Surgical oncology societies: Global curriculum to address training variations, inadequacies

The lack of an adequately trained workforce of surgical oncologists can be a major detriment in efforts to address the rising global cancer burden, according to two leading international surgical oncology societies.

The Society of Surgical Oncology (SSO) and the European Society of Surgical Oncology, (ESSO) in two jointly published reports, highlight the global variations in training and make the case for a streamlined global surgical oncology curriculum of uniform standards. It is envisioned that the application of this minimum uniform standards of training will create a robust workforce of well-trained surgical oncologists to meet the growing need resulting from the rising global cancer burden.

The cancer burden is projected to rise globally, from 14.1 million new cases and 8.2 million cancer-related deaths in 2012 to 23.9 million new cases and 14.6 million cancer-related deaths in 2035. A significant proportion of the predicted global cancer burden will affect the less developed regions of the world, which by 2035 will account for 61% (14.7 million) of new cancer cases and 70% (10.3 million) of all cancer-related deaths. Nearly 80% of cancer patients will need surgical intervention at some point, and by the year 2030, it is estimated that 45 million surgical procedures will be required annually.

The two surgical oncology societies together published their findings on global variations in training and recommendations for a global curriculum in the May 1 online issues of both the Annals of Surgical Oncology and the European Journal of Surgical Oncology. The companion articles will appear in print in the June issues.

The efforts to develop a global curriculum were initiated when the leaders of the SSO and the ESSO convened a Joint Global Curriculum Committee co-chaired by SSO representative Russell S. Berman, MD, Chief, Division of Surgical Oncology, New York University School of Medicine [SSO Executive Council member and Past Chair of SSO's Training Committee] and ESSO President Ricardo A. Audisio, MD, to develop a global curriculum for surgical oncology education and training. Each Society had previously developed its own curriculum and both were utilized as a starting point for building the global curriculum.

"It is my fervent hope that this proposed global curriculum in surgical oncology will serve as a major step forward in our international efforts to address the continued dramatic rise in the global cancer burden," said Dr. Berman.

The new global curriculum incorporates essential standards derived from each Society's curriculum to provide a uniform scaffolding of minimum standards that can help to tackle the significant variations in training from region to region throughout the world as identified by Are, et.al. in Variations In Training of Surgical Oncologists: Proposal for a Global Curriculum. It is hoped that such a curriculum will help to build a cadre of well-trained surgical oncologists to meet the global need.

"As a Committee, we agreed that the curriculum should be constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world with their inherently diverse sociocultural, financial and cultural differences," said Dr. Audisio. "We also recognize that the curriculum is aspirational and not mandatory in intent."

During its global research, the Committee noted several concerning findings of which some are highlighted below:

• Total surgical training length varied between 8 and more than 17 years, depending on the country.
• Several countries do not have the capability to offer surgical oncology fellowship training programs.
• Several countries do not offer domestic surgical oncology fellowships yet still consider such training a requirement.
• There is a wide variability in the location of foreign countries that physicians travel to in order to obtain required training.
• There are no structured pathways to integrate the knowledge acquired abroad into the native health and medical systems.

It is these variations that led the two organizations to call for a streamlined global curriculum of minimum and uniform standards to tackle the rising global cancer burden.

"The obligation to confront what was learned from this study falls on every individual within every surgical oncology organization, and no one can serve this role better than those societies that possess the needed academic and financial resources," said Daniel G. Coit, MD, SSO President, Attending Surgeon, Memorial Sloan Kettering Cancer Center, Professor of Surgery, Weill Cornell Medical College.

In developing this new global curriculum, the SSO and the ESSO are following a model created by the American Society of Clinical Oncology and the European Society of Medical Oncology for a medical oncology training approach.