Guidance

Education pathway

Updated 14 September 2023

Applies to England

1. Introduction

The NHS England Clinical Professional Group for Cervical Screening Education and Training (CSET) have updated this guidance, first published in December 2016.

The main changes are:

• the introduction of an initial assessment (conducted by the cervical screening mentor) that the trainee must complete satisfactorily before starting their unsupervised clinical practice
• a minimum of 12 hours for the initial training (theory) course, this to include at least 3 hours practical (classroom) training where the sample taker can practise their technique on a pelvic model
• cervical screening laboratories no longer provide feedback to trainee sample takers on their transformation zone (TZ) sampling as this is no longer used as a quality marker in primary human papillomavirus (HPV) screening: all practice sample takers including trainees will continue to receive laboratory feedback on sample acceptance
• the trainee sample taker must take 20 acceptable samples (as determined by national guidance) before undertaking a final clinical assessment

The guidance includes:

• an outline of the training provider and commissioner responsibilities
• an outline of the role of cervical screening mentor and the role of cervical screening assessor

2. Aims of this guidance

Sample quality is one of the fundamental principles for the programme’s success and it is essential to maintain this now that HPV testing is the primary screen. This guidance describes a post registration education pathway for new cervical sample takers in the NHS Cervical Screening Programme (NHS CSP).

The guidance aims to:

• promote high quality, specialist training that is consistent with national policy recommendations and programme requirements
• advise on the training requirements for sample takers in the NHS CSP
• provide clarity on the training provider role and responsibilities
• provide clarity on the cervical screening mentor role and the cervical screening assessor role to promote consistency in training and assessment
• provide a common core of learning for all sample takers to a required minimum standard
• observe the competency framework standard CHS37 ‘Obtaining cervical cytology samples from women’
• promote effective interaction across the care pathway
• highlight the role of audit and its importance in routine practice

This guidance also describes the requirement for update training to support sample takers in meeting their clinical and professional responsibilities for continuing professional development and revalidation.

3. Education pathway

3.1 Eligibility of health professionals to train as sample takers

Cervical sample taking is one element of a complex screening pathway. A cervical screening test is a consultation and clinical examination. A cervical sample taker must have the required level of knowledge and understanding of the cervical screening programme, and clinical skill, to safeguard the individual.

The following UK registered healthcare professionals are eligible to train to undertake the role of cervical sample taker:

• registered nurses
• registered nursing associates*
• registered midwives
• physician associates who are registered on the Physician Associate Managed Voluntary Register (PAMVR)
• registered healthcare professionals working in integrated sexual health (ISH) clinics
• registered paramedics working in primary care**
• General Medical Council (GMC) registered medical doctors licenced to practice in the UK

*Taking cervical samples is a delegated activity and the nursing associate works within the remits of their professional code. The screening provider must consider safety, quality, competency and the treatment of disease, disorder or injury (TDDI) legislation when deploying a nursing associate. When a nursing associate has registered with the Nursing and Midwifery Council (NMC), a registered professional listed under the legislation (registered nurse or GP) will need to supervise their practice. The individual who provides this professional support must be present at the GP practice in order to undertake indirect supervision of the nursing associate when carrying out the procedure.

**Applies to registered paramedics working in primary care where cervical sample taking is relevant to their clinical practice.

Registered nurses, nursing associates, midwives and physician associates must complete a recognised theoretical course followed by a period of supervised training as described in this guidance.

Many registered healthcare professionals working in ISH clinics already have the necessary clinical skill for taking cervical samples. The NHS Public Health Functions Agreement (Service specification no. 25 Cervical Screening) requires healthcare professionals working in ISH services to complete the programme of training described in this guidance and maintain their competencies in the sample taker role.

The NHS CSP recommends as best practice that qualified medical doctors undertake the cervical screening training as described in this guidance to enhance their specialist training.

GMC revalidation requires satisfactory annual appraisal and CPD activities should reflect routine work. An element of cervical screening is essential to fulfil professional obligations for CPD. The NHS CSP provides eLearning modules to support clinicians who take cervical samples.

