A guide for trainers and trainees has been developed to assist training for certification in colposcopy by encouraging standardisation of training and by providing explanation of the various requirements of the curriculum. Any difficulties in understanding or achieving various requirements for training can be discussed with the Certification and Training Committee (c/o the BSCCP). This section is intended for all trainers and also should be read by all trainees at the outset of training.
The training programme was established as a response to concerns being expressed by the public and medical authorities about the quality and organisation of the NHS Cervical Screening Programme (NHSCSP).
A working party commissioned by the NHSCSP, which involved representatives from a variety of professional bodies, identified the need for an agreed training programme, which would ensure that colposcopists were adequately trained.
Although a formal training needs analysis was not performed, it was self-evident that women wanted colposcopists to be technically and diagnostically proficient and also to be good communicators.
As a minimum standard the BSCCP/RCOG colposcopy training programme needs to produce sufficient colposcopists to maintain the status quo. There are currently approximately 2000 practising colposcopists in the UK, most of whom are BSCCP certificated.
If the professional life span of a trained colposcopist is 30 years, then the programme needs to produce 65 trained colposcopists a year. In fact, possibly only a quarter of trainees will complete training or continue to practice colposcopy in the UK so the training programme will need to enrol approximately 260 colposcopist trainees annually if the status quo is to be maintained.
Please click here to download the Trainer-Trainee Guidelines
The aim of the BSCCP/RCOG colposcopy training programme is to enable trainees to obtain the core knowledge, develop the necessary skills and the personal and professional attributes to enable competency in colposcopy.
The programme is competence-based which means that the objectives of the programme are the competences that trainees are expected to acquire in the course of their training. There are 45 key competences, which comprise basic skills, colposcopic technical skills, practical procedures, the ability to recognise the normal and abnormal cervix, administration and communication skills. View the syllabus
Colposcopy is a high profile and integral part of the NHSCSP. For the service to meet the standards it has set itself colposcopists need to acquire a range of professional skills other than diagnostic ability. It is unrealistic to expect a training course in colposcopy to equip future colposcopists with all these skills but it does provide the opportunity to emphasise their importance and develop a progressive evidence based and enthusiastic culture. The course should include all the following areas:
- Clinical competence
- Generic competencies
- Commitment to continued medical education
- Core professional values
The course requires that the trainee perform at least 150 colposcopies under supervision. The bulk of the training programme is about the transference of theoretical knowledge into practical know-how. Actually performing colposcopy under supervision, i.e. apprenticeship, is the best way of learning not just how to recognise different clinical conditions but how to manage them.
The syllabus specifically details a number of generic competencies and lists a number of related competencies in the log book which the trainee needs to acquire (see table).
Other competencies such as communication skills and problem solving are an integral part of colposcopic practise and necessarily form part of clinical competence.
Commitment to continued medical education
All certificated colposcopists (including trainers) must attend a BSCCP approved conference or meeting every 3 years to maintain basic competency but involvement in colposcopy related audit and research would be seen as prerequisites for trainer status.
Core professional values
Whilst the main focus is on learning the skills directly related to performing colposcopy (communication, proficiency in conducting the examination etc.) there are a variety of other areas that are involved informally, although not specifically detailed (e.g. medico-legal aspects, complaints, need for clear documentation etc).
Overall the programme has comprehensive content, though there are, perhaps, deficiencies particularly dealing with issues such as risk-management and medico-legal areas. However, adding additional areas could result in overload. Not all parts of the curriculum are of equal relevance to all trainees and these issues will be addressed by using a core curriculum and optional special study modules. At present the only optional special study module is the treatment module.
The curriculum is subdivided into two phases:-
The theoretical areas that need to be addressed in training are stated in the syllabus. In general, the theoretical aspects of colposcopy are initially covered in a basic colposcopy course, attendance at which is an entry requirement for training and subsequently studied in parallel with clinical experience. Trainees are then expected to further develop their theoretical knowledge as it relates to clinical practise during their training and apply it to the clinical problems they meet.
The theoretical knowledge covers a wide range of topics, including an understanding of normal cervical cytology and histology, the theories relating to cervical and lower genital tract neoplasia and related clinical areas that include microbiology. In particular trainees must acquire a detailed understanding of the role of human papillomaviruses in lower genital tract neoplasia. In addition they need to understand the aims and organisation of the cervical screening programme, as well the principles of audit and clinical governance. Vew the Theoretical Understanding Syllabus
This is based upon direct clinical supervision (50 cases) and indirect clinical supervision (100 cases). The trainee should see at least 50 cases under direct supervision, which means that the trainer is physically present throughout the colposcopic examination. The trainer would also witness the consultations until the trainer is satisfied that history taking and counselling skills are satisfactory. Ordinarily far less than 50 cases would require supervision during consultation. Some trainees will need to see more than 50 cases under direct supervision if this is required. When the trainee and trainer feel that the trainee has enough experience to manage patients without the presence of a senior clinician, the trainee then sees at least an additional 100 cases under indirect supervision. In this phase of training the trainee will independently undertake diagnostic colposcopy but the trainer should always be on hand if help is needed i.e. in the hospital and not committed to another procedure (eg. surgery). All cases should be discussed and reviewed. Ideally the best time for this feedback is at the end of each training session.
