APGO

Britt K. Erickson, MD
University of Alabama at Birmingham, Birmingham, AL

Objective: As screening guidelines and management recommendations for pre-invasive cervical disease evolve in complexity, teaching medical students and OBGYN residents these concepts has become more challenging. As such, we created a protected educational forum for residents and medical students to review pre-invasive cervical disease in a multidisciplinary forum incorporating cytology, cervical imaging, histology, and updated screening and management guidelines.

Methods: Monthly colposcopy conferences were planned through the joint efforts of the surgical pathology, cytopathology, and gynecologic oncology fellows. Each month, 5-8 patients were selected for presentation at the conference from our University-based colposcopy clinic which is attended weekly by medical students, residents, and gynecologic oncology fellows. During the conference, patient demographics were presented including age, parity, referral cytology, and medical and social history. Next, the cytology specimen was reviewed through the multi-headed teaching microscope and notable findings were discussed. Images captured directly from the colposcopy exam (both before and after application of acetic acid and/or Lugol’s solution) were also displayed. Residents were asked to describe the images, render a diagnostic impression, and discuss optimal locations for biopsy. After reviewing the cervical images and the biopsy sites, the histopathology of the biopsy specimen was reviewed using the teaching microscope. The pathology fellow emphasized the cyto-histologic features used to differentiate normal from both low and high-grade squamous intraepithelial lesions. Once a final diagnosis was made, medical students and residents were asked about subsequent management and follow-up according to the most recent American Society for Colposcopy and Cervical Pathology (ASCCP) screening and management guidelines. When available, loop excisional specimens were also reviewed and correlated with previous biopsy results.

Results: A total of ten monthly conferences were held between August 2012 and May 2013. Three OBGYN residents had protected time to attend the conference each month (1 PGY-2, and 2 PGY-1). In addition, 2-5 medical students from the rotation, 3-4 fellows (oncology, cytopathology, and surgical pathology), and 1-4 pathology and/or oncology staff attended each conference. Feedback in the form of an anonymous survey was obtained regarding the utility of the conference at the completion of the academic year. The survey consisted of 10 questions, 6 of which were part of standardized departmental conference evaluations. Residents had four answer options, including: “Not Applicable”, “No”, “Yes/Somewhat”, “Yes/Definitely”. All fifteen members of the 2012-2013 first and second year resident classes submitted evaluations. Fourteen residents attended at least one conference (range 0-5, median 2). Of these 14 residents, 93% indicated that the conference “Yes/Definitely” provided a unique opportunity for inter-professional collaboration, increased their medical knowledge, and introduced them to new concepts. Nine residents attended two or more colposcopy conferences. Of these residents, 100% indicated that conferences “Yes/Definitely” improved their ability to recognize cervical pathology and decide where to best perform directed biopsies, as well as improve their understanding of the ASCCP screening and management guidelines.

Conclusions: The comprehensive evaluation of pre-invasive cervical disease is a complex topic for medical students and OBGYN residents. Through an interdisciplinary approach involving gynecologic oncology, surgical pathology, and cytopathology, we were able to successfully create a forum for medical students and residents to review and learn this important subject.

Key Words: colposcopy, multidisciplinary education