OK, we should get started. Thanks, everyone, for coming today, and good morning. Welcome to the IGCS 2022 Early Career Workshop. Nice to see you all. After the past two years of virtual meetings, we're so happy to see you all in person here at New York City. The last time I was here before today was 33 years ago as a medical student, so I'm particularly excited to be back, a bit older. My name is Rhonda Farrell. I'm a gynaeoncologist from Sydney in Australia. I'm an IGCS council member, and I'm the senior mentor, as if you can tell that, of the Early Career Research and Publications Network. It's great to be here with you all today, and I'll be chairing this session. We have a fantastic program for you, so welcome. Now, before we begin our educational session, I'd just like to share with you some of the background of our Early Career Network. So, today, we've grown to have 223 members from 59 countries in the world, and it's increasing all the time. I'm honoured to be involved in the Early Career Network as it's truly incredible we have been able to bring together young professionals from all around the world because, really, these people are the future of our society. We're extremely grateful for the participation and collaboration of all of our network members. For those of you here today that may not be familiar with our network, our group provides members with a supportive network of peers and mentors to discuss publishing and writing as critical components to career development. On the screen, I've just highlighted some of our activities over the last year and our accomplishments. So, this year, we've had two webinars with many attendees from around the world. For the first time, we've held applications for our Early Career Oral Abstract presentations, and you'll see that we've accepted seven abstracts, which will be shown this morning. We also have held applications for two new junior faculty members, and I'd like to congratulate Arthur Jayraj from India and Anis Muraburu from Kenya, who have joined our faculty. The other members of our faculty over here on the left are Floria Noll. Floria, would you like to stand? And Arthur Zhu. Floria's from Argentina and Arthur's from Taiwan. Unfortunately, Gitu Bandura and Navya Nair couldn't join us today, but will be attending virtually, as will lots of our Early Career Network members from around the world, who, due to visa difficulties, couldn't come today. We've created a very active WhatsApp group, which is being utilised by our Early Career members, which is where they share content and information about opportunities relevant to the field. And lastly, we've planned a very exciting session this morning. Today's workshop is filled with opportunities to learn from our expert speakers here, to network with one another and ask questions and share your experiences during and in between each presentation. So, if you're not currently a member of the Early Career Network, please, I encourage you to join. The network is open to all members, young members dedicated to the study of gynaecological cancers, who are either currently enrolled in training in their country or within the first five years of completion of their subspecialty training. And you can find more about the network and how to join on the website. So, I please encourage you and encourage your junior members to join. So, I'd like to take this time to thank all of you for being here. We're truly grateful to have such an incredible and diverse network of people in our group, and we hope you enjoy the presentations. So, we'll now begin our first session. We will have a Q&A panel discussion with editors of four of the top journals in gynaecological oncology, who I'd now like to introduce, who are sitting up on our podium here. First of all, we have Dr. Jason Wright. He's a gynaecological oncologist at Columbia University Irving Medical Center, and he's editor-in-chief of Obstetrics and Gynaecology, or the Green Journal. Thank you, Jason, for joining us. Welcome. We have Dr. Larry Copeland, Larry's professor in the Division of Gynaecological Oncology at The Ohio State University, president of the GOG Foundation, and editor of the American Journal of Obstetrics and Gynaecology. Hi, Larry. Susan Modisette is professor and director of the Division of Gynaecology at the Department of Gynaecology and Obstetrics at Emory University School of Medicine. She's also editor-in-chief of Gynaecological Oncology Reports and deputy editor of Gynaecological Oncology. Welcome. And last but not least, we have Dr. Pedro Ramirez, professor in the Department of Gynaecological Oncology and Reproductive Medicine at MD Anderson Cancer Center and editor-in-chief of the International Journal of Gynaecological Cancer. Welcome, Pedro. Good morning to you all, and thank you so much for joining us here at the Early Career Research Network session. So the first half of the session, we'll have some questions that have been preset by our junior faculty, and these questions will be around how they, as early career members, can get involved in developing and publishing their quality research in fantastic journals like yours and also how they can focus on improving their academic careers going forward. Questions won't be too hard, so we won't grill you too much. And in the second half, we'll open questions up to the floor to ask, really, any questions you like. Okay, so I'll take the opportunity to ask you the first question, if that's okay. So it can be really hard for young early career members to get their papers published in high-profile journals like yours. So one of the questions they would like to know the answer to is what is the common reason for rejection of a manuscript in your journal, considering that the paper has a reasonable methodology? So maybe, Susan, you'd like to start? Thank you. Can you guys hear me? No. Oh, there it goes. I guess the first thing, if anyone's interested, we did actually just publish a paper on how to write a paper, which I think is somewhat helpful. But first of all, you have to have a good scientific merit, because if there's not something scientific or that is important to the readers of the journal, it won't get in. So if you send us, for example, we do sometimes see some things on breast cancer or osteosarcoma or things like that, which in general, while it might be good science, you're probably not going to publish it. So the first thing is to find something of interest to the readership of each of the journals, and it might be slightly different depending on which journal you're going to. So that's the first thing. The second thing is don't shoot yourself in the foot. So make sure that someone else has read your paper, that the grammar is correct, that you have all your tables correct and all of that, and so that it is in as best a form as it can so that the reviewers can read it, can understand it, can love it, and recommend it for publication. So those are the things I'd recommend, is one, making sure you choose your subject matter and put it to the appropriate journal depending on what's going on, and second, make it as good and polished as you can. And I do know that for some folks, you know, I couldn't write a paper in another language. I'd just be upfront about that. It would be a disaster. But some journals, like, for example, Geinach Reports does have a language editor. So if the content is good but need help with language, we can sometimes send it out for editorship for that as well. So you can look into the journals to see if they have those. But those are the things I would recommend, and I'm sure that the guys have other recommendations. Thank you. That's great. Great tips, Susan. So Adamant, who goes next? Larry? Yeah, sure. Yeah, so as an editor, the Holy Grail is impact factor. So you want to accept articles that are going to be cited by other future articles. So anything that's practice-changing is certainly going to be cited. And I'm trying to remember what the other part of the question is. The most common thing for being rejected? Don't worry if you don't have that. For most of us, I'm not going to have an impact factor of 30. Just while we're on impact factor, what is impact factor for our junior members? What is it? What does it mean, and how important is it? Right, so it's a complicated calculation that essentially ranks journals based on the articles they've published and the fact that they've been used as a reference in other future articles. That's kind of the simplification. So you need to take that into consideration when you're submitting your article. And you probably need to get some senior mentorship. And you need to probably go for as high an impact journal as what's reasonable for the quality of your paper. And if you don't get it in then, then you resubmit it to another journal with a little lower impact factor. And you keep going until you hit a journal that gets accepted. But your age score, which is kind of another mathematical calculation based on papers you've published and how often they've been cited and whatnot, will be dependent on the impact factor. So you should always go to a journal as high an impact factor as you can. And if you don't make it, that's fine. Don't be insulted. Just move down to another journal with a little bit lower impact factor. My quickest rejection was literally under an hour. Land speed record. They couldn't have even read the title. I'm not sure how they rejected it that quickly. But at least it was quick and you get to move on. One thing on the impact factor is some journals don't have an impact factor. For example, Geinach Reports doesn't yet. They're changing the rules so that I think next year every journal will have an impact factor. Because for a while you had to be around a certain length of time. You had to have a certain number of publications. And again, it was a super complicated formula but yes, the impact factor is important. But again, as a junior faculty, don't necessarily go for the impact factor over 10. Great. So Pedro and Jason, what are some of the common reasons that articles are rejected from your journals and what tips do you have for young researchers to get their articles accepted? What really makes you impressed in an article? I think certainly it's very important to take into consideration some of the same points that were discussed in our journal. We have a process where when the manuscripts come in, within 48 hours we notify the authors whether the paper is going to go out for review or whether it's rejected without review. About 43% of the manuscripts that are submitted to our journal are rejected without review. And the most common reason for rejection without review is that it is not novel. So obviously, as was mentioned before, ideally you don't want to publish sort of like what we say, Me Too papers. So if you see that a topic has been extensively published in the literature and your manuscript is not really adding anything to the literature, that's not really going to be of interest to the journals because, as Dr. Copeland was mentioning, the journals are interested in citations. And it's unlikely that a repeat paper on a topic that has been extensively published is not going to be cited very much. I think the second is the methodology. Certainly regardless of what type of manuscript you're writing, focus on having very good study design and methodology because often the papers are not going to be rejected on an introduction or frequently not on a discussion, but generally it's the methodology that the reviewers are really critical about. And certainly, again, I think it's important just to reinforce the statements that was made before. Aim for a high impact factor, but also be realistic. And certainly if it doesn't get accepted to that, then subsequently move forward with the other journals. Just like Susan was mentioning, in our journal also we have a video for the authors exactly as to what we consider are ideal tips for publication of the manuscript and also what the reviewers are supposed to be evaluating. So I think it's also important for the authors to look at the video for reviewers because then you're going to get a sense of what they're going to be looking for. Yeah, I would really echo a lot of what you've heard. I think our general motto is, is it new, is it true, and so what? So as Pedro brought up, is this a new finding and not just a Me Too paper? Is it true, is the methodology adequate to answer the study question? And then is this a question that's important, that's worthy of answering, that's going to be interesting to the readership of the journal? Kind of the two other points that I would raise, I think it's incredibly important when you're an early career physician really to have a mentor to help you with your submission strategy who kind of knows what journals are looking for, knows ballpark what impact factor to shoot for. Even among the four of us up here, Dr. Copeland and my journal both have a general obstetrics and gynecology focus. So what we accept is going to be a little bit different than what Pedro accepts or what Susan accepts in their journal. I think that the last point I would make is really focus on your writing. So the writing probably is not going to be the overarching factor that makes or breaks a manuscript, but if you have a poorly written paper, peer reviewers really get stuck with that. If you have a methodology, a method section that's hard to understand, that's hard to follow, that the peer reviewers can't understand what you did, that can be a real killer and a deal breaker. So really focus on your writing. Focus on the method section. Don't overstate the claims in your manuscript. And I think, again, having a senior person, having a mentor who can really help guide you with this process, can help with the writing, help with the interpretation of the data, I think for folks early in their career, I think that's really, really critical. Yeah, they're great tips. We have a question from Florencia Knoll, one of our junior faculty members, to you. Thanks, Rhonda. Well, first, thank you for being here. For us, as junior faculty, it's an honour to share this session with you, the top editors in our gynecology world. As Dr Wright says, for us, it's really important to share your experience, to hear your experience. And my question is, do you feel that low- and middle-income countries are represented enough in leading gynecology journals? Go ahead. I can never tell if I'm on. I guess I'm on. Probably not. And I think each journal may have a different strategy. For example, and I can't claim credit for this, Dr...oh, thank you for turning the lights down. That was awesome. Whoever did that. Dr Beth Carlin spearheaded this for Gyne-Onc Reports, that we have an ongoing special issue totally devoted to low- and middle-income countries. We have an open-access journal, which I'll just go over briefly, which means it's open to anyone. So anyone can pull up an article from Gyne-Onc Reports, but how that is covered is that there's a publication charge. And we've waived that for articles to that special issue. So that's kind of our way of trying to get some representation and making the ease of access, both for accessing the journal as well as submitting articles a little bit easier. And so I'm happy to send out information about that and I'm sure each of the other journals has a way of trying to address that as well. Yeah. So for the American Journal of OB-GYN, and I just wanted to correct one thing. I currently do not serve as an editor for AJARG. I stepped down from that position after a number of years, about two years ago. Prior to that, I did serve as an editor also for GYN-Oncology. But I wanted to correct that introduction. Stuart Massad now does the GYN-Oncology aspects for the American Journal of OB-GYN. And I don't recall there being any policy for low-middle-income countries with AJARG. I don't. You know, we got a wide swath of papers from countries globally, but I don't recall any policy whatsoever. Yeah, I mean, the answer to your question is yes. We would love to see more submissions from low- and middle-income countries. In our journal, routinely, when we look at the end-of-the-year reports, less than 3% of submissions are from low- and middle-income countries. So ideally, we would like to increase that. And I think that, you know, certainly it's a responsibility of many of you, of us, myself included, to advocate for publications from those regions. You know, obviously, they go through the same peer-review process. And any manuscript that comes from those countries will go through that same level of evaluation. I think, you know, as you mentioned, a deterrent may be the issue of open access and the charge for article processing fees. And for many publishers, they have different tiers with regards to how much is charged to individuals from those countries. So, you know, certainly, I would urge everyone to look into that before just basically, you know, walking away from the possibility of submission to a journal because of the concern for the open access fee. Yeah, I would agree. I think, you know, unfortunately, we probably are underrepresented by low- and middle-income countries. And I think we'd love to see more of the science at the Green Journal. You know, those manuscripts are peer-reviewed. We are trying to encourage more manuscripts. But I think there's not, you know, not an easy strategy. I mean, it is competitive, I think, for all of our journals. You know, there are a lot of submissions, and all of the manuscripts are essentially evaluated with the same bar. But I think there definitely needs to be, you know, more of a forum to get these studies published. I think there's a lot of great work that's being done, so we want to try to highlight that to whatever extent that we can. Thank you. That's very helpful. Thank you. Thank you so much. Our next question to you is from Arthur Hsu, one of our other junior faculty members. Thank you, Rhonda. I'm Arthur Hsu from Taiwan. I'm very happy to be here in person in New York. My question is that what is the importance of the second author and the last author, the senior author? And how do I persuade people to work with me on a manuscript that he or she cannot be the first author? Thank