1. Aims and Purpose >
  2. Details of Training >
  3. Training Syllabus >
  4. Trainers Criteria, Appointment and Recognition >
  5. Registration Process >

Click here to download the Structured Colposcopy Training Programme

 

 

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1. Aims and Purpose

Setting standards and continuous quality improvement is essential to a high quality, organised public health program such as the National Cervical Cancer Screening Program.

 

Colposcopy is required for the optimal management of women with abnormal smears and other disorders of the lower genital tract. It is an integral part in the whole process of screening and prevention of Cervical Cancer and therefore essential to the process of reducing the incidence and mortality of cervical cancer in Singapore.

 

Therefore in keeping with the objectives set up by the Health Promotion Board Subcommittee in Quality Assurance in Colposcopy and Smear Taking, the aims and purpose of the Colposcopy Registration Committee (CRC) set up under the auspices of the SCCPS are as follows:

 

A
To develop a structured training programme for colposcopy in Singapore in line with the National Cervical Cancer Screening Programme.
B
To maintain a Register of Colposcopists.
C
To set up national standards and audit practices of practising colposcopists thereby setting the standards for colposcopy in Singapore.
D
The Committee will provide recommendations and feedback to the Subcommittee in Quality Assurance in Colposcopy and Smear Taking.

Disclaimer

 

The SCCPS is not a regulatory body and is not responsible for the professional conduct of its members or those on its Register of Colposcopists.

 

Individuals whose names appear on the Register of Colposcopists are not appointed by the Society, but have applied to be included on their own accord.



2. Details of Training

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2.1 Who Should Be Performing Colposcopy?

 

A
Any qualified gynaecologist with recognised qualifications (MMed O&G, MRACOG, MRCOG, or recognised equivalent) who has completed the required training.
B
Grandfather clause for SAB (Specialist Accreditation Board) registered specialists as at December 2004 and who are currently performing colposcopy. They should register with the Society by 31 December 2004.

 

 

2.2 New Colposcopists

 

A
Completion of training logbook within 3 years, which includes a minimum of 50 directly supervised colposcopic examinations and 50 indirectly supervised colposcopic examinations.
B
Attendance of a formal certified basic colposcopy course.
C
A written test.
D
A supervised treatment module, consisting of 15 cases of which at least 5 should be cone biopsies.

 

 

2.2.1 Logbook

 

1. The logbook may be obtained from the SCCPS Secretariat.

2. Purpose of the logbook

 

A
The logbook clearly identifies the training objectives.
B
It also sets the minimum standards and competency level required.
C
It aims to record experience, knowledge and competence.
D
It aims to help the trainee monitor their own competence and to identify gaps in their knowledge and competence and address them.
E It also forms part of the final summative assessment.


3. The modules of the curriculum

 

A
The logbook consists of 2 main sections, a theoretical understanding and a practical one.
B
The theoretical understanding section lists out the number of individual subjects which should be addressed during the course of the trainee's reading, at the colposcopy courses or from the trainer.
C
The practical experience section contains a number of targets, which should be signed by the trainer when it is assessed that the trainee is competent in these.

4. Using the logbook

A
In the theoretical understanding section, when the trainee has addressed a given topic in their reading and feels confident about it, then the relevant box is ticked.
B
When the whole section has been filled up, the trainer has to sign it.
C
For the practical experience section, when the trainer feels that the trainee is competent in performing the targets set, this should be ticked and signed off.
D A minimum of 50 directly supervised and 50 indirectly supervised colposcopic examinations should be performed and the cases recorded in the logbook.
E The smear results and biopsy results should be entered for clinical correlation.
F The 15 supervised treatment cases should be recorded.
G A summary page at the end of the logbook should be filled out for a final assessment.

 

 

2.2.2 Basic Colposcopy Course

 

A
This can be a course organised by a registered Society (SCCPS / OGSS), Academy of Medicine, a restructured hospital or private hospital in Singapore.
B
It can also be a course accredited by the RCOG / BSCCP, ACOG / American SCCP, RACOG / Australian SCCP, at any centre overseas.
C
Other courses attended overseas may be considered on review of the course content and organising body.

