Key:

Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Colposcopy (2016) as approved by GMC on 17 May 2016

Introduction:

This ATSM is designed to provide training in both basic and complex areas of colposcopic practice. Successful completion of the ATSM will give a doctor the necessary
knowledge and skills to manage a wide range of colposcopic problems. The ATSM will also prepare an individual to ultimately take up a leadership role in a colposcopy
service. It is therefore aimed at doctors wishing to develop advanced colposcopic knowledge and practice and those wishing to develop the necessary skills to become unit
lead colposcopists in the future.

In order to practice independently as a colposcopist in the UK, it is necessary to complete the training programme laid down by the British Society for Colposcopy and
Cervical pathology (BSCCP). The BSCCP programme is an integral first step in this module and is mandatory to complete this ATSM. Trainees who already hold BSCCP
accreditation will be able to proceed immediately with work to complete this module. Doctors who have yet to complete the BSCCP programme can commence the
module and will be able to achieve many required elements, but it will not be possible to complete the ATSM without BSCCP accreditation. Either registration with the
BSCCP as a trainee colposcopist, or maintaining accreditation with the BSSCP are therefore specific entry requirements for the ATSM.

Successful completion of the ATSM will provide knowledge and experience in:

 Non-standard colposcopy e.g. vulval colposcopy; pregnancy

 Management of complex patients
 The role of the trainer in colposcopy
 The role of the lead colposcopist
 The work of the colposcopy MDT
 The Quality Assurance process in colposcopy
 Audit against national standards

This ATSM has a work intensity score of 1.0. A minimum of 1 session per week should be devoted to the ATSM. The stipulation of 1 session is to give trainees and trainers
an understanding of the expected time needed to complete this ATSM. It should be completed in 12 – 18 months

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Section 1: Clinical Competences

Learning outcomes:

To demonstrate an advanced understanding of the clinico-pathology of pre-malignant disease of the lower genital tract To demonstrate appropriate skills in colposcopy, including
colposcopy of the vulval and vagina in addition to colposcopy of the cervix
 To diagnose and plan management of in common and uncommon disease presentations
 To demonstrate competency in more than one treatment technique
Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment

Indications and limitations in relation to 1 Understand, explain and support equal 1,2,3,4 BSCCP accreditation in
screening and investigative techniques access to cervical screening NHSCSP publication no colposcopy
To interpret and counsel about cervical cytology and 1,2,3,4 23 Taking samples for
Cytology HPV screening reports Appreciate the importance of cervical screening BSCCP accreditation in
psychological factors for patients Diagnosis and Treatment
NHSCSP publication 20
Epidemiology, aetiology, diagnosis, Perform colposcopy of the lower genital tract: Show empathy with patients ‘Colposcopy and Course certificate(s)
prevention, management prognosis  Recognise colposcopic features of the programme
including HPV screening and triage and HPV normal cervix, vagina and vulva Explain, clearly and openly treatment, management Quality improvement project
vaccination  Recognise and diagnose extension of pre- complications and side-effects and obtain guidelines for the NHS’
malignant disease in the vagina (VAIN) appropriate consent for both examination
Complications and anatomical  Recognise and diagnose pre-malignant and treatments Local and regional
considerations of pre-malignant conditions disease of the vulva (VIN) protocols and Case logbook supported by
of the lower genital tract  Recognise coloscopic features of benign Manage patients in keeping national and guidelines relevant WPBAs
pathology of the cervix: local guidelines  Mini CEX
 Inflammation/infection 2011 IFCPC  OSATS
Knowledge of recognised national and  HPV infection Effectiveness in liaising with colleagues in Nomenclature  CbD
international colposcopy classifications and  Benign polyps other disciplines, clinical and non-clinical
terminologies  Pregnancy Educational and clinical Record of meetings attended:
 Post-menopause supervision from  Local MDM
 Changes associated with prior Document findings, collate results and BSCCP accredited  Regional colposcopy
Colposcopy; methods and the limitations for treatment communicate results to patients and GP trainer who is a GMC meeting
colposcopy  Recognise cervical malignancy and arrange registered Educational  Annual national BSCCP
urgent referral to Gynaeoncology MDT and Understand principles of diagnosis an Supervisor meeting
Colposcopy in special circumstances cancer centre management of VAIN/VIN
including  Recognise vulval malignancy and arrange Suitable colposcopy
 Immunocompromised patients urgent referral to Gynaeoncology MDT and Demonstrate knowledge of the pathways courses including
 Pregnancy cancer centre for referral of patients with multi-centric / BSCCP recognised Case record of treatments
 Post-menopause patients  multi-focal disease advanced colposcopy carried out
 Transplant patients Perform appropriate directed biopsies Understand the importance of cancer course
 Cervix MDT in management of variant disease Relevant WPBSs:
Indications, techniques, complications and  Vagina Educational ant raining  Mini CEX
outcomes of treatment of benign and pre-  vulva Organise appropriate imaging for patients resources at  OSATS
malignant conditions of the lower genital with advanced or multi-foal disease www.bsccp.org.uk  CbD
tract Control bleeding from biopsy sites

