Cytotechnology in Saudi and Cytotechnology in the US - Research Paper Example

?Cytotechnology Cytotechnology is the branch of science that is involved with studying cells. Cytotechnologists interpret Pap smears microscopically to see if they are normal or not. They make decisions about diseases by analyzing cellular patterns and small changes in the different parts of cells, especially the nucleus and the cytoplasm while correlating it to the patient’s history. Most of the work of the cytotechnology is independent and requires attention to detail as most of their work is microscopic. They have a great responsibility in making decisions for their interpretations of their findings based on the cells they investigate. Cytotechnologists work with samples from many parts of the body, such as lungs, bladders, body cavities, nervous system, GI tract, liver, lymph nodes, thyroid, salivary glands, breasts, and others to create preliminary interpretations of specimen. They work together with pathologists to determine what disease is afflicting the patient and whether this disease is benign, infectious, precancerous, or other malignancies. By providing these diagnoses quickly and efficiently, they can save many lives by pointing health care staff towards the right path to treatment of the patient as quickly as possible (“Profession of Cytotechnology; Hatt; “Cytotechnology” CAAHEP; “The Cytotechnologist”). Cytotechnology in the US History of Cytotechnology The basis for cytotechnology can be found as early as the 1800s. It started when cancer cells were reportedly found in various kinds of body cells. Even though people found these cancer cells, it was such a new concept to them that they did not make any effort to use cytology in a systematic approach to diagnose cancer during the time. In the 1900s, Dr. George Papanicolaou contributed greatly to the field with his research on cellular changes seen in vaginal smear of guinea pigs at different periods of the menstrual cycle, which he then applied to humans. As his research progressed, he was able to find cervical cancer cells from some of his smears and recognized them for what they were. From this, he made one of the most important advances in the field of cancer detection by applying wet fixation and developing what is now called the Papanicolaou staining method, or the Pap smear. This method uses a microscope to view the details of the nuclei of cells, which are important determiners in the diagnosis of cervical cancer (Naik and Zaleski). Dr. Papanicolaou’s collection of vaginal smears from women and his findings were published in his paper entitled New Cancer Diagnosis. This was presented at the Third Race Betterment Conference in Battle Creed, MI, in 1928. He concluded his paper by saying: “We have a better understanding of the situation in a cancer case, and we may have some help in analyzing the cancer problems in the future.” In that same year, Dr. Aurel Babes, a Romanian pathologist, also published a similar article entitled Diagnostic du cancer du col uterin par les frottis (The diagnosis of cancer of the uterine cervix from smears) in La Presse Medicale in April of that year. He gained little recognition from his research, and it never advanced farther than that. Dr. Papanicolaou initially found little recognition from the medical community during the first decade since his discovery until Dr. Joseph C. Hinsey, the dean of Cornell Medical College at the time, told him to try again. In 1939, Dr. Papanicolaou, with the help of gynaecologist Dr. Herbert Traut, reevaluated the efficacy of the vaginal smear as a diagnostic tool and procedure for detecting cervical cancer. They published Diagnostic Value of Vaginal Smears in Carcinoma of the Uterus in 1941 in the American Journal of Obstetrics and Gynecology. They also created the monograph Diagnosis of Uterine Cancer by the Vaginal Smear in 1943 (Naik and Zaleski). These groundbreaking studies paved the way to better detection methods of cervical cancer and revealed that there were a large number of patients with undetected cancer. They proved that one can detect cancer even without biopsy, which was the standard protocol at the time. They showed that cytologic screening is the more practical solution in the detection of cervical cancer. The American Cancer Society began to teach the people about the importance of the vaginal smears. Because of the large number of women interested in taking vaginal smears in case they had cancer, it became difficult for doctors to handle all the patients alone. They needed more people who could perform a vaginal smear and were trained to examine the specimens. There were some early programs which were very informal, mimicking an apprentice type of training. These first cytotechnologists were called technical assistants of the pathologists. The first special course of cytology was taught by Dr. Papanicolaou in 1947, and by the 1950s, the term cytotechnologist had emerged and was widely used (Naik and Zaleski). After vaginal smear technique was accepted, Dr. Papanicolaou tried to apply this technique in the detection of cancer in other parts of the body such as the lungs, esophagus, the