A Longitudinal Assessment of Remote IMRT/VMAT Training for Medical Physicists in Low- and Middle-Income Countries.

Abstract

Equitable access to high-quality cancer care depends on scalable, sustainable training initiatives, particularly in radiation oncology. This study evaluated whether gains in treatment planning competency, confidence, and knowledge among medical physicists were maintained 2 years after a virtual volumetric modulated arc therapy/intensity modulated radiation therapy (VMAT/IMRT) training course. Medical physicists who completed a 15-week virtual training in 2022 were reassessed 2 years later via remote submission of a head and neck VMAT/IMRT plan, a multiple-choice knowledge test, and a confidence survey. Plan quality was assessed using automated scorecards (25 points) and expert rubrics (14 points), whereas knowledge and confidence were measured via surveys. Wilcoxon signed-rank tests compared pre, post, and follow-up outcomes. Effect sizes were calculated using Cohen's d. Nineteen of the 40 invited participants who had completed the prior postcourse assignment (47.5%) were enrolled in the follow-up study, representing 15 countries across four continents. Seventeen participants had complete data, defined as submitting pre, post, and follow-up responses for both objective and subjective assessments. Objective scores improved from 10.5/25 (±8.1) pretraining to 16.4/25 (±6.8) posttraining and 18.6/25 (±6.4) at follow-up (P = .011 and P = .001), with no significant change from posttraining to follow-up (P = .26). Subjective scores declined posttraining (11.1/14 ± 5.9 to 8.5/14 ± 3.0; P = .021) but rebounded at follow-up (10.8/14 ± 3.4; P = .037), with no difference from baseline (P = .96). Among 18 participants with complete survey data, confidence improved from 3.18 ± 1.26 at baseline to 4.14 ± 0.95 posttraining and was sustained at 4.12 ± 0.74 at follow-up, with a significant improvement from baseline to follow-up (P = .0023). Knowledge increased from 65.3% ± 29.9 at baseline to 83.3% ± 17.1 posttraining and was sustained at 80.6% ± 20.2 at follow-up, with a significant improvement from baseline to follow-up (P = .026). Remote VMAT/IMRT training led to lasting improvements in treatment planning, confidence, and knowledge, with objective scores continuing to rise over time. These findings support remote education as a sustainable model for building radiation therapy capacity in low- and middle-income countries.