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Patel PN, Dombkowski KJ, Madden B, Raphael JL, Plegue M, Braun TM, Reeves SL. Patterns of primary and specialty care among children with sickle cell anemia. Pediatr Blood Cancer 2024; 71:e31048. [PMID: 38693643 DOI: 10.1002/pbc.31048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVE National guidelines recommend that children with sickle cell anemia (SCA) be seen regularly by primary care providers (PCPs) as well as hematologists to receive comprehensive, multidisciplinary care. The objective is to characterize the patterns of primary and hematology care for children with SCA in Michigan. METHODS Using validated claims definitions, children ages 1-17 years with SCA were identified using Michigan Medicaid administrative claims from 2010 to 2018. We calculated the number of outpatient PCP and hematologist visits per person-year, as well as the proportion of children with at least one visit to a PCP, hematologist, or both a PCP and hematologist annually. Negative binomial regression was used to calculate annual rates of visits for each provider type. RESULTS A total of 875 children contributed 2889 person-years. Of the total 22,570 outpatient visits, 52% were with a PCP and 34% with a hematologist. Annually, 87%-93% of children had a visit with a PCP, and 63%-85% had a visit with a hematologist. Approximately 66% of total person-years had both visit types within a year. The annual rate ranged from 2.3 to 2.5 for hematologist visits and from 3.7 to 4.1 for PCP visits. CONCLUSIONS Substantial gaps exist in the receipt of annual hematology care. Given that the majority of children with SCA see a PCP annually, strategies to leverage primary care visits experienced by this population may be needed to increase receipt of SCA-specific services.
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Affiliation(s)
- Pooja N Patel
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin J Dombkowski
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Madden
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas, USA
| | - Melissa Plegue
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas M Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah L Reeves
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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2
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Silvestre J, Aakhus E, Weldeslase TA, DeLisser HM. A 15-Year Analysis of Supply and Demand for Hematology and Oncology Training in the United States. JCO Oncol Pract 2024; 20:717-724. [PMID: 38285966 DOI: 10.1200/op.23.00531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/14/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
PURPOSE There is a paucity of research on the supply of the hematology and oncology workforce despite projected shortages in the United States Over the past 15 years of the hematology and oncology match (HOM), we hypothesized that there would be more growth in the number of training positions relative to applicants, higher match rates for US allopathic graduates relative to non-US allopathic graduates, and fewer applicants matching at their top fellowship choices. METHODS This was a national, retrospective cohort study of all applicants in the HOM (2009-2023). Match rates and applicant-to-training position ratios were calculated and compared over time with Pearson tests. RESULTS Growth in the number of annual training positions (426-708; 66% increase) exceeded growth in the number of interested applicants (706-945; 34% increase; P < .001). Annual applicant-to-training position ratios decreased from 1.7 to 1.3 (r = -0.813; P < .001). Match rates increased over the study period for both US allopathic graduates (79%-88%; r = 0.761; P = .001) and non-US allopathic graduates (45%-63%; r = 0.801; P < .001). During each year, match rates for US allopathic graduates exceeded those for non-US allopathic graduates (P < .001). From 2018 to 2023, US allopathic graduates (83%) had higher match rates than US osteopathic graduates (60%) and international medical graduates (50%; P < .001). The percentage of applicants that matched at one of their top three fellowship choices increased from 53% to 60% (r = 0.480; P = .070). Fewer available annual training positions went unfilled over the study period (3%-0.3%; r = - 0.870; P < .001). CONCLUSION Match rates have increased in the HOM but remain competitive especially for non-US allopathic graduates. Future investigation is needed to understand disparities in match outcomes by additional applicant and fellowship program characteristics. Ongoing surveillance of HOM outcomes remains critical given the projected shortages in the US hematology and oncology workforce.
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Affiliation(s)
| | - Erin Aakhus
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Horace M DeLisser
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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3
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Marshall AL, Masselink LE, Kouides PA, Davies FE, Farooqui A, Nagalla S, Herrera A, Mortier N, Brodsky R, Erikson CE. Advanced practice providers in hematology: actionable findings from national paired APP and physician surveys. Blood Adv 2024; 8:1179-1189. [PMID: 38127271 PMCID: PMC10910059 DOI: 10.1182/bloodadvances.2023011927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT Advanced practice providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of 2 national surveys, 1 for APPs and 1 for physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology, and the physician survey was distributed to physician members of ASH. A total of 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. A total of 42.1% of APPs and 29.3% of physicians reported burnout, and >50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.