stomach, the rectum, and the bladder. In 1954, he published Atlas of Exfoliative Cytology, which talked about cancer in other body sites, as well as the female vagina (Naik and Zaleski). Cytologic technique evolved and expanded beyond just the vaginal smear, and cervical cancer screening began to form. In the 1950s, the ACS and the National Cancer Institute financed public health screening projects. The first large-scale, mass-screening project with the Pap smear was done in Memphis and Shelby County, TN, in 1952. A lot of sponsoring agencies worked together to bring cervical cancer screening to the population. The United States Public Health Service funded project had a goal of screening 200,000 women between 20 to 50 years old within 3 years with an estimated budget of more than 200,000 per year. This event was featured in newspapers and magazines, and there were even billboards encouraging women to have this annual exam for the early detection of cervical cancer. Even some sororities raised some money to furnish clinic treatment rooms (Naik and Zaleski). In the first 3 months of screening, 10,000 women had already been screened; 63 were found with cancer. After 3 and a half years, even though they did not achieve their goal of 200,000 women, they were able to screen 108,000 women, or more than half of the female population in Shelby County. Among the 108,000 women, 773 had been detected with cancer (Naik and Zaleski). The findings of this screening project were recorded in detail by Dr. Erickson in his 1955 publication of the American Cancer Society with the title of CA: A cancer journal for clinicians, with 3 important conclusions: a) That exfoliative cytology is an effective and practical test in detection of uterine cancer, b) that detection must be followed by follow-up investigation of pathological studies of tissue biopsies to have an early diagnosis, and c) The best way to increase the patient’s chances of survival is to detect the cancer while the lesion is confined to the cervix (Naik and Zaleski). To meet the demand for pathologists during the mass-screening, 15 girls were trained as laboratory technicians to run tests. Three more girls got special training in Boston at Massachusetts General Hospital. They contributed to the screening program by carefully studying slides under microscopes to detect suspicious cells (Naik and Zaleski). After the success of this program, other large cities started to follow. Charlotte, NC; Washington, DC; Providence, RI; Louisville, KY; Columbus, OH; and Madison, WI all had their own mass cervical cancer screening programs. After a decade, The Times Picayune, a New Orleans newspaper, touted the Pap smear as a “true lifesaver and should be included as part of every woman’s yearly medical checkup” (Naik and Zaleski). Because of the spread of the Pap smear and the increased demand, there was a great need for more trained cyto-technologists. The ACS, the College of American Pathologists, and the American Society of Clinical Pathology, with the help of other organizations, began to investigate the creation and developments of standards and requirements for applicants to schools of cytotechnology in the 1950s. The first list of tentatively approved schools was released in 1957 by the ASCP Board of Schools of Medical Technology and the American Medical Association. By 1961, there were around 1,300 cytotechnologists employed in 800 laboratories with a total of 5,100,000 women served. This total of women served could double over the next few years, so even more technologists were needed to meet the demand. The success of the program and the need for more trained personnel encouraged educational workshops in Colorado Springs, CO, in December 1961. Directors of schools of cytotechnology shared teaching methods and student recruitment methods. During these meetings, they discussed educational requirements of their faculty, the organization and the allocation of study on gynecologic, and non-gynecologic specimens, materials, space, and equipment, and time for training. They also recommended inspections of training and a proper certification process with a practical examination (Naik and Zaleski). In 1962, the first set of educational standards, or the requirements for accreditation of cytotechnology training programs, was put to use by the ASCP Board of Schools and the AMA. By the early 1970s, the accreditation reviews and recommendations were being performed by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). This was replaced in the mid 1970s by the Committee on Allied Health Education and Accreditation (CAHEA). Also in the 1970s was when the American Society of Cytopathology petitioned the AMA to be the official body that would conduct accreditation reviews and make recommendation actions. They were granted recognition, and they formed the Cytotechnology Programs Review Committee in 1976 to face the task. The CPC worked together with CAHEA until the mid-1990s when the responsibility for accreditation went to the Commission on Accreditation of Allied Health Education Programs (Naik and Zaleski). As the training programs for cytotechnology became more structured and organized, certification