TRAINING AND EDUCATION OF CYTOTECHNOLOGISTS IN EUROPE Anic V. et al. on behalf of EACC

BACKGROUND  Updated, extended and revised version of the Questionnaire on training of Cytotechnologists in Europe that was presented at the EFCS meeting during the 17th International Congress of Cytology in Edinburgh.

 There are included issues related to the numerical state, academic level, included subjects and duration of the basic education and training in cytology. Required number of slides examined under supervision prior to sign out cervical cytology specimens.

 Accreditation and recognition of education, also issues related to the strategy of continuing education and external quality assurance scheme.  We will try to answer the questions about the future optimal training Cytotechnologists, degrees and diploma that would enhance the acknowledgement of Cytotechnologists in Europe.

MATERIAL AND METHODS:  A questionnaire was sent to 25 countries, 14 countries that are EACC members and to the 11 countries that are members of the EFCS but without representatives in EACC.  On this questionnaire, we received responses from 18 countries.

Countries – EACC members Reply Austria (AUT)YES Belgium (BEL)YES Croatia (CRO)YES Denmark (DEN)YES Finland (FIN)YES France (FRA)YES Germany (GER)YES Italy (ITA)YES Netherlands (NED)YES Norway (NOR)YES Slovenia (SLO)YES Sweden (SWE)YES Switzerland (SUI)YES United Kingdom (UK)YES

Countries EFCS members – without EACC representative Reply Albania No reply Greece (GRE) YES Hungary No reply Macedonia No reply Poland No reply Portugal (POR) YES Romania No reply Russia No reply Slovakia No reply Spain (ESP) YES Turkey (TUR) YES

Note: Replies from Italy, Greece and Turkey are excluded from this survey because:  In Italy, education does not exist, and answers to the rest of questionnaire are not received.  In Greece, Cytotechnologists do not exist as a profession. Cytopathologists perform screening.  In Turkey there is no official Cytotechnologists, however few biologists with MSC or PhD are practising as Cytotechnologists at some laboratories.

RESULTS AUSTRI A BELGIUM CROATI A DENMAR K FINLAN D FRANCEGERMANY THE NETHERLAND S 300± NORWAY PORTUGA L SLOVENIASPAIN SWEDENSWITZERLAND UNITED KINGDOM UNKNOWN220UNKNOWN± 1300 The approximate number of fully trained and employed Cytotechnologists:

 According to competence level most of the Cytotechnologists are on intermediate level (can report and sign out negative and unsatisfactory cervical cytology specimens, can undertake rescreening and offer a differential diagnosis on abnormal specimens).

 Denmark, Finland, Germany, The Netherlands, Sweden, UK and Portugal also have some Cytotechnologists that are on an advanced level (can report and sign out normal and abnormal cervical cytology specimens), while only few in all the countries are on a basic level (cannot report negative or unsatisfactory cervical cytology specimens).

BASIC EDUCATION  The basic educational standard required before entry into cytology training is mostly medical/laboratory technologist, but also biomedical scientist.  Academic level and duration of the given basic education is mostly college (in seven countries: AUT, BEL, DEN, SLO, SUI, ESP, partly UK) in duration of 3 years with bachelor degree after completing education.

 In eight countries (BEL, FIN, FRA, NOR, SWE, POR partly CRO and UK), academic level of the basic education is university in duration from 2- 4 years with master or bachelor degree.  Three countries (partly CRO, GER, NED) have a high school in duration of 4 years as an academic level of the basic education.

 Cytology, cell biology, molecular biology and/or biochemistry subjects are included in the basic education with exception of Portugal where these subjects are not included and cytology is not included in Belgium and France.

TRAINING IN CYTOLOGY  The training in cytology is mostly (in seven countries: CRO, FRA, NED, SLO, SWE, SUI, ESP) given as a separate course/education.  In five countries (FIN, GER, NOR, UK, POR) it is possible to have training/education as a part of general program of in-house training in the laboratory and as a separate course/education.  In three countries (AUT, BEL, DEN), education is given as a part of general program of in-house training in the laboratory.

 Duration of the training in cytology as a part of general programme of in-house training in the laboratory varies from 3 months up to 2 years.  In most of the countries, gynaecology cytology is joint with non-gynaecology cytology in the education. In five countries (AUT, GER, UK, POR, SLO) gynaecology cytology is separated from non- gynaecology cytology in the education.