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Affiliation(s)
- Ariela L. Marshall
- Division of Hematology Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Leah E. Masselink
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | - Faith E. Davies
- Pearlmutter Cancer Center, New York University Langone Health, New York, NY
| | - Azam Farooqui
- Department of Hematology and Oncology, Ironwood Cancer & Research Centers, Chandler, AZ
| | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA
| | - Nicole Mortier
- Sickle Cell Disease Clinical Trials Network, ASH Research Collaborative, Washington, DC
| | - Robert Brodsky
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
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4
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Sharief MH, Elghazaly AA, Al Abbas AM, Al Basri RS, Alsirafy SA. Does hematology rotation impact the interest of internal medicine residents in considering hematology as a career? BMC MEDICAL EDUCATION 2024; 24:223. [PMID: 38431580 PMCID: PMC10909288 DOI: 10.1186/s12909-024-05192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The ongoing need for hematologists is not met in many parts of the world. The hematology rotation during internal medicine residency is an opportunity to attract more physicians to the hematology field. This study aimed to assess the impact of a hematology rotation on internal medicine residents' interest in considering a hematology career. METHODS Internal medicine residents were invited to complete an anonymous questionnaire before and after a mandatory hematology rotation. Their interest in pursuing a hematology career was assessed by asking them to rate "Consider hematology as a career" on a 0 to 10 scale (0 = never, 10 = strongly agree). In addition, viewing the hematology workload as manageable, comfort in dealing with cancer and satisfaction with the hematologist lifestyle were assessed before and after the rotation. RESULTS Sixty out of 62 IM residents completed the pre- and post-hematology rotation questionnaire (response rate 97%). 80% were in the age range of 25-29 years and 73% were males. Two-thirds were in the senior level (3rd and 4th year) of their residency program and 40% had a prior rotation in a hematology unit. Rating considering hematology as a career increased significantly from a median of 7 (IQR: 5-9) pre-rotation to 8.5 (IQR: 7-10) post-rotation (p = 0.0018). Subgroup analysis showed a significant increase in interest among subgroups except residents > 29 years of age, those with prior hematology rotation and junior residents (1st and 2nd year residency). The change in viewing hematology workload as manageable, comfort in dealing with cancer patients and perceiving the hematologist lifestyle as satisfactory were strongly positively correlated with the change in considering hematology as a career (p = 0.0014, < 0.0001 and < 0.0001; respectively). CONCLUSIONS A hematology rotation is associated with an increase in the interest of internal medicine residents in considering hematology as a career. Further research is needed to Identify factors that may make hematology rotations an effective tool in attracting residents to the hematology field.
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Affiliation(s)
- Mamoun Hassan Sharief
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Assem A Elghazaly
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Raed Saleh Al Basri
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Samy A Alsirafy
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia.
- Palliative Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
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5
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Russell H, Hord J, Orr CJ, Moerdler S. Child Health and the Pediatric Hematology-Oncology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678L. [PMID: 38299998 DOI: 10.1542/peds.2023-063678l] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hematology-oncology (PHO) is 1 of the oldest recognized pediatric subspecialities. PHO physicians care for infants, children, adolescents, and young adults with all types of cancer and nonmalignant blood conditions, in many cases temporarily assuming the role of a primary care physician because of the complexity and intensity of treatment. However, the number of clinically active PHO subspecialists needed to care for children in the United States remains unknown. Recent papers suggest a potential oversaturation of PHO physicians in some geographic areas. This article is part of a Pediatrics supplement focused on projecting the future supply of the pediatric subspecialty workforce. It draws on information available in the literature, data from the American Board of Pediatrics, and findings from a new microsimulation model estimating the future supply of pediatric subspecialists through 2040. The model predicts a workforce growth in PHO subspecialists of 66% by 2040. Alternative scenarios, including changes in clinical time and fellowship size, resulted in a difference in growth of ±18% from baseline. The model also forecasts significant geographic maldistribution. For example, the current workforce is concentrated in the Northeast Census region and the model predicts the New England Census division will have a 2.9-fold higher clinical workforce equivalent per 100 000 children aged 0 to 18 years than the Mountain Census division by 2040. These findings suggest potential opportunities to improve the PHO subspecialty workforce and the outcomes and experiences of its patient population through educational changes, practice initiatives, policy interventions, and dedicated research.