was introduced. The first certification examination in 1957 by the Board of Registry of Medical Technologists was given to 63 people and used individual boxes of glass slides with questions that the test takers were supposed to answer. Over the years, the examination has changed in content and format as newer standards are followed. In the 1960s, due to the few examinees, tests were sent individually; as the number of cytotechnologists increased, it became centralized in 1970; Computer adaptive testing was used (CAT) in the mid 1980s. CAT was fully implemented for Cytotechnologists in 1991. Before, the certification was optional for the cytotechnologists, but because of the CLIA ‘88, certification or at least being eligible for one, became more necessary. The APA is still considered the certifying body of cytotechnologists. By 2006, there were 14,423 certified cytotechnologists. Specialty examinations in Cytotechnology were offered in 1959 to differentiate higher proficiency of the occupation with different skill sets. It was suspended from 1969 to 1986, but by the end of 2006, the ASCP had 555 Special cytotechnologists (Naik and Zaleski). Technological advances in the field have led to the integration of molecular diagnostics, immunocytochemistry, flow cytometry, and automation in the field of cytology. One of the more significant changes was Automation. Using automated tools in cytopreparation and computer-assisted screening has improved the cytotechnologist’s ability to detect abnormalities compared to traditional methods. It also made work faster and easier, increasing productivity, and consistency while decreasing turn-around (“Profession of Cytotechnology”). Molecular diagnostic testing also contributed to the detection of clinically relevant infections common to Cervical cancer. It is similar to cytotechnology in that it uses microscopic analysis and interpretation of specimen. The American Society for Clinical Pathology offers a certification program in molecular biology and other medical laboratory scientists (“Profession of Cytotechnology”). In Saudi Arabia, Cytotechnology started in the early 1990s to provide the citizens of the Kingdom with a faster means of diagnosis and treatment of diseases. There are currently around 25 certified cytotechnologists in the country. Most of them get their certifications from US agencies. Recently, the National Guard Health Affairs (NGHA) of Saudi Arabia made their own Cytotechnology Training Program in collaboration with Thomas Jefferson University in Philadelphia, Pennsylvania, USA to be able to certify more Medical Technologists as Cytotechnologists. Students who complete this new program can sit for the ASCPi or the IAC certification examination. Some of the major hospitals in the Kingdom have started on Molecular testing programs to further enhance the profession. Education/training Requirements In preparation for a career in cytotechnology, it is advisable for the interested individual to have a strong background in the basic high school sciences: Biology, Chemistry, math, and computer science. The individual must have formal education leading to a baccalaureate degree. To become a cytotechnologist, you must first attend any accredited program in cytotechnology accredited by the Commission on Accreditation of Allied Health Education Programs. There are around 31 accredited programs in cytotechnology (“Profession of Cytotechnology”). Applicants should be grounded in biological sciences and chemistry. This means completion of at least 28 semester hours in biological sciences and chemistry by the end of a cytotechnology program, and three semester hours of mathematics and/or statistics. The baccalaureate degree is needed to qualify for the national certification exam (“The Cytotechnologist”). The curriculum includes the principles of cytopreparation, cytologic evaluation from various body sites, introduction to management, research, and education involved in the cytology laboratory, and cytology applied to clinical medicine (“Cytotechnology” CAAHEP). The length of the program changes depending on the organizational structure. Generally, after finishing the prerequisites, at least one year of structured professional instruction in cytotechnology is enough to accomplish the program objectives and make the student competent enough in entry level-cytotechnology skills (“Cytotechnology” CAAHEP). There are also some requirements for International Cytotechnologists for US employment. The Clinical Laboratory Improvement Act of 1988 imposed that applicants must have graduated from a school of cytotechnology accredited by the CAHEA, or currently, the CAAHEP (Commission on Accreditation of Allied Health Educational Programs) (“Profession of Cytotechnology”). The ASCP also offers certification in Gyn cytology for international candidates. Being certified as an International Technologist in Gynecologic Cytology, CTgyn (ASCPi) means that you are committed to the high standards of the ASCP, but is not as good as fulfilling the US employment requirements stated in the previous paragraph) (“The Cytotechnologist”). Cytotechnologists in Saudi Arabia have similar educational requirements