Distance Learning courses

Laparoscopy and Colposcopy

• Gynaecology and Obstetrics has

transformed over the last 20 yrs

– In patient to outpatient procedures

– Specific targeted therapy

– Open surgery to endoscopy

– Reproductive medicine

Teaching clinical skills

• Witnessing has some but limited value

• Skills are largely generic

• Learning a procedure is easy if you have the generic skills

– Suturing, energy and irrigation

– Ergonomic efficiency

– Equipment and assistant management

– Image recognition skills

Examine skills training in other

high risk professions

• The airline industry

• The mining industry

• The Diving / exploratory industry

WHAT IS NECESSARY TO

BECOME AN EXPERT

• Communication skills

• Technical skills

• Information

• Decision making skills

• Management of personnel

• Image and anatomy recognition skills

International Federation of Cervical

Pathology and Colposcopy

Walter Prendiville

President elect

IFCPC

International Federation for Cervical Pathology and

Colposcopy

• 45 National Societies

• > 9500 individual colposcopists

Canada, United States, Mexico, UK, France, Spain, Portugal, Austria, Germany, Czech Republic, Croatia, Greece, Hungary, India, Ireland, Israel, Japan, Korea,

Yugoslavia, Poland, Slovak Republic, Turkey, Netherlands

Argentina, Brazil, Uruguay, Paraguay, Chile, Bolivia, Costa Rica, Dominicana, Ecuador, Guatemala, Indonesia, Singapur,

Filipinas, Australia, New Zealand

<3.9 <7.9 <14.0 <23.8 <55.6

Cervical cancer mortality/100,000

Mortality falling in developed worldMortality rising in developing world

EUROPE -HIGH

ASIA -LOWSOUTH AMERICA -LOW

NORTH AMERICA-HIGH

INCIDENCE OF COLPOSCOPISTS

EUROPE -LOW

ASIA -HIGHSOUTH AMERICA -HIGH

NORTH AMERICA-LOW

INCIDENCE OF CERVICAL CANCER

Constitution and by laws of the

Federation – Ambitions of the IFCPC

• The primary responsibility in the developed world was to maintain standards, promote improvement through quality assurance, education and training.

• In the emerging economies the emphasis of the Federation was different and should be to respond to individual needs: focusing on training and education in colposcopy and the treatment of pre-invasive disease in support of regional initiatives and from other International agencies for example IARC, WHO, and others

The twinning initiative• A centre or national society would engage

with an emerging centre or society

• Regular frequent videoconferences of

clinico-pathological / multidisciplinary

meetings

• Occasional visits between centres /

national societies

The future

• Serious attempt to examine any and all

initiatives that might reduce the burden

of cervical cancer, worldwide

• Embrace colposcopic and non

colposcopic endeavours

• Respond to local / regional initiatives

• Collaborate, collaborate, collaborate

Colposcopy practice and

training• Hugely variable in the developed world

• Structured training becoming the norm in Europe, Australia, Canada and the USA

• Continuing debate about the true value of colposcopic assessment for large screening / treatment programmes in the developing world

• Has a role in certain if not all cases

• If colposcopy is to be employed it should be done so by properly trained personnel

Colposcopy training in the

developing world

• Concern about long term value of

running basic courses

1. Run by Western colposcopists,

2. ? Fully appraised of local circumstances

3. Not followed up by ongoing training

4. ? relevant to local circumstances

Training alternatives

1. Preceptorships

2. Basic course followed by short period of training in a centre

3. Basic course followed by continuing training in – Image recognition

– Case management

– Treatment technique, especially if excisional

Distance learning project

• Collaboration between

1. AORTIC

2. IARC

3. IFCPC

Distance learning project

• Collaboration between

1. Lynn Denny

2. Rengaswamy Sankaranarayanan

3. Walter Prendiville / Patrick Walker

4. Narendra Pisal / Charles Redman

5. Christine Bergeron / Jean luc Mergui

6. And many others!

Tamil Nadu / Dublin initiative

– Basic course,

– equipment provision from Dublin (HRB grant)

– Evolution of screening camps

– Fortnightly videoconference of cases

– Interim visits to and from each centre

– Advanced course

– Relatively well funded, by Irish HRB

Distance learning case

discussion via the web

Africa

• Very few oncology or pre-cancer

services

• Distances a real problem

• Training opportunities very limited

• Potential to run a distance learning

programme

Distance learning programme

first steps

• Assessment of need in region

• Assessment of delegate’s colposcopy

clinic equipment

• Assessment of screen positive

population profile

• Treatment options

• Ambitions of the delegate

Distance learning programme

first steps

• Determination of relevant competencies for the region dependant on

– Screening activity

– Treatment possibilities

– Facilities vs Need

Distance learning programme

IFCPC pilot course

Lecture series

Structured, progressive,

Either internet based (web or email)

Each subject to be referenced

Each lecture to be followed by an exam’ before

proceeding to next lecture

Series of clinical cases during second half of

year

Intermittent submission of case presentations

Distance learning programme

IFCPC pilot course

AssessmentOSCE

Clinic management

Case management

Dexterity skillsSpeculum and colposcopy

Treatment

Pilot course of 20 delegates from Tamil Nadu and 12 sub-Saharan African countries

Pilot course 2012

• Practical course held in Cape Town at

Grut Schoor c/o Prof Lyn Denny’s

colposcopy service

• 100 patients with cervical disease

• Four faculty in four colposcopy rooms

over four days

Pilot course 2012

• OSCE

• Along similar lines to the BSCCP

• Multiple and varied stations of clinical,

theoretical, management and colp

image questions

• High pass rate

Distance learning programme

Sub Saharan Africa

Challenges

Assessment of clinic practice and facilities

Commitment of a large faculty

Duplication or translation of core subject matter

Should we exclusively train doctors

Recruitment of visiting faculty and exit exam

faculty

IFCPC Distance Learning

Projects

Progress to date

• First course completed in 2012

• Second course in English is ongoing.

• Third course due February 14 in French

• Courses in Spanish and Portuguese in

preparation

• Further courses in Russian, German,

Italian and Chinese under consideration

DISTANCE LEARNING

PROGRAMME

international federation for cervical

pathology and colposcopy

Outline of Distance Training Programme

•20 trainee colposcopists to be recruited

•Course to run over 12 months period

•24 lectures and supportive reference material

on the web on a fortnightly basis

•A scheduled web based assessed question

and answer module following each lecture

•24 video/still image colposcopy clinical cases

Assessment

A four day practical / colposcopy clinic session to be held at the end of the

year’s course

An OSCE immediately after the practical session

IFCPC Certificate will be awarded to the successful delegates

Prerequisites for participation in the

course

•Work in a unit where some form of screening is

provided such that pre-cancer patients need

colposcopy and management

•Have the support of the unit where the delegate

is working

•Have the necessary colposcopic equipment

•Have regular access to the internet