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Continuing Education for the Young Oncology Workforce in Portugal

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Part of the Sustainable Development Goals Series book series (SDGS)

Abstract

In this chapter, I will be describing the challenges that young oncologists meet during their residency and how the Portuguese Society of Oncology met these challenges by implementing a series of trainings and adapting them during the COVID-19 pandemic to a virtual/blended format.

The series of courses covers aspects of professional training that are not or insufficiently part of medical school training: a welcome course, a master class covering all cancer types, training skills in communication, statistics, oncological emergencies, formation in cancer research, support and palliative care, and more recently medical writing. Even though their educational aspect is central to the activities, a welcome side effect is a professional interchange among peers of the same generation leading to robust networking and resilience, a desired trait in this line of work.

Keywords

  • Medical oncology training
  • Communication training
  • Cancer research
  • Statistics
  • Medical writing
  • Resilience

Introduction

Oncology is a field of medicine dedicated to prevention, diagnosis, staging, treatment, and follow-up of patients with malignant neoplasms and their complications, as well as to palliative and supportive care. The medical oncologist, in addition to the crucial role they play in monitoring of the cancer patient, should be able to understand the natural history, biology, and genetics of cancer and the principles of its treatment; prevent and diagnose stage cancer and malignant diseases; decide and propose the appropriate therapies; execute the various modalities of medical treatment of neoplasms, as well as assessing and controlling their side effects, throughout the evolution of the different tumors, including the terminal stage of the disease, in ambulatory and/or inpatient, as well as in an individual, family, social, and professional context through close communication with their patients and family members; and outline, conduct, and interpret clinical and/or laboratory research studies (Dittrich et al. 2016; Portuguese Oncology Society 2021; Nucleus of Young Oncologists 2021).

The Situation in Portugal

In fact, medical oncology in Portugal was for years a sub-specialization of internal medicine residency, but nowadays, it is a five-year specialization comprising internships of oncology, internal medicine, intensive medicine, hematology, and radio-oncology along with a research project development.

As worldwide, residency is demanding, clinically, scientifically, and personally, and most of the residents embrace it with a profound dedication and commitment, as medical oncology covers more than the disease itself and its treatment. This specialty sees the patient as a whole, integrating psychological, social, and spiritual aspects, namely, in the constant confrontation with the threat at the end of life. As such, medical oncology is a challenge for all healthcare professionals, the complexity of its pathophysiology, the constant increase in scientific knowledge, and the countless hopeful therapeutic strategies that are discovered every day.

It does not make sense to talk about medical oncology without talking about multidisciplinary teamwork, dedicated and prepared to embrace the patients and the disease in all their aspects. This feature is an added value to any physician, having the privilege of sharing and discussing cases and learning from their peers every day. On the other hand, research in oncology underlies our daily practice in either basic, translational, and clinical research, being also an important mark of medical oncology residency.

All in all, gathering all the complexity of this branch of medicine, along with the challenging path of the residency, little time remains for theoretical education.

Therefore, the importance of gathering experiences and knowledge within residents and young oncologists led to an informal meeting between oncology youngsters aiming to support the education and networking of residents and young oncologists in Portugal.

The Nucleus of Interns and Young Specialists (NIJE)

In 2014, a group of young residents organized a national medical oncology residents’ meeting and that generated the need for creating a Young Oncologists Committee.

The Nucleus of Interns and Young Specialists (NIJE) of the Portuguese Society of Oncology (SPO) was born in 2015 firstly through an installer group which was followed in 2016 by the first official NIJE of SPO in which I had the pleasure to participate (Portuguese Oncology Society 2021; Nucleus of Young Oncologists 2021). Gradually, and with the unconditional support of the SPO’s presidency, this committee created events, courses, and new initiatives, always with the objective of improving training in oncology in Portugal and bringing together the younger generations of this field.

