Cervical screening: guidance for the training of cervical

sample takers
Personal training record: examples of forms and templates

All novice sample takers must have a personal training record and present this as either a
portfolio of evidence or workbook. The training organisation provides the required
documentation and template format (this can be hard copy or digital).

As a minimum, the training record must include evidence of the trainee’s:

 attendance at the initial theoretical training course

 visit to a cervical screening laboratory as part of the above (logistics permitting –
record date attended and signature of host); a virtual tour is acceptable where this is
part of the theory course and supplemented by information from the local cervical
screening laboratory
 visit to a colposcopy unit - record date attended, duration of clinic(s) and signature of
host
 interim assessment
 clinical practice (observed, supervised and unsupervised)
 results review and audit
 final evaluation and clinical assessment

The training record must also include:

 the learning plan

 records of professional discussion
 performance evidence record
 records of reflective learning accounts
 record of update training

Learning plan

The training record should begin with a learning plan. We recommend that the training
provider, mentor, trainee and their employer agree a learning plan at the outset of training
and document what learning activity needs to take place to support individuals through their
full training programme.

The learning plan should be a prospective account (journal) of all planned learning activity
including assessment, review and feedback (including action plans and follow up). Clearly

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 Training record example forms

record key dates and signatures as they form part of the audit trail. Learning activity should
fulfil or consolidate all training requirements.

Professional discussion

This is a planned activity. The mentor and trainee prepare for a specific learning activity and
record details of discussion. Document the questions asked and trainee responses.

Performance evidence record

This is a record of any learning activity observed, witnessed or for which a reflective or self-
account has been produced. Include names and job role of anyone else who may be
involved in the activity.

Reflective learning accounts

The trainee should regularly reflect on their learning activity and clinical practice. Reflective
or self-accounts must be documented (these are part of the training record).

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 Training record example forms

Summary of training
Name

Current role within practice

Sample taker trainee ID (pin

or code number)

Training provider
organisation

Training provider course co-

ordinator (name)

Cervical screening mentor

Cervical screening assessor

Initial sample taker training (theory)

Date(s) attended

Training course co-ordinator

signature

Visit to cervical screening laboratory *

Location and date attended
(* where logistics permit)

Name and signature of host

(cytologist in charge)

Visit to colposcopy unit

Location and date attended

Name and signature of host

(colposcopist in charge)

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Interim assessment
(Performance evidence record)

Use this form to record details of the interim assessment. Read in conjunction with the
interim assessment guide. Record the number of each cervix image selected. The mentor
asks specific questions relating to this activity – record these and the trainee responses (this
can be a bulleted list).

Trainee’s name _________________________________________________

Mentor’s name ________________________________________________

Date of activity __________________________________________________

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Mentor comments (formative feedback)

Action plan and follow up

Assessment outcome - delete as applicable:

(1) The trainee has satisfactorily completed the interim assessment and is ready to
commence their unsupervised clinical practice.

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(2) The trainee is not yet ready to commence their unsupervised clinical practice (see action
plan above).

Signature of Mentor_________________________ Date______________________

Signature of trainee_________________________ Date______________________

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Record of practical training

(Complete 1 form for each sample taken)

Trainee name

Sample number Sample date

Trainee role Observed  Supervised  Unsupervised 

Client details
Name

NHS number Age

Date of last test Date of LMP

Screening history

Reason for this test Routine call  Routine recall  Previous

abnormal 

Opportunistic  Follow up after Previous

treatment  inadequate 

hrHPV positive Other 

surveillance 
Taking the sample
Appearance of cervix

Any unusual vaginal

discharge

Sampler used

Transformation zone Yes/No SCJ seen? Yes/No

seen?

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Reflection on the practical training session

Trainee’s comments

Mentor’s comments
(for directly
supervised samples
only)

Test result
Date result received

hrHPV result code

Cytology result code

Follow-up action Routine recall  Early recall  Referral for

colposcopy 
Other 
Comments

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Record of practical training continued

Review of initial 20 consecutive samples

Date Age Patient id code Result TZ seen by

sample taker
Y/N

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Name of trainee: ____________________________________________________

Continuous self-evaluation audit of 20 consecutive samples
Comments/
Date Age Code Results
reflections

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Final clinical assessment

(Performance evidence record)

Welcoming the individual

Appropriate environment for sample taking 
Giving information and answering questions in relation
to cervical screening and HPV 
Checking of screening request details 
Taking a history 

Visualising the cervix

Positioning the individual 
Choice of speculum 
Inserting the speculum 
Assessing the cervix 

Taking the sample

Sampling the cervix 
Transferring to LBC vial 
Removing the speculum 

Ending the consultation

Explaining how and when results are received and what they mean 
Completing the Request Form 
Completing the individual’s records 

Infection control and disposal of waste 

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Trainee comments

Signature of trainee_______________________ Date________________________

Assessor comments (formative feedback)

This trainee has demonstrated competence and satisfactorily completed assessment:

Name and signature of assessor _______________________________________

Date________________________

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Completion of training

I confirm that all the records within this portfolio or workbook are authentic and my own.

Name and signature of

trainee sample taker

Date

This is to confirm that the above named trainee has satisfactorily completed training in
accordance with national guidance and is competent in taking samples for cervical cytology.

Name and signature of

mentor

Date

Name and signature of

assessor

Date

This is to verify the above named trainee has satisfactorily completed training in accordance
with national guidance. They meet the minimum theoretical knowledge requirements, are
competent in taking samples for cervical screening and are now eligible to request their
sample taker id (pin or code number) is updated.

Name and signature of

training provider

Date

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Update training

Name of sample taker

Current role

Number of rejected
samples (rate)

Date eLearning module

accessed and completed

Complete the following if update attended was a classroom style course

Name and contact details
of training provider

Topics covered (attach a

copy of the programme)

Date attended

Signature of trainer /
course co-ordinator

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