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As therapeutic strategies are rapidly evolving, propelled by better understanding of cancer biology and the development of innovative therapies, gynecologic oncologists are exposed to new knowledge and ever-growing skills to master. Surgical techniques have evolved to become more precise and targeted, and the use of neoadjuvant chemotherapy in ovarian cancer has led to an approach leading to less aggressive surgery with lower rates of complications. These factors taken together underscore the importance of sub-specialty training in gynecologic oncology in high-volume centers. Like several countries, Israel has intermediate numbers of gynecologic cancer cases. The country has a population of nearly 9 million, and in 2020 there were 829 cases of endometrial cancer, 320 cases of ovarian cancer, and 254 cases of cervical cancer, and the rate is projected to decrease.1
This burden of disease is distributed among 21 gynecologic oncology centers spread over a geographical area approximately less than twice the size of New York City Metropolitan Area (Figure 1). It is therefore challenging to gather sufficient volume to obtain the required high-level education for young gynecologic oncologists in training, requiring mentoring abroad. Fellowship positions worldwide for international graduates have become extremely competitive for various reasons, including the need to train local practitioners, the need for a sponsor, difficulties in obtaining visa and licensure, and rare global events such as the COVID-19 pandemic. Historically, in the field of gynecologic oncology, the sources for fellowship training for many global graduates including Israeli postgraduate doctors have relied mostly on Canada, the USA, and the UK.
Active gynecologic oncology units in Israel.
Studying the current landscape of practising gynecologic oncologists in Israel published by The Israeli Society of Gynecologic Oncology,2 49 of 66 registered practitioners have had some sub-specialty training overseas. Of these, 22 have been trained in Canada, 14 in the USA, and eight in the UK. It is important to highlight the contribution made by the Fellowship at McGill in Montreal, which leads with 11 Israeli graduates, seven of whom are heads of departments or gynecologic oncology units (one-third of all active units) (Figure 2). The Fellowship at McGill is funded by the Israel Cancer Research Fund, which is the largest non-governmental source of cancer research funding in Israel and, more recently, the Azrieli Fund in collaboration with the Israel Ministry of Health. This underscores the importance of the philanthropy of non-governmental organizations and facilitating stable infrastructure and academic relationships for sustaining opportunities for international graduates in international fellowship training. This results in providing essential training at high-volume centers with exposure to a variety of disease presentations and management practices. On their return, the fellowship trained junior gynecologic oncologists bring back special skills, cultural diversity, and experience of equitability gained training.
McGill’s Fellowship mentor Dr Walter H Gotlieb and past and present mentees Dr Ido Laskov, Dr Liron Kogan, Dr Emad Matanes, and Dr Gabriel Levin.
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X @Glevin22908, @YoavBrezinov
Contributors GL: Guarantor, conceptualization, data curation, methodology, investigation, writing - original draft, writing - review, and editing. RM: conceptualization, project administration. WG: data curation, methodology, investigation, writing - original draft, writing - review. YB: writing - review and editing. YT: writing - review and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.