Colposcopy Training Research Articles

Utility of colposcopy for the screening and management of cervical cancer in Africa: A cross-sectional analysis of providers’ training and practices.

10555 Background: Cervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a critical issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region. Methods: A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice. Results: Of the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% were working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine visual screening in 21.2% of clinicians, to visualize the transformation zone in 15.2% of respondents, to assess vascularization of cervical mucosa in 33.3% of respondents, and to determine treatment modality in 12.1% of respondents. Conclusions: Providers’ training and utilization of colposcopy for cervical cancer screening remain suboptimal in Africa. To address this situation in the region, further training is needed to improve providers' knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately.

Enhancing colposcopy training using a widely accessible digital education tool in China

Colposcopy is a cornerstone of cervical cancer prevention; however, there is a global shortage of colposcopists. It is challenging to train a sufficient number of colposcopists through in-person methods, which hinders our ability to adequately diagnose and manage positive cases. A digital platform is needed to make colposcopy training more efficient, scalable, and sustainable; however, current online training programs are generally based on didactic curricula that do not incorporate image analysis training. In addition, long-term assessments of online training are not readily available. Therefore, innovative digital training and an assessment of its effectiveness are needed. This study aimed to evaluate the short- and long-term effects of DECO (an online Digital Education Tool for Colposcopy) on trainees' colposcopy competencies and confidence. DECO can be used both on laptops and smartphones and comprises 4 training modules (image interpretation; terminology learning; video teaching; and collection of guidelines and typical cases) and 2 test modules. DECO was tested through a pre-post study between September and November 2022. Participants were recruited in China, and DECO training lasted 12 days. Trainees initially learned basic theory before completing training using 200 image-based cases. Pretest, posttest, and follow-up testing included 20 distinct image-based questions, and was conducted on Days 0, 13, and 60. Primary outcomes were competence and confidence scores. Secondary measures were response distributions for colposcopic diagnoses, biopsies, and DECO training satisfaction. Multilevel modeling was used to determine improvement from baseline to posttraining and follow-up for the outcomes of interest. Among 402 participants recruited, 96.8% (n=389) completed pretesting, 84.1% (n=338) posttesting, and 75.1% (n=302) follow-up testing. Colposcopic competence and confidence increased across this study. Diagnostic scores improved on average from 55.3 (53.7-56.9) to 70.4 (68.9-71.9). The diagnostic accuracy for normal/benign lesions, low-grade squamous intraepithelial lesions, and high-grade squamous intraepithelial lesions or worse increased by 16.9%, 13.1%, and 16.9%, respectively. Mean confidence scores increased from 48.1 (45.6-50.6) to 56.2 (54.5-57.9). These improvements remained evident 2 months after training. Trainees were also satisfied with DECO overall. Most found DECO to be scientific (82.5%), easy to use (75.2%), and clinically useful (98.4%), and would recommend it to colleagues (93.2%). DECO is a useful, acceptable digital education tool that improves colposcopy competencies and confidence. DECO could make colposcopy training more efficient, scalable, and sustainable because there are no geographic or time limitations. Therefore, DECO could be used to alleviate the shortage of trained colposcopists around the world.

Fostering Prevention of Cervical Cancer by a Correct Diagnosis of Precursors: A Structured Case-Based Colposcopy Course in Finland, Norway and UK.

Simple SummaryCervical cancer prevention is presently undergoing a thorough reformation due to introduction of human papillomavirus (HPV)-testing and vaccines in primary prevention. The screening program, however, is more than a single test or preventive intervention—the possible lesion has to be found, located and treated. Colposcopy plays a major role in this management. Literature dealing with training and learning, especially with colposcopy, is extremely scarce. The aim of the European Federation of Colposcopy, EFC, is to improve the education and training in colposcopy, e.g., by organizing colposcopy courses. The aim of our prospective interventional study was to pilot this intensive participant activating EFC Basic Colposcopy Course on the short- and long-term learning of colposcopy-related knowledge, image recognition and the diagnostic confidence.High-quality colposcopy is essential in cervical cancer prevention. We performed a multicentre prospective interventional pilot-study, evaluating the effect of a six-hour case-based colposcopy course on short- and long-term learning of colposcopy-related knowledge, diagnostic accuracy levels and confidence. We recruited 213 colposcopists participating in three European Federation of Colposcopy (EFC) basic colposcopy courses (Finland, Norway, UK). The study consisted of three tests with identical content performed before, after and 2 months after the course, including ten colposcopic images, ten patient cases and scales for marking confidence in the answers. Outcome measures where mean scores in correct case-management, diagnosis (including high-grade lesion recognition), transformation-zone recognition and confidence in answers. Results were compared between the three tests and stratified according to experience. Mean test scores improved after the course for all participants. The increase was highest for beginners. Confidence in answers improved and the number of colposcopists showing high confidence with low scores decreased. A structured case-based course improves skills and confidence especially for inexperienced colposcopists; however, trainers should be aware of the risk of overconfidence. To complement theoretical training, further hands-on training including high-quality feedback is recommended. Conclusions drawn from long-term learning are limited due to the low participation in the follow-up test.

