Effect of Short Training on Vaginal Fluid Microscopy (Wet Mount) Learning Gilbert G.G. Donders, MD, PhD, 1,2,3 Camila Marconi, MSc, 1,4 Gert Bellen, RN, 1 Francesca Donders, MS, 2 and Thirsa Michiels, MS 2 Objective: Is it feasible to learn the basics of wet mount microscopy of vaginal fluid in 10 hours? Materials and Methods: This is a pilot project wherein 6 students with different grades of education were invited for being tested on their ability to read wet mount microscopic slides before and after 10 hours of hands-on training. Microscopy was performed according to a standard protocol (Femicare, Tienen, Belgium). Before and after training, all students had to evaluate a different set of 50 digital slides. Different diagnoses and microscopic patterns had to be scored. J indices were calculated compared with the expert reading. Results: All readers improved their mean scores significantly, espe- cially for the most important types of altered flora (p G .0001). The mean increase in reading concordance (J from 0.64 to 0.75) of 1 student with a solid previous experience with microscopy did not reach statistical significance, but the remaining 5 students all improved their scores from poor performance (all J G 0.20) to moderate (J = 0.53, n = 1) to good (J 9 0.61, n = 4) concordance. Reading quality improved and reached fair to good concordance on all microscopic items studied, except for the detection of parabasal cells and cytolytic flora. Conclusions: Although further improvement is still possible, a short training course of 10 hours enables vast improvement on wet mount microscopy accuracy and results in fair to good concordance of the most important variables of the vaginal flora compared to a reference reader. Key Words: phase contrast microscopy, lactobacillary grades, bacterial vaginosis, aerobic vaginitis, vulvovaginal candidiasis (J Lower Gen Tract Dis 2015;19: 165Y169) T he diagnosis of vaginal infections is quite cumbersome in many medical practices. Often doctors feel annoyed by pa- tients presenting with vulvovaginal complaints, either because they do not feel keen or sufficiently skilled to examine them properly or because of disappointment if the resolution of the condition is still remote despite several trial-and-error treat- ments and recurrences. Even physicians performing proper examinations in an effort to solve these problems may get frustrated because they have to rely on specimens sent to an external laboratory for Gram stain or cultures, necessitating them to start empiric therapies without proper diagnosis. Also, the need to call in the patient again for further treatment ad- justments, and, most important of all, the high likelihood that the results obtained (e.g., a positive culture for enterococci or Escherichia coli) will not contribute much to the therapy that needs to be installed are posing severe constraints on the effi- cient management of these frequent diseases. It was shown that phase-contrast microscopy examination shows optimal accuracy and interobserver agreement rates [1], and a great variety of different abnormalities and flora patterns can be discerned in a much superior way than when pH or an- other point-of-care test were used [2Y11]. Still, fresh vaginal fluid microscopy is not a very popular test in most practices, mainly because of the vague idea that the examination will be time consuming, insufficiently enumerated, or may be too difficult to master. To our knowledge, no one has ever studied the learning curve of fresh vaginal fluid micros- copy before. Therefore, we tested the ability of students with different levels of knowledge, education, and experience to perform microscopy in a standardized manner and studied the influence of a short intense education on their performance. The purpose of this pilot study was to evaluate the efficacy of 10 hours of guided bedside training on the quality of fresh wet mount phase-contrast microscopy to diagnose different subtypes of microbial abnormalities of the vagina by inexperi- enced medical students. METHODS Proposed Strategy of Training From September 2009 to February 2010, 6 candidates without previous knowledge of wet mount microscopy were asked to evaluate a set of 50 images taken from vaginal smears slides through a phase-contrast microscope (Leica MD1000, Wetzlar, Germany) at 400Â magnification. All candidates were students with a sufficient theoretical background of microscopy, microbiology, and the composition of normal and abnormal vaginal flora, but their level of practical experience, including exposure to microscopy of clinical specimens, varied from none (n = 2), some (n = 3), to extensive (n = 1). After a total edu- cation time of 10 hours during a 4-week training period (see below), all candidates evaluated a second set of 50 distinct images. All images were digital pictures taken from wet- mounted slides from Femicare Research Center files and were chosen in a way to contain some examples of the most common abnormalities to be detected on vaginal smears. The results of both readings were compared to the results of an experienced microscopist (G.D.), totaling 7 readers with 100 evaluated im- ages each. Before reading the first set of images, all candidates had a concise explanation from the microscopist about how to fill the forms containing a standardized list of items to be evaluated on the images, as in used in both research and clinical settings at Femicare Research Center (see Table 1). After that, they ana- lyzed all images without pause and had their reading time recorded. All candidates evaluated the images independently without any interference and being alone in a separated room. All candidates analyzed the same set of images. During the J Lower Gen Tract Dis & Volume 19, Number 2, April 2015 165 1 Femicare vzw, Clinical Research for Women, Tienen, Belgium; 2 University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium; 3 Regional Hospital Heilig Hart, Tienen, Belgium; and 4 Department of Pathology, Botucatu Medical School, Sa ˜o Paulo State University, Botucatu, Sa ˜o Paulo, Brazil The authors have declared they have no conflicts of interest. Reprint requests to: Gilbert G.G. Donders, MD, PhD, Femicare Clinical Research for Women, Gasthuismolenstraat 31, 3300 Tienen, Belgium. E-mail: gilbert.donders@femicare.net * 2014, American Society for Colposcopy and Cervical Pathology Copyright © 2015 American Society for Colposcopy and Cervical Pathology. Unauthorized reproduction of this article is prohibited.