and trainings with US based Cytotechnology programs. Cytotechnologists from Saudi Arabia are usually sent to the US for further training and certification. Certification/licensure Requirements Once the student has met the academic and laboratory education requirements, they have to take the national certification exam given by the ASCP Board of Registry. This certification is valid for three years, which can be renewed by taking the Certification Maintenance Program every three years (“Profession of Cytotechnology”; “The Cytotechnologist”). To be able to work as a Cytotechnologist in major hospitals of Saudi Arabia, it is required to have certification from the Saudi Council Healthcare Specialties (SCHS) as a “Specialist” and a certification from ASCP or IAC. Completing the NGHA program allows the students to attend the ASCPi or IAC certification examination. Continuing Education Requirements Depending on the level of education and the number of years of experience, a cytotechnologist can choose to take in some opportunities for specialization. A cytotechnologist with a baccalaureate degree and five years of experience, a master’s degree with four years of experience, or a doctorate with three years of experience can all qualify to take the examination to become a Specialist in Cytotechnology (SCT). This means that they are proficient and are capable of examining all types of body specimens, including needle aspirates and fine needle aspirates. Other opportunity of specialization is the Technologist in molecular pathology (MP), which is a new field of cytotechnology that is fast becoming a popular field (“Profession of Cytotechnology”; “The Cytotechnologist”). Employees in Saudi Arabia must meet continuing medical education requirements in accordance to the ASCP, IAP, and SCHS guidelines. WorkPlace Characteristics Cytotechnologists are essentially specially trained technologists who have a role in working with pathologists in the evaluation of cellular material from almost all body sites using a microscope. The cytotechnologist recognizes and differentiates between normal and abnormal cells and changes, such as malignancies, inflammations, neoplasms, lesions, infections, among others. They utilize a wide variety of skills that allows them to work with almost any cytologic specimen, and they also have the basic knowledge in contemporary procedures and technologies. Part of the job of the cytotechnologist is the retrieval of the Cell specimens from various parts of the body, such as the female reproductive system, the lungs, or most body parts that shed cells. They prepare slides of these specimens for evaluation. Using a microscope, they examine these slides carefully and take note of any abnormalities or changes that could indicate a disease. They submit his findings to the pathologist for a final evaluation. Most cytotechnologists work in hospitals or commercial laboratories. Experienced cytotechnologists can also work in a private industry or as a supervisor, a researcher, or an instructor (“The Cytotechnologist”; “Cytotechnology” CAAHEP). For cytotechnologists working in Saudi Arabia, most of them are required to have some common characteristics like problem solving skill, responsibility and accountability, and the drive to face challenges at work. There is a high standard requiring accuracy and good quality in their work. They need to be very reliable, detail oriented, and can work well under pressure. Most of them are task-oriented and can complete any and all assigned tasks. They also need to have good communication skills and must show dedication to their profession. Cytotechnologists are primarily female in Saudi Arabia. Professional Organizations American Society for Clinical Pathology The American Society for Clinical Pathology is the largest professional membership organization for pathologists and other laboratory professionals. This is the organization that guided the application and evolution of pathology and laboratory medicine specialty since 1922. The ASCP is an organization devoted to providing resources to pathologists, medical affiliates, laboratory professionals, and medical students to help them on the way to professional success. They publish medical reference manuals, multimedia, journals, and magazines including the American Journal of Clinical Pathology, which is the one of the top clinically oriented, peer-reviewed pathology and laboratory medicine research journals in the world; LABMEDICINE, which is a monthly periodical that provides continuing education, career development, and information about new technology to people in the laboratory community; and the Critical Values quarterly news magazine. The ASCP also plays a role in the education of cytopathologists by helping them meet institutional, licensure, and Maintenance of Certification or Certification Maintenance Program requirements. ASCP accredited with Commendation by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians, and continuing medical laboratory education for laboratory professionals, such as Cytopathologists. Their education programs have online self-study guides and assessments, live teleconferences and