Oncology Education in Medical Schools: Towards an Approach that Reflects Australia's Health Care Needs

Junior doctors' workplace well-being and the determinants based on ability-motivation-opportunity (AMO) theory: Educational and managerial implications from a three-year longitudinal observation after graduation

PURPOSE

Junior doctors function as trainees from an educational perspective and as employees from a human resource management perspective. Employing the ability-motivation-opportunity (AMO) theory as a conceptual framework, this study longitudinally investigated the factors affecting the workplace well-being and career progression of junior doctors over a 3-year period following their graduation from medical schools.

MATERIALS AND METHODS

This 3-year prospective cohort study enrolled junior doctors who graduated from 2 medical schools in June 2019 in Taiwan. This study collected data by implementing web-based, self-administered structured questionnaires at 3-month intervals between September 2019 and July 2022. The collected data encompassed ability indicators (i.e. academic performance and perceived preparedness for clinical practice), motivation indicators (i.e. educational and clinical supervision), opportunity indicators (i.e. clinical unit cultures), and workplace well-being indicators (i.e. burnout, compassion satisfaction, and job performance). A total of 107 junior doctors participated, providing 926 total responses. The data were analysed using univariate analyses and structural equation modelling with path analysis.

RESULTS

Over the 3-year period following graduation, the junior doctors' confidence in their preparedness for clinical practice and the educational and clinical supervision had varying degrees of influence on the junior doctors' workplace well-being. The influence of clinical unit cultures, which can provide opportunities for junior doctors, became evident starting from the second year postgraduation; notably, unit cultures that emphasised flexibility and discretion played positive and critical roles in enhancing the junior doctors' workplace well-being lasted to the third year.

CONCLUSIONS

Our findings provide insights into the distinct critical factors that affect the socialisation of junior doctors within workplace environments over 3 consecutive years. These findings can provide guidance for medical educators and healthcare managers, helping them understand and support the progressive integration of junior doctors into their work environments.

A Virtual Curriculum to Increase Exposure to Oncologic Subspecialties for Undergraduate Medical Students

Medical student exposure to oncology is imperative given the prevalence of cancer, growing need for survivorship care, and ever-evolving therapies. Our institution offers a Cancer Care Elective for undergraduate medical students focused on clinical shadowing, but the COVID-19 pandemic necessitated completely redesigning a virtual alternative. In this study, we utilize a post-elective survey to 1) assess whether the novel virtual elective effectively promoted student learning and 2) identify which components were most impactful. We created an entirely virtual, semester-long course with structured mentorship, subspecialty panels, physician-led didactics, and patient exposure. Students attended multidisciplinary tumor boards and presented on oncologic topics. A post-elective survey assessed the course's impact on students' knowledge and the perceived value of each elective component. Of the 29 enrolled students, 12 responded to our survey (41%). Most students reported that the elective highly enhanced their understanding of medical (67%), surgical (75%), and pediatric (66%) oncology. The highest rated didactic involved patients discussing their cancer journeys, with 80% of students reporting that this session enhanced their understanding of patient-physician collaboration. Students reported that physician mentorship helped them better understand oncology (90%) and promoted interest in pursuing an oncologic career (100%). This study demonstrates that our virtual Cancer Care Elective was effective at increasing student understanding of oncology in practice. The results also suggest that patient exposure and physician mentorship are particularly educational and encouraging.

A Cancer Education Framework for Australian Medical Schools: an Announcement of a New Educational Program

This framework draws upon national and international cancer curricula to identify the essential cancer-related learning outcomes for Australian medical students. The framework incorporates feedback from medical, radiation and surgical oncologists, haematologists, and palliative care physicians on what medical graduates need to know about cancer. The consensus view was that medical students require a basic understanding of the principles of cancer management and the opportunity to see cancer patients in a cancer service unit. The framework assumes that certain knowledge, skills, and attitudes are already embedded in current Australian medical school curricula, presenting instead only the core cancer content in order to provide a clear and concise framework designed to maximise integration within existing curricula.

