Defining the educational needs for a community-based hematology/oncology career: A national needs assessment.

Abstract

11011 Background: Fellowship training is largely rooted in academic medical centers, though many graduates will ultimately pursue careers in community-based settings. We initiated a national survey of hematologists/oncologists practicing in community or academic-community hybrid settings to understand providers’ educational needs. We hypothesized that the current model of fellowship training is not optimized for those pursuing community-based hematology/oncology careers. Methods: An electronic questionnaire was developed surveying current attitudes and practices of community-based hematologists/oncologists. Survey participants from across the United States were contacted via professional organizations. We primarily assessed whether survey participants received any specific training during fellowship for community-based practice. Participants were also surveyed regarding whether such training may have affected their preparation. Relative risk (RR) and 95% confidence intervals (CI) were calculated using modified Poisson regression with robust error variance adjusted for: time in clinical practice ( < 10 years), size of graduating fellowship training program ( > 5), board certification (hematology and oncology vs. either), and training program geographic location (by region) to identify factors associated with receiving community oncology-specific training. Results: Of the preliminary cohort of 120 participants from across 25 states, 66% were male, 69% identified as White, and 69% had been in practice for > 10 years. Less than half (43.2%, binomial 95% CI 34.6%-52.2%) received any training for a career in a community-based setting. Participants identified rotations in community settings (48%), direct mentorship from community-based physicians (41%), and longitudinal clinic in a community setting (39%) as experiences that would have been valuable. Specific curricula of interest included: medical operations and administration (67%), health policy (38%), and quality improvement (30%). Respondents in clinical practice for < 10 years were more likely to have received any community oncology-specific training (RR 2.02, 95% CI 1.10–3.72); other factors were not significantly associated with the primary outcome (P > 0.05). Conclusions: National trends indicate a growing need for hematology/oncology graduates in community-based settings. Our study demonstrates substantial unmet needs as they relate to training fellows destined for careers in community-based practice. Prospective design of clinical training and curricula emphasizing longitudinal exposures to and key aspects of health care delivery in the community setting are paramount to achieving optimal, goal-concordant hematology and oncology training.