All UK registered health professionals who take cervical samples and those who are involved in cervical screening training must keep up to date with developments in the programme and their own clinical practice to fulfil their professional obligations for continuing professional development.

For additional guidance and information you can refer to the standards and guidance for healthcare professionals and managers working in the NHS CSP.

3.2 Regulation of training (theory)

Training providers must seek external accreditation for their cervical screening initial training (theory) course as described in this guidance. The requirement for accreditation also applies to update training. Training provision must take place within the period of accreditation.

Accreditation can be provided by a national awarding body, a professional organisation (for example a royal college), a higher education institute or a university which offers this service. Educational content, teaching, assessment and evaluation methods must meet the programme quality standards as outlined in section 4, and those of the accrediting organisation. Accreditation from an external organisation provides a stamp of approval which validates the quality and rigour of training programmes.

3.3 Training providers and their responsibilities

Training providers are responsible for making sure trainee cervical sample takers have access to specialist training. Appropriately qualified and experienced staff must provide the training to the standard described in this guidance.

A training provider can be:

• a training organisation in the public or private sector
• a training department within the public sector
• an individual trainer or federation that operates independently

Training providers must:

• be registered under the Data Protection Act (DPA) with the Information Commissioner’s Office if operating independently
• have employee and public liability insurance (includes vicarious liability)
• have a clear governance structure and quality systems which meet local commissioning, Health Education England (HEE) and Screening Quality Assurance Service (SQAS) requirements
• work with local commissioners to make sure there is sufficient training course provision to the required standard as described in this guidance
• check that sample taker trainees are UK registered healthcare professionals and eligible to train to undertake the role of cervical sample taker
• provide the mechanism to make sure trainee sample takers are registered on the local cervical screening laboratory database
• check that cervical screening mentors and assessors meet the eligibility criteria described in this guidance and are sufficiently prepared to carry out their respective roles
• take full responsibility for the content of their training programmes (including accuracy and relevance of theoretical content and its provision)

Training providers must operate within a quality framework. The key elements of a quality framework are:

• management systems
• physical resources (training environment and equipment)
• staff resources
• training and assessment

Section 4 of this guidance gives checklists for training providers to use when developing their quality frameworks.

3.4 Clinical and professional support for trainees

Trainees must have easy access to an experienced sample taker who is on site at the time they are taking cervical samples during unsupervised practice. This applies to all trainees whether they work on one site or within a federation.

3.5 Cervical screening mentors and assessors

Cervical screening mentors and assessors however termed (sometimes called trainers, supervisors, or external assessors) and who are responsible for supporting novices to complete their practical training must themselves be active sample takers.

NHS cervical screening mentor

The cervical screening mentor (‘mentor’ from this point) supports the trainee through their practical sample taker training and confirms their achievement for progression to the final evaluation and clinical assessment.

The trainee identifies to the training provider an individual who will take on the mentor role in their place of work.

The trainee must notify the training provider of any change in local circumstances that affects or is likely to affect their mentor support.

Mentors must be one of the following, a:

• registered nurse
• registered midwife
• registered physician associate
• GMC registered medical doctor

Mentors must be practising sample takers with at least 12 months continuous experience, having taken at least 50 cervical samples following completion of their own initial training. Mentors must have effective communication skills and ideally hold a relevant mentoring and, or teaching qualification.

The training provider makes sure the mentor understands the role, is sufficiently prepared to carry it out and supported for the duration of the training programme.

Cervical screening assessor

The cervical screening assessor (‘assessor’ from this point) provides an element of externality which is crucial to quality assuring the training and verifying the assessment process. The assessor is responsible for conducting the trainee’s final clinical assessment.

The training provider is responsible for recruiting and inducting individuals to the role of assessor making sure they understand the role, are sufficiently prepared to carry it out and are consistent in their practice.

The assessor is external to the trainee’s place of work. A mentor can take on the role of assessor for a trainee outside their own practice. The assessor must meet the same criteria as described for mentors.

