The International Gynecologic Cancer Society Global Fellowship Program: advancing access to gynecologic oncology and...

Gynecologic malignancies remain a leading cause of death among women in low- and middle-income countries. In 2017, the International Gynecologic Cancer Society (IGCS) started the Global Gynecologic Oncology Fellowship Program in countries without existing training. This 2-year structured program allows fellows to train locally with support from international mentors through in-person visits, virtual mentorship, and didactic instruction. Fellows participate in monthly tumor boards, conduct research, complete international observerships, log surgical cases, and complete an oral exam upon graduation. Our objective was to characterize the growth of this program from 2017 to 2024 and determine best practices and areas for improvement.

Between February and April 2024, 40 IGCS fellowship graduates were invited via email to complete a 38-question survey about their training and post-fellowship experiences. Data were analyzed using descriptive statistics and thematic analysis.

Since 2017, the IGCS fellowship program has expanded from 5 pilot sites to 22 training sites in 18 countries. To date, 52 fellows have graduated and 38 are currently in training. There are 40 international mentors and 53 local supervisors, of whom 15 are previous graduates. Twenty fellows (50%) completed the survey. Nineteen respondents (95.0%) reported practicing as gynecologic oncologists, with an average of 70% of their clinical work focused on this area. However, most reported continuing to provide obstetric and benign gynecology care. Six respondents (30%) reported being the sole gynecologic oncologist at their hospital. Half of respondents never visited their international mentor's site, although 70% reported consistent virtual support. All graduates expressed a need for post-fellowship support, including mentorship, meetings with other graduates, advanced surgical training, and sub-specialty collaboration.

The IGCS fellowship program has significantly expanded gynecologic oncology capacity in low-resource settings. Graduates report valuable training experiences but desire ongoing post-fellowship support, a next step in growth for the IGCS fellowship program.