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Affiliation(s)
- Heidi Russell
- University of Texas Health Houston School of Public Health, Department of Management, Policy and Community Health, Houston, Texas
| | - Jeffrey Hord
- Akron Children's Hospital, Pediatric Hematology-Oncology, Akron, Ohio
| | - Colin J Orr
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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6
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Idossa D, Velazquez AI, Horiguchi M, Alberth J, Abuali I, Smith-Graziani D, de Lima Lopes G, Lubner S, Florez N. Mentorship Experiences Are Not All the Same: A Survey Study of Oncology Trainees and Early-Career Faculty. JCO Oncol Pract 2023; 19:808-818. [PMID: 37192431 PMCID: PMC10860955 DOI: 10.1200/op.22.00643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Physician workforce diversity can be a driver of institutional excellence, improving innovation and reducing health disparities. However, the current diversity of the hematology/oncology (HO) workforce does not reflect that of the US population. METHODS We conducted a cross-sectional online survey of current trainees and faculty within 5 years of completing terminal training in oncology specialties. RESULTS Of the 306 respondents, 64 (21%) were under-represented in medicine (URiM) and 161 (53%) identified as male. URiM participants were less likely to have a primary mentor (66%) than non-URiM participants (80%; P = .015). Among those who had a primary mentor, URiMs met less frequently (once every 3-6 months or less) with their mentor (19% v 7% non-URiM; P = .003). Furthermore, URiMs were more likely to report having mentors outside their own institution (47% v 40% non-URiM; P = .002) and making compromises to gain access to mentorship (36% v 23% non-URiM; P ≤ 0.001). URiMs were also less likely to apply for grants (34% v 42% non-URiM; P = .035) and awards (28% v 43% non-URiM; P = .019). In multivariable models, URiM individuals were more likely to make compromises to gain access to mentors (odds ratio [OR], 1.96; 95% CI, 1.01 to 3.82) and this remained significant for females (OR, 2.17; 95% CI, 1.26 to 3.75). CONCLUSION URiM individuals may be less likely to have effective mentorship and apply for awards and grant support. Understanding the challenges of URiM trainees can help shape training environments in academic medicine to ensure that they are grounded in diversity, inclusion, and retention.
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Affiliation(s)
- Dame Idossa
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
- Masonic Comprehensive Cancer Center, Minneapolis, MN
| | - Ana I. Velazquez
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, CA
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Miki Horiguchi
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School Boston, MA
| | - Julia Alberth
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Inas Abuali
- Harvard Medical School Boston, MA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | | | - Gilberto de Lima Lopes
- Department of Medicine, Division of Hematology/Oncology, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sam Lubner
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin, Madison, WI
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School Boston, MA
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7
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Chase ML, Drews R, Zumberg MS, Ellis LR, Reid EG, Gerds AT, Lee AI, Hobbs GS, Berry J, Freed JA. Consensus recommendations on peripheral blood smear review: defining curricular standards and fellow competency. Blood Adv 2023; 7:3244-3252. [PMID: 36930800 PMCID: PMC10336252 DOI: 10.1182/bloodadvances.2023009843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023] Open
Abstract
Graduate medical education training in hematology in North America is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Trainees routinely review peripheral blood smears (PBS) in providing clinical care. Competency in PBS review at graduation is required by the ACGME. However, there are no consensus guidelines on best practices surrounding PBS review, education, or competency. We describe the generation of proposed theory and the consensus recommendations developed through a multi-institutional focus group, developed using constructivist grounded theory and a modified nominal group technique. Eight academic hematologists, spanning classical and malignant hematology, enrolled and participated in 2 one-hour focus groups. All routinely worked with fellows and half had formally instructed trainees on PBS interpretation. Focus group data were analyzed using mixed-methods techniques. Tenets of emerging theory were identified through inductive coding. Consensus recommendations (CR) were generated. Participants reviewed CR in an iterative fashion until consensus was reached. Strong consensus was reached on multiple aspects of PBS education. All agreed that trainees should learn PBS review through a systematic approach. Group discussion focused on disorders of red and white blood cells. The diagnoses of acute leukemia and thrombotic microangiopathies were most commonly discussed, with specific emphasis on disorders in which prompt recognition was required to avert significant patient morbidity. These CR offer external validity to future research and curricular development for both PBS review and other visuospatial tasks in medical education.
