The Royal Australian and New Zealand College of Obstetrician and Gynaecologists (RANZCOG) announced last week its intention to postpone the Colposcopy Quality Improvement (C-QuIP) Recertification.
Introduced 3 years ago it aimed to close a gap in the audit of cervical cancer screening. While pathologists who sign off on cervical cytology reports are subject to audit, the RANZCOG has made only minimal progress towards the audit of its accredited specialists or trainees who provide colposcopy services to Australian and New Zealand women.
Clinical audit is still recommended and heavily incentivised but not enforced by RANZCOG, the organisation renewing the license to practise of almost 2,000 specialist Obstetricians and Gynaecologists every year.
By COB today, approximately 2000 O&G specialists should have submitted their C-QuIP accreditation documents but apparently only a minority (~220 colleagues) actually have done so.
What has held O&G specialists back from submitting their accreditation documents to RANZCOG?
- Some colleagues were unable to reach the minimum number of 75 colposcopies required for the 3-year audit cycle. These may be colleagues with special interests. For example, as a gynaecological oncologist, I see patients with abnormal cervical cytology but I never considered management of woman with abnormal smears are the cornerstone of my practice. How about colleagues in remote or rural settings who may cover a geographical area but the incidence of abnormal cervical cytology findings in this area is simply not high enough? How about colleagues who are starting their practice and whose practice is not in “full swing” as yet?
- The effort of data entry: Again, other O&G colleagues specialise in colposcopy and the additional data entry effort is considerable. If one sees 10 new patients for a colposcopy per week (working an average of 42 weeks), it comes to more than 1200 colposcopies in the 3-year cycle. I have a dedicated person who enters all my surgical data into SurgicalPerformance. Even though I only had a few colposcopies to document, the biggest challenge that remained was to follow-up on my patients, entering the pathology from a LLETZ, the 12 –month follow up cytology, HPV test or colposcopy. SurgicalPerformance allowed me to enjoy a payoff, which is to see the outcomes of my hard work and I enjoy benchmarking myself against peers.
- I also heard from colleagues that the paper submission process of C-QuIP is unacceptably cumbersome. In SurgicalPerformance, I was given the option of a purpose built report for RANZCOG that I only needed to print and submit.
One of the issues professional standards bodies will have to come clean on is how they propose to manage outliers. In the C-QuIP case, no such information was offered.
For the Australian C-QuIP example, there may not be any consequences for failing the RANZCOG audit requirements. A letter disseminated to Australian Gynaecological Oncologists earlier this month suggests that certified or non-certified O&G specialists will be able to continue offering colposcopy to patients, remuneration will be the same and access to Medicare will continue unchanged.
Nevertheless, it would be interesting to hear from the RANZCOG whether colleagues who fail to do a minimum of 25 colposcopies per annum will be forced to discontinue providing colposcopy.
Some colleagues mentioned concerns that failing the accreditation may mean the loss of privileges, remuneration or accreditation. By contrast, they would appreciate if professional standards bodies would develop incentives for O&G colleagues to engage in audit. In addition, RANZCOG could develop innovative plans how to engage with their (paying) members to create a better future for both, doctors and patients.
Undisputedly, colposcopy has improved the management of women with abnormal PAP smears significantly and needs to remain available across Australia regardless.
Professional standards bodies like RANZCOG may consider engaging with stakeholders (including those with a wealth of audit experience) to develop programs that seek engagement and offer the carrot rather than the stick.