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment
Attendance at Colposcopy MDT 1,2,3,4 Records of at least two
Document examination findings using UK recognised 1,2,3,4 treatment methods including
classifications Attendance at Gynaecology MDT LLETZ and at least one other
Multi-disciplinary and treatment method applicable
Explain diagnosis and likely prognosis clinical team meetings for type 3 TZ lesions / CGIN /
Recognise, counsel and plan the initial management of Educational and clinical micro-invasion
features suggestive of invasive disease of the lower Explain follow up processes supervision from BSCCP
genital tract accredited trainer Treatments may include:
Explain the nature of treatment and  Knife cone biopsy
Recognise when local treatment is not appropriate possible complications and side-effects  SWETZ
and counsel about hysterectomy and / or vaginal including:  NETZ
surgery  Possible obstetric  Cold coagulation
complications  Ablation

Records of treatment of VIN

Counsel and perform treatment under local and / or VAIN
anaesthetic using techniques for:
 Ablation/destruction
 Excision
 Control bleeding

Select patient requiring treatment under general

anaesthetic

Perform treatments under general anaesthetic using

techniques for:
 Ablation/destruction
 Excision
 Control bleeding

Perform appropriate treatment for VIN or VAIN

Counsel regarding management and complications

after treatment

Liaise with GP and patient

Arrange appropriate follow up

Understand failsafe and recall

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Section 2: Leadership and management of service

Learning outcomes:
 To understand the organisation and administration of a colposcopy service
 To understand the role of the lead colposcopist and to develop the ability to undertake that role
 To demonstrate knowledge and experience of Quality Assurance processes in Colposcopy

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment

Roles and responsibilities of all involved in 1,2 Ability to interact within multi-professional and multi- 1,2,3,4 Effective and timely working with 1,2,3,4 NHSCSP publication Relevant WPBAs
the provision of cervical screening services. disciplinary structures both within and outside a colleagues in other disciplines, clinical and No.23: Taking samples
colposcopy service non-clinical for cervical screening Team Observation forms
Roles and responsibilities of staff involved in
the provision and running of a colposcopy Ability to liaise with those within Trust responsible for Work to comply with national service NHSCSP publication 20 New or revised evidence-
service facilities and staffing of the colposcopy service specifications and targets ‘Colposcopy and based guideline
programme
Knowledge of the roles and responsibilities Development and implementation of clinical Understanding of processes of successful management Completed audit report
of the lead colposcopist including: guidelines clinical audit guidelines for the NHS’
 written protocols Perform cervical cancer audit
 Audit programme Preparation and review of quarterly reports (KC65 or Organise and chair Colposcopy MDT Local and regional on at least one case
 BSCCP training programme equivalent) meetings. protocols and
 Requirements for re- guidelines HBPC report (if applicable)
accreditation of colposcopists Complete relevant Clinical Audit including Communicate MDT decisions to patients
 Colposcopy MDT identification, implementation and review of audit and to relevant members of multi- BSCCP publication: Evidence of attendance at
recommendations disciplinary team Lead Colposcopist relevant meetings
Understand Role of Hospital Based
programme Co-ordinator Ensure appropriate pathways are in place for Role of MDT in the management of multi- Observation and
(or equivalent) Colposcopy MDT centric and multi-focal disease discussion with senior Evidence of attendance at
colleagues / lead meetings
colposcopist
Knowledge of *Quality Assurance structures Involvement in producing/ producing HBPC Annual Understand role of HBPC or equivalent *Evidence of participation in
and processes in Colposcopy including: Report (where applicable) within the colposcopy service Observation and QA visits
 History and development of discussion with HBPC
Colposcopy QA Attendance local and regional meetings with HBPC or Be able to support and participate in work or equivalent
 Role of QA within NHSCSP equivalent of HBPC or equivalent
 Quality Assurance reference NHSCSP publication 30:
centres (QARC) / relevant QA Demonstrate practical understanding of interaction Effective liaison with key professionals Guidelines for Quality
structures and their purpose between Primary Care/ Colposcopy/ Cytopathology/ Assurance Visits in the
 Colposcopy QA visit (where Histopathology within Quality Assurance Working within the local, regional and cervical Screening
applicable) national *QA structures programme (where
Understand and participate in critical incident applies)
reporting Identify and encourage adoption of good