you. Yeah, that's a great question that we all find difficult to answer. Yeah. So, you know, you're really talking about criteria for promotion, for academic promotion, and first authorship is kind of the holy grail, but the, quote, senior authorship, which seems to have varied over the years as to either the second author or the last author, it probably is more dominant as the last author is recognized as the senior author or the mentor. You know, they're both important, but as a young faculty, I wouldn't get over-focused on that. If you can get your name on a paper, you know, if you can help out being third, fourth, or fifth, go for it, take it, you know, because it is a publication. But when it comes to promotion in many academic centers, they're going to look at both the quantity and quality of what you're producing, and the quality is going to translate into first authorship predominantly or senior authorship, and it varies. If you're going from assistant professor to associate, they're going to want to see some first authorships. If you're going from associate to professor or a higher professor level, depending on what system you're in, then they're just as happy with senior authorship because they want to see that you're mentoring young people. One thing I will say about authorship, it's really important when you've got the germ of an idea to do a study that you very quickly decide who's going to be participating and the author order, okay? Because if you don't, and people assume they're going to be first or second or last and you haven't had that discussion, it can get ugly and that's not something for us as journals and journal editors to mediate. So it's really important that you talk to people like maybe your stats person is going to be your second or your middle author or your medical student is going to be helping with chart review and is going to be in the middle, but making it really clear at the outset what everyone's roles are and what order they're going in. And I would echo what Dr. Copeland said, any authorship is better than no authorship, but trying to get some first ones, especially as a junior career, and that's where you talk to your mentor ahead of time and say, hey, I have this idea, how do you think this would fly? Jason, you had a comment? I was going to actually say the same thing Susan said. I think there are many relationships that have been soured over authorship order on manuscripts, so trying to sort that out early on I think is important. Probably for everybody in this room, if you're an early career investigator, if you have an idea that's yours, if there's something that's going to be the focus of your research of your career, it's probably something you want to be the first author on if you're driving that, and oftentimes your mentor, someone senior in the field, will be the last author on a manuscript. But certainly this can lead to sticky situations, so I think having a plan early on, make sure everyone's on board with that so you're not fighting about it when the manuscript is drafted in essence. You know, there's a saying about mentorship, and there's reference made to, I wouldn't have been so successful but for the opportunity to stand on the shoulders of giants, which is referring to your mentors. The opposite can happen. You can have mentors that take away stuff from you, and so the corollary of that is I would have done better but for the giants standing on my shoulders. So I think Susan's recommendation of getting things clarified up front are appropriate because there are mentors out there that will take first authorship away from you, and so just be careful with that. One last thing I would just add, Arthur, is that every author should have legitimately contributed to the manuscript. There shouldn't be authors that are just writing on the coattails of the first author or senior author because of their rank within the department, so they really should have had meaningful contributions to the authorship. And one just very kind of like simple rule that I would often discuss with our fellows is if you write the paper, you do the main part of the work of the paper, you're the first author, the mentor is the senior author. And then as Dr. Copeland was referring, it depends on your institution, but typically how we choose that second author generally is, well, if the middle authors have had equal contributions, it's whoever's getting promoted next goes to second author. And I think Dr. Ramirez makes a great point about what we call gift or ghost authorship, like I'm actually making a new rule in my journal because I had a case report come in with no joke 20 authors. Come on. I mean, really, it should not be that many. And so for many of us, I would say for if it's not a randomized controlled trial that had 20 institutions, that you really should be kind of along the six is a good number to not go over. And we're starting to say in many places have criteria for what you have to do to make authorship and you have to describe what each author did as part of that. You know, Tom Burke, who is one of the former faculty at MD Anderson, used to say that if a manuscript has more authors than patients included in the study, you know that's a bad paper. That's great. So just to let you know, last year we had a webinar on mentorship, a couple of hours. It was very helpful for early career network members. So you can always go back on the IGCS website and look that up. And it was around research. It was very, could be very helpful for you. You can have mentors not at your own institution too. So most of us have had people reach out to us just with a quick question or go up to people at meetings and ask them. I mean, most people are pretty nice and are happy to give you advice or steer you in a direction. You don't have to take it necessarily because sometimes I give bad advice, but you know, don't hesitate to reach out to people. Thank you. So in terms of reaching out, that raises the issue, you need a database to produce a paper. And sometimes your center doesn't have that database. And so it's great to include multiple centers. Just call Jason. Yeah, if you want to do a SEER article, call him for mentoring. Any of them. Any database. But joining with other centers, and it also develops a professional network for you. And so you not only have a co-author that you've done an article with, you're developing close relationships and professional friendships. So reach out to other centers. If you have a good idea, but you don't have the database, then reach out to other centers to get it. That's great. Floor has a question. I think there's a question. Oh, sorry. We're going to have questions from the floor. These are just questions from the junior faculty to start with. Sorry about that. In about five minutes, we'll invite all of the members that are on the floor to come and ask questions. So sorry about that. I didn't make that clear. We have probably one or two more questions from the junior faculty, and then we'll open up the questions to the floor. Okay, thank you. Well, the next question is about what type of articles we are going to publish. Because numerous new treatment modalities, immunotherapy, target therapy, receive priority in high-impact journals, but not surgical-based studies. So the question is, why is it so difficult to get surgical-based studies published? I think priority is given to good quality papers, regardless of what they're about. But obviously, certainly there's a predominance of manuscripts now of very good quality that are demonstrating what's happening in our field. Our field is changing. There's a lot of novel therapeutics that are impacting the care of women with gynecologic cancers. Many of those key studies are obviously very well supported by industry. So it is a sign of the times that we're constantly seeing many of those manuscripts. I think, you know, certainly for surgical papers, it's exceedingly difficult to conduct a prospective surgical trial. There's very, very limited funding. They take an exceedingly long time. You know, I think that when we published the LAC trial in the New England Journal, we looked back to see when was the previous surgical trial. And it was the neoadjuvant Virgo TURTC study, which was probably about nine years before the one that we published. So you know, certainly there are a lot of barriers to surgical trials. But again, I think that ultimately whatever journal looks at is the quality, regardless of whether it's therapeutics or surgical. Yeah, if you can anastomose the cervix to the umbilicus, you're probably going to get that published, just as an example. Yeah, I think there's probably just not enough funding out there. As Pedro alluded to, a lot of the new drugs and new therapeutics are funded. I think probably all of us would love to have more, you know, high quality, randomized control trials, even prospective cohort trials looking at surgical issues. I think, you know, and I think it's not just gynecologic surgery or gynecologic oncology. I think many procedural disciplines have kind of fallen into publishing, you know, if we can do it kind of studies and not necessarily efficacy studies for procedures. And there are, you know, undoubtedly a lot of hurdles on getting those done. But I think all of the journals, you know, we would love to see more high quality procedural based studies coming to us. Yeah, and we are seeing surgery studies, just not as randomized controlled trials. So there are a lot of the quality looking at particular, especially as new procedures come on board. Sometimes we adopt them before we've really rigorously studied them, and now we're kind of on the back end figuring out where we may or may not have gone wrong. So I think all of us love to have, you know, we're all surgeons, so we love to have surgery papers. So don't be dissuaded from sending them, even if it's not a randomized controlled trial. So there's been some inhibitors regarding surgical trials, not the least of which has been our federal funding mechanism and CTEP. They've just frankly said to us, we're not going to fund surgical trials, which seems unfair, might be related to the fact that the leadership are medical oncologists. But the GOG Foundation has resources, and we have two surgical trials that we're getting going now. The ROC trial to prove Pedro wrong in terms of his robotic outcomes in cervical cancer. The ROC trial, of course, is taking into consideration some strategies to hopefully overcome hypothetical issues that led to worse outcome. And we're actually doing a HIPEC trial as well, again, trying to correct some factors related to prior HIPEC trials to get a clearer understanding of the potential. So the GOG Foundation is funding two big surgical trials. We do have grants from various sponsors to help with that, but we will be putting millions of dollars in in terms of supplemental funding as well. The other thing, one last thing also, is that if you look at, interestingly, at surgical gynecologic oncology trials on average, they take about 10 years. You look at the LAG trial, you look at, well, GOG 213 was a lot longer than that. The Desktop 3, the CONSERVE, the TRUST, the SHAPE, you look, and on average it's 10 years. Thank you. Thank you so much. OK. So I'd like to open the questions up to the floor. If you could just, if you want to ask a question, just make your way to the microphone, introduce yourself, where you're from would be great. Thank you. And then ask your question. Yep. Go ahead. Thank you. My name is Michael Steller. I'm a retired gynecologic oncologist in the United States, and I volunteer with the IGCS in trying to develop research for low and middle income countries in particular. One thing that we encounter all the time is how disparate the resource allocation is. You're dealing with, at times, situations where the trainees who are trying to develop a research project don't even have paper to write on. So I guess one of the things is that in New York City, in the height of our country's affluence, and the journals that each of the lovely faculty are representing, are publishing things that are changing at a molecular level, at the highest possible level. And unfortunately, the resource differences are such that you can't expect people in Ethiopia or Uganda to publish those kinds of studies. So what I'm wondering about is whether we need to have a shift in thinking about what represents a publishable paper. What happens when you're in a place like Ethiopia that has two radiation machines to service 100 million people? We have 3,500 radiation machines in this country. So you have an 18-year-old kid who's got advanced cervical cancer, and there's an 18-month wait for that patient to get treated. And by the time that happens, oftentimes, they succumb. So the point isn't so much to emphasize the disparity of wealth or allocation, it's to try to understand if there is a place in the publication world to describe what you do when you have less than optimal resources. And if that is considered practice changing, because really, that's the reality on the street is that you have people who are in situations where you have much less resource. So that's one question that I throw out is, how do we tackle that? Maybe there's a special journal we should have or something. Then the other thing is that we desperately need mentors, people who are sensitive to aware of what the resource differences are, and also people who really understand what the cutting edge issues are, and whether we can marshal the resources within the IGCS training program to answer some of those questions. So volunteer mentors would be really, really welcome in this regard. And I welcome any feedback from any of the faculty. Thank you, Michael. We might just answer those questions or attempt to answer them separately. So the first question was about disparities with low-income countries that really have limited resources, how we can make some changes to improve care and get the word out to the world about what's going on in those countries in a research, I presume research. So what I would say about that is that is partially the focus of our special issue, focused on low-middle-income countries. And so, yes, we have published things that address exactly that. We're about to publish an editorial from someone in a war-torn country and how they're having to deal with providing gynecologic cancer care in the midst of a war zone. And so, yes, they're totally different issues, and so we are trying to bring some of those things to light. Obviously, we can't solve the world's problems, but we can choose to highlight some of them in things like that. Yeah, so we don't have to go to Ethiopia to find disparities. We need to get our own track together here in the U.S. on that. So that's definitely an important topic, a contemporary topic. And so any article that's currently on disparities is going to probably get some prioritization in any journal at the present time. There's things that happen that are opportunities to publish. So disparities is an example, but when COVID hit, all the journalists were looking for articles related to how COVID was impacting medicine. And so to get an article published, if you had anything related to COVID, your probability of it getting accepted was very high. You know, if you're in Ethiopia and you get some kind of other disease, outbreak, Ebola, or whatever, and it has some relationship to gynecology, then that's a unique opportunity. And so it's a matter of seizing kind of contemporaneous events to publish. You know, one of the other things that I would add is that to seek out journals that are already looking to publish these types of works, and, you know, in our journal, we have a segment called Corners of the World, where we're interested in the work that is being done in low- and middle-income countries by many gynecologic oncologists with limited resources, you know, certainly where the training may be a challenge. And this is an opportunity to highlight and feature some of the great work that is being done that would not really apply, obviously, as original research or a review, but it gives them an opportunity to provide an insight into what's happening with that program that is reaching so many people in secluded areas on the limited resources. And I think that this has been very well-received, and we actually had an agreement with a publisher where every article of Corners of the World is free access. Fantastic. Yeah, I would probably agree with everything that's said. I would try to leverage your local resources if there's, you know, some pressing problem in Ethiopia. So, you know, as Dr. Copeland said, you know, you can write about a hot topic. I think that's a great forum. I think when you look at all of our journals, we have different types of features that I think are open for us. We have a procedures and instruments section. We have sections on systematic reviews. We have, you know, we accept case reports. So it's not just randomized controlled trials and original research. So again, I think that's, you know, especially I think from low and middle income countries, I think having some mentorship who can guide you to the journal, you know, think about what journals are looking for in particular. But you know, probably the overarching, you know, issue is, I mean, we need to do something to make things more accessible to the science and to get it published, and there's probably no easy solution, unfortunately. And in regards to your question about mentorship from IGCS members, is that what you're asking? Well, I think that what I see as I participate in these ECHO meetings and these Zoom meetings is it's wonderful. You get very high quality input from all over the world from really great people. But what we are really lacking is the vision of mentors, many mentors, to help to cultivate research as a culture in the training process of the IGCS fellowship. So it's almost, my comment is really a call for as many people as have the spirit to get involved as mentors to understand what the resource, what the resources are, and what represents a question that will bear publication. Yeah, I suppose if there's anyone who wishes to be a mentor, they can contact IGCS or myself through the Early Career