A garden requires patient labor and attention. Plants do not grow merely to satisfy ambitions or to fulfill good intentions. They thrive because someone expended effort on them.

Liberty Hyde Bailey

 It’s SPRING – time to plant seeds! There are two types of seeds in cytology – people and ideas. It takes the right people, with dedication and motivation, to instigate change. And it takes ideas that can take root, branch out, cross-pollinate and grow into something new and beautiful. The ASC has been working on both.

Barbara A. Crothers, DO President, American Society of Cytopathology

Growth is painful; so is change. Flowers and fruit don’t emerge without both. It is the journey of growth and change that defines us as humans and it is part of our natural condition. As an optimist, I believe that we usually make things better through experimentation, personal growth and change. Our profession – indeed, all of health care – is in a time of monumental change. What is important is that we have a vision for our contributions to the future. Growth doesn’t happen overnight; it has been happening for years. I recall when the idea of a mid-level practitioner was first pitched to the ASC Executive Board by Jean Taylor, SCT(ASCP) in 2004 – it caused quite a stir! Now we have the very individuals that were envisioned and are on the way to solidifying a curriculum that will become the standard for all future “cytotechnologists,” if that title is retained.

I’ve been hearing from some of our cytotechnologist members lately about the state of cytotechnology, and they’ve been experiencing growing pains. One of them asked, “What happened to cytotechnology, and why haven’t you converted everyone to a Master’s Degree Program?” Cytotechnology is changing, and for the better. Gone are the “screeners” who “dotted” slides for pathologists. Newly minted cytotechnologists are more involved with diagnostics, specimen adequacy and quality, and ancillary testing. They have evolved into pathologist extenders, moving into other positions where their background and skills are valued. When I think of the cytotechnologists that I’ve worked with in my career, most of them are now involved with molecular testing and diagnostics, histology/ immunohistochemistry, management, quality improvement and/or research. Several have obtained Master’s degrees in public health, business or other health-related areas. Some now work at the Centers for Medicare and Medicaid Services, Food and Drug Association, and National Institutes of Health; others have managed anatomic pathology laboratories. I’ve seen upward mobility of cytotechnologists improve, from the old glass-ceiling job, where the only “promotion” options were to become a cytology school instructor or a cytology supervisor, to the current state where many expanded positions are available.

The change to a Master’s degree program is happening; the Cytotechnology Programs Review Committee (CPRC) reports the following:

At present, there are 24 accredited Cytotechnology training programs in the United States and Puerto Rico. There are 8 certificate-only Programs, 8 degree-only Programs, and 9 certificate and degree Programs.  As of 2017, there are 5 Masters Programs with another to begin in 2018. While the number of Programs has decreased, satellite sites and distant learning/online education have become more prevalent.  The CPRC continues to focus on “phase II entry-level competencies” and collecting data as part of the process of moving 3 different levels of education to a Masters level curriculum.  Fitting [this] robust curriculum into the current academic structure is difficult; realistically, most Programs are educating their students at Masters level in bachelor and certificate programs.

The CPRC will be working this year on recommending new entry level competencies (ELC) for the 2018 revision of the Standards and Guidelines for the Accreditation of Educational Programs in Cytotechnology. These competencies will define the new cytology mid-level practitioner. These are powerful seeds, indeed, that will yield a new crop of “cytotechnologists” who will not be as limited in their scope of practice. The movement towards a team approach in medicine requires partners trained in rapid on-site evaluation, triage of specimen for ancillary testing, digital pathology and informatics, and molecular techniques.

Cytotechnologists were seeded into our organization decades ago, became ASC members, had their own board and then became members of the Executive Board. They are now committee Chairs and members. They are the heart behind the organization and remain a driving force in sowing seeds of change. The ASC/ASCP (American Society for Clinical Pathology) Workgroup, consisting primarily of cytotechnologists, was established in 2014 to identify professional trends and develop goals and outcomes to support the profession’s longevity. I am delighted to report that the culmination of their tireless efforts will be available to you in the fall, as manuscripts in the Journal of the American Society of Cytopathology and the ASCP’s Laboratory Medicine. They will be publishing their data on current and future trends (collected through focus groups and a Delphi Study), the ASCP Board of Certification Practice Analysis data, and the outcomes of the Advanced Education in Cytopathology grass-roots courses. Now that their initial goals have been achieved, the ASC/ASCP is restructuring to become the Workgroup on Emerging Roles for Cytopathology (WERC).

Speaking of planting seeds, the ASC has been invited to join the ASCP and USCAP “Africa Calls” efforts to deliver cytopathology education to sub-Saharan Africa. The ASCP has been supporting this effort for over 20 years, with 22 sites in 13 countries, but these programs are looking for teaching slide sets and physical materials. If your institution or program has materials that they would like to contribute, please contact David B. Kaminsky, MD, FIAC, the Executive Vice-President of the United States and Canada Academy of Pathology (USCAP). The ASC will be investigating ways that we can facilitate these efforts through our organization. Meanwhile, the WERC will be “werking” on the ACE University – a certificate program that will offer cutting-edge updates to cytopathology practices in the form of on-line modules for current practitioners to fine-tune current skill sets.

There’s still time to get out into your cytogarden and spread a few seeds of your own; you never know what might take root.

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