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Affiliation(s)
- Matthew L. Chase
- Division of Hematology and Hematologic Malignancies and Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Reed Drews
- Division of Hematology and Hematologic Malignancies, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc S. Zumberg
- Division of Hematology/Oncology, University of Florida, Gainesville, FL
| | - Leslie R. Ellis
- Section on Hematology and Oncology, Comprehensive Cancer Center of Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Erin G. Reid
- Division of Hematology/Oncology, Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Aaron T. Gerds
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Alfred I. Lee
- Division of Hematology, Yale University School of Medicine, New Haven, CT
| | - Gabriela S. Hobbs
- Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jonathan Berry
- Division of Hematology and Hematologic Malignancies and Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jason A. Freed
- Division of Hematology and Hematologic Malignancies, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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8
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Stern RM, Shields HM, LaCasce AS, Pelletier SR, Berliner N. Putting the Heme Back in Heme-Onc: an Evaluation of the Redesigned Hematology Track within the Dana Farber/Mass General Brigham Hematology-Oncology Fellowship. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:691-696. [PMID: 35596109 DOI: 10.1007/s13187-022-02178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 05/20/2023]
Abstract
In 2019, the Dana Farber/Mass General Brigham Hematology-Oncology Fellowship redesigned the 6-month Hematology training track/curriculum required for all fellows seeking to double board in hematology and oncology. Responding to both national and local trends suggesting a future shortage of hematologists, the goal of the redesign was to create a new curriculum that would increase fellow interest in hematology, improve fellows' clinical knowledge of hematology, and serve as an example to other Hematology-Oncology programs across the country. The revised track has now been in place for four years, and, in this paper, the authors present the fellow experience with the first four years of the redesigned curriculum. Based on the number of fellows who chose to complete the new curriculum, as well as the fellow evaluations and performance on the Hematology In-Training Exam, the authors conclude that the new curriculum has successfully increased both fellow interest in and knowledge of hematology.
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Affiliation(s)
- Robert M Stern
- Division of Hematology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.
| | - Helen M Shields
- Harvard Medical School, Boston, MA, USA
- Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann S LaCasce
- Harvard Medical School, Boston, MA, USA
- Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephen R Pelletier
- Harvard Medical School, Boston, MA, USA
- Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Nancy Berliner
- Division of Hematology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
- Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
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9
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Ragni MV, Young G, Batsuli G, Bisson E, Carpenter SL, Croteau SE, Cuker A, Curtis RG, Denne M, Ewenstein B, Federizo A, Frick N, Funkhouser K, George LA, Hoots WK, Jobe SM, Krava E, Langmead CJ, Lewis RJ, López J, Malec L, Mann Z, Miles ME, Neely E, Neufeld EJ, Pierce GF, Pipe SW, Pitler LR, Raffini L, Schnur KM, Shavit JA. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: facilitating research through infrastructure, workforce, resources and funding. Expert Rev Hematol 2023; 16:107-127. [PMID: 36920855 DOI: 10.1080/17474086.2023.2181781] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The National Hemophilia Foundation (NHF) conducted extensive, inclusive community consultations to guide prioritization of research in coming decades in alignment with its mission to find cures and address and prevent complications enabling people and families with blood disorders to thrive. RESEARCH DESIGN AND METHODS With the American Thrombosis and Hemostasis Network, NHF recruited multidisciplinary expert working groups (WG) to distill the community-identified priorities into concrete research questions and score their feasibility, impact, and risk. WG6 was charged with identifying the infrastructure, workforce development, and funding and resources to facilitate the prioritized research. Community input on conclusions was gathered at the NHF State of the Science Research Summit. RESULTS WG6 detailed a minimal research capacity infrastructure threshold, and opportunities to enable its attainment, for bleeding disorders centers to participate in prospective, multicenter national registries. They identified challenges and opportunities to recruit, retain, and train the diverse multidisciplinary care and research workforce required into the future. Innovative collaborative approaches to trial design, resource networking, and funding to surmount obstacles facing research in rare disorders were elucidated. CONCLUSIONS The innovations in infrastructure, workforce development, and resources and funding proposed herein may contribute to facilitating a National Research Blueprint for Inherited Bleeding Disorders.
