COMPUTERIZED TRAINING AND PROFICIENCY TESTING - IAC TASK-FORCE SUMMARY

Issues Computerized technologies probably will revolutionize the field of gynecologic cytology in the next century. Such technologies will b e useful in both training and evaluating proficiency. However, manual screening/review of gynecologic cytology preparations is the current ' 'gold standard'' for both training and assessment of proficiency. Cons ensus Position Training programs for cytotechnologists and pathologist s should provide instruction and experience in new technologies, but t heir introduction may depend on the availability of equipment and staf f. Advantages of digital images for training include standardization o f teaching sets and interactive capabilities, allowing educational fee dback. Computerized supoort/assistance devices aid in complete screeni ng of the slide during training and provide feedback to cytologists on screening techniques. Liquid-based cytopreparatory instruments facili tate multiple glass slides for teaching or testing. Proficiency testin g (PT) in cytology has similar quality assurance goals as in other are as of the laboratory, but the subjective nature of cytologic analysis poses many challenges for implementation. There is consensus that all cytology practitioners would like to know the proficiency of the labor atory. However, the majority question the value and validity of any la rge-scale formal testing programs. Locator and diagnostic skills are b oth critical in cytology, but assessment of each skill may occur in di fferent ways using computerized technologies. Any type of assessment s hould provide educational feedback to participants. Psychometric issue s in PT include the consideration of different types of validity, incl uding face, content, construct and criterion related. The reliability or consistency of the testing event is also critical. A valid and reli able correlation between work performance and performance on a PT need s to be established. The goal is to ensure that PT will identify subma rginal practitioners and that persons successful on PT are in fact com petent. Any cytology PT program should also be considered in the conte xt of other laboratory quality assurance tools and the entire cervical cancer screening program. Regulatory agencies should evaluate entire laboratory performance, while each laboratory director should assume p rimary responsibility for evaluating and documenting the competency an d daily performance of each practicing cytologist. Professional scient ific organizations should take the lead in recommending methods and st andards of performance assessment. Ongoing Issues A reliable method of correlating daily competency with results on PT is not yet establishe d. Methods may evolve over time using new technologies. The use of com puterized techniques and images for assessment will require careful de liberation by experts as well as validation by practicing cytologists. Variables include diagnostic categories for testing, numbers of chall enges per testing event, types of slide preparations and characteristi cs of the digital images. Availability of equipment and staff will aff ect the introduction of new technologies in different regions.