CYTOPATHOLOGY
Aptitude for cytology: the QUATE experience
The European Congress of Cytology and QUATE examinations are being held in Liverpool in October. Here, Allan Wilson provides a European perspective on the challenges of aptitude testing in cytology.
Many cytology and cellular pathology readers will be aware of the primary screening qualification in the UK, which has been running under various names since the 1990s. However, I suspect less well known is its overseas cousin, the QUATE examination. The QUATE (Quality Assurance, Training and Examinations committee) aptitude test is an international examination for cytotechnologists who fulfil the criteria for accreditation in their own countries. The examination has been running since 1992 and is designed to provide an objective assessment of a cytotechnologist’s competence to screen conventional cervical smears or liquid-based cytology samples, and is available in conventional smears, SurePath or ThinPrep technologies. The examination is administered and
funded by the European Federation of Cytology Societies (EFCS). The British Association for Cytopathology (BAC) is a member of the EFCS and IBMS Council member Allan Wilson is a member of the examination board. Unlike the UK, many European countries did not have their own ‘registry examination’ for staff who primary screen in order to demonstrate their screening competence, and the QUATE examination plugs this gap and offers a test as a qualifying examination for cervical cytology primary screening staff.
Examination format The examination comprises a written and a practical element. The written element is in the form of 50 multiple-choice questions (MCQs). Each has only one correct answer and there is no negative marking. The practical component comprises 16 slides available as conventional smears or based on ThinPrep and SurePath technologies. Candidates are allowed 10 minutes per conventional cervical smear or eight minutes
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for an LBC preparation. The pass mark for the MCQ is 50% and for the screening test is 75%. Candidates must pass each section in
order to be awarded an overall pass. There is no transfer of marks between different sections of the examination. Missing an abnormal sample results in automatic failure, while an overcall of a negative smear as abnormal in the screening test scores zero. Repeated overcalling of negative slides is the most common reason for failing the screening test.
Slide selection The criteria for slide selection are practically the same as those for the UK examination. No ‘trick’ slides are used, nor are borderline and unsatisfactory smears. The slides assessed are intended to reflect routine practice and are assessed by many pairs of eyes before being logged in the slide bank. The difference is that three slide banks are required, one for each slide format available to candidates.
Largely the same slide sets have been
used over the past two years. This has been a deliberate strategy started by Nick Dudding, who was my predecessor as examiner. The reason is simple and is an attempt to produce data that allow a comparison between the performance of candidates from different countries. It is tempting to suggest that the resulting data could be used as an indicator of effectiveness of training in different countries. However, there are risks in using the
same slides sets and great care is taken to avoid using the same set for candidates who are resitting the examination. It is also vital to record the country of training because this may differ from the base laboratory, as movement across borders is relatively common.
Examples of good practice Analysis of recent examination results has allowed us to suggest areas of good practice. For example, all 18 of the Slovenian candidates passed and 13 of these scored maximum marks on the screening. In the same examination, 11 Slovenian candidates scored over 40/50 in the MCQs (Table 1). These are exceptional results for a small country and there may be much to learn by looking at training methods in Slovenia.
Example of a complex examination Candidate numbers vary widely. A minimum of six are required for a viable examination
Fig 1. Candidates undertaking the examination held in Milan last year. AUGUST 2016 THE BIOMEDICAL SCIENTIST
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