Variations in gynecologic oncology training in low (LIC) and middle income (MIC) countries (LMICs): Common efforts and challenges

Johnston, Carolyn; Ng, Joseph; Manchanda, Ranjit; Tsunoda, Audrey Tieko; Chuang, Linus

doi:10.1016/j.gore.2017.01.003

Cited by 33 publications

(35 citation statements)

References 14 publications

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“…While efforts to establish gynecologic oncology training programs in LMICS are underway, at present they are insufficient in number to meet the current and growing demand. In Africa, for instance, there are only 6 formal gynecologic oncology training programs (South Africa, Ethiopia, Ghana, Kenya, Uganda, and Zambia) ( Johnston et al, 2017 ) and most are in their infancy. While necessary and commendable, the establishment of such programs requires considerable resources, infrastructure, commitment and time to develop and mature.…”

Section: Discussionmentioning

confidence: 99%

“…Our competency-based, intensive surgical oncology training approach can complement ongoing international efforts to expand formal gynecologic oncology training opportunities for physicians practicing in LMICs ( Johnston et al, 2017 ). However, lack of a certification system for those trained under this arrangement can potentially demotivate local physicians from engagement.…”

Section: Discussionmentioning

confidence: 99%

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A tailored approach to building specialized surgical oncology capacity: Early experiences and outcomes in Malawi

Chinula

Hicks

Chiudzu

et al. 2018

Gynecologic Oncology Reports

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ObjectivesCervical cancer can often be cured by surgery alone, if diagnosed and treated early. However, of the cancer patients who live in the world's poorest countries less that 5% have access to safe, effective and timely cancer surgery. We designed a novel, competency-based curriculum to rapidly build surgical capacity for the treatment of cervical cancer. Here we report experiences and early outcomes of its implementation in Malawi.MethodsCurriculum implementation consisted of preoperative evaluation of patients and surgical video review, discussion of surgical instruments and suture material, deconstruction of the surgical procedure into critical subcomponents including trainees walking through the steps of the procedure with the master trainers, high-volume surgical repetition over a short time interval, intra-operative mentoring, post-operative case review, and mental narration. This was preceded by self-directed learning and followed by clinical mentorship through electronic communication and quarterly on-site visits.ResultsBetween June 2015–June 2017, 28 patients underwent radical abdominal hysterectomy with bilateral pelvic lymphadenectomy. The first 8 surgeries were performed over 5 days. After the 7th case the trainee could perform the procedure alone. During and between quarterly mentoring-visits the trainee independently performed the procedure on 20 additional patients. Major surgical complications were rare.ConclusionsLife-saving surgical treatment for cervical cancer is now available for the first time, as a routine clinical service, in Central/Northern, Malawi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A tailored approach to building specialized surgical oncology capacity: Early experiences and outcomes in Malawi

Chinula

Hicks

Chiudzu

et al. 2018

Gynecologic Oncology Reports

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“…Neither surgical nor gynecologic societies can certify professionals who dedicate themselves to gynecologic cancer treatment, hampering gynecologic oncology training in the country. 11 There is no data regarding who are the OB-GYNs involved in women's cancer care in Brazil or those who are more dedicated to gynecologic oncology. Therefore, the present study aims to obtain basic demographic information, the level of interest and of training in gynecologic oncology among OB-GYNs.…”

Section: Descritoresmentioning

confidence: 99%

Interest In and Practices Related to Gynecologic Oncology among Members of the Brazilian Federation of Associations of Gynecology and Obstetrics

Júnior

Carvalho

Derchain

et al. 2019

Rev Bras Ginecol Obstet

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Objective The present study aims to obtain basic demographic information, the level of interest and of training in gynecology oncology among Brazilian obstetricians and gynecologists (OB-GYNs) to create a professional profile. Methods An online questionnaire was sent to 16,008 gynecologists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). We considered gynecologists dedicated to gynecologic oncology (OB-GYNs ONCO) those who self-reported that > 50% of their daily practice consists in working with women's cancer care. Results A total of 1,608 (10%) of 16,008 FEBRASGO members responded. The OB-GYNs are concentrated in the southern and southeastern states of Brazil. Gynecologic oncology was considered the 8th greatest area of interest in gynecology among the OB-GYNs. A total of 95 (5.9%) of the OB-GYNs were considered OB-GYNs ONCO. Obstetricians and gynecologists are actively engaged in cancer care: > 60% of them dedicate up to 25% of their daily practice to oncology. The role of the physicians in screening and prevention, diagnosis, in the treatment of precancerous lesions, and in low complexity surgical procedures is notably high. Gynecologists dedicated to gynecologic oncology in Brazil have a heterogeneous, nonstandardized and short training period in gynecologic oncology. These professionals had a more significantly role in performing medium- and high-complexity operations compared with OB-GYNs (65.2% versus 34%, and 47.3% versus 8.4%, respectively). Conclusion The role of OB-GYNs and of OB-GYNs ONCO appears to be complementary. Obstetricians and gynecologists act more often in screening and prevention and in low-complexity surgical procedures, whereas OB-GYNs ONCO are more involved in highly complex cases. Strategies to raise standards in cancer training and to encourage the recognition of gynecologic oncology as a subspecialty should be adopted in Brazil.

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“…Most structured training programs do not stipulate a minimum number of procedures required for accreditation as a gynecologic oncologist; instead the emphasis is on the overall volume of surgical exposure and some form of assessment process during training. Regions with structured training programs have identified a need for exposure to extended scope surgical procedures . This is largely related to extended cytoreductive procedures in surgical management of ovarian cancer.…”

Section: Training In Gynecologic Oncologymentioning

confidence: 99%

“…Regions with structured training programs have identified a need for exposure to extended scope surgical procedures. 3 This is largely related to extended cytoreductive procedures in surgical management of ovarian cancer. Trainee surveys have identified the inability of some training programs to provide adequate experience in general surgical procedures.…”

Section: Training In Gynecologic Oncologymentioning

confidence: 99%

Essential surgical skills for a gynecologic oncologist

Arora

Somashekhar

2018

Intl J Gynecology & Obste

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Gynecologic oncology has seen a tremendous growth as a surgical specialty over the past four decades. However, many regions of the world still lack structured training programs in this discipline. The aim of this article is to identify the essential skills for a gynecologic oncologist to be able to provide optimal care to women diagnosed with gynecologic cancer. Where the evidence exists in the literature we identify the learning curve necessary. Identifying essential skills required for the practice of gynecologic oncology should assist in standardizing care provision globally, and could be a starting point for health systems beginning structured training programs. Development of surgical skills requires adequate training, mentorship, and self‐evaluation as an ongoing process beyond the years spent in training programs.

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Variations in gynecologic oncology training in low (LIC) and middle income (MIC) countries (LMICs): Common efforts and challenges

Cited by 33 publications

References 14 publications

A tailored approach to building specialized surgical oncology capacity: Early experiences and outcomes in Malawi

A tailored approach to building specialized surgical oncology capacity: Early experiences and outcomes in Malawi

Interest In and Practices Related to Gynecologic Oncology among Members of the Brazilian Federation of Associations of Gynecology and Obstetrics

Essential surgical skills for a gynecologic oncologist

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