The cervical screening mentor role and the cervical screening assessor roles are completely separate from the NMC ‘academic assessor’, ‘practice supervisor’ and ‘practice assessor’ educational roles.

Maintaining competence in the mentor and or assessor roles

The training organisation provides a forum in which mentors and assessors can discuss any training issues with their peers and participate in standardisation activity to verify their compliance with the national guidance.

The training organisation provides an update (separate from the required 3 yearly update) for assessors and mentors to ensure they remain competent in their respective roles.

Mentors and assessors must undertake a formal cervical screening update at least every 3 years as a practising sample taker (refer to section 3.22 below).

In addition, mentors and assessors must:

• regularly attend and participate in the training provider’s forum(s) to update and maintain competence in their respective roles
• stay updated with any local and or national changes to the cervical screening programme (including equipment and sample preparation)
• show continuing competence in taking cervical samples in accordance to their professional codes of conduct
• meet their professional obligations for continuing professional development (CPD)
• undertake continuous self-evaluation
• audit and reflect on their own rates of inadequate tests and abnormal test results compared with the rates reported by the local cervical screening laboratory - see NHS CSP guidance on sample acceptance

3.6 The training period

The training period for trainee sample takers is a maximum of 9 months from enrolment through to completion.

3.7 The training model

The training programme requirements are:

• directed pre-course reading (approximately 3 hours)
• initial screening (theory) learning
• a visit to a colposcopy clinic
• a visit to a cervical screening laboratory (where logistics permit) or a virtual tour and laboratory presentation (a laboratory presentation must be included in the theoretical course)
• to observe the mentor taking at least 2 cervical samples
• practical training (supervised and unsupervised clinical practice)
• to take at least 5 cervical samples directly supervised by the mentor
• satisfactory completion of the initial assessment before starting unsupervised practice (conducted by the mentor)
• to take 20 acceptable cervical samples without direct supervision and no more than 25 up to the point of final assessment
• a final clinical assessment of a minimum of 3 samples (observed by the assessor)
• submission of the completed training record (verified by the trainee, mentor, assessor and training provider)

Training providers must make sure:

• the trainee is eligible to undertake training
• the mentor and their employer are fully aware of the time commitment for the training (do not underestimate the amount of work and involvement needed to support the trainee)
• a learning plan is agreed with the trainee, their mentor and employer before the trainee attends the theory course
• the trainee visits a colposcopy unit to attend for the duration of a clinic and follow the patient journey (ideally within 3 months of the initial training course)

3.8 Initial training course (theory)

The initial theoretical training course is intensive and we expect trainees to undertake some directed pre-course reading (allow approximately 3 hours for this).

Theoretical training must cover all the competencies outlined in the Skills for Health competency framework and all topic areas set out below and described in this guidance.

The initial training must take place in a classroom setting and include an element of practical sample taking using a teaching pelvic model and range of specula. The training provider must make sure the equipment is available for the duration of the course.

Cervical screening theory: topic areas, learning objectives and teaching checklists

There are 8 topic areas. Please see the guidance on minimum course content accompanying this document.

Topic 1: the NHS CSP
Topic 2: background to cervical screening
Topic 3: organisation of the NHS CSP
Topic 4: equality of access to cervical screening
Topic 5: cervical screening sample requests
Topic 6: understanding the test results
Topic 7: anatomy and physiology of the pelvic organs
Topic 8: practical aspects of taking cervical samples

Trainers must provide sufficient detailed information for each topic area.

Each topic area outlines (where applicable):

• what the trainee should know (minimum theory)
• what the trainee should understand (implies a greater level of learning)
• what trainees are expected to be able to do as a result of a learning process
• teaching checklists (the minimum expected content)
• guidance for trainers (including suggested reading and resources for trainees)
• guidance for mentors on planned learning activity (including suggested topics for professional discussion with the trainee)

Trainers can download a suite of PowerPoint slides to supplement their own course materials.

3.9 Course duration

We recommend a minimum of 12 hours contact time for the initial theoretical course, to include at least 3 hours practical (classroom) training.

