Principal Investigators:
Graham A. Colditz, MD, DrPH
Joaquin Barnoya, MD, MPH
Lauren Arnold, PhD, MPH

Peter Benson, PhD
Katherine Stamatakis, PhD, MPH

Teaching Faculty:
John Crowley, PhD
Robert E. Greenberg, MD

Program Description
Guatemala is undergoing an epidemiological transition and today faces the “double-burden” disease problem of significant infectious and noninfectious disease. Of particular interest is Guatemala’s cancer burden; four of the top ten cancers in men (skin, stomach, prostate and colon) and women (cervix, breast, skin and stomach) could be decreased with interventions such as risk factor modification or screening.

The Instituto Nacional de Cancerologia (National Cancer Institute, INCAN) is the primary source for cancer data in Guatemala. However, infrastructure and resources limit information about prevalence and mortality rates, as well as surveillance and research activities. Simultaneously, U.S. clinical and research trainees have substantial interest in international health. Thus, there is a need to train future clinicians in fundamentals of research from an interdisciplinary perspective, with a focus on working in a resource-challenged region.

Program Goals

This project aims to:

  1. Develop a sustainable cancer research training course for future researchers in Guatemala (INCAN) and the U.S.
  2. Provide guidance and assist with interdisciplinary, inter-institutional cancer research protocol development by INCAN and Washington University in St. Louis postdoctoral trainees
  3. Foster multidisciplinary mentored relationships and collaborations between diverse faculty and trainees from Washington University and INCAN, as well as create opportunities for future research projects.

Program Structure
Led by a multi-disciplinary team of public health faculty, a year-long research training program was developed to: 1) build INCAN’s research capacity; 2) expand Washington University’s capacity for international cancer control; and 3) foster international collaborations and mentorships.

A call for applications was announced at both INCAN and Washington University during the first month of program funding. Interested applicants submitted a summary of research interests and were interviewed by two faculty. The first cohort of ten participants includes five faculty clinicians from INCAN and five resident physicians from Washington University. Participants come from training in internal medicine, oncology, surgery, surgical oncology and palliative medicine.

Educational Sessions
The training program relies on both in-person (held in Guatemala and St. Louis) and web-based sessions. In-person sessions address fundamentals of human subjects research ethics, epidemiology, biostatistics, research methods, clinical trials, cancer prevention and the interaction of culture and health. Emphasis is placed on both didactic and applied learning.

Journal clubs are conducted both in person and via the web.

Mentoring and Protocol Development
On the basis of research interests, each INCAN participant was partnered with a Washington University participant. The resulting dyads were matched to a faculty mentor. Dyads hold regular online meetings to identify a research project relevant to INCAN and to use the training framework to develop a feasible research project. By the conclusion of the program, dyads will have written a research protocol to be submitted to the IRB at Washington University and in Guatemala. It is expected that dyads will conduct research in the year following the program. Dyads present regular updates to their faculty mentors and the larger group throughout the training year.

Program Evaluation
Evaluation was conducted at baseline and is continuously conducted throughout the program year. Quantitative and qualitative data were collected on participant goals/expectations and demographics. A research appraisal tool was used to assess comfort with research design and implementation. Evaluation was done after the first in-person training session and will be conducted again at the six- and twelve-month time points.

Program Timeline

September/October 2010Participants selected
November 2010Baseline data gathered
Dyads and mentors began communication
December 2010In-person training in St. Louis
January 2011In-person training in Guatemala
March 2011In-person training in St. Louis
Mid-point program evaluation
June 2011Mock IRB review
August 2011In-person training in Guatemala
IRB protocol submission
Final program evaluation
November 2010-August 2011Dyad/mentor meetings via Skype
Journal clubs