Personal commentaryExternal quality assessment (EQA) in gynaecological cytology: radical rethinking required?

Accepted for publication 19 February 1999 THE PAST The value of EQA in pathology, including proficiency testing in gynaecological cytology, has been the subject of much recent lively debate 1–6 . In summary, the proven role of EQA in the monitoring of personal performance and ability is still uncertain. Furthermore, its potential to prevent critical incidents remains purely speculative. Also, whether EQA would be better replaced, for some or all professional groups, by other methods of quality assurance is unknown. Similarly, whether EQA can justify the considerable professional time, effort and expense involved has not been resolved. THE PRESENT Not surprisingly, events at Kent & Canterbury Hospitals abruptly halted much of the debate about the foregoing issues 7 . Indeed, as a direct consequence of this and other incidents, the NHS Executive stipulated unilaterally that EQA is now mandatory within the NHS Cervical Screening Programme (CSP) 8 and reinforced the necessity for all qualified laboratory staff to participate 8–10 . A surprise, however, was the Executive's enlightened comments on EQA. First, and of greatest significance, that the principal function of EQA in pathology is to improve standards and advance quality through personal education. Second, that EQA should be seen to complement other QA systems for the early identification of potential problems which might affect patient care. Third, that the identification of individual poor performance through EQA will be exceptional and in essence is a by‐product of the basic educational exercise. The latter conclusion was drawn, as far as one can judge, from previous experience with the NHS Breast Screening Programme (NHSBSP) EQA. THE FUTURE—PERSONAL SUGGESTIONS FOR OPEN DEBATE