Comparison of traditional vs. virtual simulation-enhanced training for scaling the cervical cancer surgery workforce in Zambia Proposed work  We will use virtual reality simulation of a surgical procedure to pre-train surgical trainees by helping them acquire the psycho-motor skills, sensory acuity, and to a lesser extent, cognitive planning required to achieve the surgical dexterity necessary to perform cervical cancer surgery. After the have reached surgical proficiency we will use proctor them with a form of web-based tele mentoring technology that allows the surgical trainee who is performing surgery to wear a headset that transmits a live, real-time video feed of the surgical procedure to the monitor of an expert surgical mentor who is offsite. The mentor can provide real-time telestration feedback (drawings on the video feed) to the bedside monitor of the surgical trainee while the surgical procedure is being performed, i.e., the video feed from the trainee is transferred to the mentor and then back to the trainee from the mentor with the latter's telestration, much like commentators illustrating in a football game on a separate screen. We will measure the speed at which surgical trainees acquire and maintain the technical skills necessary to safely effectively perform cervical cancer surgery using the technology above with that when they are trained using traditional methods. We will also compare the economic and financial costs of traditional vs. technology-enhanced training for a surgeon to achieve proficiency in treating cervical cancer.  Context  Cancer, the world's leading cause of death, is projected to increase at a staggering rate in the next two decades. Most of the new cases, and deaths, will occur in the world's poorest regions. Africa will be hardest hit, as it is estimated that by 2030 cancer will kill one million Africans each year. Within Africa, women will bear the heaviest burden, because cervical and breast cancers are its most common malignancies and causes of cancer-related death. In fact, one in every five of the world's annual cervical cancer deaths takes place in sub-Saharan Africa, making it the global killing field of cervical cancer.   A major bottle neck in the care of cancer patients in low and middle income countries is the shortage of surgeons, particularly those with specialized cancer training. A recent report (Lancet Oncology Commission on Global Cancer Surgery - 2105) revealed that only 20% of cancer patients living in middle income countries who need cancer surgery can access it, while in low income countries it's <5%.   Potential Applications and Benefits  1. Use in the training curriculum for surgeons in LMI countries, including  a. Major shift in the way surgeons are trained in LMI countries b. Faster, safer and more effective training of surgeons to perform cervical cancer surgery c. Standardized training for cervical cancer surgery with options to adapt training to individual needs  2. Rapid expansion of cancer surgery services in low income settings, leading to a   a. Decrease in waiting times for surgery, and associated pain and psychological effects b. Decrease in fatalistic attitude towards cancer in the community  c. Decrease in the economic and societal consequences associated with deaths of young  mothers in LMI countries, i.e., institutionalization of children in orphanages, failure of children to complete primary education, drop in economic status of the families etc.  3. Scientific proof-of-princple that technology-enhanced surgery training is effective, thus ensuring   a. Contribution towards policy changes on the local, national and international level b. Shaping and enhancing the effectiveness and image of public health services c. Attract investments from global businesses for purposes of selling the technology d. Potential of spin out companies, and the creation of new processes, products and services e. Increase in donor funding for research and implementation  of technology-based surgical training in LMI countries The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.