Hematology-oncology Fellows Research Articles

Integration of a focused podcast curriculum (PC) to improve hematology oncology fellow (HOF) knowledge: A multi-center cluster randomized controlled trial.

9041 Background: Several studies demonstrate widespread use of medical podcasts as learning resources. Utility of integration of educational podcasts in fellowship curricula remains unknown. Here we describe a multicenter cluster randomized trial comparing a supplemental PC with standard curriculum (SC) to SC alone for HOF. Methods: HO fellowship programs in the United States were eligible. One HOF from each program was invited via email to participate as a local PI. The trial protocol was reviewed by program directors for approval. Programs were cluster randomized to novel PC with SC (intervention) or SC alone (control). Permuted block randomization stratified by program size was performed using STATA. The PC arm was given access to a website developed by the study team with links to podcasts episodes (PE) covering 4 topics: breast oncology, myeloma, bleeding disorders, and HIT. Written show notes (SN) were provided as separate links. PE and SNs were previously developed employing an inductive approach and released by The Fellow on Call and Two Onc Docs podcasts and are freely available. Pre and post qualitative surveys (QS) and knowledge assessments (KA) were administered via REDCAP. QS utilized a 7-point Likert score. KAs were peer reviewed by expert disease-specific faculty. QS and KA links were included on the PC website. To maintain blinding, the SC arm was given a separate website with these links. HOF participation was voluntary. To improve enrollment, at minimum, QS completion was required; KA was optional. Baseline data was obtained from October to November 2023. Post data cut off will be June 2024. Power calculation was based on mean difference in comfort level and knowledge. Assuming a mean improvement by 0.5 points for QS, a total sample size of 210 HOF, 11 clusters in each arm would provide at least 80% power assuming a standard deviation (SD) of 1, intracluster correlation coefficient (ICC) of 0.05, and coefficient of variation of cluster sizes of 0.7. For improvement in KA by 10%, a total sample size of 60 HOF would provide the same power assuming SD of 15%. We therefore planned to recruit 30 HO programs to account for non-response rates. IRB review deemed the study exempt. Results: Baseline characteristics from 28 randomized programs are presented below. Conclusions: This is the first randomized education trial in graduate medical education of its kind with a priori power calculations. Our innovative use of HOF as local PIs may have led to increased participation in KAs. Recruited sites will serve as a consortium for future multicenter education research. Interim analysis will be presented at ASCO 2024. [Table: see text]

Implementing a research methods curriculum for first year hematology oncology fellows.

9034 Background: The Hematology/Oncology Fellowship Program at the University of Alabama at Birmingham is an ACGME accredited, three-year academic training program. Fellows are expected to participate in at least one mentored research project during their second and third years of training. The program, however, did not provide formal training in research methods. Here, we provide the results of implementing a research methods curriculum for first year fellows to fulfill that educational need and to facilitate engagement in research projects throughout their fellowship training. Methods: We developed a structured curriculum composed of 10 didactic sessions covering the fundamental concepts of epidemiology and biostatistics. Based on the core competencies of research methods, learning objectives integrated concepts of 1) study design; 2) identifying bias and confounding; 3) exploratory data analysis, statistical inference, hypothesis testing; and results interpretation; and 4) critical appraisal of research evidence. The course was designed to promote self-directed learning and build on individual experiences and interests. One-on-one meetings between curriculum faculty and fellows facilitated identification of fellow research interests and pairing with mentors with aligned expertise. The didactic sessions were evaluated using a 21 question pre- and post- knowledge assessment. Fellows also self-rated on a 10-point scale their level of confidence performing research related activities. Following the course, fellows were expected to complete at least i) one research project, present it at a scientific meeting and submit for publication in peer-reviewed journal; and/or ii) one research proposal grant application. Results: To date, 13 first-year fellows across three cohorts have participated in the course, two of which have been completed, and the third will conclude in March 2024. Complete pre- and post- assessment scores were available for 8 fellows. Mean score difference was statistically significant comparing pre- to post- knowledge scores (3.79 points (SD= 4.43), paired t-test p-value=0.02). Self- ratings improved across all components on average from 3.7 pre- to 6.5 post-course (p<0.001). The largest change in self-ratings were in understanding study design concepts, basic principles of research and critical appraisal, followed by interpreting statistical outputs. All fellows are leading at least one mentored research project and 7 out of 8 fellows have presented abstracts at national meetings including the American Society of Clinical Oncology and the American Society of Hematology. Conclusions: Implementing a dedicated research methods curriculum to clinical fellows is feasible, and improved learner knowledge, skills, and engagement in research activities. Research methods principles can be effectively incorporated into the first year of clinical fellowship training.

Two years of teaching close to home: Lessons learned from a near-peer model for an introductory lecture series for hematology-oncology fellows.

