Development and Evaluation of a Cervical Cancer Screening Training Program for Midwives in Japan

Abstract

Background: In Japan, cervical cancer incidence has increased over the last decade and screening coverage is extremely low (35.8%). In 2016, the Japanese government allowed nursing professionals to perform cervical screening for the first time if instructed to do so by a gynecologist. Following this, a training program was developed for midwives to perform cervical screening. Objective: To evaluate a training program for Japanese midwives to perform cervical screening. Methods: Eight experienced midwives participated at 1 medical center in November 2019. After a lecture, skills-lab and 3-week practice using a manikin, midwives who passed the skills-check proceeded to the practicum for routine screening. After passing the practicum, each midwife took 20 samples under indirect supervision. Evaluations by supervising gynecologists and 160 screened women, as well as midwives’ self-reports were analyzed. Results: The pass rate was 86%. In 21 (13%) of 160 cases, midwives needed assistance from a gynecologist to locate the cervix, including 5 cases which were taken over by a gynecologist. None of the samples were unsatisfactory. Women’s evaluation of midwives as screeners was both positive and high. Conclusions: This training program enabled experienced Japanese midwives to take adequate samples while methods of evaluation should be elaborated. Women were highly satisfied with midwives performing cervical screening. Implications for Practice: Task shifting to midwives may be an important policy approach to improving cervical screening coverage. Foundational: This study was the first in Japan to give foundation to task shifting of cervical screening from physicians to midwives.