Research Network, because that's one way that that can be fostered. And there are other ways, as you say, the ECHO program's a fantastic program for tumor boards around the world. We have another question from the audience. Hi. Hi. Thank you so much. Thank you so much for this opportunity. And one thing, my name is Anissa, I'm an IGCS graduated fellow from Kenya, and my question is based on something that you've talked about, the mentorship. And it's, for us fellows, we have a lot of international mentors, and for some of us, they've actually helped us get papers through. But then when it comes to submission of articles into journals, we cannot afford, of course, the open access fee. But there's an excellent opportunity for wavering of the fees. But then comes, it has one eligibility criteria, that you should not have a mentor from an international or a high income country. So it kind of knocks off your mentor, and at the same time, it knocks you away from getting a waiver. So how can we marry those two? Thank you. I can only speak to our journal, and we don't have any requirement in terms of having authors from anywhere. You can get into the special issue with a waiver. Yeah, I think for us at the Green Journal, we don't have submission fees, so there's no fee, so it can be freely submitted. And for AJARG, I don't recall there being any fees related to that either. Yeah, I mean, I think it's a topic that is changing, and it may be very different a year from now. But many journals are still hybrid journals, where you have an opportunity to publish without paying a fee. But that may change, as many publishers are all going to open access, or the majority are going to open access. Yeah, so around that question about open access in the journals that currently don't have a fee, are you being pushed to become open access and charged for your articles? Because it is going to become a major issue for young researchers. Yeah, I think open access is going to be a major issue. So for those of you in the audience who don't know what open access is, traditional publishing has made articles, and journals have made articles free, and subscribers, libraries, and universities are charged a fee. There's a big move towards open access, where essentially authors and investigators will pay a fee to have their science published, and then it's made free to anyone who wants to view those articles. And this has really, I think, come to a fore initially in Europe with something called Plan S, where groups of funders require that if they funded investigators that they make their articles open access. In the U.S., within the last month, the federal government has now put forward some regulations where essentially studies funded by the NIH, those investigators will have to make their articles open access, and often other philanthropic organizations and funders follow. So as Pedro alluded to, there's a big debate in the publishing industry on how this is going to change, who is going to pay these fees and who is going to offset these fees. And I think certainly if you have a federally funded study, a pharmaceutical study, it's not so much an issue, but if you're from a low middle income country, if you're doing a resident or fellow project that perhaps is unfunded, who bears out those fees is going to be a real concern. And I think this is an ongoing debate, I don't think anyone knows how this is going to settle out or what the final answer is going to be, but this may be the way that all of us publish and the way that publishers manage their journals, this may all be very different a couple of years from now. And as I mentioned, I think that also looking into the journal and their publisher, because there's different tiers with regards to what the article processing fee may be, depending on the country, there may be waivers depending on the country as well, but I think ultimately is moving towards all open access. And one of the things also I should clarify, because a lot of the discussions that often come up with open access and there's misconceptions where many authors consider that open access means you're paying to get your article published without really a rigorous review. In other words, just send in anything and as long as you pay for it, they'll publish it. That's not open access. It'll still go through the same rigorous review, it'll go through exactly the same process, but once it's accepted, then the authors will be asked to pay that article publishing fee. Of course, there are very low quality journals that will do exactly that. They won't review it and they'll just, as long as you pay for it, they'll take it. But those are journals that ideally you do not want to have your paper published in, but it's important to understand that the open access model is expecting that the articles will go through the same process, the same rigorous review, but the author pays for the processing of that manuscript. Yeah, as Suze mentioned, they're referred to as predatory journals and they're essentially a business to make money and their impact factor is zero, essentially. So things are going to change as we move forward, of course, and I think it's just a matter of time before you don't have a journal that consists of a piece of paper that you sit and read at your desk. It's going to be all online. So it's all about the money and publishing paper journals costs money. They do get advertising to support them, but they can have advertising in a website as well. So it's probably just a matter of time before the paper journals are gone and it's all online. It's not going to happen overnight. Thank you. We have another question from the audience over here. Hi. Thanks. Good morning. My name is Ling from the United Kingdom. So obviously research is changing. I handled the COVID surge collaborative paper. It's got hundreds of collaborators and as a prerequisite of joining, they have promised kind of authorship model that is slightly different from what we traditionally would have regarded as also on the paper. I just wonder for each journal, what do you think of collaborative research and how do we handle the authorship for such type of research as well, which is increasingly common for surgical trials? I don't understand the question. I think it's an important question. It goes back to the point of the authorship agreement and particularly for multi-institutional studies, particularly for, I think it's actually a requirement for prospective studies that prior to initiation of the study, you have to have an authorship agreement that everyone understands the criteria to get that authorship. So I think that that's really very critical prior to the initiation of every study. And actually, we encourage our fellows also when they're working on manuscripts, even in a retrospective study, that there should be an authorship agreement prior to initiating the project. If you have huge trials, for example, some of the collaborative group trials, not every institution gets to have one of their folks be an author. It's set. The highest accruing centers will get an authorship, the study PI, and same thing for surgical trials. So there may be an addendum that lists every person that helped, but not everyone will be able to be an author. I think when you look at target journals, all journals have requirements for the authors. I think you want to, as Peter and Susan have said, you want to lay out beforehand who's going to be an author on the manuscript and then make sure everyone does fulfill those author requirements. In many journals, those are listed in the manuscript on who contributed, what their contributions to the study were. I think certainly in today's world, we want to encourage collaborative science and we want contributors to get their due if they contributed to a study. So I think it's certainly, that's to be encouraged, but you just want to make sure that everyone does meet the authorship requirements. One other thing that also I would add is that particularly if you're doing a prospective study, you might want to reach out to investigators who have already conducted a previous prospective study to just get a sense from their authorship agreement as to the details of that authorship agreement. Because often one might think, well, this is pretty simple. If you put the most patients, then you get three authors. And if you put the second most, then you get, not necessarily does it work that way. Because you should have also standards for quality of the data. And that's going to be evaluated and measured by the auditing team and the regulatory team often will also look at certain details with regards to how the study is being conducted at that site. And when you look at the data that is being entered onto the database of the study against the source documents of that institution for each patient, you also have to have a measure of the quality. So in other words, it doesn't matter to you if the institution put 150 patients, if most of that data is incorrect, then that institution should not have four authors as you initially promised. So I think it's important to look at other authorship agreements and determine what is the template that they have used, what is the model, and what fits for you and your collaborative group. Yeah, I think the reality is probably slightly more tricky once the study gets a bit bigger, especially for low middle income countries. I think for COVID research, I mean, one in four of our centers are patients actually from low middle income countries. To do that backtracking is actually quite tricky in a sense. But it's just really interesting to see how when we try to publish the work, the policy or the view of different journals are actually widely different in terms of incorporating the additional authors in the collaborative. So I'm just intrigued by what individual journals' views are. Thank you. We have a question over here on the side. Hello. Good morning. I'm Pernilla Bjartrand. I'm a doctor at the Norwegian Radem Hospital, also Norway. I had a question about novelty and the Me Too papers. As I work in a country where we have established the public health care system, and we know that all patients visiting us are actually the old patients in our country. And I was wondering, how can I sell that into editors so my paper doesn't seem like just a repetition of what an American center already did and kind of show that these are actually reflecting the whole society in my country? Great question. Well, I think most of us are quite jealous of the Scandinavian data because you can do population studies. And, for example, looking at the salpingectomy data that were able to be gathered, I think it was in Sweden, but still just being able to find that. So I think we all know the differences there. And so, again, picking something that we can't do in the U.S. because we don't get the long-term follow-up, we don't follow every single patient, we don't know all of their medications or things like that. So I think you have the capability of doing some of these population studies and cohort studies where you actually have the long-term outcome and you know the exposure. So I think most of us know that. And so, just again, it's trying to find something that, a question that we can't answer as well here in the U.S. Yeah, I think it also ultimately goes back to what Jason was alluding to initially, is that so what factor. And I think that's really important. And one of the things that I always emphasize when I discuss these topics of manuscript writing and reviewing is that always look for where's the gap. Often, in a previous paper related to your topic, the authors will say, future studies should look at this, or the gap in knowledge is this. And that's where you should take an opportunity to then look and say, what is my study going to add? Because, again, many times we will get papers that will say, well, I don't understand why this was rejected. I mean, we're showing that sentinel lymph node mapping could be done in Uruguay. And then say, well, what makes you think that sentinel lymph node mapping couldn't be done in Uruguay with the same results as in Brazil or in Argentina or in the United States? So it's not just about saying, well, you know, this is how it is in my country. Always think of, like, scientifically, what is it going to contribute? What is it going to add? And I think it's also important with regards to, particularly for the junior faculty that we are, is that many times you will have a more senior faculty mentor who will say, it would be really interesting if we looked into this. And it may be that this is already extensively published, and it's just a fact that the junior faculty hasn't been keeping up with the literature. And then because it's interesting to him or to her, that doesn't mean that it's going to be interesting to the reviewers. So also look at those details as well. That's a great answer. I think we've almost finished our session. But I do have a last question from the junior faculty to our great panel members. Later on this morning, we're having a session about work-life balance, and you're all very successful academics. So briefly, how have you managed to achieve work-life balance in your own careers? And what advice would you give to our junior members to stay balanced throughout their careers? We should go by increasing age. The youngest. I'm not the youngest. Jason's the youngest. I think, and I'm going to just put it out there, I think it's a myth, the work-life balance things. You know, you have to decide what's important to you, okay, and you have to go after what's important to you in figuring out what you're going to give up. If you want to work 40 hours a week only and never work weekends, you know, and make full professor in 10 years, that's not realistic. But that may be the life choice you want, and sometimes you're going to prioritize certain things. Sometimes it's going to be your career. Sometimes it's going to be your family. Sometimes it's going to be your exercise. So, again, it's different for everyone, and everybody up here has a different way of doing it. You know, I'll always quote Laurel Rice, who was one of my big mentors, who her husband said if she could pay someone to do X, she would. She literally, if there's anything she didn't want to do, she paid someone to do it, and that was how she got more time to do the things she cared about. Other people do it other ways. So there are a lot of different ways to do it. But just recognize, do what you want to do and what you like to do, both in your work and your home, and figure out how to best do that. And there are a million different strategies for that. But you can't have every single thing all at once, sorry to say. So outsource. Outsource sounds like a great idea. I mean, certainly echoing what Susan said, but I would add one thing. Think about what adds value to your career and what adds value to your personal life, and be selective. So don't get caught up in all of these projects that are going nowhere or projects that are going to be incredibly time-consuming for a very low yield on return on investment. So just always try to prioritize the things that are really going to add to your life. Yeah, I would really echo what you've heard. I think probably the most important advice I always give is do what you love. When I finished my fellowship, I went into the lab because I thought that's what clinician scientists did, and I hated being in the lab, quite frankly, and wasn't honest with myself. So I think you need to self-reflect. If you want to be the best surgeon out there, if you want to be a researcher, if you want to be the best educator out there, think about what it is you want to do, what you enjoy doing, and then set your career around doing that. I think strong time management skills is certainly important. As Pedro said, kind of keep a mental list. If you have something that's going to be of little value but take a ton of time, that should probably go off the list and move up things that you can easily accomplish and get done. I think all of us, everyone in this room is probably very driven professionally. Keep your family in mind, too. My wife always tells me, when you die, nobody's going to care how many papers you wrote. I think that's true. Focus on your family, things outside of your career, things that you enjoy doing, and really try to fit those things in, whether it's outsourcing or whatever it takes to really do that. That's great advice. In the final few minutes, I'd just like to— Wait, wait. Sorry, Pedro. I would definitely love to hear what Copeland has to say about that. Oh, sorry. I don't have a lot more to add. Having a strong partner in your life is important, and obviously prioritizing your family is important. There are professional traps that I think you need to try to avoid, which I didn't. One of them is writing chapters or books. Talk about high time commitment, low rewards. Don't say that. I'm in the process of hounding a lot of these people to finish their chapters. Yeah, I know. I totally understand. Except for principles of gynecologic oncology. Yeah, I'm sorry. That's a trap. You need to try to avoid chapters. The best way to get into chapters is if you're a young faculty and one of your senior faculty already has a chapter in a book and another edition is coming out, then agreeing to go on that chapter as a co-author and updating that chapter, that's a little easier. Writing a chapter from de novo, or even worse, editing a book, my God, there is nothing more unrewarding than editing a book. So there's traps there that you need to be careful of, and your mentors will suck you in. Like Dr. Rares here, he'll say, Hey, I need a chapter on this, and I know you would love to write it, and your name will get out there and increase your visibility. Bullshit. Except for principles of gynecologic oncology surgery. And there is a certain amount of, book chapters aside, there is a certain amount of things you have to do. You don't get to go all the way to the top and be an editor without having done some of the work before. Dr. Copeland and I were talking about this. Take a chance to do a few reviews if you want to get into publishing because we're always looking for reviewers, and if you