2. Education: Basic / Advanced
Colposcopy Courses
Pekka Nieminen, M.D., Ph.D
Associate Professor, Chief Physician
Dept. of Obstetrics & Gynecology
Helsinki University Central Hospital

3. EFC has agreed approval of courses at the 2014 Satellite
meeting in Berlin.
• General principles
• Only applications for approval of courses by the board of the national
societies are accepted.
• The members of the boards of the national societies have to be registered i.e.
at the website’s section „members“.
• Approvals are applied only for courses within the area of their national
society member countries.

4. Basic courses
Principles
i. Send the application form to the chair of the education
committee
ii. Programme of the course (max. 2 pages)
iii. Duration 1-2 days ( min. 6 hours exluding the breaks)
iv. EFC will send approval or refusal within 3 months
v. Fee of 100 €
vi. Re-approval every 3 years

5. Aims and objectives of the EFC Basic Courses
• The aim is to provide an introduction to colposcopic methodology.

6. Structure
• 1 day course: 3 x 1½ - 2½ hour sessions (total 360 min)
• As part of the introduction there is an initial interactive session which aims to indicate
the teaching objectives of the course and serve as a baseline assessment.
• Talks on the theoretical background of colposcopy and the principles of colposcopic
management.
• The interactive sessions will focus on image recognition and management.
• Interactive sessions comprise a number of images which participants are asked to
comment on (is SCJ visible?: is there an abnormality?: what is the abnormality?). The
answers/explanations occur in this and the feed-back session.

7. Lectures
• Introduction
• Aim
• To describe how the course works and to start engagement.
• Objectives
• Describe/explain the design of the course
• Ground rules for the interactive sessions
• Undertake initial course assessment

8. Lecture 1: Colposcopic principles
• Aim
• Provide an overview of the basic concepts of colposcopy
• Objectives
• Explain the key questions that must be addressed in any colposcopic examination
• Taking history
• Illustrate the SCJ and explain its significance
• Describe normal cervical cytological and histological morphology (incl. metaplasia/SCJ)
• Describe normal findings – including effects of age and pregnancy
• Outline the colposcopic features of abnormality
• Describe the features of CIN/ cGIN/ VaIN
• Describe the features of cervical cancer
• Indicate the key steps in colposcopic decision making
• Comment
• To lay down the template for the next interactive session

9. Lecture 2: Colposcopic diagnosis
Aim
• Provide an overview of the basic diagnostic principles of colposcopy
Objectives
• Describe common non-neoplastic pathology
• Describe the features of CIN/ cGIN/ VaIN
• Describe the features of cervical cancer
• Indicate the key steps in colposcopic decision making
Comment
• To lay down the template for the next interactive session

10. Lecture 3: Colposcopic management
Aim
• To describe the role of colposcopy in the management of CIN
Objectives
• Refer to the European guidelines / National guidelines
• Illustrate the relative value of colposcopy in relation to cytology and clinical setting
• Describe the influence of colposcopic findings on management
• Describe the different types of biopsy (punch biopsy, simple excisional, extended)
• Colposcopic findings on management
Comment
• To lay down the template for the next interactive session

11. Interactive sessions
• Colposcopic images and videos
• Clinical cases
• Feedback

12. EFC Advanced colposcopy course
Aim
• content should be relevant to senior and expert colposcopists

13. Objective:
• reinforce basic concepts
• provide information and discussion on different cases
• discuss introduction and content of QA
• provide information on recent development
• provide information how to train in colposcopy

14. Process
• Lecture based with good opportunities for interaction and discussion
• Administration:
• EFC approved advanced colposcopy course.
• 100 € fee for approval per course, if repeated as such, 100 € per year
• If the Course has EFC officers as teachers, 20 € per course participant/trainee
will be paid to EFC
• Local organizer is responsible for the administration of the course and test,
including the content and marking

15. 2 days, 6 + 6 hours, excluding breaks
• Day 1
• Basic science 2 h
• Cases 2 h
• Management 2 h
• Day 2
• Cases 1,5 h
• Management 2,5 h
• Quality assurance 1,5 h
• Training 0,5 h
• Course assessment

16. Structure in details:
1) Basic science: 2,0 h
• screening 30 min
• HPV 30 min
• cyto and histology 20 min
• molecular, new development, scientific update and open questions 40 min

17. 2) Cases: 2 hours day 1 and 1,5 hours day 2
• Setting the scene
• cx, vagina and vulva
• pregnancy, persistent discrepancy, microinvasion
• features, images, videos

18. 3) Management: 2 h day 1 and 2,5 h day 2
• low grade
• high grade
• glandular lesions
• treatment methods with videos, if possible
• concepts of depth, length, etc. in cone
• follow-up
• vagina
• vulva
• novel strategies

19. 4) Quality assurance: 1 hour
• guidelines (local - in organizing country) and in other countries, incl
EU-guidelines)
• performance of guidelines, i.e. are they followed?
• are they evidence based?
• QA in practice
• Certification

20. 5) Training: 1 hour
• criteria for basic colpo course
• training programmes
• course assessment
• test

