NHS Cervical Screening Programme (CSP): liquid-based cytology system conversion training
Updated 26 September 2024
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1. Introduction
The Clinical Professional Group for Cervical Screening Education and Training (CSET) has updated the guidance on liquid-based cytology (LBC) system conversion training which was first published in March 2016.
Conversion training is a programme requirement for all staff switching to, or reverting from, one LBC system to another or from conventional cytology to LBC.
This edition gives additional information on:
- training conditions for all staff switching to one LBC system to another
- competency requirements for staff — as well as pathology screening education and training centres — following system conversion and reversion
The programme can still be used to provide full conversion training from conventional cytology to LBC cytology (where this has been requested).
2. Training conditions
A programme-approved screening and education centre (from this point called ‘training centre’) must provide the LBC conversion training.
Laboratory training officers, with advice from the training centre, should decide the best time for trainee cytology screeners to start system conversion.
Representatives from the commercial LBC companies can provide on-site technical support for laboratories undergoing system conversion. This does not (and must not) replace the required training as detailed here.
The local screening quality assurance service (SQAS) must endorse any arrangements for system conversion training and its provision.
The training centre should issue a ‘certificate of completion of LBC system conversion training’ to individuals who have completed the course satisfactorily. The certificate should be specific to the system the individual was trained on.
LBC conversion training can count towards the 3-yearly NHS CSP update, but this is subject to meeting the conditions set out in this guidance.
2.1 Training venue
The course should be held at a programme-approved training-centre or at a laboratory.
Laboratories must make sure their existing approvals are still valid if they are planning to have their training provided on-site, or arrange to have their facilities approved as soon as possible.
The laboratory manager and training centre manager should contact the visits co-ordinator to make arrangements for a site visit.
The site visit must take place at least 3 months before the proposed course dates and should be taken into account when setting the conversion schedule.
3. LBC system conversion training
3.1 An overview
Training is specific to LBC cervical cytology collection and preparation systems.
All qualified staff converting from one LBC technology to another must complete the theoretical course and follow-on assessment of 200 slides.
The theoretical course includes lectures and microscopy. This includes multi-header review and discussion of cases (approximately 80%).
Staff may screen the self-assessment slides at the training centre by arrangement, or at the home laboratory.
3.2 Course duration
The full system conversion training takes about 39 hours. This may vary according to each person and their learning needs.
Estimates for the amount of time taken up by the various course components are included below.
| Activity | Approximate duration | Rationale |
|---|---|---|
| One-day theory course | 6 hours | See course content below |
| Primary screening of 200 assessment slides | 25 hours | 7.5 minutes per slide based on NHSCSP-recommended screening rate of 8 slides per hour |
| Follow-up review and feedback | 8 hours | 2.5 minutes per slide based on anticipated learning curve |
3.3 Course objectives
The course objectives include:
- making sure participants are familiar with the morphological features of the LBC system on which they are being trained
- resolving any interpretation difficulties arising from converting from one system to another
- explaining the LBC system competence requirements of the CSP
3.4 Course content
The course includes:
- a brief comparison of the system’s technical aspects (including collection technique and technical troubleshooting)
- a minimum of 45 minutes’ lecture time on comparative morphology, screening techniques and assessment of sample adequacy
- a minimum of 4 to 5 hours’ microscopy — to include a workshop as well as self-assessment cases, test sets, and multi-header review of test set cases
- a final assessment of 10 fully screened slides at the end of the course
- instructions for the slide self-assessment component and course evaluation
3.5 Assessment and satisfactory performance
Course participants must complete 1 set of 200 assessment slides within 2 months of attending the system conversion course. The slide set should contain 40 to 50 high-grade samples.
The training centre should provide review and feedback to the participant at agreed intervals, allowing for any interpretation difficulties to be addressed and corrected.
Course attendees must achieve a minimum of 95% high-grade cytology sensitivity and 70% cytology specificity.
If an individual has a valid reason for not completing the 200 assessment slides within 2 months of attending the course, local management can exercise discretion and extend the training period, on advice from the training centre.
If an individual does not achieve the required cytology sensitivity and cytology specificity on the 200 assessment slides, they should get additional support from the training centre.
