Implementing Standards in Training in Latin America
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1 Implementing Standards in Training in Latin America Prof. Silvio Tatti MD, MSc, Phd, FACOG Immediate Past President IFCPC Full Professor of Gynaecology Chief Division Gynaecology Buenos Aires University Argentina
2 Disclosures No financial relationships or conflict of interest to disclose
3 IFCPC Represents 46 National Colposcopy Societies Aspires to reduce the burden of cervical cancer: Mar del Plata Argentina 1972 Nomenclature, Training, Tri-ennial world congress
4 Cervix Uteri: Age-Standarized mortality rate per 100,000 Mortality is falling in developed world; but is rising in LMICs
5 INCIDENCE OF COLPOSCOPISTS INCIDENCE OF CERVICAL CANCER NORTH AMERICA-HIGH NORTH AMERICA-LOW EUROPE -HIGH EUROPE -LOW SOUTH AMERICA -LOW SOUTH AMERICA -HIGH ASIA -LOW ASIA -HIGH
6 Applicability of training programmes across national and continental borders Differences in clinical practice Differences in regulatory authorities Differences in training opportunities
7 Applicability of training programmes across national and continental borders Differences in CIN management practice Screening Colposcopy treatment
8 Different training efforts Preceptorships Theoretical Courses Twinning initiatives Collaborative projects Distance learning
9 IFCPC Distance Learning Course in Latinamerica Reference Training Centers México Hospital Lopez Mateos (México DF) Dr. Jose Luis Lopez Colombia Hospital San José FUCS (Bogotá) Dr. Carlos Humberto Perez Moreno Ecuador Hospital Solca (Cuenca) Dr. Hernán Neira Argentina Hospital Maternidad (Córdoba) Dr. Otilio Rosato Hospital de Clínicas (Buenos Aires) Dr. Silvio Tatti
10 IFCPC Distance Learning Course Course plan Fortnightly lectures Follow up questions Log of cases seen in unit Followed by Series of clinical cases and associated discursive critique Video or still image of colposcopy Cyto and histo slide presentation Case management plan
11 IFCPC Distance Learning Course End of course practical colposcopy week in each site End of course exit exam Eligibility requires that all lecture questions answered the practical course is attended satisfactory display of clinical skills OSCE style exam including image recognition questions, management questions, patient interaction assessment
12 IFCPC Distance Learning Course in Latinoamerica 6 Sections 25 Lectures 23 Speakers from different countries of Latinamerica and Spain in France all of them opinion leaders The course is all in Spanish
13 IFCPC Distance Learning Course in Latinoamerica The speakers are from: Argentina - Costa Rica Colombia France Chile Mexico USA Uruguay - Spain
14 IFCPC Distance Learning Course in Latinoamerica Section 1: Essentials Colposcopy of the Normal and Abnormal Transformation Zone 1. Introductory and Explanatory talk outlining the rationale, process and timeline of the course Walter Prendiville, Silvio Tatti y Laura Fleider 2. Colposcopy, the equipment Facundo Gomez Cherey (Argentina) 3. Colposcopic examination of the normal cervix Fernando Madrigal Cordero (Costa Rica) 4. Colposcopy of the abnormal cervical transformation zone Carlos Humberto Perez (Colombia)
15 IFCPC Distance Learning Course in Latinoamerica Section 2: Science Molecular biology, Epidemiology and Screening 1. The anatomy, physiology and colposcopy of normal and abnormal cervical epithelium Verónica Maldonado (Argentina) 2. The Biology of Human Papilloma Virus cervical infection Alfonso Alba Menéndez (España) 3. Cervical cytology screening, principles, utility and future perspectives Christine Bergeron (Francia) 4. The clinical utility of HPV testing Eugenio Suarez (Chile) 5. The epidemiology of HPV and Cervical cancer worldwide Rolando Herrero (IARC) 6. Analysis of costs of different strategies of screening. The experience in Mexico Eduardo Lazcano Ponce (México)
16 IFCPC Distance Learning Course in Latinoamerica Section 3: Diagnostic Colposcopy 1. New IFCPC colposcopic nomenclature and useful scoring systems Silvio Tatti (Argentina) 2. Difficult Colposcopic Circumstances and Physiological Variations (Previous treatment, Atrophy, Infection, menopause, DES) Aureli Torné Bladé (España) 3. Glandular abnormalities : Recognition and management Andrés Humphreys (Argentina) 4. Case histories / cytology-colposcopy-histology correlation Lili Diaz y Laura Fleider (Argentina)
17 IFCPC Distance Learning Course in Latinoamerica Section 4: Treatment and Follow-up 1. The treatment of CIN using ablative methods María de los Angeles Tinnirello (Argentina) 4. The treatment of microinvasion, adenocarcinoma in situ and the type 3 TZ Elsa Diaz Lopez (México) 2. Excisional treatment of CIN (i) practical aspects Laura Fleider (Argentina) 3. Excisional treatment of CIN (ii) benefits and disadvantages Ramón Cestero (USA) 5. Follow up of treated and untreated women, with and without HPV testing Alejandro Eiriz (Uruguay) 6. The colposcopy and management of CIN in Pregnancy Enrique Copolillo (Argentina)
18 IFCPC Distance Learning Course in Latinoamerica Section 5: Miscellaneous issues 1. HIV and CIN Laura Fleider (Argentina) 2. Cervico-vaginal infections : Colposcopic recognition and management Ricardo Caruso (Argentina) 4. Multifocal disease : Diagnostic and management issues Silvio Tatti (Argentina) 5. Colposcopy of the Vagina and the Vulva Montserrat Cararch Tur (España) 3. Extragenital HPV infection. H & N Tumors HPV related. The evidence base for management choices screening, investigation and treatment Jean René Clemenceau (México) 6. Vulvar Dermatoses Verónica Suzuki (Argentina)
19 IFCPC Distance Learning Course in Latinoamerica Section 6: Finale OSCE (i) OSCE (i) Practical course and practical exam Silvio Tatti / Laura Fleider / Walter Prendiville
20 IFCPC Distance Learning Course Preconditions for acceptance on the course Screening current in region Therefore access to patients who need colposcopy Colposcopy equipment available Support of unit Access to a computer and the Internet
21 IFCPC Distance Learning Course Theoretical and image recognition parts of the course entirely on line at: But is password protected for delegates and faculty Course material released over time (i.e. over one year, lectures first, cases subsequently)
22 IFCPC Distance Learning Course Post course follow-up ambitions Quality Assurance visit of each colposcopy unit Assessment of equipment and practice Perhaps recognition of training centre status If funding provided, then an equipment upgrade
23 Evolution of training program since 2014 Recognition that on line lectures aren t enough Liaison with EFC Development of still image and video case library Opening discussions with major societies/federations Pilot program in Brazil in July 15
24 Principles A graduate of an IFCPC course should be competent independent of region Colposcopy clinic experience is core 50 Supervised cases is minimum needed 100 unsupervised cases follow Examination is mandatory Accreditation is desirable
25 Practical / Clinic part of Course To manage 50 cases under supervision will take 1 to 2 months depending on patient numbers 100 unsupervised cases may be logged at trainees own center and assessed by trainer OSCE exam next year Review of program continuously
26 planned courses Brazilian ongoing pilot (Portuguese) 2 in Africa (French and English) One in Spanish Latin America (Spanish) One in Eastern Europe (Russian and English) One in India (English)? China in 2017
27 Many Thanks for Listening
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