Cancer is a leading cause of morbidity and mortality across the globe. Europeans face a disproportionate burden considering that despite representing just 10% of the global population, Europe accounts for roughly a quarter of all cancer cases worldwide each year (Dyba et al., 2021).

Gastric cancer was the 5^th higher cancer related death cause worldwide in 2022, accounting for more than 660 000 deaths. In Europe, 135 610 new cases were diagnosed, and 95 431 deaths were caused by gastric cancer in 2022, however, some countries, such as Portugal and Lithuania, show disproportionate higher incidence and death rates (Global Cancer Observatory, 2022).

The implementation of screening programs applying evidence-based quality parameters and performance measures may enhance the detection rate of precancerous lesions and early gastric cancer, reducing mortality (Bisschops et al., 2016), however, reports on the implementation of population-based cancer screening programs in Europe revealed insufficient quality control, inequalities within and between countries, and stressed the need for healthcare professionals training (Council of the European Union, 2022).

Involving thirty-one European countries, the “Joint Action on the New EU Cancer Screening Scheme Implementation” (EUCanScreen) aims at ensuring sustainable implementation of high-quality screening for breast, cervical, colorectal, lung, prostate and gastric cancers with the purpose of reducing cancer burden and achieving equity across the European Union. The EUCanScreen task 11.4 focuses on training and audit of upper Gastrointestinal (GI) endoscopy, through the development, implementation and assessment of the “Eucanscreen course on upper GI endoscopy: How to improve your cancer detection rate”. The course comprises 3 editions, starting in September 2025, mid-2026 and early 2027, respectively. The course has been developed for gastroenterologists, working in the European context, with an active role in the clinical training of endoscopists in upper GI endoscopy and/or holding leadership roles in the field of cancer screening.

Over the last decades, a few continuous education e-learning (Yao et al., 2024), face-to-face (Luo et al., 2023), or b-learning (Zhang et al., 2015) courses on upper GI endoscopy have been implemented across the world, showing that upper GI endoscopy training may increase the detection rate of early cancer. However, not only does the training in upper GI endoscopy remain insufficient, but there is still a gap in the literature regarding conceptualized visions of the curriculum development and characteristics.

This study aims at describing and conceptualizing the curriculum of the “Eucanscreen course on upper GI endoscopy: How to improve your cancer detection rate”, answering to the following research question:

• How may the curriculum of a continuous education course on upper GI endoscopy be characterized to increase gastroenterologists’ cancer detection rate?

This study will be framed by an ecological perspective, which emphasizes the symbiotic relationship between education, creation and application of knowledge, occurring in the intersection of multiple interacting ecosystems and contributing for their well-being  (Barnett, 2018). Curriculum will be approached as a complex and dynamic framework, connected to the needs of learners and society, which involves teaching, learning, and assessment processes, and empowers learners to take ownership of their educational experiences, develop critical thinking and apply what they learn to the betterment of the world (Barnett & Coate, 2005).

Funded by the European Union programme EU4Health under Grant Agreement No. 101162959. Views and opinions expressed are however those of the author(s) only and not necessary reflect those of the European Union or the Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.

Curriculum development processes were based on Kern's curriculum development model in medical education (Thomas et al., 2022). "So far, the first steps of Kern's curriculum development model have been initiated but still need to be consolidated: problem identification and general needs assessment; targeted needs assessment; the definition of goals and objectives; and definition of educational strategies. This approach was adopted considering that it is a systematized, evidence-based and step-by-step model for curriculum development that considers the interplay between the needs of society and the specific needs of the learner and guides the establishment of connections between the steps of curriculum development and the different dimensions of the curriculum. The identification of the problem and assessment of general needs was based on literature review and on the contributions of experts from the project consortium during the project proposal writing and in the kick-off meeting. The kick-off meeting occurred in Latvia, in September 2024, with the participation (face-to-face or online) of 279 attendees from 30 partnering countries. A preliminary version of the curriculum (goals, objectives and outcomes, contents, pedagogic activities and teaching methods) was developed by a gastroenterologist, an educationalist and a biomedical sciences researcher and submitted to the analysis of experienced endoscopists with wide clinical and educational experience. Curricula of the courses developed within the seven WP11 tasks will also be discussed in online meetings with the different teams. This preliminary version may be adjusted according to the results of the targeted needs assessment. Furthermore, the curriculum will be shared with the trainers, whose feedback will also be considered. Targeted needs assessment will be based on a needs assessment questionnaire (planned for June 2025) regarding sociodemographic data, motivations, availability for training and previous training on upper endoscopy, readiness for online learning, barriers to learning and knowledge application and topics that they would like to address in the course.

With the purpose of reducing cancer burden and achieving equity across Europe, this course aims at: increasing best-of-practice knowledge and alter attitudes and behaviors of endoscopists towards gastrointestinal (GI) upper endoscopy; improving quality and reporting of upper GI procedures; and increasing the detection rate of gastric cancer.  A b-learning, flipped classroom methodology was adopted. The preliminary curriculum comprises asynchronous webinars, small-group interactive webinars (approaching challenges in a peer-assessment activity or in clinical practice) and a face-to-face component in Portugal (1st and 3rd editions) or in Lithuania (2nd edition). Teaching methods combine expository (mainly in the asynchronous webinars), and active methods (e.g., discussion-based and case-based learning). Assessment methods include quizzes, peer-assessment assignment (critical analysis of anonymized videos and reports of endoscopies performed by other trainees). Training assessment will be done through an assessment questionnaire, and a pre- and post-test on the implementation of quality parameters and performance measures and the detection rate of neoplastic lesions. The educational strategies were developed to facilitate the enrolment of trainees from different locations, foster time management and promote active learning, engagement, autonomy, motivation and interaction (Challa et al., 2021). Interactive online and face-to-face activities may promote the sense of belonging to a community of practice engaged a on shared values and attitudes (Cruess et al., 2018), which was not addressed in previous studies about training in upper GI endoscopy. Discussion should address the educational sciences concepts and theoretical approaches underpinning the curriculum. Hidden curriculum should also be discussed. Stemming from a multidisciplinary view, this study may contribute to the knowledge on the processes, characteristics and concepts behind curricula in upper GI endoscopy, informing curriculum developers, decision makers and researchers about how the interplay between education and health can promote an increase in cancer detection rate, with potential benefits for the health and well-being of the population.

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