Didactic Sessions
The provider should have gained a working knowledge of basic and clinical science of anal cancer screening, all aspects of the procedures used for screening and management of anal dysplasia and HPV-related anal disease by completing the International Anal Neoplasia Society(IANS) Standard Virtual HRA Course. Didactic sessions will be conducted through presentations, multimedia materials, visual aids, case studies and interactive discussions to enhance learning and understanding in the practice of HRA and HSIL treatment.
Hands-on Training
The provider will have the opportunity to perform real life HRA exams with standardized patient models. The provider will be able to collect specimens including anal cytology, rectal high-risk HPV test and other STI tests. The provider will be able to go through the steps of conducting HRA utilizing the anal speculum, HR anoscope and imaging software. The provider will learn to how to use the imaging software by capturing and reviewing the images, annotating them appropriately, and storing them in the electronic medical record.
Simulation Exercises
Simulations will be used to create realistic learning environments that allow the provider to practice certain procedures in a safe and realistic way. Simulations will utilize a manikin for digital anal rectal exam (DARE). DARE will be taught and instruction on palpating anal lesions and masses will be provided. An anal model will be used to gain knowledge on how to use the anal speculum in combination with the HR anoscope so that eye-hand coordination is practiced. Anal biopsies will be obtained with the anal model. Electrocautery and infra-red coagulation will be utilized to practice anal precancer treatment.
Observation and Preceptorship
The provider will have the opportunity to observe experienced HR Anoscopists performing HRA,HSIL treatment, obtain specimens, and communication skills between the preceptor and patient. The provider will observe EMR documentation and appropriate coding and billing procedures. The preceptor will then observe and provide valuable feedback at the provider’s practice as they demonstrate what was learned at the preceptor’s office.
Assessment and Feedback
Assessment and feedback are essential to help the provider improve their procedural skills. The provider will keep HRA and HSIL treatment logs in real time. Log entries will be reviewed and compared to the quality metric standards as published in the International Anal Neoplasia Society article“2016 IANS International Guidelines for Practice Standards in the Detection of Anal Cancer Precursors” and according to the quality metrics standards developed by Anal Dysplasia Consulting International(ADCI). Feedback will be specific, timely, and constructive.
Continuing Education
Opportunities for ongoing education and professional development will be provided. Regular webinars with providers will consist of journal club, case study presentations, and question and answer sessions.
Proficiency Certification
The preceptorship will culminate with the provider becoming proficiency certified in HRA and HSIL treatment. The proficiency certification obtained from ADCI will provide the documentation needed to become certified with the International Anal Neoplasia Society.