Colposcopy/Vulvovaginal Disease ClinicOur Colposcopy/Vulvovaginal Disease Clinic provides a valuable service for Women's Health Practice (WHP) patients with pre-malignant and malignant conditions of the lower genital tract. The clinic also evaluates and manages a variety of other vulvovaginal conditions such as lichen sclerosus, lichen Planus, and vulvodynia. Prior to the start of the weekly Colposcopy Clinic on AC-5, our residents and full-time faculty participate in a Clinicopathologic Correlation (CPC) for lower genital tract neoplasia/disease in conjunction with the Department of Pathology and with the assistance of Professor Thomas Bonfiglio, Director of Cytopathology. Following the CPC, our residents and medical students participate in a set of six teaching modules presented weekly, ranging from the "Art of Colposcopy" to "Molecular biology of the HPV." Our colposcopy training emphasizes an understanding of the histopathologic changes that form the basis for visible changes seen at the time of colposcopy. Additionally, the clinic session includes the evaluation and management of difficult non-neoplastic vulvar problems that are also commonly referred to the clinic. Our referral sources include selected groups of women at high risk for genital tract neoplasia, as well as complicating medical problems. The volume of colposcopy on AC-5 from July 2002 to June 2003 was 162 patients from the WHP and 70 from the faculty practices. Schedule1st - 6th week 1:00 p.m.—Correlation Session (Room 2-2118) 1:30 - 2:00 p.m.—Lecture Module in the AC-5 Conference Room (see topics) 2:00 - 4:30 p.m.—Colposcopy/Vulvovaginal Disease Clinic DescriptionThe Correlation Session will incorporate a discussion of the management of returning patients for the day and include a review of pap smears, prior biopsies, and colposcopic photos (if available). The more senior resident attending the correlation session should be prepared to present the patients for the day. Significant information should include but not be limited to: age, race, parity, smoking history, immune status and CD-4 count if positive, pap/colpo/biopsy history, and treatment history. The Colposcopy/Vulvovaginal Disease Clinic nurse will be responsible for maintaining a database through the clinical year and will maintain management continuity as well. The Correlation Session will include the completion of a standardized evaluation and management sheet by the Colposcopy/Vulvovaginal Disease Clinic nurse-in-charge. The majority of the work collecting cases, slides, etc., will be left to the chief gyn resident-in-charge of Ambulatory Service or the designated gyn resident responsible for the Colposcopy Clinic. On the Friday before the Colposcopy Clinic, the designated resident is responsible for calling Dr. Bonfiglio's office (5-6920). Before contacting Dr. Bonfiglio's office, the junior resident on the Colpo Service should have reviewed the workup and management of cases for the week at a mutually agreed upon time with the senior resident. The designated resident, time permitting, can arrange a time to review with one of the Path Faculty or perhaps Chief Resident in Path the selected/scheduled cases. It would be ideal for a member of Path (Faculty or Resident) to be available for the 1/2 hour of Correlation Clinic, but given the time restrictions, attendance may not be absolutely necessary assuming a review can be done by the designated gyn resident before the day of clinic. A 30-minute Lecture Module will follow the Correlation Clinic and will take place in the AC-5 conference room. Topics will cover basic science, surgical pathology, the clinical perspectives of colposcopy, and therapeutic aspects. The schedule will follow the sequence below:
The Colposcopy/Vulvovaginal Disease Clinic portion of the experience will be run by the designated gyn resident(s), the nurse-in-charge, and attended by DC Foster or a designated faculty attending in his absence. Medical students (when present) should be actively involved in the colposcopy visit. Other Issues for Discussion
Assigned Colposcopy ArticlesThe 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology (PDF) 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities (PDF) 2001 Consensus Guidelines for the Management of Women with Cervical Intraepithelial Neoplasia (PDF)
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