EP155 - High-Resolution Anoscopy Training Utilizing Anal Simulation Models And Standardized Model Patients: Results From The ADCI Preceptorship And Practice Management Program

Purpose/Background: The International Anal Neoplasia Society (IANS) and CDC have released anal cancer screening guidelines, highlighting the need for skilled providers in high-resolution anoscopy (HRA) to evaluate and treat HPV-related anal dysplasia. Traditional HRA training relies on clinical practice patient encounters, limiting standardized learning opportunities and creating variability in skill acquisition. The Anal Dysplasia Consulting International (ADCI) Preceptorship and Practice Management Program addresses these limitations through use of customized anal simulation models (CASMs) and standardized model patients (SMPs) designed to enhance training accuracy and provide consistent, repeatable learning experiences for physicians and advanced practice providers.

Methods/Interventions: Two providers completed the first part of the ADCI program incorporating didactic sessions, hands-on training with SMPs, and simulation exercises using a CASM. The program combined prior theoretical knowledge with practical skills training utilizing the anal speculum, HR anoscope, imaging software and telepresence instruction. Following the immersive training week at ADCI, each provider was subsequently proctored during 8 HRA procedures at their medical practice. Providers started tracking detailed quality assurance (QA) metrics of each patient in their 50 patient HRA log. QA metrics were implemented to evaluate ongoing competency including discordant cytology rates, biopsy adequacy, perianal exam patterns, inadequate exam frequency, HSIL detection rates, and mean HSIL biopsy rates across sequential 25-patient cohorts.

Results/Outcomes: Both providers successfully completed the immersive training week at ADCI. Provider 1 demonstrated significant improvement from first to second 25-patient cohort: discordant cytology remained at 0%; inadequate biopsy rate decreased from 8% to 0%; inadequate exam frequency decreased from 8% to 0%; HSIL detection rate increased from 36% to 52%; and mean HSIL biopsy rate improved from 19% to 31%. Perianal biopsy patterns remained consistent at 20% with 4% HSIL yield. Provider 2 showed similar improvements: discordant cytology remained at 0%; inadequate biopsy rate decreased from 8% to 4%; inadequate exam frequency decreased from 24% to 20%; HSIL detection rate increased from 40% to 48%; and mean HSIL biopsy rate improved from 28% to 34%. Perianal examination efficiency improved with biopsy rates decreasing from 12% to 4% while maintaining diagnostic accuracy.

Conclusion/Discussion: The ADCI Preceptorship and Practice Management Program utilizing customized anal simulation models and standardized model patients demonstrates measurable improvements in HRA performance metrics over sequential patient encounters. Both providers achieved excellent concordance rates (0% discordant cytology) and progressive improvements in HSIL detection rates (Provider 1: 36%→52%; Provider 2: 40%→48%) with corresponding increases in targeted biopsy efficiency. The elimination of inadequate examinations in Provider 1 and reduction in Provider 2 demonstrates enhanced technical proficiency following simulation-based training. These objective outcomes validate the effectiveness of structured hands-on training programs incorporating specialized simulation models for HRA education, supporting broader implementation to meet growing clinical demands for anal cancer screening in high-risk populations.