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Expertise in a Resident-Centered Colposcopy Clinic: Are You Smarter Than a Third Year?
Journal article   Peer reviewed

Expertise in a Resident-Centered Colposcopy Clinic: Are You Smarter Than a Third Year?

Tommy Buchanan, Justin Rasner, Michael Podolsky and Scott Richard
Obstetrics and gynecology (New York. 1953), v 123 Suppl 1(Supplement 1), pp 16S-16S
May 2014
DOI: https://doi.org/10.1097/01.AOG.0000447268.23212.f7

Abstract

OBJECTIVE:Colposcopic evaluation is integral to proper patient care and duty-hour limitations are feared to hinder learning this art. We aim to observe adequate resident training in colposcopy by assessing whether clinical findings in a resident-centered colposcopy clinic are equivalent to the expected national trends for health care practitioners who have already completed training. METHODS:Retrospective review of colposcopy reports for patients presenting with new abnormal Pap tests were performed in a large, urban, teaching hospitalʼs resident-centered colposcopy clinic between June 22, 2011, and June 13, 2012. Six residents in their third postgraduate year performed each colposcopy and demographic, pathologic, and follow-up data were compiled. The study includes patients aged 21–70 years with documented squamous abnormality. Patients younger than 21 years, older than 70 years, or patients with screening done after prior treatment or with vaginal cuff cytology were excluded. Data were analyzed based on the proportion of each category. RESULTS:In 50 clinic sessions, 416 patients were seen and 103 included in analysis (24.7%). Demographics were similar. There were 47 atypical squamous cells of undetermined significance with positive high-risk human papillomavirus (HPV), 44 low-grade squamous intraepithelial lesions, five atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions, and seven high-grade squamous intraepithelial lesion Pap test results. We found 22.3% high-grade lesions overall, 14.9% among atypical squamous cells of undetermined significance+high-risk HPV, 20.4% among low-grade squamous intraepithelial lesions, 20.0% among atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions, and 85.7% among high-grade squamous intraepithelial lesions. The false-negative and false-positive rates were 16% and 17%, respectively. CONCLUSIONS:Our analysis shows that a resident-centered clinic with proper exposure and guidance can adequately diagnose cervical dysplasia consistent with national trends. This would indicate that limitations on resident work hours are not affecting teaching with regard to cervical cancer screening and treatment.

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Obstetrics & Gynecology
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