ESO-ESSO-ESTRO Multidisciplinary Course in Oncology for Medical Students: 4 Years of Experience (2016-2019)

The ESO-ESSO-ESTRO Multidisciplinary Course in Oncology is intended to fill the gap of the undergraduate fragmented oncology education, to provide insight into all theoretical and practical aspects of oncology, and to encourage future professional choices towards an oncology discipline. Students are exposed to (a) preclinical cancer topics; (b) natural history of the disease; (c) laboratory diagnostic tests; (d) medical, radiation, surgical, and palliative treatment; and (e) direct or through multidisciplinary patients' approach. Students are obliged to attend (i) all theoretical lectures, (ii) clinical case presentations, (iii) laboratories and ward visits, and (iv) to prepare and present a specific project under supervision. Participation is limited to 24 medical students who are selected through a competitive application process. Between 2016 and 2019, 96 students from 29 countries have attended. Data analysis derived from a given questionnaire demonstrates that most of the participants have declared that (1) they have achieved their expectations and objectives, (2) they have highly rated both clinical and non-clinical teaching oncological topics, and (3) they have been stimulated in developing a professional career in the field of oncology.

Perception of Oncology Evaluated by Medical Students (P.O.E.M.S)-a Single Institutional Study

Rising incidence of cancer coupled with lack of structured oncology teaching in the undergraduate (UG) medical curriculum could be detrimental by generating unmet needs in the proper care of cancer patients in the future. To determine the orientation amongst undergraduate medical students regarding Oncology as a specialization and future career option, a cross-sectional, single institutional study was conducted amongst 950 undergraduate students by using an online survey over 2 months. The perception of the subject of Oncology as a career option and the opinion regarding the need for inclusion in the undergraduate curriculum were assessed. Students themselves or those with first-degree relatives as cancer survivors were excluded. A total of 317 responses (33.4%) met the inclusion criteria. Majority were MBBS students from semesters 6 to 9. Even though students ranked the future prospect of Oncology 7.5 on 10, only 6% of the respondents actually wanted to pursue it as a career option stating high mortality amongst cancer patients (63.6%) and emotional burnout (49.7%) as the primary limitations. On a brighter note, better job opportunity due to increasing global cancer incidence (61%) and opportunity for research (42.8%) were thought to be the promising features of the specialization. Majority (51.3%) wanted the inclusion of Oncology in the undergraduate curriculum. Due to limited exposure in the undergraduate curriculum, there is a lack of knowledge and interest regarding the scope of Oncology as a future career option. We therefore advocate revision of the undergraduate curriculum to include Oncology.

A Successful Model for an Introductory Oncology Teaching Conference and Its Impact on Preclinical and Clinical Medical Students

PURPOSE

Oncology education at medical schools is often fragmented, under-represented, and nonstandardized. Medical students lack essential knowledge, skills, and attitudes necessary for them to provide optimal primary care to patients with cancer upon graduation.

METHODS

In this study, we designed and assessed the impact of a compact oncology teaching conference on medical students. The conference covered topics in cancer biology, public health, diagnosis, patient management, treatment, and communication skills. Medical students completed voluntary presurveys and postsurveys regarding their perceived knowledge, attitudes, and perspectives. The event was promoted by student groups, particularly our ASCO Oncology Student Interest Group, and took place online.

RESULTS

A total of 228 responses from medical students representing 50 universities were analyzed. We revealed significant baseline confidence and perceived knowledge deficits especially in diagnosis and patient management, and treatment modalities. Our conference positively affected self-assessed knowledge acquisition among students, with the most pronounced differences seen in diagnosis and patient management (2.51 ± 1 v 3.87 ± 0.81) and treatment modalities (2.54 ± 0.96 v 3.79 ± 0.88), P < .001. Students believed the program was beneficial, felt more confident in applying their knowledge in the clinic and in delivering bad news, and were more interested in pursuing oncology-related fields, P < .001.

CONCLUSION

We demonstrated that a compact teaching conference resulted in significant improvements in students' confidence and perceived knowledge about oncology. Our successful teaching model can be adapted and implemented at medical schools globally. Development and evaluation of teaching programs are important to urgently reform undergraduate medical education in oncology.

Precision Cancer Medicine: Dynamic Learning of Cancer Biology in a Clinically Meaningful Context

PURPOSE

Precision medicine is revolutionizing healthcare practices, most notably in oncology. With cancer being the second leading cause of death in the USA, it is important to integrate precision oncology content in undergraduate medical education.

METHODS

In 2015, we launched a Clinical Cancer Medicine Integrated Science Course (ISC) for post-clerkship medical students at Vanderbilt University School of Medicine (VUSM). In this ISC, students learned cancer biology and clinical oncology concepts through a combination of classroom and patient care activities. Student feedback from mid- and end-of-course surveys and student match data were analyzed and used to develop ongoing course improvements.

