Thursday, September 21, 2023

Training of Cancer Specialists – The INTERACT-EUROPE Project

The INTERACT-EUROPE Project aims to improve training by promoting cross-disciplinary training among medical oncologists, cancer surgeons, and radiotherapists; it has received support from various organisations, including the European Commission, by Professor Niall O’Higgins

For the past thirty years, the practice of combined meetings of specialists has become a standard feature in the planning of care for patients with cancer. The diagnosis and treatment plan for every patient is discussed in order to reach the most appropriate decision for each.

At first these were multidisciplinary meetings, taking place among medical specialists involved in diagnosis (radiologists, pathologists) and treatment (cancer surgeons, radiotherapists, medical oncologists).

Later these meetings became multiprofessional, as they became enhanced by the participation of specialist nurses, physiotherapists, and other allied specialists.

Unanimous agreement exists that such meetings, preferably held in person, have advanced the quality of decision-making and planning of patient care, particularly at the crucial points of diagnosis and primary treatment.

They have led to improved accuracy, reduction of error and better communication throughout the pathway of cancer care.

In order to have meaningful dialogue, it is self-evident that each specialist has a full understanding of each of the others’ specialties.

Since modern cancer care may require newer sequencing of treatment (for example, primary chemotherapy or radiotherapy before rather than after surgery, or primary chemo-radiation), it is necessary that each of the therapeutic specialists has a deep understanding of the merits and the limitations of each of the other disciplines.

It is particularly important that the short-term and longer-term complications of each type of treatment is fully appreciated by all involved in planning treatment.

And yet…training of cancer specialists rarely involves mutual understanding among these disciplines.

Cancer specialists in medical oncology, cancer surgery and radiation oncology are trained in different systems and are controlled by different authorities – Royal College of Physicians of Ireland (RCPI), Royal College of Surgeons in Ireland (RCSI) and the Faculty of Radiology, (RCSI) – which are largely independent of each other.

This educational apartheid is an obstacle in the delivery of better cancer care and this difficulty is both unnecessary and remediable.

Development of the INTERACT-EUROPE Project
The INTERACT-EUROPE Project aims at improving training of cancer specialists by promoting the concept and introducing the practice of inter-disciplinary training during the formation of cancer specialists.

The purpose of the programme is not to supplant or compete with existing training systems, but rather to enhance them by adding to the depth and scope of their training arrangements.

In 2016, with the support of the Department of Health, we proposed to the Expert Group on Cancer Control of the European Commission (EC) that a mandatory period of time during the training of medical oncologists, cancer surgeons and radiotherapists be spent in each of the other two specialties in order to develop better mutual understanding among specialists, and thereby enhance the value and quality of multidisciplinary meetings. This proposal was accepted and approved by the EC and also by the European Society of Surgical Oncology (ESSO), the European Society for Radiation Oncology (ESTRO), the European Cancer Organisation (ECO) and patient advocacy groups.

The idea of interdisciplinary or cross-disciplinary training of cancer specialists was strongly supported by the Commission’s Beating Cancer Plan, officially launched in February 2021.

The Plan commits €4 billion to improving cancer care through prevention, screening, reducing inequalities and strengthening dialogue among specialists.

The Plan also announced an ‘Inter-Specialty Cancer Training Programme’ focused on delivering ‘a more skilled and mobile workforce through cross-border training and information-sharing’ and on optimising ‘collaboration among cancer specialists’.

In response to the Plan, a consortium of 33 educational and specialist partners, including UCD and TCD, was convened and a bid for the development of a training programme was submitted to the EC. The bid was successful.

Spearheaded by the European Cancer Organisation, an inter-disciplinary training programme was devised to include the nursing as well as the medical profession. The project is entitled INTERACT-EUROPE.

Progress to date
In developing the project, agreement was reached that ‘inter-specialty’ training (IST) occurs when two or more specialties within professions or multidisciplinary teams learn from each other, and practice in collaboration to provide high quality cancer care to patients.

A learning needs analysis was carried out involving (i) a scoping review of interprofessional education in oncology (ii) a survey investigating the perceived value of defining specific competencies in oncology (iii) a qualitative study surveying respondents’ knowledge and experience of interprofessional education.

The conclusions strongly supported the concept, and encouraged the development of inter-disciplinary training.

Curriculum development
The development of a competencies-based curriculum derived from published European curricula, including the European Code of Cancer Practice, ESSO core curriculum, ESTRO core curriculum, European Oncology Nursing Society (EONS) Cancer Nursing Education Framework, European training requirements for the specialty of medical oncology and the European Pain Federation core curriculum.

The curriculum consists of 127 competencies aligned in accordance with the CanMEDS framework, slightly modified so that the central competency is described as ‘Clinical Expert’ rather than ‘Medical Expert’. The other pillars of the framework are Collaborator, Professional, Health Advocate, Scholar, Leader, Communicator.

Trainees and training centres
A pioneer cohort of trainees and cancer centres has been recruited to take part in the programme. Each trainee will be supported by a mentor within their centre/hospital. Eligibility of trainees to participate incorporates criteria utilised for appointing trainees to specialist training in oncology across Europe.

Criteria for eligibility of training centres include those hospitals which (i) are designated as cancer treatment centres (ii) can deliver inter-specialty cancer care within the centre or its associated network (iii) can arrange an appropriate mentor/trainee interactive dialogue and (iv) can provide trainees with the time and support to complete the programme.

Centres are encouraged to achieve a balanced representation of trainees from their centre, preferably to include at least one designated cancer surgeon, one medical oncologist, one radiation oncologist and one cancer nurse.

Rotation among specialties and on-line components
The programme has both on-line and face-to-face components. It is expected that a physical rotation for trainees in medical oncology, cancer surgery and radiation oncology can be arranged for a period of at least one month to each of the other two specialties.

This arrangement could take place within a single hospital setting or across a network of associated hospitals designated as cancer centres.

It is likely that this arrangement is applicable to many states within the EU. Where it is not possible the on-line component alone will apply.

Translation requirements
The pioneer cohort will take part in an online event, delivered in English and arranged for September, at which the pre-recorded session will be translated into French, Spanish, German and Slovenian). Work continues on other languages involving both synchronous and asynchronous translation capability.

Assessment and certification
Methods of assessment of the programme are under evaluation, and it is expected that online and in-person training events for doctors will be submitted for accreditation to the Accreditation Council of Oncology in Europe (ACOE). Certification for nurses will probably include the recommendation of the European Credit Transfer and Accumulation System, 0r equivalent, for learning activities and completion of the training programme.

Following the satisfactory progress of the project, a second bid (INTERACT-EUROPE 2) was submitted to the EC for funding to disseminate and implement the programme across the Member States of the EU.

An announcement was made last month that this bid has been successful, and a programme to recruit 100 cancer centres will be established once the first phase has been completed at the end of 2023.

The project has been welcomed throughout the EU and beyond by doctors, nurses, other health professionals, and patient advocates and greeted with enthusiasm by MEPs and by senior members of the EC. It is a pleasure to acknowledge the assistance of the Department of Health in encouraging this Irish-led initiative during the early stages of its development.

The favourable and widespread response to the proposal for inter-disciplinary training for cancer specialists suggests that this concept might be applied to other areas of healthcare such as mental illness, cardiovascular disease, and chronic neuro-muscular-skeletal disorders.

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