To address the Oncology education needs of physicians in India, any changes or enhancements should start from feedback from Oncology professionals in the country. The survey of Indian Oncology professionals for the current study described the viewpoint of those professionals about the state of Oncology education in that country and generated some suggestions about means to resolve the perceived deficiencies.
The International Agency for Research in Cancer report predicted a rise in the cancer burden worldwide with a disproportionate rise in developing countries such as India . It is also documented that countries like India have health care workforce shortages [3, 17–19]. One avenue to address the health care workforce shortage is to educate a larger number of professionals and to expand the continuing educational opportunities for those already in practice. Most 'developing world' countries do not have the educational capacity to increase the pool of health care workers rapidly . For example, although some increases in the number of fellowship training position in India has happened in the last few years, this number may still be inadequate to meet the rising burden of new cancer cases.
The ability to address the disease burden in any population depends on the availability of an adequate pool of appropriately trained health care professionals. This in turn requires the presence of a satisfactory number of training positions that will prepare those health care professionals. Beyond the training at the undergraduate, graduate and fellowship levels, there needs to be a systematic process for providing continuing medical education so that medical care adheres to the most current evidence based principles. The lack of resources for training and continuing medical education would exacerbate a shortage of health care professionals and can pose a major problem. A well-designed CME program for evidence-based practice in Oncology would contribute significantly to alleviating such shortages.
The results of our survey demonstrated that even among a group of highly specialized Oncology professionals, there was a sense that cancer education is grossly inadequate at several levels, except for residency and fellowship training. This was felt most acutely during medical school training where a large percentage (75%) felt that cancer education was poor to fair. It appears that the majority of Indian medical schools do not have separate academic divisions or student rotations dedicated to Oncology. The current curricula appear to be outdated without sufficient emphasis on how to manage the rising number of cancer cases. This is compounded by the fact there is a shortage of adequately trained faculty. Although not as acute, the survey respondents also noted that Oncology education is not ideal during post graduate training as well. The only segment of health care workers felt to have an adequate educational environment in Oncology are candidates in fellowship training. Given this and the small number of fellowship positions  currently available, major reforms are needed to address the problem in the near future.
The resources available to provide education for practicing physicians are also felt to be inadequate and this has been noted by other authors . This is of concern since these individuals are not only the ones responsible for treating patients but also training the future pool of health care workers. Although the majority of survey respondents reported attendance at CME, many also felt there is both a shortage of CME activities and that the quality of the current activities needs to be improved. The majority of the respondents indicated they obtain their CME from attending live courses. This can be a problem in a large country such as India with limited resources and a lack of streamlined transportation facilities. There is a distinct under usage of web based educational activities which seems ironic given the perception of India as a technology center. For a country like India with a rapidly developing information technology framework, web based activities can provide a solution to address CME in remote locations.
The lack of educational curricula and CME translates into inadequate emphasis placed on evidence based practice of cancer care. Nearly four-fifths of the respondents noted that little-to-none or only some emphasis is placed on evidence based medicine. This is particularly noteworthy in cancer care where the field is in constant flux with the availability of new technology, drugs and guidelines on a regular basis. In Oncology, it is vitally important to make current treatment guidelines available to health care professionals. Lastly there are no uniform guidelines developed for the Indian population since those available from the developed world may not always be applicable to the developing world.
The results of our survey point out that, Oncology professionals perceive gaps and needs for enhanced cancer education in India. Although this study employed an exploratory survey instrument, these findings can still be of help in initiating efforts to improving Oncology education in India. Such measures may include: increasing training positions in Oncology, promote awareness of Oncology as a required specialty, updating and streamlining the existing curricula, making CME more widely available and encouraging adherence to evidence based medicine.
There are several limitations to this study. First, it represents the findings of a limited, non-representative sample. Although the meeting at which the survey was conducted was well attended and the survey response rate was adequate, additional investigation is called for before substantial investments are made. Also, although India is representative of the conditions of most developing countries, the educational context may differ in other countries even though the problems of provider shortages and inadequate training are similar in much of the developing world.
The results of this study demonstrate that there are several avenues for enhancement in Oncology education for health care professionals across the spectrum of training and practice in India. In addition, written comments from the respondents helped us to identify gaps and needs for CME. A follow-up survey administered to a representative sample in the future may be useful in targeting measures to address these gaps and needs and should help create the pool of health care professionals needed to tackle the oncoming rising burden of cancer cases in developing countries.