Dear Member Societies

It gives me great pleasure to introduce you to the EFC's 1st Newsletter which I hope you will find both informative and interesting.

The Working Group has met on several occasions over the last 2 years and, I think you will agree, have achieved a considerable amount during that time.

The following is a short piece about the history of the formation of the EFC

European Federation for Colposcopy (EFC)

The principle of a European Federation for Colposcopy was conceived in Krakow in 1995. At the time of the IFCPC meeting in Sydney in 1996 the principle of a European Federation was agreed in principle. In 1999 the first all-European meeting for colposcopy was held in Dublin and the representatives of the European Colposcopy Societies agreed that a European Federation for Colposcopy should be founded. At the time of the IFCPC Meeting in Buenos Aries in November 1999 EFC was founded. The Founder President was Joe Jordan (U.K.), the Secretary Renzo Barasso (France) and the Treasurer was to be appointed by the British Society for Colposcopy and Cervical Pathology because BSCCP had given a grant of £10,000 to found the EFC. BSCCP nominated Mrs. Liz Dollery, co-ordinator of BSCCP, to be Treasurer. EFC held its first congress in Rhodes in November 2000.

Objectives of EFC

• Promote the best possible standards of colposcopy in Europe.
• To agree minimum standards for treatment of CIN in Europe.
• To support the International Federation for Cervical Pathology and Colposcopy (IFCPC) in its aims to promote colposcopy worldwide.
• Affiliated Societies and Countries Austria, Belgium, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Israel, Italy, Lithuania, Netherlands, Poland, Portugal, Romania, Spain, Sweden, Switzerland, U.K., Yugoslavia, and Irish Republic.

EFC links with other organisations

• WHO International Network on Control of Gynaecological Cancer - this will allow EFC to support the aim of WHO to reduce deaths from cervical cancer worldwide.
• WHO Collaborating Centre for Research in Human Reproduction - this will allow EFC to work with WHO to reduce deaths from cervical cancer, in particular in Eastern Europe and Central Asia.
• European Cervical Cancer Screening Network - this gives EFC a voice in the European Screening Network.
• IFCPC - EFC is committed to supporting the principles of IFCPC.

The work towards the introduction of minimum standards of training has been undertaken by a multinational task force under the guidance of the President and Dr. Charles Redman (U.K.)

The work of the Training Committee was possible only through a grant from the European Union of 86,000 Euro for the period December 2001-December 2002. The grant has been extended with an award of 96,000 Euro for the period leading up to December 2003.

Joe Jordan
President, EFC

Dr Jordan would like to pass on his thanks to Dr Renzo Barrasso (France) who was involved in the original instigation of the EFC and who, for some time was the Secretary of the organisation. However, unfortunately, dueto unforeseen personal circumstances he had to step down as Secretary.

In Rhodes 2001 Proffessor Jean Ritter agreed to act as Secretary, but again, due to unforeseen reasons, he was unable to take up the position.

In 2002 Professor Thomas Löning of Germany very kindly accepted the duties. Thomas has written a short article about himself

The 'Secretary'