do a really nice review, A, you will learn something, and B, you can look and see who else reviewed that paper, what they said about that paper. And so that is a way of entering into, if someone is interested in publishing and interested in getting on an editorial board, that is a really good way to do it, and you learn something, too. Don't let it suck all your life out, though. You don't want to do ten reviews a month because that's not worth it. Yeah, so as an editor, one of the most difficult things is getting good reviews. And I remember a young colleague of mine a number of years ago said, hey, I want to be on the editorial board of the journal. I said, okay, hey, here's what I'm going to do. I'm going to start sending you some reviews, and you do good reviews, and we review the quality of reviews each year at our editorial meeting, and you'll get on the editorial board. And so I sent this person an article and sent back, reject, no comments. And so I called this person up. I said, you know, I don't think you'd get this. You know, you're not going to be on the editorial board if you can't critique a manuscript. Reject, no comments is just not there. And something that people don't appreciate is all reviewers are profiled. You're profiled on the quality of your review, it's scored, and you're profiled on how fast you return it. And I can tell you as an editor and having served on ABOG in leadership and having served in GOG in leadership, I know who the volunteer workers are. And I will give them opportunities to serve on committees and advance their career and indirectly mentor them. You don't realize the information behind what happens in terms of people having career opportunities. And being an editor of a journal was like a window into the soul of my colleagues. And there's some very prominent people that would do poor reviews or no reviews. I would not mentor them into ABOG leadership and or GOG leadership. I'm not going to do it because they're not in a good place to help our discipline. There's others who are stars. And these three people sitting beside me, I sent all of them reviews. I can remember sending emails to some of the people at this table saying, your review was unbelievable, and one day you need to be editor of a journal. Yeah, yeah. That's great. Yeah, and that happened. But that's based on the quality of the review that was coming in. So if you're going to take something on, do a good job because it may be more recognized than you realize. Thank you. That's some great advice for all of our early career network. If you're going to take something on, do a good job. And that will help drive your academic career forward. So thank you. I'd like to thank our great panelists, Jason, Pedro, Larry, and Susan, who have been with us this morning. And they've really done a fantastic job in giving our early career members some advice about their careers, how to conduct research, and how to be successful. So I'd also like to thank those of you who have asked questions, which has really contributed to this morning's discussion. So it's time for our next session, but we'd like to just thank our panel members. Thank you. So in our next session, we'll have three oral presentation of abstracts, and this will be chaired by our junior faculty members, Florencia Knoll and Arthur Zhu, who'd like to come up to the stage. Thank you. Thank you, Rhonda. Thank you all for joining us in our workshop today. I am Florencia Knoll. I am a junior faculty. I'm a member of the Early Career Network, and also I'm a member of the Junior Regional Team. So we are going to start with the next session with the oral presentations. Hi, I'm Arthur Zhu from Taiwan, and I'm a junior faculty of the Early Career Research Group, and I'm very honored to be here. Thank you. Okay, so Arthur and I will be moderating this session. Before we introduce the first presentation, we would like to congratulate all the presenters that have been accepted to present their abstracts. It is truly an amazing accomplishment, and it is clear that you have such a bright career ahead of you. Unfortunately, some of the abstract presenters could not travel to be here to present their abstracts in person, however, we did not want to lose these presenters and to miss out on the opportunity to share their experience and their work during today's workshop, so we have pre-recorded their presentations and will play this recording throughout this session. At this time, we will be announcing our first presentation, Dr. Marcina Farouk is a fellow in Gynecological Oncology in Bangladesh and her abstract is titled Preoperative Serum Vascular Endothelial Growth Factor as a Predictor of Malignant Ovarian Tumors. Dr. Farouk could not travel to be here today, so we will now begin playing the record of her presentation. Respected contenders, this is Dr. Marcina Farouk, fellow of Gynecological Oncology on behalf of Bangladesh. Now, I am going to present my paper on Preoperative Serum Vascular Endothelial Growth Factor as a Predictor of Malignant Ovarian Tumors. Ovarian cancer is the fourth most common cancer of human reproductive organs around the world. It is the fifth cause of cancer death in humanity. To date, a golden standard biomarker has not yet been established to diagnose all histological types of ovarian cancer. Assessment of multiple markers in same individual with ovarian cancer or endexoma is not rational, time-consuming, and causes economic burden to patients' family as well. Hence, it is essential to have a supreme diagnostic test by which we can differentiate between malignant, benign, and malignant ovarian tumors of all histological types. Recent study has been done with the motive to uncover the predictive value of serum vascular endothelial growth factor in ovarian cancer. It will be extremely helpful for developing more effective treatment and subsequently reduce the morbidity and mortality due to ovarian cancer. And this is the ultimate pathway to achieve sustained development goal in our country and globally. So, what is the research question? Whether serum vascular endothelial growth factor is an effective predictive factor of malignant ovarian tumor? Purpose of my study is evaluation of the efficacy of serum level of vascular endothelial growth factor for detection of malignant ovarian tumor. So, we have done on some specific objectives, that is preoperative serum vascular endothelial growth factor and serum CO125 levels among patients with different ovarian tumors and trending cell masses. To compare preoperative serum vascular endothelial growth factor and CO125 levels among different ovarian tumors. And to correlate the histopathology report of ovarian tumors with the level of serum vascular endothelial growth factor and CO125. And finally, to measure the accuracy of serum vascular endothelial growth factor and serum CO125 in predictive malignant ovarian tumor, that is sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. This was a cross-sectional analytic study done on the 86 patients in the Department of Gynecological Oncology of Bangabandhu Sheikh Mujib Medical University and National Institute of Cancer Research Hospital in Bangladesh. And the study subjects are enrolled on bipartisan sampling and included the patients with primary ovarian tumor and ending cell masses. Patients with ovarian tumor received treatment or receiving treatment malignant metastatic or recurrent ovarian cancers. Pregnancy, endometriosis, and pelvic inflammatory diseases are excluded. At first, all patients are ready to be screened about the purpose and procedure of the study. Informed data positive is taken, and patients are prepared for managed by a codified standard protocol. So, 24 to 48 hours prior to the study, 3 ml of blood was taken from each patient, immediately centrifuged for 10 minutes, and stored at minus 30 degrees centigrade until final measurement. Phenobascular negative growth factor was measured by ELISA using ELISA kit in the Department of Microbiology and Immunology. Data were collected using kits and structured questionnaire on the variables of interest. Microsoft Office Access 2013 was used for prospect and store all the data. And SPSS-23 was used for editing and training. As distribution of phenobascular negative growth factor in C125 were asymmetrical, so MEN50 sample linkage was used to compare the labels. Visible operative characteristic curves was plotted to find out the cut-off value and area under curve and diagnostic accuracy. Each distribution of patients with malignant ovarian tumor shows maximum patient, that is, 29% of patients was within 41-50 years. And among the study subjects, prevalence of malignant ovarian tumor was found at 64%. This study clearly shows that serum level of phospholipidic growth factor was elevated and statistically significant in epithelial ovarian cancer, that is, median level 86.9 kg per ml, and also in the Janssen ovarian cancers, that is, 809.4 mg per ml, and also in 6-colistomal malignant ovarian tumors, that is, 557.3 kg per ml. And these were statistically significant. But serum C125 was not only elevated in epithelial ovarian cancers and not in other non-epithelial ovarian cancers. Accuracy of serum phospholipidic growth factor shows it has better sensitivity than C125, that is, 90.1% in detecting malignant ovarian tumors, and specificity 93.5% is far better than C125. Accuracy 91.8%, positive predictive value 96.2%, and negative predictive value 85.3%. Area under curve of serum phospholipidic growth factor shows that 0.97, that proves it an excellent test for measurement. So, at the end of this study, we can say serum phospholipidic growth factor has better sensitivity and specificity for identifying both malignant epithelial and non-epithelial ovarian tumors. Measurement of serum phospholipidic growth factor is an excellent test to detect malignant ovarian tumor, as the area under curve is 0.97, and accuracy to detect malignant ovarian tumor is 91.8%, which suggests a promising future role of phospholipidic growth factor as a predictor in ovarian cancer. Limitation of my study was borderline ovarian tumors are not included. So, thank you for patient's feedback. Congratulations to Dr. Farouk's study. I think it tries to increase the detection rate of ovarian cancer to differentiate it with benign ovarian tumors. I can imagine it might be potentially useful if it can be combined with imaging parameters to differentiate benign ovarian tumors and ovarian cancers in young women, because they have the real need to preserve ovaries. So now, we now invite Dr. Anissa Biru, gynecologic oncologist at Aga Khan Hospital and International Cancer Institute in Kenya to give a presentation of her abstract titled Epidemiological Profile and Clinical Pathological Features of Pediatric Gynecological Cancers at Moa Teaching and Referral Hospital, Kenya. Thank you. Good morning, everyone, and thank you for the opportunity. As you've heard, my name is Anissa. I'm from Kenya, and my study was on epidemiological profile and clinical pathological features of pediatric gynecological cancer at the Moa Teaching and Referral Hospital, where I did my fellowship. As a bit of introduction, we're aware about the main pediatric gynecological cancers are mostly the stromal carcinomas, such as the juvenile granulosa cell tumors and Sertoli lady tumors, as well as genital rhabdomyosarcomas and ovarian germ cell. Now, outcome of these cancers tend to depend on the time of diagnosis, the stage, tumor type, and the treatment, which can also have long-term effects on the reproductive career of these patients. Now, the main reason why we went through this kind of retrospective review is because our program in Kenya, again, oncological fellowship, is very young, less than 10 years old, and we realized most of our focus had been on cervical cancer. But through the years, we had a sprinkling of pediatric gynecological cancers, and we needed to answer the questions. What types of cancers are we seeing? What kind of treatments are we giving? And are we having good outcomes out of them? Now, the method that we used was just a retrospective review of all the clinical pathological profiles and treatment outcomes of these particular patients, and we started from 2010, when our program was starting, up to 2020. Now, the data was abstracted from the gynecological oncology database and the patient medical charts. As you read, retrospective reviews can be very difficult to have because data is not well-preserved, especially when a program is young and is just starting up. There's a lot of data that was missing, and so we ended up finding that we had 43 medical records, but out of those, three were missing, and so we were only able to analyze 40 medical records. Now, out of these 40, we found that most of the patients, that's about 93 percent, were between 10 and 18 years of age. For about 25 percent of them, that's 14 out of 40, they underwent a primary surgery, with only eight of them having fertility-sparing surgery. I need to mention that the hospital setup is a referral setting, so we'd receive a lot of patients who'd already been managed in different facilities, and they probably had a wedge biopsy. Some had even had, at the tender age of 10 or 12, had a complete hysterectomy and bilateral salpingofrectomy, and they were sent to us after the histology came back as an oncological diagnosis. Now, the patients, about 70 percent of them received an adjuvant platinum-based chemotherapy, and the commonest regimen that we used was the bleomycin, etoposide, and cisplatin. And out of the 40 patients that we reviewed, 14 of them died, which is a very high number for these highly chemo-sensitive tumors. So a bit on the results. As I said, a majority of the patients were between 10 and 18 years. Of note is that 60 percent of them did not report a family history of any malignancy, and we received about 30 percent of them in the performance status of one. When it came to the histological types of the cancers that we had, the ovarian germ cell tumors were the leading histological diagnosis in 73 percent, with dysgerminomas being the commonest subtype seen in about 12 of 37 patients. We had a few patients who had sex-cord stromal diseases, and one 16-year-old who had cervical cancer stage 3C1R. Again, with the results of the Kaplan-Meier survival estimates, we were looking at the patients, the kind of treatment that they received, and how the survival, as much as the time period that we were reviewing this patient was about 8.2 years, so not quite enough for good survival analysis. But we found that only seven patients who were confirmed to have a recurrence during follow-up, and out of those who are still alive, as I said, only 65 percent. And the main conclusions that we could come out of this is fertility-sparing surgery, with or without adjuvant platinum-based chemotherapy, was the standard of care for excellent prognosis, and this requires early detection and treatment initiation. As I said, most of our patients that we received had been managed elsewhere in other healthcare centers, because, like, our pediatric oncology program is only about three years old, and so we're still dealing with the late diagnosis and late treatment initiation. For most of our LMICs, we've faced several challenges in accessing quality care, and that tends to affect survival of these patients. We lost 35 percent of these young girls, and most of them could have actually been saved if treatment had been initiated early. And now, due to its commonality, and with also access to other different papers from around the world, ovarian germ cell cancers are very common, and they should warrant a high index of suspicion, especially amongst primary healthcare providers, attending to any patient with an agnesal mass in this age group. And so, all notes and forwards, I hope you can give better care of these little humans, and you can access the full paper through the QR code shared above. Thank you very much for your attention. Thank you so much, Dr. Muru. Very well done. We are going to introduce our next presenter, Dr. Upasana Palo. She's a gynecological oncology fellow at Tata Medical Center in Kolkata, India. Dr. Palo also could not travel to present in person, so we will be showing the pre-recording of her abstract titled, Pelvic Excentration in Gynecological Cancer, a Single Center Study from India. Good morning, everyone. I present our study on Pelvic Excentration in Gynecologic Cancers, a Single Center Study from India. Pelvic Excentration is a potentially curative surgical salvage option, but the procedure-related complication rate is high. MSQCC study reported in 1989 showed 9.2% early post-operative mortality and a 23% five-year overall survival. Latest studies demonstrated improved perioperative outcomes and survival. Few contemporary studies and lack of prospective studies in the era of modern systemic therapies for recurrent or advanced gynecological cancers, and there is a dearth of studies from the LMIC. We undertook this review to assess the perioperative outcomes and survival in our cohort of patients with gynecologic cancers. This was a single center retrospective study where clinical information of patients undergoing pelvic excentration at the Department of Gynecologic Oncology from 2011 until 2022 were reviewed. Ovarian cancer patients requiring excentrative procedures were excluded from the study. Only those surgeries which were done with radical intent were included. Restrictive statistical analysis was used wherever appropriate and survival analysis was done with the help of Kaplan-Meyer method. Surgical morbidity was graded according to the Clavin-Dindu classification. If we look at the baseline characteristics of the patients undergoing pelvic excentration, among a total of 24 patients, local recurrence accounting for 70.8% of the patients was the most common indication for the surgery. The majority of the patients, that is 41.7% had cervical cancer followed by uterine, vulval, and vaginal cancers respectively. 