Minimum Standards for Colposcopy Training
Through the auspices of the European Cervical Cancer Screening Network, the EU gave the EFC a grant to promote a programme for the introduction of minimum standards of training in colposcopy. This grant ran from December, 2001 to December, 2003. The Chairman of the Training Group was Charles Redman (UK). All member societies agreed on 51 core competencies, which were deemed essential for colposcopists to be considered competent to practice colposcopy.
At the outset it was agreed that the primary aim of the training programme was to produce competent diagnostic colposcopists, because diagnosis is the foundation for clinical management. Despite the fact the colposcopy can be performed in different settings and for different indications throughout Europe, there is, nonetheless, a common set of competencies that are required. It was decided to identify and use these necessary core competencies as the basis for curriculum design. Each identified competence would then act as a learning objective for the programme. In other words, the training programme was more concerned with what a competent trained colposcopist should be able to do rather than producing a list of things they need to know.
During 2001 the Training Committee undertook a consensus exercise in order to identify what these essential core competencies were. This was achieved by using a consultative technique called the Delphi technique, which sought the views of a number of expert colposcopists throughout Europe. In all, 28 participants from 21 countries took part. The list of identified core competencies was presented to the EFC at its scientific meeting in Rhodes in October 2001 and they were accepted as a basis for designing colposcopy-training programmes in each of the member societies.
Programme Structure
Since that time there has been further discussion about the structure of European colposcopy training programmes. Currently there are 4 countries with a colposcopy training programme and these share many common features. It was important to acknowledge the need for flexibility but to recognise the need for certain shared principles. Following a meeting of the Training Committee in Munich in February 2002 it was agreed that each country should identify what criteria are needed for a colposcopist to be able to train. In addition, each society was asked to determine the minimum amount of supervised clinical experience needed for each trainee to complete the training programme and also to describe how assessment will carried out.
Where do we go from here?
In October 2002 an agreed programme of 51 core competencies was accepted.
In addition to laying down the training framework, we need to consider how the training itself can be delivered. In this respect study guides are likely to be very important as these can facilitate communication not only between trainers and trainees, but also between those responsible for the training programme and trainers. They enable all concerned to become familiar with the programme aims and objectives and how they will be achieved.
It is proposed that over the next 12 months a European colposcopy training study guide should be designed to complement clinical training. This study guide will utilise a combined CD/web approach and produce a truly interactive teaching package for colposcopy. The guide will use a problem based learning approach based on the EFC curriculum and this will allow the interactive potential of this approach to be maximised.
President of EFC
C. Redman
EFC Minimum Standards for Training in Colposcopy – 51 Core Competencies
A. Preliminary/Preparatory
1. Understand the development of cervical pre-cancer
2. History taking
3. Positioning of patient
4. Insertion of vaginal speculum
5. Perform cervical smear (including Cytobrush)
6. Perform bacteriological swabs
7. Take samples for HPV testing
8. Practise complies with Health and Safety recommendations
9. Understand National Cervical Screening Guidelines
B. Colposcopic examination
10. Position and adjust the colposcope
11. Determine whether or not the entire transformation zone (TZ) is visible
12. Determine whether or not colposcopy is satisfactory
13. Recognise abnormal vascular patterns
14. Examination of TZ with saline and green filter
15. Examination of TZ with acetic acid
16. Quantify and describe acetic acid changes
17. Use endocervical speculum
18. Schiller’s Test
19. Examination of vagina with acetic acid
C. Colposcopic features of the normal cervix
20. Recognise original squamous epithelium
21. Recognise columnar epithelium
22. Recognise metaplastic epithelium
23. Recognise Congenital Transformation Zone
24. Recognise features of a postmenopausal cervix
25. Recognise effects of pregnancy
D. Colposcopic features of the abnormal lower genital tract
26. Recognise low grade pre-cancerous cervical abnormality
27. Recognise high grade pre-cancerous cervical abnormality
28. Recognise features suggestive of invasion
29. Recognise and assess Vaginal Intraepithelial Neoplasia
30. Recognise and asses Vulval Intraepithelial Neoplasia
31. Determine the extent of abnormal epithelium
32. Recognise acute inflammatory changes
33. Recognise HPV infection
34. Recognise condylomata plana
35. Recognise condylomata accuminata
36. Recognise changes associated with treatment
37. Recognise benign cervical polyps
E. Practical Procedures
38. Administer local analgesia
39. Determine where to take directed cervical biopsies
40. Perform a directed cervical biopsy
41. Perform a directed vaginal biopsy
42. Perform a directed vulval biopsy
43. Control bleeding from biopsy sites
F. Administration
44. Document findings
45. Manage appropriately patients according to guidelines
G. Communication
46. Ensure adequate information given to patient
47. Counsel patients prior to colposcopy
48. Obtain informed consent correctly
49. Counsel patients after colposcopy
50. Break bad news
51. Communicate well with other health professionals