Training cytotechnologists to perform papanicolaou smear screening: development and testing of a third world program

Our objective was (1) to develop a training program for teaching cytotechnology students how to perform Papanicolaou (Pap) smear collection, and (2) to compare the Pap smear adequacy rates of trained cytotechnicians to those of physicians screening the same population.

Cytotechnology students received formal lectures about collection and transport of Pap smears and clinical proctoring of Pap smear collection in at least 20 patients. Ten months after completion of training, a review of screening Pap smears collected by all health care professionals over 1 month was performed. Cytopathology review was performed in a blinded fashion.

In November 1994, 1,411 screening Pap smears were performed. Patients were seen randomly by generalists, gynecologists, cytotechnicians, or oncologists with collection rates of 991 (70%), 221 (16%), 100 (7%), and 99 (7%) Pap smears, respectively. Inadequate sampling rates (i.e., less than 70% of the slide surface covered with a cell monolayer, endocervical cells present if uterus was in situ, and fewer than 25% of marker cells obscured by blood or inflammatory cells) were: generalists, 8.8%; gynecologists, 9.9%; cytotechnicians, 9.0%; and oncologists, 58.6%. No significant differences were seen in the inadequacy rates of the first three groups, though the oncologists were more likely to perform inadequate Pap smears (p < .01).

Third World cytotechnicians can be taught the rudimentary aspects of Pap smear collection, with acceptable rates of inadequate sampling similar to their physician colleagues. Oncologist specialists either should be retrained in the proper collection and processing of Pap smears or should be excluded from this primary care activity.