RESULTS

To date, 72 medical students have taken the Clinical Cancer Medicine ISC. Over 90% of students who completed end-of-course surveys agreed or strongly agreed that this course advanced their foundational science knowledge in clinical cancer medicine, that clinical relevance was provided during non-clinical foundational science learning activities, and that foundational science learning was embedded in course clinical experiences. Students who took this course most commonly matched in Internal Medicine, Pathology, Pediatrics, and Radiation Oncology. VUSM students who matched into Pathology and Radiation Oncology were more likely to take this ISC than students who matched in other specialties.

CONCLUSION

The Clinical Cancer Medicine ISC serves as a model for incorporating precision oncology, cancer biology foundational science, and oncology patient care activities in undergraduate medical education. The course prepares students to care for oncology patients in their fields of interests during their future career in medicine.

Inspiring the future generation of oncologists: a UK-wide study of medical students' views towards oncology

BACKGROUND

One in 2 people born in the UK after 1960 are expected to require oncology input in their lifetime. However, only 36% of UK medical schools provide dedicated oncology placements and teaching indicating a discordance between public health impact and training. We designed a UK-wide survey to capture medical students' views on current oncology teaching and the potential role of a national undergraduate oncology symposium as an educational, networking and motivational tool.

METHODS

We undertook a national cross-sectional survey of UK medical students' views in oncology and satisfaction with teaching using pre-designed questionnaires. We also distributed a dedicated survey (pre and post-conference) to compare medical students' motivation towards a career in oncology after attending the national symposium. This study was prospectively approved by QMUL Ethics Committee (Reference number QMREC2348). Statistical analysis included univariate inferential tests on SPSS and GraphPad software.

RESULTS

The national survey was completed by 166 students representing 22 UK medical schools. Students reported limited interest, knowledge and exposure to oncology, lack of confidence in skills, and teaching dissatisfaction. Oncology was perceived as a challenging specialty (mean 4.5/5 ± 0.7), yet most students estimate receiving only 1-2 weeks of dedicated oncology teaching. The national symposium generated a statically significant increase in students' interest, knowledge, and confidence in skills surrounding oncology, improving students' perceived ability to cope with the emotional challenges in this field.

CONCLUSION

Students' views towards oncology alongside their teaching dissatisfaction underpin the need to revisit and strive to improve current undergraduate oncology curricula. Increasing medical student oncology exposure by proposing outcome-based guidelines and adopting a standardised undergraduate oncology curriculum should be the foremost priority in inspiring future oncologists to ensure excellent cancer patient care.

Student Exposure to Cancer Patients: an Analysis of Clinical Logbooks and Focus Groups in Clinical Year Medical Students

Despite cancer being the leading cause of mortality, cancer education and patient exposure are lacking in many medical schools. The aim of this study was to evaluate the nature of cancer patient exposure, relative to the clinical setting for medical students on placement and to explore their experiences. Participants were asked to maintain a logbook of cancer patient encounters and were invited to attend a structured focus group upon completion of the academic year. Eleven students submitted logbooks (rr = 6.15%) and eight participated in the focus groups (4.47%). A total of 247 cancer patient encounters were recorded. Third-year students primarily saw cancer patients in surgery (18.62%) and general practice (8.50%), whilst final year students saw cancer patients most frequently in palliative care (35.22%) and ENT surgery (13.77%). Students highlighted that the quality of their interactions with cancer patients varied significantly between clinical settings. Outpatient clinics and surgical in-patients had the lowest level of interaction, with students having a predominantly observatory role. Repeated themes of uncertainty and awkwardness regarding history, examination and discussing death and dying were outcomes of the thematic analysis. Exposure to cancer patients remains highly variable and opportunistic. Students voiced concerns for preparedness to practice and many found it worrisome that they will likely examine a primary cancer when they have graduated, without having done so during their training. Our study suggests that a more structured approach to teaching and clinical exposure to cancer patients is required.

A Junior Doctor's Perspective on Oncology and Palliative Medicine Education in Western Australia: Comparison Between Graduation and Completion of Internship

Cancer is a leading cause of death in Australia and is also the leading cause of disease burden as survivorship continues to improve. Given the prevalence of oncology patients in the community, it is likely to be a condition encountered by every junior doctor. Despite this oncology and in conjunction with that, palliative care has not been a core component of medical curriculum until recently. This means that the junior doctor experience is often complicated by lack of knowledge, poor understanding of the disease process, treatment options and complications and therefore makes managing these patients complicated and often an uncessarily stressful process. This reflective article explores current issues in cancer education, a reflection and comparison between pre- and post-internship experience and offers some potential solutions to these issues.

