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Creation and evaluation of a cancer survivorship curriculum for pediatric resident physicians

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Abstract

Purpose

There is a paucity of formal clinician education concerning cancer survivorship care, which produces care barriers and poorer outcomes for survivors of childhood cancer. To address this, we implemented a curriculum in childhood cancer survivorship care for pediatric residents at the University of California, Los Angeles (UCLA). We examined the efficacy of this curriculum following program completion.

Methods

A case-based curriculum was created and integrated within existing educational structures using Kern’s model. We utilized the retrospective pre-posttest method to evaluate participating residents’ knowledge, clinical skills, and attitudes towards cancer survivorship topics before and after receiving the curriculum. Pre-posttest items were compared using paired t tests and one-sided binomial tests. We analyzed free-response question items for major themes using constant comparative methods.

Results

Thirty-four residents completed the curriculum and its evaluation. Each assessment item significantly increased from pre- to post-curriculum; p < 0.05. Greater than 40% of residents improved in all but one assessment item post-curriculum; p < 0.05. Residents reported the curriculum enhanced their pediatric knowledge base (M = 3.24; SD = 0.65) and would recommend it to other residency programs; M = 3.24; SD = 0.69. Major themes included residents’ request for additional oncofertility information, training in counseling survivors, and cancer survivorship training opportunities.

Conclusions

A cancer survivorship curriculum can successfully increase trainees’ knowledge, clinical skills, and comfort in discussing topics relevant to survivorship care.

Implications for Cancer Survivors

With increasing numbers of childhood cancer survivors living into adulthood, residents will likely treat this population regardless of intended career path. This curriculum represents one method to deliver formal cancer survivorship training.

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References

  1. Phillips SM, Padget LS, Leisenring WM, et al. Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiol Biomark Prev. 2015;24(4):653–63.

    Article  Google Scholar 

  2. Howlader N, Noone AM, Krapcho M, et al (eds). SEER cancer statistics review, 1975–2014. In: National Cancer Institute Reports on Cancer. National Cancer Institute. 2017. https://seer.cancer.gov/csr/1975_2014/. Accessed 15 May 2017.

  3. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Childhood cancer survivor study: chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.

    Article  CAS  Google Scholar 

  4. Oeffinger KC, Mertens AC, Hudson MM, Gurney JG, Casillas J, Chen H, et al. Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Ann Fam Med. 2004;2(1):61–70.

    Article  PubMed  PubMed Central  Google Scholar 

  5. American Academy of Pediatrics Section on Hematology/ Oncology, Children’s Oncology Group. Long-term follow-up care for pediatric cancer survivors. Pediatrics. 2009;123(3):906–15.

    Article  Google Scholar 

  6. Nathan PC, Greenberg ML, Ness KK, Hudson MM, Mertens AC, Mahoney MC, et al. Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2008;26(27):4401–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mertens AC, Cotter KL, Foster BM, Zebrack BJ, Hudson MM, Eshelman D, et al. Improving health care for adult survivors of childhood cancer: recommendations from a Delphi panel of health policy experts. Health Policy. 2004;69:169–78.

    Article  PubMed  Google Scholar 

  8. Nathan PC, Daugherty CK, Wroblewski KE, Kigin ML, Stewart TV, Hlubocky FJ, et al. Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer. J Cancer Surviv. 2013;7(3):275–82.

    Article  PubMed  Google Scholar 

  9. Suh E, Daugherty CK, Wroblewski KE, et al. General internists’ preferences and knowledge about the care of adult survivors of childhood cancer: a cross-sectional survey. Ann Intern Med. 2014;160(1):11–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zebrack BJ, Eshelman DA, Hudson MM, Mertens AC, Cotter KL, Foster BM, et al. Health care for childhood cancer survivors: insights and perspectives from a Delphi panel of young adult survivors of childhood cancer. Cancer. 2004;100(4):843–50.

    Article  PubMed  Google Scholar 

  11. Institute of Medicine and National Research Council. From cancer patient to cancer survivor: lost in transition. Washington, DC: The National Academies Press; 2006.

    Google Scholar 

  12. Shayne M, Culakova E, Milano MT, Dhakal S, Constine LS. The integration of cancer survivorship training in the curriculum of hematology/oncology fellows and radiation oncology residents. J Cancer Surviv. 2014;8(2):167–72.

    Article  PubMed  Google Scholar 

  13. Uijtdehaage S, Hauer KE, Stuber M, Liang Go V, Rajagopalan S, Wilkerson L. Preparedness for caring of cancer survivors: a multi-institutional study of medical students and oncology fellows. J Cancer Educ. 2009;24(1):28–32.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nathan PC, Schiffman JD, Huang S, Landier W, Bhatia S, Eshelman-Kent D, et al. Childhood cancer survivorship educational resources in North American pediatric hematology/oncology fellowship training programs: a survey study. Pediatr Blood Cancer. 2011;57:1186–90.

    Article  PubMed  Google Scholar 

  15. American Board of Pediatrics. Hematology and oncology. In: Goals and objectives by competency and level of training. American Board of Pediatrics. 2014. http://docs.wixstatic.com/ugd/9ebadf_89800da775c54d4f909f79eef7352b5d.pdf. Accessed on 10 Sept 2015.

  16. Kern DE, Thomas PA, Hughes MT. Curriculum development for medical education: a six-step approach. 2nd ed. Baltimore: The John’s Hopkins University Press; 2009.

    Google Scholar 

  17. McLean S. Case-based learning and its application in medical and health-care fields: a review of worldwide literature. J Med Educ Curric Dev. 2016;3:39–49.