webcasts, workshops, and conferences. They can also help with the Part II and Part IV of the MOC requirements from the American Board of Pathology and the CMP requirements. They even have tools that would help you navigate the process with ease. Aside from the education, the ASCP also covers certification programs for laboratory workers. The ASCP Board of Certification has accreditation from the American National Standards Institute and is the oldest and biggest certification agency for laboratory professionals. They have so far certified more than 450,000 people since its formation. It sets the bar for the certification of pathologists’ assistants and laboratory professionals. There is also another program called the ASCPi, which provides international certification credential and is now available worldwide. As the biggest organization for cytopathologists and other laboratory professionals, the ASCP is also the voice of its members. It represents the interests of laboratory professionals in the United States by taking issues pertaining to those in the profession to the congress, the administration, federal regulatory agencies and state governments in an effort to create a better workplace for its members, improved insurance, and the ability to reach out to patients in need. Their office in Washington, D.C. also serves by communicating between patient, allied health, laboratory, and medical organizations to build coalitions to achieve the goals of the ASCP (American Society for Clinical Pathology). American Society for Cytotechnology The American Society for Cytotechnology is an organization that models themselves as the “collective voice for the profession.” They define and promote cytotechnology by developing practice standards, monitoring and evaluating legislative/regulatory issues and new technologies related to cytotechnology, and it provides opportunities for continuing education for its members. Members of this organization will have their own subscription to the VOICE, which is their newsletter; they will get discounted registration fees at conferences with continuing education credits; they will get access to the interactive website; they will have official representation with other organizations; and student membership dues include first year of practice after graduation. They have an ASCT foundation whose mission is to support and enhance special programs of the Society by providing funding for its various activities and resources in the name of the advancement of cytotechnology. Some of these resources include publications such as the Guide to Cytopreparation, Cytopathology Quality Assurance Guide, Risk Management for the Cytopathology Laboratory, and an Introduction to the Cytopreparation Laboratory, which is an online course. This organization also conducts an annual wage and employment survey for cytotechnologists to assess the job market. They also have annual conferences that serve as continuing education for its members at affordable prices (American Society for Cytotechnology). Since Saudi Arabia is relatively new to Cytotechnology, the certified Cytotechnologists in Saudi Arabia usually get their certifications from the American Society of Clinical Pathology and/or the American Society of Cytotechnology. Salary and Benefits According to the ASCT, the average hourly pay for a cytotechnologist is $30.51 in 2007. This figure changes depending on the geographic location, experience, and ability. The American Society for Clinical Pathology also conducted a study and found out that the average wage for staff cytotechnologists was $50,032 every year. The annual median wage for Cytotechnology supervisors was $71,053. Another survey by salary.com showed that staff cytotechnologists can make as low as $61,887 to $79,678 in a year (“Cytotechnology” University of Medicine and Dentistry of New Jersey). In other countries, salary and benefits vary depending on the country of origin, usually lagging behind the US salary. Currently, a full time Cytotechnologist can have 54 annual leaves and 6 sick days. Full time employees receive up to 90 days of sick leaves with pay as per the labor laws of the country. Medical insurance is provided at no cost to the employees provided the employees and their families obtain their treatments in the hospital and its affiliated clinics. Value of a Cytotechnologist in Society From its inception, cytotechnology is a field of health care that was created out of necessity because new technology needed trained personnel to spread the usage of the technology for the betterment of the health of thousands of people. From the time the Dr. Papanicolaou developed the Pap smear, the role of the cytotechnologist has changed little. They are still considered as the people who assist the pathologist reach diagnoses by examining cells with a systematic and trained eye to look out for abnormalities. The difference is that the technology has moved on, and from vaginal smears and simple microscopes, the world of cytotechnology has had dozens of changes not in WHAT they do (helping pathologists reach diagnoses from microscopic examinations of cells), but HOW they do it. The field of cytotechnology is as dynamic