International collaboration

Collaboration with the International Cervical Cancer Prevention Association, the UK Royal College of Pathologists and the British Association for Cytopathology to strengthen cervical cytopathology and gynaecological histopathology services in the Republic of Moldova

The Department of Pathology has an ongoing collaboration with the International Cervical Cancer Prevention Association (ICCPA), the UK Royal College of Pathologists (RCPath) and the British Association for Cytopathology to strengthen cytopathology and histopathology services in the Republic of Moldova (RM).

 This collaboration commenced at the beginning of 2016 with discussions between the Department of Pathology, the ICCPA and the RCPath about Moldova – UK training exchanges and these discussions led to the RCPath undertaking an initial assessment visit to the Republic of Moldova (RM). For this assessment, Dr Charles van Heyningen, RCPath International Regional Advisor for Europe and Dr Mike Coutts, Consultant Gynaecological Pathologist at the West Kent Gynaecological Oncology Centre, Maidstone and Tunbridge Wells NHS Trust Hospital visited RM in June 2016 to get a better understanding of RM’s training requirements. This assessment was followed by a gynaecological pathology training exchange in which 2 Moldovan pathologists, Drs Ecaterina Foca and Tatiana Fortuna went to the UK from 15 September to 15 December for a three-month placement with Dr Coutts. Then, the knowledge and skills acquired during the training exchange were reinforced by having regular telepathology case reviews in which Dr Foca would discuss her more difficult cases with Dr Coutts. More recently, Dr Foca and Dr Coutts organised a 2-day gynaecological pathology training workshop for 15 Moldovan pathologists on 13-14 June 2017 in Chisinau.

In parallel with the actions listed above, the Department of Pathology, the ICCPA and the British Association for Cytopathology (BAC) organised a collaboration with Dr Mary Brett, Consultant Cellular Pathologist at Southmead Hospital, North Bristol NHS Trust and Mr Hedley Glencross, Advanced Specialist Biomedical Scientist at the Queen Alexandra Hospital in Portsmouth and Executive Committee Member, British Association for Cytopathology. As part of this collaboration, Dr Brett conducted a short preliminary visit to Chisinau in March 2017, where she visited 3 cervical cytology screening laboratories at the Republican Diagnostic Centre, the Institute of Mother and Child and the AMT Centru. Subsequently, in partnership with the RCPath, Dr Mike Coutts and Mr Glencross came to RM for a week in June 2017 to conduct a more detailed analysis of cervical cytology and gynae pathology laboratories in Chisinau (the Institute of Oncology, the Republican Diagnostic Centre, the Republican Hospital, the Municipal Hospital No.1 and AMT Centru) as well as the regional hospitals in Balti and Cahul. In addition, both Dr Brett and Mr Glencross have been very actively supporting the National Society of Pathology in Moldova to prepare the Cervical Cytology (Pap Test) Screening Laboratory Specification for the Republic of Moldova and the Cervical Cytology (Pap Test) Management Recommendations for the Republic of Moldova.

Finally, the Department of Pathology, the ICCPA and Dr Brett have worked with EuroCytology to adapt and translate their online cervical cytology course (http://www.eurocytology.eu/en/course/3) for use in RM and that will provide an introduction to the theoretical aspects of cervical cytology screening. The Romanian version is expected to be available from mid-September 2017. In addition, Dr Brett is preparing the curriculum for a complementary hands-on workshop that will provide an introduction to the practical aspects of cervical cytology screening.

Taken together, these ongoing collaborations have been exceedingly useful in strengthening the cervical cytopathology and gynaecological pathology services in RM and the Department of Pathology is extremely grateful to Dr Michael Coutts, Dr Mary Brett and Mr Hedley Glencross for their time and expertise, as well as all their colleagues at the RCPath and BAC. Their generosity will help to improve the health of many Moldovan women.

International - Moldova (2016) 2

Building a gynaecological cytopathology capacity in the Republic of Moldova (RM) to support the introduction of an organised cervical screening programme.

A substantial amount of work has already been done within the context of a large international partnership that includes the RM State University of Medicine and Pharmacy (USMF), Society of Pathology in Moldova, International Cervical Cancer Prevention Association (ICCPA), UK Royal College of Pathologists (RCPath), British Association for Cytopathology (BAC), UK Institute of Biomedical Science and the Italian Society of Pathology and Cytopathology to strengthen gynaecological cytopathology and cytoscreening expertise in RM and to create the permanent training programmes within the USMF Department of Pathology that are required to sustain this expertise into the future.

Starting in September 2016, Dr Ruslan Pretula from the USMF Department of Pathology has been pursuing a 2-year training programme in gynaecological cytopathology and cytoscreening so that he can gain the knowledge and skills required to be a national expert trainer and then run the USMF cytology training programmes that will be launched in the autumn of 2018.

As part of this programme, Dr Pretula has already:

1)      Completed a 1-month training exchange in Papanicolaou stained cervical cytology with Prof M.R. Giovagnoli at the Universitatea La Sapienza, Roma, Italia. (September 2016)

2)      Completed another 1-month training exchange in Papanicolaou stained cervical cytology with Prof M. Galatir and Prof R. Pais at the Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania. (March 2017)

3)      Worked with Dr Mary Brett (Consultant Cellular Pathologist at Southmead Hospital, North Bristol NHS Trust in Bristol, UK) and Mr Hedley Glencross (Advanced Specialist Biomedical Scientist at the Queen Alexandra Hospital in Portsmouth, UK and Member of the Executive Committee of the British Association for Cytopathology) to:

a)      Plan curricula for the following USMF programmes:

i)        Gynaecological cytopathology CME.

ii)       Gynaecological cytopathology module within the pathology residency programme.

iii)     Cervical cytoscreening CME.

iv)     Cervical screening basic training.

b)      Adapt and translate the EuroCytology evidence-based gynaecological cytopathology online course so it can be used as the theoretical introduction for all 4 programmes.

Currently, Dr Pretula is undertaking a 2-month training exchange in the UK with Dr Brett and Mr Glencross to:

1)      Further strengthen his skills in gynaecological cytology and prepare him to take the RCPath Certificate of Higher Cervical Cytology Training in the autumn of 2018.

2)      He is participating in a four-week training course run by the South West Regional Cytology Training Centre in Bristol to learn how the UK Cytoscreener Training Programme is run so that he can use this as a model for the USMF cytoscreener training course.

3)      Work with Dr Brett and Mr Glencross to finalise the USMF gynaecological cytopathology and cytoscreening training curricula.

4)      Prepare the teaching materials that are required for the USMF cytology courses, including teaching slide sets that will be prepared from the 3,000+ Pap tests that have been collected by Dr Brett and Mr Glencross over the past 6 months.

5)      Learn about the structure and operation of cervical cytology laboratory quality assurance programmes.

When this current training exchange is finished in March 2018, Dr Pretula will return to RM but continue to work with Dr Brett and Mr Glencross to run the USMF gynaecological cytopathology and cytoscreening CME training workshop pilots so that:

1)      The structure and curricula for the workshops can be reviewed and refined.

2)      Dr Pretula can learn from Dr Brett and Mr Glencross about teaching cytopathology and cytoscreening and be better prepared to deliver these programmes in the future.

Finally, Dr Pretula will go back to the UK for a further month of cytopathology training in September 2018 and then take the examination for the RCPath Certificate of Higher Cervical Cytology Training.

7