Colposcopy training and assessment across the member countries of the European Federation for Colposcopy

ObjectivesColposcopy training and assessment is not uniform across Europe with individual countries determining their own required standards and regulations. In light of the significant changes in colposcopic practice that have occurred over the past decade and the expansion of the European Federation for Colposcopy (EFC) membership, a study was conducted firstly, to assess the current requirements for training in each of the member countries and secondly, to review an EFC-approved core training curriculum for colposcopy. Study designA questionnaire survey of the EFC representatives from all member countries investigating their country's current practices/requirements with regard to training, assessment and accreditation for colposcopy. A two-round Delphi consultation with representation from the full, associate and three potential member countries was conducted using a 5-point Likert scale for scoring opinions. The results were analysed with respect to each country's population size and World Bank economic classification. ResultsFor the questionnaire survey, responses were received from 31/34 countries invited to participate. Training programmes were reported to be in place in 21 of the 31 countries but only 17 of the 21 countries had a committee overseeing the training programme. An assessment was part of the training programme in 20 countries with multiple choice questions and portfolios the most common assessment tools. Countries with a population size less than 2 million have a statistically significant lower probability of having a structured training/assessment programme, 1/5 compared to 20/26 for a populations greater than 2 million, p=0.013. For the Delphi study, responses were received from 34/39 countries invited to participate. Of the 51 competencies previously identified only 2 did not receive full support: ‘perform bacterial swabs’ and ‘provide data to national body’. There was no significant difference in the responses given by member, associate member or potential member countries. ConclusionsThere is considerable variation in colposcopy training and assessment across Europe. This study has enabled consensus opinion with the EFC on the contents of an EFC core curriculum. The revised curriculum has a mandate from the EFC member countries to be implemented across Europe as the standard for colposcopic training.

LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training.

This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome. This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher's exact test was used. 75% of all specimens were obtained intact. When the LLETZ specimen was intact, 89% of smear tests were reported as negative, against 86% when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation. Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6months post treatment. Enhancing the colposcopy training may help improve clinical outcome.

A questionnaire survey to study the effect of colposcopy training in Europe

The objective of the study was to see if colposcopy training can provide a measurable effect. A questionnaire containing 10 clinical scenarios requiring colposcopy was completed by delegates attending three colposcopy training courses in Europe. A total of 128 and 132 questionnaires were returned pre- and post-training, respectively. The means and standard deviations for the number of correctly assessed scenarios were M = 4.21, SD = 1.71 at pre-training and M = 5.05, SD = 1.82 at post-training. The χ2-test showed a statistically significant difference in the proportions of correct answers at pre- and post-training for five questions. The two factor ANOVA showed that there is a statistically significant difference between the pre- and post-training measures (F(2,124) = 17.13, p < 0.001) although the effect of training is not the same for all three locations. Trainees’ results show that there is a positive effect of training. The questionnaire may be used as a quality tool for measuring the effectiveness of training for colposcopy.

The Optimum Organization for the Delivery of Colposcopy Service in Ontario

To determine the optimum organization for colposcopy service delivery in Ontario, Canada. A multidisciplinary expert panel was convened to develop a systematic review to inform organizational guidelines. MEDLINE, EMBASE, CINAHL, HealthSTAR, and the Cochrane Library databases were searched from 1996 to February 2006 for articles that reported guidance or outcomes relating to improved outcomes in colposcopy training, qualifications, accreditation, maintenance of competency, the delivery of colposcopy, reducing default from colposcopy clinics, and/or strategies to improve patient satisfaction or comfort. In addition, an environmental scan identified unpublished documents related to the delivery of colposcopy services. Sixteen guidance documents related to the delivery of colposcopy services were identified; 5 from the published literature and 11 from the environmental scan. These documents were used by the panel to inform the systematic review and companion guidelines. Overall, the Ontario Colposcopy Guidelines Development Group believes that the benefits associated with the implementation of colposcopy recommendations in Ontario will result in greater organization of care and improved patient outcomes. In addition, the group anticipates that these recommendations will provide useful guidance to regional planning authorities, hospital administrators, and Cancer Care Ontario, as well as colposcopists and other practitioners, in the planning of integrated regional and provincial cancer screening services.

