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What is the fellowship all about?
The fellowship is about producing a reproductive health physician who is highly skilled in Gynecologic Oncology. This encompasses all aspects of cancer care including counseling, screening, diagnosis, treatment, and end-of-life care. Treatment includes advanced pelvic surgeries and directing chemotherapy and radiotherapy treatment decisions.
When is it beginning?
The course will begin on 1st October 2017
How many students shall be admitted?
The course shall admit only two students each year.
Duration?
The course shall be conducted over a period of 24 months.
What shall be the benefit to Ugandans and East Africans
Uganda has a huge burden of gynecological cancer arising mainly from the heavy burden of cervical cancer whose incidence rate is one of the highest in the world at 47.5 per 100,000 per year. This high prevalence of cervical cancer is the result of a high prevalence (33.6%) of human papillomavirus (HPV) among women in Uganda combined with low screening. Cervical cancer is the leading cause of cancer death among women in Uganda. Addressing this huge challenge shall require an effective cervical cancer screening and treatment program, which in turn requires the training of the much needed specialized manpower, the development of infrastructure, surveillance mechanisms of the targeted women and therefore adequate financial resources. According to the WHO, Africa in 2008 accounted for 25.2% of the new cases of cervical cancer, with a mortality rate of 17.6%, while Eastern Africa region accounted for 34.5% incidence and 25.3% mortality respectively. This fellowship training in gynecological oncology is expected to produce the much needed specialists who shall lead the fight against Gynecological cancer in the East African Region.
At the moment the only other institute offering training in gynecological oncology in the East African Region is Moi University in Eldoret Kenya.
Greetings from Uganda, the Pearl of Africa located in East Africa, home to some of the rarest species of wildlife naturally inhabiting the lush savanna plains of Midwestern , north and northeastern Uganda, the impenetrable forests(Bwindi) the mountain heights of Rwenzori, Elgon and Virunga and the renown lakes and rivers. Not forgetting the several national parks that treat you to wildlife at its best, wonderfully cascading waterfalls and other breathtaking scenery. All immensely beautiful to indulge in for a weekend after a long week of hard work.
As a nation we are populated by 39 million people with a bottom heavy structure of about 52% of our population being dependent on the older generations. Like several other Sub Saharan countries in Africa our main health priorities have been infectious diseases especially malaria, tuberculosis and HIV. Over time we have noted a shift in health trends with alarming rates at which non communicable diseases (NCD’s) are fast emerging and threatening to overtake former priorities. Despite WHO members states’ commitment to a 25% reduction in premature mortality from NCD’s by 2025 and the UN General Assembly goal of a 30% reduction in the same by 2030, the reality for this achievement is grim. Though Uganda formed a programme to prevent and control NCD’s in 2006, a recent survey revealed desperately low national budgetary allocations and a poorly responsive health system for the management of NCD’s. The MOH, Uganda still maintains a policy of large primary health care funding and an integrated health care delivery for the efficient and maximal use of financial resources for health.
Early cancer detection and prevention comes with the challenge of a weak health system plagued by minimal financial support, human resource constraints, undeveloped road networks and infrastructure leading to difficult referral transportation and the ever present low literacy levels and low health awareness and health seeking behavior in general. At the other end of the spectrum though is the social media explosion with our population constantly demanding improved healthcare and particularly looking at subspecialty expertise now as opposed to general physicians and surgeons.
In this regard Mulago National Referral Hospital that has served as a teaching hospital for the oldest University in Uganda, Makerere is now a College of Health Sciences. With the lack of employment in the public sector, the many mushrooming medical schools continue to churn out scores of medical graduates who are spending less time in the field and returning earlier into post graduate studying. As the specialized posts become saturated, we have found a need for sub specialization as a new area for excellence in patient care to improve our service delivery and quality of care.
Globally, cancer continues to be a leading cause of mortality with 8.2 million cancer related deaths in 2012 (World Cancer Report 2014). The number of new cases is expected to rise to 22 million per year over the next two decades. The increasing numbers of cancers disproportionately affects low to middle income countries (LMIC’s). According to the WHO, Africa accounted for 25.2% of the new cases of cervical cancer, with a mortality rate of 17.6%, while Eastern Africa region accounted for 34.5% incidence and 25.3% mortality respectively in 2008. This presents a marked discrepancy with the developed nations such as the United States which had an incidence of 8.1 cases per 100,000 and mortality rate of 2.4 per 100,000 compared to an incidence of 34 cases per 100,000 and mortality of 23 cases per 100,000 in Africa. Cervical cancer is the leading cause of cancer-related deaths in Ugandan women. In 2014, WHO estimated that approximately 3,915 Ugandan women are diagnosed with cervical cancer every year, with 2,160 dying from the disease. While emphasis is being placed mainly on cervical cancer, Mulago Hospital records show an alarming incidence of ovarian cancer in our population previously thought to be more predominant in high income countries. With limited screening strategies for this cancer and a generally poor prognosis, new challenges of morbidity and mortality from gynecological cancers are being registered amidst low resource availability for comprehensive care.