Trainees should learn by seeing and managing cases, through reflection and discussion with their trainers. In this way they can identify and address areas or topics where their knowledge or skills are deficient. This competence-based approach results in the trainee having to deal with a variety of simultaneous or integrated learning issues. The learning areas may involve a variety of completely different areas of knowledge, which are linked by their relevance to the case in question.
This approach avoids the danger of the required training becoming overloaded with extraneous and irrelevant items. Most, if not all the trainees will already have a significant knowledge base prior to training as they are fully qualified nurses or doctors and it would be redundant to go over the underlying disciplines of cytology, histology and pathology in isolation from what they actually need to know in order to practise competently. This methodology promotes learning as it is relevant and reflects real life. The ‘on-the-job’ nature of the programme makes learning more effective as knowledge is not being acquired in isolation.
The main risk of the colposcopy programme is failure to cover the required curriculum and whether topics are covered in sufficient depth. Unless consideration is given to case-mix, a trainee could receive inadequate exposure to the problems necessarily required by the programme and this type of approach requires that both the trainer and trainee understand what is required and that progress is monitored.
The training programme should be largely student or trainee-centred but active trainer involvement is essential. The syllabus is clearly detailed in the logbook but it is very much up to the trainee to target what they need to learn.
Although trainee-centred, what the trainee learns clinically is dependent on what is made available and this can be influenced by the trainer. In addition the trainer is essential in helping the trainee to learn through discussion and providing advice.
There needs to be interaction between the trainees and trainers and regular formative review and feedback is important. Whilst the practical aspects of colposcopy are learnt via apprenticeship, there is a difference between clinical supervision and tuition; trainers should not function simply as overseers should actively be tutors, providing direction and assessment in training.
The trainer has an important role in helping the trainee appreciate the theoretical background to clinical problems and also to provide advice on where and how to best go about obtaining the necessary information to do this.
Much of the theoretical background to colposcopy is initially introduced by gathering information. However the integrated nature of the clinical training strongly enables problem-based learning. Each case presents an individual problem, which acts as a stimulus for learning. Trainees should consider what and why they do what they do and this practical experience should be supplemented by focused background reading in order to put cases into perspective.
This process is augmented by requiring the trainee to produce 5 of each of the OSATS for each clinical technique in which they wish to be trained (diagnostic colposcopy; treatment ablation, treatment laser, treatment loop and treatment knife cone), 10-12 mini CEX and 6 CBD’s from 2 or 3 trainers. This applies equally for non-medical and medical trainees. A trainee nurse colposcopist would not have to do a knife cone OSAT. Diagnostic colposcopy trainees would only have to complete the diagnostic colposcopy OSAT. All trainees must complete the specified numbers of assessments with their trainer(s).
Trainers should have received training in administering these formative assessments. The BSCCP encourages trainers to certify with the society to demonstrate that they have received appropriate training and that they regularly update their skills.
These exercises should be used as educational tools and involve active discussion between the trainer and trainee. The trainer should help the trainee to determine what the learning objectives are with each case. Completion of these tools is required as part of the trainer declaration at the end of training. See the BSCCP website (Healthcare Professionals – Training – Training Assessment Methods) for a further explanation and for the forms.
If the colposcopy training programme were solely an exercise in certification and regulation (e.g. safety certificate in diagnostic radiology, certificate in basic life support, the driving test) then there would be a need for uniformity. If, on the other hand, it was a professional qualification forming part of a broad based clinical education then a more flexible approach would seem preferable. At present, the training programme covers both aspects but probably leans more towards certification rather than professional development in that it has a predominately uniform diagnostic component core with an optional treatment element.
Colposcopy training is apprenticeship-based. It involves the recognition of clinical patterns as well as developing ways of working, which are best learnt by working closely with an expert. The dangers of gaps that can arise from this approach can be minimised by using the logbook to check topic coverage. It follows that individual trainers have a significant influence on the quality of the product and that objective assessment of both is needed. A provisional selection of quality issues relating to training is shown overleaf.
Basic Colposcopy Course
All trainees must have completed a BSCCP-recognised Basic Colposcopy Course, preferably, prior to starting clinical colposcopy training. However, this may be at a later date, after training has commenced, if the Trainer has no objection.
It is recommended that clinical training should be completed within 12 months. The trainee is required to see 50 cases (20 of which must be new cases) under direct supervision and 100 (30 new) cases under indirect supervision. Half of all new cases must be high-grade smear referrals.
