2015/05/02 Sharon Crafter

Transcription

1 IS THERE A CRISIS IN CYTOTECHNOLOGY IN ONTARIO: COMPETENCIES FOR THE FUTURE May 2015 Objectives Describe what we know about the past, current and evolving environment of the practice of cytopathology Identify issues as they relate to cytotechnologists as a result of changes to gynecological screening practices Describe what we know about the current skill sets of those who support the practice of cytopathology today Assess the skills needed in the cytotechnologist of the future A look back s 2000 s Liquid based collection media Automated processing Computer screening Improved staining techniques Rigid government regulation Vaccines Guidelines / Task Force ASCCP & QMPLS Consensus Guidelines ASC Education, Forbes Report: Re-define scope of practice, Expand the role of cytotechnologists, Expanding scope not the answer 2012 CSMLS Competency Review 1

2 Our Skills. Morphology is the strength and core competency Work independently Collaborate to deliver services Gather and review patient history/clinical data to facilitate optimal testing and reporting Perform high complexity testing, validation and test verification Capable of performing ancillary testing Troubleshoot specimen collection, handling, preparatory issues Our Skills. Training in anatomy and histology Participate in quality assurance activities Well versed in issues of laboratory accreditation and compliance Educate others in many aspects of collection, testing and interpretation Capable of excelling in other areas of laboratory administration, testing and quality assurance Survey Monkey Survey of Cytotechnologists in Ontario Autumn 2013 Response rate 131/140 (94%) Provincial Election Response Rate 52.1 % 2

3 Who we are. 50 % hospital lab 45% private lab 5 % not in Cytology lab 3

4 Q1 & Q2 Comments: Positive for the patient?... n=58 Not so for women under 21; 30 (34) Interval too long (16) Savings may not lead to better patient care (7) HPV vaccine and testing coverage may not be adequate (11) Research supports this change (4) Reductions in Staffing Comments: Changes Directly Impacted?... N=23 Reduction in student intake in training programs OK if Hospital with Non-Gyn as the main volume; increasing ROSE Uncertainty in the profession; new grads Must justify our utility to management Terrifying to come to work not knowing if more will be laid off 4

5 500, , , , , % drop 250,000 Total # Cases Jan - Mar 2012 Total # Cases Jan - Mar , , ,000 50, % drop 0 Hospital Cytology Laboratories Community Cytology Laboratories QMPLS Patterns of Practice CYTO-1305-PP Cytotechnologists used in other areas / laboratories? 5

6 Recommendations for CSMLS Competency Review? Comments: Recommendations to Competency Profile?... N=19 CMLTO licensing limits the scope of practice Support an expanded role with additional competencies Don t know what path to explore Roles already covered by other MLTs 6

7 What is the scope of practice for a cytotechnologist? Medical laboratory technologists (MLTs) all share a common scope of practice and are individually accountable both to the employer and to the [College] for their conduct and for ensuring that they have the knowledge, skill and judgment to practice safely. The MLT Scope of Practice in Ontario is defined in The Medical Laboratory Technology Act, 1991: The practice of medical laboratory technology is the performance of laboratory investigations on the human body or on specimens taken from the human body and the evaluation of technical sufficiency of the investigations and their results. Employers may provide an MLT with education and training to enable an MLT to practice in areas that fall outside the specialty(ies) included on the MLT certificate of registration. MLTs are accountable to their employer and the College for their conduct and professional practice. The employer is also accountable for an MLT practicing outside the specialty(ies) listed on their certificate of registration. If a new molecular test is being introduced in a microbiology laboratory, can an MLT with microbiology on his/her registration perform the test? Specific laboratory techniques, and as such, an individual MLT s ability to perform them are of registration. Under the Medical Laboratory Technology Act, 1993, technique safely and competently, then there is to perform a new them from doing so. However, facility policies and training need to be considered and supervision of the individual would be a based on the individual MLT s knowledge, skill and judgment in the area they are working in. 7

8 3.03 Prepares specimens for current and future analysis e.g. gynecological and nongynecological, grossing, immunohistochemistry, molecular, and flow cytometry 5.06 Analyzes routine, special and ancillary stains and techniques e.g. Papanicolaou, H&E, telepathology, flow cytometry, FISH, PCR and EM The Present? Transferable Skills 8

9 Changes Underfoot. Continuing Education Molecular Biology (Michener) Grossing (Michener) Histology Refresher (CSMLS) Training Program Increased histology (grossing, embedding, staining) Increased pathology Clinical rotation to histology, molecular Emerging roles? CAP Cytotechnology Programs Review Committee Advanced level position To assist pathologists Extended role FNA adequacy assessment (with professional fee charge) Special stains Selecting material for molecular testing Digital pathology Prep for tumour boards Test development Regulatory compliance Staying afloat. Educational sources to supplement current knowledge base Image analysis and quantitation of immunohistochemistry In-situ hybridization analysis Operational and regulatory aspects Screening special stain slides on histology/identification of tumor on sections Role of genetics in cancer management and prevention Develop a keen understanding of validation Understand the pros and cons of screening algorithms 9

10 The future. Proceed with anticipation and caution! Cytomorphology training is still valuable Will expanding the role of the cytotechnologist polarize our profession? Will turf wars slow progress? Will cross training undermine the specific locator skills inherent in our craft? Will the changes affect patient safety and care? Will developing a new professional enhance job satisfaction and create a more stable workforce? Face the music If it involves the cell it should be ours The work to be done is our own look to ourselves Be aggressive in defining our scope keep what is in our purview and gain evolving technology Courage to be vocal on our own behalf; be open-minded Play an active role Advocate to the CSMLS Advocate to the CMLTO Advocate to your employer Come together as the full pathology specialty; one size may not fit all No one saves us but ourselves. Buddha 10