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A sustainable model for raising colposcopy expertise in low-to-middle-income countries
  1. Ida Ismail-Pratt1,
  2. Edward John Jr Mayeaux2,
  3. Quang Van Ngo3,
  4. Jieying Lee4 and
  5. Joseph Ng1
  1. 1 Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
  2. 2 Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
  3. 3 Da Nang Center for Disease Control, Vietnam, Da Nang, Vietnam
  4. 4 Keio-NUS CUTE Center, Smart Systems Insitute, National University of Singapore, Singapore
  1. Correspondence to Dr Joseph Ng, OBGyn, Division of Gyn Onc, National University of Singapore, Singapore 119228, Singapore; joseph_ng{at}


Objective The objective of the study was to assess the effectiveness of training low-to-middle-income countries' local healthcare providers using the Train-the-trainers model in basic colposcopy for cervical cancer prevention.

Method This project was designed based on a philosophy known as Train-the-trainers which train proficient colposcopists and a cadre of local trainers who can continue to train and maintain their expertise in a self-sustaining system. The Train-the-trainers workshop is a 1-day program that focuses on three domains; knowledge, communication, and practical skills. Trainer candidates were given pre-course reading assignments and presentation decks. The expert trainers provided feedback on their presentations and tips on communication skills. The practical aspects of the training are supported by proficiency at the Loop Electro-excision procedure simulator and their responses to frequently asked questions.

Results Sixteen physicians from Vietnam attended the Colposcopy Workshop in 2018 and are used as controls. Eleven attended a workshop conducted by trainer candidates who went through the training program outlined above in 2019. A Wilcoxon Signed-ranks test indicated that differences between pre- and post-quizzes' scores were statistically significant in both the 2018 (Z=4.21, P=0.003, r=1.26) and 2019 cohorts (Z=3.558, P<0.001, r=0.89) while Mann–Whitney U test did not detect the difference between the 2018 and 2019 cohorts, U=70.0, P=0.359, r=0.176. The subjective feedback scores from Year 2019 were similar to scores to Year 2018.

Conclusion Our preliminary data did not highlight any differences between lectures delivered by expert trainers and lectures delivered by trainer candidates trained in the program. Train-the- trainers might be a more sustainable model for organically raising expertise to effectively provide cervical cancer screening and prevention in low-to-middle-income countries.

  • cervix uteri

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  • Contributors II-P designed and implemented the program, wrote and revised the current manuscript. EJM, Jr co-designed and implemented the program and also wrote and revised the current manuscript, QN implemented the program in Vietnam and performed data collection and analysis. JL performed data analysis and wrote the current manuscript. JN initiated the program and wrote the current manuscript.

  • Funding This project was supported by the International Gynecologic Cancer Society (IGCS), and American Society for Colposcopy and Cervical Pathology (ASCCP). The authors are supported by the National University Cancer Institute, Singapore (NCIS) and National University of Singapore (NUS).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics exemption was obtained from the National Healthcare Group Domain Specific Review Board Ref: 2020/00246.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request. Please contact the corresponding author.