50% of the patients underwent anterior excentration, 37.5% underwent total excentration, and 12.5% had posterior excentration. Urinary diversion was required in 87.5% of the patients, colostomy in 50% of the patients. The median age of the patient was 53.5 years while the median BMI was 25. Most patients had an ECOG PS of 0 and were without any comorbidities. Equal number of patients had prior treatment with surgery or radiotherapy. The median time to progression after last curative intent treatment was 18.2 months. Now coming to the perioperative outcomes, 70.8% of the patients had infectious complications and in 58.3% of them, urinary tract was the most frequent focus. A third of the patients were readmitted with infections. The median estimated blood loss was 1000 ml and the median hospital stay was 16 days. The median ICU stay was three days. Clavin-Nido grade three or more 30 day complication rate was 20.8% and the 30 day mortality rate was 4.2%. We had one death on the 14th postoperative day owing to sepsis. 20.8% of the patients had local regional failures and 25% had recurrence at a distant site. The two year local regional control rate was 87% while the median progression free survival was 16.8 months. The median overall survival was 33.9 months and the estimated five years overall survival rate was 35%. No factor had a significant association with survival. To conclude, pelvic excentration in gynecologic cancers had acceptable perioperative outcomes with low treatment related early morbidity and mortality albeit a high postoperative infection rate. Survival outcomes were comparable to those reported in prior studies. Thank you. So congratulations to Dr. Powell's study. We will now begin the Q&A portion. Since two of the presenters could not be here today, we will invite only Dr. Biru back to the stage so that we can ask her some questions about her study and findings. Dr. Biru. Hi. Great. Thanks for coming back, everyone. So I hope you enjoyed your quick break. We're going to now proceed with our next session in the Early Career Research Network meeting this morning. It's called Challenges in Gynecological Oncology for Early Career Professionals. And in this session, we'll discuss some common challenges faced by young gynecology professionals early in their careers and try and discover some solutions that can be implemented in both professional and personal lives of our early career members to improve their work-life balance and identify ways to incorporate research into their career. So please join me in welcoming the panellists to this stage. We have Florencia Knoll, who's one of our junior faculty members, Arthur Zhu, and the moderator is Georgia, Georgia Fontes-Cintra from Brazil. Welcome. So good morning, everyone. It's a great honour to be here and to be part of this. So I'll be moderating today's session, and alongside these amazing, incredible panellists, you already know the two besides me, but we're having Dr. Juliana Rodriguez, who's a gynecologic oncologist and Master of Epidemiology in Colombia. We'll also have Dr. Anissa Mumburu, who you just saw her research on the oral abstracts, and Dr. Michael Steller, a retired gynecologic oncologist from the United States, who had that great question as well. And I'd like to welcome Dr. Juliana Rodriguez to give her presentation. Good morning to everyone. My name is Juliana Rodriguez. I am a gynecologic oncologist from Bogota, Colombia. Today I will be speaking about the finding for life balance for young gynecologic oncologists. When I was asked to give this lecture, I had 31 windows open, it's insane, two papers to review, multiple tasks in my home, and my daughter, Dina Sofia, saying to me, please, Mom, let's play with me. The main question is, do I have the ideal work-life balance? Of course not. So, thank you for your invitation. See you in the next IGCS. But wait a minute. Balancing your professional and personal life can be challenging, but it's essential. What life balance is aligning your personal values and priorities in your career or personal life? Life balance is a perceived state. Only you know when your life is or isn't balanced. An ideal life balance is a subject concept. Your ideal balance is different from my balance. However, the outside of the medical profession are long working hours, emotionally demanding situations, and the usual self-care network. In the medicine, culture of prioritizing patient can over personal need is definite. So, this topic was addressed by the SGO in a paper published about wellness, burnout, and gynecology oncology. The most population was female. The most important topics are work encroaches on my personal time and excessive clinical and administrative requirements have adversely impact my personal life. Females gynecology oncology report the worst work-life balance across all five domains. In consequence, the effects of poor work-life balance are stress, get burnout, illness, insomnia, clinical depression, among others. When you look at information about this topic, you can find more than a million articles, but none of them is perfect about the ideal formula. Some general recommendations are, what makes me happy? What does balance look like for you? What do you want your schedule to look like? And when you're clear about that, it becomes easier to find a position that can offer what you seek. Of course, time is essential. Effective time management becomes the key to feeling like you have time to dedicate to yourself. Comprehensive time management is important. Identify time-wasting situations is important. And take time to temporarily withdraw from responsibilities and obligations of everyday life. Please don't be afraid to say no. Pay my bills, my paper submissions, my conference, my vacations, my family demands, my love life, and my research interests. Please zone. I love the mariachis. And the self-care is very important. Create time for personal reflection. Time to 10 minutes every day. Maintain physical well-being. Nurture your closest relationships. And create a hobby or nurture your own you already have. They are my friends. Thank you for this. Remember, you have to let go your need to control everything and to be perfect. You can change how you have built your life every day. Take challenge and don't be afraid to get out of your comfort zone. I'm not fluent in English, however I am here talking about all of you. And life will never change if you are expecting for the future. This is the lag and the end of the tunnel of the medical profession. Angela is my patient. She had a cervical cancer and she is her daughter. They are my patients of ovarian cancer in Bogota. The balance is possible. An award for my activities in the IJGC and the award for my daughter. She had the best student in her class. Two papers, many important. A paper in the International Journal of Ovarian and Colorectal Cancer with editorial of David Sibula and the letter of my daughter. It's very important. I'm blessed that my colleagues are my friends. Colleagues in the conference and at the bus. And finally, I have achieved my life-world balance. It's not perfect, but it makes me happy. Thank you for your attention. Thank you. Thank you, Dr. Rodriguez. It was amazing. A lot of good advices in very few minutes, but we have time to talk about it later. So please join me now in welcoming Dr. Anissa Mburu again to give her presentation on challenges for young gynecologists in low and mid-income countries and how to handle them. Thank you, Dr. Anissa. Good morning once again. Please don't get tired of seeing my face. So I was given a very simple topic to talk about today, and that's the challenges we face as gynecology fellows, particularly working in low and middle-income countries. Most of it we know. Oh, well, I have no disclosures. Let's start there. And so I'm going to illuminate about some of the challenges that we face. I know most of you have worked in LMICs. Some of you have come to LMICs and see the struggles that we face. So none of this is actually new to you. So to put some words into this very busy chart, we're going to look at mostly the problems that we face in terms of the place, the process, and the public that we're trying to help. When it comes to the organizational support, especially the places where we're working, we tend to have a lot of problems, especially with getting skilled staff. Some of the time when you're going through surgeries, we don't have good anesthetist or anesthetist to actually know how to deal with cases, the kind of cases that we deal with. We don't have access to extensive surgeries, upper abdominal surgeries. We cannot do them. We don't have access to good ICUs, readily available ICUs. And of course, in my university, we had a lot of lecturer strike. So even my education was delayed by six months because of the industrial action by lecturers who had not been paid over a while. And of course, when it comes to things like blood and blood products, radiotherapy, chemotherapy, immune therapies, in fact, immune therapies is just a thought in the cloud. We don't have access to this. And of course, high-tech, it's nowhere in Kenya where I practice. Now, unemployment is also something that we face. Personally, I've been a victim of this. To start my residency, I had to resign my position and I was unemployed for six years when I went through my residency and my fellowship because no one wants to hire students. And the hospital where I was training, they did not want to hire anyone or they couldn't hire people. And another thing that we really worry about is the diagnostics. When it comes to our patients, we want to be able to provide them with the accurate care that we can. But in terms of the screening them, providing them with vaccines, the HPV vaccine has done wondrous thing in places like Australia and where have you, and we still don't have access to it. When it comes to the surgeries we're doing, when it comes to pathology, at the same time, we can't get, we don't have an oncological pathologist who can actually give us accurate diagnosis and timely diagnosis. It takes about two to three weeks to be able to get a biopsy result back. And by that time, as you know, it delays initiation of treatment for our patients. Specialized imaging, again, a thing of the clouds. MRI, PET scans, we don't exactly have access. Sometimes we have x-rays, sometimes we have CT scan, but that's the best we can do. And I cannot even talk about genetic testing because this is something also not accessible to most of us. When it comes to the very public that we're trying to help, we suffer a lot of stigma and ignorance. Patients, as I'd said earlier in a different presentation, when you give a patient a diagnosis of cancer, the first thing they think about it is that they're going to die. And so they don't want to come to hospital, they don't want to receive treatment, and most of all, they won't want to even hear that there's something that can be done about that cancer. And we are currently competing with traditional healers or faith healers such that patients will decide to go get herbal remedies before they come to hospital, and then when they come, it's far too late for us to help them. Political instability is a major issue in LMICs, and also because of distance, very few specialists around, we have a lot of late referrals. And in the hospital I worked in, we had one clinic day per week, and we would see about 40 to 60 patients on that day, and we'd be about two or three fellows at a time. And of course, the one big thing as fellows is research. We are not able to access data, we don't have good quality data, or even consistency, security, or access to publication of said data. So having gone through all the dark clouds of the challenges that you're facing, I want to just talk about a few building blocks or things that really helped us or me as I went through my fellowship. So the first thing is collaborations. When you're a fellow, wherever you are, you need to build a team that you can work with. A pathologist you can sit with and look at the slides. This is one of the things that really helped us. We identified a pathologist who we kind of forced him to develop an interest in gynecology pathology. He would join us for our IGCS tumor boards, and he will give an opinion, share with other pathologists on the IGCS panel, and we're able to actually get a diagnosis, a timely diagnosis on our patients. The same goes to the radiation oncologist. During my fellowship, we were fortunate enough to start giving radiotherapy for our patients, which was something that we did not have before, and it's only been happening for the last two years. And now we were able to get a radiation oncologist who we can actually discuss patients, because most of the time, we'd actually rely on the IGCS radio oncologist like Dr. Anuja Jhingran, who would actually help us, and then we'd send our patients away to a different town. Another thing is sometimes we are single fellows in different institutions, and one way that IGCS has helped is getting fellows who we can actually have discussion with, and this is something that really helped. I formed a WhatsApp group with a few of the fellows from Vietnam, Bahamas, Fiji, and Uganda, and we would actually, through a WhatsApp group, we'd discuss cases, look at even question papers, and just try and help each other from different parts of the world, and that was really important. And of course, if you can have a surgeon who can come in through your surgeries to help you when you're stuck interoperatively, you have gut that needs resection, you can also learn from them, get them on your team. And of course, if you have a plastic surgeon who can make our patients pretty again, it always helps. We have a lot of vulva cancer, so we need a lot of vulva reconstruction for our patients. So in general, just play nice with others. And of course, it's said that the man who does not read has no advantage over the man who cannot read. So it is very, very important that you keep updating your knowledge. And it's one of the books that we use in our center is the Principle and Practice of Gynecologic Oncology. And this book, we call it the Bible, essentially, for our, in our setting. And we go through chapter reviews, and we go through with our biweekly meetings. Every Tuesday and Friday, we'd have our international mentors and local mentors, Barry Rosen, Alan Covins, every Tuesdays and Friday. We go through a chapter, we discuss it, we go through different cases and even papers in relation to each of the chapter that we've reviewed, such that by the end of the two-year course, we've been able to go through the entire book, supplemented it with the cases and additional papers, and that's why it actually builds up on our knowledge. And one thing I would add is that let us not be afraid to challenge what is known. We're seeing people doing crazy, amazing advances in the scientific world. So us in LMICs, we shouldn't feel left behind. We can still be innovative and work with what we have. There are a lot of resources that are at our disposal. And one thing that has really helped me personally is the tumor boards. When we have access to all the different tumor boards, you can attend any different tumor board, and this can help, especially if you have a case that has been discussed in a previous case, you can actually apply what was discussed in that time in your case, and you get to learn and meet other people and other fellows and other mentors who can actually keep you on track. The education portal by IGCS has a lot of material that we can also use, as well as the AGL site and the SurgeryU. Now, one thing that we don't, as I said, we don't have access to things like upper abdominal surgeries robotics or laparoscopic surgeries are not very common, especially in Kenya. But through SurgeryU, we're able to watch some of the surgeries and at least get an idea of how things are done. And I cannot emphasize enough on mentors. You need to deal with your mentors, talk to them, get them to work with you. And for these mentors, it's not just about them guiding you. There's some who can actually uplift you, give you opportunities, help you in achieving what you need to achieve as a gynecologist. And this has been discussed quite a bit this morning. Research is still a part of us. Just because you're in LMICs or you're a fellow doesn't mean that you cannot participate in research. Get a topic that is of interest to you, get that idea, and something that you will not get bored of. Some of these research topics, you will go through them for a year, 10 years. So you have to be interested in it. And then find mentors who have excelled in this topic. I was fortunate enough to run into Dr. Raymond Osborne, who's a GTN specialist, and I was interested in a GTN case. And he was able to mentor me through two, three years of putting together that case and be able to finally publish it. And of course, we might not be able to have access to big, big grants, but there's still small grants that are accessible to us as junior researchers. So learn the essentials of grant writing. There's some many, many resources that you can use. For example, the link I've shared on the ASCO Career Development and Grants Awards, there are also talks in grants.concur.org. Go through them, find things that you can actually apply for. I know in my last two years, I've worked with my mentors, local and international, to apply for U54 NIH grants. And through a lot of processing, going through a lot of steps, I was able to get a few grants which have actually sustained my research in terms as a resident and a fellow. And of course, find journals that are interested in your topic, as it was said earlier this morning, that they can actually publish what you have to say, who are interested in what you have to say, where articles from your country have been published before, and then submit to them. And there's always rejection. So do not take it personally. Do not take it as a means that you're not good enough. I've been rejected by several journals. Pedro Ramirez is one of them. Thank you very much. But again, he's also published some of my papers. So you take that as a learning point so that you can move forward, learn from them. If you're lucky, you'll get a few reviews, a few comments on how you can make your topic better, and you can move on to publish something even greater. And these are a couple of papers that I got to publish in the International Journal of Gynecological Cancer, where