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Xavier Carcopino MD PhD
Department of Obstetrics and Gynecology, Hôpital Nord
Marseille, France
xcarco@free.fr
TRAINING THE TRAINERS
BECOMING A COLPOSCOPIST
The challenge of training
• Objectives of training
• Theoretical knowledge: basic and advanced courses
• Practical knowledge:
- Precisely localise TZ
- Recognize normal and abnormal TZ
- Characterize abnormal TZ / classification
- Clinical skills: Punch biopsy, LLETZ…
• Patients’ further information, management and follow up
MODEL OF COMPETENCE
Miller GE Acad Med1990
Knows
Knows how
Shows how
Behaviour~
skills/attitudes
Cognition~
knowledge
Does
Professionalauthenticity
COLPOSCOPY TRAINING AND
ASSESSMENT ACROSS EUROPE
Moss et al. EJOGRB 2015
COLPOSCOPY TRAINING AND
ASSESSMENT ACROSS EUROPE
Moss et al. EJOGRB 2015
TRAINING CASE LOAD
Stipulated minimum number of cases seen and managed
• New cases (86.2%) : Median 50 (range: 15-300)
• Cases under supervision (80%) : Median 40 (range: 5-300)
EXAMINATION UNDER DIRECT
SUPERVISION
Experience
Self confidence
Accuracy of
colposcopy
Transient
images
TRAINER
WHO CAN BE A TRAINER?
Those who have:
• Experience in colposcopy
• Experience in other areas of clinical training
• Knowledge of the training programme
• Time and enthusiasm to support trainee (weekly meeting)
• Adequate numbers of cases
• Offer training clinics with 5-8 patients
• Time and experience to mentor a trainee and help trainees with
difficulties
INFLUENCE OF GUIDELINES CHANGES
Keehbauch Fam Med 2012
P=0.13 P<0.01
WHY TRAINING THE TRAINERS?
• Complex training requires professional trainers
• Training skills can be learned (and can be taught)
• Trainers need some knowledge of
- learning theories
- practical applications
- giving effective feedback
- structures that govern training & assessment
QUALITY STANDARDS IN COLPOSCOPY
Luyten et al. EJOGRB 2015
COLPOSCOPY TRAINING AND
ASSESSMENT ACROSS EUROPE
Moss et al. EJOGRB 2015
ROLE OF THE TRAINER
• Enable trainee to complete training
• Assess if trainee has satisfactorily completed training
• Complete work place assessments throughout training
• Monitor trainee’s progress with regular meetings and
review of progress
• Provide advice and feedback
THE PROBLEM WITH TRAINERS
• Buzy people
• Buzy clinic
• Difficult to catch…
BECOMING A COLPOSCOPIST
What’s easy and what’s hard
EASY
• Basic and theoretical knowledge
• Colposcopy courses
• Colposcopy books & dvds
HARD (time…)
• Experience
• Clinical skills
• Patients’ management and follow up
• Self confidence
THE TRAINER SHOULD…
Be aware of the difficulties the trainee will go through
• Colposcope settings and use / focus
• Identify and define the TZ / SCJ
• Memorize different images / signs identified at the different
times of colposcopic examination
• Acquire enough experience / confidence
COLPOSCOPE SET UP
DIFFICULTIES IN TRAINING
MEMORIZING IMAGES
Without coloration Acetic Acid Lugol
GIVE FEEDBACK AND MAKE AN
ACTION PLAN
Ian Lang 1991
Teaching without
testing is like
cooking without
tasting or writing
without reading
GIVE FEEDBACK AND MAKE AN
ACTION PLAN
Feedback
• Identify good practice
• Identify how to improve practice
• Benefit from the experience of the trainer
Purposes
• For patients : « Is this trainee ok to progress? »
• For the trainee : « How am I doing? » & « How can I improve ? »