9027 Background: First-year hematology-oncology fellows face a large initial knowledge gap due to limited disease-specific content exposure during residency training. To facilitate their transition, we introduced a near-peer lecture series during academic year (AY) 2021-22, featuring near-peers (2nd and 3rd year [“senior”] fellows) as the primary instructors guided by content experts (disease specific faculty) [Berry, et al. JCO OP 2023]. This follow-up study’s primary aim was to assess the lectures’ continued impact on learning for 1st year fellows, as well as the impact on the educational skills of senior fellows. We also sought to assess the continued support of this format by faculty. Methods: For AY 2023-24, each rising senior fellow attended a one-hour preparatory workshop on active learning techniques in Spring 2023. They were then assigned 2-3 topics to teach and paired with ≥1 expert faculty. Lectures were conducted from July to September 2023. We administered anonymous surveys immediately post-lecture to attendees and at end-of-series to senior fellows and faculty. Results are summarized as proportions with binomial 95% confidence intervals (CI). Results: We received 109 immediate post-lecture responses for 26 lectures (66% of total lectures). Of 1st year fellow respondents (82.5% of all responses), 80% (95% CI [72-88%]) found the lectures very engaging, 82% (95% CI [76-90%]) found them relevant, 54% (95% [CI 46-62%]) felt very confident in disease diagnosis and staging, and 43% (95% CI [37-49%]) felt very confident in disease treatment following the lectures. All responding senior fellows (N=7) endorsed the lecture format. The majority of senior fellows (67%, 95% CI [50-84%]) found the one-hour workshop only somewhat helpful, and 71% (95% CI [50-92%]) felt only somewhat well equipped to give their lecture. Over half (57%, 95% CI [41-73%]) of senior fellows reused previous slide decks and did not meet with faculty in person to prepare for their sessions. On qualitative review of senior fellow feedback, common themes included time constraints and lack of structured format during the preparation phase. Of faculty respondents (N=9), 78% (95% CI [50-99%]) supported continuation of the format, but only 44% (95% CI [38-50%]) met in-person with their assigned senior fellow in advance of the teaching session. Conclusions: Our near-peer lecture series has broad support for its continuation and is meeting the needs of 1st year fellows. To better help senior fellows improve their education skills, future iterations will focus on optimizing the pre-session coaching and preparatory phase. This will include structured coaching with an expert educator for content planning and development, an augmented process for pre-session meetings between senior fellows and faculty, and greater focus on defining the optimal timeline for session preparation.

Longitudinal curriculum to address wellness and professional development in a hematology/oncology fellowship program.

9004 Background: Many trainees, including Hematology/Oncology (HO) fellows, face burnout throughout their training. Here we implemented a longitudinal curriculum to help fellows with a focus on professional development and burnout mitigation skills. Methods: Interventions to address wellness were initiated in our HO fellowship program in academic year (AY) 2022-2023 based on a needs assessment, including faculty-led sessions, fellow debrief sessions, and social activities (data previously reported). In AY 2023-2024, a new baseline needs assessment was distributed to fellows to determine topics of interest for developing a fellowship retreat and for discussion throughout the year. This assessment also included the Mini ReZ survey to evaluate learning environment, the Patient Health Questionnaire 2 to assess for depressed mood, and the Generalized Self-Efficacy Scale. Surveys were completed anonymously in person and online and were sent throughout the year (data to be fully analyzed by June 2024). T-test and Chi-square test were used for statistical analysis. Results: 22 out of 27 fellows (81.5%) completed the baseline assessment in July 2023. Topics of interest for further discussion included work-life balance, management of scholarly expectations, and professional boundary setting. A day-long, off-site fellowship retreat was designed to address these concerns, with a specific focus on fellow strengths, leadership skills, boundary setting, and communication. Retreats were divided into senior and first-year fellows. Of the 27 fellows who attended the retreats, 22 responded to post-retreat surveys, with 21 of 22 fellows indicating they found the retreat helpful (95.4%). When asked what the most meaningful part of the retreat was, fellows responded “connection with colleagues,” “sharing what inspires/motivates [them],” and “discussing methods to try and prevent burnout.” Scores of self-efficacy and perception of positive learning environment did not significantly differ before and after retreats, and levels of depression remained low. Additional faculty-led didactic sessions were held including a session titled “Grief and Awe” and another titled “Shame Resilience”, with plan for 2 additional sessions. Evaluations of these sessions are planned for the end of the AY to assess effectiveness. Conclusions: The development of a curriculum to address wellness and professional development, including a fellowship retreat that focused on topics identified by a needs assessment, was found to be helpful among HO fellows. More data must be collected to evaluate the effect of these interventions; final data on the entire experience will be available to report at the annual meeting. This curriculum could serve as a model for other programs and be integrated into ASCO’s array of trainee resources to address HO fellow wellness and professional development skills during training.

Educating hematology-oncology fellows about how to communicate with patients about cancer clinical trials: A needs assessment.

