Accuracy of Papanicolaou smears. Art or science?

We examined the relationship between various levels of experience and the ability to obtain adequate Papanicolaou smears as defined by the presence of endocervical cells. From July 1, 1984, through June 30, 1986, 16,360 cervical smears were evaluated for the presence of endocervical cells. Of those smears, 9,243 contained endocervical cells; 7,117 did not. The results were evaluated for seven groups of providers: professional staff, residents (postgraduate years 1-4), nurse practitioners and student nurse practitioners. The range of smears with endocervical cells for individual providers was 22.2-73.1%. Significant differences existed between all the groups. Longer training did not equate with greater skill in obtaining endocervical cells. Obtaining adequate smears appears to be as much an art as a science.