Course Instructions

The Virtual High Resolution Anoscopy Course will be open March 1 through November 30, 2024. This will be a self-paced course with pre-recorded thematic modules that can be completed at any time during the period the course is open.

You can submit questions to the HRA Q&A Forum.  Make sure to include the Module numbername of instructor and the title of the lesson in your question.

Once you have registered for the course, the event confirmation will be emailed to you which includes the link to the course and the instructions. 

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 - 30 mins

    2.    Epidemiology of Anal Cancer and Squamous Intraepithelial Lesions (SIL) – 31 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 2.3 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 – 24 mins

        2.    Topical Therapies – 30 mins 

        3.    Ablative Therapies: Technique – 49 mins

        4.    Anesthesia for Procedures – 11 mins

        Total time: approximately 2 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 – 35 mins

        2.    Judging who to screen for prevention of anal cancer: where do we stand today - 39 mins

        3.    Screening tests for anal cancer: Current approaches and future directions – 30 mins

        4.     Screening for anal cancer: IANS Consensus Guidlines – 18 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 – 44 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
              • 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.    HPV Vaccination for prevention – 28 mins

              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 – 24 mins

                4.    Diseases of the Colon and Rectum – 29 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

                8.    Incorporating research into clinical practice - Optional – 11 mins

                    Download Program

                    The International Anal Neoplasia Society

                    P.O. Box 1543
                    Leesburg, Virginia 20177


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