A sustainable healthcare system relies on an array of infrastructural resources to provide for the
healthcare needs of a population, including material inputs (like clinics, hospitals, medicines, and
equipment,) cultural and system inputs (health awareness, management systems, educational and
training processes, insurance and other payment or financing mechanisms) and significant human
resources (doctors, nurses and other personnel.) The OPEN Pathology Education Network aims to support
and partially stabilize the system in developing settings by offering curated, high quality, pathology
training materials virtually, in company with intermittent live virtual mentoring to pathology trainees and
pathologists. At current training rates, literally hundreds of years will be required to reach parity with
developed countries in terms of numbers of pathologists relative to population for many sub-Saharan
African countries. Training program spaces are limited due to trainee salary support and access to
instructional and clinical materials. Furthermore, trainees who travel to developed countries frequently
do not return to their country of origin, and if they do find it difficult to adapt their knowledge and
training to local circumstances. Based on a sample of applicants for the CAP Foundation Global Education
Award, a number of pathologists in sub-Saharan Africa also practice in solo-practice settings, with limited
institutional support to advance their skills through participation in continuing education events with
access to international expertise. Practitioners in such settings risk burn-out and other adverse responses
to the settings of isolation.
OPEN aims to remedy a number of the issues associated with the above circumstances by offering a
freely available pathology learning portal through which individuals can access curated and organized
training materials comparable to what would be obtained during a standard residency training program
without leaving their resident country. COVID-19 and the antecedent social media transformation
resulted in a plethora of remote learning materials directed at pathology residents and others; however,
these are widely dispersed among a sea of other materials in a largely disordered, chaotic cyberspace
morass. Additionally, many organizations house materials that are more organized, even into a sub-
curriculum, but which have exceeded their shelf life in the Western medical education market, but which
may have value in other settings where standard of care lags that of the developed countries. These
types of materials are what OPEN aims to offer through the portal. The curriculum is being designed by
experienced pathology educators (under the direction of Kamran Mirza and Raul Gonzales) into modules
composed of a mixture of video lectures, case presentations, self-assessments, virtual textbook content,
open access journal articles, recorded sign-out sessions, and live and recorded mentoring sessions.
Extensive use of digital slide content for morphologic disciplines is made possible by open access to the
resources of PathPresenter (thanks to Raj Singh) and the DPA’s Digital Anatomic Pathology Academy
(DAPA). Each module will include an assessment aimed to establish diagnostic competence. Additionally,
OPEN aims to encourage the development of pathology care networks, by promoting interaction between
portal users and mentors, reinforcing the concept that pathology is a “team sport.” In order to optimally
track user accomplishments and use of the OPEN portal, appropriate software and IT infrastructure will
be required.
Currently, OPEN has two pilot projects underway, though without the benefit of a functioning portal, they
are operating entirely in a “manual” mode. The OPEN Asia Bladder Cancer (ABC) project is a
collaborative effort of OPEN volunteers at the Universities of Michigan, Oklahoma and Arkansas with
leadership at the University of Medicine and Pharmacy in Ho Chi Minh City to empower them to offer
bladder cancer screening and follow-up via urine cytology, a service currently not offered anywhere in
the country. This project will develop a country-appropriate methodology along with training materials
and local training capacity to begin to expand this service to other pathology divisions in the country.
This project is only about 15% complete at this point, but all the key participants are engaged and
optimistic.
The second project includes mentors from Yale University (Vinita Parkash) and the University of
Oklahoma (Lewis Hassell) to provide a training curriculum in GYN pathology to general pathologists and
trainees supporting a Gyn-Oncology Virtual Tumor Board. This tumor board is part of a global virtual
training program in gyn-oncology supported by the International Gynecologic Cancer Society (IGCS) at
Da Nang Oncology Hospital (DOH). Based on discussions with IGCS leadership, if proven successful, the
program can be further rolled out to others among the more than 50 such sites being supported by IGCS
in Africa, Central Asia and other under-resourced sites. Ten Vietnamese pathologists and trainees
(including several pathologists based at hospitals other than DOH) are participating in the project which
includes self-study materials such as those described above, and live interactive sessions at least
monthly. Metrics used to evaluate the progress include the number of cases presented at the tumor
board where expert review results in a change in diagnosis, and individual performance on diagnostic
challenges and assessments. Training materials will include applying diagnostic criteria according to
WHO 5th edition Female Genital Tumors, and application of the CAP Cancer Checklists for gynecologic
sites.
OPEN has determined to use open source software (Moodle) to provide the learning management system
and foundation for our portal. Additionally, we believe that employing within platform/app messaging
software (SendBird) will promote learner interactions and networking and also facilitate more frequent
mentoring contact. The grant seeks funding to provide the IT licensing and operational/hosting and
marketing costs for the first two years of the project as we come to scale and provide demonstrable
proof of concept. We believe that longer-term infrastructure support will then be possible through
affiliation arrangements with other organizational stakeholders such as IARC, CAP, ASCP and DPA, along
with commercial stakeholders like Roche, Leica and Merck.