The Development of an Objective Structured Clinical Examination to Assess Completion of Training in Colposcopy

In Brief Objective. To comply with the Postgraduate Medical Education Training Board and the Royal College of Obstetricians and Gynecologists guidance, the British Society for Colposcopy and Cervical Pathology (BSCCP) introduced a new assessment method for certification. The medical education evidence, practicalities, and experience of the BSCCP Objective Structured Clinical Examination (OSCE) are presented in this article. Materials. The rationale behind the OSCE has been supported by medical education literature. Methods. The experience of those running the BSCCP OSCE has been used to provide a theoretical basis for considerations when planning an OSCE. The BSCCP introduced an OSCE to confirm competency in performing colposcopy on completion of training in the United Kingdom. The content for the OSCE was defined already in the BSCCP trainees' manual, and training is delivered locally. Current evidence from medical education research was used to support the introduction of the OSCE, including the development of a bank of OSCE questions, the construction of the OSCE content, and the standard setting of the examination at a level appropriate for completion of training for both medical and nursing colposcopy trainees. Examiners were recruited from the society membership and provided with training. The OSCE has been run since November 2006 to determine competency and to identify excellence. Results. The first OSCE was held on November 23, 2006, and 5 OSCEs have been held to date. One hundred forty-five candidates have sat the examination. The mean pass mark for the examination was 60% (range = 58-63%). The mean pass rate for the examination was 82% (range = 76-90%). Conclusions. We have developed and run an OSCE examination for completion of training in colposcopy in the joint BSCCP/Royal College of Obstetricians and Gynecologists training program for medical and nursing trainees. This has proved to be feasible, and we are conducting an ongoing evaluation of the reliability, validity, and acceptability of this assessment. The British Society for Colposcopy and Cervical Pathology has developed and introduced an Objective Structured Clinical Examination to confirm completion of training in colposcopy in the United Kingdom.

Admission for Treatment???Does the Degree of Training of Colposcopist Make a Difference?

Because of concern over the number of patients admitted to the hospital for cervical intraepithelial neoplasia (CIN), a retrospective audit was carried out over a 23-month period in the years 2003 to 2004, during which time 331 women presented for surgical excision of the cervical transformation zone because of CIN. The rate of admission to the hospital was 18.5%. Nurse colposcopists treated 96 women during the period under review. Another 78 procedures were done by trainees being certified for colposcopy, 43 by associate specialists, and 114 by consultants. Inpatient excisional biopsy was performed because of cervical glandular intraepithelial in 6 of 61 women who were admitted. Seventeen other inpatients had persistent borderline and mild changes, whereas 38 had moderate or severe dyskaryosis on smear examination. Excision was offered only when abnormal colposcopic findings were confirmed. Outpatient care was progressively more frequent when patients were seen by a nurse, a trainee, an associate specialist, or a consultant. Nurse colposcopists referred 27% of the women they saw. The figures for trainees, associate specialists, and consultants were 18%, 14%, and 13%, respectively. The most frequent indications for inpatient referral were anxiety, difficult access, a relatively large lesion, and the need for repeat treatment. For other indications, there were no marked differences in inpatient referral relating to the degree of training in colposcopy. Fewer than one fifth of women with CIN in this study underwent loop excision on an inpatient basis. Improved supervised training, increased confidence, and better patient counseling hopefully will further lower the proportion of women who are admitted for this procedure. Morbidity from general anesthesia would be correspondingly reduced.

Digital Tools for Collecting Data from Cervigrams for Research and Training in Colposcopy

Colposcopy is a critical part of gynecologic practice but has documented deficiencies, including lack of correlation between the colposcopic appearance and the severity of underlying neoplasia, limited reproducibility, and difficulty in the optimal placement of colposcopically directed biopsies. In a collaborative effort to improve colposcopy, we are analyzing digitized cervigram images from National Cancer Institute-funded studies. Specifically, the National Cancer Institute has collected close to 100,000 cervigrams, digitized to create a database of images of the uterine cervix for research, training, and education. In addition to the cervigram images, this database contains clinical, cytologic, and molecular information at multiple examinations of 15,000 women, with password and ID labeling strategies to protect patient privacy. The National Library of Medicine has designed two web-accessible software tools. The Boundary Marking Tool allows experts on colposcopy to perform an evaluation of the pictures and to mark boundary regions of normal and abnormal regions of the uterine cervix; these evaluations are collected and saved in the database. The Multimedia Database Tool enables retrieval of test and image biomedical data according to specific queries, for example, all women with cervical intraepithelial neoplasia 3 whose cytologic results are atypical squamous cells of undetermined significance. The resource soon will be available as an open resource, via a teaching tool coordinated by a database manager, which will permit a variety of applications for teaching and research. In this article, we describe the perceived need for the resource and its components.

