The performance of colposcopy is debatable. Many articles, especially from US, demonstrate poor sensitivity and specificity. On the other hand some, predominantly from UK, show it to be significantly better. Colposcopy could be compared to pathology or radiology, where the performance of the study is much dependent on the experience of the actor, i.e. here the colposcopists education and training. Still in many countries the incidence of cervical cancer has decreased significantly, thus colposcopy obviously has worked reasonably well, but the quality could be improved
The European Federation for Colposcopy (EFC) has declared three colposcopy quality steps: education, training and practice. The education consists of recently developed and revised core curriculum, agreed standards for basic and advanced courses, EFC recognition of courses and provision of targeted courses. The training forms of defined training programme structure, caseload, assessment and electronic log-book. Not many European countries have their own training programmes, OBGYN training usually includes only the basics of colposcopy. Thus EFC is focusing to promote the subject and simultaneously trying to provide education, above all in forms of the core curriculum and colposcopy courses.
What is a good colposcopist? The training should be recognized and preferably with a certification (and recertification). To keep the skills on acceptable level, continued medical education, caseload high enough and audit should be provided with proper intervals. To monitor the colposcopist’s performance, EFC has identified few targets: Colposcopic examination prior to treatment should be done in 100% of cases, as well as the documentation of SCJ status. 85% of excisional treatment biopsies should have a CIN2+ in the lesion and 80 % clear margins in excisional treatment biopsies.
As a conclusion colposcopy should only be undertaken by trained colposcopists. There is a need for defined training programmes with QA and for agreed performance QA standards. The colposcopic practise needs also to be monitored.