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Colposcopy training and practice
181
Int J Gynecol Obsrer, 1994, 45: 18 I- I82 International Federation of Gynecology and Obstetrics
Colposcopy
training
and practice
ACOG Committee Opinion: Committee on Gynecologic Practice Number 133 - March 1994
Over the past two decades, colposcopy has become the, standard method for evaluating abnormal cervical cytology. When combined with the appropriate interpretation of histopathologic specimens, the technique can be used to successfully evaluate abnormal cervical cytology and aid in treatment planning. Colposcopy also is useful in the evaluation of abnormal vaginal cytology and subtle changes of the vulvar epithelium. Ideally, training in colposcopy will occur during a 4year obstetrics and gynecology residency. In this setting, it is possible to learn the natural history of genital intraepithelial neoplasia, review cytologic and histologic specimens, perform many examinations by colposcopy, and learn to biopsy and treat intraepithelial lesions of the cervix, vagina, and vulva. SUGGESTED CURRICULUM CONTENT FOR COLPOSCOPY TRAINING m Cytology and histology of the cervix ??
Evaluation of Pap test results
??
Indications for colposcopic examination
.
Colposcopic terminology
m Normal and abnormal patterns seen on colposcopy ??
??
Patterns seen on colposcopy and histologic correlations Clinical colposcopic techniques
.
Biopsy of the cervix and endocervical curettage
??
Documentation of findings
??
Referral and followup
??
Legal and insurance issues
??
Preceptorship
9 Continuing professional education
When a physician or other health care practitioner learns the technique of colposcopy in a setting other than residency, it is important that the training program include all the elementsboth didactic and preceptor-that would be part of a residency program (see the box). Specifically, the health care practitioner must have sufficient didactic training to learn the natural .history of intraepithelial lesions and their cytologic and histopathologic correlations. Completion of a didactic course alone does not constitute adequate training to perform colposcopy. A period of preceptorship should always follow the didactic material. The student colposcopist should perform examinations jointly with an experienced colposcopist until the technique is well learned. All cases should be reviewed with the preceptor once the final histology and cytology have been reported and a further management plan has been developed for each patient. The technique of colposcopy requires that the examiner recognize subtle changes in the epithelial patterns of the lower genital tract. A practicing colposcopist should be expected to perform a sufficient number of examinations on an ongoing basis to maintain colposcopic skill. It is highly desirable for the practicing colposcopist to be involved in continuing quality assurance activities to document proficiency. This should be encouraged in all settings, including clinics, hospitals, and private offices. BIBLIOGRAPHY Eenedet JL, Anderson GH, Matisic JP, Miller DM. A quality-control program for colposcopic practice. Obstet Gynecol1991;78:872-875 Burke L, Antonioli DA, hcalman BS. Colposcopy. Norwalk, Connecticut: Appleton and Lange, 1991 Inr J Gynecol Obsrer 45
182
ACOG
Committee
Opinions
PS. The colposcopy clinic data system. J Reprod Med 19@34:645-646 Coppleson M, Pixley E, Reid B. Colposcopy. 3rd ed. Springfield, Illinois: Charles C. Thomas, 1986 Homesley HD, Wolff JL, Reish RL, Jobson VW. Evaluating the acquisition of colposcopy skills in an ob-
Cartwright
Copyright
stetric-gynecologic residency program. J Reprod Med 1985;30:911-914 Julian TM. Teaching colposcopy. The colposcopist 1990;22(2)57
0 March 1994
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. The American College of Obstetricians and Gynecologists 409 12th Street, SW ??Washington, DC 20024-2188 Int J Gynecol
Obsrer 45
Int J Gynecol Obsrer, 1994, 45: 18 I- I82 International Federation of Gynecology and Obstetrics
Colposcopy
training
and practice
ACOG Committee Opinion: Committee on Gynecologic Practice Number 133 - March 1994
Over the past two decades, colposcopy has become the, standard method for evaluating abnormal cervical cytology. When combined with the appropriate interpretation of histopathologic specimens, the technique can be used to successfully evaluate abnormal cervical cytology and aid in treatment planning. Colposcopy also is useful in the evaluation of abnormal vaginal cytology and subtle changes of the vulvar epithelium. Ideally, training in colposcopy will occur during a 4year obstetrics and gynecology residency. In this setting, it is possible to learn the natural history of genital intraepithelial neoplasia, review cytologic and histologic specimens, perform many examinations by colposcopy, and learn to biopsy and treat intraepithelial lesions of the cervix, vagina, and vulva. SUGGESTED CURRICULUM CONTENT FOR COLPOSCOPY TRAINING m Cytology and histology of the cervix ??
Evaluation of Pap test results
??
Indications for colposcopic examination
.
Colposcopic terminology
m Normal and abnormal patterns seen on colposcopy ??
??
Patterns seen on colposcopy and histologic correlations Clinical colposcopic techniques
.
Biopsy of the cervix and endocervical curettage
??
Documentation of findings
??
Referral and followup
??
Legal and insurance issues
??
Preceptorship
9 Continuing professional education
When a physician or other health care practitioner learns the technique of colposcopy in a setting other than residency, it is important that the training program include all the elementsboth didactic and preceptor-that would be part of a residency program (see the box). Specifically, the health care practitioner must have sufficient didactic training to learn the natural .history of intraepithelial lesions and their cytologic and histopathologic correlations. Completion of a didactic course alone does not constitute adequate training to perform colposcopy. A period of preceptorship should always follow the didactic material. The student colposcopist should perform examinations jointly with an experienced colposcopist until the technique is well learned. All cases should be reviewed with the preceptor once the final histology and cytology have been reported and a further management plan has been developed for each patient. The technique of colposcopy requires that the examiner recognize subtle changes in the epithelial patterns of the lower genital tract. A practicing colposcopist should be expected to perform a sufficient number of examinations on an ongoing basis to maintain colposcopic skill. It is highly desirable for the practicing colposcopist to be involved in continuing quality assurance activities to document proficiency. This should be encouraged in all settings, including clinics, hospitals, and private offices. BIBLIOGRAPHY Eenedet JL, Anderson GH, Matisic JP, Miller DM. A quality-control program for colposcopic practice. Obstet Gynecol1991;78:872-875 Burke L, Antonioli DA, hcalman BS. Colposcopy. Norwalk, Connecticut: Appleton and Lange, 1991 Inr J Gynecol Obsrer 45
182
ACOG
Committee
Opinions
PS. The colposcopy clinic data system. J Reprod Med 19@34:645-646 Coppleson M, Pixley E, Reid B. Colposcopy. 3rd ed. Springfield, Illinois: Charles C. Thomas, 1986 Homesley HD, Wolff JL, Reish RL, Jobson VW. Evaluating the acquisition of colposcopy skills in an ob-
Cartwright
Copyright
stetric-gynecologic residency program. J Reprod Med 1985;30:911-914 Julian TM. Teaching colposcopy. The colposcopist 1990;22(2)57
0 March 1994
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. The American College of Obstetricians and Gynecologists 409 12th Street, SW ??Washington, DC 20024-2188 Int J Gynecol
Obsrer 45