The current education of cytologists is a far cry from its humble beginnings.¹ Emerging in the late 1950s shortly after the founding of the cytology profession by Dr. George Papanicoloau, cytotechnologists, typically medical technologists, were often recruited in hospitals and medical centers and trained by pathologists. During the 1960s, more structured and formalized education systems were established.² Over the last forty to fifty years, the structure of cytology education programs has undergone a tremendous change, with certificate, undergraduate, and graduate programs offered in hospitals and universities.³ Cytology education programs now deliver education through innovative ways, such as satellite campuses and online programs, with dynamic teaching modalities, such as the incorporation of virtual microscopy in teaching. The move to graduate-level education is the latest advancement in the education of cytologists, a profession recognized historically for its morphology-based, diagnostic skills.⁴ With increased demands for advanced diagnostic testing and expansion of roles in laboratory practice, there are new opportunities for innovation in cytology education at a time when the demand for cytology practitioners is increasing. 

Graduate level education for cytologists

In 2023, the American Society of Cytopathology’s (ASC) Cytology Program Review Committee (CPRC) mandated that all Commission on the Accreditation of Allied Health Professions (CAAHEP) accredited cytology education programs begin providing master's-level cytology education programs.⁵ The “move to the masters" as it is often referred to, centered on curriculum changes designed to prepare cytologists for their expanding scope of practice. One important part of the transition was a name change of the profession from cytotechnologist to cytologist, reflecting roles of higher-level critical thinking more so than performing routine diagnostic testing. While cytology is still primarily a morphology-based practice, cytologists are increasingly performing molecular and other diagnostic tests, including immunohistochemistry, digital pathology, and computer-based image analysis. As critical thinkers, cytologists are ideal for partnering with pathologists on research and other projects leading to evidence-based practice, while becoming leaders in laboratory and pathology practice and impacting and improving patient care and outcomes.

The foundation of the new graduate-level curriculum includes cognitive, affective, and psychomotor learning domains focusing on knowledge, professionalism, and physical practice (e.g., using a microscope, hand pipetting). These domains have always been central to cytology education curriculum, but now graduate coursework in research methods, companion technique applications, and professionalism rooted in the domains is included. Cytology education programs are required to convert programs to the graduate level by 2031. The shift to graduate-level programs was not without some degree of controversy. One major concern is the decline in the number of educational institutions educating cytologists. Currently, there are 17 US CAAHEP-accredited cytology programs, a decline in number from the over one hundred education programs that existed in the 1970s through 1980s.⁶ Concerns on the ability of hospital-based programs to restructure, ongoing issues with recruitment, and increasing tuition costs were raised during conversations and discussions on the proposal of the move. It was clear, however, that with changes in professional practice and the increasing demand for the cytologist skill set, a master educated laboratorian was needed. With that, cytology programs began tailoring education modalities and teaching practices for the next frontier of cytology education.

Education modalities

New frontiers require innovation. Cytology education programs are actively considering how to implement innovative education methods and the delivery of curriculum in shifting higher education environments. There are four primary models of cytology education programs: traditional, hybrid, satellite, and online. Historically, cytology education occurred in brick-and-mortar institutions, in laboratories, and in colleges and universities across the country. Traditional, in-person programs at colleges and universities are still the primary type of cytology education programs in the United States, comprising 13 of the existing 17 accredited programs. Traditional programs typically draw students from local and regional colleges and universities, but also an increasing number of international students, as is our experience. Recruitment typically involves partnering with local and regional institutions to establish pathway programs. Graduate-level education partnerships may be more challenging to implement than undergraduate and certificate programs but are nevertheless important to consider as programs convert to graduate degrees.

Hybrid or blended cytology education programs educate cytologists in more than one way. The two main methods are in-person and online (live and/or asynchronous). This model allows flexibility in scheduling for both faculty and students, but there are differences in teaching as well as learning. For example, online asynchronous coursework requires increased self-directed learning that many students may find challenging. Faculty, accustomed to the dynamics of classroom and laboratory teaching now use online discussion boards and chats as teaching tools.

