Students like practical ‘hands-on’ training not only in diagnosis but also in treatment. For diagnosis we have been using plastic simulation models which when looked at through the video colposcope, commonly used in India and the Middle East, appear as an exact replica of a real cervix.
This allows us to project images of the models onto a television screen where they seem identical to those seen with live colposcopy on a patient. We call this process ‘simulation colposcopy’ (#simulationcolposcopy).
At our Colposcopy Courses seminars in Dubai we hold a practical session on the last day where students are tested on their ability to use the colposcope and make diagnoses from models. They are also asked to demonstrate how they would use many of the ancillary instruments used in the colposcopic examination including endocervical forceps, biopsy forceps with local anesthetic and various specula.
They have to complete a questionnaire detailing whether the transformation zone (TZ) is satisfactory or unsatisfactory, whether the TZ is normal or abnormal and if it is the latter, if the lesion low or high grade. We also ask them how they would treat this woman. After they have completed 5 stations, they are interviewed by an experienced colposcopist who reviews their answers. This is very similar to the OSCE exam which is used as part of the BSCCP accreditation.
The treatment session involves using an electro-diathermy loop (LLETZ). Animal tissue is used, usually beef or kidney because these have a similar consistency to the human cervix. When beef is used a circular piece is taken and the Key’s Punch is used to remove a few millimetres in the centre, imitating the normal endocervix. When acetic acid is placed on the meat it produces aceto whitening very similar to that seen on the cervix with the presence of abnormal tissue.
The same can be done with the kidney and these tissues are then placed in a short tube imitating the normal vagina and an electro-diathermy insulation pad is placed behind the tissue. A smoke extractor is incorporated into the model to remove the smoke produced during the excision process. In some models it is possible to place a vaginal speculum.
In London a similar practical training course has been developed at the Portland Hospital using a model developed by Anna Barbour, a nurse colposcopist.
The following pictures illustrate the different stages of the practical workshop.
|1. Answering questions while viewing an image of a model using a video colposcope|
|2. Using the Gynocular (a monocular colposcope) to view the models|
|3. Using the Gynocular with a smart phone attached which can take a high quality colpo-photograph. Additional data can also be collected on the smartphone, including patient details, biopsy position, Swede score. All of which can be stored in the cloud and emailed. It is extremely useful for teaching and audit purposes and is light weight (450g) and easily transportable.|
|4. Answering questions while using the video colposcope|
|5. Plastic simulation model as viewed down the colposcope (video or monocular). The image seen looks almost identical as when viewed on a real patient. This model shows a high grade pre-cancer, with changes indicating early #cancer (micro-invasion)|
|6. Low grade, pre-cancer from which a #biopsy was accidentally taken by a candidate who thought it was real.|
|7. Performing ‘simulation colposcopy’ under the guidance of tutor, Mr Narendra Pisal, a consultant at the Whittington Hospital, London|
|8. Doing a Loop Excision with diathermy using an animal’s kidney being viewed on the television monitor|
|9. Using a vaginal model to perform a Loop Excision with diathermy on an animal’s kidney|
|10. Reviewing answers with the tutor Mr Pisal|
The Dubai #ColposcopyCourses are offered by our partner companyIBC Medical, an independent training institute which runs workshops and hands-on courses for a variety of medical and surgical specialities including. It also offers training for those undertaking the RCOG membership examinations.
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