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Sonia Andersson - The case for an EFC Diploma in Sweden


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Sonia Andersson - The case for an EFC Diploma in Sweden

  1. 1. Prof Sonia Andersson Chair of Swedish Colposcopy Society
  2. 2. Sonia Andersson Professor, senior Consultant Karolinska Institutet
  3. 3. The case for an EFC Diploma in Sweden 15 december 2017Namn Efternamn 2
  4. 4. Presentation outline  Cervical cancer in Sweden  The history of colposcopy in Sweden  Swedish guidelines and new requirement to treat women with dysplasia  Education in colposcopia in Sweden  Swedish Society of Colposcopy  Examination in colposcopy 15 december 2017Namn Efternamn 4
  5. 5. Since the early sixties, population based vaginal cytological screening has been available in most Swedish counties. Due to organized Pap smear screening the incidence of squamous cell carcinomas in Sweden has decreased with 60 % 15 december 2017Namn Efternamn 5
  6. 6.  The incidence of cervical cancer in Sweden is 7.5 /100 000 women.  Cervical cancer in Sweden is a relatively uncommon event with about 560 new cases and 200 deaths yearly.  5-year survival 73 %
  7. 7. 15 december 2017Namn Efternamn 7
  8. 8. History of colposcopy in Sweden  Colposkopy has had an uneven history in Sweden.  Early in the 1980s, colposcopy training courses had been started and it was a group interested gynecologists but mostly they were interesting in screening programs and in HPV.  At the same time, until the 1990s, women with CIN were treated solely on the basis of the findings of cell sampling in most parts of the country.  This led primarily to overtreatment but probably also a certain undertreatment.  Treatments procedures were often performed by the least experienced doctors, and the assessments and interventions were considered relatively simple.  No quality control was available!
  9. 9.  With time more education in colposcopy has been introduced.  Colposcopy courses in Gothenburg and in Stockholm for both seniors and fellows.  A Swedescore system in Gothenburg has been introduced and has helped fellows to understand the colposcopy images.
  10. 10. Professor Eva Rylander Swedish pioneer in colposcopy 15 december 2017Namn Efternamn 11
  11. 11. According to Swedish National Program  Although basic knowledge of clinical colpososcopy is of high value.  In particular, the process of new knowledge about HPV testing, cytology trials and more complicated guidelines requires a knowledge in colposcopy.  The new guidelines sets some limited minimum requirements for gynecologists to investigate and treat women with different grade of dysplasia(colposcopists):
  12. 12. •Investigate at least 50 women with different grade of dysplasia during one year. • Have completed a 3-4 days course as above. • To treat dysplasia, perform at least 25 treatments per year  No formal licensing with examination is proposed in Swedish guidelines, but these minimum levels should be followed up in the quality register.  In the long term, a licensing of colposcopists should be introduced, but it is not mandatory to have to be able to treat patients with dysplasia!
  13. 13. According to Swedish guidelines Knowledge objectives for colpososcopic education  Theoretical understanding of the dysplastic process.  The doctor should be able to •  Describe and explain the development of precancerous changes  Understand all clinically relevant aspects of HPV in the transformation zone: transmission, natural process, spontaneous healing, progress, proliferation, genome integration, cell regulation •Describe and explain the nomenclature of atypical cell samples and histopathology.
  14. 14. Analyze data and communicate  The doctor should be able to •Acquire and interpret the patient's dysplasia and screening history •communicate with the patient in a clear and incoming way about her cell sample abnormalities and propose further treatment •understand the guidelines and be able to make clinically and scientifically well-founded assessments of patient treatment •independently handle combinations of discrepancies, findings and background factors.
