Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

Awusi Kavuma; Solomon Kibudde; Matthew Schmidt; Tianyu Zhao; Hiram Gay; Benjamin Li; Jeff Michalski; Geoffrey Hugo; Enkhtsetseg Vanchinbazar; Minjmaa Minjgee; Erdenekhuu Nansalmaa; Fred Ssewamala; Angel Velarde; Vicky De Fella; Milton Ixquiac; Lauren Henke; Jacaranda van Rheenen; Baozhou Sun

doi:10.1016/j.adro.2023.101180

Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

Adv Radiat Oncol. 2023 Jan 16;8(3):101180. doi: 10.1016/j.adro.2023.101180. eCollection 2023 May-Jun.

Authors

Awusi Kavuma¹, Solomon Kibudde¹, Matthew Schmidt², Tianyu Zhao², Hiram Gay², Benjamin Li³, Jeff Michalski², Geoffrey Hugo², Enkhtsetseg Vanchinbazar⁴, Minjmaa Minjgee⁴, Erdenekhuu Nansalmaa⁴, Fred Ssewamala⁵, Angel Velarde⁶, Vicky De Fella⁷, Milton Ixquiac⁷, Lauren Henke⁷, Jacaranda van Rheenen⁸, Baozhou Sun²

Affiliations

¹ Department of Radiation Therapy, Uganda Cancer Institute, Kampala, Uganda.
² Department of Radiation Oncology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
³ Rayos Contra Cancer, Nashville, Tennessee.
⁴ National Cancer Center of Mongolia, Ulaanbaatar, Mongolia.
⁵ Brown School, Washington University in St. Louis, St. Louis, Missouri.
⁶ Perelman School of Medicine, University of Pennsylvania & Center for Global Health, Philadelphia, Pennsylvania.
⁷ Liga Nacional Contra el Cancer/Instituto de Cancerologia, Guatemala City, Guatemala.
⁸ Global Health Center, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri.

Abstract

Purpose: There is a vital need to train radiation therapy professionals in low- and middle-income countries (LMICs) to develop sustainable cancer treatment capacity and infrastructure. LMICs have started to introduce intensity modulated radiation therapy (IMRT), which is the standard of care in high-income countries, because of improved outcomes and reduced toxicities. This work reports the efficacy of a complementary asynchronous plus synchronous virtual-training approach on improving radiation therapy professions' self-confidence levels and evaluating participants' attitudes toward asynchronous and synchronous didactic hands-on learning in 3 LMICs.

Methods and materials: Training was provided to 37 participants from Uganda, Guatemala, and Mongolia, which included 4 theoretical lectures, 4 hands-on sessions, and 8 self-guided online videos. The 36-day training focused on IMRT contouring, site-specific target/organ definition, planning/optimization, and quality assurance. Participants completed pre- and postsession confidence surveys on a 0 to 10 scale, which was converted to a 5-point Likert rating scale to evaluate the training outcomes. The pros and cons of the 3 different training formats were compared.

Results: The participants included 15 (40.5%) radiation oncologists, 11 (29.7%) medical physicists, 6 (16.2%) radiation therapists, and 5 (13.5%) dosimetrists. Approximately 50% had more than 10 years of radiation therapy experience, 70.8% had no formal IMRT training, and only 25% had IMRT at their institutions. The average experience and confidence levels in using IMRT at baseline were 3.2 and 2.9, which increased to 5.2 and 4.9 (P < .001) after the theoretical training. After the hands-on training, the experience and confidence levels further improved to 5.4 and 5.5 (P < .001). After the self-guided training, the confidence levels increased further to 6.9 (P < .01). Among the 3 different training sessions, hands-on trainings (58.3%) were most helpful for the development of participants' IMRT skills, followed by theoretical sessions with 25%.

Conclusions: After completing the training sessions, Uganda and Mongolia started IMRT treatments. Remote training provides an excellent and feasible e-learning platform to train radiation therapy professionals in LMICs. The training program improved the IMRT confidence levels and treatment delivery. The hands-on trainings were most preferred.