Colposcopy can enhance your diagnostic skills
Challenged by the number of abnormal cytology reports returned on your patients and interested in building your skills level? Consider adding colposcopy to your practice to increase your knowledge and maintain continuity of patient care. Colposcopy, the technique of visualizing the cervix and vaginal and vulvar mucosa through high-powered magnification, crosses all disciplines of gynecological providers, with physicians, nurse practitioners, certified nurse midwives, and physician assistants represented in the membership of the American Society for Colposcopy and Cervical Pathology, the national professional society based in Hagerstown, MD.
Educational guidelines for colposcopy, such as those from the national colposcopy society and the Washington, DC-based National Association of Nurses in Reproductive Health, closely mirror each other, so the knowledge base is equal for all, says Mary Rubin, RNC, PhD, CRNP, director of clinical education for Education Program Associ-ates, a Campbell, CA, non-profit health, education, and human services organization. Rubin is the first advanced practice clinician to serve on the national colposcopy society’s board of directors.
The need for colposcopy will continue to grow as more patients present with human papilloma virus (HPV) infection. An estimated 24 million Americans are infected with HPV, with as many as one million new cases added each year.1 The colposcope often is used following an abnormal Pap smear to diagnose HPV presence on the cervix.
Women who are infected with HIV also are candidates for multiple colposcopies because they are at higher risks for abnormal Pap smears, says JoAnn Woodward, RNC, BSN, NP, a nurse practitioner at Seaside Women’s Services, a private practice in Manhattan Beach, CA. Cervical cancer is the most common cause of sexually transmitted disease-related deaths among U.S. women.2 If colposcopy can help reduce this outcome, it will provide a valuable public health service, she says.
Continuity of care is one of the strongest reasons for adding colposcopy to your practice, Rubin says.
Take advantage of comprehensive educational sessions available through the national colposcopy society and other facilities. (See list, at right.) Look for a four- or five-day course to allow you to study the entire content area and review case studies, Rubin advocates. Physician residents in obstetrics and gynecology and family practice should seek basic colposcopy courses to acquire fundamental diagnostic skills. Plan to log somewhere between 25 and 100 cases with a preceptor or mentor before your training is complete, she says. There are several colposcopy atlases, slides, videos, and computer CD-ROMs to strengthen your knowledge. The American Society for Colposcopy and Cervical Pathology offers a wide variety of educational material. (See list.)
Intermediate and advanced courses are available to enhance diagnostic skills. The national colposcopy society’s intermediate session focuses on case-based learning, with the advanced curriculum adjusted to reflect current challenges, says Kathleen Poole, the society’s administrative director. Basic, intermediate, and advanced sessions are offered in various locations, Poole says.
There is no national certification for colposcopists. Many providers believe that completion of a comprehensive course, time with a preceptor or mentor, and evaluation through written and visual tests serve as adequate indicators of colposcopy competency, Rubin explains. Look at the number of patients you are referring for colposcopy services, she says. If you occasionally refer patients for such services, you may believe you don’t have the volume needed to stay sharp in detecting cervical and vaginal changes through the colposcope. If that is the case, consider volunteering at community or free clinics, Woodward suggests. This offers a dual benefit: Women gain a needed service, and clinicians see a wider number of cases for possible colposcopy evaluation.
Colposcopy education will not eliminate the need for referrals, Woodward says, but it can help clinicians enhance their level of health care delivery and cut the current waiting time caused by the limited number of colposcopists now in the field. "We can teach someone how to eliminate that wait; we can teach the person to do it safely and to know when to stop," she says of the educational process. "For instance, if I find a patient with something on their cervix that I am not familiar with, or if I find somebody who has something that looks like invasive cancer, and that is not something I feel trained or comfortable taking care of, I can know when to stop and when to refer."
References
1. Centers for Disease Control and Prevention, Division of STD/HIV Prevention. Annual report 1994. U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, 1995.
2. Ebrahim SH, Peterman TA, Zaidi AA, et al. Mortality Related to Sexually-transmitted Diseases in Women, U.S., 1973-1992. Proceedings of the Eleventh Meeting of the International Society for STD Research. New Orleans; August 1994.
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