Korean J Fam Pract. 2016; 6(1): 49-56  https://doi.org/10.21215/kjfp.2016.6.1.49
Quality Management Activities for Improving the Pap Smear Sampling Performance with Adequate Specimens among Family Medicine Residents
Wookyong Lee, Juhyung Hong, Kyongmin Park, Kyeyeung Park, Hoonki Park*, Hwansik Hwang
Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
Hoonki Park
Tel: +82-2-2290-8738, Fax: +82-2-2281-7279
E-mail: hoonkp@hanyang.ac.kr
Received: August 31, 2015; Revised: August 31, 2015; Accepted: November 3, 2015; Published online: February 20, 2016.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The clinical skills test of the Korean Medical Licensing Examination has been driving medical schools to improve undergraduate education through clerkships and skills training on the published test topics, including Pap smear. There have been few studies evaluating the ability of family medicine residents to perform the Pap smear procedure. We conducted this study in order to investigate family medicine residents’ performance based on the requisition rate of endocervical cell/transformation zone (EC/TZ) in Pap smear specimens, and to evaluate the effects of quality improvement measures.
Methods: A retrospective study was conducted reviewing the results from liquid-based cervical Pap smear tests performed at a university hospital health check-up center between March 2013 and June 2015. An obstetrics and gynaecology (OB/GYN) professor and 12 family residents were observed with action research and structured interview.
Results: Of the total 6,462 cervical Pap smear tests performed, 2,573 (39.8%) were reported to be lacking an EC/TZ component. In 2013, the presence rate of an EC/TZ component in cytology specimens taken by family medicine residents improved from 37.0%±11.8% to 80.3%±8.8% after a quality improvement intervention. The presence rate of an EC/TZ component was higher in specimens taken by residents compared with those by an OB/GYN specialist (69.3%±10.9% vs. 44.7%±5.0%, P=0.0002). The baseline individual monthly requisition rate of the EC/TZ component improved after quality management intervention (50.0%±18.3% vs. 75.8%±15.8%, P=0.01). The presence of an EC/TZ sample varied among residents. Transfer activities of the task, topic conferences, self-directed learning from online educational materials, gynecologic training, and self-monitoring of laboratory results had a positive effect on quality improvement.
Conclusion: Quality management activities at the individual level of family medicine residents improved the requisition rate of the EC/TZ component in Pap smear specimens. Further studies are needed in order to develop more efficient educational modules for improving Pap smear sampling quality.
Keywords: Papanicolaou Test; Quality Control; Cervical Cytology; Mass Screening
References
  1. National Cancer Control Institute. National cancer incidence 2012,Korea. Goyang:NationalCancerCenter; 2014.
  2. MinKJ,LeeYJ,Suh M,YooCW,Lim MC,ChoiJ,et al.TheKorean guideline forcervicalcancerscreening.JGynecolOncol 2015;26:232-9.
    Pubmed KoreaMed CrossRef
  3. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC,Wacholder S. Human papillomavirus and cervicalcancer.Lancet 2007;370:890-907.
    CrossRef
  4. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M,et al. The 2001 Bethesda System:terminology forreporting results ofcervicalcytology.JAMA2002;287:2114-9.
  5. Baer A, Kiviat NB, Kulasingam S, Mao C, Kuypers J, Koutsky LA. Liquidbased Papanicolaou smears without a transformation zone component:should cliniciansworry?ObstetGynecol 2002;99:1053-9.
    Pubmed
  6. ZhaoC,AustinRM.Adjunctive high-risk human papillomavirusDNAtesting is a useful option for disease risk assessment in patients with negative Papanicolaou tests without an endocervical/transformation zone sample. Cancer 2008;114:242-8.
    Pubmed CrossRef
  7. Park HK.Theimpact of introducing the Korean Medical Licensing Examination clinical skills assessment on medicaleducation.J Korean MedAssoc 2012;55:116-23.
  8. Baker RM. Improving the adequacy of Pap smears.Am Fam Physician 1989;39:109-14.
    Pubmed
  9. Sandelowski M, Barroso J.Writing the proposal for a qualitative research methodology project.QualHealthRes 2003;13:781-820.
    CrossRef
  10. Sams SB, Currens HS, Raab SS. Liquid-based Papanicolaou tests in endometrial carcinoma diagnosis: performance,error root cause analysis, and quality improvement.AmJClin Pathol 2012;137:248-54.
    CrossRef
  11. Committee on Practice Bulletins?Gynecology.ACOG Practice Bulletin Number 131:screening forcervicalcancer.ObstetGynecol 2012;120:122238.
  12. Whitlock EP,VescoKK,Eder M,Lin JS,SengerCA,Burda BU.Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force.Ann Intern Med 2011;155:687-97,W214-5.
  13. Lee KR,Ashfaq R, Birdsong GG, Corkill ME, McIntosh KM, Inhorn SL. Comparison of conventional Papanicolaou smears and a fluid-based,thinlayersystemforcervicalcancerscreening.ObstetGynecol 1997;90:278-84.
    CrossRef
  14. Vooijs PG,EliasA, van derGraafY,Veling S.Relationship between the diagnosis of epithelial abnormalities and the composition of cervical smears. ActaCytol 1985;29:323-8.
    Pubmed
  15. Martin-Hirsch P, Lilford R, Jarvis G, Kitchener HC. Efficacy of cervicalsmear collection devices: a systematic review and meta-analysis. Lancet 1999;354:1763-70.
    CrossRef
  16. Tacken MA, Braspenning JC, Mulder J,Hermens RP, NelenWL, de Bakker DH,et al.Lossto follow-up ofcervicalsmearswithoutendocervicalcolumnarcellsis not disturbing.EurJGynaecolOncol 2006;27:42-6
    Pubmed
  17. Saslow D, Solomon D, Lawson HW,Killackey M,Kulasingam SL,Cain J,et al.American Cancer Society,American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.Am J Clin Pathol 2012;137:516-42.
    Pubmed CrossRef
  18. Massad LS,EinsteinMH,HuhWK,KatkiHA,KinneyWK,SchiffmanM,et al. 2012 updated consensus guidelines for the management of abnormal cervicalcancerscreening tests and cancer precursors.J LowGenit Tract Dis 2013;17(5 Suppl 1):S1-S27.
    Pubmed CrossRef
  19. Fox R,NixAB, Fielder H.A comparison of variability in Papanicolaou and liquid-based cytology inadequacy rates using Shewhart control charts.Cytopathology 2006;17:175-81.
    Pubmed CrossRef
  20. Buntinx F,Knottnerus JA,Crebolder HF, Seegers T, Essed GG, Schouten H. Does feedback improvethe quality of cervical smears?: a randomized controlled trial.BrJGen Pract 1993;43:194-8.
    Pubmed KoreaMed
  21. Sirovich BE,WelchHG.Cervicalcancerscreening amongwomenwithout a cervix.JAMA2004;291:2990-3.

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