3.10 The trainee sample taker pin code

The cervical screening laboratory has oversight of the sample taker database for its locality. The training provider advises the trainee how to obtain a pin or code number.

The trainee’s pin or code number is unique to them and they are wholly accountable for its use. The trainee must use only their own pin code during clinical practice. They must not use someone else’s pin code, share their own pin code or allow other sample takers in the practice to use it (including locum staff for example).

3.11 Practical training

The trainee should be familiar with the consultation and screening process before starting their supervised practice.

People attending the clinic for their cervical screen must consent to the presence of the trainee before the consultation starts. Notify people in advance that the individual who is observing the procedure or taking their sample (as applicable) is:

• a qualified professional
• undergoing specialist training under supervision
• being assessed

3.12 Observing samples taken by the mentor

The trainee observes and documents at least 2 samples taken by their mentor.

3.13 Directly supervised clinical practice

The mentor must directly supervise the trainee taking a minimum of 5 samples in the first practical sessions (the mentor must document this). Both the mentor and trainee must be able to fully view and assess the cervix and full sample taking technique.

If additional training or supervision is required, address these needs before moving on to the initial assessment. Use CHS37 ‘Obtaining cervical cytology samples from women’ to inform additional training needs.

3.14 The initial assessment

Before moving on to unsupervised clinical practice, the trainee must undertake an initial assessment and complete it successfully. This assures the mentor and training provider that the sample taker is confident and safe to proceed with their unsupervised clinical practice.

There is a library of numbered images of cervices for use in the initial assessment. Please refer to section 5 (guide to the initial assessment) which explains how to access and use this resource. It also provides instructions for the mentor on how to conduct and record the interim assessment.

3.15 Unsupervised (indirectly supervised) clinical practice

Once the trainee has satisfactorily completed the initial assessment and the mentor is confident the trainee can proceed safely, the trainee should arrange to take and document 20 samples without direct supervision. Allow at least 30 minutes per appointment to take the sample and complete the paperwork. Easy access to an experienced sample taker is essential throughout this period.

The trainee must maintain regular contact with their mentor to:

• identify and discuss any emerging training issues or problems
• discuss progress towards meeting identified training needs
• review their progress throughout their unsupervised practice
• prepare for the final evaluation session and clinical assessment

The training provider reviews the trainee’s completed portfolio and final clinical assessment report. The training provider checks the portfolio for completeness and accuracy and determines whether the trainee has achieved the required standard of knowledge and understanding.

3.16 Review of the first 20 unsupervised cervical samples

The trainee must review their first 20 unsupervised cervical samples and discuss the results with their mentor.

If the review identifies any rejected samples, including those inadequate for cytology, the trainee writes a reflective learning account and discusses this with the mentor. Both parties must agree an action plan and notify the training provider at the earliest opportunity.

The trainee can take up to 5 additional samples to meet the target of 20 acceptable samples (there must be no further rejected samples) before proceeding to the final assessment.

The trainee must not take more than 25 cervical samples without further reviewing their progress with their mentor.

If the mentor is satisfied that the trainee is competent to proceed once they have taken 20 or 25 acceptable samples, the trainee can complete their final assessment.

If the mentor and trainee identify a problem at 25 samples then the trainee must stop taking samples and notify their training provider, cervical screening laboratory and employer immediately.

All parties must discuss and agree whether or not the trainee should continue with their training. If all parties agree the trainee should not continue with their training, the training provider notifies the local screening and immunisation team of this decision.

3.17 Formal evaluation and final clinical assessment

The trainee and assessor plan and arrange a formal evaluation session which includes a final clinical assessment.

The trainee must provide evidence of having taken and reviewed 20 acceptable cervical samples before proceeding to the final clinical assessment. We advise the trainee to book in at least 5 people for their cervical screening test.

The assessor observes and assesses the trainee taking a minimum of 3 samples.

The assessment will focus on the trainee’s:

• professional conduct
• knowledge and communication skills
• cervical sampling technique
• adherence to infection control measures
• accurate and timely completion of the request form
• reflection and evaluation of own practice

The assessor will stop the assessment immediately if they see the trainee engaging in unsafe or unprofessional practice.