 

 

2.2.3 Practical Hands-On Training in Colposcopy & Treatment

 

These can be obtained at any hospital or clinic under the supervision of an accredited colposcopist registered with the SCCPS list of trainers.

 

 

2.2.4 Written Test

 

A written test which includes general theory and an interactive section including cytology, colposcopy and histology images.

 

The test will be conducted on an annual basis. The dates and location of the tests will be announced on the SCCPS website.

 

The coordination of the test will be carried out through the SCCPS.

 

 

2.3 Grandfather Clause

 

Those wishing to be registered with the Society on the Register of Colposcopists under the grandfather clause are expected to fill a form attesting that they have attained the basic training standards as recommended by the SCCPS and have maintained the knowledge and skills consistent with those recommendations.

 

Those wishing to register under the grandfather clause should do this by 31 December 2004. However, there will be a provision to register beyond this date under this clause on a case-by-case basis in exceptional circumstances.

 

 

2.4 Maintenance of Registration

 

A
To remain on the Register of Colposcopists, a minimum attendance at a colposcopy course every 2 years is required.
B
They are also expected to keep a record of their own practice and submit a declaration form attesting to performing at least 30 colposcopies over a 2-year period".

 

 

 

3. Training Syllabus

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3.1 Theoretical Considerations

 

1. The Normal Cervix

 

A
Normal Structure.
B
Metaplasia.
C
The transformation zone.
D Congenital transformation zone.
E Changes with age.
F Tissue basis of colposcopic appearance.
- Role of epithelium
- Role of stroma
- Role of surface configuration

 

2. Cervical Neoplasia

 

A
Nomenclature
B
Epidemiology
C
Pathogenesis
D Natural history
E Histological features
F Staging

 

3. Cervical Screening

 

A
Rationale
B
National screening guidelines
C
Risks of screening
- Limitations
- Disadvantages
D Quality assurance and performance criteria

 

 

4. Vaginal Neoplasia

 

A
Nomenclature
B
Epidemiology
C
Pathogenesis
D Natural history
E Histological features
F Staging

 

 

5. Vulval Neoplasia

A
Nomenclature
B
Epidemiology
C
Pathogenesis
D Natural history
E Histological features
F Staging

 

 

6. Perianal and Anal Neoplasia

 

A
Nomenclature
B
Epidemiology
C
Pathogenesis
D Natural history
E Presentation
F Histology features

 

 

7. Other Conditions of the Lower Genital Tract

 

A
Human papillomavirus
B
Cytomegalovirus
C
Herpes
D Bacterial infections
E Chlamydia trachomatis
F Trichomonas vaginalis
G Candida
H Cervical polyps

 

 

8. Pregnancy and Contraception

 

A
Normal cervix in pregnancy
B
Cytology in pregnancy
C
Abnormal cervix in pregnancy
D Physiological change
E Chlamydia Effects of Oral Contraceptive Pill on cytology
F Effects of Oral Contraceptive Pill on histology
G Effects of Oral Contraceptive Pill on colposcopy
H Effects of IUCD on cytology

 

 

9. Cytology

 

A
Preparation of a cervical smear
B
Principles of cytological diagnosis
C
Cytological classifications
D The normal smear
E The effect of hormones
F Pathogens
G How a smear should be taken
H Different sampling devices
I How a cytology laboratory works
J Fail-safe
K Call / re-call

 

 

10. Histology

 

A
Preparation of specimens
B
Principles of histological diagnosis
C
Normal epithelium
D Congenital transformation zone
E How biopsy taking might influence histological interpretation
F How a histology laboratory works

 

 

11. The Equipment

 

A
The colposcope
- Its elements
- Filters
- Magnifications
- Focal length
B
Type of specula
C
The role and use of saline and green filter
D The role and use of acetic acid
E The role and use of Lugol's iodine
F The role and use of Monsel's solution
G Principles of sterilisation/decontamination of colposcopy clinic equipment
H The physics of local treatment modalities
I The safety aspects of local treatment modalities
J The use and safety aspect of local analgesia

 

 

12. Principles of Management

 

