Q-GOAL study: quality in gynecologic oncology advancement for learning: a global perspective

Gynecologic oncology surgery is delivered by clinicians with diverse specialty backgrounds and varied training pathways. The Q-GOAL (Quality in Gynecologic Oncology Advancement for Learning) study aimed to explore the heterogeneity of these training experiences, identify common training structures and surgical exposure profiles, evaluate self-reported surgical confidence, and compare these findings across income levels.

An open, cross-sectional, web-based survey was conducted between July and September 2025 using convenience and snowball sampling. The survey was distributed globally to trainees and consultants in obstetrics and gynecology, general surgery, gynecologic oncology, and surgical oncology. Descriptive statistics and exploratory unsupervised multi-variate analyses were performed.

A total of 1,035 clinicians participated (92% completion rate), of whom 64% were from low- and middle-income countries. Most respondents had an obstetrics and gynecology background, with general surgeons contributing a greater proportion in low- and middle-income countries than in high-income countries (23% vs 5.5%). Training pathways included dedicated sub-specialty programs, rotation-based training, and a small proportion reporting no formal training. Rotation-based training was associated with a less structured training environment in the latent class analysis. Multiple correspondence analysis identified distinct low-, intermediate-, and high-volume training profiles. Increased surgical exposure was associated with higher self-reported confidence, and income status remained an independent predictor of surgical confidence.

The study demonstrated the diversity of the workforce delivering gynecologic oncology surgery globally. These findings highlight the need for internationally harmonized training standards and a minimum level of surgical exposure, while recognizing the differences among health care systems worldwide.