Longitudinal Remote IMRT Training in Africa: A Prospective Cohort Study

Abstract

<h3>Purpose/Objective(s)</h3> Intensity-modulated radiation therapy (IMRT) can significantly enhance patient outcomes compared to 3D-conformal radiotherapy (3D-CRT), yet African patients' access to IMRT is sparse. Limited opportunities for continuing education and training for radiation oncology professionals has been identified as a significant problem. We aimed to evaluate a telehealth training curriculum for clinicians and medical physicists in low- and middle- income countries in Africa. <h3>Materials/Methods</h3> A 30-session remote training program on transitioning from 3D to IMRT was provided at no cost to radiation oncology centers in Africa and one sister institution in Pakistan. The program consisted of twice weekly 1-hour live video conferencing sessions for 4 months with interactive didactics and case-based learning utilizing a cloud-based contouring platform. 15 radiation oncology centers across Africa were invited to participate, of which 13 were transitioning to, or had recently began, IMRT programs. A Likert scale (1-5) confidence evaluation on 7 foundational domains of IMRT treatment planning and delivery, 8 physics-specific domains, and 3 physician-specific domains was electronically administered to enrolled individuals pre- and post- curriculum. Participation was tracked for each session. <h3>Results</h3> A total of 12 centers (9 public, 2 private, and 1 semi-private) formally enrolled in training. Of these, 4 began IMRT in the last 3 years and 8 had plans to transition from 3D-CRT to IMRT. 128 individuals participated: 47 medical physicists (36.7%), 21 radiation oncologists (16.4%), 16 radiation therapists (12.5%), 30 residents (23.4%), 9 medical physics trainees (7.0%), and 5 other staff (3.9%). Average participation per session was 31 (range 17–83, SD = 16.6), and 36 individuals attended 10 sessions or more. 30 respondents, who attended 12/30 sessions on average (range 4 to 21, SD = 5.2), completed both pre- and post- surveys and were eligible for paired analysis. Overall pre- and post-curriculum mean self-confidence scores were 2.51 (n = 142) and 4.1 (n = 30), respectively, out of a possible 5. Paired pre- vs. post- analysis for 30 individuals revealed statistically significantly (<i>P</i> < 0.05) higher scores for 7 of 7 foundational domains (n = 30), 5 of 8 physics-specific domains (n = 15), and 3 of 3 physician-specific domains (n = 13). Higher attendance rates significantly correlated with larger gains in confidence scores (<i>P</i> = 0.047). <h3>Conclusion</h3> Longitudinal telehealth training integrating cloud-based tools for radiation oncology professionals is a viable and efficient method for continuing education in Africa. Despite low attendance rates, this program significantly and comprehensively improved confidence in IMRT across multiple training domains, with confidence improving with greater course participation. Future work remains to facilitate and explore the efficacy of similar programs and to assess concordance of participant confidence with clinical knowledge and skill.