|Year : 2022 | Volume
| Issue : 7 | Page : 1038-1045
Unveiling research training gaps in oncology: Evaluating a research capacity-building effort among Nigerian physicians
IA Owoade1, F Wuraola2, O Olasehinde2, PA Akinyemi1, K Randolph1, AJ Dare1, TP Kingham1, OI Alatise2
1 African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
2 African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex; Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Nigeria
|Date of Submission||27-Apr-2021|
|Date of Acceptance||30-May-2022|
|Date of Web Publication||20-Jul-2022|
Dr. I A Owoade
African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Cancers are a disease of growing public health importance in Africa, but cancer research capacity in the region is underdeveloped. The quest to foster and promote locally conceptualized and conducted oncology research in Africa have informed the African Research Group for Oncology's (ARGO) research capacity-building efforts in Nigeria. Aim: To evaluate the effectiveness of oncology research capacity-building initiatives among Nigerian senior trainees and junior faculty physicians. Subjects and Methods: Panel study design was employed to study Nigerian senior trainees and junior faculty physicians who participated in two research capacity-building symposia. Data were collected pre-and immediate post-symposia, and 3-month post-first symposium. Changes in knowledge were assessed using the Chi-square test and confidence levels using the Wilcoxon signed rank test. A P value of <0.05 was considered statistically significant. Results: In the first symposium, the participants' pass rate in the knowledge-based questions improved from 9.8% to 46.7% to 81.5% at the baseline, immediate post-symposium, and 3-month post-symposium, respectively (P < 0.001). Likewise, the participants' confidence level in carrying out certain research-related activities increased after the second symposium (P < 0.001). Conclusion: The study concludes that building capacity for oncology research in low- and middle-income countries is possible with focused symposia and educational programs.
Keywords: Cancers, capacity building, research
|How to cite this article:|
Owoade I A, Wuraola F, Olasehinde O, Akinyemi P A, Randolph K, Dare A J, Kingham T P, Alatise O I. Unveiling research training gaps in oncology: Evaluating a research capacity-building effort among Nigerian physicians. Niger J Clin Pract 2022;25:1038-45
|How to cite this URL:|
Owoade I A, Wuraola F, Olasehinde O, Akinyemi P A, Randolph K, Dare A J, Kingham T P, Alatise O I. Unveiling research training gaps in oncology: Evaluating a research capacity-building effort among Nigerian physicians. Niger J Clin Pract [serial online] 2022 [cited 2022 Aug 8];25:1038-45. Available from: https://www.njcponline.com/text.asp?2022/25/7/1038/351443
| Introduction|| |
The incidence of cancer in Africa is increasing, making it a major public health burden and an increasingly common cause of death.,, However, cancer research capacity in the region remains underdeveloped and is an area of significant unmet need. Research which is conceptualized, conducted, analyzed, and published by Africans is central to meeting the health needs of the continent. Building research capacity can promote problem-solving, reduce the gap between evidence and practice, and promote health gains. Research capacity building is defined as “the process by which individuals, organizations, and societies develop the ability (individually and collectively) to perform research functions effectively, efficiently, and sustainably to define objectives and priorities, build sustainable institutions, and bring solutions to key national problems.” Building capacity for health research in low- and middle-income countries (LMICs) has also been identified as a driver of development and an essential component of strengthening the healthcare system and as a requirement for efficient investment of limited resources.,
Some of the unique challenges that LMICs face when undertaking healthcare-related research are a persistent scarcity of proficient researchers and competent interdisciplinary research teams and limited research career opportunities and funding, among others. These challenges are particularly obvious in cancer research and contribute to a lack of local evidence necessary for driving change and improving outcomes.
In Nigeria, there is a clear need for training in oncology research. As in other LMICs, there appears to be a rising incidence of cancers in the country, although population-based cancer registry data is lacking in most states. Nigeria has committed to a National Cancer Control Plan (2018–2022) that includes scaling up cancer services, promoting earlier detection, and improving cancer outcomes. Achieving these ambitious goals will require training of oncologists and other physicians and healthcare providers in cancer care and cancer research, monitoring, and evaluation science. Supporting Nigerian physician scientists in oncology is vital and doing so requires an opportunity for them to develop cancer-specific research skills and career pathways. The content of cancer-focused research training should include study design and methodology for carrying out cancer-focused epidemiological, translational, health services, and clinical trial research., To the best of our knowledge, there is little oncology research capacity building currently taking place in Nigeria.
