Evidence for direct learning curve for technique on change of cervical sampling device.

The recommended sampling device within the NHS Cervical Screening Programme is the Aylesbury spatula. A local decision was taken to decrease brush usage (either alone or in combination) by 50% from an initial level of 41.8%, with an initial inadequate smear rate of 9.93%. This was managed by controlling smear taking equipment through provision of smear taking kits. The monthly inadequate rate unexpectedly rose to 17.8% before dropping back to previous levels. Brush usage overall fell to 35.2%, with a corresponding increase in spatula use. The possible reasons for this are discussed. The facts suggest that these changes were directly linked, and that there is a learning curve with change of sampling device and that a rise in the inadequate rate should be expected under these circumstances.