Medical Student Exposure to Cancer Patients Whilst on Clinical Placement: a Retrospective Analyses of Clinical Log Books

In Australia, one in two men and one in three women will be diagnosed with cancer by the age of 85. Several studies have demonstrated a decline in the number of medical graduates having examined cancer patients during their training. The aim of this study was to evaluate the exposure of medical students to cancer patients during clinical placements. Eighty-eight logbooks (response rate = 24.75%) containing 9430 patients were analysed. A total of 829 patients (8.79%) had a diagnosis of cancer. Most cancer patients were seen on surgical placements, whilst general practice placements returned the lowest numbers. None were seen in paediatrics or ophthalmology. Given the role surgery plays in the staging and treatment of cancer, it is unsurprising that most cancer patients were seen during surgery.  Most concerning was the number of patients with common cancers seen by our students. Only 46% of students saw a patient with breast cancer. Even fewer saw patients with colorectal (41%), lung (32%) and prostate cancer (30%). Only 14% saw a melanoma patient. Variability in the quality of the logbooks is the main limitation of this study, and therefore, it is not a complete picture of cancer patient exposure. However, it builds upon previous studies by providing insight to the number and types of cancer patients to which students were exposed. Overall, the exposure to common cancers remains concerning and further research is needed to explore the type and quality of these interactions over the course of an entire year.

The Impact of Curriculum Design in the Acquisition of Knowledge of Oncology: Comparison Among Four Medical Schools

Over the past 5 years, cancer has replaced coronary heart disease as the leading cause of death in the Netherlands. It is thus paramount that medical doctors acquire a knowledge of cancer, since most of them will face many patients with cancer. Studies, however, have indicated that there is a deficit in knowledge of oncology among medical students, which may be due not only to the content but also to the structure of the curriculum. In this study, we compared students' knowledge acquisition in four different undergraduate medical programs. Further, we investigated possible factors that might influence students' knowledge growth as related to oncology. The participants comprised 1440 medical students distributed over four universities in the Netherlands. To measure students' knowledge of oncology, we used their progress test results from 2007 to 2013. The progress test consists of 200 multiple-choice questions; this test is taken simultaneously four times a year by all students. All questions regarding oncology were selected. We first compared the growth of knowledge of oncology using mixed models. Then, we interviewed the oncology coordinator of each university to arrive at a better insight of each curriculum. Two schools showed similar patterns of knowledge growth, with a slight decrease in the growth rate for one of them in year 6. The third school had a faster initial growth with a faster decrease over time compared to other medical schools. The fourth school showed a steep decrease in knowledge growth during years 5 and 6. The interviews showed that the two higher-scoring schools had a more focused semester on oncology, whereas in the others, oncology was scattered throughout the curriculum. Furthermore, the absence of a pre-internship training program seemed to hinder knowledge growth in one school. Our findings suggest that curricula have an influence on students' knowledge acquisition. A focused semester on oncology and a pre-internship preparatory training program are likely to have a positive impact on students' progress in terms of knowledge of oncology.

The status of radiation oncology teaching in Australian and New Zealand medical schools

INTRODUCTION

Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession.

METHODS

An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval.

RESULTS

Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5 days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5 years; however, most have no intention of changing radiation oncology teaching.

CONCLUSION

Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.

A Survey of Medical Oncology Training in Australian Medical Schools: Pilot Study

BACKGROUND

Oncology is a rapidly evolving field with continuous advancements in the diagnosis and treatment of cancer. Therefore, it is important that medical students are provided with the knowledge and experience required to care for oncology patients and enable them to diagnose and manage toxicities of novel therapeutic agents.

OBJECTIVE

This study was performed to understand the medical students' perspective of the oncology education provided in universities across Australia and identify areas of education that could potentially be modified or improved to ultimately attract more students to a career in oncology.

METHODS

This pilot cross-sectional study consisted of an 18-question survey that was submitted online to medical students in their final year and interns rotating to the Tamworth Hospital.

RESULTS

The survey was completed by 94 fifth-year medical students and interns. Oncology was taught both theoretically and clinically for 68% (63/93) of participants, and 48% (44/92) had an exclusive oncology rotation. Both theoretical and clinical oncology assessments were conducted for only 21% (19/92) of participants. Overall, 42% (38/91) of participants were satisfied with their oncology education, and 78% (40/51) were dissatisfied with the number of oncology teaching hours. The importance of a career in oncology was rated as low by 46% (41/90) of participants.

CONCLUSIONS

This pilot study indicates that there are potential areas to improve oncology teaching in Australian universities. The majority of surveyed students were dissatisfied with the number of teaching hours they receive in oncology. More global assessment of students and/or interns from other Australian institutes may yield further useful information.