Colposcopy (2016) as approved by GMC on 17 May 2016

Introduction: Colposcopy (2016) as approved by GMC on 17 May 2016 This ATSM is designed to provide training in both basic and complex areas of colposcopic practice. Successful completion of the ATSM will give a doctor the necessary knowledge and skills to manage a wide range of colposcopic problems. The ATSM will also prepare an individual to ultimately take up a leadership role in a colposcopy service. It is therefore aimed at doctors wishing to develop advanced colposcopic knowledge and practice and those wishing to develop the necessary skills to become unit lead colposcopists in the future. In order to practice independently as a colposcopist in the UK, it is necessary to complete the training programme laid down by the British Society for Colposcopy and Cervical pathology (BSCCP). The BSCCP programme is an integral first step in this module and is mandatory to complete this ATSM. Trainees who already hold BSCCP accreditation will be able to proceed immediately with work to complete this module. Doctors who have yet to complete the BSCCP programme can commence the module and will be able to achieve many required elements, but it will not be possible to complete the ATSM without BSCCP accreditation. Either registration with the BSCCP as a trainee colposcopist, or maintaining accreditation with the BSSCP are therefore specific entry requirements for the ATSM. Successful completion of the ATSM will provide knowledge and experience in: Non-standard colposcopy e.g. vulval colposcopy; pregnancy Management of complex patients The role of the trainer in colposcopy The role of the lead colposcopist The work of the colposcopy MDT The Quality Assurance process in colposcopy Audit against national standards This ATSM has a work intensity score of 1.0. A minimum of 1 session per week should be devoted to the ATSM. The stipulation of 1 session is to give trainees and trainers an understanding of the expected time needed to complete this ATSM. It should be completed in 12 18 months 1

Section 1: Clinical Competences Learning outcomes: To demonstrate an advanced understanding of the clinico-pathology of pre-malignant disease of the lower genital tract To demonstrate appropriate skills in colposcopy, including colposcopy of the vulval and vagina in addition to colposcopy of the cervix To diagnose and plan management of in common and uncommon disease presentations To demonstrate competency in more than one treatment technique Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Indications and limitations in relation to screening and investigative techniques Cytology Epidemiology, aetiology, diagnosis, prevention, management prognosis including HPV screening and triage and HPV vaccination Complications and anatomical considerations of pre-malignant conditions of the lower genital tract Knowledge of recognised national and international colposcopy classifications and terminologies Colposcopy; methods and the limitations for colposcopy Colposcopy in special circumstances including Immunocompromised patients Pregnancy Post-menopause patients Transplant patients Indications, techniques, complications and outcomes of treatment of benign and premalignant conditions of the lower genital tract 1 To interpret and counsel about cervical cytology and HPV screening reports Perform colposcopy of the lower genital tract: Recognise colposcopic features of the normal cervix, vagina and vulva Recognise and diagnose extension of premalignant disease in the vagina (VAIN) Recognise and diagnose pre-malignant disease of the vulva (VIN) Recognise coloscopic features of benign pathology of the cervix: Inflammation/infection HPV infection Benign polyps Pregnancy Post-menopause Changes associated with prior treatment Recognise cervical malignancy and arrange urgent referral to Gynaeoncology MDT and cancer centre Recognise vulval malignancy and arrange urgent referral to Gynaeoncology MDT and cancer centre Perform appropriate directed biopsies Cervix Vagina vulva Control bleeding from biopsy sites 1,2,3,4 Understand, explain and support equal access to cervical screening Appreciate the importance of psychological factors for patients Show empathy with patients Explain, clearly and openly treatment, complications and side-effects and obtain appropriate consent for both examination and treatments Manage patients in keeping national and local guidelines Effectiveness in liaising with colleagues in other disciplines, clinical and non-clinical Document findings, collate results and communicate results to patients and GP Understand principles of diagnosis an management of VAIN/VIN Demonstrate knowledge of the pathways for referral of patients with multi-centric / multi-focal disease Understand the importance of cancer MDT in management of variant disease Organise appropriate imaging for patients with advanced or multi-foal disease 1,2,3,4 NHSCSP publication no 23 Taking samples for cervical screening NHSCSP publication 20 Colposcopy and programme management guidelines for the NHS Local and regional protocols and guidelines 2011 IFCPC Nomenclature Educational and clinical supervision from BSCCP accredited trainer who is a GMC registered Educational Supervisor Suitable colposcopy courses including BSCCP recognised advanced colposcopy course Educational ant raining resources at www.bsccp.org.uk BSCCP accreditation in colposcopy BSCCP accreditation in Diagnosis and Treatment Course certificate(s) Quality improvement project Case logbook supported by relevant WPBAs Mini CEX OSATS CbD Record of meetings attended: Local MDM Regional colposcopy meeting Annual national BSCCP meeting Case record of treatments carried out Relevant WPBSs: Mini CEX OSATS CbD 2