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Affiliation(s)
- Margaret V Ragni
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Medical and Scientific Advisory Council, National Hemophilia Foundation, New York, New York, USA
| | - Guy Young
- Cancer and Blood Disorders Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Glaivy Batsuli
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Emily Bisson
- Hemostasis & Thrombosis Center, Connecticut Children's, Hartford, Connecticut, USA
| | - Shannon L Carpenter
- Department of Pediatric Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Stacy E Croteau
- Boston Hemophilia Treatment Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam Cuker
- Penn Comprehensive Hemophilia Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Randall G Curtis
- Hematology Utilization Group Study (HUGS), University of Southern California, Los Angeles, California, USA
- Patient Reported Outcomes, Burdens and Experiences (PROBE) Washington, DC, USA
| | - Michael Denne
- Hematology and Rare Disease, Takeda, Cincinnati, Ohio, USA
| | - Bruce Ewenstein
- Takeda Development Center Americas, Inc, Cambridge, Massachusetts, USA
| | - Amber Federizo
- Hemostasis and Thrombosis Center of Nevada, Las Vegas, Nevada, USA
| | - Neil Frick
- National Hemophilia Foundation, New York, New York, USA
| | - Kerry Funkhouser
- Foundation for Women & Girls with Blood Disorders, Montclair, New Jersey, USA
| | - Lindsey A George
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - W Keith Hoots
- Division of Blood Diseases and Resources, National Heart, Lung and Blood Institute, National Institutes of Health; Health and Human Services, Bethesda, Maryland, USA
| | - Shawn M Jobe
- Department of Pediatrics and Human Development, Michigan State University College of Medicine, East Lansing, Michigan, USA
| | - Emily Krava
- Department of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | | | - José López
- Bloodworks Northwest, Seattle, Washington, USA
- Department of Hematology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Lynn Malec
- Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
| | - Ziva Mann
- National Hemophilia Foundation, New York, New York, USA
- Ascent Leadership Networks, Newton, Massachusetts, USA
| | - Moses E Miles
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
| | - Emma Neely
- National Hemophilia Foundation, New York, New York, USA
| | - Ellis J Neufeld
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Glenn F Pierce
- World Federation of Hemophilia, Montréal, Québec, Canada
| | - Steven W Pipe
- Medical and Scientific Advisory Council, National Hemophilia Foundation, New York, New York, USA
- Division of Pediatric Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa R Pitler
- Alliance for Clinical Trials in Oncology Foundation, Chicago, Illinois, USA
| | - Leslie Raffini
- Hemostasis and Thrombosis Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathaleen M Schnur
- Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA
| | - Jordan A Shavit
- Division of Pediatric Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Human Genetics, University of Michigan, Ann Arbor
- Hemophilia and Coagulation Disorders Program, University of Michigan, Ann Arbor, Michigan, USA
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10
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Butt A, Mankbadi M, Erikson C, Marshall A, Masselink LE, Tong G, Hafler J, Podoltsev N, Lee AI. Bias Against International Medical Graduates in the Hematology/Oncology Fellowship Recruitment Process: Findings From a Nationwide Survey of Fellowship Program Directors. JCO Oncol Pract 2022; 18:783-787. [PMID: 36108253 DOI: 10.1200/op.22.00219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Ayesha Butt
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Michael Mankbadi
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Clese Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University, Washington, DC
| | - Ariela Marshall
- Department of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA
| | - Leah E Masselink
- Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University, Washington, DC
| | - Guangyu Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Janet Hafler
- Teaching and Learning Center, Yale School of Medicine, New Haven, CT
| | - Nikolai Podoltsev
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Alfred Ian Lee
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
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11
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Marshall AL, Halfdanarson TR, Alkhateeb H, Hobday T. Pilot Study Characterizing the Hematology-Oncology Fellow Job Search Process: Tools Used and Identification of Potential New Resources. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1385-1388. [PMID: 33517561 PMCID: PMC7847292 DOI: 10.1007/s13187-021-01967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
While the search for post-fellowship employment is an essential part of early career development, little is known about the tools and techniques fellows use during their job search and the specific challenges they face during the process. In this pilot survey study of hematology-oncology (HO) fellows at a large academic training program, the majority of 20 respondents (43% of all fellows) reported a plan to specialize in medical oncology, and most planned to practice in an academic setting. Fellows who had started the job search process reported using several tools/techniques including online job centers and email distribution lists, word of mouth, prior connections with other institutions, and their HO fellowship program leadership, and most reported that their current institution provided help for their job search in at least one way. Job search challenges included learning about available positions, lack of mentorship on the process, lack of sufficient time for the process, and lack of preparation for negotiation. Fellows suggested additional resources that could be helpful to future job searchers including access to information about prior HO fellowship graduates, training in negotiation and interviewing, and career development mentorship. We plan to use this information to expand our own Career Development program for fellows enacting many of these suggestions, and we encourage the use of this information as pilot data for the development of larger studies across other medical and surgical specialties.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy Hobday
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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12
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Velazquez AI, Gilligan TD, Kiel LL, Graff J, Duma N. Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do? Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35649205 DOI: 10.1200/edbk_350691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.