9029 Background: Cancer clinical trials (CCTs) are vital to advancing treatment yet only 5-8% of people with cancer ever participate, with even lower rates among underserved groups. Teaching oncologists in training how to communicate about CCTs may improve the frequency and quality of patient-oncologist communication about CCTs and increase participation. However, little is known about interest in or feasibility of such training during Hematology-Oncology (Hem-Onc) graduate medical education (GME) fellowships. We aimed to determine Hem-Onc fellowship programs’: 1) current practices, needs, and preferences for CCT-related communication training; and 2) the acceptability and feasibility of implementing a CCT communication skills workshop. Methods: We recruited and surveyed program directors (PDs) from Hem-Onc fellowship programs across the U.S. PDs were recruited via email through the ASCO program directors’ community, a publicly accessible list of ACGME Hematology-Oncology programs, and co-authors’ professional networks. Participants were compensated with a $50 gift card. Survey data were analyzed using descriptive statistics and responses were measured on a 5-point Likert scale (1 = “strongly disagree” to 5 = “strongly agree”). Results: 40 PDs were surveyed, most representing programs in the Northeast (30%), Midwest (25.6%), Southeast (20.5), and Southwest (15.4%) U.S. Most were male (57%) and identified as White (55%), Asian (30%), Black/African American (2.5%) and Native American/Alaskan Native (2.5%). PDs stated their institutions prioritize CCT accrual (M=4.58, SD=.78) and clinical research training (M=4.20, SD=.85). They reported their GME CCT curriculum least often addressed: (1) How to talk to patients about CCTs when none are available (27.5%), and (2) How to help patients find CCTs at other institutions (17.5%). PDs rated their fellows’ CCT knowledge as lowest in: (1) Provider-level barriers to enrolling/referring patients in CCTs (M=3.41, SD=.91) and (2) System-level barriers to patient accrual to CCTs (M=3.33, SD=.95). Fellows’ lowest-rated CCT communication skills areas were: (1) Making shared decisions with patients about CCT participation (M=3.54, SD=1.14) and (2) Patient-centered communication (M=3.50, SD=1.15). PDs were interested in a CCT communication workshop (‘yes’=67.5%, ‘maybe’=32.5%) and said such training was feasible (M=4.28, SD=.78) and useful (M=4.47, SD=.78). Training preferences were live presentations (M=3.9, SD=1.03) and program-tailored virtual workshops (M=3.9, SD=1.08). Conclusions: Hem-Onc fellowship program leaders expressed a need for training that improves fellows’ CCT knowledge and patient-centered communication skills. By highlighting current practices, challenges, and preferences, this study is an important step towards implementing and scaling communication skills training in GME programs.

Trainee-led quality improvement (QI) project examining PCP prophylaxis in patients on chronic, high-dose corticosteroids.

e23211 Background: Patients with cancer who develop Pneumocystis pneumonia (PCP) have 30-day mortality rates estimated to be > 50%. Despite consensus guidelines from the American Society of Clinical Oncology (ASCO) and Infectious Diseases Society of America (IDSA), appropriate PCP prophylaxis is reported as low as 3.9% for patients with solid malignancies on chronic, high-dose corticosteroids. In this trainee-led QI initiative, we investigated rates of appropriate PCP prophylaxis at a tertiary care cancer center and surveyed clinicians regarding barriers to prescribing prophylaxis. Methods: An interprofessional, multidisciplinary team consisting of hematology-oncology fellows and cancer-center level QI staff was established. This analysis combined a retrospective chart review and survey at a tertiary care center. Retrospective chart review examined PCP prophylaxis rates among patients with solid malignancies prescribed high dose/duration corticosteroids per ASCO/IDSA guidelines (≥20mg prednisone equivalents daily for ≥1 month) between May 1, 2022 and May 31, 2023. The survey, conducted between December 2022 and May 2023, assessed prescriber knowledge of, and attitudes towards, appropriate PCP prophylaxis prescription. The survey was open to clinicians across oncology specialties. Results: Over the study period, 297 patients met inclusion criteria for PCP prophylaxis (median age 62, 178 (60%) were male, 212 (71%) were White, and 55 (18%) were Black). Fewer than half of eligible patients were prescribed prophylactic antibiotics (n = 140, 47%). There were no sociodemographic differences between patients prescribed prophylaxis and those not prescribed prophylaxis. Survey responses (n = 71) included 33 (46%) attending physicians, 21 (30%) advanced practice providers, 8 (11%) residents/fellows, and 9 (13%) unknown. Thirty participants (42%) had cared for a patient who developed PCP while on corticosteroids. While 62 participants (87%) had experience prescribing PCP prophylaxis, only 18 (25%) accurately identified the dose and duration of corticosteroids at which prophylaxis is needed. Lack of guideline knowledge/education was the most commonly cited barrier to prophylaxis (Table). Conclusions: Our study shows strikingly fewer than half of eligible patients on chronic, high-dose steroids were prescribed PCP prophylaxis. Lack of provider knowledge and systems-related obstacles were noted as primary barriers. Based on these findings, an urgent QI intervention is underway to address each barrier, increase rates of PCP prophylaxis, and reduce rates of PCP incidence towards the broader goal of improving outcomes in this at-risk patient population. [Table: see text]

Factors influencing career choices and post-fellowship perspectives in adult hematology/oncology fellows: A nationwide cross-sectional study.