A
Expectant management
B
Destruction vs excision
C
Ectropion
D Inadequate smears
E Infection
F Glandular cytological abnormalities
G Suspected low-grade CIN
H Suspected high-grade CIN
I Proven CIN 1
J Proven CIN II
K Proven CIN III
L Proven CGIN
M Suspected invasion
N Proven Stage IA1
O Proven Stage IA2
P Proven Invasion (Stage IB+)
Q Follow up for treated CIN
R Follow up for treated CGIN
S Suspected VAIN
T Proven VAIN
U Suspected VIN
V Proven VIN
X Abnormal smears in pregnancy
Y DES exposed patient

 

 

3.2 Practical Considerations

 

1. Preliminary Skills

 

A
Take a relevant history
B
Position patient
C
Pass a speculum
D Perform bimanual examination
E Perform a smear including with the endobrush
F Perform bacteriological swab

 

 

2. Colposcopic Examination

 

A
Identify the transformation zone
B
Examine the TZ with saline and green filter
C
Examine the TZ with acetic acid d) Examine the TZ with Lugol's
D Examine the TZ with Lugol's iodine
E Expose the endocervix with endocervical speculum
F Recognise abnormal vascular patterns

 

 

3. The Normal Cervix

 

A
Original squamous epithelium
B
Columnar epithelium
C
Metaplasia
D Congenital TZ
E Pregnancy
F Postmenopausal cervix

 

 

4. The abnormal lower genital tract

 

A
Low grade cervical intraepithelial abnormality
B
High grade cervical abnormality
C
Microinvasive carcinoma
D Invasive carcinoma
E VAIN
F VIN
G Determines extent of abnormal epithelium
H Recognise appearance of Candidal infection
I Recognise appearance of Trichomonal infection
J Recognise appearance of Bacterial vaginosis
K Recognise appearance of Wart virus infection

 

 

5. Practical procedures

 

A
Administration of local analgesia
B
Determine where to take directed biopsies
C
Directed cervical biopsy
D Directed vaginal biopsy
E Directed vulval biopsy
F Control of bleeding from biopsy sites
G Performing endometrial sample
H Remove an IUCD
I Insert an IUCD
J Perform local cervical treatment

 

 

6. Administration

 

A
Documentation of cervical findings
B
Understanding modes of data collection and storage
C
Understand clinical administration
D Aware of national clinical standards for cytology
E Aware of National standards in colposcopy
F Understand service requirements

 

 

7. Communication

 

A
Understand psychological effects of colposcopy
B
Able to counsel patients prior to colposcopy / treatment
C
Able to counsel patients after colpscopy / treatment

 

 

8. Audit

 

A
Understanding of the audit cycle
B
Perform an audit
C
Write an audit report
D Audit report presentation

 

 

 

4. Trainers Criteria, Appointment and Recognition

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4.1 Who Can be Trainers?

 

A
Colposcopists who are registered on the SCCPS Register of Colposcopists.
B
They should see a minimum of 100 colposcopic cases over a one year period of time on a personal basis.

 

 

4.2 List of Trainers

 

The list of trainers will be maintained by the SCCPS.

 

 

 

5. Registration Process

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5.1 New Colposcopists

 

Those wishing to apply for training should contact the SCCPS and fill out a form signed by their identified trainer.

 

 

A logbook at a surcharge of $10 each will be issued to the trainee together with a training number.

 

The trainee will then undertake the theoretical and practical training as set out above.

 

Upon completion and submission of the logbook and basic colposcopy course certificate, the trainee will take the written test conducted by the SCCPS. Upon completing the training programme and submitting a registration fee of $50, the trainee will be issued a certificate and placed on the Register of Colposcopists.

 

For SCCPS members, the registration fee is waived.

 

 

5.2 Maintenance Requirements

 

Reminder letters together with an application form attesting to the minimum requirements for re-registration will be issued every two years

 

 

Upon return of the signed form together with an administrative charge of $50, a new certificate will be issued and the registration renewed for a further 2 years.

 

Administrative charges for SCCPS members are waived.

 

 

5.3 Register of Colposcopists

 

This Register which is updated regularly will be published on the SCCPS website.

 

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February 2006
August 2005
July 2004