Residency training in colposcopy: A survey of program directors in obstetrics and gynecology and family practice

Objective: Our goal was to identify how colposcopy is being taught to residents in obstetrics and gynecology and family practice programs and to see if the program directors think their residents receive sufficient clinical exposure to be adequately trained in colposcopy. Study Design: A 30-question survey was sent to all obstetrics and gynecology and family practice residency program directors. The survey included questions about the didactic nature of the colposcopy curriculum, the type of supervision, how resident skills are evaluated, estimates of the numbers and types of patients evaluated, the numbers and types of procedures being done by each resident, and the program director's perception of residents' competence in colposcopy. Results: The overall response rate was 485 of 752 program directors (64.5%). Significantly fewer family practice than obstetrics and gynecology program directors thought they had adequate numbers of colposcopy patients to train their residents. By their program directors' estimates, 86% of family practice residents evaluate 10 or fewer patients with high-grade lesions (versus 16.5% of obstetrics and gynecology residents); 51.4% evaluate 10 patients or fewer with low-grade lesions (versus 6.7% of obstetrics and gynecology residents), and 40.6% evaluate 10 patients or fewer with atypical squamous cells of undetermined significance (versus 3% of obstetrics and gynecology residents). Experience with vulvar disease is also limited. Program directors thought their residents' colposcopy skills were roughly comparable with their general obstetrics and gynecology skills. Conclusions: It is possible that many program directors underestimate the number of colposcopic examinations required to achieve and maintain colposcopic skills. Many training programs have insufficient clinical volume to properly train residents in colposcopy. (Am J Obstet Gynecol 2001;185:507-13.)

Training in colposcopy: experience with a videocolposcopy test.

The authors evaluate the results of a videocolposcopy test (330 total cases, 12 cases of histologically confirmed CIN2 or more severe lesions) taken by 9 accredited and 17 unaccredited colposcopists during 1995. Seven of 9 accredited and 4 of 13 unaccredited colposcopists reached the requested standard (sensitivity > 90%, biopsy rate < 60%). Performance was definitely better when the test was not blind to the cytologic report (4 of 13 reached the requested standard) with respect to blind reading (none of 17). The study confirmed that colposcopy at unaccredited practices is poorly accurate. Colposcopic assessment of patients with abnormal smears should be centralized in accredited practices, which should undergo periodic quality control to guarantee screening efficacy. Tape-recorded videocolposcopy tests are a good, simple, practical and inexpensive method for interobserver quality control of colposcopic performance.

International standards for training in colposcopy.

International standards for training in colposcopy.

Procedural training in family practice residencies: current status and impact on resident recruitment.

Although procedural training in family practice has recently received greater emphasis, the current status of this training in residency programs has not been reported. Considerable variation in procedural training among family practice residencies is allowed by the American Board of Family Practice and accreditation requirements. This study was performed to report the current status of procedural training in family practice residencies and to determine whether a correlation exists between the number of procedures taught in family practice residencies and successful resident recruitment. A one-page questionnaire was developed to determine availability of teaching and type of instructor for 24 selected procedures. This questionnaire was mailed to all 398 family practice residency directors in the United States. Data from the survey were compared with the published residency match results in 1993 and 1994. Questionnaires were received from 363 programs, for a response rate of 91 percent. The current status of training in these procedures, presented by program type and geographic region, reflects considerable regional variation. Training in colposcopy and in cardiac stress testing was reported to be available in a greater percentage of programs than in previous studies. A significant positive correlation was found between the number of procedures taught by family physicians and residency match results. The 91 percent response rate lends credibility to this status report and indicates that family practice program directors recognize procedural training as an important issue. The trend toward greater availability of procedural training in family practice residencies is confirmed for selected procedures. Emphasis on procedural training by family physicians has a positive correlation with successful resident recruiting. The impact on medical student interest in family practice deserves further study.

Colposcopy training and practice: ACOG committee opinion: Committee on gynecologic practice number 133 — March 1994

International Journal of Gynecology & ObstetricsVolume 45, Issue 2 p. 181-182 ACOG committee opinion Colposcopy training and practice ACOG committee opinion: Committee on gynecologic practice number 133 — March 1994 First published: May 1994 https://doi.org/10.1016/0020-7292(94)90132-5Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume45, Issue2May 1994Pages 181-182 RelatedInformation

Colposcopy practice and training in family practice residency programs.

The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.

Should training in colposcopy be obligatory in higher specialist training in genitourinary medicine?

Should training in colposcopy be obligatory in higher specialist training in genitourinary medicine?

Residency training in colposcopy

Residency training in colposcopy