Lessons Learned from Remote Global Radiation Oncology Education and Training on IMRT for Low- and Middle-Income Countries

Abstract

<h3>Purpose/Objective(s)</h3> There is a vital need to train radiation oncology professionals in low-and middle-income countries (LMICs) to develop sustainable capacity and infrastructure for clinical oncology care. Radiotherapy departments in LMICs have started to introduce intensity-modulated radiotherapy (IMRT), which is widely utilized in high-income countries and has become the standard of care due to reduced toxicity and improved outcomes in a wide variety of cancers. This work reports on the initiatives and experience with the use of an online training and learning program for global radiation oncology education and training across three LMICs: Uganda, Mongolia and Guatemala <h3>Materials/Methods</h3> Four interactive lectures and four sequential hands-on (step-by-step on IMRT processes) training sessions were given by radiation oncologists and medical physicists at XXX University in XXX, focusing on site-specific target definition, normal tissue contouring, IMRT planning and optimization, and IMRT QA. Additional four weeks of eight online videos and materials developed by XXX were provided to participants to review with quizzes after each week. Pre- and post- surveys, including 10-point confidence scores and free-response questions were performed to evaluate the outcome of the training sessions. Padlet was used as a platform for questions and answers during and after the training sessions. <h3>Results</h3> On average, 37 participants, including 15 radiation oncologists, 11 medical physicists, 5 dosimetrists, and 6 radiation therapists, participated in the virtual training sessions. Eighty percent of the participants responded to the surveys taken immediately following training. 66.7% had not received the IMRT training before. The level of confidence level using IMRT in the clinic increased from 3.25±1.98 to 5.25±2.20. Lessons learned include: 1. Hands-on training sessions are preferred to lectures; 2. Through virtual training, interactions between trainers and trainees are important to engage participants; 3. Different training sessions designed for specific groups (radiation oncologists, medical physicists, radiation therapists and dosimetrists) are needed to improve the relevance; 4. Online self-guided videos are easy to scale up but are a challenge to meet the specific needs of specific groups. 5. Language barrier is one of the limitations to performing the training for non-English speaking LMIC participants. <h3>Conclusion</h3> Remote training provides an excellent and feasible e-learning platform to train radiotherapy professionals in LMICs. If adequately supported, the use of virtual training model can be an effective way to build capacity, as there are limited numbers of academically and clinically qualified radiation oncology professionals. These findings add to the limited knowledge of radiotherapy training developed for LMICs.