Integration of academic programs from high-income countries (HIC) into LMIC are critical to support advances and improve disparate cancer outcomes. Past reports highlight the critical need for training programs for healthcare workers from LMIC, specifically SSA. An audience survey of African cancer specialists at the Breast Cancer in Africa Symposia showed the two highest priorities and needs as (1) the development of educational and training programs and (2) the sharing of medical supplies [14]. However, despite a strong desire and need for sustainable international training programs, very few are available, and only a small minority of healthcare workers may have the opportunity to advance their medical education. A 2019 survey showed a strong desire for continued education but a severe lack of opportunities [12]. Challenges with HIC integration into SSA programs are several but generally include sporadic involvement without sustainability, programs not tailored to needs of the healthcare workers or region, and timelines that do not match the needs program.

In the present paper, we describe the results of a satisfaction survey after participating in a preceptorship program focused on supporting and training healthcare workers from Ghana. All participating organizations contributed substantial time and effort with unique and critical leadership support to enable the success of the program. We acknowledge the countless hours of work, planning, and training from hundreds of colleagues that directly contributed to the success of the program. Both participants and preceptors indicated strong satisfaction in the program with a desire for future participation and expansion of the program. Most participants indicated they achieved all on-site objectives of the preceptorship program with confidence in the post-program objectives of implementation at their home institution. Areas for improvement were identified and included long-term metrics of success and translation of training to direct patient care and outcomes.

The ideal model of medical education and training between HIC programs and LMICs is unclear, though several models of past training exist. These range from short in-person and in-country workshops focusing on a specific skill to that of a diploma oriented long-term (e.g., 12-month duration) training program at a foreign institution. Like our program, the Program for Enhanced Training in Cancer (POETIC) program from Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a 3-week program supplementing training of seven African oncologists practicing in their home countries [15]. Program strengths felt to influence patient care in Africa included: patient-centered care, clinical trial experience, and observation of collaboration among medical, radiation, and surgical oncologists. While development of a skill or skillsets is a critical aspect of training programs, observation of host institution workflow and organization are equally important for the trainees to adapt and develop processes at their own institution based upon the resources available. In the present program, all participants indicated confidence in developing specific guidelines, protocols and workflow for their organization based on their experience with the multi-disciplinary team at Mayo Clinic, which will be presented in a future manuscript.

Program sustainability as well as defined and achievable metrics of success and program sustainability are critical to the long-term success of a training program. Two collaborative head and neck training fellowships at Johns Hopkins and University of Cape Town, which have trained a combined total of 14 trainees, highlight measures of successful clinical training [16]. As a key metric of success, surgical skill transfer and knowledge retention was assessed as measured by the number of head and neck surgical cases, which increased by 335%, in addition to demonstrating increasing complexity level of the procedures. Further, the French African Pediatric Oncology Group has provided clinical training via didactic lectures, both in person and online; onsite practicum; and mentored research projects since 2014 [17]. With nearly 5-years of follow-up that includes 72 participants, a total of four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates of the program. As an example of the importance of sustainability, a genetic testing workshop performed in Kenya in 2013 at the Kenyan National Retinoblastoma Strategy meeting developed an apparent effective program with lectures, group discussions, role play [18]. While the initial metric of success, as defined by a post-workshop assessment, was favorable, within 12 months the post-workshop knowledge matched that of the pre-workshop period.

Our preceptorship program is sustained through a free of charge weekly web-based case-centric lecture series with an emphasis on multi-disciplinary management of cancer. Experts in cancer control, diagnostics, and therapeutics cover a range of critical topics delivered in 6-week blocks of cancer topics relevant to cancer types, stages, and resources available in SSA. With direct input from participants involved in the preceptorship program, the web-based course offerings have been expanded to other disciplines including oncology nursing and medical physics. With over 300 learners in numerous African countries, and more than 100 sessions to date, this model of continuous education has proven highly effective and serves to supplement trainee education at several residency programs in Africa. Additionally, based on a need’s assessment of our African partners, we developed research training and mentorship programs to enhance research capacity and output with our partner institutions.

While many of the reported training programs focus on physician training, a unique aspect of our training program was the inclusion of oncology nurses. A cancer nurse is defined by the European Oncology Nursing Society as a registered nurse with the expert skills, clinical competency, and authority to provide essential nursing care to those with cancer [19]. With greater recognition of the importance of nursing staff, there are now formal development of oncology nurse programs in 16 countries in sub-Saharan African with various levels of training [20]. Many challenges constrain the expansion of oncology nurse training programs, primarily related to scant financial support and lack of recognition of the importance within Africa, as indicated by the fact that less than a third of SSA countries have programs [21, 22]. Training of oncology nurses is a key focus of our program, and in addition to our preceptorship program, we have ongoing continued medical education programs for oncology nurses in Ghana, which focus on safety in administration of anticancer therapies, adverse event management, and palliative care.

In addition to the participant benefits we report in the present study, our survey also revealed many benefits for the participating preceptors. Despite busy clinics and workloads, all preceptor respondents indicated they found joy and value in participating in the program and the desire to participate in future similar programs. The concept of volunteering in global medicine programs to improve mental health and reduce burnout syndrome is not new, and our data may add further evidence that such volunteer programs may be an effective means or strategy to improve both career satisfaction and benefit underserved communities around the globe [23]. It is worth noting that the rate of response from preceptors was less than 50%, which may introduce bias into the analysis and limit our understanding.

The opportunities to collaborate with and support medical colleagues and patients in LMIC are numerous and readily available in all facets of oncology. Here we present the results of participant and preceptor satisfaction in a program that collaborates with academic centers, local governments, and NGOs. With an aging population and soaring cancer rates around the globe, there is an immediate and critical need to broaden our reach and deepen our collaborations to find the means necessary to bridge the ever-widening divide of health disparity.