 Duration of gynaecology cytology education is from 30 up to 120 credit points, or 90 up to 165 hours.  Duration of non-gynaecological cytology (only few answers) is from 20 up to 180 credit points, or from 3 months up to 369 hours.  Duration of joint education is from 30 up to 120 credit points, or from 100 up to 640 hours.

 Possibility of joining just one part of education (only education for gynaecology cytology) is accessible in seven countries (AUT, BEL, FIN, GER, NOR, UK, POR), not possible in seven countries (CRO, FRA, NED, SLO, SWE, SUI, ESP).  Subjects included in the curriculum are mostly gynaecology and non-gynaecology cytology, staining methods, molecular techniques and also lot of variations from anatomy, pathology, histology, quality assurance etc.

 Academic level that instructors/training officers at the workplace possess varies from senior cytotechnologists, staff with master or bachelor degree, with IAC exam certificate, cytopathologists, pathologists....

 Required number of slides screened with supervision before the Cytotechnologists trainees can sign out cervical specimens is from 770 up to 7000 slides, but mostly around  Approximate number of persons training to be Cytotechnologist varies from three up to 25 each year (Spain from ?)

 Who decides the training requirements for Cytotechnologists in the country ?  In six countries, it is professional society, in three Ministry of education, government in two and nobody in four countries!

ACCREDITATION AND CERTIFICATION  Cytology training programme is accredited from academic institution on university level in five countries (AUT, FRA, NOR, SWE, POR), on college level in one country (ESP), on high school in one country (NED).

 In the other countries, cytology training programme is accredited from other institutions: professional society, Ministry of health or education and institution that carry out the above mentioned education, in one country education is without accreditation.

 Training programme is recognized nationally in almost all of the countries, exception is Belgium, Finland and Sweden where training programme is not recognized.

Students who complete training programme are awarded a: DIPLOMADEGREE CERTIFICATE OF COMPETENCE FranceCroatiaAustria The NetherlandsFinlandBelgium NorwaySwedenDenmark (QUATE exam) SpainGermany SwitzerlandPortugal United KingdomSlovenia

CONTINUING EDUCATION AND QUALITY ASSURANCE  Arrangements/strategies for continuing education in cytology: almost all have annual meetings and courses that are usually not mandatory, but mandatory for all staff reporting cervical cytology in UK and Norway.  Congresses are also represented in most of the countries, but not mandatory.  From the other options accessible are slide seminars, one-day meetings and workshops.

Approximate number of cytotechnologist who has taken and passed the exam of the: COUNTRYIACQUATE Austria (300) 2232 Belgium (±300) few Croatia (225) 00 Denmark (175) 19Approx. 130 Finland (±200) France (±800) Germany (2600) 15%Very few Netherlands (600) No data Norway (130) 20 Portugal (2000) 6020 Slovenia (35) 01 Spain Sweden (220) 185 Switzerland -- No data United Kingdom (±1300) No data

 On the question “Is the Eurocytology Website learning platform widely used in their countries ?” - all participants answered with NO!  Eurocytology Website learning platform is not widely used in their countries.

AUSTRIABELGIUMCROATIADENMARK FINLAN D FRANCEGERMANY THE NETHERLANDS NO YES NO YES 1 x /year every 1-3 year NORWAYPORTUGAL SLOVENI A SPAINSWEDENSWITZERLAND UNITED KINGDOM NO YES (IMC)YES 4 x / year4 × /year1 x / year 1x every 2 years 1×/year Is there an organised external quality assurance (EQA) scheme running in your region or country and how frequently does it run?

OPTIMAL EDUCATION?  Finland, the Netherlands, Norway, Switzerland, and Portugal believe they have the optimal or close to optimal education of Cytotechnologists.  All the others answered that they do not have the optimal education of Cytotechnologists in their country and thinks that the optimal education will be on the university level.

 Every participant have the opinion that diploma certified or accredited by EFCS would or probably would enhance the acknowledgement of Cytotechnologists in Europe.

CONCLUSION  The results of this survey is a summary of an existing and accessible education and training of Cytotechnologists.  What is common and what is different in 18 European countries, as well as suggestion for guidelines on which future training and education should be developed based on needs and deficiencies of the existing.