Development of an INCTR Faculty and Partnerships with Universities
Given that a major component of INCTR’s work is education and training, a faculty of sufficient size, potentially involving partnerships with academic centers or professional societies, is required. The following observations were made by committee members:
- Experience has shown that there is a pool of talent interested in existing programs (e.g., pathology, palliative care, pediatric oncology) ready to undertake expert visits, assessment, and web-based case discussions, and assist in the implementation of solutions.
- Twinning (institutional partnerships) is a basic model to pursue, however, this program should be based on INCTR Teams, often from several centers rather than single individuals, should, in general, participate in the selected activities – predominantly training and education, but also clinical studies or advocacy relating to early detection of cancer. Several such programs have been initiated by the palliative care program, and multiple potential partners have come forward (Georgetown University, University of Lund, NCI, INCA, etc.).
Faculty Members
The issue of faculty credentials was discussed. It was felt that appropriately qualified persons (e.g., oncologists, palliative care specialists) working at reputable institutions, particularly if well known to INCTR staff, would be eligible to be faculty members. Faculty will need, however, to be familiar with the problems of countries with limited resources, such that their first visits should, in general, be undertaken with INCTR staff or faculty members already working in the country or region as a form of “orientation” and also to introduce them to INCTR associates working in collaborating centers in developing countries. It was recognized that Faculty should not necessarily be exclusively derived from high income countries (HIC); some well-trained and experienced persons working in low- and middle-income countries (LMIC) may have much – even more, due to their familiarity with resource-poor circumstances – to offer.
Since faculty members would have various amounts of time available, it was not felt that a minimal amount of time should be expected, although it would be useful to know how much time faculty would be able to commit – either as an online discussant or consultant, or in visiting one or more institutions in specific countries. Assessment visits might ideally be comprised of multiple experts.
Faculty members could be at various levels of seniority. The more junior members would be primarily engaged in teaching and education, the more senior may play an important role in developing strategies, e.g., relating to a specific project, or even to cancer control at a national level. Even medical students and trainees would benefit greatly from an international experience of this kind. INCTR has already organized visits of medical students, young physicians and nurses to various institutes it works with, particularly the Ocean Road Cancer Institute.
Mechanisms and Incentives
A variety of mechanisms of donating time by faculty members could be envisioned. One might be a sabbatical period, another might be simply leave, or unpaid leave. In the latter case a “consultation fee” may be required since it would not be fair to expect persons to lose income as a result of participating in the faculty.
Incentives to participate were felt to be essential and could include advantages in the pursuit of an academic career path insofar that faculty members would have a broader perspective and may engage in specific international research projects. At a personal level they would have opportunities to learn something of other cultures and other health systems. Persons interested in a career in international cancer control, e.g., with the United Nations or an NGO such as INCTR – an area of increasing importance likely, therefore, to require persons with international experience – would be in a better position to secure a desired post, or to be promoted as a consequence of their experience.
The Program
INCTR will need to develop a more structured program that is well coordinated and focused on areas or disciplines already within the scope of existing INCTR programs (although new programmatic areas are anticipated to be developed as time goes by). The two major components would be actual visits, and participation in the development of training tools, whether for use in “hard copy” format or online. The latter might be well-constructed, comprehensive courses, or simply information, as for example INCTR and MERLOT have made freely available via the OERC program (see page 24). In addition, specific online case discussions as generally conducted in “tumor boards” or multidisciplinary meetings would be another format to be considered. This would also help orientate faculty members who have not visited institutions in LMIC to the problems created by limited resources.
It was felt that bilateral exchanges, where trainees from LMIC spend time in institutions in HIC, held a significant risk of permanent migration of the participants for reasons of improved professional and personal circumstances.
Another discussion point was accreditation of specific competences. This could be performed by INCTR, or INCTR in conjunction with another organization or university. This is already ongoing in Brazil, where some 20 centers have been accredited by INCTR Brasil as competent to manage clinical trials.
Not only was it felt that this program is essential to INCTR’s evolution, but that it would bring added credibility and “branding” that would eventually be of great value to fundraising endeavors of many different kinds.
- INCTR Faculty and Partnerships working session.
CEC - Cancer Expert Corps - the Peace Corps for Cancer
Dr. Norman Coleman presented a similar concept he has been working to establish for many years – in essence, a multinational corps of mentors. He would envisage INCTR being among programs CEC would support. He pointed out that while this was critical to organizations like INCTR working in the field, this kind of activity is generally not valued by most academic institutions or promotion committees in HIC, albeit, the issue goes well beyond cancer care and has implications for global collaboration and bilateral partnerships.
The goal of CEC is to mentor Associates-in-Training to a point where they are able to conduct protocol-based cancer care at a high standard. This would require the development of multiple skills and talents, a high degree of motivation, adaptation to specific countries and would involve a range of health care providers, not just physicians.
For success, academic institutions would need to recognize the value of this kind of activity (or at least to accept it as a possible activity for staff in periods when they are not required for patient care – as is the case for the University of Lund, for example. In addition, funding would need to be found, potentially via government to government agreements.
The project sequence was identified as 1. Needs assessment, 2. Establishment of goals and timeline, 3. Identification of the expert team (that may change as progress is made and needs change), 4. Metrics (measurement of progress) and 5. The development of independence in trainees who may then become mentors.
It was felt that INCTR could serve as a model and as a laboratory. Several of its programs, including pathology, pediatric cancer and palliative care, already have established programs of this kind. However, funding the needed expansion remains a problem.
