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Teaching Cervical Cancer Surgery in Low- or Middle-Resource Countries
  1. Laurie M. Elit, MD*,
  2. Barry Rosen, MD,
  3. Waldo Jimenez, MD*,
  4. Christopher Giede, MD,
  5. Paulina Cybulska, MD,
  6. Sarah Sinasac, MD,
  7. Jason Dodge, MD,
  8. Erdenejargal Ayush, MD§,
  9. Orango Omenge, MD,
  10. Marcus Bernardini, MD,
  11. Sarah Finlayson, MD,
  12. Jessica McAlpine, MD and
  13. Dianne Miller, MD
  1. * Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada;
  2. Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada;
  3. Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, Canada;
  4. § National Oncology Hospital, Ulaanbaatar, Mongolia;
  5. Moi Teaching and Referral Hospital, Eldoret, Kenya; and
  6. Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
  1. Address correspondence and reprint requests to Laurie M. Elit, MD, Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada. E-mail: laurie.elit{at}


Background: With the widespread implementation of screening programs internationally, there will be an increase in early stage cervical cancer cases. In response to this, the Ministry of Health in each country will need to plan strategies to provide care such as radical surgery or radiation for this potentially curable group of women.

Methods: The Gynaecologic Oncologists of Canada created a teaching module to intensively train a small number of locally identified gynecologists to perform radical hysterectomy and pelvic lymphadenectomy. The process was based on adult learning principles; it involved a Canadian gynecologic oncologist working in the low- or middle-resource country with the gynecologists and problem-solving local issues in health care delivery.

Results: The teaching process included a pretest and a posttest on the basis of the objectives of the module. There were 7 modules including preoperative evaluation of the patient, cone biopsy, radical hysterectomy, pelvic lymphadenectomy, ureteric injury, vascular injury, and follow-up after surgery. Each module was divided into background information, techniques, and complications. There were video clips imbedded in the modules. After the educational modules had been reviewed, the learners were walked through the surgical procedures repeatedly including a detailed assessment of performance after each case. Participants had the opportunity to provide feedback on the training program. The module was reviewed in Mongolia and implemented in Kenya.

Conclusions: In low- and middle-resource countries where there is an urgent need to provide a curative surgical option for the management of early cervical cancer, a focused high-intensity curriculum delivered by a trained surgeon can translate into immediate change in clinical and surgical practice.

  • Surgery
  • Low- and medium-resource countries
  • Cervical cancer

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