Recommendations of the European Advisory Committee of Cytotechnology and European Federation of Cytology Societies for Training and Education of Cytotechnologists in Europe

The training and education of cytotechnologists in European countries varies greatly in terms of qualifications, methods, quality, level of education, and the recognition of the profession. The aim of these recommendations is not to impose, but to guide and assist national cytological and cytotechnological societies in drafting, amending, and supplementing the basic education program for cytotechnologists. It is important to harmonize the education and training of cytotechnologists in European countries, and there is an urgent need to develop and adapt these so as to meet the paradigm shift in cervical screening programs and the future needs in cytopathological diagnostics. We strongly believe that these guidelines will be helpful in the training and education of cytotechnologists. On a daily basis, they are confronted with the fact that, besides a good knowledge of morphology, they also need to be familiar with a growing range of new tests such as HPV-testing in screening programs against cervical cancer, automated screening, liquid-based cytology, new diagnostic methods and technologies including molecular and cytogenetic methods that are contributing to a more accurate diagnosis. Cytotechnologists must maintain the existing position in cytopathology diagnostics and be able to perform, understand, and correlate morphological findings with the findings of other relevant diagnostic methods. Proper training and education for the future needs in cytopathological diagnostics, especially in nongynecological cytology for the purpose of prescreening is a necessity, both for keeping the cytotechnologists in the laboratory as the number of cervical specimens will decrease substantially in a few years, as well as for the future of cytology in general.

In 2010, the European Federation of Cytology Societies (EFCS), represented by the General Secretary Philippe Vielh, gave the assignment to draft guidelines for minimum requirements for practising Cytotechnology in Europe to members of the European Advisory Committee of Cytotechnology (EACC). An EACC Working Group, chaired by Veronika Anic and cochaired by Maj Liv Eide – on behalf of the EACC members was established. During 2019, the EFCS accepted the proposal of the EACC Working Group to develop a joint proposal for the education of cytotechnologists in European countries. The EACC/EFCS Working Group was expanded with new members: Beatrix Cochand – Priollet as a Secretary-General of the EFCS, Danijela Vrdoljak-Mozetic as a Chairperson of the EFCS Educational Committee, Giovanni Negri from EFCS Tutorial Committee and Philippe Vielh as a former EFCS General Secretary, and the initiator of this document. On this occasion, this joint educational proposal was made.

Data were collected from the previous surveys and presentations delivered during the European Congresses of Cytology (ECC) of EFCS and during the International Congresses of Cytology (ICC) of the International Academy of Cytology regarding training and education of cytotechnologists:

• Training of cytotechnologists in Europe, from 2006 (EFCS/Eurocytology project)

• Preliminary report – basic requirements for practising cytotechnology in Europe, from 2010 (17th ICC, Edinburgh, Scotland)

• Training and education of cytotechnologists in Europe, from 2011 (36th ECC – Istanbul, Turkey)

• Minimum requirements for practising cytotechnology in Europe, from 2012 (37th ECC – Cavtat, Croatia)

• EACC recommendations for minimum requirements for practising cytotechnology in Europe, from 2013 (18th ICC – Paris, France)

• EACC recommendations for training and education of cytotechnologists in Europe, from 2015 (39th ECC – Milan, Italy)

• EACC training and education recommendations, from 2016 (40th ECC – Liverpool, England)

• Reality knocks at the door – do we need recommendations for education of Cytotechnologists in European countries from 2018 (41st ECC Madrid, Spain)

Data were also collected from articles related to this subject published in Cytopathology [1-3], articles from the American Society of Cytopathology [4, 5], and data provided by the European National Cytological and Cytotechnological Societies. All data collected, taking into account the needs and opportunities acceptable to all participating European countries, form the basis of this common conclusion on the basic requirements and guidelines for future education of cytotechnologists in Europe.

In most of the countries who responded to the survey in 2010 and 2011, the basic educational requirement for entering into cytotechnology training was medical laboratory technology or bachelor’s degree in biomedical science. The authors suggest that the basic educational standard required for entering into cytotechnology training should be a bachelor’s degree (180 ECTS) in medical laboratory technology, biomedical science, or other medical profiles that are at college/university level where the educational level meets the criteria for entry into further training in cytotechnology. The subjects in the bachelor’s program should encompass cell biology, biochemistry, anatomy, basic pathology, histology, molecular biology, laboratory technology methods, molecular diagnostics, and, preferably, an introduction to cytology. An introduction to cytology in the bachelor’s program would be an advantage for recruiting students to the profession and with this background the training period in cytotechnology could be more efficient. Future cytotechnologists have to be multiskilled in order to meet the future needs and a bachelor’s degree with the proposed subjects would be a prerequisite. In a future with uncertainty about the cytotechnologist’s place in diagnostic cytopathology, this issue needs serious and urgent attention.