9016 Background: The aim ofour study was to explore the characteristics, aspirations, and factors influencing career choices among adult Hematology/Oncology (HO) fellows, as well as their post-fellowship perspectives. Methods: An anonymous 25-question survey was distributed online to adult HO fellowship programs in the United States. The survey collected data on demographics, educational background, career plans, and specific factors influencing career choices. Results: Of the 56 fellows completing the survey, 54% identified as male, and 46% as female. The majority were White (40%), followed by Asian (34%), Middle Eastern (12%), Hispanic (7%), and Black (3%). Most fellows (79%) were aged 30-34 years, and 68% were MD graduates of US/Caribbean schools. A significant proportion expressed certainty (80%) during residency about pursuing adult HO as a career. Thirty eight percent of the respondents planned to practice both hematology and Oncology. While 39% hoped to work in an academic/university setting, 41% planned to stay within the community. Geographically, 45% preferred suburban, and 39% urban areas. Only 3% of respondents had plans to pursue a career in classical hematology. Factors influencing career choice included clinical interest in the field (98%), previous research experience in HO (54%), career mentorship (70%), lifestyle considerations (66%), and perceived job market (60%) (Table). Almost all respondents (97%) expressed a high likelihood of pursuing adult HO fellowship if they had to choose again. Fellows were confident about finding positions aligned with their interests, including clinical (72%), providing research opportunities (43%), and those offering intellectual stimulation (73%). While the majority were confident in achieving work-life balance (84%), 16% expressed some concerns. Conclusions: This study offers valuable insights into the factors influencing career choices among adult HO fellows. The findings emphasize the necessity of adjusting strategies to align with the evolving needs and aspirations of prospective fellows. Key initiatives could include fortifying career mentorship programs, providing increased support for those interested in classical hematology, fostering research experiences during residency training, and actively promoting a diverse and inclusive environment. Understanding these aspects and results is crucial for program directors, educators, and policymakers to optimize training programs and support the diverse needs of future practitioners in the field. [Table: see text]

Integration of Clinical Trial Development in Hematology-Oncology Fellowship Training.

Several barriers to physicians becoming clinical investigators exist, including inexperience, lack of available mentors, and inconsistent instructive approaches with varying degrees of participation during training. These barriers cause fewer hematology-oncology fellows to pursue academic careers. A consensus is needed on structuring education in clinical investigation paired with active participation in development of a clinical trial guided by a mentor with the goal of increasing fellow interest in clinical research and pursuit of careers in academic medicine. The clinical trial development (CTD) program was initiated at Washington University School of Medicine in St. Louis in 2002 as a hands-on learning experience for hematology and oncology fellows in the design, implementation, and publication of clinical trials. Each fellow was required to identify a mentor and propose at least 1 prospective investigator-initiated clinical trial. At the time of data abstraction in July 2023, 118 fellows had participated in the CTD program and initiated protocols in a variety of areas according to their interests. Fellows were included in data abstraction if their fellowship began in 2002 through 2021; the program is ongoing, and the most recent class will graduate in 2024. Disease types were evenly distributed between solid tumor oncology (60 [51%]) or classic and malignant hematology (58 [49%]). Ninety-three fellows (79%) obtained institutional review board approval, and 60 (65%) published their results. Among graduating fellows, 67 (66%) secured an academic faculty appointment. Fellows with institutional review board-approved projects had significantly higher odds of obtaining an academic faculty appointment (odds ratio, 4.96; 95% confidence interval, 1.54, 15.98; P = .007).Next StepsNext steps will be to further evaluate the effect of the mentorship network on early career productivity of trainees that graduate and the feasibility of extending the program to another institution.

Interactive Pathology Tutorial in Neoplastic Hematology Disorders for Medical Hematology-Oncology Fellows.