Thomas Löning, born on February 4th, 1950 in North-western Germany in close neigh-bourhood to the Dutch border, passed his High School years in Lingen and Muenster before moving to Southern Germany to study medicine at the University of Freiburg. There, in 1974, he got his medical degree and finished a thesis on vascularization of skin grafts. After a period of two years as "flying doctor" at Jever Air Base in Friesland, he entered the Residency Program at the Institute of Pathology at the University of Hamburg. He finished this training in 1981, and after a board examination and habilitation, became a professor in 1985 and obtained the tenure position as a full professor in 1990. Essential for all these academic steps were re-search activities on tumour markers, which resulted in the development of immunohistochemical techniques and molecular methods for virus detection, especially HPV analysis. Part of this work was done during fellowships in Dermatology and Immunology at the University of Lyon in 1980/1981, and in Molecular Pathology at the University of Iowa in 1984 and 1991. These were supported by the Deutsche Forschungsgemeinschaft, the National Institute of Health, and the Deutsche Krebshilfe. During 1981-1990, together with Hans Stegner, who at that time was one of the leading German gynecologists and gynepathologists, Professor Löning organised training courses for colposcopy, cytology and HPV analysis. Hans Stegner provided the spirit and opened the avenue to specialize in the field of cervical pathology and colposcopy. In 1990, Thomas Löning was elected to head the Institute for Clinical Pathology of the University of Zürich. At the same time he was asked to follow Hans Stegner as Director of the Department of Gynecopathology of the Clinics of Gynecology and Obstetrics and to continue his work at the University of Hamburg, and accepted. In this position, he further developed the outpatient unit for lower genital diseases, and integrated molecular techniques for analysis of HPV-presence and activity and other biomarkers for gynecological tumours in general. At present, Thomas Loening is chairman of the Institute of Pathology at the University of Hamburg. The next challenge will be the organization of the National Congress of Cervical Pathology and Colposcopy which takes place in Hamburg from September 18 - 21, 2003.

T Löning
Secretary, EFC

The Standards of Colposcopy Training Programme

Introduction

One of the aims of the EFC is to promote high quality colposcopy throughout Europe. Adequate training is essential to realise this aim and over the last 2 years the EFC Training Committee has been active in laying down a framework that will promote high quality and uniform training throughout Europe. The principle goal of the Training Committee is for all member societies of the EFC to be able to offer training programmes that share common aims and objectives, and have a similar structure. It is hoped that these programmes will become operational by December 2003.

Any training programme must contain a number of essential components. Firstly, there need to be clear aims and objectives. In addition, a clinical skill such as colposcopy requires a period of supervised clinical experience whereby trainees can learn and practise these skills. This necessarily requires trainers. Assessment is also an important part of training and education to ensure that trainees are proficient in colposcopy at the end of their training.

Aims and Objectives

At the outset it was agreed that the primary aim of the training programme was to produce competent diagnostic colposcopists, because diagnosis is the foundation for clinical management. Despite the fact the colposcopy can be performed in different settings and for different indications throughout Europe, there is, nonetheless, a common set of competencies that are required. It was decided to identify and use these necessary core competencies as the basis for curriculum design. Each identified competence would then act as a learning objective for the programme. In other words, the training programme was more concerned with what a competent trained colposcopist should be able to do rather than producing a list of things they need to know.

During 2001 the Training Committee undertook a consensus exercise in order to identify what these essential core competencies were. This was achieved by using a consultative technique called the Delphi technique, which sought the views of a number of expert colposcopists throughout Europe. In all, 28 participants from 21 countries took part. The list of identified core competencies was presented to the EFC at its scientific meeting in Rhodes in October 2001 and they were accepted as a basis for designing colposcopy-training programmes in each of the member societies.

Programme Structure

Since that time there has been further discussion about the structure of European colposcopy training programmes. Currently there are 4 countries with a colposcopy training programme and these share many common features. It was important to acknowledge the need for flexibility but to recognise the need for certain shared principles. Following a meeting of the Training Committee in Munich in February 2002 it was agreed that each country should identify what criteria are needed for a colposcopist to be able to train. In addition, each society was asked to determine the minimum amount of supervised clinical experience needed for each trainee to complete the training programme and also to describe how assessment will carried out.

Where do we go from here?

In October 2002 an agreed programme of 45 core competencies was accepted.

In addition to laying down the training framework, we need to consider how the training itself can be delivered. In this respect study guides are likely to be very important as these can facilitate communication not only between trainers and trainees, but also between those responsible for the training programme and trainers. They enable all concerned to become familiar with the programme aims and objectives and how they will be achieved.

