1 prof walter colposcopy jan14


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1 prof walter colposcopy jan14

  1. 1. Distance Learning courses Laparoscopy and Colposcopy • Gynaecology and Obstetrics has transformed over the last 20 yrs – In patient to outpatient procedures – Specific targeted therapy – Open surgery to endoscopy – Reproductive medicine
  2. 2. Teaching clinical skills • Witnessing has some but limited value • Skills are largely generic • Learning a procedure is easy if you have the generic skills – Suturing, energy and irrigation – Ergonomic efficiency – Equipment and assistant management – Image recognition skills
  3. 3. Examine skills training in other high risk professions • The airline industry • The mining industry • The Diving / exploratory industry
  4. 4. WHAT IS NECESSARY TO BECOME AN EXPERT • Communication skills • Technical skills • Information • Decision making skills • Management of personnel • Image and anatomy recognition skills
  5. 5. International Federation of Cervical Pathology and Colposcopy Walter Prendiville President elect
  6. 6. IFCPC International Federation for Cervical Pathology and Colposcopy • 45 National Societies • > 9500 individual colposcopists
  7. 7. Canada, United States, Mexico, UK, France, Spain, Portugal, Austria, Germany, Czech Republic, Croatia, Greece, Hungary, India, Ireland, Israel, Japan, Korea, Yugoslavia, Poland, Slovak Republic, Turkey, Netherlands Argentina, Brazil, Uruguay, Paraguay, Chile, Bolivia, Costa Rica, Dominicana, Ecuador, Guatemala, Indonesia, Singapur,
  8. 8. <3.9 <7.9 <14.0 <23.8 <55.6 Cervical cancer mortality/100,000 Mortality falling in developed world Mortality rising in developing world
  11. 11. Constitution and by laws of the Federation – Ambitions of the IFCPC • The primary responsibility in the developed world was to maintain standards, promote improvement through quality assurance, education and training. • In the emerging economies the emphasis of the Federation was different and should be to respond to individual needs: focusing on training and education in colposcopy and the treatment of pre-invasive disease in support of regional initiatives and from other International agencies for example IARC, WHO, and others
  12. 12. The twinning initiative • A centre or national society would engage with an emerging centre or society • Regular frequent videoconferences of clinico-pathological / multidisciplinary meetings • Occasional visits between centres / national societies
  13. 13. The future • Serious attempt to examine any and all initiatives that might reduce the burden of cervical cancer, worldwide • Embrace colposcopic and non colposcopic endeavours • Respond to local / regional initiatives • Collaborate, collaborate, collaborate
  14. 14. Colposcopy practice and training • Hugely variable in the developed world • Structured training becoming the norm in Europe, Australia, Canada and the USA • Continuing debate about the true value of colposcopic assessment for large screening / treatment programmes in the developing world • Has a role in certain if not all cases • If colposcopy is to be employed it should be done so by properly trained personnel
  15. 15. Colposcopy training in the developing world • Concern about long term value of running basic courses 1. Run by Western colposcopists, 2. ? Fully appraised of local circumstances 3. Not followed up by ongoing training 4. ? relevant to local circumstances
  16. 16. Training alternatives 1. Preceptorships 2. Basic course followed by short period of training in a centre 3. Basic course followed by continuing training in – Image recognition – Case management – Treatment technique, especially if excisional
  17. 17. Distance learning project • Collaboration between 1. AORTIC 2. IARC 3. IFCPC
  18. 18. Distance learning project • Collaboration between 1. Lynn Denny 2. Rengaswamy Sankaranarayanan 3. Walter Prendiville / Patrick Walker 4. Narendra Pisal / Charles Redman 5. Christine Bergeron / Jean luc Mergui 6. And many others!
  19. 19. Tamil Nadu / Dublin initiative – Basic course, – equipment provision from Dublin (HRB grant) – Evolution of screening camps – Fortnightly videoconference of cases – Interim visits to and from each centre – Advanced course – Relatively well funded, by Irish HRB
  20. 20. Distance learning case discussion via the web
  21. 21. Africa • Very few oncology or pre-cancer services • Distances a real problem • Training opportunities very limited • Potential to run a distance learning programme
  22. 22. Distance learning programme first steps • Assessment of need in region • Assessment of delegate’s colposcopy clinic equipment • Assessment of screen positive population profile • Treatment options • Ambitions of the delegate
  23. 23. Distance learning programme first steps • Determination of relevant competencies for the region dependant on – Screening activity – Treatment possibilities – Facilities vs Need
  24. 24. Distance learning programme IFCPC pilot course Lecture series Structured, progressive, Either internet based (web or email) Each subject to be referenced Each lecture to be followed by an exam’ before proceeding to next lecture Series of clinical cases during second half of year Intermittent submission of case presentations
  25. 25. Distance learning programme IFCPC pilot course Assessment OSCE Clinic management Case management Dexterity skills Speculum and colposcopy Treatment Pilot course of 20 delegates from Tamil Nadu and 12 sub-Saharan African countries
  26. 26. Pilot course 2012 • Practical course held in Cape Town at Grut Schoor c/o Prof Lyn Denny’s colposcopy service • 100 patients with cervical disease • Four faculty in four colposcopy rooms over four days
  27. 27. Pilot course 2012 • OSCE • Along similar lines to the BSCCP • Multiple and varied stations of clinical, theoretical, management and colp image questions • High pass rate
  28. 28. Distance learning programme Sub Saharan Africa Challenges Assessment of clinic practice and facilities Commitment of a large faculty Duplication or translation of core subject matter Should we exclusively train doctors Recruitment of visiting faculty and exit exam faculty
  29. 29. IFCPC Distance Learning Projects Progress to date • First course completed in 2012 • Second course in English is ongoing. • Third course due February 14 in French • Courses in Spanish and Portuguese in preparation • Further courses in Russian, German, Italian and Chinese under consideration
  30. 30. DISTANCE LEARNING PROGRAMME international federation for cervical pathology and colposcopy
  31. 31. Outline of Distance Training Programme •20 trainee colposcopists to be recruited •Course to run over 12 months period •24 lectures and supportive reference material on the web on a fortnightly basis •A scheduled web based assessed question and answer module following each lecture •24 video/still image colposcopy clinical cases
  32. 32. Assessment A four day practical / colposcopy clinic session to be held at the end of the year’s course An OSCE immediately after the practical session IFCPC Certificate will be awarded to the successful delegates
  33. 33. Prerequisites for participation in the course •Work in a unit where some form of screening is provided such that pre-cancer patients need colposcopy and management •Have the support of the unit where the delegate is working •Have the necessary colposcopic equipment •Have regular access to the internet