The assessor can engage the trainee in professional discussion on other aspects of practice not necessarily covered during the consultation (once the person having screening has left).

The assessor documents their observations and completes a report on the trainee’s clinical competence to practice.

The trainee submits their completed portfolio to the training provider after the final assessment.

3.18 The sign off process

The training provider reviews the trainee’s completed portfolio and final clinical assessment report. The training provider checks the portfolio for completeness and accuracy and determines whether or not the trainee has achieved the required standard of knowledge and understanding.

The training provider raises any record keeping issues with the trainee if their portfolio is incomplete. The trainee must address these issues before the training provider can validate their training record.

Assessment decisions must be valid and reliable. Following a successful final clinical assessment:

• the assessor confirms the trainee as being competent and proficient in cervical screening clinical practice
• the training provider confirms the trainee has achieved the required level of knowledge and understanding of cervical screening theory
• the training provider confirms the trainee is eligible to request their pin code is updated (to remove ‘trainee’ status)

The training provider should make sure the entire sign off process is documented. Sign off confirms that the trainee is proficient in the competencies outlined in the CHS37 – obtaining cervical cytology samples framework and is capable of safe and effective practice.

If the trainee has not passed the final clinical assessment, the training provider must notify the local cervical screening laboratory of the training outcome at the earliest opportunity.

3.19 Certification

Certificate of attendance

If they wish to, the training provider can issue a certificate of attendance or certificate of learning after a trainee completes the theoretical course. On the certificate, the training provider must make it clear that:

• the recipient of the certificate is a trainee
• the certificate refers to completion of the theory course only
• the certificate does not imply competency to practice
• the certificate does not imply completion of the full training pathway

Certificate of completed training

The training provider issues the trainee with a certificate of completed training and competency to practice upon successful completion of the full training pathway.

3.20 Managing trainee performance

Trainee fails to complete training

The training period is a maximum of 9 months. Trainees who are unable to complete within this time must seek advice from the training provider and request an extension (up to 3 months). The training provider, mentor, trainee and their employer must agree an action plan for completion within this extended timeframe.

If the trainee does not complete by 12 months, they must stop taking samples. The training provider must notify the trainee’s mentor, employer and the local cervical screening laboratory.

The training provider should:

• discuss the reasons for non-completion with the trainee
• establish what support the individual needs to complete their training
• agree an action plan with the trainee, mentor and their employer and timeframe for completion

If the trainee has an extended period of planned or unplanned absence from work part way through their training, the training provider and employer must make reasonable adjustments to enable the individual to complete their training upon returning to work.

Trainee fails to gain competency

If a trainee fails to achieve the required standards of competency at the final clinical assessment, they must stop taking cervical samples. The training provider must notify the trainee’s mentor, employer and the local cervical screening laboratory service.

The number of times a trainee can repeat the training programme is determined locally. However, after any failed attempt to achieve satisfactory competence, the training provider, trainee, mentor, assessor and their employer must consider whether or not continued support is appropriate. The trainee’s employer is responsible for making the final decision.

If supported to continue, the trainee must repeat both the initial and practical training in full. This is necessary to ensure safe practice.

The training provider, trainee, mentor and their employer must agree and document an action plan to address the issues and achieve the required competencies.

3.21 The training record

Training records are a vital part of the learning process. Trainees must have a personal training record and the record must show that:

• all training is complete and documented
• all records are signed and dated where appropriate prior to submission for final assessment

Trainees must retain an intact copy of their training record (paper or digital) for a minimum of 3 years from the date they complete their training.

The training provider must hold a copy of the record for audit purposes for minimum of 3 years from the date the trainee completes their training.

We have provided some examples of recording forms as a guide to what should be included in the portfolio of evidence (or when designing a personal workbook). These forms are to record:

• a summary of training
• completion of training
• interim assessment (performance evidence)
• practical training
• the review of the initial 20 consecutive samples
• the continuous self-evaluation audit of 20 consecutive samples
• the final clinical assessment (performance evidence)
• update training

You can download the suite of example forms accompanying this guidance and adapt them for local use.