It is proposed that over the next 12 months a European colposcopy training study guide should be designed to complement clinical training. This study guide will utilise a combined CD/web approach and produce a truly interactive teaching package for colposcopy. The guide will use a problem based learning approach based on the EFC curriculum and this will allow the interactive potential of this approach to be maximised.

C Redman
Chair of the Training Group, EFC

2nd European Congress for Colposcopy and Cervical pathology in Rhodes, Greece

As I expect many of you are aware, our second Congress took place in Rhodes in October 4th - 6th 2001 on the beautiful Greek Island of Rhodes. It was even suggested by a few members of the society that we cancel it in respect for the terrible event of 11th September in New York. However, we decided that we should go ahead and the resulting success of the congress showed that our decision was correct as it turned out to be one of the most scientifically educational and socially enjoyable congresses ever.

The Opening Ceremony took place in the historic Palace of the Grand Master of the Knights of St John, in the medieval Old Town of Rhodes, and was attended by over 600 people. The Opening Address was given by myself, as President of the Congress, and of the Greek Society for Colposcopy, and a most delightful address was given by the President of the EFC, Dr Joe Jordan which was admired by all for its sincere content and virtuosity, being partly in Modern Greek. Professor David Luesley, as Chairman of the Scientific Committee, in his address underlined the importance of the scientific content of the meeting, which was exceptional in its high standard. The Dean of the Athens Medical School also honoured us by opening the Congress. Other speeches were made by the Mayor of Rhodes, the Governor of the Dodecanese Islands and the Chairman of the Rhodian Medical Association. Afterwards a sumptuous buffet was served to the strains of Baroque music. A truly magical evening on a balmy Autumn night.

The Congress was attended by participants from 19 European countries, as well as delegates from as far afield as the USA, Argentina, Singapore, Thailand, Israel, Cyprus and Iran, with the UK providing the largest contingent of 110 overseas participants. There were 25 invited speakers and Chairmen of Scientific Sessions, as well as many exhibitors. The main sponsors were Cytyc & Digene. It was against this background that we discussed the future of the EFC and we addressed the need for shared standards of training for Colposcopy throughout Europe. At the General Meeting it was voted that Joe Jordan would remain as the President of the society and new officers were elected as follows: President Elect, Professor E Diakomanolis (Greece); Secretary, Professor Jean Ritter (France) and Treasurer, Mrs E Dollery. It was also decided that the next congress would take place in Paris, France and that Yugoslavia would be awarded the congress after Paris.

I wish to thank Joe Jordan, David Luesley and the BSCCP for their wonderful support and help in organising and making this Congress such a success, and we look forward to the next one in Paris with pleasurable anticipation.

Emmanuel Diakomanolis
President Elect, EFC

EFC Congress in Paris, 2004

The European Federation of Colposcopy has rapidly evolved between the time of the 1st meeting back in Dublin in 1998, which attracted an enthusiastic group of gynaecologists, pathologists and scientists., up to the present time when we are preparing for the 3rd Congress in Paris in January 2004. The 3rd Scientific Congress, therefore, has an important goal: discussing the place of colposcopy in Europe, the quality of care given to women with an abnormal smear, and the minimum standard of care will be established.

An objective of the meeting should be to start introducing uniformity of standards of training in Europe within the next 10 years.

The Scientific Committee will use the same format as was used at the Rhodes Congress, namely important and knowledgeable speakers will lead each topic, and each session, and half of the session will be for free communications. Topics will be training, screening problems and new concepts, cytological and colposcopical terminology, multifocal disease, and invasive carcinoma.

The EFC has to cope with these fascinating challenges. The participants of the meeting will have so much to share towards the goal of significantly reducing morbidity and mortality from cervical cancer in Europe.

Dr Christine Bergeron, will be the organiser of the EFC Congress, Paris 2004. It is planned to keep the registration fee to a minimum to encourage as many participants, as possible, especially young people, and colleagues from Easter European countries.

