Screening & E Learning – past, present & future Linda Lewis Training Manager Cervical Screening Wales Bethan Morgan South West Regional Nurse Coordinator Cervical Screening Wales

College of Medicine, Newport Introduction Background to CSW Smear Taker Training before CSW Marie Curie Course University of Wales, College of Medicine, Newport Smear Taker Training after CSW Cervical Screening Wales was formed in 1999 as a result of the first National Service Framework for Wales. It’s aim is to provide the same level of service to all eligible women throughout Wales. There were 5 administration departments across Wales, each with a Programme Coordinator who is a medic and in 2000 5 nurse coordinators were employed to cover each area. This ahs changed slightly since then but if you want to know more about how CSW works now please ask. Since the National Service Framework for Cervical Screening and Cervical Screening Wales was established, there has been an all Wales approach to the education and training for all health professionals. New ways of working in primary care placed evidence based practice at the forefront of clinical practice. The emphasis on providing a quality service stresses the need to ensure that all health professionals who undertake clinical work have the opportunity to access programmes which will ensure they are clinically effective. So part of the Nurse Coordinators role was to provide smear taker training. At that time there were two choices; The Marie Curie Course – a very good course developed in England and approved for use in Wales. The quality of the information delivered and by whom depended very much on the organiser of the course and who they chose as experts on the subjects. Initially CSW tried to work with Marie Curie to adapt the course for Wales as the screening programme was slightly different in Wales to England. Also, at that time Practice Nurses were trying to acquire credits for the training they were undertaking to meet their expanding role and the Marie Curie course was not accredited. The other course that was available was run by Julia Styles at the then, University of Wales, College of Medicine. The course was run out of Caerleon, Newport and was accredited at certificate level. In 2001 it became clear to CSW that someone needed to be appointed to organise this training and I was appointed as Training Coordinator for half my time and Nurse Coordinator for the other half. After much discussion with Marie Curie and the University of Wales, it was decided to adapt the University of Wales course to deliver the same course across Wales and accredit it at certificate and diploma level to meet the needs of Practice Nurses in particular.

Past Three day classroom taught course Change to e learning Development of e learning with CSW Move e learning to NHS Wales Learning Academy (Moodle) At that time CSW continued the original format of the course which was a three day classroom taught course. This covered the theoretical information as well as using a model to demonstrate the clinical skills. The following six months were undertaken in the clinical environment under supervision and then the student completed a clinical practice portfolio and was assessed by an assessor appointed by CSW. To meet the University standards and assess the theoretical knowledge, the student completed an case study. The overall evaluation was very positive and participants comments, as well as successful outcomes confirmed that the development of an all Wales approach was an effective, efficient and consistent approach. However, while the training programme received positive feedback, some negative comments were made regarding the amount of information that was delivered in three days and how difficult it was to assimilate the knowledge in such a short time. As a result of the feedback and to develop the existing training, it was decided to explore alternative ways of education delivery. After several months and a lot of input from web based developers at CSW, an e learning programme was developed to deliver the theoretical information. This would allow the participants to undertake some of the theory via e learning prior to attending and reduced the classroom time to one day but kept the rest of the course as previously. Following an initial pilot the participants were asked to complete an evaluation form about the site, commenting on the accessibility, navigation of the site, layout etc. Some modifications were made but overall it was received very positively and it was decided to continue with this method of delivery. It was not without it’s problems and the server provider went bust and we had to quickly move to another server provider as at that time we were delivering 10 courses per year throughout Wales. So there were always participants who wanted to access the information. Reducing the taught days and providing e learning also encouraged Doctors who required smear taker training to access the course. As a result of one of the Programme Coordinators who was also a GP, CSW started to work with PLATO (Post Graduate Learning And Teaching Online) which is a secure online learning platform managed by Health Solutions Wales. Their main focus is a learning portal called ‘Moodle’ set up to centralise and standardise online training across Wales. PLATO is a specialist section of this portal.

Present Cervical Screening and Breast Awareness Training Course www.mle.wales.nhs.uk Cervical Screening Update Ideas for development PLATO currently hosts 2 cervical screening modules: the Training Module and the Update Module. With ongoing development for both of these courses over the past 12 months, we have witnessed a significant increase in trainee enrolment, with the training course now hosting 122 trainees from across Wales. These modules provide excellent learning tools to deliver learning materials in supporting a national, on-site training program.   The courses structure consists of the following learning tools and activities. Secure enrolment National Forum Online assessment in the form of quizzes Certification Instant messenger However, what CSW wanted to ensure was that the quality of work of the course participants wasn’t different following the change in training programme delivery to e learning and more importantly that women were receiving the same quality service. As all smear takers in Wales have a unique identification code it was relatively easy to track course participants who had undertaken the three day taught course and compare them to participants who had undertaken the course via e learning. Their academic levels were matched and then their statistical information was examined i.e. The amount of smears performed, inadequate rate and transformation zone sampling rate. There was no significant difference with the academic achievements of the groups and the inadequate rate and transformation zone sampling was comparable in both groups. Therefore, it was determined that the method of delivery of information for the cervical screening and breast awareness training had not affected the quality of smears taken and had not disadvantaged the patient. Also during this time and as a result of feedback, the course was accredited at diploma and degree level and moved to Cardiff University. As a result, it was decided to continue with the e learning mode of delivery. It was agreed that the new methodology would not only make access to the programme more accessible to professionals but would also provide a more flexible approach to learning across the Principality. As a result of this CSW updates are now delivered via e learning for health professionals who are unable to attend update sessions or prefer to undertake e learning. The same structure applies to both courses. So before we look at the next stage I will just show you the web site.

Future Develop more e learning course MSc Screening Post Graduate Certificate in Colposcopy For Volunteers & GP Administration staff using Qualification and Credit Framework 3D animation Working with Cardiff University we have now developed an MSc in Screening which we hope will have an e learning component. This is not only for the screening undertaken by the screening services but covers all screening. Screening services work closely with administration staff from GP surgeries and volunteer groups. Although an internet site as been developed to provide information to GP practices via a screening link person, we are looking at the possibility of accrediting e learning information via the Qualifications and Credit Framework for GP administration staff and volunteers. We have now begun the development of a new resource: an online, 3D training simulator for smear takers. Developed by PLATO in conjunction with Swansea Metropolitan University, this resource will be launched in autumn 2009. It is very exiting and innovative and has possibilities not only for cervical screening training, but also colposcopy training, breast biopsies, colonscopy and who knows where we will end up.

Special Thanks Paul Kirk – business development manager (PLATO) Joel Benson – unit manager (PLATO) Neil Phillips – lead developer (PLATO) Henry Lutum – lead animator (PLATO) Al Kang – animator (PLATO)

Thank you for listening Any Questions. Linda Lewis linda Thank you for listening Any Questions? Linda Lewis linda.lewis@cswswansea.wales.nhs.uk Mobile 07813667318