Course Instruction

The Virtual High Resolution Anoscopy Course will be open March 1 through November 30, 2022. This will be a self-paced course with pre-recorded thematic modules that can be completed at any time during the 4-month period the course is open.

In addition to the recorded modules, a live Q&A session with faculty members will be scheduled towards the end of the 4-month period.  Questions can be submitted at any time during the course for discussion during the Q&A session. You can submit questions to the HRA Q&A Forum.  A recording of the live Q&A will be available for those who cannot attend live.

For instructions on the course, click LMS Instructions. Once you have registered you can enter the course by clicking on the button below.  Login to the course using your IANS user name and password.

Virtual HRA Course

    Virtual Standard HRA Course Program

      Module 1 

      HPV Background (Epidemiology, Pathogenesis and Anatomy)


      • Apply knowledge of lower genital HPV infection, including natural history, to the anal canal
      • Describe anal canal and perianal anatomy
      • Define and identify histopathological and cytopathological features of anal squamous intraepithelial lesions and anal cancer

      1.    Introduction to HPV: General Epidemiology - 28 mins

      2.    Epidemiology of Anal Cancer and Squamous Intraepithelial Lesions (SIL) – 25 mins

      3.    Anal Anatomy – 13 mins

      4.    Pathology 1: Anal Squamous Intraepithelial Lesions and Cancer – 30 mins

      5.    Pathology 2: Interpretation of Anal Cytology – 25 mins

        Total time: approximately 2 hours

        Module 2

        Introduction to HRA and Related Procedures


        • Understand and define terminology related to HRA
        • Interpret the normal features encountered during HRA with respect to the transformation zone and anal/perianal anatomy
        • Learn the steps of performing an HRA exam and related procedures

        1.    HRA Terminology – 26 mins

        2.    HRA: Features of the Normal Anal Transformation Zone – 21 mins

        3.    HRA Procedures/Skills – 45 mins

        4.    Putting it together: HRA Video – 25 mins 

        Total time: approximately 2 hours

          Module 3

          HRA Pattern Recognition


          • Identify and differentiate Low-grade (L)SIL and High-grade (H)SIL within the anal canal and perianus
          • Recognize features of invasive disease

          1.    HRA: Identification of LSIL – 20 mins

          2.    HRA: Identification of HSIL – 26 mins 

          3.    HRA: Identification of Perianal Lesions – 28 mins

          4.    HRA: Identification of Cancer – 33 mins

          5.    Tips to improving HRA skills – 31 mins 

          Total time: approximately 2.2 hours

          Module 4

          Treatment of ASIL


          • Summarize current treatment options for Anal SIL including topical, ablative and excisional methods
          • Describe their mode of action, benefits and complications 
          • Requirements for anesthesia associated with different treatment modalities

          1.    Principles of Treatment – 30 mins

          2.    Topical Therapies – 30 mins 

          3.    Ablative Therapies 1: Background - 30 mins

          4.    Ablative Therapies 2: Technique – 49 mins

          5.    Anesthesia for Procedures – 11 mins

          Total time: approximately 2.5 hours

          Module 5

          Screening for HPV-associated Lesions


          • Summarize the key principles of screening
          • Recognize how current screening criteria are used in anal cancer screening and anal cancer precursor screening 
          • Identify high-risk groups appropriate for screening

          1.    The WHO Screening Criteria – 34 mins

          2.    Screening for prevention of anal cancer: where do we stand today? - 31 mins

          3.    Tools for anal cancer screening – 32 mins

          4.     Screening guidelines – 21 mins 

          Total time: approximately 2 hours

            Module 6

            Management of Anal Cancer


            • Describe the standard of care for treatment of invasive anal cancer
            • Recognize the indications for and risks of conservative treatment for early anal cancer
            • Understand the management for recurrent anal cancer
            • Define the role of HRA following treatment of anal cancer

            1.    Anal Cancer Treatment - 31 mins 

            2.    HRA following Cancer – 14 mins 

            Total time: approximately 45 mins

              Module 7

              Management and Counseling


              • Outline appropriate management for anal SIL including treatment in the operating room, and follow-up post-treatment
              • Understanding the impact of anal neoplasia on patients

              1.    Treatment Triage: Cases – 45 mins

              2.    HRA in the Operating Room: Two Perspectives – 34 mins

              3.    Messaging: Counseling the Patient with HPV-associated Disease – 28 mins

              4.    The Patient’s Perspective – 32 mins

              Total time: approximately 2.3 hours

                Module 8

                Practicalities for Establishing an HRA Practice


                • Define components of an HRA practice 
                • Recognize practice metrics, practice standards and international guidelines
                • Learn how to Incorporate research prevention into HRA clinical practice 
                • Describe the indications for HPV vaccination

                1.    Essential Equipment for HRA – 21 mins

                2.    Documentation for HRA – 22 mins

                3.    Guidelines for Creating a New HRA Practice – 20 mins

                4.    HRA Practice Metrics – 28 mins

                5.    Incorporating research into clinical practice – 11 mins

                6.    HPV Vaccination for prevention – 23 min

                Total time: approximately 2 hours

                  Module 9

                  Anal Neoplasia in Context

                  To receive full CMEs please choose a minimum of 3 topics (subjects noted as optional do not count towards CMEs)


                  • Expand knowledge to that of other specialty areas that overlap with management of lower anogenital tract disorders

                  1.    Non-infectious Disease of the Anus and Perianus – 39 mins

                  2.    Vulvar Disease – 31 mins

                  3.    Sexually Transmitted Infections, Testing and Treatment – 39 mins

                  4.    Diseases of the Colon and Rectum – 30 mins

                  5.    Dermatologic conditions – 26 mins

                  6.    Coding and Billing (US based providers) - Optional – 34 mins

                  7.    HRA and Cervical Colposcopy: Differences - Optional – 23 mins


                      Download the printable program

                      The International Anal Neoplasia Society

                      P.O. Box 1543
                      Leesburg, Virginia 20177


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