August 2008
PAP/NGC Programs Review

Barbara Benstein, PhD, SCT(ASCP)^CM
E. Blair Holladay, PhD, SCT(ASCP)^CM
Kathy Kenwright, MS, MT, MP(ASCP) SI
Marilee Means, PhD, SCT(ASCP)
M. Sue Zaleski, MA, SCT(ASCP)

Cytotechnologists must expand their education if they wish to continue to help patients and be able to perform an increasing number of job functions. Educational programs must address new technologies that are having an impact on the profession and prepare graduates for the many opportunities they will have in the future.

Advances in molecular technology are affecting every area of science and medicine, including cytopathology. An expanded scope of practice for pathologists will influence the responsibilities of cytotechnologists also. Traditionally, testing in the cytopathology laboratory has centered on screening for and diagnosing cancer and other diseases. Today, molecular diagnostic testing in the cytopathology laboratory can also influence treatment and prognosis.

As more molecular tests become available, the demand for technologists with these skills will grow. Trying to meet the training needs for an ever-expanding number of different molecular tests is an impossible task. The focus should be on acquiring the knowledge needed to understand the basic principles and to develop the skills needed to perform some of the standard techniques. Once the basic skills are developed, learning the specific molecular tests your laboratory should offer or offers can be done on the job through in-service training. With the new automated extractors and real-time thermalcyclers, training is going to be specific to the instrument purchased. Many vendors will send a technical specialist to spend a couple of days training technologists on site. Other vendors may pay for a couple of technologists to train at their facilities. Employees are more receptive to taking on new tasks if they are comfortable with the basic skill sets and vocabulary needed to understand the tests they will perform.

General principles of biology and genetics—such as DNA structure, gene expression, and recombinant DNA technology—should be prerequisite to any formal program of study in molecular diagnostics. Most students entering laboratory training programs today have this basic knowledge, but technologists who have been in the field for years may need to take a course or two to bring their knowledge up to date. A formal program in molecular diagnostics should include specific techniques in nucleic-acid extraction, evaluation of quality and quantity of DNA and RNA, restriction enzyme digests, agarose gel electrophoresis, and techniques in nucleic-acid blotting. Education in the principles of and techniques for real-time and conventional polymerase chain reaction and in situ hybridization (ISH), including FISH, is also necessary. Although most clinical labs do not use manual molecular methods, when troubleshooting skills are needed, it is important to have an understanding of the theory behind what’s going on in the little black box.

Cytology laboratories are sharing with molecular laboratories specimens such as bronchioalveolar lavages and liquid-based Pap tests. In states where cytotechnologists are not licensed to perform these tests they still need to be knowledgeable about the specimen handling requirements for molecular tests. If the specimen is not handled properly, it could become contaminated and lead to a false-positive result, or the nucleic acid may be degraded and lead to a false-negative result.

Cytotechnologists are uniquely trained in cellular morphology and will want to concentrate on those tests that make the most of this expertise, such as FISH and ISH. Their interpretive skills will also be needed in laser capture microscopy, image analysis, and tissue banking. Cytotechnologists should understand molecular pathways and how probes are used to locate expression of specific molecules. The location and expression of molecules within certain areas of the cell may have implications for diagnosing, treating, and managing disease in the future.

Cytotechnology education programs are feeling the pressure to incorporate more skill sets into the curricula to better prepare their graduates for the future. The challenge will be finding a way to integrate new technologies while continuing to teach the traditional courses in cytomorphology that are needed regardless of what happens with Pap testing. Locator and interpretive skills remain essential to evaluating the growing volume of nongynecologic and fine-needle aspiration specimens. At the University of Tennessee Health Science Center in Memphis, cytotechnology and medical technology students take courses together in genetics, cell biology, and molecular techniques. The goal for instruc­tors is to teach fundamental principles and, for stu­dents, to develop basic laboratory skills that can be applied in different lab settings. The cytotechnology curriculum was expanded by nine months to incorporate the additional coursework. Students continue to evaluate cytologic specimens throughout the curriculum to maintain competence. Graduates of the program now receive a master’s degree to reflect the degree of coursework and preparation they have obtained to enter the profession.

Recognizing the need for individuals to document their expertise in the field of molecular testing, the American Society for Clinical Pathology Board of Registry established the Molecular Pathology (MP) certification in 2003. Individuals with a baccalaureate degree who are already certified by ASCP as technologists or specialists are eligible to take the MP certification exam. Other routes to fulfill the eligibility requirements to take the exam can be found on the ASCP Board of Registry Web site by clicking on “certification” at www.ascp.org. At the end of 2007, 227 people had attained MP(ASCP) certification. Of these, 43 were cytotechnologists and 48 were medical technologists. Two were certified in both medical technology and cytotechnology before obtaining their MP certification. Of the 43 cytotechnologists, nine were specialists in cytotechnology (SCT). The overall pass rate for the exam for the years 2003 through 2007 was 62 percent.

A survey was created to determine the immediate and future numbers of cytotechnology graduates who are preparing to take the ASCP certification examination in molecular pathology. The survey was distributed to participants of the program faculty seminar at the 2007 American Society of Cytopathology annual scientific meeting. Twenty-three surveys were returned. Three programs have 19 students who are preparing to take the exam this year. Seven programs plan for about 30 students to take the MP exam within the period 2009–2011. Thirteen programs have no plans to prepare cytology students for this examination.

If you ask cytotechnologists why they chose their career, they’ll tell you in so many words it was because they loved science and wanted to be part of the fight against cancer. Many chose the profession because they could be essential to patient care while remaining in the background. Choosing any health care profession requires a dedication to patients and to lifelong learning. As the lines between clinical and anatomic pathology transect and the scope of practice expands, new opportunities will continue to arise for all laboratory professionals. We need to be prepared to do what is needed in the interest of best patient care.