1. 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
2. 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
3. Examine skills training in other
high risk professions
• The airline industry
• The mining industry
• The Diving / exploratory industry
4. WHAT IS NECESSARY TO
BECOME AN EXPERT
• Communication skills
• Technical skills
• Information
• Decision making skills
• Management of personnel
• Image and anatomy recognition skills
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
18. 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!
19. 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
21. Africa
• Very few oncology or pre-cancer
services
• Distances a real problem
• Training opportunities very limited
• Potential to run a distance learning
programme
22. 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
23. Distance learning programme
first steps
• Determination of relevant competencies
for the region dependant on
– Screening activity
– Treatment possibilities
– Facilities vs Need
24. 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
25. Distance learning programme
IFCPC pilot course
Assessment
OSCE
Clinic management
Case management
Dexterity skills
Speculum and colposcopy
Treatment
Pilot course of 20 delegates from Tamil Nadu
and 12 sub-Saharan African countries
26. 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
27. 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
28. 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
29. 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
31. 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
32. 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
33. 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
