Reaching the women with the greatest needs: Two models for initiation and scale‐up of gynecologic oncology fellowship trainings in low‐resource settings

Abstract

Women in low‐ and middle‐income countries (LMICs) are significantly more likely to develop and die from invasive cervical cancer, while rates of other gynecologic malignancies are comparable to those faced by women in high‐income countries. Despite this increased need, there are few specialist physicians in LMICs available to treat women with gynecologic cancers. Training specialists in low‐resource settings faces multiple challenges, including ensuring protected time from other clinical demands, access to best practice guidelines, training that is tailored to the specific challenges faced in the trainee's environment, and isolation from other fully trained professionals and securing support services. In addition, training specialists from LMICs in high‐resource settings is costly and return of trainees to their own country is not guaranteed. Here we describe two approaches to gynecologic oncology training in LMICs. The International Gynecologic Cancer Society (IGCS) developed the Global Curriculum Mentorship and Training Program (Global Curriculum) to support gynecologic oncology fellowships in regions of the world that do not currently have formal training in gynecologic oncology. In India, on the other hand, leaders in world‐class gynecologic oncology centers must find a way to meet the training needs of a vast and disparate country.

Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

“…Outcomes included metrics such as number of fellows trained, cases logged during the program, and academic output achieved. Only one study described the accrediting body through which they sought credentialing, 16 while others offered a certificate of completion. 16,27…”

“…25 Challenges in implementation include inadequate diagnostic tools, poor preoperative staging, limited preoperative care, supply chain delays and interruptions, lack of necessary instruments, equipment failure, lack of available blood products, as well as transition to virtual learning and surgical backlog related to COVID. 16,21,24,[28][29][30] Additionally, some of the mentorship programs required a surgeon or community to establish a relationship with a university or organization that could provide access to an individual with subspecialized gynecologic oncology training. 16,21,23,25,27,29,30 The breadth of programs described provides many options for communities seeking to improve their capacity for the surgical management of cervical cancer.…”

“…A total of 11 studies (58%) focused on capacity-building interventions to build surgical capacity for gynecologic oncology. 16,[21][22][23][24][25][26][27][28][29][30] More traditional modes of training included fellowship programs and mentorship programs, such as the International Gynecologic Cancer Society (IGCS) Global Curriculum Mentorship and Training program. 16,27 Training was largely directed toward medical students, resident trainees, and fellows.…”

“…14,15 Although establishing these programs increases capacity for comprehensive treatment of gyneocologic malignancies, it is not growing rapidly enough to meet the current needs for curative surgery. 16 Cervical cancer is one of the most successfully treatable forms of cancer, providing it is detected early and managed effectively. When scaling up surgical capacity, it is also important to note that the complexity of cervical cancer surgery can vary drastically by stage.…”

Gynecologic Oncology at Home: a new opportunity to teach and learn

“…Currently, there is a wide disparity in the training of gynecologic oncologists, especially in low- and middle-income countries, resulting in a deficiency of adequate healthcare for patients with gynecologic cancer 1. Gynecologic oncology in Venezuela is a relatively new specialty which has been provided to obstetrician-gynecologists in a single training center in the country since 2010 for a 3-year period, so currently there are few qualified specialists.…”