Based on the desire to proffer a solution to the shortage of oncology specialists and oncology researchers in Nigeria, the African Research Group for Oncology (ARGO), a consortium formed in 2013 through the collaborative efforts of surgeons at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, and the Memorial Sloan Kettering Cancer Center, New York, United States of America, is focused on training and conducting cancer-related research by strengthening local research capacity. The ARGO training initiatives include organizing symposia for physician scientists with a special interest in oncology. The ultimate goal of these training initiatives is to improve the outcomes for cancer patients in Nigeria as well as other countries in the continent. One such training initiative was that supported by a grant from the US Civilian Research and Development Foundation in 2019. The goal was to create training that can foster cancer-focused health research capacity building among senior trainees and junior faculty physicians, which can also be scaled up in the future. The objective of this study, conducted among the physician scientists who attended ARGO onsite and online symposia, was to evaluate the effectiveness of the oncology research capacity building on them.
| Materials And Methods|| |
This study was conducted among senior trainees and junior faculty who participated in two separate symposia (onsite and online) organized by the ARGO 1 year apart. The first symposium was held between the 2nd and 3rd of October 2019 at the OAUTHC main auditorium, in Ile-Ife, Nigeria. The second symposium, held between 10th and 11th September 2020, was virtual via Zoom owing to the COVID-19 pandemic gathering restrictions. The goal of these symposia was to create a platform to boost proficiency in the fundamentals of research so that each of the participants would be poised to participate as an investigator in ongoing ARGO studies and as well be able to develop their independent research by taking advantage of ARGO infrastructure. To meet this goal, fifteen topics, including fundamentals of research, mentorship and collaborative opportunity in research, basics of statistics, grant opportunities, and grant management, to mention a few, were chosen by different international and local faculty members.
Study design and study population
Senior trainees and young faculty within 3 years post-fellowship program, drawn from some specialties involved in cancer care, namely, surgery, radiology, pathology, clinical and radiation oncology, and community medicine in the Nigerian ARGO collaborating institutions using panel study design, constituted the study population. The onsite symposium excluded faculty members in the selected departments who had spent more than 3 years post-residency training. However, the online symposium was attended by medical students, junior trainees, and faculty members who had spent more than 3 years post-residency training, in addition to the original target population.
Sample size and sampling technique
First symposium (October 2019): Fifty eligible doctors were selected from the 25 ARGO collaborating institutions to attend the onsite symposium of which forty-seven attended the symposium. The convenience sampling method was used to administer the questionnaire.
Second symposium (September 2020): Ninety-two potential participants registered through the online link sent to them via email addresses and the group WhatsApp.
First symposium: Data were collected using a self-administered questionnaire. The pre-symposium questionnaire comprised four sections: section A: socio-demographic variables, section B: participants' previous research experience and grant management, section C: participants' expectation from the symposium, and section D participants' knowledge in the fundamentals of research (study design, methodology, and basic statistics).
The immediate post-symposium questionnaire comprised two main sections: section A, participants' rating of how helpful/relevant each topic taken in the symposium was; section B, participants' knowledge in the fundamentals of research (study design, methodology, and basic statistics) covered during the symposium. The knowledge-based questions contained in both pre- and post-symposium questionnaires were categorized into three domains, namely, epidemiological design, qualitative research, and basic statistics. These questions directly assessed the immediate impact of the symposium on the participants' knowledge of the fundamentals of research and basic statistics.
The same set of questions assessing the participants' knowledge of fundamentals of research were contained in the questionnaire administered via e-mail 3 months after the symposium to assess medium-term retention of the knowledge gained, in addition to other questions assessing participants' progress in the area of conduct of research.
Second symposium: Data were collected using a self-administered questionnaire hosted on Survey Monkey. The pre-symposium questionnaire comprised three sections: section A, socio-demographic variables; section B, questions that assessed participants' previous research experience and mentorship; and section C, which assessed participants' level of confidence in carrying out certain research-related activities such as generating a research question, choosing an appropriate research design, applying basic statistical tests, analyzing qualitative data, clinical trial study design, interpretation, etc.
Data were analyzed using IBM SPSS version 25 for Windows (IBM SPSS Inc., Chicago, USA).
First symposium: Categorical variables such as socio-demographic variables, participants' previous experience with research and grant management, and perceived usefulness of the lectures were summarized using frequency tables and charts. Knowledge scores at pre-symposium, immediate post-symposium, and 3 month post-symposium assessments were compared using Chi-square tests. A P value < 0.05 was considered to be statistically significant.
Second symposium: Categorical variables such as socio-demographic variables, participants' previous experience with research, grant management and mentorship, and participants' level of confidence in carrying out certain research-related activities before and after the symposium were likewise presented in tables. The difference in the confidence level was analyzed using the Wilcoxon signed rank test.