21. How to teach and learn?
The ColpoEdu 2015 study
Sabrina Forsell, M.D.,
Ilkka Kalliala M.D.,PhD
Mervi Halttunen-Nieminen M.D., PhD,
Ameli Tropé, M.D., PhD
Esther Moss, M.D, PhD,
Simon Leeson, M.D, PhD,
Charles Redman M.D., PhD
Maria Kyrgiou, M.D., PhD
Pekka Nieminen, M.D,PhD,
and European Federation for Colposcopy

22. Research questions
• How does an interactive course in colposcopy affect short and long
term learning?
• Is learning affected by level of experience of the colposcopist?
• Does the course affect the confidence in the diagnosis of the images and
patient cases?
• Does confidence correlate with performance and does this change after the
course
• Is learning between visual and written cases different?
• How different kinds of prior training affect learning

23. Material and methods
• Three EFC Basic Colposcopy Courses in Finland, Norway and U.K.
• The courses were primarily conducted by, Charles Redman, Esther
Moss, Simon Leeson and Pekka Nieminen
• Colposcopists attending the courses were invited to participate in the
study

24. Material and methods
• The study consisted of pre-, post- and follow-up
tests
• Pre-test immediately before the course
• Post-test immediately after the course
• Follow-up 2 months after the course
• During the pre- and post-test each image was
shown for 30 seconds
• The follow-up test was done with a web-based
questionnaire giving unlimited time to answer
the questions

25. Results - demographics
Finland Norway UK All
Female 63 (90,0%) 30 (75,0%) 58 (56,3%) 151
Male 6 (8,6%) 7 (17,5%) 29 (28,2%) 42
Sex not known 1 (1,4%) 3 (7,5%) 16 (15,5%) 20
Total 70 (100%) 40 (100%) 103 (100%) 213
Finland Norway UK All
Mean age [years] 43,4 39,0 49,0 45,0
Experience of
colposcopies [years] 10,41 5,12 12,33 10,33

26. Results
1.0
7.5
16.5
60.0
62.5
6.8
17.0
15.0
29.1
11.0
7.5
20.4
10.0
7.5
27.2
F INLA ND NORW A Y UK
EXPERIENCE OF COLPOSCOPIES, ANNUAL AMOUNT
[%]
not known 0-50 50-100 100-200 >200

27. Results
0
1
2
3
4
5
6
7
8
Correct treatment or follow up Correct junction type Correct diagnosis
6.03
5.57
3.37
7.18
p<0,01*
6.39
p<0,01*
3.70
p=0,014*
6.91
p<0,01**
5.78
3.70
Points,max10
All participants
pre-test post-test follow-up
Cases Images
* change pre to post
** change pre to follow-up

28. Results – correct category
7
7.2
7.4
7.6
7.8
8
8.2
High/low grade lesions correctly recognized Abnormal/normal lesions correctly recognized
7.45
7.84
7.58
8.12
p=0,039*
7.72
8.15
p=0,042**
Points,max10
All participants
pre-test post-test follow-up
* change pre to post
** change pre to follow-up

29. Results – according to experience
0
1
2
3
4
5
6
7
8
Beginners Intermediate Experts
5.68
6.10
6.59
7.28
p<0,001*
7.03
p<0,001*
7.26
6.83
p<0,001**
6.83
7.18
Points,max10
Correct treatment or follow-up, case questions
pre-test post-test follow-up
* change pre to post
** change pre to follow-up

30. Results – according to experience
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Beginners Intermediate Experts
5.67
5.34
5.79
6.64
p=0,005* 6.29
p=0,002*
6.085.91
5.58
6.00
Points,max10
Correct junction, image questions
pre-test post-test follow-up
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Beginners Intermediate Experts
3.35 3.36
3.72
3.90
3.62 3.673.69 3.62
4.18
Points,max10
Correct diagnosis, image questions
pre-test post-test follow-up
* change pre to post
** change pre to follow-up

31. Results according to experience,
correct category
7.20
7.54
7.63
7.57 7.54
7.73
7.82
7.92
8.18
6.60
6.80
7.00
7.20
7.40
7.60
7.80
8.00
8.20
8.40
pre-test post-test follow-up
Points,max10
High/low grade lesion recognition
Beginners Intermediate Experts
7.83 7.84
7.97
8.24
7.98
8.25
8.11
8.31
8.09 p=0,002**
7.50
7.60
7.70
7.80
7.90
8.00
8.10
8.20
8.30
8.40
pre-test post-test follow-up
Points,max10
Abnormal/normal lesion recognition
Beginners Intermediate Experts
* change pre to post
** change pre to follow-up

32. Confidence
0
10
20
30
40
50
60
70
80
90
Confidence for case questions Confidence for picture questions
76.4
50.3
80.5
58.2
78.9
52.6
VASscale,0-100
Mean confidence - all participants
pre-test post-test follow-up
0 = not at all confindent 100 = very confident

33. Conclusions
• Improvement of performance after the course,
which seems to maintain (both cases and
images)
• Surprisingly low pre-course image recognition
rate
• Normal/atypia and Low/high-grade lesion recognition
better
• The effect of the course was more significant in
the case questions

34. Conclusions
• The improvement in performance was most significant for the
beginners
• In the follow-up test the beginners showed the same performance
levels as the experts pre-test

35. Conclusions - confidence
• Confidence increases due to the course for
beginners and intermediates
• The confidence of the experts was lower after
the course and follow-up