and as fluid as the new technologies that keep coming out to make diagnosis of an illness easier. Through the organizations supporting the cytotechnology workforce, the ASCT and the ASCP, these cytotechnologists are updated constantly with new developments in their fields so as not to get left behind. They attend conferences and supplied with numerous publications and other resources to make sure that their continuing education keeps them updated with newer and better ways to do their job (Hatt). The job of the cytotechnologist is essentially supportive in nature. They work together with a health care team in the diagnosis, care, and treatment of the patient. Their greatest input is to the patient’s diagnosis. They help pathologists reach the right diagnosis quickly and accurately by assessing the patient on the cellular level. When a patient experiences an illness, there are many cellular changes to different parts of the body that are not detectable through regular physical assessment. It is the job of the cytotechnologist to collect tissue and cell samples from various organs so that they may examine them closely for those changes, which could determine what is wrong with the patient. They submit their findings to the pathologist, and together with other data that they picked up during assessment, they can piece together what disease the patient has, and how to deal with it. This is really important in life-threatening diseases wherein any delay in treatment could spell death for the patient. The accuracy and speed at reaching a diagnosis that comes from the cytotechnologists’ contribution together with the rest of the health care team is valuable and has saved many lives (Hatt). Because of the vast number of technology available, the field of cytotechnology has been able to branch off and diversify their profession. Depending on the cytotechnologist’s strengths and weaknesses, they can go into management as cytology supervisors or anatomic pathology managers; academia as an education coordinator or instructor; research; quality assurance for private industry in jobs like equipment sales and applications. They can branch off into various specializations such as cytopreparation management, cytogenetics, or even research in specific disease processes such as certain types of tumors or cancers. There are many places where a cytotechnologist can work. They can work in private labs, universities and other academic medical centers, community hospitals, and even health research facilities (Hatt). In other countries such as Saudi Arabia, there is a shortage of Certified Cytotechnologists which makes professionals in these countries an immediate asset held in high esteem. Cytotechnology is relatively new in Saudi Arabia; yet, they are capable of reaching and fulfilling the requirements and standards of service of cytotechnologists from the United States. The future of cytotechnology can only be more varied as new technologies change the way things are done. Remaining dynamic and flexible throughout these changes is what gives cytotechnologists the edge for the future. There are already some new fields in molecular diagnostics, genetics, personal medicine, and automated assisted diagnosis that could revolutionize the field. These advances make diagnosis even more efficient and reliable. It is important that cytotechnologists always strive to learn about these new technologies so that they might not get left behind (Hatt). Summary Cytotechnology is not just about diagnosis. Advances in this field could pave the way to newer, better treatments to some diseases. Molecular diagnostics can improve treatments of various diseases, while circular tumor cell analysis can help physicians create therapies not just for specific types of cancer, but also the specific cellular and molecular sites for these therapies. By applying these, Cancer treatments and their side effects can be limited only to the areas that are affected, greatly reducing problems and increasing the effectiveness of the treatments such as chemotherapy (Hatt). In a world that is quickly changing due to technology, cytotechnologists serve society as a supplementary part of the health care team that gives valuable information, which helps bring about timely, accurate, and cost-effective treatment. Works Cited American Society for Cytotechnology. American Society for Cytotechnology, n.d. Web. 27 Nov. 2012. . American Society for Clinical Pathology. American Society for Clinical Pathology, n.d. Web. 27 Nov. 2012. . “Cytotechnology.” University of Medicine and Dentistry of New Jersey. School of Health Related Professions, n.d. Web. 27 Nov. 2012. . “Cytotechnology.” Commission on Accreditation of Allied Health Education Programs. CAAHEP, n.d. Web. 27 Nov. 2012. . Hatt, Kerri. “Mystery diagnosis.” Advance 1 Nov. 2010: 16-17. Web. . Naik, Kalyani, and Zaleski, M. “Cytotechnology: A Profession on the Move - Then and Now.” LABMEDICINE 39.4 (2008): 201-206. Web. 27 Nov. 2012. . “Profession of Cytotechnology.” American Society for Cytotechnology. ASCT, n.d. Web. 27 Nov 2012. “The Cytotechnologist.” American Society for Clinical Pathology. ASCP, n.d. Web. 27 Nov. 2012. . Read More