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Pekka Nieminen - Education: basic/ advanced colposcopy courses

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Pekka Nieminen - Education: basic/ advanced colposcopy courses

  1. 1. Education: Basic / Advanced Colposcopy Courses Pekka Nieminen, M.D., Ph.D Associate Professor, Chief Physician Dept. of Obstetrics & Gynecology Helsinki University Central Hospital
  2. 2. 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.
  3. 3. 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
  4. 4. Aims and objectives of the EFC Basic Courses • The aim is to provide an introduction to colposcopic methodology.
  5. 5. 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.
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. Interactive sessions • Colposcopic images and videos • Clinical cases • Feedback
  11. 11. EFC Advanced colposcopy course Aim • content should be relevant to senior and expert colposcopists
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 5) Training: 1 hour • criteria for basic colpo course • training programmes • course assessment • test
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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

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