Hematology-oncology (HO) fellows receive limited instruction in the process of establishing a diagnosis for hematologic neoplasms, and learning neoplastic hematology often occurs in limited encounters. In the current study, we developed a web-based interactive pathology tutorial in neoplastic hematologic disorders for HO fellows to work up simulated cases and establish the diagnosis. An online system ("Pathology Playground") was utilized to load case materials including microscopic images and ancillary studies. Twelve high-yield simulated cases of common leukemias and lymphoma were included. At the beginning of each case, trainees review the clinical history and slide images, and then, they are given the option to request additional pathology work-up. Based on the results, they can enter their diagnostic impression. If the diagnosis is correct, the user is shown a short educational presentation. If the diagnosis is not correct, the user gets notified by the message "Incorrect." The tutorial was integrated in the educational curriculum of our HO fellowship program, and bimonthly teaching sessions were held to review two cases each time. During the sessions, trainees request ancillary studies to complete the diagnostic work-up using the software and interpret the findings. As the case is being worked up by the trainee, the hematopathologists and HO fellowship program director discuss the findings, the appropriate work-up tools, and the implications on management. All of our six HO fellows attended the sessions, and a survey from the trainees showed high ease of use of the system and they viewed it as a very useful educational tool. A pre-test and post-test were administered for one of the sessions, and the result showed improvement in the average from 62 to 73%. Expanding the use of this online interactive tutorial and incorporating additional cases would enhance its value as a learning resource.

Educating Hematology-Oncology Fellows About How to Communicate with Patients About Clinical Trials: A Needs Assessment.

Only 5-8% of adults with cancer participate in cancer clinical trials (CCTs), with even lower rates among underrepresented groups. Improving oncologists' communication skills may enhance the frequency and quality of their discussions with patients about CCTs, consequently increasing participation. However, little is known about interest in or presence of CCT-related communication training during Hematology-Oncology (Hem-Onc) fellowships. This study aimed to describe, from the perspective of Hem-Onc fellowship program directors (PDs): (1) the current landscape of CCT education for Hem-Onc fellows; (2) the acceptability and feasibility of implementing a CCT communication skills workshop for Hem-Onc fellows. We used an explanatory sequential mixed-methods approach. PDs were surveyed and interviewed about their graduate medical education (GME) programs' current CCT curriculum, training challenges, fellows' CCT knowledge and CCT communication skills, and preferences for a CCT communication workshop. PDs were surveyed (n = 40) and interviewed (n = 12). PDs reported that their institutions prioritize CCT accrual (M = 4.58, SD = .78; 1-5 scale, 5 = "Strongly Agree") and clinical research training (M = 4.20, SD = .85). CCT skills that programs least often addressed were how to (1) discuss CCTs with newly diagnosed patients, (2) talk to patients about CCTs when none are available, and (3) help patients find CCTs at other institutions. PDs were interested in a CCT communication workshop for fellows ("yes" = 67.5%, "maybe" = 32.5%) and said training would be feasible (M = 4.28, SD = .78) and useful (M = 4.47, SD = .78). Qualitative results described programs' current approaches to CCT education and insights about developing and implementing CCT communication training. There is a clear need to improve CCT communication skills training in Hem-Onc fellowship programs and to implement and scale such training to increase CCT participation, especially among diverse patient populations. Furthermore, Hem-Onc GME PDs view such training as feasible and useful.

Interactive Pathology Tutorial in Neoplastic Hematology Disorders for Medical Hematology-Oncology Fellows

Context: Hematology-Oncology (HO) fellows receive limited instruction in the process of establishing a diagnosis for hematologic neoplasms. Learning neoplastic hematology often occurs in limited encounters such as reviewing slides with pathologists or during a tumor board where the diagnosis has already been established. In the current study, we developed a web-based interactive pathology tutorial in neoplastic hematology disorders for HO fellows to work up simulated cases and establish the diagnosis. Design: An online system (“Pathology Playground”) was utilized to load case materials including microscopic images and ancillary studies. Twelve high-yield simulated cases of common leukemias and lymphomas likely to be encountered in the daily practice, such as acute promyelocytic leukemia, were included (www.drdoubleb.com/crowdunknowns/study-set/30). At the beginning of each case, trainees review the clinical history and slide images (image 1), and then they are given the option to request additional work up, such as flow cytometry, immunohistochemistry, karyotype and/or molecular studies. Based on the results, they can enter their diagnostic impression. If the diagnosis is correct, the user is shown a short educational presentation about the entity with the key pathology findings. Results: The tutorial was integrated in the educational curriculum of our HO fellowship program, and bimonthly teaching sessions were held to review two cases each time. During the sessions, trainees request ancillary studies to complete the diagnostic work-up using the software, and interpret the findings. As the case is being worked up by the trainee, the hematopathologists and HO fellowship program director discuss the requested work up findings, the appropriate work-up tools of the case as well as the clinical picture and the implications on the patient management. All of our six HO fellows attended the sessions, and a survey from the trainees showed high ease of use of the system and they viewed it as a very useful educational tool. Conclusions: The interactive tutorial in hematopathology was highly received by our HO fellows, and they found it beneficial for their education. Expanding the use of this online interactive tutorial and incorporating additional cases would enhance its value as a learning resource.

