Kane B R, Berger M S, Lisney M
Department of Family Practice, Reading Hospital and Medical Center, Penn., USA.
Fam Med. 1997 May;29(5):315-7.
The Papanicolaou (Pap) smear is a widely accepted tool for the detection and prevention of cervical cancer. Under the Bethesda Scoring System, the key internal control for adequacy of the smear is the presence of endocervical cells. Over the past several decades, much effort has been undertaken to maximize the adequacy of this acquisition. The present study determined if Pap smear sample adequacy is related to clinician experience.
This study includes a retrospective analysis of 1,356 Pap smears acquired between January 1992 and January 1995. The procedures were performed by family practice residents and faculty physicians. Cervical smears were obtained with a combination of a cytobrush and an Ayre spatula and were placed on two slides. Adequacy was subsequently determined by a cytotechnologist. Chi-square analysis was used to determine if the adequacy rates for faculty and for PGY-1, PGY-2, and PGY-3 residents were significantly different.
The adequacy rates for PGY-1, PGY-2, PGY-3 residents and faculty physicians were 80%, 89%, 89%, and 93%, respectively. The adequacy rates for the first-year residents were significantly different from that of all other studied groups.
This study demonstrates the relationship between clinician experience and the ability to perform an adequate Pap smear. Considering the cost and potential medical risk of an inadequate Pap smear, family practice residency programs should increase the degree of PGY-1 education and experience in performing Pap smears.
巴氏涂片检查是一种广泛应用于宫颈癌检测与预防的工具。在贝塞斯达评分系统下，涂片充分性的关键内部控制是宫颈管细胞的存在。在过去几十年里，人们付出了诸多努力来使这种取材的充分性最大化。本研究确定了巴氏涂片样本的充分性是否与临床医生的经验有关。
本研究对1992年1月至1995年1月期间采集的1356例巴氏涂片进行回顾性分析。这些操作由家庭医学住院医师和带教医师完成。宫颈涂片通过细胞刷和艾氏刮板联合取材，并置于两张载玻片上。随后由细胞技术人员确定涂片的充分性。采用卡方分析来确定带教医师以及PGY - 1、PGY - 2和PGY - 3住院医师的充分率是否存在显著差异。
PGY - 1、PGY - 2、PGY - 3住院医师和带教医师的充分率分别为80%、89%、89%和93%。第一年住院医师的充分率与所有其他研究组的充分率存在显著差异。
本研究证明了临床医生经验与进行充分巴氏涂片检查能力之间的关系。考虑到不充分巴氏涂片检查的成本和潜在医疗风险，家庭医学住院医师培训项目应提高PGY - 1在进行巴氏涂片检查方面的教育程度和经验。
