Oncology Curriculum Research Articles

City of hope cancer center hematology–oncology fellowship and hematopoietic stem cell transplantation fellowship

The City of Hope (COH) ACGME-accredited Hematology-Oncology fellowship began in 1978 with two fellows and has grown up to seven fellows per year. It remained as the last fellowship independent of an Internal Medicine Training Program until its affiliation with Harbor-UCLA Internal Medicine Program as the Research Track of the fellowship in 1995. City of Hope Cancer Center is an NCI-designated comprehensive cancer center, a founding member of National Comprehensive Cancer Network, and one of the top medical centers as named by the US News and World Report. This provides an ideal environment for learning patient care and research within both a county hospital and a tertiary teaching hospital setting. In addition, it provides ample opportunities for both basic science and clinical research in the latter years of the fellowship. The fellowship is a fully-funded 3-year program which provides experience through a multidisciplinary approach to prepare trainees for a successful career in academic medicine or private practice.

Digestive oncologist in the gastroenterology training curriculum

Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum end-points in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce well-trained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal of these programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.

Knowledge needs of nurse practitioners new to oncology care.

e16532 Background: There is growing evidence that the nation is facing a shortage of providers needed to provide high quality cancer care. Nurse practitioners are increasingly utilized as cancer care providers with no standardized oncology curriculum at practice entry. The purpose of this study was to: 1) Identify the knowledge needs of the Oncology Nurse Practitioner (ONP) on entry to to cancer care; 2) Identify the educational resources used to fill knowledge needs; 3) Describe the impact of ONP knowledge needs on patient care outcomes. Methods: Cross sectional, descriptive study of thirty item electronic survey to assess knowledge needs at entry into and through the first year of practice for ONPs. The questionnaire was randomly distributed (June 21, 2009 through July 27, 2009) via electronic survey to 610 self-described oncology nurse practitioners in the Oncology Nursing Society's data base. Results were tabulated and analyzed in SPSS, V. 14 according to descriptive and correlational statistics. Learning gaps at entry to oncology NP practice were identified and ranked one (not at all prepared) to four (very prepared). Results: One hundred and four (104/607, 17%) ONPs responded. Respondents came to cancer care practice with mean 12.7 years nursing experience. In first year of practice, 90% of ONP's rated themselves as “prepared” or “very prepared” in obtaining patient history, performing physical exam and documenting findings. ONP's rated themselves as “not at all or only “somewhat” prepared” in clinical issues of chemotherapy/biotherapy competency (n = 81, 77.9%); recognizing and managing oncologic emergencies, (n = 77, 70.2%); and recognition and management of drug toxicities, (n = 63, 60.6%). The Primary source of oncology education for ONP's new to practice was almost exclusively collaborating/supervising physician (n = 84, 80.8%). No poor patient outcomes were reported as a result of knowledge deficits. Conclusions: Although highly experienced nurses, ONPs are entering oncology practice adequately prepared as nurse practitioners, but without essential cancer care knowledge. These results hold implication for collaborating physicians, schools of nursing and for continuing education offerings. No significant financial relationships to disclose.

Radiation Oncology in Undergraduate Medical Education: A Literature Review

To review the published literature pertaining to radiation oncology in undergraduate medical education. Ovid MEDLINE, Ovid MEDLINE Daily Update and EMBASE databases were searched for the 11-year period of January 1, 1998, through the last week of March 2009. A medical librarian used an extensive list of indexed subject headings and text words. The search returned 640 article references, but only seven contained significant information pertaining to teaching radiation oncology to medical undergraduates. One article described a comprehensive oncology curriculum including recommended radiation oncology teaching objectives and sample student evaluations, two described integrating radiation oncology teaching into a radiology rotation, two described multidisciplinary anatomy-based courses intended to reinforce principles of tumor biology and radiotherapy planning, one described an exercise designed to test clinical reasoning skills within radiation oncology cases, and one described a Web-based curriculum involving oncologic physics. To the authors' knowledge, this is the first review of the literature pertaining to teaching radiation oncology to medical undergraduates, and it demonstrates the paucity of published work in this area of medical education. Teaching radiation oncology should begin early in the undergraduate process, should be mandatory for all students, and should impart knowledge relevant to future general practitioners rather than detailed information relevant only to oncologists. Educators should make use of available model curricula and should integrate radiation oncology teaching into existing curricula or construct stand-alone oncology rotations where the principles of radiation oncology can be conveyed. Assessments of student knowledge and curriculum effectiveness are critical.