Match Date-to-Start Date: Engaging Fellows Pre-Training

Background: The accelerating pace of progress in hematology and medical oncology is stressing an already packed curriculum. Finding time for innovative curriculum-design or to improve current curricula is challenging. We found no data in the literature about using the pre-training Match Date-to-Start Date period effectively for any educational activities of fellowship training in any discipline in the USA. Our aim was to target fellows matched to our program and see if the six months from Match Date-to-Start Date could be meaningfully utilized without interfering with their pre-training workload and activities. Method: Within four weeks following their match date, the four incoming fellows received a questionnaire. The questionnaire targeted six key research variables, encompassing their field of interest, preferred type of research, desired mentorship, self-assessment of current skills, and the amount of time they were willing to dedicate per week to any fellowship program-related recommended reading until the official start date of July 1. We sent each fellow one email each week with one or two PDFs as educational material. Each fellow received a list of potential mentors with mentor-CVs and information about each mentor's area of focus. Each fellow could choose up to two mentors to interview with. Using their responses as a guide, we arranged 30-minute video meetings between the fellows and their choice of potential mentors. Prior to the start-date, we administered a questionnaire to evaluate the effectiveness and impact of this process. Results: A total of 4 fellows were given a questionnaire post-match to gather their interests, skill set and time willing to dedicate to research. The responses were received in less than 24 hours (table 1). 2/4 chose to focus their research and scholarly activities in medical oncology/solid tumors and the other two chose to focus on malignant hematology. ¾ did not have a chosen mentor already. For their self-reported skills, 75% felt confident in abstract writing and poster presentation while only 50% felt confident in manuscript and grant writing skills. All 4 of them were willing to Commit 1-3 hours match date to start date on items related to research and scholarly activity. By April, each of the four fellows had been successfully paired with a mentor of their choice. At the end of the study period, the pre-start-date questionnaire demonstrated that all 4 fellows strongly agreed that that this Match Date-to-Start Date program was helpful, was not disruptive, and liked the process of choosing their mentor prior to starting their training. Conclusion: This program was designed as a pioneering initiative to optimize the time between the match date and the start date of fellowship training for incoming hematology oncology fellows. Its primary objectives were met: to facilitate a seamless transition for fellows, providing them with valuable opportunities to connect with mentors who share their research interests, enabling them to make informed choices. Additionally, we have implemented a semi-annual follow-up system to document the progress, challenges faced, and gather feedback on how to enhance and refine the program.

Evaluating efficiency of electronic consult requests in an outpatient classical hematology clinic.

46 Background: The classical hematology department at Beth Israel Deaconess Medical Center had 2,200 new outpatient consults in 2022. The conventional process for initiating consults was provider dependent, involving emails to practice hematologists and calls to clinic. Without a standardized process of requesting consults and providing relevant data, providers are not able to efficiently prepare for new visits, which can lead to patient/provider dissatisfaction and repetitive visits. Methods: As a convenience baseline sample in January 2023, hematology-oncology fellows were asked how often they were able to determine the consult reason in coagulation clinic, using a 5-point Likert scale. On 2/1/23, an electronic consult request became available to referring providers within the electronic medical record, and fellows received shared access of the consult list. Following the interventions, fellows were asked how often they were able to determine the consult reason and how often they utilized the electronic order and shared consult list. An additional metric included how often a follow up visit was needed due to insufficient information prior to the appointment. Results: Prior to the intervention, 212 new consults were requested in January 2023. Since the intervention, there have been 963 new consults requested in 115 days, 291 of which were submitted by electronic request [30.2%]. Prior to the intervention, fellows rated ease of finding the consult question an average of 2.2 with median 2.0 on a 5-point Likert scale (1=very difficult, 5=very easy). After addition of the electronic consult request, the average rating improved to 3.75 with median 4.0. To determine the consult question after the intervention, fellows utilized various resources including the new electronic order (28.6%), shared consult list (71.4%) and scanned records or forward emails (42.9%). Prior to the intervention, 3/20 [15%] classical hematology patients in a convenience sample required a follow up visit due to insufficient information available to the provider pre-initial visit. This improved to 0/20 patients after the intervention. Conclusions: Adding electronic consult requests and sharing referral reasons with the entire clinical team improved provider satisfaction with new visits and decreased need for repeat visits. However, utilization of a new electronic consult request by referring physicians remains low. Next steps include efforts to increase electronic consult request use, so that classical hematology clinic visits can be more efficient, which is essential to patient and staff satisfaction and value-based healthcare. [Table: see text]

Gender equity education in oncology: A survey study of hematology-oncology fellowship program directors.

