Abstract Background Limited access to subspecialty training and multidisciplinary expertise remains a major barrier to pediatric neuro-oncology care in low- and middle-income countries (LMICs). The Virtual Pediatric Neuro-Oncology Fellowship (VPNOF), developed by St. Jude Children’s Research Hospital, aims to address workforce gaps through structured virtual mentorship and global collaboration. While program-level outcomes have been reported, evidence describing country-level implementation impact remains limited. This study describes the early impact of VPNOF training on pediatric neuro-oncology practice and capacity building in Indonesia. Methods We conducted a descriptive, implementation-focused evaluation following VPNOF training of one of the first fellowship graduates in Indonesia. Proxy indicators included changes in multidisciplinary care integration, leadership in treatment planning, tumor board activity, registry development, referral patterns, diagnostic capacity, educational activities, and international collaboration. Data sources included institutional records, clinical documentation, and programmatic review. Results Prior to VPNOF participation, pediatric central nervous system (CNS) tumors were predominantly managed by neurosurgery and radiation oncology, with limited pediatric oncology involvement and largely non-standardized chemotherapy practices. Following VPNOF training, pediatric oncology assumed a central coordinating role, with increased adoption of guideline-informed, multimodal treatment approaches. Multidisciplinary pediatric tumor board discussions expanded in frequency and scope and were attended by international pediatric neuro-oncology experts, providing external expert input and quality assurance to support appropriate treatment decisions. A unified pediatric CNS tumor registry integrating data across departments was established, improving case capture and longitudinal documentation. Increased consultation to pediatric oncology services and growing referrals from external hospitals were observed. VPNOF participation also facilitated professional networking, multicenter research collaboration, and access to advanced molecular diagnostics, including DNA methylation profiling. Importantly, the program created opportunities for local mentorship and knowledge transfer, supporting the development and multiplication of future pediatric neuro-oncology expertise in Indonesia. Conclusion Early implementation of VPNOF training was associated with strengthened multidisciplinary integration, improved treatment standardization, enhanced diagnostic capacity, and emerging workforce development. This experience supports virtual fellowship models as effective and scalable strategies for building and multiplying pediatric neuro-oncology capacity in LMIC settings.
Rahmartani et al. (Tue,) studied this question.