After completing a bachelor’s degree, we suggest that additional education in cytotechnology should be organized in the form of a 1-year postgraduate training program (60 ECTS) in cytotechnology divided into 3 modules: module A: gynecologic cytology, duration 12 months, module B: nongynecologic exfoliative cytology, duration 6 months, and module C: nongynecological fine-needle aspiration cytology, duration 6 months, which means that trainings in gynecologic and nongynecologic cytology are combined and learned in parallel. Training programs should be organized by an accredited university. The training should, preferably, be a combination of in-house training in a cytology laboratory, and education courses at the university. The curriculum for the postgraduate training programs for cytotechnologists should include specific subjects, with defined knowledge and skills in anatomy, physiology, histology and cytology of organs and tissues, theoretical and practical training in gynecologic cytology (Table 1), nongynecologic exfoliative cytology (Table 2), and nongynecologic fine-needle aspiration cytology (FNAC) (Table 3). The training program should also include ancillary techniques, quality assurance, quality control, and basics of informatics. The supervisors/teachers should be cytopathologists and cytotechnologists with minimum of 5 years of experience in practising cytopathology and cytotechnology. The trainee should have access to teaching slide collections with a variety of slides from different organs and body sites, with various staining methods and ancillary techniques, covering nonmalignant, inflammatory, premalignant, and malignant diagnosis. The trainee should keep a record of training activities in a portfolio, which should be regularly assessed by a supervisor. For obtaining EFCS Cytotechnology degree, the Universities should seek the approval of the cytotechnology course program from EFCS. At the end of each module, the level of competence should be tested with an exam. After completion of all 3 training modules and a successful final examination, EFCS and EACC propose that the cytotechnologist receive a national university diploma with an official title: EFCS certified cytotechnologist. For those who wish to obtain a master’s degree, we suggest an additional education at the university working toward a relevant master’s thesis, but this would be optional. EFCS diploma in cytotechnology is suitable for laboratory management, training, teaching, and research. Given the diversity and absence of European standards in the education of Cytotechnologists, it is recommended that, after completing the training, cytotechnologists can verify their acquired knowledge through a National exam, through QUATE (Quality Assurance, Training, and Examinations committee) Aptitude Test in cervical cytology or International Academy of Cytology comprehensive cytotechnology examination, depending on relevant national or local regulations.

Cytotechnologists should participate in discussions and reviews of difficult cases with cytopathologists. They should participate in training courses, tutorials, and professional development courses on new techniques and developments, have access to cytology journals and textbooks, and participate at national and international cytology meetings and congresses. They should also participate in external quality assurance programs where available.

Major changes will happen in the cervical screening programs in the next few years, due to HPV vaccination and HPV primary screening. Now is the time to make an effort to agree on minimum requirements for practising cytotechnology in Europe. It is extremely important that these recommendations, especially for nongynecological cytology, become a guiding principle in the education of cytotechnologists in Europe. The curriculum is not very different from the one that the American Society of Cytopathology, American Society of Cytotechnology, and other societies approved in 2013 [4, 5]. EACC and EFCS as professional Societies are the only competent bodies to draw up guidelines for training and education of cytotechnologists in Europe. The authors of these recommendations believe that it is important to spread the word about EACC and EFCS attitudes toward the future training and education of cytotechnologists. We are aware that these recommendations mainly apply to those countries that have well-organized cytology settings, to those who will be trained and employed in the future, but also provide a good professional instruction to those societies that do not yet have a program/have incomplete educational program for cytotechnologists in their countries. Cytotechnologists possess a unique combination of morphological, medical laboratory, and technological knowledge; hence, it would be a loss for the cytology and pathology departments if the cytotechnologists lost their positions.

The authors have no ethical conflicts to disclose.

The authors have no conflicts of interest to declare.

The authors have no funding to report.

Veronika Anic and Maj Liv Eide writing and design of the original draft, review and editing, and creation of tables. Beatrix Cochand-Priollet, Danijela Vrdoljak-Mozetic, Giovanni Negri, and Philippe Vielh provided critical comments. All the authors contributed to the editing and proofreading of the final manuscript for submission.