I worked with Dr. Raymond Osborne and even Dr. Alan Covins, as well as one on the paper I presented earlier on epidemiological profile and clinical pathological features of pediatric gynecological cancers at the Gynecology Oncology Report. So it can be done. It is possible. And I will not, I'll be remiss if I don't say a line from one of my favorite musicals, Hamilton. Do not throw away your shot. Every moment that you have, every hurdle that you face, you can actually not just jump over it, you can fly over it. And thank you very much for your attention. Thank you, Dr., for this incredibly motivating lecture. So I'll now hand it over to Dr. Michael Steller to give his presentation on incorporating research into your practice. Thank you, Dr. Steller. Good morning. I have to admit, after those presentations, I feel like I'm reinventing the wheel and duplicating. They were so well done. But I do want to share with you some of the work that's been done fairly recently to try to leverage technology so that we can organize research for the IGCS fellows in training and try to take advantage of the vast clinical volume that all of the centers have collectively and also try to leverage technology because we're able to communicate now in ways that previously we never were able to. And the combination of technology and the clinical volume, hopefully, can be brought to bear so that we can start to publish better and better papers. Recently, there was a survey that many people who are trainees participated in. And it was a survey that involved 27 of the fellows in training. And 25 of them actually attended an introductory Zoom meeting, a lot like the Project ECHO meetings that we regularly have. And then we were able to tabulate the results of the survey. So this slide shows you some of the hurdles that were identified by the trainees as obstacles for them to conduct research. First and foremost, most people do not know of any specific area to work on. So that issue really underscores the incredible need that we have for mentorship. Because really, the trainees are looking to people with more experience to guide them in where to funnel their energy in order to produce something that is worthwhile. There are also other obstacles, like insufficient support to do statistical analysis. As I mentioned earlier this morning, there's sometimes even an obstacle where there's a limitation in having available paper, which is kind of mind boggling. But it's a reality. And we have to be sensitive to that in order to try to facilitate and foster a new generation of researchers who are working in places with limited resources. So how do you identify a good journal for submission? It has a lot to do with mentorship and guidance. And as Anissa earlier pointed out, you have to read a lot. And I'll get to that later in this discussion. But that's really an important component of it. And so as far as the mentors are concerned, they want to try to simplify the journey of doing research. They want to provide guidance in paper writing. They want to help to build hypotheses. These are the building blocks of doing medical research. So the survey asked some very important questions that I'm kind of condensing into just a few point and answers. What current resources do you have available? And most of them have the IGCS early career network as something. And there are other resources that Anissa pointed out that very few people take advantage of, but they are available. The big take home from the survey is that every single one of the fellows that answered the survey said that they would like to be part of a research network if it were organized. And then if a research network were organized, how often would they like to meet? And by and large, the preponderance of respondents said monthly. So when it comes to mentors, of course, you have your local mentors, and then there are the international mentors that are available on the Project Echo, Zoom meetings that are held monthly. And then one really important source of mentorship is to try to seek somebody who will guide you in an area that you're interested in. And you can reach people just by sending them emails, and you'd be amazed at how attentive and responsive most people will be. You can formulate your plan with the guidance of a mentor. And then the IGCS Research and Publication Committee, of which I'm a member, is a resource to trainees if they need to get some input from any of us about resources, about available mentors, about journals that might be ones that would be interested in publishing your work. And then you have to establish, given the resources, measurable endpoints and timelines and goals. The survey outlined areas that the fellows thought were of interest, and the one that stands out to me is meta-analysis. And that is highlighting the fact that most of the fellows feel that they don't have the leverage of their single institution in order to answer important clinical questions, and so they want to collaborate and bundle them in order to try to have a much more powerful clinical point to make by getting other institutions involved, other studies involved, other fellows involved. So you have to, of course, assess your resources. You have to identify journals and databases that are likely to accept the publications, especially from low- and middle-income countries. Then there are issues regarding cost, expenses. The committee right now is in the process of generating a list of journals that waive the publication fees, and a list of journals that have a targeted interest in the topics of interest to low- and middle-income countries, because, as we've discussed this morning, they're different. Places with high resources have different clinical approaches, but it doesn't mean that places with low resources don't have very important points to make. What do you do, optimally, when you have limited resources? Well, it's worth it to describe it, because one day some people will be in a similar position and it will help. We want to leverage the resources of other IGCS training sites, and you can do that using technology that's under development portals, for example. And then, lastly, there is a database available to all the IGCS fellows, as you know, because all of you feed your data, your case volume, into REDCap, and this serves as a database for you to mine in order to develop a clinical point that you wish to make and publish. So collaboration is a big focus when the resources might be limited in your community. If you broaden your horizon to include the greater IGCS community, then sometimes there's vast resources. So you can join the IGCS Research Network, which is in development and really being spearheaded by Dr. Asimov from India. Of course, the rest of the committee is also involved. And then we have to establish mechanisms for regularly updating each other, and for this you can use websites like the Central Blackboard area, which is useful for collaborating. You need to schedule dedicated time. This doesn't just happen without structure. You need to either carve out time daily or weekly or monthly or as often as you possibly can in order to meet the goals of your project. And you want to have regular meetings established among collaborators at scheduled times, which will help to keep you on target with your timeline. As I mentioned earlier, you need to read, read, read, read, read, because this is the basis of understanding what the questions are today that might be valuable to try to examine and work on. The IGCS will provide links to the journals and databases, as I mentioned earlier, that may be the types of forums for publishing topics of interest in the communities that you all work in. And this is a shout-out to Anissa, who just showed you this slide, but through her persistence and dogged determination, she was able to publish not just this, but many other publications. And she did it by digging deep. This is a topic, this is a case study, and that's a perfectly legitimate research topic that was published. Was it truly novel? No, it wasn't. And if you read the paper, you'll find that the patient even died. But was it instructive? You bet it was. And it was really scholarly. She included and got mentorship from Dr. Ray Osborne. And the contributions of the mentor and the dogged determination of Anissa produced a really great paper that was not just a disclosure of and a description of a case report, but also a review of what you would do if you had abundant resource. So it was an education both from the practical and the optimal. So really, these kinds of efforts are instructive to people from all different walks of life, no matter whether they're from high-income resources, high-resource areas, or low. So I want to thank you for your attention today, and shout-outs to all of the people on the committee, including Asima and Donna Chakraborty and Susan Ralph. Thank you for your attention. Thank you, Dr. Steller. So now we'll have the time for some questions, and I would like to ask the panelists to join us here, please, Dr. Steller, Dr. Juliana, and Dr. Anissa. Does anyone from the audience? Dr. Pedro. Yeah. Hi. So congratulations, obviously, to all the speakers. My first couple of comments for Anissa, congratulations again on your presentation. One thing I want to change in your program is that book that you call the Bible, so I would like to actually later on ask you how many copies of Principles of Gynecologic Oncology Surgery would serve you well in your program, and I'll be happy to provide those free of charge. Oh, my God. So we need to do away with that other book that you're using. You know, the other thing also is that, you know, one of the things that we have done at the journal is to incorporate a number of educational forums where, you know, certainly we have the monthly journal clubs, we have weekly podcasts as well that I would encourage certainly in this type of setting to consider listening to those or participating in those because I think it opens an opportunity for not just, you know, certainly those in low and middle income countries, for everyone to actually get an insight into what went into the study, the publishing of the study, what are some of the gaps in that study, and I think it's really very important to participate in those. We're going to talk a little bit later about the fellowship in the journal, so I think that's also a great opportunity for young faculty to be involved in the process of manuscript writing, manuscript reviewing, being critical about the literature, because I think that that's actually one of the most important impacts that many mentors today can make. You know, certainly when I'm often asked to speak about, well, you know, you want to speak about the LAC trials or you want to speak about ovarian cancer surgery, I often say, especially, you know, I want to speak to the young faculty about how to put together a manuscript, how to actually improve the likelihood that they're going to be able to achieve that. One last question. Basically, my question to you is, you know, when you get back home and your colleagues say, well, you had the opportunity to go to New York and have an interaction and a networking with all of these individuals, colleagues, leaders in gynecologic oncology, if there's one thing that you can bring back to us as a community of gynecologic oncologists, what would be your ideal take home? Thank you so much, Dr. Ramirez, and thank you so much for the offer of the book, I mean for the offer of the books. And going through this kind of conference, it's my first IGCS conference, and it was amazing to be able to meet all these people and be able to talk to people who have just been seen on Zoom meetings. And if there's one thing that I can take back is the collaborations and networks that I've been able to establish this time. I think I've talked to a few people around here and told them about my country, the problems we're facing, and they're willing to carry on the discussion to be able to continue mentoring us, teaching us, and helping us set up better care for our patients, better research, and even ideas on how to build our country, not just our institution, but our countries in the face of women's cancer. And that is the one thing that I can really carry forward and we can actually continue. Because in the meetings, we're not just talking, we're looking for ways to go back on the ground and actually do something, create change, and be the change, and that is what I'm looking forward to. Thank you. Yeah, great. Congratulations. And then I have a, you know, comment and a question for Juliana, fantastic job, of course. You know, obviously you are a leader, you are someone that leads by example. You are not only, obviously, demonstrating a great role model to other gynecologic oncologists as well, but certainly your daughter will learn so much from what you're doing. And certainly my question to you would be, what would you say to a young trainee gynecologic oncologist from a low-income country who's saying, you know, how do I get to the podium, how do I get to actually be up there speaking, rather than being in the audience? What would you say? Can I speak in Spanish? This time, yes, but next year, no. It's a challenge, because in my country, not all the people have the opportunity of studying English full-time, for example, to travel for this conference. It's very difficult, occasionally, to take this challenge. Thank you for this opportunity, and today, it's the most evidence, it's possible, all is possible. So, do you want to speak in Spanish or English is perfect. Right, thank you, congratulations. Go ahead. Rahel Gebra, I'm a practicing gynecologist at the University of Minnesota, and I'm a mentor for the program both in Ethiopia and Rwanda, and have been for some time. I really want to thank the organizers and all of you that are there today. I think this is really the first time that we are talking about research as a critical component of the international fellowship training. So much of the efforts to date have really been on the clinical component. What has made the clinical part really work is meeting our international colleagues in their own setting, so that they are doing less of having to do the adaptation, but that we, as international mentors, are adopting more to their needs and their locations and their priorities. And I think this is an excellent first step in terms of research, but as I can see from those that are present today, it's really the exceptional ones that are coming and meeting us here in our own setting. So, there are growing organizations like Aortic that really focus on a regional, building a community in the local sites, so Aortic is one example. So, I wonder if there's also a way from the research community to think about, to reduce the barriers so that we are meeting them in their locations, whether that means wanting to speak their local language, present in their local language, seek funding that is much more benefit. I think, for example, the listing of the reduced costs, those are really fantastic opportunities. Maybe there's not one answer, but maybe for those that are doing the research, to let us know how much effort is it taking for you to do the research right now. I'm going to try to interpret your question, but I very much enjoyed your comments. One of the things that's a challenge is to try to pick topics that are consistent with the resources in the location that the fellows are training in. There are a lot of important questions to answer. You know, today we have biologicals and PARP inhibitors, and we have amazing new technologies that sadly are not uniformly available in all parts of the globe. So, I think your comments about the research component, and it's now kind of becoming a discussion item, this is a little bit of a fledgling effort, and baby steps, one thing at a time. But the great thing is that we can all communicate using technology, and the fellows, they already know each other. I mean, that's pretty amazing. When I did my fellowship, I didn't know people in the next city within the city. So, this is all very, very good. And I think that if we kind of pool the resources, it will allow some questions to be entertained and thoughtfully described and mapped out. Go ahead, Henrik. Thank you, Yuria. I want to make a comment. The learning, teaching is a dynamic process. Now, we are the mentors, and you are the mentees. But in some years, we are going to get retired, and the mentees will become mentors. And the responsibility of a mentor is to convince others to be able to do the things, just wishing it, just working on it. If you want it, you can do it. So, the compromise is to become, to you, to become good mentors. A mentor is a kind of talent hunter. So, it's easiest for the mentor to try to find mentees, that for mentees, try to find a mentor. So, my advice is try to become good mentors, because you are having a very, very good starting point. Thank you for doing this activity. Thank you, GCS, for opening this space. That's it. I have some final comments. We have still more three minutes. So, I think we had really excellent lectures. Juliana really talked very nicely about prioritizing our self-care and our family care, and how that's important even to how we deal with our patients and how we become doctors. And something that we all learned, I think, is that if we want to treat someone, then we need to be well with ourselves as well. And that's very important for early careers where we're so overwhelmed about everything we have to do. We feel the need to accept most of the invitations we have, because we feel we're missing some opportunities there if we don't accept that. And, of course, we always have to do some unpleasant tasks at the beginning, but I think it's very hard when you advise how you have to learn how to say no in this setting, because it's hard to know what's not, like it was said before, like maybe I should not be accepting to write book chapters anymore, or what's acceptable and pleasant work that all young gynecologists should do and what's not. And the challenges of doing gynecology, oncology is such a complex area in low- and mid-income countries. Dr. Anissa showed very well we are not alone. We are just one part