Global Oncology Fellowship Electives: The Impact on Cancer Care and International Collaborations

BACKGROUND: To meet the rising demand for cancer care in low- and middle-income countries (LMICs), educational partnerships are needed. The Geisel School of Medicine at Dartmouth (GSMD) Hematology-Oncology Fellowship Program (HOFP) piloted a bi-annual elective in Rwanda supervised by GSMD faculty.

OBJECTIVE: Exchange of knowledge and collaborations regarding treatment of advanced cancer in a low-resource setting.

METHODS: Program objectives were implemented by GSMD HOFP, Rwandan Ministry of Health, the NGO Partners In Health, and the Butaro Hospital Cancer Center of Excellence (BCCOE) in Butaro, Rwanda. Education, organizational changes, research projects, and funding sources were tracked. Fellows were evaluated using American College of Graduate Medical Education clinical competencies.

RESULTS: The two-year pilot program was 100% enrolled. Ten educational, research, and organizational projects were implemented. Three grant proposals are in process. Fifty percent of participating Fellows plan to pursue careers in Global Health. The Hematology-Oncology (HO) Fellows gained perspective on cancer care capacity-building in a LMIC, and confidence in teaching. BCCOE staff gained knowledge and mentorship, ideas for quality improvement, and increased expertise with treatment protocols. Rwandan and U.S. colleagues valued the solidarity generated by the regular exchange, and a long-term commitment is planned.

CONCLUSION: A Global Oncology Fellowship elective is feasible and has a qualitative impact on care delivery and collaboration in LMICs influencing Fellows’ career choices and professional growth of colleagues at partner sites. Long-term partnerships complement the task-sharing approach to cancer care. Financial sustainability requires formal institutional support for faculty participation.

Keywords
Medical education; global oncology; global health; low resource setting; fellowship