1. DIY Colposcopy Course for Family Medicine Residents LIZ MCELLIGOTT ERIK SOLBERG, MA, MEd PITA ADAM MD, MSPH

2. What you are you hoping to get out of this talk?

3. Objectives Describe how a low-cost procedural model can be constructed using commercially available components. Recall the educational innovations used in the colposcopy course. Apply procedural course innovations to other educational settings.

4. Times are Changing

5. 1 year out Alumni survey data 2014 graduates: 7/27; 26% currently performing colposcopies –response rate for survey was 49%; 29/59 2013 graduates: 8/30; 27% currently performing colposcopies –response rate for survey was 58%; 30/52 2012 graduates: 12/42; 29% currently performing colposcopies –response rate for survey was 78%; 42/54

6. Times are changing Years of providing a Basic Colposcopy Course –Goal: a foundational course (lectures and hands on) to prepare residents for providing colposcopy in the clinic Dramatic drop in last 10 years of colposcopies in clinic Decision: –Drop the Basic Course –Create an Advanced Course More rigorous and more hands on practice

7. Advanced Course Principles Pre-course prep work to limit lectures As much hands on as possible Hands on as real as possible, working with a colposcope through a “vagina” Lots of cervical images End of course testing

8. Original Basic Course Basic Course –Lectures –Hands on: Megacolp –Uses plastic pelvic model with bought silicon abnormal cervix (can’t biopsy) ECC: red potato w/dyed hole Cervical Bx: Gizzard Cryo: freezing a slab of steak –Cervical image review as a group

9. New: Everything through the “vagina” Vagina: –PVC pipe with threaded insert that accepts caps –“cervix” secured to cap with heavy duty toothpick –Stockinette to approximate vaginal walls Cervix: –ECC: Potato with dyed hole –Cervical Biopsy: turkey gizzard shaped in circle –Cryo: Steak cut into circles –Megacolp: turkey gizzard cervices

10. Cryotherapy practice using model Issue: so cold, gun doesn’t release Tried and failed: heal warmers for blood draw Tried and worked: Make sure meat is at room temperature Freezes much faster so limit to 10 second freeze Wait for the gun to detach, before pulling OK if the cervix falls off - can still analyze Can also do freezing on the table to get sense of time

11. Vaginal Model ●2 inch PVC “T” mounted on slanted wooden board ●Threaded 2 inch joint glued into it, which accepts the threaded cap

14. All the stations have colposcopes

15. Cervical Image Review Difficult to build – need a lot of images 45 minute cased based talk: Algorithms that include images 30 minute Image Lecture: –All images –Learners describe the cervical images 30 minute Image Review: more images

16. End of course testing Megacolp: –Goal is for resident to demonstrate proper technique ASCCP test: –Tests image recognition and knowledge –Need 70 % Program Directors: job is to find opportunity for resident to practice with patients and demonstrate competence

17. Course evaluations Faculty estimate that most do the pre-work Residents rate the hands-on highly –May 2014: 4.79, n=11 (overall course rating 4.72) –November 2014: 4.95 n=7 (overall course rating 4.85) –November 2015: 3.50, n=7 (overall course rating 3.50) ASCCP test: –Technically difficult to do during the course –Difficult content material –Faculty believe it helps discern who is prepared and willing to do the work Faculty meet over lunch to evaluate course

18. Competence determination The Executive Council of the Society of Canadian Colposcopists: 2006 –Require 100 colposcopies with 30 on high grade paps AAFP Colposcopy Position Paper: 2015 British Society for Colposcopy and Cervical Pathology: –50 directly and 100 indirectly supervised - 50% high risk J Obstet Gynaecol Can 2006;28(4)314–316 http://www.aafp.org/about/policies/all/colposcopy.html#III https://www.bsccp.org.uk/healthcare-professionals/colposcopy-training/

19. Discussion How do you use models with simulation? How do you translate competence from a simulation to work on a patient?

20. Conclusions Procedural courses play a role in resident training There are creative DIY solutions that are cost effective DIY solutions provide: –Course flexibility to modify as needed –Opportunity for many learners –Ability to “biopsy”

21. Our contact information Erik Solberg: Construction Engineer esolberg@umn.edu Liz McElligott: Course Coordinator emcellig@umn.edu Pita Adam MD: Course Director adamx005@umn.edu