Unique Fellowship Aims to Lessen Global Cancer Burden by Training Foreign Medical Graduates in Surgical Oncology

Key Points

  • The program actively enrolls surgeons who have a long-term plan of practice and development back home. These steps have enabled the MSKCC program to see 80% of its trainees return to their home countries after their fellowships conclude.
  • Graduates can pass along skills to others so that the training continues beyond their experience.
  • Study authors tracked foreign medical graduates who completed the MSKCC fellowship from 1994 to 2014. The study authors said 69% of fellowship graduates were involved in academic positions with a high level of job satisfaction.

Many low- and middle-income countries do not have a defined medical specialty in surgical oncology, and lack an educational infrastructure to respond to the local burden of cancer, but a Memorial Sloan Kettering Cancer Center (MSKCC) fellowship is succeeding in addressing this problem by training foreign medical graduates in surgical oncology. The MSKCC oncology fellowship program was discussed by Dominguez-Rosado et al in the Journal of the American College of Surgeons.

Changing the Scenario

For patients with solid tumors, surgeons are at the center of care in countries that have few, if any, medical or radiation oncologists. This concern is the driving force behind the International General Surgical Oncology Fellowship at MSKCC. By educating and training foreign medical graduates, there is the possibility of a significant intervention in cancer care through the establishment of a qualified surgical oncology workforce “that understands local needs and can foster change towards care improvement, creating a sustainable model of intellectual and technological infrastructure for cancer management,” study authors wrote.

Historically, there has been a high rate of foreign medical graduates who stay in the United States permanently after training. MSKCC is working to change this scenario and have foreign medical graduates return to their country of origin to help improve cancer care. The program accomplishes this goal by actively enrolling surgeons who have a long-term plan of practice and development back home.

These steps have enabled the MSKCC program to see 80% of its trainees return to their home countries after their fellowships conclude. Not only can these surgeons use the skills they acquired to treat patients, they can also pass along those skills to others so that the training continues beyond their experience.

“This fellowship training program is more than just teaching trainees technical aspects of operations,” said lead study author Sir Murray F. Brennan, MD, FACS, Vice President for International Programs; Benno C. Schmidt Chair in Clinical Oncology; and Director, The Bobst International Center, at MSKCC. “There is a heavy emphasis on these surgeons becoming good educators, learning about databases, and how to evaluate surgical outcomes.”

Study Findings

Study authors tracked foreign medical graduates who completed the MSKCC fellowship from 1994 to 2014. During that time, 39 trainees from 24 countries came through the program—17 from Europe, 8 from Australia/New Zealand, 6 from the Middle East, 5 from Latin America, and 3 from Asia. The study authors said that 69% of fellowship graduates were involved in academic positions with a high level of job satisfaction.

The MSKCC fellowship program provides foreign medical graduates direct surgical experience in the operating room and perioperative care experience. The inclusive nature of the program requires trainees to develop communication skills, which can be a challenge for those whose first language is not English.

Study authors said that the MSKCC fellowship gives broad exposure to different areas in surgery and fulfills the recommendations from the Society of Surgical Oncology (SSO) regarding training competences. Additionally, fellows surpass 120 cases per year—the SSO requirement—without interfering with the training of U.S. fellows.

Study authors acknowledged that the limitations of the study are “the reporting bias that results from obtaining data from a survey and the inclusion of recently graduated fellows who are just starting their practice. Most of the fellows have come from [high-income countries], which limit the generalization of the outcomes to less favored settings.”

More Programs Needed

Dr. Brennan said that although MSKCC has seen success in training foreign medical graduates, there is still a need for other programs to help assist developing nations. One such program is the American College of Surgeons International Scholarship Program. “During 40 years, 212 surgeons from 62 countries have participated in the program with a positive effect on their practice, opening the possibility of international leadership and remarkable social interactions among surgeons,” study authors noted.

“Our hope is to provoke a dialogue to develop other opportunities for international medical graduates at the senior or chief resident level, or even as community assistants,” said Dr. Brennan. “We should do more of this training. It's the kind of outreach we have to provide.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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