolio during my working hours.

Overall, I have been very pleased with the NEPSEC cytology course and all the comprehensive training provided. While my experience has been, on the whole, largely positive, if I were to offer any constructive feedback I would suggest implementing more regular official multi-header sessions for the trainees.

The Trainee Cytoscreener /Trainee Biomedical Scientist – Georgina Wong

I joined the Gynae cytology department as a trainee biomedical scientist in February 2023. In addition to working on my IBMS registration portfolio to become a biomedical scientist, I am also in the process of completing the NHS cervical screening portfolio to qualify as a cytoscreener. Trainees are allocated 4 hours of protected screening time daily to achieve their target of 5000 slides. I appreciate the flexibility our training officer provides in managing our time for the remaining work hours, typically spent updating patient histories and working on portfolio assignments.

The formal training that I have received for the cervical screening portfolio includes a 4-week training course and a 4-day follow-up course, both of which were informative and well-organized. Our department also holds monthly multi-header sessions where consultants present challenging slides. These sessions have been extremely useful for continuous learning. In the future, I think it will be beneficial to have scheduled multi-header sessions where trainees can present challenging slides they’ve encountered and receive instant feedback.

Key points for training officers: Role can be very time consuming with a large investment in initial set up – question banks/slide libraries/test sets. Hopefully this can then be rolled out for multiple trainees. There is a large amount of paperwork required for portfolio, formal tracking of numbers and regular internal verification. Allowance of protected screening time to ensure screening numbers achieved, and time for assignment completion. Regular multi-header slide reviews for discrepant reports and challenging cases – this can be difficult to find time for, but can be the most beneficial for trainees.

Key points for trainees: Time management is key – particularly when undertaking other training such as portfolio completion alongside the cervical cytology diploma. Ensure you have regular updates with training officer where you can assess screening numbers and ensure you are on track to meet targets. Check your knowledge and understanding against the training syllabus – your training officer can help you with this. Take any opportunities to discuss cases you are not sure about, or where the report differs from your opinion. Training officers and consultants are usually happy to look at these with you. Give feedback – if there is anything that can be done to improve your training experience, please tell someone.