Global cooperation in gynecologic cancer

Global cooperation in gynecologic cancer

Report of the Multisociety Task Force on GI Training

In summary, the task force recommends that the 4 gastroenterology/hepatology societies work with the ABIM to develop a competency-based curriculum that incorporates the Maintenance of Certification process to accommodate the need and desire for training and subsequent practice in specific areas of gastroenterology/hepatology. Given the increasing complexity of treating digestive diseases, allowing trainees the opportunity to develop enhanced ability and experience in specific disease areas or procedures will benefit patients. By developing these training pathways, training programs will need to measure the achievements of trainees in terms of specific defined competencies rather than the duration of training alone.

The new curriculum in radiation oncology–everyone should win!

The new curriculum in radiation oncology–everyone should win!

AGA Institute Future Trends Committee Report: The Future of Gastroenterology Training Programs in the United States

The American Gastroenterological Association (AGA) Institute Future Trends Committee (FTC) developed this report based on a consensus conference it convened on March 8–9, 2008, in Washington, DC. The report was prepared for the FTC by Carol Regueiro, MD, MSc, a medical writer under contract to the AGA Institute, and Michael Stolar, PhD, staff liaison to the FTC. This report was approved by the FTC on July 1, 2008, and accepted by the AGA Institute Governing Board on July 26, 2008.

Why do we need a core curriculum in surgical oncology in Europe?

Patients with cancer are often treated by multidisciplinary collaboration between many specialities where thorough knowledge about cancer, and surgical expertise is necessary. Most European surgeons with an interest in surgical oncology were trained according to their local organisations and national regulations. Formal education as per a national training programme is rare and little collaborative effort has taken place within Europe to standardize training between the relevant national surgical societies. The outcome measure of completion of training is vague. Surgical oncology is at present only recognised by a few European countries. Training in surgical oncology has been guided by tradition and common sense rather than by specific aims within the framework of a recognised internationally established core curriculum. Any educational initiative has to be delivered during restricted working hours as determined by European regulation. Accordingly, the actual number of surgical procedures that each trainee will perform under supervision is limited. A modern core curriculum necessitates an evidence-based approach, rather than common sense medicine.

Caring for the Elderly Cancer Patient: Training the Next Generation of Oncologists

Caring for the Elderly Cancer Patient: Training the Next Generation of Oncologists

Integrating Gross Anatomy into a Clinical Oncology Curriculum: The Oncoanatomy Course at Duke University School of Medicine

The amount of time devoted to teaching gross anatomy to medical students is declining. This topic remains critically important for some medical students, especially those seeking training in anatomy-laden specialties. The authors describe a course currently offered in the department of radiation oncology in the Duke University School of Medicine, developed in 2005, that expands anatomy education into the medical school clinical years. The aim of the course is to help reinforce anatomy knowledge in the clinical context of radiation oncology priorities and concerns, as well as to provide direct visualization and palpation of human cadavers, thus enabling the understanding of complex three-dimensional and anatomic principles. The audience for this course consists of medical students rotating through and the residents and clinical faculty in the department of radiation oncology. Anatomists and radiation oncology residents together present monthly didactic lectures, clinical case presentations, and cadaver-based demonstrations about the relationships between a tumor's anatomic location and its symptoms, patterns of spread, and treatment considerations. Anonymous surveys were distributed to course participants to assess the three components of the course. Survey results indicate that the participants found the anatomy lectures, clinical case presentations, and dissection presentations all to be interesting, relevant, and of high quality. This course is therefore favored by students, residents, and faculty as a way to supplement gross anatomy education during training for a specialty in which anatomy knowledge is essential.

Oncology Curriculum in Developing Countries and the Lessons to Be Learned

TO THE EDITOR: We read with great interest the article by Gaffan et al on educating undergraduate medical students about oncology. We come from a developing country where oncology teaching was effectively nonexistent. We admire the efforts invested in creating an oncology curriculum for training. Oncology is an ever-expanding field, and with the current progress in research of new treatment modalities and the ever-aging population, this trend will no doubt continue. Trained properly, the doctors of tomorrow will be in a better position to understand and subsequently better manage this complex group of patients. From our personal perspectives, having moved to the United Kingdom where the management of oncologic conditions is much more aggressive and effective, we can appreciate the importance for the early foundations of knowledge. Good undergraduate training is dependent not only on the teaching methodology, but also on the curriculum content, which we acknowledge can be hard to balance for such a vast subject. Both aspects, however, seem to have been thoroughly addressed by the Oncology Education Committee of the Cancer Council of Australia, with its work on the ideal oncology curriculum, and by Gaffan et al, regarding the teaching methods. While we appreciate the epidemiologic differences and variability of disease between the developed and developing worlds, we would like to see this approach to training being mirrored in Pakistan for the future generations of doctors. Developing countries with limited research resources must make use of the ideal oncology curriculum. This would be an immense contribution to the medical community of the lessdeveloped countries.

