Converting the converted

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Converting the converted

• An overview of LBC training

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Roll out of LBC

• 5 year roll out
• Approximately 3000 laboratory staff
• Approximately 40,000 primary care sample takers

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Provision of LBC training

• NHSCSP approved Cytology Training Centre
• Training for particular system dependent on first
  hand experience
• Minimum of 15,000 samples per system
• 6 months experience

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Situation at NPH

• T3000 since October 2003
• Commenced LBC training December 2003
• Completed LBC training June 2004
• Smear taker training commenced March 2004
• Full conversion 1st July 2004

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Slide requirements for training

• For 12 people-
• 3 day course 720
• In-house training 420
• Total number of slides 1140

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LBC training courses at NPH

• First intake expected by end of the year

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Laboratory LBC training
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NHSCSP Certificate of Completion in Liquid Based
Cervical Cytopathology Training
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Format of LBC training

• 3 day LBC Induction Course
• In-house consolidation stage
• In-house NHSCSP LBC Interim test
• In-house LBC Performance review
• Liquid based cervical cytopathology training log

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Who has to undergo training?

• Every one involved in screening and reporting
  cervical smears

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Who has to do what
Primary screeners Checkers / APs Pathologists
Induction course Yes Yes Yes
Consolidation set Yes Yes Yes
Interim test Yes Yes Yes
Performance review Yes Yes No
Training Log Yes Yes No
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Requirements

• Fully trained in conventional smear microscopy
  and qualified to sign out negative and
  unsatisfactory smear reports
• Time
• Access to multiheaded microscope

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LBC Induction Course

• NHSCSP accredited Cytology Training Centre
• 3 days
• Minimum of 20 hours
• Approximately 12 hours dedicated to individual
  microscopy
• Approximately 6 hours allocated to multiheader
  discussion of cases

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LBC Induction Course

• Lectures topics
• Background to LBC
• LBC preparation devices
• Use of Training Log
• Normal cytological appearances and infections
• Squamous and glandular dyskaryosis
• Rapid rescreening technique
• Troubleshooting

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LBC Induction Course

• Microscopy
• 20 slides per set
• Test sets 1 2 dotted
• Test sets 3 6 unmarked
• Work in pairs
• Marked by Training Centre staff
• Reviewed at multiheaded microscope

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Marking of slides

• Slide no examined 0 marks
• Assessment matches 5 marks proffered response
• One grade out from 4 marks proffered response
• 2 or 3 grades out from 3 marks proffered
  response
• Negative smear called 2 marks abnormal
• Dyskaryotic smear called 2 marks negative
• Glandular neoplasia called 5 marks severe
  dyskaryosis or vice versa

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LBC consolidation stage

• In-house
• 200 unmarked slides
• High proportion of abnormals
• Individual response sheets
• Marked by Training Centre
• Obtain sensitivity of 95 (moderate dyskaryosis
  and above)
• Multiheader review of slides

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LBC consolidation stage

• Pass Interim test
• Fail Additional training / slides

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Interim Test

• 20 unmarked slides
• In-house
• Individual response sheets
• Marked by Training Centre
• Pass mark is 80

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Interim test stage

• Pass Performance review
• Medical staff can stop at this stage
• Fail Additional training / slides

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LBC Performance Review

• In-house
• 200 unmarked slides
• 95 sensitivity for moderate dyskaryosis and above

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LBC Training Log

• Completed by all grades of scientific staff
• Record of individuals progress
• Progress monitored by Training Officer
• Scientific lead must indicate date on which
  training completed
• Completed Log Book sent to Training Centre

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How long will this take?

• 10 12 weeks

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Smear taker training
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Smear taker training

• Needs to be co-ordinated with laboratory LBC
  training
• All smear takers must undergo training
• Roll out of LBC smear taker training to be agreed
  with PCTs

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Smear taker training

• Taught course
• Cascade training

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Taught course

• Minimum of 2 hours
• Content to include-
• Lectures
• Interactive sessions
• Preparation for clinical practice

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Cascade training

• Clinical lead or experienced sample taker
• Nurse trainers

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Training records

• PCT should keep a register of primary care sample
  takers who have undergone training
• PCT and laboratory need to agree procedure for
  signing off practices and clinics when all sample
  takers have been trained

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Ideal situation

• Completion of laboratory and smear taker training
  should coincide

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What happens if you change to other preparation
system?

• Need to complete LBC conversion course

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LBC system conversion course

• One day course at NHSCSP accredited Cytology
  Training Centre
• Minimum of 7 hours
• Basic comparison of technical aspects
• Lecture on comparative morphology
• Multiheaded microscopy discussion
• Discussion of interesting / difficult cases
• 100 slides done in-house

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