192 Background: Understanding gender equity (GE) as it pertains to patient care as well as the healthcare workforce is essential to the education of future physicians. However, the landscape of GE education in hematology-oncology (HO) fellowship programs is not well-characterized. The purpose of this study was to examine if and how current HO fellows receive training about GE for both patients and physicians. Furthermore, we aimed to identify barriers to providing such training and establish opportunities for educational initiatives regarding GE in HO. Methods: We conducted an online survey of program directors (PDs) of adult HO fellowship programs in the United States. We asked for PD perceptions of how important GE is for patients and physicians and whether their training programs currently offer GE training. For programs without such training, PDs were asked about reasons for lack of current training and level of interest in providing it in the future. Responses were recorded using Likert scales, multiple choice, and open-ended responses. Data were analyzed using descriptive statistics, and open-ended questions were analyzed with thematic analysis. Results: Of 172 PDs contacted, 57 PDs completed the survey (33.1%). Most PDs felt that training in GE issues is “somewhat important” or “very important” regarding patient care (n = 39, 68.4%) and the physician workforce (n = 45, 80.4%). However, most PDs reported that their program does not provide formal training in GE issues regarding patient care (n = 48, 84.2%) or the physician workforce (n = 44, 78.6%). Common reasons listed for lack of GE training include lack of resources (regarding patients: n = 28, 68.3% and regarding physicians: n = 24, 54.5%). Most PDs were interested in resources for patient and physician GE (n = 46, 93.9% and n = 39, 88.6%, respectively). Several programs were open to sharing their training materials for patient (n = 3, 44.4%) and physician GE (n = 8, 66.7%). Conclusions: While most HO PDs feel that GE training is important for patient care and the physician workforce, most reported their fellowship does not offer such training primarily due to lack of resources. Given the interest of many PDs for more educational GE resources, there are opportunities to share existing materials and create new resources to enhance the GE training for future HO physicians.[Table: see text]

Development of a palliative care lecture series for hematology-oncology fellows.

e24112 Background: Many major organizations endorse provision of palliative care (PC) services for patients with advanced cancers from both oncologists and PC specialists. While ACGME has outlined core PC competencies, PC education during hematology-oncology (HO) fellowship is highly variable, and many fellows feel inadequately trained. We assessed whether incorporation of a PC lecture series could improve fellows’ self-perceived preparedness in basic PC skills. Methods: In this educational quality improvement initiative, current HO fellows at an NCI-designated cancer center received lectures on PC topics. Members of both the HO and hospice and palliative medicine fellowship programs met to discuss key components of a PC curriculum and identify available experts. Seven multidisciplinary faculty members delivered eight one-hour video-recorded virtual lectures to HO fellows over a three-month period. Lecture videos remained available online for later viewing in the event of fellow absences. Within a few weeks both pre- and post-lecture series, HO fellows completed surveys addressing their level of preparedness on a 5-point scale (from 1-not at all prepared to 5-extremely prepared) in performing several key skills. Two-tailed paired t-tests were performed to analyze pre/post changes in fellows’ level of preparedness. Results: Eleven fellows participated in the PC lecture series. Fellows’ level of preparedness increased across several PC topics (Table). The greatest increases were in creating a survivorship plan, converting from one opioid to another, and managing pain in a patient at risk for a substance use disorder. Fellows ranked individual lectures as very helpful to their learning, especially lectures on management of GI symptoms (4.9 +/- 0.3), pain management with opioids (4.8 +/- 0.4), and communication (4.5 +/- 0.5). Conclusions: Incorporation of a structured PC didactics series into HO fellowship is feasible, perceived as very useful, and associated with increased self-perceived preparedness. While more longitudinal and hands-on PC experience would likely promote HO fellows’ PC skills more deeply and durably, dedicated PC lectures are an important adjunctive component that can be easily incorporated into HO fellowship education. [Table: see text]

Improving compliance with post-hospitalization follow-up visits: A single community cancer center experience.

