EVALUATION OF PROFICIENCY TESTING AS A METHOD OF ASSESSING COMPETENCETO SCREEN CERVICAL SMEARS

Regular proficiency testing of pathologists and cytotechnologists who undertake the analysis of cervical smears has been carried out in cyto logy laboratories in the North Thames (West) Region since 1989. The pr otocol followed is one that has been adopted nationally. Since the sch eme started, laboratory personnel from 17 cytology laboratories in the Region have participated and seven rounds of testing have been comple ted. Nine hundred and seventy-one tests were carried out and a pass ra te of 96.4% was recorded. Two hundred and forty-seven cytologists took the test on at least one occasion and 63 cytologists took part in all seven rounds. Our results indicate that proficiency testing is capabl e of detecting cytologists who consistently perform below an acceptabl e standard and require retraining. They also show that even the most c ompetent screeners can miss an abnormal smear. Seven cytologists who h ad proved their competence to screen on six occasions, missed an abnor mal smear on the seventh, despite the fact that they were screening un der test conditions when their vigilance should have been at its peak. Our findings indicate that false-negative reporting will inevitably o ccur during manual screening, and emphasize the need for further resea rch into the causes and prevention of screening error.