The Ideal Oncology Curriculum for Medical Students

TO THE EDITOR: We have read with interest the article by Gaffan and colleagues on educating undergraduate medical students about oncology. The authors focus on teaching methodology rather than curriculum content and comment that there is no consensus on what should be learned. The readers of the Journal of Clinical Oncology may be interested to know of the Ideal Oncology Curriculum, which provides some progress toward the consensus of what the content of cancer education should be. The Ideal Oncology Curriculum was developed in 1999 by an Oncology Education Committee of the Cancer Council of Australia—a multidisciplinary group of cancer clinicians and educators representing all medical schools in Australia, whose objectives are monitoring and improvement of standards of cancer education in Australian medical schools. The development of this consensusbased curriculum involved extensive consumer consultation across the country. Since then, the Ideal Oncology Curriculum has served as a basis of newly developed medical school curricula and as a guide to development of cancer teaching in other areas, for example, nurse practitioner training and professional development of cancer professionals. As Gaffan and colleagues point out, cancer teaching can be fragmented across disciplines with resulting risk of duplication or omission of cancer knowledge and skills. An Ideal Oncology Curriculum provides a comprehensive checklist for course design that allows adaptation to local conditions, as well as a checklist against which outcomes can be monitored. Perhaps evidence for the value of the Ideal Oncology Curriculum lies in its endorsement by the International Union Against Cancer and in the Curriculum’s similarities (albeit in the more limited version) to the recently developed American Society of Clinical Oncology Core Curriculum.

Online pediatric oncology education: A novel teaching tool for oncology residents

9048 Background: Deficiencies in pediatric oncology training for residents have been identified internationally. A lack of training in pediatric oncology during residency is correlated with impaired outcomes for pediatric patients. There is a clear need for novel teaching tools to supplement training in pediatric oncology. Purpose: The goal of this project was to develop a series of multimedia web-based learning modules for the interactive instruction and review of pediatric oncology. A needs-based assessment of pediatric oncology training in Canadian radiation oncology residency programs was used to guide web-site development. Methods: A needs-based analysis was conducted via a web-based survey sent to all Canadian radiation oncology program directors and residents. The survey was designed to identify the limitations of current training curriculum in pediatric oncology. A multidisciplinary team, including pathologists, radiologists, medical physicists, radiation and medical oncologists, developed the web site curriculum. The site was designed using teaching modules to focus on pediatric tumour sites. Modules were developed using a common format, divided into chapters detailing specific tumour types. Each chapter reviewed relevant epidemiology, anatomy, pathology, radiology, and treatment for the tumor type. A self-assessment tool was included at the end of the modules. User satisfaction surveys were used for feedback. Results: 100% (10/10) of Canadian radiation oncology program directors and 66% (69/106) of Canadian residents responded to the survey. 56% (59/106) of resident respondents felt that teaching in pediatric radiation oncology was inadequate and 56% (20/36) of senior residents felt unprepared for questions in pediatric oncology on qualifying board exams. 90% (105/116) of respondents felt that a web-based teaching tool would be useful. The first module, pediatric neuro-oncology, has been completed. Results indicate users find this module useful for supplementing traditional training. Conclusions: There are no other interactive teaching tools in pediatric oncology. This unique web-based educational program will allow self-directed study in the area of pediatric oncology, providing more effective learning of this challenging yet essential area of study. No significant financial relationships to disclose.

