A Roadmap for Implementing Radiation Oncology Residency Training in Low and Middle Income Countries (LMICs)

Abstract

LMICs need more qualified radiation oncology professionals to confront the cancer pandemic. However, institutionalized training programs are needed for this. Despite the accessibility of reports, from IAEA, ASTRO and ESTRO and the related recommendations, practical 'how-to' guidance for establishing and managing competency-based training programs is non-existent in many LMICs. This is especially true for countries where no programs exist, and there is no frame of reference on how to initiate one. To approach this problem, we sought to transfer the mostly-rigid recommendations available into an easy-to-implement roadmap.Three main axes of work were targeted for improvement with specific gaps to address. 1) Didactic lectures and practical training: Many reports discuss the "what" to teach. Absent is an illustration of how involved the topics (e.g., physics) are in the daily clinical practice of a radiation oncologist beyond the didactic lectures. 2) Managing workflow: Most LMIC centers treat patients with minimal quality management. Absent are peer review, disease site-specific clinics and guidelines, and how to promote a learning environment when many patients are lost to follow up. 3) Assessment and evaluation: Many LMICs rely on paper-based exams for assessing trainees. Absent are ways to assess the competencies of a radiation oncology trainee more comprehensively. Using the perspectives of LMIC-origin professionals, a "roadmap" document was drafted to address these axes with practical examples based on real-world experience in LMICs.A 157-page roadmap document was developed. The document details the amount of lecturing, material content, and the timeline for completing each training topics. It includes tables for site-specific rotations and a daily-work schedule to cover all aspects of clinical work such as new patient clinics, simulation, planning, on-treatment and follow-up clinics. Forms for documentation and assessment are proposed with an explanation of each assessment level. This roadmap document was developed built over the years and was piloted successfully, eight years ago, at a cancer center north of Iraq, which graduated its first batch of residents in 2017. It has since been going through various improvements and reevaluation.LMIC-origin professionals can help identify practical gaps and build roadmap documents to support radiation oncology training programs. This roadmap document was peer-reviewed at the University of Qatar Press in Doha, Qatar and was published as an open-access book in Feb 2021. As of this writing the document has been accessed 1702 times; the table below shows the top country views. Future work remains to assess the benefit of this roadmap document and its ease of implementation.