Government-mandated cytology proficiency testing: practical, equitable, and defensible standards.

Maryland's Proficiency Testing (PT) Program in cytology has attempted to meet eight technical criteria by implementing PT standards that include rigorously criterion-referenced Papanicolaou smear-stained glass slides from actual patients; conducting PT in the laboratory; having PT conducted and monitored by a regulatory agency; testing cytotechnologist and pathologist in conjunction, yet employing separate grading systems based on a limited number of fully defined diagnostic categories; and using PT results to compel practitioners to obtain retraining. Maryland believes its PT program not only is effective, efficient, and legally defensible but also meets the intended purpose and goals of the Clinical Laboratories Improvement Amendments of 1988. This paper reviews the technical and administrative aspects of Maryland's state-mandated PT program and compares its standards and methods to those mandated by the federal Health Care Financing Administration.