Additional support may include:
- one-to-one tuition
- online webinar
- the loan of additional training material
3.6 The marking scheme for assessment slides
The slides are marked as below.
| Marking scheme | Marks allocated |
|---|---|
| For a slide that is not examined | 0 |
| If the assessment matches the proffered grade | 5 |
| If the assessment of an abnormal specimen (borderline or above) is one grade different from the proffered grade | 4 |
| If the assessment (as above) is 2 or 3 grades different from the proffered grade | 3 |
| If a negative sample is called either borderline or dyskaryotic | 2 |
| If a dyskaryotic sample is called negative or inadequate | 2 |
| If the assessment is glandular neoplasia and the proffered diagnosis is severe dyskaryosis or vice versa | 5 |
Please note:
- there is no reduction in score for a missed infection
- there is no reduction in score for a negative slide assessed as inadequate or vice versa
- over-calling of negative preparations as borderline nuclear abnormality or above are recorded
- under-calling categories of low grade and high grade are recorded (separately)
- squamous carcinoma is grouped with squamous dyskaryosis for marking purposes
- a slide will be scored according to the highest abnormality recorded if more than one box in the morphological features section of the response sheet is ticked (transcription error)
4. Maintaining competency in LBC systems
It is the responsibility of the lead pathologist in the cervical screening laboratory to make sure staff are qualified and competent to undertake their professional duties.
4.1 Converting from one system to another and reverting
Local management will determine the specifics of updating staff who have previously converted from one LBC technology to another and plan to revert, and with advice from a training centre. Staff must demonstrate their competence in signing out or reporting abnormal cytology, through successfully completing a set of self-assessment slides.
If the laboratory reverts to a previous system within 12 months or less, then staff should complete a minimum of 50 self-assessment slides.
The self-assessment exercise should be formally documented.
If the laboratory reverts to a previous system after more than 12 months, staff must complete a minimum of 100 assessment slides. The training centre must provide and assess these slides.
4.2 Staff switching from one system to another
Staff switching from one system to another within a relatively short period (12 months or less) having previously had full training in both, including locums, should complete a competency assessment on a minimum 50 slides.
The laboratory should provide the slides and formally document the exercise, as confirmation the individual is competent to screen.
The laboratory manager is responsible for making sure the record is completed and signed off. The record should include:
- the individual’s name
- date of employment
- date technology last screened
- date 50 slides completed
- high grade sensitivity
- specificity
4.3 Competency requirements for trainers
Trainers (training centre staff) who convert to a new system must complete the conversion training course described here. In addition, the trainers must consolidate their skills and experience through routine screening work for a period of 6 months before training laboratory staff in that system.
If a training centre reverts to a previous system, depending on the time lapse and available material, staff must validate their competency and document a self-assessment up to at least 100 slides before they can provide training for laboratory staff.
A trainer who no longer uses a system in routine practice can continue to teach for up to 6 months from the time it is withdrawn from use.
Training centres can offer training on current systems. The staff providing system-specific training must be currently undertaking routine screening work using the relevant system.
Trainers should not themselves provide training on systems which they employ outside routine screening, such as systems used primarily for colposcopy samples.
5. Conversion from conventional cytology to LBC
Although conventional cytology technology is no longer used in the CSP, there are occasions when full conversion training is requested by laboratories which have employed a qualified cervical cytology screener with no previous experience of LBC.
The programme should keep the ability to provide full conversion training, although it is expected that the need for this will be in the short term only.
Full conversion training is in addition to any local ‘return to work’ requirements. The induction course must be provided by a programme-approved training centre.
Full conversion training is comprised of:
- an induction course
- a consolidation stage
- an interim test
- a performance review phase
5.1 Induction course
The induction provides an introduction to LBC covering the basics which are common to all available commercial systems, as well as system-specific morphological training.
We expect the induction to last a minimum of 20 hours over 3 days, although this will vary.
The training programme will include lectures, workshops, test sets and discussion of cases on a teaching microscope.
The training centre should provide the individual with a written assessment at the end of the induction course.
5.2 Consolidation stage
Following successful finishing the induction course, the individual must complete an in-house consolidation stage. This lasts up to 4 weeks, and individuals are expected to fully screen a total of 200 unmarked LBC slides compiled into 10 training sets.
The training centre should mark each person’s response sheets as described in this guidance.
5.3 LBC interim test
At the end of the consolidation stage, the training centre should work out the individual’s screening sensitivity. If this meets or is over the national target for moderate dyskaryosis and above, the person can take the LBC interim test.
The interim test comprises a set of 20 unmarked slides of both negative and abnormal cases. Individuals must achieve a score of 80% or more before moving to the final stage of training.
Individuals who do not pass the interim test should be offered further training and support. An individual must successfully complete the interim test before moving on to the next stage of training.
5.4 Performance review
The performance review phase is the final part of practical training.
An individual should gain further experience and build confidence by screening a further 200 samples to achieve the required level of sensitivity.
The slide sets should reflect routine laboratory experience as far as possible and seeded with enough abnormal cases to allow sensitivity to be worked out.
Each individual should aim to finish this part of their training within a 4-week period.
The training centre should mark each person’s response sheets.