Implementation of a gynecologic oncology ultrasound training program to support cervical cancer staging at Queen Elizabeth Central Hospital in Malawi

OBJECTIVE

To describe the development, implementation and educational evaluation of a structured gynecological oncology ultrasound training program designed to support loco-regional assessment of cervical cancer in a low-resource setting.

METHODS

A context-adapted ultrasound training program was implemented at Queen Elizabeth Central Hospital, Malawi, within the Blantyre Cervical Cancer Project. The program combined participation in the International Workshop on Ultrasound in Gynecologic Oncology, on-site supervised training, continued clinical practice, and refresher mentorship. Program implementation and educational outcomes were evaluated using the Kirkpatrick framework. Data were derived from trainer evaluation forms, program documentation, and clinical activity records.

RESULTS

The training program was implemented in phases between 2019 and 2023 and involved 2 gynecological oncology trainees. During the initial on-site training period, 168 patients with cervical cancer were evaluated, and 131 supervised ultrasound examinations were performed. Trainees also participated in 38 gynecological oncology surgical procedures, providing opportunities to correlate preoperative ultrasound findings with intraoperative anatomy. Following training, ultrasound was integrated into routine clinical practice, with 2995 patients evaluated and 2852 ultrasound examinations performed over a 10-month period. Refresher training reinforced assessment skills through additional supervised clinical practice. Trainer assessments documented progressive improvement in trainees' knowledge, technical skills, and confidence in gynecologic oncologic ultrasonography. Ultrasound assessment was subsequently incorporated into routine outpatient assessment, multidisciplinary discussion, and treatment planning, demonstrating successful integration of the program into routine clinical workflows.

CONCLUSIONS

A structured, context-adapted ultrasonography training program can enable integration of ultrasonography-based loco-regional assessment into routine care for women with cervical cancer in resource-limited settings. This implementation model represents a feasible strategy for strengthening local imaging capacity.