GIVE FEEDBACK AND MAKE AN
ACTION PLAN
Feedback: technique
Techniques used have a huge influence on impact
– Appropriate location
– Ask trainee to give their own view early
– Non judgemental
– Specific comments
– Right amount vs. too much
GIVE FEEDBACK AND MAKE AN
ACTION PLAN
Pendleton’s rules
1. Check the learner wants and is ready for feedback.
2. Let the learner give comments.
3. The learner states what was done well.
4. The observer(s) state what was done well.
5. The learner states what could be improved.
6. The observer(s) state how it could be improved.
7. An action plan for improvement is made.
GIVE FEEDBACK AND MAKE AN
ACTION PLAN
• Don’t forget the trainee’s emotional response.
• Don’t criticise without recommending action.
• Don’t comment on personal attributes (that cannot be
changed).
• Don’t generalise.
• Don’t be dishonestly kind – if there is room for
improvement be specific and explore alternative
approaches.
Action plan
• Action plan leads to change
• “Feedback alone does not cause change, it is the goals that people
set in response to feedback”
• Ensure you agree together on the plan
• Colposcopy is often a short episode and an action plan may be a
single action or reflection for future practice
GIVE FEEDBACK AND MAKE AN
ACTION PLAN
Hewson 1998
TRAINING MODELS
Hefler et al. Am J Obstet Gyn 2012
IFCPC DISTANCE LEARNING PROGRAM
Distance learning program across the world : english,
spanish, russian, french…
Online lectures
Local trainers :
• Cases under supervision
• Mini Clinical Evaluation Exercices (CEX)
• Cases loads : colposcopic examinations and LETTZs
Final assessment / OSCE and graduation
CONCLUSIONS
Trainers are essential to optimal training in colposcopy
Training the trainers :
• Optimize practical training and feedback
• Homogenize the training
The trainers should know about
• Common difficulties in colposcopic practical training
• How provide feedback and make action plan
• Identify when the training is completed
THE LONG ROAD TO COLPOSCOPY
The human eye may be
wrong…
It takes some time and
experience to properly
analyze what you see
Thank you for your attention…

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Xavier Carcopino - Training the trainers

  • 1.
  • 2. Xavier Carcopino MD PhD Department of Obstetrics and Gynecology, Hôpital Nord Marseille, France xcarco@free.fr TRAINING THE TRAINERS
  • 3. BECOMING A COLPOSCOPIST The challenge of training • Objectives of training • Theoretical knowledge: basic and advanced courses • Practical knowledge: - Precisely localise TZ - Recognize normal and abnormal TZ - Characterize abnormal TZ / classification - Clinical skills: Punch biopsy, LLETZ… • Patients’ further information, management and follow up
  • 4. MODEL OF COMPETENCE Miller GE Acad Med1990 Knows Knows how Shows how Behaviour~ skills/attitudes Cognition~ knowledge Does Professionalauthenticity
  • 5. COLPOSCOPY TRAINING AND ASSESSMENT ACROSS EUROPE Moss et al. EJOGRB 2015
  • 6. COLPOSCOPY TRAINING AND ASSESSMENT ACROSS EUROPE Moss et al. EJOGRB 2015 TRAINING CASE LOAD Stipulated minimum number of cases seen and managed • New cases (86.2%) : Median 50 (range: 15-300) • Cases under supervision (80%) : Median 40 (range: 5-300)
  • 7. EXAMINATION UNDER DIRECT SUPERVISION Experience Self confidence Accuracy of colposcopy Transient images TRAINER
  • 8. WHO CAN BE A TRAINER? Those who have: • Experience in colposcopy • Experience in other areas of clinical training • Knowledge of the training programme • Time and enthusiasm to support trainee (weekly meeting) • Adequate numbers of cases • Offer training clinics with 5-8 patients • Time and experience to mentor a trainee and help trainees with difficulties
  • 9. INFLUENCE OF GUIDELINES CHANGES Keehbauch Fam Med 2012 P=0.13 P<0.01