  15. 15. Skills in colpososcopy  The colposcopist should be able to •  Determine whether colposcopy is complete and evaluate and classify the transformation zone  examine vagina and exclude or evaluate dysplastic lesions  • identify and describe epithelium and benign pregnancy-related changes  • identify, recognize and classify low- grade high-grade changes, suspicion of microinvasion and invasion •  apply the Swedescore scoring system  Apply the IFCPC (International Federation of Colposcopy and Cervical Patology) classification
  16. 16. Skills in biopsy The colposcopist should be able to:  Determine where biopsy should be taken • Determine when to take biopsy  To be able to take biopsies from different patients with different types of cervix, transformation zones and lesions.
  17. 17. Skills in excision treatment  The colposcopist should be able to  handle the current anesthesia method (preferably local anesthesia) and its conditions and limitations for the procedure •be familiar with the physical conditions and effects of the method used (LEEP, LLETZ excision, laser excision, etc.) • handle the safety aspects of treatment •after appropriate supervision, independently carry out interventions on different types of cervix with different transformation zones and lesions • manage complications that may occur per- and postoperatively (bleeding, etc.)
  18. 18. Special challenges in the new guidelines  The National Board of Health's is expected that the introduction of new guidelines will result in increase of a volume of the number of coposcopical investigation in 20%.  This means that the need for educated colposcopists increases, probably correspondingly.  The guidelines has a greater emphasis on restraint with treatments. At the same time, it increases the requirements for not treating only wait and see and follow-up.  Adequate delegation for sampling to dysplasia midwife / dysplasia nurse, as well as referral to control file and relaying patients to screening, will be essential steps.  The new guidelines recommends that multidisciplinary conferences on dysplasia cases be held. In particular, in areas where colposcopy receptions are outside hospitals.
  19. 19. The New Course started  At spring 2012 we started a course together with doc Dr Simon Leeson Consultant Gynaecologist and Oncologist, Honorary Senior Lecturer Betsi Cadwaladr University Health Board, Wales  Dr Panos Sarhanis Lead Colposcopist for North West London Hospital UK  Dr Nick Nicholas Lead Colposcopist for Hillingdon Hospital in London UK
  20. 20. 15 december 2017Namn Efternamn 21
  21. 21. We discussed the program and the course was planed as follow: first day theoretical 15 december 2017Namn Efternamn 22
  22. 22.  second day practical day in form of interactive lectures and the third day also practical day and discussions and even we did candidate assessment from the beginning of day two and when the course was finished.  The course have been certificated by EFC and this is only one Swedish course that have been certificated internationally.  How much doctors have participated?  In between 60-70 a year fellows an seniors.  A lot of doctors have been learned according to international requirements. 15 december 2017Namn Efternamn 23
  23. 23.  Approximately 350 doctors participated at ous courses since 2012, and the evaluated our courses very high!  A Swedish Society for colposcopy had been built and we became members of EFC
  24. 24. LOGGBOK FOR EDUCATION IN COLPOSKOPI NAME: …………………………………………… HOSPITAL……………………………………….. 15 december 2017Namn Efternamn 26
  25. 25.  Some of them that participated in our courses became very interested in colposcopy, some already leaving the logbook that are prepared according to our recommendations.  Those that left log-books also want to do the examination in form of OSCE or maybe in an other form. 15 december 2017Namn Efternamn 27
  26. 26. With all this facts in background we need now answer to some questions Why is a training program for colposcopists needed?  Moments during training Examination, OSCE Logbook - Instructions for logbook Theory, knowledge goals Own cases Summary of knowledge requirements. Retention of competence for continued certification
  27. 27. What we need to discuss today ou need to be  What will be our next step  The most easily way to go is maybe to take the British program and apply it in Sweden, but this will not work!  Sweden is a small country with a population of 8,5 millions and doctors cannot work at small hospitals and only concentrate on colposcopy y all-round
  28. 28.  Since 2016 the Swedish Society for Obstetrics and Gynecology have decided that the courses will be only for seniors and not for fellows and how we will solve this interesting question???? Nobody knows!!!!!
  29. 29. 2017-12-15Sonia Andersson
  30. 30. 15 december 2017Namn Efternamn 32