3.22 Guidance for trained sample takers on maintaining competence

Maintaining competence

Sample takers must fulfil the competency requirements in accordance with their professional codes of conduct. They should:

• undertake continuous self-evaluation
• review and reflect on any rejected samples, including those inadequate for cytology, and abnormal test results

Required update training for cervical sample takers

Sample takers must undertake a minimum of 3 hours update training every 3 years. The national eLearning resource for sample takers meets the programme requirements for update training (this module equates to approximately 3 hours of learning).

Where face to face update training takes place, it must equate to a minimum of 3 hours of learning and fulfil the requirements of this guidance in addition to any local training requests. Training providers should link to their local screening and immunisation teams for the purposes of local update training.

Update training must cover:

• current developments in the NHS CSP (national and local)
• recent guidance updates relevant to cervical sample taking
• changes to screening policies and procedures (national and local)
• identification of personal learning needs to meet professional obligations for CPD and revalidation
• learning from incidents in the programme (common national and local themes)

To be eligible for the update training, sample takers must have completed their initial training. Then every 3 years they must complete an update as outlined in this guidance. Sample takers can download a certificate once they have completed the eLearning, or if the update was face-to-face they will receive a certificate from the training provider. The sample taker must provide evidence of the update to the cervical screening laboratory that holds the sample taker register for their locality.

3.23 Returning to sample taking after an extended period of absence

Upon returning to practice, the healthcare professional trained in cervical screening (sample taker) should contact the cervical screening laboratory to check the status of their pin or code number and if there has been any subsequent change to the liquid based cytology (LBC) system previously employed. They should then follow the relevant course of action detailed below.

For an absence of 12 months and less than 5 years

The sample taker must:

• complete the cervical screening update eLearning which provides information on the entire programme pathway including failsafe responsibilities and pathway changes
• complete eLearning for health primary HPV screening for sample takers
• take 2 samples and have the consultation and sample taking process peer-reviewed to confirm their competency

For an absence of 5 years or more

The sample taker must:

• complete the cervical screening update eLearning which provides information on the entire programme pathway including failsafe responsibilities and pathway changes
• complete eLearning for health primary HPV screening for sample takers
• take 5 samples and have the consultation and sample taking process peer-reviewed to confirm their competency

An experienced sample taker who meets national standards and fulfils their professional obligations for CPD can undertake peer review. The sample taker’s employer should manage any concerns raised in connection with meeting competency requirements. Sample takers may have to repeat the training if their employer has concerns about their competency to take cervical samples.

4. Checklists for training providers

We have included these checklists to help training providers identify any gaps in their existing processes and supporting documentation, and to develop their quality framework.

4.1 Management systems checklist

Training providers should have a:

• document identifying training activity and describing how it is resourced (training activity plan)
• procedure describing the training administration process
• procedure describing how to maintain IT system(s) in accordance to local and national regulations
• procedure to describe how you support trainees from enrolment through to the completion of their training (sign up to sign-off)
• procedure describing how to manage and report trainee performance in line with local protocol
• procedure describing how to respond to any training issues (action taken and or escalation) as necessary
• procedure describing how to provide feedback to trainees, teaching staff and employers
• procedure describing how to review, approve and update training documents (paper and electronic)
• procedure describing how to store and maintain training records within the management system
• procedure describing how to monitor training content and quality
• procedure describing how to identify and induct cervical screening mentors and assessors to their respective roles
• procedure describing how to collect, evaluate and use feedback from trainees, mentors, assessors (and others) to inform subsequent training courses and future programmes (management review)
• procedure describing how to communicate training outcomes to all relevant stakeholders (for example periodic activity reports, annual reports)

4.2 Physical resources (facilities and equipment) checklist

Training providers should ensure that:

• the training (classroom) facility is appropriate in terms of lighting, heating, ventilation, seating and so on
• the teaching facility is suitable for accommodating the number of course attendees, course format, frequency, and duration
• there are sufficient training resources (pelvic models, cervical sampling equipment and laboratory consumables) available for the trainee cohort (and that they are available for the duration of the course)
• course equipment is functional, safe, checked and maintained to provide training to the standard described in this guidance
• steps are in place to keep the training area free of all distractions for the course duration (including interruptions by people and or electronic devices)
• there is a document displayed in the training room which provides relevant health and safety information
• there is an appropriate confidentiality statement displayed in the training room

4.3 Staff resources checklist

Training providers must clearly define staff roles, responsibilities and authorities. They should make sure that:

• trainers have the appropriate specialist expertise for the sessions they teach on the theoretical course
• there are adequate numbers of assessors for the cohort of trainees
• mentors and assessors have sufficient information to be able to carry out that role to the standard described in the national guidance (induction)

Training providers should have a:

• procedure describing cover arrangements and contingency plans in the event of unexpected absence
• document describing the staff recruitment process (including induction, performance review and appraisal)
• procedure describing how to conduct pre-employment checks (professional registrations and qualifications)
• procedure describing how to check the experience, competencies and continuing professional development (CPD) records of teaching staff, including invited speakers
• procedure describing how contracts or agreements are set up (for example sessional commitments for outsourced training provision)
• document describing the staffing structure (organisation chart)

4.4 Training and assessment checklist

Training provision must adhere to this guidance and meet all competencies outlined in CHS37 ‘Obtaining cervical cytology samples from women’.

Training providers must have systems for assuring the quality, content and safety of training and assessment.

They must develop and evaluate courses using the expertise and experience of all those involved in planning and providing the training.

Courses must cover all the required competencies and the minimum training content described in the guidance.

Training providers must:

• use a range of teaching methods on the initial training (theory) course (for example, lectures, discussion, role play and case studies)
• have a procedure describing how to assess and evaluate trainee participation on the course
• have a document describing the course aims, objectives and learning outcomes (a scheme of work or teaching aid)
• make sure courses enable trainees to connect their learning to their routine practice
• ensure courses observe the relevant Royal College of Nursing (RCN) Principles of Nursing Practice
• ensure courses observe the professional body codes of conduct (GMC, NMC)
• consider anti-discriminatory legislation, diversity, human rights, ethical and medicolegal aspects when planning course content and provision
• consider copyright legislation and accurately credit and cite all resources
• identify and mitigate any operational and reputational risks associated with the training (and record these)

The training provider is responsible for supporting and or providing the initial (theory) training course. This includes:

• inviting guest speakers to provide specialist elements of the theoretical course
• providing an overview of the education pathway at the start of the course
• explaining the importance of developing and maintaining a personal training record (this can be an electronic or hard copy resource)
• providing an overview of the practical training and assessment requirements including:
  • limits on the number of samples to be undertaken at each stage of training
  • where and to whom they submit their completed training record (portfolio) following final assessment
  • what options are available to them if they fail to complete their training in the designated time, or fail to complete their training to the required standard

The training provider is also responsible for making sure the trainee:

• has booked to visit a colposcopy clinic (and produces a reflective account of their visit)
• has booked to visit a cervical screening laboratory where logistics permit; a virtual tour supplemented with up-to-date information provided by the cervical screening laboratory is an acceptable alternative (must be part of the theoretical course)
• knows how to make a complaint in the event they are unhappy about any aspect of their training
• participates in the course evaluation process

Remind trainees to book their colposcopy visit early in their training due to the variation in local availability. Trainees must attend for the duration of a clinic. Record this in the learning plan and factor in protected time for the visit (and any follow up visits where necessary).

