Development of a Curriculum for the Implementation of Stereotactic Radiation Therapy Programs in Middle-Income Countries

Abstract

PURPOSE The aim of this work was to develop a curriculum to be used in the implementation of stereotactic radiation therapy programs in middle-income countries. The curriculum needed to be scalable and flexible to be easily adapted to local situations. METHODS The curriculum was developed through a partnership between multidisciplinary teams from established clinics in both middle-income and high-income countries. The curriculum development followed a nonlinear progression, allowing greater flexibility throughout the process. A blended learning model was used, combining virtual and in-person interactions. RESULTS The initial training plan was based on a needs assessment provided by the learners and on the experience of the facilitators with stereotactic radiotherapy. The needs assessment was refined during in-person site visits at each institution which highlighted aspects of the training, such as image guidance workflows and technical specifications, that were not previously emphasized in the curriculum. Both teams found that the in-person visits were important for training purposes, but aspects of the curriculum delivery such as treatment planning and patient selection were well suited to virtual platforms. The training addressed all aspects of the stereotactic program, from patient selection to treatment, and included a review of both technical and clinical workflows. CONCLUSION The inclusion of contributions from both teams ensured that the curriculum covered the required elements of the stereotactic program implementation, met the needs of the learners, and was relevant to local practices. The nonlinear approach to the curriculum development allowed the flexibility to change the focus as the project progressed. The in-person visits were valuable in conducting a thorough needs assessment.

Pan-Canadian Survey of Radiation Oncology Professional Involvement in Global Oncology Initiatives in Low- and Middle-Income Countries

“…Global oncology is becoming an increasingly common career direction. Recent examples of past international collaborations with Canadian involvement include the following: development of a curriculum for stereotactic radiotherapy programs in middle-income countries, 27 investigation into the geographic availability of radiotherapy in Ghana, 28 investigation into financial toxicity of cancer treatment in LMICs, 29 investigation into choosing wisely in LMICs, 30 and the development of the Global task Force on Radiotherapy for Cancer Control. 31 However, in its nascent state, radiation professional career paths are still not clearly characterized nor easily built.…”

Stereotactic radiotherapy: An educational narrative review

“…A survey from the LMIC region reported only 10% utilization of the SABR modality from their potential case and identified lack of recourse, infrastructure and training as the main limiting factors for adaptation of this modality 7 . This makes it an essential core of learning at the postgraduate residency level in any well‐structured radiation oncology certification program 8,9 . The Accreditation Council for Graduate Medical Education (ACGME) recommends logging 30 cases (10 with SRS and 20 with SABR) to fulfill residency training requirements in radiation oncology 10 .…”

“…7 This makes it an essential core of learning at the postgraduate residency level in any well-structured radiation oncology certification program. 8,9 The Accreditation Council for Graduate Medical Education (ACGME) recommends logging 30 cases (10 with SRS and 20 with SABR) to fulfill residency training requirements in radiation oncology. 10 More recently, the role of SABR in inoperable oligometastases has led to encouraging reports showing a new paradigm in radiation oncology, as reported by the SABR COMET group.…”