Insight into ‘gynecological oncology’ training in the developing world: perspectives of in-training candidates in India

Abstract

<h3>Objectives:</h3> In the last decade, gynecological oncology has seen an enormous growth and practice changing reforms after its inception almost four decades ago. Various societies across the globe have developed structured training program for trainees in gynecological oncology. India had started its structured training program of 3 years since 2011 although fellowships did exist prior. There are more than 15 centres in India, averagely training 1 to 2 candidates per year which includes both government and private sector. Training varies from region to region across the country depending on factors such as availability of advanced training facilities, mentorship, duration of course and cancer burden. We aim to study trainee profile, satisfaction levels and future expectations of in-training candidates across India. To our knowledge, this is the only study from South-Asian subcontinent in this context. <h3>Methods:</h3> We developed, validated and administered a cross-sectional web-based (Google forms) survey questionnaire to all the trainees in gynecological oncology across India listed in our directory. Questionnaire was sent to them in the first week of August, 2020. Data collected was analysed using Google sheets. Results were expressed as percentages of total responses received excluding unattended responses. Inferences were drawn from the content-specific responses. <h3>Results:</h3> Thirty-nine in-training candidates across the country responded, of which majority (71.8%) were females. Most of the trainees (84%) were from university/teaching hospital run dedicated cancer care centres which see a high burden of cases. Almost two-thirds (64.1%) were extremely satisfied with their training while 28% were just satisfied. Most of the trainees were satisfied with the surgical exposure (64%) and academic activities (61%) at their centres. Of all recent innovations in gynecological oncology, respondents had a special interest in cytoreductive surgeries (CRS) - 41% and robotics - 28% while 59% and 85% suggested for a dedicated fellowship respectively in same post completion of training. Unanimously (97%) suggested that trainees should be adequately exposed to gynecological oncology in their post-graduate training of obstetrics and gynecology while 92% suggested harmonisation of training curriculum across the country. <h3>Conclusions:</h3> Although majority of trainees expressed satisfaction, there is a greater need for uniformifization of training curriculum in gynecological oncology. Our study reflects on the training satisfaction levels in the developing world and esp., Lower Middle Income Country (LMIC) group along with future aspirations of trainees. An interesting finding of inclination of in-training candidates towards cytoreductive surgeries and robotics emerged, inferring building in future - high quality training standards in these complex surgeries with needed resources and infrastructure.