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Attendance at Colposcopy MDT 1,2,3,4 Records of at least two Document examination findings using UK recognised classifications 1,2,3,4 Attendance at Gynaecology MDT Multi-disciplinary and treatment methods including LLETZ and at least one other treatment method applicable Explain diagnosis and likely prognosis clinical team meetings for type 3 TZ lesions / CGIN / Recognise, counsel and plan the initial management of features suggestive of invasive disease of the lower genital tract Explain follow up processes Educational and clinical supervision from BSCCP accredited trainer micro-invasion Treatments may include: Recognise when local treatment is not appropriate and counsel about hysterectomy and / or vaginal surgery Explain the nature of treatment and possible complications and side-effects including: Possible obstetric complications Knife cone biopsy SWETZ NETZ Cold coagulation Ablation Counsel and perform treatment under local anaesthetic using techniques for: Ablation/destruction Excision Control bleeding Records of treatment of VIN and / or VAIN Select patient requiring treatment under general anaesthetic Perform treatments under general anaesthetic using techniques for: Ablation/destruction Excision Control bleeding Perform appropriate treatment for VIN or VAIN Counsel regarding management and complications after treatment Liaise with GP and patient Arrange appropriate follow up Understand failsafe and recall 3

Section 2: Leadership and management of service Learning outcomes: To understand the organisation and administration of a colposcopy service To understand the role of the lead colposcopist and to develop the ability to undertake that role To demonstrate knowledge and experience of Quality Assurance processes in Colposcopy Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Roles and responsibilities of all involved in the provision of cervical screening services. Roles and responsibilities of staff involved in the provision and running of a colposcopy service Knowledge of the roles and responsibilities of the lead colposcopist including: written protocols Audit programme BSCCP training programme Requirements for reaccreditation of colposcopists Colposcopy MDT Understand Role of Hospital Based programme Co-ordinator (or equivalent) Knowledge of *Quality Assurance structures and processes in Colposcopy including: History and development of Colposcopy QA Role of QA within NHSCSP Quality Assurance reference centres (QARC) / relevant QA structures and their purpose Colposcopy QA visit (where applicable) 1,2 Ability to interact within multi-professional and multidisciplinary structures both within and outside a colposcopy service Ability to liaise with those within Trust responsible for facilities and staffing of the colposcopy service Development and implementation of clinical guidelines Preparation and review of quarterly reports (KC65 or equivalent) Complete relevant Clinical Audit including identification, implementation and review of audit recommendations Ensure appropriate pathways are in place for Colposcopy MDT Involvement in producing/ producing HBPC Annual Report (where applicable) Attendance local and regional meetings with HBPC or equivalent Demonstrate practical understanding of interaction between Primary Care/ Colposcopy/ Cytopathology/ Histopathology within Quality Assurance Understand and participate in critical incident reporting 1,2,3,4 Effective and timely working with colleagues in other disciplines, clinical and non-clinical Work to comply with national service specifications and targets Understanding of processes of successful clinical audit Organise and chair Colposcopy MDT meetings. Communicate MDT decisions to patients and to relevant members of multidisciplinary team Role of MDT in the management of multicentric and multi-focal disease Understand role of HBPC or equivalent within the colposcopy service Be able to support and participate in work of HBPC or equivalent Effective liaison with key professionals Working within the local, regional and national *QA structures Identify and encourage adoption of good 1,2,3,4 NHSCSP publication No.23: Taking samples for cervical screening NHSCSP publication 20 Colposcopy and programme management guidelines for the NHS Local and regional protocols and guidelines BSCCP publication: Lead Colposcopist Observation and discussion with senior colleagues / lead colposcopist Observation and discussion with HBPC or equivalent NHSCSP publication 30: Guidelines for Quality Assurance Visits in the cervical Screening programme (where applies) Relevant WPBAs Team Observation forms New or revised evidencebased guideline Completed audit report Perform cervical cancer audit on at least one case HBPC report (if applicable) Evidence of attendance at relevant meetings Evidence of attendance at meetings *Evidence of participation in QA visits 4