    Article  Google Scholar 

  18. Srinivasan M, Wilkes M, Stevenson F, Nguyen T, Slavin S. Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions. Acad Med. 2007;82:74–82.

    Article  PubMed  Google Scholar 

  19. Talwalkar JS, Fenick AM. Evaluation of a case-based primary care pediatric conference curriculum. J Grad Med Educ. 2011 Jun;3(2):224–31.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Institute of Medicine and National Research Council. Childhood cancer survivorship: improving care and quality of life. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

  21. Children’s Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers (Version 4.0). Children’s Oncology Group. 2013. www.survivorshipguidelines.org. Accessed on 9 November 2015.

  22. Compas BE, Jaser SS, Dunn MJ, Rodriguez EM. Coping with chronic illness in childhood and adolescence. Annu Rev Clin Psychol. 2012;8:455–80.

    Article  PubMed  Google Scholar 

  23. Turkel S, Pao M. Late consequences of pediatric chronic illness. Psychiatr Clin North Am. 2007;30(4):819–35.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bloom BS, Engelhart MD, Furst EJ, et al. Taxonomy of educational objectives: the classification of educational goals. Handbook I: cognitive domain. New York: David McKay Company; 1956.

  25. Accreditation Council for Graduate Medical Education (ACGME). ACGME program requirements for graduate medical education in pediatrics. ACGME. 2017. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_2017-07-01.pdf. Accessed on 1 July 2017.

  26. Howard GS, Ralp KM, Gulanick NA, et al. Internal invalidity in pretest-posttest self-report evaluations and a re-evaluation of retrospective pretests. Appl Psychol Meas. 1979;3(1):1–23.

    Article  Google Scholar 

  27. Howard GS. Response-shift bias: a problem in evaluating interventions with pre/post self-reports. Eval Rev. 1980;4(1):93–106.

    Article  Google Scholar 

  28. Lam TC, Bengo P. A comparison of three retrospective self-reporting methods of measuring change in instructional practice. Am J Eval. 2003;24(1):65–80.

    Article  Google Scholar 

  29. Pratt CC, McGuigan WM, Katzev AR. Measuring program outcomes: using retrospective pretest methodology. Am J Eval. 2000;21(3):341–9.

    Article  Google Scholar 

  30. Allen JM, Nimon K. A retrospective pretest: a practical technique for professional development evaluation. J Ind Teach Educ. 2007;44:27–42.

    Google Scholar 

  31. Bhanji F, Gottesman R, de Grave W, Steinert Y, Winer LR. The retrospective pre-post: a practical method to evaluate learning from an educational program. Acad Emerg Med. 2012 Feb;19(2):189–94.

    Article  PubMed  Google Scholar 

  32. Skeff KM, Bergen MR, Stratos GA. Evaluation of a medical faculty development program: a comparison of traditional pre/post and retrospective pre/post self-assessment ratings. Eval Health Prof. 1992;15:350–66.

    Article  Google Scholar 

  33. Clasen DL, Dormody TJ. Analyzing data measured by individual Likert-type items. J Agric Educ. 1994;35(4):31–5.

  34. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42(4):1758–72.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality and Quantity. 2002;36(4):391–409.

    Article  Google Scholar 

  36. Kolb SM. Grounded theory and the constant comparative method: valid research strategies for educators. J Emerg Trends Educ Res Pol Stud. 2012;3(1):83–6.

    Google Scholar 

  37. Jones G, Hughes J, Mahmoodi N, Smith E, Skull J, Ledger W. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update. 2017;23(4):433–57.

    Article  PubMed  Google Scholar 

  38. Quinn GP, Vadaparampil ST, King L, Miree CA, Wilson C, Raj O, et al. Impact of physicians’ personal discomfort and patient prognosis on discussion of fertility preservation with young cancer patients. Patient Educ Couns. 2009;77(3):338–43.

    Article  PubMed  Google Scholar 

  39. Taylor JF, Ott MA. Fertility preservation after a cancer diagnosis: a systematic review of adolescents’, parents’, and providers’ perspectives, experiences, and preferences. J Pediatr Adolesc Gynecol. 2016;29(6):585–98.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ussher JM, Parton C, Perz J. Need for information, honesty and respect: patient perspectives on health care professionals communication about cancer and fertility. Reprod Health. 2018;15:2.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65:s63–7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the UCLA Clinical and Translational Science Institute (CTSI) in addition to Lonnie Zeltzer, MD, Margaret Stuber, MD, Theodore Moore, MD, and the UCLA Pediatric Residency Training Program leadership and staff, especially Alan Chin, MD, James Lee, MD, Jasen Liu, MD, and Savanna Carson, PhD.

Funding

This study was funded by the Western Region of the Association of Pediatric Program Directors’ (W-APPD) Medical Education Research Grant (Award Number: #2017-106; Recipient: Lindsay F. Schwartz, MD) and the NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881.

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Authors and Affiliations

  1. University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    Lindsay F. Schwartz

  2. University of California, Los Angeles, 885 Tiverton Avenue, Los Angeles, CA, 90024, USA

    Clarence H. Braddock III

  3. University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA

    Roy L. Kao & Jacqueline N. Casillas

  4. University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA, 90024, USA

    Myung-Shin Sim

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  1. Lindsay F. Schwartz
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Corresponding author

Correspondence to Lindsay F. Schwartz.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Schwartz, L.F., Braddock, C.H., Kao, R.L. et al. Creation and evaluation of a cancer survivorship curriculum for pediatric resident physicians. J Cancer Surviv 12, 651–658 (2018). https://doi.org/10.1007/s11764-018-0702-z

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  • DOI: https://doi.org/10.1007/s11764-018-0702-z

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