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Affiliation(s)
- Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Julie Graff
- Veterans Affairs Portland Health Care System, Portland, OR
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
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13
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The case for classical haematology: the impact of a name and the future of a field. THE LANCET HAEMATOLOGY 2022; 9:e455-e459. [DOI: 10.1016/s2352-3026(22)00096-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022]
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14
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Strasser JH, Jewers MM, Kepley H, Chen C, Erikson C, Regenstein M. A Mixed-Methods Study of Teaching Health Center Residents' Experiences of Mentorship, Career Planning, and Postresidency Practice Environments. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:129-135. [PMID: 34554952 DOI: 10.1097/acm.0000000000004419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The Teaching Health Center (THC) Graduate Medical Education program enables primary care physicians to train in community-based, underserved settings by shifting the payment structure and training environment for graduate medical education. To understand how THCs have successfully trained primary care physicians who practice in community-based settings, the authors conducted a mixed-methods exploratory study to examine THC residency graduates' experiences of mentorship and career planning during their residencies, perceptions of preparation for postresidency practice, and how these experiences were related to postresidency practice environments. METHOD Surveys were conducted for all 804 graduating THC residents nationally, 2014-2017 (533 respondents, 66% response rate). Three quantitative outcomes were measured: graduates' perceptions of preparation for practice after residency (Likert scale), satisfaction with mentorship and career planning (Likert scale), and characteristics of postresidency practice environment (open-ended). A qualitative analysis of open-text survey answers, using thematic content analysis, was also conducted. RESULTS Most THC graduates (68%) were satisfied with their mentorship and career planning experience and generally felt prepared for postresidency practice in multiple settings (78%-93%). Of the 533 THC graduates who provided information about their practice environment, 445 (84%) were practicing in primary care; nationally, 64% of physicians who completed primary care residencies practiced in primary care. Of the 445 THC graduates practicing in primary care, 12% practiced in rural areas, compared with 7% of all physicians. Just over half of THC graduates (51%) practiced in medically underserved areas, compared with 39% of all physicians. CONCLUSIONS This study offers early evidence that the THC model produces and retains primary care physicians who are well prepared to practice in underserved areas. Given these promising findings, there appears to be a substantial benefit to growing the THC program. However, the program continues to face uncertainty around ongoing, stable funding.
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Affiliation(s)
- Julia H Strasser
- J.H. Strasser is senior research scientist, Fitzhugh Mullan Institute for Health Workforce Equity, Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Mariellen M Jewers
- M.M. Jewers is cofounder and vice president, Open Avenues Foundation, and chief operating officer, Project Alianza, Boston, Massachusetts
| | - Hayden Kepley
- H. Kepley is deputy director, National Center for Health Workforce Analysis, Bureau of Health Workforce, Health Resources and Services Administration, Rockville, Maryland
| | - Candice Chen
- C. Chen is associate professor of health policy and management, Fitzhugh Mullan Institute for Health Workforce Equity, Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Clese Erikson
- C. Erikson is deputy director, Health Workforce Research Center on Health Professions Education and Training, Fitzhugh Mullan Institute for Health Workforce Equity, Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Marsha Regenstein
- M. Regenstein is professor, Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
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15
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Moerdler S, Li Y, Weng S, Kesselheim J. Burnout in pediatric hematology oncology fellows: Results of a cross-sectional survey. Pediatr Blood Cancer 2020; 67:e28274. [PMID: 32277803 DOI: 10.1002/pbc.28274] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/07/2022]
Abstract
Burnout is a significant problem in the medical community, including among pediatric hematology/oncology (PHO) faculty. However, the prevalence of burnout, its associated risk factors, and outcomes within PHO fellows are unknown. We present the results of a cross-sectional study of PHO fellows from 21 training programs. A total of 45/115 fellows (39.1%) met criteria for high level of burnout. Fellows who met criteria for high burnout also demonstrated poor outcomes including decreased empowerment, increased doctor-centered care, decreased self-assessed humanism, and decreased satisfaction with training. Further longitudinal investigation is needed to better understand burnout and the causative factors affecting PHO fellows.
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Affiliation(s)
- Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Yunhui Li
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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