e13508 Background: Hospital discharge follow-up visits are crucial for the continuity of care and for reducing rehospitalizations. They prevent medication disruptions, missing opportunities for making a post-discharge treatment plan, and identifying complications. Our aim is: 1. To review the compliance of post-hospitalization follow-ups for a medical specialty. 2. To study the timeline from the discharge to the time they were seen in the hematology-oncology clinic. 3. To identify why patients seen in the hospital were lost to follow-up. 4. To improve compliance with post-discharge follow-up visits. Methods: This is a retrospective chart review of patients seen by our Hematology-oncologists at Einstein Medical Center Montgomery between January 2021 to December 2021. Data collected included: Specialty consulted- Hematology versus Oncology; if follow-up is indicated; if they have a Hematology Oncology provider elsewhere; if they were seen in the clinic and how long did it take for the patient to be seen after discharge; if they did not follow-up, the reason for failure to follow-up was reviewed. We defined “No contact from our office” when there was no documentation that our office staff tried to contact the patient to make a follow-up appointment. Results: Out of the total 526 inpatient consultations, 338 were for hematology, 169 were for oncology and 19 were for both hematology and oncology. Follow-up upon discharge was recommended for 429 patients (82%). Out of those 429 patients, 168 patients (39%) were seen in the clinic and 176 patients (41%) were not seen after discharge from the hospital. 85 patients (20%) had a Hematology Oncology provider in a different institution. 118 patients (68%) in this group of 168 patients were seen in less than 30 days. 41% of the patients that were not seen after discharge from the hospital had various reasons, which included 18% of patients who expired, and 10% of patients who chose to be on comfort care. 41% of the patients were lost to follow-up (unable to track after the discharge – data was limited due to this being a retrospective study), 2% of the patients were incarcerated, 23% of the patients had no contact from our office to make a follow-up appointment, 1% of the patients were subsequently hospitalized, and finally, 5% of the patients followed up in a different institution. Conclusions: Hematology was consulted more often than Oncology for the subspecialty in-hospital consultations. 41% of the patients were lost to follow-up due to reasons unknown who should have been seen in the Hematology/Oncology Clinic. Interventions that we recommend in improving this compliance are 1. Formulate a rapid discharge clinic – run by Hematology-Oncology fellows with attending oversight. 2. Involve the Oncology Nurse Navigator to help coordinate patient follow-up. 3. Provide better education for hospital staff about the importance of reviewing discharge instructions with the patients.

Diversity, equity, and inclusion (DEI) and health equity (HE) education in hematology/oncology (HO) fellowship: A longitudinal curriculum.

11002 Background: The medical workforce remains markedly less diverse than the patients we care for, and outcomes disparities persist. This highlights the need for DEI efforts and HE education. In 2021, we implemented a DEI curriculum in the HO fellowship at Yale Cancer Center (YCC) and found improvements in our fellows’ upstander responses. We present an assessment 1 year after initiation of this series and we share our longitudinal 3-year DEI/HE curriculum and other institutional steps taken to improve equity. Methods: An anonymous survey assessing DEI/HE needs, experiences with and comfort level addressing discrimination, and preferences for curriculum was emailed to all YCC HO fellows. 1st year fellows had no formal DEI education prior to the survey. Senior fellows had completed 1 year of the fellowship’s DEI series. Results: 23 fellows (79%) responded, including 8 1st year and 13 senior fellows (2 unknown). Most fellows had experienced (78%) or witnessed (87%) some form of discrimination. Notably, 1st year fellows felt under-equipped to navigate bias and microaggressions compared to senior fellows. 1st year fellows reported a mean confidence score of 2.5/5 navigating these events when experienced personally and 2.9/5 when directed at others, compared to senior fellows (mean confidence scores 3 and 3.2 respectively). Fellowship DEI education was perceived as important (mean 8.6/10). When asked which DEI/HE topics they would be interested in learning about, the most popular choices among the 23 fellows were cancer treatment and outcomes disparities (78%) and bystander training (70%). They indicated lectures from field experts (65%), affinity groups (57%), small group discussions (52%), and advocacy education (52%) would be useful to them. The chief fellows convened a series of discussions with faculty and field experts, which led to creation of a 3-year longitudinal DEI/HE curriculum. This includes an annual cancer disparities lecture and bystander training session, and 2-4 rotating lectures per year covering implicit bias training, issues of race, gender, LGBTQIA+, disability, and religion in the workforce and in patients’ experiences, pay and promotion disparities, and financial toxicity for patients. YCC and fellowship leadership have also implemented a DEI lecture series, increased recruitment of under-represented in medicine (URiM) physicians, established an URiM mentorship group and a diversity enhancement program for rotations for URiM medical students, and encouraged community engagement. Conclusions: DEI/HE education at all levels is essential for fostering equity in the workplace and patient care. Implementation of a longitudinal curriculum in parallel with other YCC initiatives has improved fellows’ confidence in navigating bias and microaggressions. This curriculum can serve as a guide for other programs developing DEI/HE education.

Hematology/Oncology Fellows' Training in Palliative Care: A Narrative Review.

Palliative care (PC) education is a vital and required part of hematology-oncology fellows' education to build PC skills, attitudes, and knowledge. However, previous research has shown that education in PC is inadequate. This narrative review of the literature on primary PC education during hematology-oncology fellowship programs aims at identifying the current state of PC education, existing gaps, and potential future directions for improving PC education. Fourteen articles were identified and reviewed. The types of articles included trainee and program leadership responses, and interventions designed to improve PC education. Results from each study are reported. Overall, trainees and program leadership rate current PC education as varied, often inadequate, and in need of improvement. Educational interventions show that some form of PC education increases perceived knowledge and confidence in PC skills. Future studies are needed to develop the most effective and impactful educational models.

471 - The First Year of Hematology Oncology Fellows: a Social Media Community for Hematology/Oncology Trainees

471 - The First Year of Hematology Oncology Fellows: a Social Media Community for Hematology/Oncology Trainees

Editorial introductions.

Editorial introductions.