  • 10. WHY TRAINING THE TRAINERS? • Complex training requires professional trainers • Training skills can be learned (and can be taught) • Trainers need some knowledge of - learning theories - practical applications - giving effective feedback - structures that govern training & assessment
  • 11. QUALITY STANDARDS IN COLPOSCOPY Luyten et al. EJOGRB 2015
  • 12. COLPOSCOPY TRAINING AND ASSESSMENT ACROSS EUROPE Moss et al. EJOGRB 2015
  • 13. ROLE OF THE TRAINER • Enable trainee to complete training • Assess if trainee has satisfactorily completed training • Complete work place assessments throughout training • Monitor trainee’s progress with regular meetings and review of progress • Provide advice and feedback
  • 14. THE PROBLEM WITH TRAINERS • Buzy people • Buzy clinic • Difficult to catch…
  • 15. BECOMING A COLPOSCOPIST What’s easy and what’s hard EASY • Basic and theoretical knowledge • Colposcopy courses • Colposcopy books & dvds HARD (time…) • Experience • Clinical skills • Patients’ management and follow up • Self confidence
  • 16. THE TRAINER SHOULD… Be aware of the difficulties the trainee will go through • Colposcope settings and use / focus • Identify and define the TZ / SCJ • Memorize different images / signs identified at the different times of colposcopic examination • Acquire enough experience / confidence
  • 20. GIVE FEEDBACK AND MAKE AN ACTION PLAN Ian Lang 1991 Teaching without testing is like cooking without tasting or writing without reading
  • 21. GIVE FEEDBACK AND MAKE AN ACTION PLAN Feedback • Identify good practice • Identify how to improve practice • Benefit from the experience of the trainer Purposes • For patients : « Is this trainee ok to progress? » • For the trainee : « How am I doing? » & « How can I improve ? »
  • 22. GIVE FEEDBACK AND MAKE AN ACTION PLAN Feedback: technique Techniques used have a huge influence on impact – Appropriate location – Ask trainee to give their own view early – Non judgemental – Specific comments – Right amount vs. too much
  • 23. GIVE FEEDBACK AND MAKE AN ACTION PLAN Pendleton’s rules 1. Check the learner wants and is ready for feedback. 2. Let the learner give comments. 3. The learner states what was done well. 4. The observer(s) state what was done well. 5. The learner states what could be improved. 6. The observer(s) state how it could be improved. 7. An action plan for improvement is made.
  • 24. GIVE FEEDBACK AND MAKE AN ACTION PLAN • Don’t forget the trainee’s emotional response. • Don’t criticise without recommending action. • Don’t comment on personal attributes (that cannot be changed). • Don’t generalise. • Don’t be dishonestly kind – if there is room for improvement be specific and explore alternative approaches.
  • 25. Action plan • Action plan leads to change • “Feedback alone does not cause change, it is the goals that people set in response to feedback” • Ensure you agree together on the plan • Colposcopy is often a short episode and an action plan may be a single action or reflection for future practice GIVE FEEDBACK AND MAKE AN ACTION PLAN Hewson 1998
  • 26. TRAINING MODELS Hefler et al. Am J Obstet Gyn 2012
  • 27. IFCPC DISTANCE LEARNING PROGRAM Distance learning program across the world : english, spanish, russian, french… Online lectures Local trainers : • Cases under supervision • Mini Clinical Evaluation Exercices (CEX) • Cases loads : colposcopic examinations and LETTZs Final assessment / OSCE and graduation
  • 28. CONCLUSIONS Trainers are essential to optimal training in colposcopy Training the trainers : • Optimize practical training and feedback • Homogenize the training The trainers should know about • Common difficulties in colposcopic practical training • How provide feedback and make action plan • Identify when the training is completed
  • 29. THE LONG ROAD TO COLPOSCOPY The human eye may be wrong… It takes some time and experience to properly analyze what you see
  • 30. Thank you for your attention…