In 2016, the Government of India launched a national program for screening and prevention of oral, breast, and cervical cancer. In support, the National Institute for Cancer Prevention Research (NICPR) adopted the Project ECHO (Extension for Community Healthcare Outcomes) model for training health care providers in cancer screening. We assess change in knowledge and skills among physicians attending hybrid (i.e., online and in person) NICPR-ECHO trainings and impact on implementation of cancer screening services. Prior to the start of the online phase and upon completion of 14 weeks, trainees answered a 23-item online questionnaire, including visual vignettes. We conducted descriptive and bivariate analysis of prepost assessments from trainees participating in the online phase and wherever available report on the weekly quizzes and the hands-on workshop assessments. A total of 641 medical officers participated in the trainings from May 2019 to February 2020. Across nine cohorts of trainees, only 116 primary care physicians completed both the pre-and post-assessments. Almost two-thirds completed medical training (69.7%) and 85% were working in government healthcare facilities. Trainees reported statistically significant improvements before and after the online phase, when queried specifically on knowledge and skills using visual vignettes about oral (p < 0.001), breast (p = 0.35), and cervical cancer screening (p < 0.001). Study findings support the effectiveness of Project ECHO in reaching primary care physicians across the country and improving their knowledge and skills related to screening for breast, oral, and cervical cancer, with additional support needed for implementation of clinical cancer screening services.

BackgroundIn an effort to address the growing cancer burden, the Government of India introduced a national program for screening and prevention of the most common cancers (oral, breast, and cervical) in 2016. To support the screening program, the National Institute for Cancer Prevention Research (NICPR) adopted the Project ECHO (Extension for Community Healthcare Outcomes) model for training health care providers in cancer screening. Very few studies examine the impact of the ECHO model on provider behavior or health outcomes related to cancer screening. We assess the change in knowledge and, skills among primary care physicians attending NICPR ECHO trainings and the impact of the training program on the implementation of cancer screening services.MethodsPrior to the start of the online phase and upon completion of the 14 weeks, trainees answered a 23-item questionnaire (administered online via SurveyMonkey). We conducted a descriptive and bivariate analysis of the pre-post assessments conducted on trainees participating in the online phase and where available report on the weekly quizzes and the hands-on workshop assessments.ResultsSix hundred forty-one medical officers have participated in the trainings, across nine cohorts of trainees and this study presents data from 116 primary care physicians that completed both the pre- and post-assessments, trained from May 2019 to February 2020. Almost two-thirds had completed medical training (MD equivalent) (69.7%) and 85% were working in government healthcare facilities. Trainees reported statistically significant improvements before and after the online phase, when queried specifically on knowledge and skills using visual vignettes about oral and cervical cancer screening. Trainees did not report significant changes in the provision of cancer-screening services after completing the program. ConclusionsStudy findings support the effectiveness of the training program in reaching primary care physicians across the country and improving their knowledge and skills related to screening for breast, oral, and cervical cancer. After the training, very few primary care physicians mentioned implementing cancer screening services highlighting barriers that require further study and development of complementary implementation strategies. Study findings could inform the development and refinement of training for cancer-screening programs in low- and middle-income countries.