Direct supervision means that the colposcopic examination is performed with the trainer in the room. Indirect supervision is when the trainee is seeing a patient without the trainer present in the room. However, the trainer should be available if needed. The trainer should review every case seen by the trainee, ideally straight after each clinical session so as to provide feedback.
Multidisciplinary Team Meetings
Trainees should regularly attend MDT meetings in their unit, and as a minimum, should attend at least 50% (a minimum of 6) of the meetings during their period of training.
This has a number of educational roles and should not simply be regarded as a record. Firstly it documents the trainee’s progress in working through the theoretical aspects of colposcopy: the trainer should regularly review this with the trainee to identify if there are any problem areas. In addition, the log-book records clinical experience and it is important that the trainer periodically reviews this in order to assess breadth of experience and to overview the correlation between colposcopic findings and histology.
Completion of the logbooks is on-line only.
Electronic Colposcopy Logbook Minimum Requirements:
50 cases performed under direct supervision:
20 must be NEW cases, (10 of these must be HIGH GRADE)
30 review cases
100 cases performed under indirect supervision:
30 must be NEW cases, (15 of these must be HIGH GRADE)
70 review cases
OSATS 5 of each. You will need to upload to the logbook a minimum of 5 OSATS (a minimum of 3 formative + 2 summative) for diagnostic colposcopy and a minimum of 5 OSATS (a minimum of 3 formative + 2 summative) for each clinical technique in which you are to be trained.
The 2 summative OSATS should be assessed by 2 independent Colposcopists one of whom should be a Consultant to confirm competence in the procedure, 10-12 miniCEX and 6 CBD’s.
The core training programme is about diagnostic colposcopy. There is an additional module for trainees who intend to perform treatment. Completion of the training programme and this additional module culminates in the awarding of the BSCCP/RCOG Certificate (Diagnostic and Treatment). This module comprises 20 local treatments (10 witnessed, 10 performed under supervision) inclusive in the 150 core module cases.
If you choose to undertake the Treatment module after becoming accredited Diagnostic only, please contact the BSCCP office 0121 335 8200 for the seperate log book sheets. In addition you will also need to complete a minimum of 5 OSATS in each of the clinical techniques in which you wish to be trained. This applies equally for non-medical and medical trainees.
Trainees should be encouraged to undertake at least one audit topic during their training, whether or not they had previous audit experience. Wherever possible they should be encouraged to participate in research studies.
All trainees should be familiar with the workings of the cyto- and histopathology laboratories and spend at least one session of 5 hours in each. Nurse trainees must dedicate 3 sessions of 5 hours each to cytopathology and histopathology. In addition all trainees should attend clinico-pathological meetings.
The aims of Colposcopy Trainees attending Pathology Laboratories are:
- To understand the practical aspects of slide preparation
- To view cytology slides
- To see how loop specimens are handled grossly
- To see how poor biopsy techniques result in problems of interpretation
- Meet the Cytology and Pathology Staff and gain an understanding of their work
Click to download the Laboratory Attendance form
Good communication skills are key competences for a colposcopist. Ideally all trainees should have attended a communications skills course at some point in their professional training.
An exit examination or OSCE must be passed to obtain certification. There are 2 sittings per year. The trainee may apply for the examination following submission of the completed on-line Colposcopy case log book. An examination fee is required. The trainer must ensure that the trainee has practical tuition in preparing for the questions.
- To provide clinical supervision
- To enable a trainee to successfully complete the training programme
- To monitor progress and provide feedback
- To perform formative assessments with their trainees
- To assess whether the trainee has satisfactorily completed training
Who Can Train?
All trainers must be BSCCP accredited colposcopists.
Certification of Trainers
The Society is committed to ensuring that high quality training is the norm. With this in mind, the Executive Committee has agreed that Trainers in Colposcopy should be able to demonstrate appropriate training in assessing and giving feedback to their trainees, thus complying with GMC standards for Trainers. Therefore the Society encourages trainers to certify that they have the requisite skills as Trainers and to maintain their skills by recertifying on a 3 yearly basis.
A potential trainer has to have the commitment and time to take on a trainee. Training is time consuming; it is probably unrealistic to have more than 8 patients in a training session.
In addition trainers need to be able to provide sufficient clinical material to enable a trainee to complete their training in 12 months. This also necessitates a trainee having access to more than one trainer.
For information on becoming an accredited trainer, view here
The aim of this group is to provide a forum for discussing educational issues relating to the training programme and to act as a link between the Certification and Training Committee and the trainers themselves. It is recommended that all colposcopy trainers attend at least 1 trainers meeting every 3 years. Certified trainers can meet the requirements for trainer re-accreditation by attending this meeting.
This meeting is once a year, the day before the BSCCP Annual Scientific Meeting.