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment practices Observation and *Preparation of required documentation for QA visit or equivalent 1,2,3 Identify training needs and consider how 1,2,3,4 discussion with senior colleagues / lead these can be met colposcopist Attendance and participation in Local Screening Group meetings The HBPC role does not exist in all parts of the UK. Trainees should participate in the work of the HBPC or in the equivalent processes in their part of the UK * QA processes vary across the UK. Trainees should participate in QA processes as described or in the relevant processes that may exist in their part of the UK *Involvement in QA visit at unit being assessed *Involvement in QA visit to another unit as observer *Attendance at regional QA meetings 5

Section 2: Teaching Learning outcomes: To demonstrate competence in clinical teaching within the colposcopy service Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment Understand the educational principles and processes of clinical and workplace supervision as applied to the Colposcopy Clinic environment 1,2 Ability to provide supervision to trainees in colposcopy and other clinical areas in accordance with local and national programme requirements 1,2,3,4 Demonstrate understanding of principles of constructive and effective feedback; SMART feedback Complete relevant WPBAs for trainees 1,2,3,4 Training course recognised for GMC Educational Supervisor Accreditation which will enables Doctor to be a registered BSCCP trainer e.g. Training the Trainers courses Online courses on educational supervision Certification from approved course Evidence to meet the criteria for GMC Educational Supervisor Accreditation /BSCCP trainer Team observation 6

Colposcopy Competence level Not required Level 1 Level 2 Level 3 Date Signature Date Signature Date Signature Clinical competences Recognise, diagnose and plan management VAIN Recognise, diagnose and plan management VIN Recognise, diagnose and plan management early cervical disease Plan and conduct management of pregnant patients in Colposcopy clinic Plan and conduct management of transplant and /or immunecompromised patients in Colposcopy clinic Document findings using recognised IFCPC classifications Loop diathermy treatment procedures (LLETZ) Alternative treatment procedure for Type 3 lesion (at least one of knife cone biopsy, SWETZ, NETZ, cold coagulation, ablation) Select and use appropriate treatment method for lesions of Type 3 TZ 7

Colposcopy Competence level Not required Level 1 Level 2 Level 3 Date Signature Date Signature Date Signature Counsel patients undergoing treatment about: complications of treatment further management of their specific condition likely outcome and prognosis Educational Supervisor Signature Date BSCCP Accreditation in Colposcopy 8

Leadership and management of the service Educational Supervisor Signature Date Assist in preparation and checking of quarterly reports (KC65)/ alternative benchmarking reports Completed clinical audit cycle Assist in production of annual HBPC report (or alternative) Identify cases requiring MDT discussion and make appropriate referrals Complete cervical cancer audit submission (at least one case) Teaching skills GMC level Educational Supervisor & BSCCP Trainer accreditation 9

Training Courses or sessions Title Signature of educational supervisor Date Attendance at Gynaecology MDT meetings (>3) Chair Colposcopy MDT meetings (>3) Attendance at Advanced Colposcopy course of equivalent (e.g. BSCCP Annual Scientific Meeting Attendance at regional QA meeting or equivalent ( 1 or more) Quality Improvement Initiative Title Signature of educational supervisor Date 10

Authorisation of signatures (to be completed by the clinical trainers) Name of clinical trainer (please print) Signature of clinical trainer 11

OSATS Diagnostic Colposcopy Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off Date Date Date Signature Signature Signature Treatment: Cold Coagulation or cryotherapy Date Date Date Signature Signature Signature Treatment: Laser excision or ablation Date Date Date Signature Signature Signature Date Date Date Treatment: Large loop excision of transformation zone Signature Signature Signature 12