Satellite education programs have emerged as innovative models for cytology education delivery. CAAHEP defines satellite programs as those occurring in off-campus locations, providing both theoretical and laboratory required program content.⁷ These programs are ideal for providing education in spaces where access to cytology education is lacking. Various teaching strategies have emerged under the satellite campus model, with some programs providing synchronous lectures by Zoom or other remote technologies and providing microscopy instruction by mailing glass slides to off-site locations or using virtual microscopy.⁸

The newest program model is that of solely online education. While no CAAHEP-accredited programs yet exist, there are those on the horizon.⁹  Similar to the satellite programs, online programs fill the gap of avoiding traditional brick and mortar infrastructure, reaching students where they live. These programs will be charged, however, with delivering all components of the required cytology education curriculum with the same level of quality and reliability that longer-standing education models have achieved.

Regardless of the education model, all programs will now have to tackle the ever-changing technological landscape both in education and cytology practice, demands that faculty hold advanced education degrees, and competition with other career opportunities available for biology and other science degree holders.¹⁰

Opportunities for partnership

As mentioned before, the demand for cytology practitioners is increasing while the number of new program graduates is critically low.¹¹ Partnering with colleges and universities, introducing the cytology career to high school students, and collaborating with laboratories to identify bright,  lower-level skilled laboratory professionals (cytopreparatory technicians)  who may be ideal for cytology careers are just some examples of opportunities to recruit to the profession. One new and exciting possibility for partnerships is through the development of apprenticeship programs through the United States Department of Labor (USDOL). The USDOL has active and robust healthcare apprenticeship programs offering a mechanism to address the workforce shortage while providing support to those in the program. The Rutgers MS Diagnostic Cytopathology program recently became a registered apprenticeship program, providing opportunities to recruit to the program in a unique and dynamic way.¹² Programs pivoting to graduate-level education are bound to seek opportunities such as these to ensure stability, expansion of the cytology workforce, and success into the future.

Closing remarks

As cytology education programs look to the future, it will be imperative that education missions, regardless of education modality, remain rooted in preparing competent cytologists who are highly skilled and valued members of patient care teams. Through collaboration, partnership, and innovative education and teaching models, cytology education programs are bound to continue in the success instituted by the pioneers of cytology education almost a century ago.

References

1. Kendall RE. An aid in the teaching of cytology. Tech Bull Regist Med Technol. Apr 1962;32:73–4. 
2. Karp R. Perceptions of the impact of baccalaureate degrees for cytotechnologists. Acta Cytol. 1979;23(4):347–51. 
3. Donnelly A, Sturgis C, Goulart R, Sheldon D, Atkison K. Editorial: The evolution of a profession through education: cytotechnology training program curriculum revisions in the United States. J Am Soc Cytopathol. 2021;10(5):459–464. doi:10.1016/j.jasc.2021.06.001.
4. Atkison K, Goulart R, Wilbur D. Forward march: Master’s degree here we come. ASC Bull. 2018;55:7–11. 
5. Standards and Guidelines: Cytotechnology. Commission on Accreditation of Allied Health Education Programs. Accessed May 28, 2026. https://www.caahep.org/program-directors/standards-and-guidelines.
6. Find an Accredited Program. Cytology. Commission on Accreditation of Allied Health Education Programs. Accessed May 28, 2026. https://www.caahep.org/students/find-an-accredited-program.
7. A Glossary of Accreditation Terms. Commission on Accreditation of Allied Health Education Programs. Accessed May 28, 2026. https://www.caahep.org/accreditation/accreditation-glossary.
8. Mukherjee MS, Donnelly AD, DeAgano VJ, Lyden ER, Radio SJ. Utilization of virtual microscopy in cytotechnology educational programs in the United States. J Pathol Inform. 2016;7:8. doi:10.4103/2153-3539.177682.
9. Master of Science in Cytology. Arizona State University. Accessed May 28, 2026. https://asuonline.asu.edu/online-degree-programs/graduate/cytology-ms/.
10. Rockson L. Cytotechnology schools: Future outlook. Diagn Cytopathol. Aug 2024;52(8):407–412. doi:10.1002/dc.25281. 
11. Satturwar S, Compton M, Miller D, et al. American Society of Cytopathology's cytopathology workforce survey in the United States. J Am Soc Cytopathol. 2025;14(2):65–77. doi:10.1016/j.jasc.2024.12.003.
12. Apprenticeships. United States Department of Labor.  Accessed May 28, 2026. https://www.dol.gov/agencies/eta/apprenticeship.