Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
Int J Gynecol Cancer. 2010 Dec;20(9):1604-8.
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.
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.
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.
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.
随着国际上筛查计划的广泛实施，早期宫颈癌病例将会增加。针对这种情况，每个国家的卫生部都需要制定策略，为这一具有潜在治愈可能的女性群体提供根治性手术或放疗等护理。
加拿大妇科肿瘤学家创建了一个教学模块，对少数经当地确定的妇科医生进行集中培训，以进行根治性子宫切除术和盆腔淋巴结切除术。这个过程基于成人学习原则；涉及一位在中低资源国家工作的加拿大妇科肿瘤学家与妇科医生一起解决医疗保健提供方面的当地问题。
教学过程包括根据模块目标进行的前测和后测。有 7 个模块，包括患者术前评估、锥形活检、根治性子宫切除术、盆腔淋巴结切除术、输尿管损伤、血管损伤和手术后随访。每个模块分为背景信息、技术和并发症。模块中嵌入了视频剪辑。在审查了教育模块后，学习者会反复进行手术程序，包括在每次手术后对手术表现进行详细评估。参与者有机会对培训计划提供反馈。该模块在蒙古进行了审查，并在肯尼亚实施。
在迫切需要提供根治性手术选择来治疗早期宫颈癌的中低资源国家，由经过培训的外科医生提供的集中高强度课程可以立即改变临床和手术实践。