Ethical approval was sought and obtained from the Ethics and Research Committee of the OAUTHC, Ile-Ife, Nigeria. The Ethics and Research Committee approved that consent be waived since this study was part of the assessments of symposia targeted at capacity building for research. Confidentiality and data security were assured. Participation was made voluntary as each participant was at liberty to opt out of the study at any point.
| Results|| |
First symposium: A total of forty-seven participants attended the onsite symposium. However, forty-one participants (87.2%) took part in the pre-symposium assessment, and forty-five (95.6%) completed an immediate post-symposium assessment questionnaire. Twenty-seven (57.5%) of participants present at the symposium were successfully contacted 3 months post-symposium through a social media platform (WhatsApp) created immediately after the symposium for follow-up. The mean age of the forty-one participants who completed the pre-symposium questionnaire was 37.5 ± 3.5 years. The majority were males (70.7%). Only 26.8% of the participants had professional experience greater than or equal to 10 years post-first medical degree [see [Table 1]]. A higher proportion of participants (78%) were interested in clinical research, whereas 17.1% were interested in both clinical and translational types of research. The top three items identified by participants as obstacles to undertaking research included lack of mentorship (75.6%), lack of financial support for conducting research (56.7%), and lack of knowledge on research design, funding, and grant management (46.3%). About 93% of the participants had no previous experience in clinical trials, 65.9% had no previous experience with cancer-related epidemiological studies, 61% had no previous involvement or experience with manuscript writing and preparation, and about 95.1% did not have any prior experience with grant management [see [Table 2]].
|Table 2: Participants' previous experience with research and grant management|
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Many of the forty-five participants who completed the immediate post-symposium questionnaire (64.4%) found the topics taught in the symposium most useful/relevant for developing and progressing in their research careers [see [Figure 1]].
|Figure 1: Usefulness/relevance of topics covered in the symposium to the participants' research career|
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Almost all participants came up with at least one research goal for the coming year including some participants whose goal centered on readiness to partner with the ARGO in various cancer-related research initiatives. In general, there was a sustained improvement in the pass rate across the three stages of the assessment. The overall pass rate (i.e., the proportion of participants who scored 50% and above in the knowledge-based questions) increased significantly from 9.8% to 46.7% to 81.5% in the baseline, immediate post-symposium, and 3 month post-symposium assessments, respectively (P < 0.001). When the performance in the knowledge-based questions was disaggregated to the three main domains covered in the symposium—epidemiological design, biostatistics, and qualitative research domains—the proportion of participants who scored 50% and above also increased significantly (P < 0.001 for epidemiological design and qualitative research domains and P = 0.002 for the biostatistics domain) [see [Table 3]].
Additionally, 66.7% of the participants who returned their questionnaire 3 months post-symposium had written at least one research proposal after the symposium. Thirty-seven percent of these written proposals were cancer-related. Whereas the cancer-related proposal writing process was completed for 11.1% of the participants, only 5.6% of them had commenced data collection [see [Table 4]].
Second symposium: Eighty-eight (95.7%) completed the pre-symposium questionnaire, whereas fifty-three (57.6%) completed the post-symposium questionnaire, both hosted on Survey Monkey.
The mean age of the eighty-eight participants who completed the pre-symposium questionnaire was 37.4 ± 7.2 years, with the majority still being males (77.3%) [see [Table 1]]. Whereas a higher proportion of participants (78.4%) were interested in clinical research, only 13.6% of them had a formal research degree. However, only 35.2% of participants in this second symposium participated in the first, and the top three items identified by participants as obstacles to undertaking research came with different rankings, namely, lack of financial support for conducting research (65.9%), lack of mentorship (60.2%), and lack of research infrastructure (52.3%). Only 4.5% of the participants hold research grants or funding. However, participants have different categories of mentors—31.8% had mentors at their home institution, 12.5% at another Nigerian institutions, and 35.2% had mentors outside Nigeria [see [Table 2]]. Participants' confidence level in carrying out some research-related activities increased significantly after the symposium compared to what it was before the symposium (P < 0.001) [see [Table 5]].
|Table 5: Pre- and post-symposium confidence level in carrying out certain research-related activities|
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| Discussion|| |
Nigeria, like many other LMICs, faces a high cancer burden associated with poor outcomes due to late presentation and low access to treatment. Efforts to improve cancer outcomes in the country should be informed by locally relevant evidence. However, there is an existing gap for cancer research capacity building. Greater ability to develop and lead cancer research focused on Nigerian priorities and needs represents a major pathway to changing the cancer narrative in the country. The ARGO is rising to the occasion, filling the existing gaps in oncology research capacity in Nigeria through its training initiatives. Another example of African initiatives to increase research capacity in Nigeria is the Consortium for Advanced Research Training in Africa (CARTA) program. This initiative has focused on training health-science researchers in Africa for the future and has ensured that the training of these young scientists would make them globally competitive., This consortium comprises institutions in Kenya, South Africa, Tanzania, Uganda, Malawi, Nigeria, and Rwanda with key northern partners. The aim of the CARTA is to build a vibrant African academy able to lead world-class multidisciplinary research that positively impacts public and population health., Some Ph.D. students in member institutions have benefited from the CARTA's capacity-building programs.
