Project ECHO: a virtual telementoring tool for training dentists in oral cancer screening and tobacco cessation

Summary:

Project Extension for Community Healthcare Outcomes (ECHO) is a globally recognized virtual telementoring tool for training primary healthcare providers (HCPs) in resource deficient settings, by experts at academic health centers, for managing complex medical conditions. Additionally, our Organisation in India is utilizing this model in training HCPs at primary and secondary cancer prevention of breast, oral and cervical cancers- the three most common cancers in India overall, with oral cancer as the most common among males. The findings of an ECHO-based advanced training course conducted among dentists across India, in oral cancer screening and tobacco cessation, showed positive outcomes. The course comprised 14, weekly, hour-long sessions, hosted online by our Organization (hub) through the free online web-conferencing application "Zoom", which was attended by 50 dentists (spokes) pan-India. Each session comprised 1 expert-led didactic and 2 participant-led case presentations, culminating with educative discussions. Twenty-six out of the 50 participants completed the online, post-evaluation questionnaires having 5 multiple-choice questions each (score for every correct response = 1) per session, the responses of which were statistically analysed. The session-wise responses and the overall scores demonstrated a significant knowledge gain among the participants regarding oral cancer screening and tobacco cessation. Hence, the ECHO model may be utilised as an effective online, communication and capacity building tool for dentists, the most appropriate HCPs for undertaking the task of oral cancer prevention, when in-person training is not available.

Background/Objectives:

Project Extension for Community Healthcare Outcomes (ECHO) is a globally recognised virtual telementoring tool for training primary healthcare providers (HCPs) in resource deficient settings, by experts at academic health centers, for managing complex medical conditions. Additionally, our Organisation in India is utilising this model in training HCPs at primary and secondary cancer prevention of breast, oral and cervical cancers, the three most common cancers in India overall. Oral cancer is the first most common cancer among Indian males. The findings of an advanced training course conducted among dentists across India, in oral cancer screening and tobacco cessation, have been discussed.

Description of Intervention and/or Methods/Design:

The training module comprised 14, weekly, hour-long sessions, on various aspects of oral cancer screening, and tobacco cessation, hosted online by our Organization (hub) through the freely available online web-conferencing application Zoom. Fifty dentists (spokes), employed at academic Institutes, government hospitals, or non-government organisations, and private practitioners, attended the sessions from their respective locations pan-India, by logging in through a unique meeting ID provided to them in advance. Each session comprised 1 expert-led didactic and 2 participant-led case presentations, culminating with educative discussions. Participants filled out online, post-evaluation questionnaires with 5 multiple-choice questions each (score for every correct response = 1) per session. The prerequisites to receive certification were дус attend at least 10 sessions, a minimum overall score of 60% in the post-session evaluations, and present atleast one case. The total responses were statistically analysed (sample t test) using the SPSS software version 21.

Results/Lessons Learned: 

A total of 26 participants fulfilled the aforementioned certification eligibility criteria. Session-wise responses of the participants were evaluated, which demonstrated a significant knowledge gain among them regarding oral cancer screening and tobacco cessation. Overall the match score was 60 with a p value of < 0.05. The scores for each session were also significant (< 0.05) except for that on pharmacological interventions for tobacco cessation (p=0.85).

Discussion/Implications for the Field:

The ECHO model is a relatively cost-effective tool due to its virtual feature. The training modules are especially apt for busy HCPs working in urban areas, owing to their weekly only once frequency and short duration of the sessions (1 hour each). The didactics, case presentations and interactive sessions facilitate co-learning and knowledge enhancement. Hence, the Project ECHO model may be utilized as an effective online, communication and capacity building tool for dentists, the most appropriate HCPs for undertaking the task of oral cancer prevention, when in-person training is not available.

Abstract submitted by:

Suzanne Nethan - National Institute of Cancer Prevention & Research
Amrita John - University Hospitals Cleveland Medical Center
Priyanka R. 
Roshni Babu
Roopa Hariprasad - National Institute of Cancer Prevention and Research (ICMR)
Shalini Singh - Indian Council of Medical Research