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Standars on Colposcopy; View from North America
H.Jones
III
Profesor
Obstetrics and Gynecology, Vanderbilt University,
Nashville, TN, U.S.A.
Colposcopic Standars in the United States are entirely
voluntary with no formal standard requirements, testing
or certification. The residency training in Obstetrics
and Gynecology is four years after graduation from
medical school. During this time residents receive
classroom and clinical training and experience under
the supervision of the faculty. Many residency training
programs in Family Medicine or General Practice also
have some training in colposcopy. There are questions
on the written and oral board certification examinations
about colposcopy and cervical pathology.
In addition to residency training, there are refresher
and advanced courses in colposcopy and lower genital
tract neoplasia to maintain and improve these skills;
the board certification examinations must be passed
again at last every 10 years.
However, once one is licensed as a physician (this
license is issued by each state usually on the basis
of national examinations), there are very few restrictions
on office practice. Anyone can do colposcopy, office
biopsy, LEEP, cryotherapy, etc with no extra license,
certification or quality control. Governmental agencies,
insurance companies, and medical societies or specialty
associations have no oversight or regulatory power
unless serious morbidity or mortality results. Medical
malpractice liability concerns exert some control
over practice habits. Patients are rarely able to
judge the colposcopic skills or the quality of management
of cervical abnormality of their physician or nurse
clinician. The American Society of Colposcopy and
Cervical Pathology administers an examination called
the Colposcopy Recognition Award that is designed
to identify colposcopists with special skills and
interests. This exam, wich consists of written, colpophotographic,
and cytologic/histolgic questions, has been given
yearly for the past 10 years but only 78 colposcopists
have passed the examination. The pass rate is about
33 % of those who take the exam. However, this Recognition
Award had not been widely publicized and public recognition
has been minimal.
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