of the patient care, and sometimes we have so many people we involve to give good care, and it's very hard to involve all these people, and I think she showed us a way to do that. I was very inspired. And I think the other thing is that we should really understand the importance of research, and as a person from a low- and mid-income country, I don't think most doctors in our countries are really aware of the importance of this and how we should really prioritize this, and for us it's even harder, I think, because we don't have really a hospital support or research support. So I learned a lot from this, and I would like to know if you have final comments. And if we can go ahead. I think that we have to try to play to our strength. Obviously, you can catalog all of the deficiencies because of the disparities in wealth and resource, but that won't move the ball forward. What will move the ball forward is to recognize and marshal the resources that we do have, and we have unprecedented resources with technology, with communication, with REDCap, with the pooled clinical volume that, I mean, the IGCS fellows are doing unbelievably large volumes of patient care, and they're able to catalog the results, and I think that's going to be very instructive. So trying to use technology and trying to collaborate and communicate among the different locations that the program is currently involved in, I think is, at the moment, something that we can leverage to advantage. Is there any final comments? I think we have one more minute to the next session. Okay. Thank you all for participating. It was really amazing. So we move forward now in the discussion. So thank you so much. Thank you, Dr. Sindra, Dr. Stiller, for your comments, Anissa, Juliana. So that was really a great discussion with so many thought-provoking points. It was very meaningful to hear different perspectives on how to deal with and overcome common challenges we have all likely faced as early career professionals. We will now move on to our second session of oral abstract presentations. First is Dr. Emmanuel Etankuni Sajo, a fellow of gynecological oncology at the University of Torea, South Africa. Dr. Sajo's abstract is titled Evaluation of the Medically Necessary Time-Sensitive Triage System During and Beyond the Local COVID-19 Pandemic in the Gynecologic Oncology Unit in a Tertiary Hospital in South Africa. Dr. Sajo could not travel to be here today, so we will now play a recording of his presentation. Thank you very much. This is an abstract of my dissertation for my master's in philosophy that was carried out in the University of Victoria, and we tried to evaluate the medically necessary time-sensitive triage system during the COVID-19 pandemic in our gynecological unit. So, during the pandemic, the onset of the pandemic in March 2020, there was a pronouncement of lockdown, and hence, most elective cases were suspended. However, in our unit, we decided to prioritize cases based on case-by-case priority. And as we all know, this wasn't a fantastic, objective way of triaging patients for gynecological surgery. So, however, there was a triaging score that was made during that period in the University of Chicago to prioritize patients for surgery during the acute period of the pandemic. So, we decided to retrospectively score all the patients that we operated during that period, and also those patients that were suspended to be able to see if this scoring system could be utilized in gynecological surgery. So, our aim was basically to evaluate this score in triaging our gynecological patients. And as we all know, most cases in gyne cancers require urgency. However, because of diversion of resources during that period to cater for the tiny population of COVID-19 patients, there was need to objectively prioritize patients in order to limit wastage and appropriately triage patients that needed surgery. So, our major objective was to describe this scoring system to see if it could be used in our gynecology unit. And we also meant to compare these scores among the patients that were operated, and also among those patients that we suspended their surgery. And in order to reduce bias, we tried to determine intra-observer reliability, and also intra-observer reproducibility of the scoring system. So, it was a retrospective cross-sectional study. We didn't use this scoring system to triage patients. So, what I have are those patients that were operated between the pronouncement, which was on the 26th of March, 2020, and at the end of the lockdown, which is 38th of September, 2020. So, we had about a total number of 209 patients that were recruited. And out of these, we operated 151 patients, and 58 patients had their surgery postponed. And the study center was Chibiko Academic Hospital, under the supervision of the University of Victoria. So, each of those patients were scored twice. It was scored twice by the main observer, in order to determine the intra-observer reliability. And the total score was done by another researcher, in order to be able to come down with intra-observer reliability of the score. And the scoring system comprised of three factors. We have the procedural factor, disease factor, and patient factor. Each of these factors, the procedural factor has seven variables, while the disease factor has six variables that were analyzed, and the patient factor has eight variables. And the cumulative score was meant to see that if a patient has a higher score, it means that such a patient will require high consumption of healthcare resources. It will also mean that such a patient with a high score will have a perioperative complication or perioperative outcome, which will be poor. And also, it means that there was increased risk of transmission of COVID-19 to health workers, and also for patients that will require prolonged hospital admission. Such a patient may be at risk of acquiring COVID-19 during their admission. So, and each score has a five-point score of one to five, and the minimum score was 21, and the maximum score was 105. We analyzed our statistical analysis using STATAR-13. So, on the average, the mean score of the patient, the mean age, it was 46.6 plus or minus 15 years, and the age ranges between six years and 80 years of age. And there was significant difference in the mean score between those patients that were operated and those patients who had their surgery postponed. The score of 49.8 versus 54.1 for patients that had their surgery postponed. And basically, the cases range between the benign cases, pre-malignant cases, malignant cases that were operated during that period. The majority of the patients had low score. The majority of the patients that were operated actually had low score. And there was no difference when we tried to compare the inter-observer reliability. There was no difference in the two observers' score. The first cumulative score by the first observer was 51.0, and the ones that was done by a separate researcher was 51.1. So, there was no difference. And over 96% of patients that had malignant cases had low score, as we know that this patient subjectively, they were classically prioritized for surgery. And in our study, we were able to demonstrate intra- and inter-observer reliability using the cross-batch alpha coefficient. We have coefficient of 0.78 and coefficient of 7.4, which means a strong reliability, internal reliability. We didn't use Kappa scoring because it was a cumulative score, which was a continuous score. It wasn't a graded score. So, that was why we used the coefficient to determine the reliability. And the mean score was statistically lower among patients that had malignant cases, as compared to patients that either had benign cases or pre-malignant cases. Also, for patients that had radical surgery, they apparently had lower score, as compared to patients that had minor surgery or major surgeries during that period. And when we tried to control for co-founding variables using our multivariable analysis, the herd of surgery among patients with low score was about five times higher than patients with higher score. And the host of patients with malignant disease having surgery was five times higher than patients with benign disease. And this, we could see the adjusted herd ratio and the coefficient for confidence interval. So, these two graphs, the first graph on the left, showed the distribution of the scores among patients that had their surgery done and among patients that had their surgery postponed. And this was similar to the one that was done by Prashant Deptor, the one that was first done in the University of Chicago. They used a cutoff score of 54, which was also similar to the one that we used. The majority of our patients fell below 55 men's score. And the score between the red and the blue threshold means intermediate score. And the essence of these scores is that it is highly malleable. It can be adjusted depending on the capacity of the operation, of the operating theater, also depending on the resources that are available at the time of scoring this patient. So, the threshold can actually be dynamically adjusted in order to fit into the availability of capacity and resources. And also, post-COVID, this adjustment can also be done to clear those backlogs that we had during the COVID period. And also, in a center where gynecological cases are more. And so, we can also use this scoring system to triage patients to adjust based on availability of human resources and hospital resources. On the right-hand side, we tried to compare the ROC, that is the receiver operation score. And this helped us to also determine the inter-observer reliability, because the model that we drew from the first observer and the second observer showed that the model was able to excellently discriminate between patients that were operated during that period, and patients that had their surgery postponed. So, in conclusion, our study was able to provide insight because of the limitation, because it was a retrospective study. But it was able to have an insight into the potential usefulness of the men's score in gynecological centers, especially in Africa, where resources are limited. And also, the score was able to perform reasonably well across all gynecological conditions, whether benign, malignant, or pre-malignant lesions. And also, because of the fact that we were able to demonstrate good inter-observer reliability, it could also make this scoring system reliable too in prioritizing patients in gyne-oncology. But, however, because of the limitation of the study design, we recommend a large longitudinal study to be able to come with a definitive scoring system in which we'll be able to prioritize patients objectively for surgery without any bias. And in this, our study, we have nothing to declare. And thank you very much for listening to my presentation. Congratulations to Dr. Sajo for this interesting presentation. As a comment, the scoring system, this medical necessary time triage system, integrates these factors, as Dr. Sajo comments, to facilitate the making decision process and the triage of procedures, weighting individual patient risks and the ethical necessity of optimizing public health concerns. And that's really important in our settings, most in low and middle income countries. So, well, now we are going to invite Dr. Betel Gulelat, gynecology oncologist at St. Paul Hospital Millennium Medical College in Ethiopia, to give a presentation of her abstract title, Impact of Global Partnership on Surgical Care for Patients with Cervical Cancer in Ethiopia. Thank you. Thank you. Good morning again. So, I was asked to prepare only 10 slides for a five-minute presentation. I think I'm going to finish it in three minutes, so I will add some of the information you may need to hear. So, I was a previous IGCS fellow and currently a local mentor in my site. So, I have nothing to disclose. So, cervical cancer is the second commonly diagnosed cancer in Ethiopia, and it's the second leading cause of death. When we say it is the second, it's among all cancers in Ethiopia, including male, female, and pediatric cancers. And you can see the greatness of cervical cancer. And Ethiopia is a country with 110 million people, nearly 60 million women living in Ethiopia. And cervical cancer accounts for 22% of the cancer cases in Ethiopia in the age group to 15 to 59. And you can see how much working manpower that we are still losing. And this makes it a symbol for global health disparity. So, our gynecologic fellowship training program was launched in 2016, and our program works in collaboration with the University of Minnesota, University of Michigan, and German Society of Gynecological Oncology. And in 2017, our program joined the global oncologic fellowship training under IGCS. And currently, we have graduated two IGCS fellows from St. Paul, and a total of, we have six gynecology oncologists and six more in training. And this study is presented to show the impact of the global partnership on surgical care for patients with cervical cancer who are managed only in our center. So, this is a hospital-based retrospective cross-sectional study, and we have used the previous five years pre-fellowship period to compare the results that we have been doing it. So, this data shows you the five years achievement after we have launched the fellowship program at St. Paul. So, we were able to see a total of 110 cervical CA patients in the five-year period, and then 56% of them were eligible for surgical management. And the average number of patients operated per year increased near 11 times from the pre-fellowship period. And the mean age of these patients were 49. And 18% of these patients were HIV positive, and a quarter of them received neoadjuvant chemotherapy, and 55% of them were eligible for surgical candidates. So, when we talk about the issue of neoadjuvant chemotherapy in the low- and middle-income countries, so, as you know, there is a limited access to radiotherapy center. We used to have only one cobalt machine for the whole nation for the past 60 years, 60 years. So, this really makes a significant difference in the waiting time for the patients to receive the radiotherapy. It may even lapse until 18 months, so majority of them will die before receiving the service, and then still majority will progress to the next level of the disease. So, when we see our surgical candidates, so these are only the surgical candidates that we're using, nearly 37% of them were in the stage 1b1, and 30% of them took chemotherapy, neoadjuvant chemotherapy, and they were operated, and still squamous cell carcinoma is significant histologic findings that we see. Among the surgical candidates who took the neoadjuvant chemotherapy, 66% of them had negative lymph nodes, 73% had negative vaginal cuff, and 75% of them had nearly negative parametrium. And among all the patients who took neoadjuvant chemotherapy, nearly 60% of them didn't need further treatment. So, equipping professionals to do their surgical skills have really changed the lives of many women in our setting. So, I think I have one more slide. So, in the bivariate analysis, you can see that those patients who took neoadjuvant chemotherapy, you can see the protective effect, including the lymph nodes, the parametrium, then the vaginal cuff. And then these are patients who were previously going to be referred for chemo radiation while waiting. Majority of them are going to lose the option of treatment because of the waiting time, but still because of the surgical skills that we were able to attain, and we were able to treat all these patients. That's all. These are my references, and thank you. Thank you for IGCS. Very well done, Dr. Gulat. Thank you so much. Next, I would like to announce our next presenter, Dr. Monica Thiagarajan, trainee in the Department of Gynecologic Oncology at Christian Medical College in Vellore, India. Dr. Thiagarajan could not travel to be here today, so we will now play a recording of her presentation titled, Compliance of Surgical Care in Patients with Carcinoma Endometrium in a Tertiary Care Center to ESGO Quality Indicators. Hello, good morning. I'm Dr. Monica, working at the Christian Medical College in Vellore, India. I have completed my subspecialty training at the same institute. I'll be talking about the compliance of surgical care in patients with carcinoma endometrium in a tertiary care center to ESGO quality indicators. So, endometrial cancer, when treated surgically, followed by tailored adjoint treatment, has shown to have very good prognosis. The quality of the surgical care should be optimal to attain the optimal survival benefit. To standardize this surgical management, ESGO has put forth quality indicators in the year October 2021. They have put forth it in completion of the previous quality indicators for cervical cancer and ovarian cancer during October 2019 and January 2020 respectively. The indicators help in self-assessment by the surgeon and the treating center to compare their care with the ideal standards of care. So, totally 29 structural process and outcome indicators were defined and at the end, there was a self-assessment form given with a score given to each indicator. So, a total score should be calculated for the institute and for getting ESGO accreditation, the score should be at least more than or equal to 115 to get entry level accreditation and to become a center of excellence, the score should be more than or equal to 150 apart from fulfilling several other criteria, apart from the three articles should be authored over the past three years. So, moving on to our study, the main aim was to audit the surgical care provided at our ESGO accredited center to assist the compliance to these indicators and find areas of improvement. Ours is a retrospective audit done in the department of gynecology oncology. The starting period is two years starting from January 2020 to December 2021. Electronic medical records of patients who underwent surgical management of carcinoma endometrium were assessed and the results were tabulated under six categories as put forth by ESGO. Total six categories of quality indicators were there under general, preoperative workup, interoperative management, molecular classification, adjuvant treatment