Course information for trainees should include:

• marketing and publicity flyers
• a welcome and introductory letter
• contact details of the course co-ordinator and lead trainer
• a course profile (a description of the full training pathway)
• the scheme of work (the course aims, objectives and learning outcomes)
• a course timetable outlining topic areas, and list of guest speakers including a brief resumé for each
• a pre-course reading list
• a description of pre-course learning activity as applicable
• an explicit statement about Intellectual Property Rights (IPR) and copyright (this can be part of the course introduction)
• an explicit statement about patient confidentiality (this can be part of the course introduction and displayed in the training room)

4.5 Adapting theoretical content for delivery on a virtual platform

Training providers who offer blended learning programmes and provide some or all theoretical content on a virtual platform (such as Microsoft Teams) must take account of the following:

• how they invite course participants to attend, and register their attendance
• the maximum group size at any one event
• how many times the event will be repeated (if necessary)

Training providers must provide guidance for course attendees to include:

• pre-course requirements (preparation and reading)
• information and materials to be downloaded for the course
• IT requirements and troubleshooting (browser, sound and camera checks, internet connectivity issues)
• access to the system and joining instructions (practice ‘sign in’)
• advice on ‘virtual etiquette’ (chat function, camera, microphone, limiting distractions)

Where sessions are recorded, training providers must be explicit that participation includes consent to be recorded (refer to local employer policy in this area).

Training providers must be able to:

• adapt course content into shorter sessions if necessary
• adapt learning outcomes and content to revised teaching time frames without compromising training quality
• ensure all participants can ask questions
• check student understanding of course content
• assess student attainment of the required learning outcomes
• evaluate the course post completion

Training providers must make sure that any certificate of attendance issued for the course makes clear that it was a virtual or online event.

5. Guide to the initial assessment

The initial assessment is obligatory. Its purpose is to make sure the trainee is confident and safe to start their unsupervised clinical practice. The initial assessment is not a test, and there are no set criteria for a pass or fail outcome.

NHS England provides a library of numbered images of cervices for use in the interim assessment. To access this library, staff must register on the Health Education England (HEE) eLearning for Health website.

Once registered, click on the module title and follow the instructions.

For the initial assessment, the trainee should be able to:

• apply their knowledge of basic anatomy and physiology to recognise the features of a healthy cervix and identify correctly which images are normal and abnormal
• make an assessment of the appearance of the cervix
• state if they would take a cervical sample, and if so describe how they would do it (using the correct sampling device to demonstrate this)
• identify correctly the type of os seen
• identify correctly the squamo columnar junction (SCJ) and the area known as the transformation zone (TZ)

The trainee should understand:

• common vulval, vaginal and cervical conditions and how to approach these
• how to recognise situations where specialist advice may be required
• when an individual should be referred directly for routine or urgent colposcopy

5.1 Guidance for the mentor

Select a minimum of 5 images from the library to discuss with the trainee. The trainee reviews the case information for each image selected. For each image selected, the trainee discusses the screening needs of that person. The mentor uses the screening history and clinical information provided for each image as trigger points for discussion.

The mentor can prompt the trainee during the discussion. For example, ask the trainee:

• to consider whether they would do anything further in addition to taking the sample
• how they would advise the person if they identify any normal cervical conditions, and what action is required
• whether any specialist advice is needed
• whether they would refer the individual for routine or urgent colposcopy (check their understanding of the follow up pathway)
• to describe what information they would enter on the sample request form

If the trainee does not identify an image correctly as normal or abnormal, gives an incorrect or vague response or offers both correct and inaccurate information in their response, the mentor should select another image for the trainee to review. The trainee and mentor should also revisit any incorrectly answered image, with the mentor providing the correct feedback.

As a guide, the mentor should allow approximately 60 to 90 minutes for the trainee to complete the initial assessment. The trainee and mentor must plan and document their preparation for the assessment.

The mentor must also document the discussion and trainee responses (see the example form provided for this exercise in the training record example forms accompanying this guidance). The trainee writes a reflective learning account of the initial assessment.

The mentor must be satisfied that the trainee is confident and safe to proceed to their unsupervised clinical practice. If the trainee does not complete the exercise satisfactorily within the allocated time, the mentor and trainee should agree and document an action plan to repeat the initial assessment. The mentor should notify the training provider if there is any concern about progress at this stage.

The trainee can print off an (elfH) system-generated certificate after completing the exercise (applies to single or multiple attempts). The certificate is a record for the trainee’s portfolio and does not imply completion of the full training pathway.