Our evaluation revealed a paucity of cancer-focused research knowledge and skills among the study population at the baseline. This reflects what has been reported in many scientific journals that health research capacity in LMICs remains deficient.,,,,, Our study also identified that participants had poor knowledge of study design and statistical analysis at the baseline. Studies have associated low authorship from LMICs with poor knowledge of study design and statistical analysis, among others, hence increasing reliance on researchers from High Income Countries (HICs)., Participants also identified lack of funding for research and lack of mentorship as major barriers to conducting research. This is congruent with what is reported elsewhere in the literature and associated with low research capacity in LMICs.,
Our study demonstrated a significant improvement in knowledge about the fundamentals of research, which was sustained 3 months after the symposium. This was also reflected in the positive progressive impact of the capacity-building initiative on the participants' own research practice and significant improvement in the participants' confidence level in carrying out certain research-related activities. This is similar to the finding in an evaluation conducted on Tropical Disease Research's (TDR) contribution to individuals and institutional research career capacity strengthening between the initiation and the end of the training program, in which participants demonstrated substantial improvements in their self-perceived efficacy for study conceptualization, study planning, and the ethical conduct of research. The difference between the two studies is that while our study was a stage-wise evaluation of serial symposium exposures, that conducted on TDRs research capacity building initiative was on grant award to pursue higher degrees in institutions of learning. The sustained improvement in the knowledge of fundamentals of research observed 3 months after the first symposium in our study could be partly attributed to the mentoring provided to the participants who were successfully followed up via the social media platform. Similar improvement in knowledge was observed in the different cadres of health workers provided with clinical mentorship required to render better-quality healthcare services in a study conducted in Jigawa State, Northern Nigeria. The study in Jigawa State focused on evaluation of capacity building for service delivery contrary to evaluation of research capacity building, which was the main focus of this study.
The two symposia evaluated in this study provide valuable lessons and guide points for future learning goals and strengthening of research capacity building in Nigeria. The onsite symposium allowed participants to engage in small participatory group work. It also provided an excellent opportunity for the facilitators to learn more about the individual participants and their respective interests in research. COVID-19 pandemic gathering restriction was also an eye-opener to the vast potential of research capacity building that can be explored online. We also learned through the review of the participants' performances at the various stages of the assessment that whereas the lectures resonated well with participants and their knowledge base and confidence level in carrying out specific research-related activities increased post-symposia, they still highlighted the need for additional support. As such, there remains an opportunity and a need for in-depth training and ongoing mentorship around the fundamentals of clinical research and their application to clinically relevant questions, coupled with assistance in budget preparation and publication of research manuscripts. The symposia evaluated in this study allowed us to introduce and open a pathway for physician researchers in Nigeria to pursue learning opportunities that would enable them to gain the knowledge and opportunities to further their scientific and professional careers in the global field of cancer research. This can gradually fill the existing gap for oncology researchers in Nigeria. Likewise, the model of small group work employed in the onsite symposium should be included in future training. Selecting a few of these participants to pursue additional degrees for research capacity building will also be explored in the near future.
| Conclusion|| |
There is a need for cancer research capacity building in Nigeria, similar to many LMICs. This study demonstrates that both in-person and online symposia focusing on the fundamentals of cancer research in Nigeria can successfully increase baseline knowledge, skills, and experience and encourage greater participation in research. This study also provided an opportunity for Nigerian physician scientists to identify and reflect on the critical areas of need and the challenges faced in conducting clinical research related to cancer in the country. It provides invaluable guidance for strengthening and building research capacity in Nigeria and for growing a network of individuals and institutions committed to undertaking rigorous research that is relevant to cancer needs in Nigeria. Through ARGO's training infrastructure, its platform for mentorship, and the expanding cancer-related studies underway; it is committed to closing the knowledge gap and building a strong cadre of physician scientists who will expand cancer research expertise across the African continent.
This publication is based on a work supported by a grant from the US Civilian Research and Development Foundation. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the US Civilian Research and Development Foundation.
The research capacity-building efforts of the ARGO is on the path of filling the existing gaps in research capacity among Nigerian physician scientists.
Financial support and sponsorship
US Civilian Research and Development Foundation CRDF.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]