The development of a new site for gynecological oncology training in Uganda is very timely and in line with the recent focus on a global curriculum and mentorship programme by the International Gynecological Cancer Society (IGCS) as a strategy to improve outcomes for women with gynecological cancers through teaching and training. Immediate past president IGCS, Professor Lynette Denny described cancer care in developing countries as abysmal and unrecognized as a public health problem. Further in his address the current society president, Dr. Michael Quinn appealed to the developing world to give back now to the LMIC’s on cancer care. With such partnerships and collaboration we can look forward to major strides in improving cancer care in LMIC’s and appropriate technologies emerging from the evidence base generated from high quality research as a key output of these partnerships.
We have therefore after two years of intense planning, coordination, stakeholder involvement and partnership development arrived at our initial goal of commencing a gynecological oncology fellowship in Uganda. The fellowship will be housed under the East African Oncology Institute with several collaborating institutions within and without the country. Both local expertise and international expertise will be drawn upon to run this two year fellowship targeting mainly qualified gynecologists. We have a wide range of patients at both referral sites, Mulago National Hospital and Uganda Cancer Institute that have been collaborating together for several years now to provide high quality care for gynecological cancer patients. Together these centers offer the broad spectrum of cancer care through surgical interventions, chemotherapy and radiotherapy along with diagnostic and supportive services. With the nearly completed Specialized Women’s Hospital, several opportunities exist for developing gynecological cancer surgical skills and medical decision making as well as conducting cutting edge research in gynecological cancers.
It is therefore my pleasure to interest you in this new venture and invite applicants, well-wishers, potential funders, partners and friends to visit this website where we will continually share updates on progress and upcoming events. Plans under the nouvelle gynecological oncology fellowship in East Africa. We believe that many will benefit and the consequences of this venture will be remembered for all time.
Yours sincerely
Dr. Judith Ajeani
The overall programme goal is to provide the highest level of medical education with a view to producing clinically and academically outstanding gynecological oncologists. The program shall provide fellows with the necessary knowledge, skills and experience to independently manage gynecologic cancer patients with complex treatment requirements and to teach medical students, residents, and allied health care professionals in the clinical or classroom settings.
Fellows shall be involved in assisting at a multidisciplinary Tumour Board which meets once every week. This will enhance the development of clinical, research, academic and leadership skills in gynecological oncology. The Tumour Board is linked through a tele-medicine network to allied leading gynecological oncologists in The University of California San Francisco and in Duke University.
Fellows shall in the course of training develop skills in the investigative and scholarly aspects of gynecological oncology with a view to establishing a lifelong learning and career path.
It is also goal to open up the minds of fellows to the values of Humanity and to the concept of value-based care the medical services. They will also therefore be mentored in leadership so as to enable them appreciate the principles from which such care springs and to ground their instincts in advocating for it.
Year 1 | |||
Core Learning Area | Total Duration | Facility | |
Gynecological oncology | 12 months | Uganda Cancer Institute MNRH –Outpatient clinics and wards | |
Palliative care | 1 month | Uganda Cancer Institute MNRH –Outpatient clinics and wards | |
Research proposal planning and writing. Data collection begins
| 3 months | Uganda Cancer Institute MNRH | |
Medical Oncology | 1 month | 1 month | |
Radiation Oncology | 1 month | 1 month | |
Pathology | 1 month | 1 month |
Year 2 | |||
Core Learning Area | Total Duration | Facility | |
Gynecological oncology | 12 months | Uganda Cancer Institute MNRH Outpatient clinics, wards and theater. | |
Palliative care | 1 month | Uganda Cancer Institute MNRH –Outpatient clinics and wards | |
Urogynecology | 1 month | Uganda Cancer Institute MNRH Outpatient clinics, wards and theater. | |
Radiation Oncology | 1 month | Uganda Cancer Institute Radiology Department. Outpatient clinics and wards | |
Medical Oncology | 1 month | Uganda Cancer Institute MNRH –Outpatient clinics and wards. | |
Colorectal surgery | 1 month | Uganda Cancer Institute MNRH Outpatient clinics, wards and theater. | |
Research project. Data analysis, Thesis writing. | 4 months | Uganda Cancer Institute MNRH | |
Electives | 1 month | Uganda Cancer Institute MNRH Moi University Eldoret Kenya |
1. Educational Goals and Objectives
Programs shall utilize the Guide to Learning for the respective subspecialty to provide the foundation and scope of education and instruction. Goals and objectives shall be specific to the program.
Guidelines to create goals and objectives are:
A. Clinical
Clinical goals and objectives shall include each assignment at each educational level. They shall be made available to all faculty and fellows.
A fellow is required to attain a level of competency that is expected of a new subspecialty practitioner; therefore, the program shall integrate the following competencies into each fellow’s curriculum:
1) Patient Care: Be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
2) Medical Knowledge: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences as well as the application of this knowledge to patient care.
