The current training paradigm in Complex General Surgical Oncology (CGSO) fellowship was established when most graduates pursued traditional academic careers. However, contemporary workforce data suggest increasing misalignment between fellowship selection criteria, training requirements, and eventual career outcomes. Fellowship selection remains heavily influenced by research productivity, leading many applicants to undertake prolonged dedicated research experiences during residency despite substantial financial and institutional costs. Recent studies demonstrate that while most CGSO fellows complete dedicated research time, only a small minority subsequently achieve sustained academic productivity or extramural funding. By contrast, most graduates devote the majority of their professional effort to clinical practice. This discrepancy raises concerns regarding the efficiency and equity of a training model that broadly emphasizes research achievement despite producing a predominantly clinically focused workforce. Simultaneously, increasing demand for cancer care and evolving workforce needs underscore the importance of optimizing training pathways. We propose a differentiated fellowship model consisting of clinically intensive and research-intensive tracks that better align trainee goals with workforce demands. Such an approach would allow more targeted allocation of educational and research resources while preserving pathways for future surgeon-scientists. A corresponding reassessment of fellowship selection metrics is also warranted, emphasizing clinical performance, leadership, professionalism, and holistic applicant evaluation. Aligning selection processes and training structures with contemporary practice realities may improve efficiency, promote equity, and better prepare the future surgical oncology workforce.
Background: Thyroid cancer accounts for over 92% of endocrine malignancies, and its incidence has been steadily rising in recent years. This increase has led to significant research focused on understanding the molecular mechanisms involved in thyroid tumor development. Among the key genetic alterations associated with thyroid cancers are mutations in the BRAF gene, particularly the BRAFV600E mutation, as well as mutations in the RAS gene family (including HRAS, KRAS, and NRAS). These mutations are known to play distinct roles in the development and progression of various thyroid cancer subtypes. Objective: The study aimed to analyze the frequency of BRAF V600E and RAS mutations in thyroid tumors using real-time polymerase chain reaction (PCR). It also sought to evaluate the sensitivity and specificity of immunohistochemistry (IHC) using a mutation-specific anti-BRAFV600E monoclonal antibody (VE1) as a diagnostic tool. Materials and Methods: A total of 50 thyroid tumor cases were included in the study. All samples underwent molecular screening by real-time PCR to detect the presence of BRAF and RAS mutations. Additionally, IHC staining was performed using the anti-BRAFV600E monoclonal antibody (VE1) to detect the presence of the BRAF V600E mutation in tissue sections. Results: The study found that BRAF V600E mutations were present in 56% of papillary thyroid carcinoma cases, showing a strong association with this subtype. In contrast, RAS mutations were detected in 16.7% of cases, specifically in follicular adenomas and follicular carcinomas. A significant correlation was established between BRAF V600E mutations and papillary carcinoma diagnosis, while RAS mutations were associated with follicular-patterned tumors. The IHC method demonstrated 90% sensitivity and 100% specificity in detecting BRAF V600E mutations. No significant correlations were found between BRAF V600E mutation status and various clinicopathological parameters. Conclusion: The BRAF V600E mutation-specific monoclonal antibody (VE1) exhibited high sensitivity and specificity, indicating that immunohistochemistry is a cost-effective and reliable screening method for detecting BRAF V600E mutations in thyroid tumors. This approach may be especially useful in routine diagnostic practice to guide targeted therapy and improve patient management.
Introduction: Surgical guidelines are essential for improving safety, reducing errors, and optimizing outcomes. Developed in 2009, Kenya’s national clinical guidelines aim to standardize surgical practices across healthcare facilities. However, there is limited evidence on their dissemination, adaptation, and utilization, especially in county hospitals. This study investigates the use of surgical guidelines in Kenya’s Level 4 and 5 hospitals, identifies barriers to implementation, and evaluates their impact on surgical outcomes. Methods: We conducted a cross-sectional study across four counties in Kenya, focusing on hospitals capable of providing emergency and specialized surgical services. Data were collected through structured, in-person interviews with surgical department heads, staff, and medical superintendents. Trend analysis of interview data was employed to examine access, training, enforcement, barriers to implementation, and impacts on surgical practices. Results: Forty-three participants from five hospitals reported that 91% had access to surgical guidelines. The World Health Organization (72%) and Ministry of Health (40%) guidelines were most commonly used, primarily covering preoperative (58%), intraoperative (44%), and postoperative (56%) care. In-person training (65%) was most common, and guidelines were credited with improved services (43%), reduced errors (38%), and enhanced infection control (28%). However, resource constraints (50%), staff attitudes (24%), and human capital shortages (15%) were significant barriers. While 76% used enforcement mechanisms, inconsistent application and resource limitations hindered effectiveness. Conclusion: Surgical guidelines are seen as valuable for improving care, but barriers such as resource limitations, poor dissemination, and inconsistent enforcement undermine their full potential. Addressing these challenges through better training, resource allocation, and leadership support is essential.
H igh-quality cancer care is a key priority worldwide. Caring for people affected by cancer requires a range of specific knowledge, skills and experience to deliver the complex care regimens both within the hospital and within the community environment. In June 2022, the European Cancer Organisation along with 33 European cancer societies began working together to develop a curriculum for inter-speciality training for healthcare professionals across Europe. As part of the project, this research consisted of a qualitative survey distributed to the European Union societies via email. The aim of this paper is to disseminate the qualitative findings from healthcare professionals across Europe. Questionnaires were sent out to a convenience sample of 219 healthcare professionals and patient advocates with a response rate of 55% ( n = 115). The findings identified that there were four key themes: ‘What is inter-speciality training?’, ‘Barriers and challenges’, ‘Support throughout the cancer journey’ and ‘New ways of working’. These results are part of a larger needs analysis and scoping review to inform the development of a core competency framework which will be part of an inter-speciality curriculum for specialist cancer doctors, nurses and other healthcare professionals across Europe. Healthcare professionals will be able to access education and training through the virtual learning environment and workshops and by clinical rotations to other specialties.