and recording pertinent information. Our center had fulfilled the general indicators and the preoperative workup indicators with the number of newly diagnosed cases being from 75 to 90 and the number of surgeries performed per year being from 71 to 83. All the surgeries were performed by gynecologic oncologists and 95 percent of the primary endometrial cancers were treated after MDT discussion and 100 percent of the recurrent cancers were treated after MDT discussion. During the study period, we had conducted a study assessing the feasibility and accuracy of sentinel lymph node biopsy in endometrial cancers. Almost 100 percent of our patients had undergone the necessary preoperative workup and only 1.5 percent of the early stage malignancies were upstage to stage 4B. Moving on to the next set of indicators which is interoperative management, we had lagged in doing successful MIS. Only 34 percent of the early stage carcinoma had undergone successful MIS and in patients who had a BMI of more than 35 kg per meter square, only 55 percent had undergone successful MIS. The conversion rate was slightly above the target being 11%, but the intraoperative injuries rate was lesser. And we had achieved the target for infracolic omentectomy in necessity patients and adequate lymph node staging in patients with high risk for HIR status. And we found a gross deficit in sentinel lymph node procedures with only 31% of the patients undergoing sentinel lymph node procedures. And among them, only 53% had been done reusing endocyanin green dye. Our bilateral detection rate was also minimal being 18%, but we had done site-specific lymphadenectomy in patients who had failed sentinel lymph node detection. Apart from that, in patients with advanced endometrial cancer, 97% of the patients had undergone complete macroscopic resection, achieving the target. Moving on to the next set of indicators, at least 50% of the patients who are treated should have complete molecular classification. But in our center, none of the patients had undergone complete macroscopic classification. And the adjuvant treatment, 93% of the patients had undergone complaints with the ESCO guidelines and adjuvant treatment was done accordingly. Moving on to the next set of indicators, which is recording pertinent information, we found that we had lacked in documenting the surgical reports and pathological reports also, with 81% being for surgical reports and 91% for pathologic reports. But we have monthly morbidity and mortality conferences in our center, achieving the target. And we had done proper prospective reporting of recurrences and deaths. There was no re-operations within the 30 days post-surgeon period. So on calculating the score, our center had got a score of 80. So we found that we had lacked in attaining the entry-level recognition, but we also found that areas which needed addressing. So in conclusion, the audit helped us to identify the need to increase minimally invasive surgery, use and adapt sentinel lymph node procedures with endocyanin green dye more aggressively. And we also found that there was need for improvement in documentation of pertinent information on surgical and pathologic reporting. So we have incorporated synoptic reporting. Apart from that, molecular classification should be tried to be routinely incorporated in the diagnostic algorithm, which is difficult in our country considering the financial problems, but we are trying to find a way for that and trying to incorporate into the management. Thank you. Well, thank you, Dr. Tiagara Young for your presentation and congratulations for sharing your analysis with us. While assessing and comparing local clinical management with ideal standard according to the guidelines as you did is a crucial component for a comprehensive multidisciplinary management. And this is in order to detect aspect of suboptimal care, avoid inadequate surgical treatment and eventually improves our practice outcomes and patient care. Well, we will now move on to our last oral presentation. Please join me in welcoming to the stage to Dr. Vinota Thomas, a Gynecology Oncologist at Christian Medical College in Vellore, India. To give her presentation titled Evaluation of Criteria of Atrium Radiation Therapy after Radical Hysterectomy for Non-High Risk Cervical Cancer. Thank you and good morning to you all. I'm Dr. Vinota Thomas from the Department of Gynecology Oncology, Christian Medical College, Vellore, Tamil Nadu, India. And these are my co-authors. We had an opportunity to collaborate with Dr. Greta Dreher from Pretoria, South Africa. I have nothing to disclose. A little bit of introduction and background to this research. Christian Medical College in Vellore was established by an American missionary, Dr. Ida Scudder, in response to the women dying in childbirth. And this is located in the Vellore district in south of India in the state of Tamil Nadu. So this was primarily an obstetric hospital which then over the past many years and a century has transitioned to a tertiary care multi-specialty hospital. Now in 2010, we separated off from the rest of the ONG department into a department specializing in gyne cancers. And in 2015, we were accredited to be a department of gynecologic oncology. In January 2016, we shifted our practice from set list criteria to the post-operative stratification table of the Pretoria Gynecological Oncology Unit to stratify patients for adjuvant radiation following radical hysterectomy. Now we know that the set list criteria was associated with 46% significant reduction in recurrence and the subsequent paper in 2006 showed no difference in overall survival. But then we thought beyond set list because the GOG-92 criteria was designed to trigger adjuvant treatment only for those patients with a recurrence risk of more than 30%. And we know that in that study, both the radiation and the observation groups were imbalanced with regard to histology and tumor size. So this post-operative risk stratification table of the Pretoria Gynecological Oncology Unit was pioneered by Professor Greta Dreher. And this is a ticket sheet type of informational report to aid MDT decision making. And besides depth of invasion, parametrium, and lymphovascular space invasion, this also included variables such as histology type, tumor size, surgical margins, and number of nodes retrieved. These were variables which had individual and collective risk for recurrence. And this was introduced to ensure uniformity and reduce variability in reporting intermediate risk factors by residents while presenting it to the MDT group. So the aims and objectives of this study was to compare the oncologic impact of the selection criteria used for adjuvant radiation in the two time periods and also audit our adherence to the criteria used in each time period. So this was a retrospective cohort study where we evaluated electronic medical records of 197 operated patients during this 10-year period. And we identified non-high-risk patients who had no lymph nodal involvement, no parametral or vaginal involvement. And we compared patients who were triaged using said list criteria in the 2011 to 2015 time period with patients who had surgery in the 2016 to 2020 period when we used the post-operative risk stratification table of the Pretoria Gynecological Oncology Unit. So during this period of 10 years, we had significantly higher number of radical hysterectomies in the latter period. We definitely had a reduction in the proportion of high-risk patients being operated in the 2016 to 2020 period. But in this research, we concentrated on patients who had intermediate risk for recurrence or one or no intermediate risk for recurrence. When you look at patient characteristics, both groups were similar. The average size of tumor being operated across the time period was about 2.5 to three centimeter. Nine patients in the 2016 to 2020 period had vaginal margin involvement by intrapithial neoplasia as against two in the 2011 to 15 period. Both groups were similar in the presence of risk factors for recurrence. The adjuvant radiation rate was lower in the 2016 to 2020 period, but this was not statistically significant. The adherence to treatment guideline was 80% in the 2011 to 15 period, and 85.7% in the 2016 to 2020 period. Though this was a little higher, this was not statistically significant. There were 25 recurrences during this time period. The recurrence rate was 18% in the 2016 to 2020 period versus 12% in 2011 to 2015 period. The number of recurrences was higher in those group who were observed, but again, this was not statistically significant. Risk factors for recurrence included vaginal margin involvement with carcinoma in situ or any vaginal involvement or close margins in less than five mm. When we used binary logistic regression, both factors had significant odds ratio for recurrence. Both time periods had similar five-year recurrence-free survival rate, about 75%. The five-year overall survival rate was also similar in both these time periods. Both criteria agreed well with a Kappa coefficient of 0.754. In conclusion, the usage of an objective risk scoring sheet resulted in a non-significant decrease in adjuvant radiation rates, but had no effect in oncologic outcome. Compliance to prescribed guidelines was 80% and 85% in the two cohorts. Now, adjuvant radiation in intermediate risk cervical cancer patients should be based on objective prognostic criteria to reduce high adjuvant treatment rates to achieve the ESCO target of less than 10% for PT1BN0. And we were concerned that our adjuvant radiation rate was as high as 40% in this non-high-risk group. And hence, we considered implementing a multidisciplinary quality management program which could ensure adherence to guidelines, moderate adjuvant treatment rate without compromise in oncologic outcome. Thank you. Thank you, Dr. Thomas, that was great. Well, thank you also, Dr. Gulelat. We have really enjoyed learning more about your findings. This concludes our abstract presentations. Once again, we would like to congratulate all seven abstract presenters on such an amazing accomplishment. Your passion for research and participation at today's workshop are so very appreciated. And we are pleased to have been part of your professional journey. And look forward to seeing you all grow in your careers. So we really love to talk about the abstracts because we are slightly behind of the time and because we want to be respectful of our schedules. So we will move on to our final session. And I would like to invite Dr. Pedro Ramirez, Editor-in-Chief of the International Journal of Gynecological Cancer, to join me on stage as we will provide an update to the IJGC International Journal of Gynecological Cancer Fellowship Program. Thank you, Arthur, and thank you all for being here. Certainly, I'm just going to provide an introduction and Arthur is going to give the details of the fellowship. But I think certainly I would encourage all who are interested in learning about the process of manuscript processing during the submission of any manuscript to the International Journal to apply and potentially consider joining the fellowship. I think certainly it adds a lot of value to young trainees and faculty. And it provides a whole range of opportunities that are not just limited to the assessment and evaluation of manuscripts, but also to getting involved with the editorial team, with the members of the editorial board, participating in many of the activities that we have, such as the podcast and the journal clubs, and then subsequently at the completion of the fellowship, becoming part of the editorial board to the journal. So I think it's an opportunity that once again adds a tremendous amount of professional value to your academic careers. I think it adds personal value to your ability to continue to evolve and develop your academic career. And I invite you all to consider applying for this fellowship. So Arthur will give you some of those details. Thank you so much for this opportunity. Thank you so much, Dr. Ramirez. And so I'm going to give a brief concept of how the IJJC Editorial Fellowship is going right now. And first of all, I'd like to thank for the opportunity to be here. I've been to IJJC, my first IJJC was in 2016 in Lisbon, and so I'm really happy to be here right now. So about the IJJC Fellowship objectives, so all of our fellows are really excited about the peer review process. So for the manuscripts submitted to our journal, the fellows get to review the articles together with Dr. Ramirez, and Dr. Ramirez shares his insights of the articles, and we discuss on the pros and cons of the article, and we make the decision to accept, reject revision of the articles together. And what's interesting is that in the beginning, when we provide our feedbacks to the authors, we do not, the fellows do not see the feedbacks from the authors. But because we told this to Dr. Ramirez and to the editorial board, and now what's changing is that the fellows do see the authors' feedback, and that's quite amazing. That makes the fellows see their impact. And the other great feature of the journal is the IJJC podcasts, and so as you all know, that there are weekly podcasts made by Dr. Ramirez and the authors of different manuscripts or different topics, and if for anyone that has not listened to any of these podcasts, I strongly recommend you to try to listen to them, because, for example, for me, before listening to these podcasts, I had never had any idea of what a sentinel lymph node is, what an enhanced recovery after surgery is, and a lot of topics. And now, after one year or two year of exposure to all of this, and I'm already doing, trying to implement these new technologies that was new to me onto my practice. And the fellows try to prepare the podcast together with Dr. Ramirez. They provide interesting manuscripts, interesting topics to Dr. Ramirez, and we also, as a team, promote it with our social media editor, Anne Gerda, promote these things on social media. And another feature of the journal is the IJJC journal clubs. So the journal club started in a Twitter platform, and in last April, it transformed into a Zoom platform, allowing anyone without registration to join the monthly journal clubs. Talking about, we would have discussions on the lead articles of the month, and so the journal clubs mostly have attendees from 40 to up to 100, and it's quite amazing. We always have these lively discussions on different topics, and so for next month, we will have discussion on how to have adjuvant treatment on patients receiving radical hysterectomy with intermediate risk factors, and does it need an update. So we just had an abstract talking about this, so I strongly recommend you to join the journal clubs. And also, what our journal and a lot of other journals are now doing is strongly promoting the articles on social media. I mean that nowadays in our modern world, social media has deeply impacted us. For instance, I see that a lot of our colleagues don't find the new articles on PubMed, but instead, they go on to Twitter and see what is newest, what is the most newest information. So the fellows participate with the whole team, with Pedro, with Angerta, on promoting the social media. We have a different task for each month. For instance, for the gynecological oncology awareness month, for the ovarian cancer month, we have different tasks for different times. And so we have had 34 fellows from 2019, and these 34 fellows come from 21 different countries, so it is really a representative of a global, we really have a global representative to let us see from very different perspectives. And so now we have 24 early career editorial board members that participate in our associate editor, editorial board, and participate in understanding how the journal operates. So if you are interested in the IGGC fellowship, who would be ideal candidates? So you must have documented interest in gynecologic oncology, and you must work in an oncology center, have interest in scientific publications, and of course, you must have interest in reviewing articles and participating in social media activities. And it's best to have involvement in IGCS, IGCS Early Career Network, ESGO, or ENEGO. So how to apply? You have to have the letter of interest, letter of recommendation from your mentors, and list of publications, and proof of proficiency in English is absolutely necessary. So these are some data's of our journal. A manuscript received in 2021 was up to 1,000, and we have a fast time to first decision, and our followers, because of our, we have worked a lot on that, with Facebook and Twitter, followers are up to 3,000 and 4,500, and podcast listens are up to 30,000, and we have 18 Zoom journal clubs, and most excitingly is that our impact factor has rised every year. Last year, I remember it was 3.4, and it's now 4.6, and which is really exciting for our journal and for the community. So please join us and file for the applications for the editorial fellowship. You see that everyone joining is having these happy faces, and I assure you that the learning process and the working process is really joyful. So with that, thank you, and I hope that we can work together soon. Thank you so much. So I'd like to thank Arthur and Pedro for their update on the International Journal Fellowship Program. That wraps up our session for this morning. Thank you to all the panelists and the presenters. We had some fantastic, inspiring presentations from our junior members. Thank you to the audience for being involved and asking your questions, and I'd also like to say a special thanks to the IGCS staff, particularly Lauren Cleary, for being available and helping us with this session this morning. I'm sure you all agree it's been a fantastic program. So if you'd like to make your way to the keynote speaker, Dr. Tal Zaks is currently speaking in Hall 501. If you'd like to go there next or alternatively get something to eat. Thank you.

panel discussion

gynecological oncology

research publication

early career networks

manuscripts accepted

authorship

mentorship

open access publication

disparities in resources

LMICs

young gynecologists

limited resources

seeking mentors

target journals

strategic research approach