Theo Helmerhorst
Training Group, EFC

A report from the Treasurer

For those who have not met me may I introduce myself. I am the Co-ordinator of the British Society for Colposcopy & Cervical Pathology (BSCCP), Treasurer of the European Federation for Colposcopy (EFC) and a member of the EFC Training Committee. I have been very honoured to be involved with the EFC since its formation in 1998 and have corresponded with most of the Member Societies either by post or e-mail at some time or another over the last few years.

I have been in charge of the finances of the Society, which to date has not been a lot of money. After the 1st EFC Scientific Meeting in Dublin, which was organised by the BSCCP, a gift of £10,000 was donated to the EFC. After the 2nd EFC Scientific Meeting in Rhodes in October 2001 the Greek Society very kindly donated a further £5000.

The Federation applied for an EU grant and was awarded the sum of 86,000 euro for the year December 2001 to December 2002. The EFC has to fund a proportion of that sum itself and so the gifts from the British and Greek Societies have been invaluable, together with money donated from other sources. The EU has only this week provided a proportion of the money and the Federation has had to rely on the monies in the original account.

I am happy to be able to report that the Federation has also been awarded a further grant for the year December 2002 to December 2003 of 96,000 euro, and so it will certainly be able to function for another 12 months. We have achieved so much to date and it is wonderful to know that we can continue to do so.

At a recent meeting of the Training Committee it was proposed and agreed that in order to maintain a balance in the Bank, the Federation would levy a fee of 2 euro per person from each member Society which we felt would not weigh too heavily on the smaller and less wealthy Societies. I will, therefore, no doubt be writing to you within the next month or two.

At the present time I hold the database for the EFC and so if you need to make contact with the Officers of the Federation, or to express any views which you wish to be discussed, please do not hesitate to contact either myself or our new Secretary Dr Löning in Hamburg and we will do out best to assist.

I hope you enjoy reading our first Newsletter. We hope to make this a regular feature of the EFC and so, should you wish to make any suggestions for future articles, do let me know.

Liz Dollery
Treasurer, EFC & Training Group, EFC

Contact E-mail addresses:

• Dr J Jordan - j.jordan@tiscali.co.uk
• Prof T Löning - loening@uke.uni-hamburg.de
• Prof S Dexeus - margal@dexeus.com
• Prof EDiakomanolis - gyninst@ath.forthnet.gr
• Mrs Liz Dollery - liz.dollery@bwhct.nhs.uk

Future Meetings

• 2004 - January 23rd and 24th - Paris. Chairman of the Organising Committee - Dr. Christine Bergeron
• 2007 - Serbia. Chairman of the Organising Committee - Dr. Vesna Kesic
• 2010 - to be decided in Paris in January 2004. Nominations for the 2010 meeting should be submitted to the Secretary of EFC prior to that meeting.

Conclusion

Support for the EFC continues to grow and it is interesting to see how committed everyone is to the principle of the EFC being truly a Federation of National Societies, each Society working within it's own country, under the overall umbrella of the Federation. Having witnessed how colposcopy is developing on a worldwide basis it seems to the Executive Committee of EFC that the Federation must continue to support the IFCPC, but at the same time recognise that Europe has its own priorities which can best and most quickly be identified and fulfilled by working together as Europeans.

Mr Joe Jordan
President of the EFC

Published Abstracts

"L'Appredimento della colposcopia: Il sistema European"
CWE Redman
Giornale Italiano di Obstetricia & Ginecologica 2002, 24, 56-61

"Development of a curriculum for colposcopy"
CWE Redman, E Dollery, J Jordan
Proceedings of the British Society for Colposcopy & Cervical Pathology, 2002

"A Survey of European Colposcopy"
CWE Redman, R Todd, E Dollery, JA Jordan
11th World Congress of Cervical Pathology & Colposcopy, 2002

"Training in Colposcopy: a European Approach"
CWE Redman
European Academy of Gynaecological Oncology Textbook (Ed. P Bozse) in press

(December 2002)