Cancer knowledge and skills of interns in Australia and New Zealand in 2001: comparison with 1990, and between course types

To compare the cancer knowledge and skills of interns in 2001 who graduated from graduate medical program (GMP) courses with those from non-GMP courses, and to compare the cancer knowledge and skills of interns in 2001 with those who completed a similar survey in 1990. Questionnaire survey of recently graduated interns in a random sample of Australian and New Zealand hospitals. The questionnaire was designed to allow direct comparison with the 1990 survey, and was guided by the Australian Cancer Society's Ideal Oncology Curriculum for Medical Schools. 443 interns completed the survey (response rate, 62%; 42 were excluded, leaving 401 surveys for analysis: 118 from GMP courses and 283 from non-GMP courses). Interns from GMP courses felt more competent than those from non-GMP courses at discussing death (P = 0.02), breaking bad news (P = 0.04) and advising on smoking cessation (P = 0.02), but less competent at preparing a patient for a hazardous procedure (P = 0.02). More GMP interns would refer a breast cancer patient to a multidisciplinary clinic (83% versus 70%; P = 0.03). Knowledge about cancer risks and prognosis was significantly less in GMP interns, but GMP interns rated their clinical skills, such as taking a Pap smear, higher than non-GMP interns. The GMP and non-GMP groups did not differ in their exposure to cancer patients, but compared with 1990 interns recent graduates had less exposure to patients with cancer. GMP curricula appear to have successfully introduced new course material and new methods of teaching, but have not always succeeded in producing doctors with better knowledge about cancer. Recent graduates have less exposure to cancer patients than those who trained 10 years ago.

A province-wide needs assessment of oncology health care professionals in psychosocial oncology.

Oncology professionals still lack the knowledge and skills to provide effective psychosocial care. Continuing education (CE) aimed at addressing this lack may improve the provision of psychosocial care to patients and their families. The authors conducted a province-wide cross-sectional mail survey of oncology health care professionals [oncologists (MDs), nurses (RNs) and radiation therapists (RTs)] and assessed psychosocial orientation, self-assessed knowledge, and motivation to learn about psychosocial oncology. In addition, they sought factors that might influence professionals' willingness to attend CE programs. In total, 241 surveys were completed and returned. Psychosocial orientation was highest in the RN subgroup. MDs rated their knowledge to deal with specific psychosocial issues higher than did RNs and RTs, while their motivation to learn more about providing psychosocial care was significantly lower. Seventy-three percent of respondents indicated that they would like CE in psychosocial oncology. Self-reported motivation to learn was the most significant factor associated with this interest. These findings raise questions about perceived learning needs and aided in the development of an interprofessional curriculum in psychosocial oncology.

Can assessment of psychosocial orientation assist continuing education program development in psychosocial oncology?

A pilot study was designed to aid in the development of a formal, interdisciplinary curriculum in psychosocial oncology for front-line health care professionals. A 190-item questionnaire was distributed to psychosocial (PP) and non-psychosocial (NPP) oncology professionals attending a psychosocial skills workshop. A 38-item attitudinal survey of psychosocial orientation was used in an attempt to identify unperceived needs of the learners. Of the 150 questionnaires distributed, 104 (69%) were completed and returned. Overall scores for satisfaction with the workshop were high, and significantly higher in the PP group. No interdisciplinary difference existed in the preferred learning formats for future events, and both groups preferred interactive, experiential forums for developing skills relevant to patient management. The two groups' perceived learning needs differed. NPPs wanted to focus on skills such as communication, counseling, crisis intervention, palliative care, and coping with life-threatening illness. The attitudinal survey results demonstrated a significant difference between the psychosocial orientations of PPs and NPPs and suggested that NPPs would benefit from: 1) information to correct misconceptions about patients' psychosocial needs and experiences, 2) demonstrations of how to overcome contextual barriers to the delivery of psychosocial care. Front-line oncology professionals in many disciplines are interested in continuing education in psychosocial oncology. The attitudinal survey provided insight into unperceived learning needs that can help in designing future curricula. Its value as a tool to measure impact of these programs is worthy of future study.

Oncology curricula in Australia

Oncology curricula in Australia

Training curriculum in oncology in France

Training curriculum in oncology in France

A review of the oncology curriculum at Dalhousie medical school.

The teaching of oncology at Dalhousie medical school is currently left to the discretion of the 30 university departments. There is no central coordination. This organization leaves no monitoring of curriculum content to see that what should be covered is indeed covered, nor does it provide teaching from the perspective of oncology rather than the perspective of the other individual disciplines. Following an inventory of the oncology curriculum and a survey of interns graduating from Dalhousie in 1991, we recognize deficiencies in the clinical portion of the curriculum that could be rectified with a small number of hours designed to teach the various aspects of the management of cancer patients in case-scenario, student participation sessions.