3) Practice-based Learning and Improvement: Demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence and to continuously improve patient care based on constant self-evaluation and lifelong learning. Fellows are expected to develop skills and habits to be able to meet the following goals:
Identify strengths, deficiencies, and limits in one’s knowledge and expertise
Set learning and improvement goals
Identify and perform appropriate learning activities
systematically analyze practice using quality improvement methods and implement changes with the goal of practice improvement
Incorporate formative evaluation feedback into daily practice
Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
Use information technology to optimize learning
Participate in the education of patients, families, students, residents, fellows and other health professionals
4) Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Fellows are expected to:
Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
Communicate effectively with physicians, other health professionals, and health related agencies
Work effectively as a member or leader of a health care team or other professional group
Act in a consultative role to other physicians and health professionals
Maintain comprehensive, timely, and legible medical records, if applicable
5) Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Fellows are expected to demonstrate:
Compassion, integrity, and respect for others
Responsiveness to patient needs that supersedes self-interest
Respect for patient privacy and autonomy
Accountability to patients, society, and the profession
Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
6) Systems-based Practice: Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Fellows are expected to:
Work effectively in various health care delivery settings and systems relevant to their clinical specialty
Coordinate patient care within the health care system relevant to their clinical subspecialty
Incorporate considerations of cost awareness and risk benefit analysis in patient and/or population-based care as appropriate
Advocate for quality patient care and optimal patient care systems
Work in interprofessional teams to enhance patient safety and improve patient care quality
Participate in identifying system errors and implementing potential systems solutions
B. Research
Research goals shall be reviewed by the fellow and shall include:
1) Opportunity for structured clinical research.
2) Enhancement of the fellows’ understanding of the latest scientific techniques and encouragement of interaction with other scientists.
3) Promotion of the fellow's academic contributions to the respective subspecialty.
4) Enhancement of opportunities for the fellow to obtain research funding and academic positions.
5) Furthering the ability of the fellow to be an independent investigator.
c. Thesis
The program shall ensure that each fellow completes a thesis and defends it during their fellowship training. A copy of the manuscript and the thesis defense documentation must be available upon request by the East, Central and South African College of Obstetricians Gynecologists. ECSACOG
A thesis topic relevant to the subspecialty
An assigned mentor
A thesis of such quality as to allow the fellow admittance to the ECSACOG Subspecialty
Oral Examination
completed the work on their thesis
Completed and submitted a written manuscript to their Program Director
Defended their thesis to their Program Director, research mentor or thesis committee, and other members of the Division
3. Didactic Conferences and Lectures
The program shall implement regularly scheduled, formal teaching conferences, seminars and didactic instruction in both basic science and the clinical aspects of the respective subspecialty.
The topics shall be obtained from the Guide to Learning for the gynecological oncology subspecialty.
4. Clinical and Research Training
The learning objectives of a program shall be accomplished through a combination of
didactics, research, and clinical education of the fellows and shall be carefully planned and balanced with concerns for patient safety and fellow well-being.
The program also shall permit the fellows progressive responsibility for patient care and management, supervision of residents, and a rich research experience over the continuum of the program.
Clinical
A sufficient number of teaching rounds, including reviews of patient care, shall be organized and conducted by qualified subspecialty faculty and should occur at least one time per week when the fellow is on a clinical rotation. Outpatient experience is particularly important and shall be organized and supervised appropriately.
A fellow must be capable of performing all appropriate diagnostic and therapeutic procedures relevant to the clinical practice of the subspecialty. A fellow must play an active role in decisions affecting patient management and participate in a program constructed to allow continuity of patient care.
Research
A program shall ensure fellows are actively pursuing a research program. A fellow shall be allowed to present their research at regional or national meetings at least once during their fellowship training. Research projects can be developed either within the Department of Obstetrics and Gynecology or in collaboration with other academic departments.
Prior to completion of fellowship training, a fellow is expected to:
Have at least one publication or one presentation at a regional, national, or international meeting
Develop the skills to continue to conduct independent research.
Develop a hypothesis and formulate a strategy to test. This step must be followed by appropriately supervised experiments/studies and statistical analyses as outlined in the thesis requirements.
Be taught quantitative techniques, including biostatistics and other areas such as epidemiology and research design and implementation
Acquire a thorough knowledge and understanding of the methodologies and analyses used in research protocols that relate to research in their respective subspecialty.
Acquire an in-depth understanding of statistical analyses of research projects
Experimentation and Innovation
Since responsible innovation and experimentation are essential to improving subspecialty education, experimental projects along sound educational principles are strongly encouraged. If a fellow pursues a project that deviates from the program’s requirements, the Program Director must obtain ECSACOG approval in advance.
5. Leadership and Faculty
Dr. Jackson Orem MB.Ch.B, M.Med, PhD Director Uganda Cancer Institute
Dr. Carolyn Nakisige MB.ChB, M.Med. Head Department of Gynecological Oncology. Uganda Cancer Institute
Dr. Okoth A Ndira MB.ChB, M.Med,Msc Programme Director
Dr. Jane Namugga. MB.ChB, M.Med,Msc Assist Program Director
Dr. Judith Ajeani. MB.ChB, M.Med
6. Partners
Prof Paula Lee. Duke University
Prof Stefanie Ueda University of California San Francisco
7. Application Forms
(Rachael Kansiime)
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