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment
practices Observation and
*Preparation of required documentation for QA visit 1,2,3 discussion with senior
or equivalent Identify training needs and consider how 1,2,3,4 colleagues / lead
these can be met colposcopist
Attendance and participation in Local Screening Group
meetings *Involvement in QA
visit at unit being
assessed

*Involvement in QA
visit to another unit as
observer

*Attendance at
regional QA meetings

 The HBPC role does not exist in all parts of the UK. Trainees should participate in the work of the HBPC or in the equivalent processes in their part of the UK
* QA processes vary across the UK. Trainees should participate in QA processes as described or in the relevant processes that may exist in their part of the UK

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Section 2: Teaching
Learning outcomes:
 To demonstrate competence in clinical teaching within the colposcopy service

Knowledge criteria GMP Clinical competency GMP Professional skills and attitudes GMP Training support Evidence/assessment

Understand the educational principles and 1,2 Ability to provide supervision to trainees in colposcopy 1,2,3,4 Demonstrate understanding of principles 1,2,3,4 Training course Certification from approved
processes of clinical and workplace and other clinical areas in accordance with local and of constructive and effective feedback; recognised for GMC course
supervision as applied to the Colposcopy national programme requirements  SMART feedback Educational Supervisor Evidence to meet the criteria
Clinic environment Accreditation which for GMC Educational
Complete relevant WPBAs for trainees will enables Doctor to Supervisor
be a registered BSCCP Accreditation /BSCCP trainer
trainer
e.g. Team observation
 Training the
Trainers courses
 Online courses on
educational
supervision

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Competence level Not required

Colposcopy
Level 1 Level 2 Level 3
Date Signature Date Signature Date Signature

Clinical competences

Recognise, diagnose and plan management VAIN

Recognise, diagnose and plan management VIN

Recognise, diagnose and plan management early cervical

disease

Plan and conduct management of pregnant patients in

Colposcopy clinic

Plan and conduct management of transplant and /or immune-

compromised patients in Colposcopy clinic

Document findings using recognised IFCPC classifications

Loop diathermy treatment procedures (LLETZ)

Alternative treatment procedure for Type 3 lesion (at least

one of knife cone biopsy, SWETZ, NETZ, cold coagulation,
ablation)

Select and use appropriate treatment method for lesions of

Type 3 TZ

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Competence level Not required

Colposcopy
Level 1 Level 2 Level 3
Date Signature Date Signature Date Signature

Counsel patients undergoing treatment about:

complications of treatment
further management of their specific condition
likely outcome and prognosis

Educational Supervisor Signature Date

BSCCP Accreditation in Colposcopy

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Leadership and management of the service

Educational Supervisor Signature Date

Assist in preparation and checking of quarterly reports (KC65)/

alternative benchmarking reports
Completed clinical audit cycle

Assist in production of annual HBPC report (or alternative)

Identify cases requiring MDT discussion and make appropriate

referrals
Complete cervical cancer audit submission (at least one case)

Teaching skills

GMC level Educational Supervisor & BSCCP Trainer accreditation

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Training Courses or sessions

Date
Title Signature of educational supervisor

Attendance at Gynaecology MDT meetings (>3)

Chair Colposcopy MDT meetings (>3)

Attendance at Advanced Colposcopy course of equivalent (e.g. BSCCP

Annual Scientific Meeting

Attendance at regional QA meeting or equivalent ( 1 or more)

Quality Improvement Initiative

Date
Title Signature of educational supervisor

10

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

Authorisation of signatures (to be completed by the clinical trainers)

Name of clinical trainer (please print) Signature of clinical trainer

11

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust
 Key:
Common competency framework competencies Medical leadership framework competencies Health inequality framework competencies

OSATS
Each OSATS should be successfully completed for Independent Practice on 3 occasions before the module can be signed off

Date Date Date

Diagnostic Colposcopy
Signature Signature Signature

Date Date Date

Treatment: Cold Coagulation or cryotherapy
Signature Signature Signature

Date Date Date

Treatment: Laser excision or ablation
Signature Signature Signature

Date Date Date

Treatment: Large loop excision of

Signature Signature Signature
transformation zone

12

GMC Good Medical Practice (GMP) Domains: Domain 1: Knowledge, skills and Performance Domain 2: Safety and quality Domain 3: Communication, Partnership and Teamwork. Domain 4: Maintaining Trust