NIJE is composed of interns and young specialists (under the age of 40 years old) from different regions of the country, aiming to represent all the young oncologists nationwide and collecting their opinions, suggestions, or concerns facilitating the active participation of all in NIJE.

One of NIJE’s main objectives was to actively monitor the training process of residents in Portugal as well as to create continuous training actions promoting postgraduate courses and other complementary training actions in oncology.

From 2016 throughout 2018, nowadays still growing, training courses were held on a monthly basis as part of the “8 months 8 courses” project. These courses were designed to cover the main areas lacking formation during residency, a welcome course, a master class covering all cancer types, training skills in communication, statistics, oncological emergencies, formation in cancer research, support and palliative care, and more recently medical writing.

In more detail, a brief description of each NIJE initiative is discussed.

In-Person Meetings and Trainings

The Course of Introduction to the Specialty of Medical Oncology, started in 2015, intends to welcome the interns of the first year of Medical Oncology residency program and addresses topics such as the presentation of the SPO and NIJE, description of the structure of the Medical Oncology Internship, share of bibliography in oncology, and the main oncology-related organizations in a day intended to promote networking. Additionally, we offered three short tutorial talks: “How to manage a database” Workshop, “How to compose a successful abstract,” and “How to survive a residency,” the latter covering important topics such as burnout in oncology healthcare professionals, mainly in residents.

The SPO Oncology Course is an initiative that aims a qualified education of interns in medical oncology, with a special focus on interns in more advanced phases of training. With this course, interns receive didactic training on basic mechanisms of cell growth, pharmacology, and theoretical bases of chemotherapy and indications and management of toxicities of systemic treatments in the various areas of oncology. They also have the possibility to discuss clinical cases interactively, with the support of voting by televote. In order to consolidate all knowledge, the interns have a final evaluation test. The video support of the lectures (sent after the course in digital format) allows interns and young specialists to revisit the lectures and maintain the “continuous learning” model. During the week, a group of 35 trainees have social moments during the week where networking and sharing experiences and knowledge are privileged.

The Oncology Communication Course is a training activity with several stations/role-plays that addresses the communication process involved in oncology practice. Topics cover communicating bad news, framing prognostic information to both patient and families, managing emotions, and communication in transition of care or end of life. This significant competence is often underestimated in our academic formation, and skills must be given to strengthen the medical-patient relationship and minimize burnout risks.

The Statistics Course was organized by NIJE/SPO in collaboration with the Association for University Extension of the Faculty of Economics of the University of Coimbra (APEU/FEUC). This course intends to assist health professionals to identify, apply, analyze, and interpret fundamental statistical procedures, which include descriptive statistics, inferential statistics, and multivariate analyses using the SPSS® statistical software. With a strong practical component, databases of own research work were discussed and suggested by NIJE members, complementing the theoretical part with a hands-on component. The aim of this course is to increase statistical knowledge in young residents in order to improve not only the interpretation of scientific publications but also with regard to a scientific project’s quality.

In a different format, the Oncology Emergencies/Critical Patient Course aimed to enhance the trainees’ skills in addressing oncology emergencies as well as promoting the discussion of practical cases and discussing the referral of cancer patients to intensive and intermediate care units. On the first day of the course, we had the support of a digital interactive simulator (Body Interact) simulating clinical cases of emergencies in clinical cases of pulmonary thromboembolism and pericardial tamponade thanks to a partnership with a local company of technology for clinical education. On the second day, some of the authors of the “Recommendations for intensive medical treatment in cancer patients,” endorsed by a SPO’s working group, were brought together with an important reflection on the decisions to be made in each situation, in a sharing environment of experiences.

The application to the Cancer Research Course was made through a research project and the candidates’ curriculum vitae. During the course, each participant was assigned to a mentor, and the research projects were discussed and refined for resubmission for a grant application. Thus, in addition to providing a theoretical component about different types of cancer research (basic, translational, and clinical), this course helps the participant, in a more practical component, with the construction of correctly designed research projects, increasing the quality of research from the early stages of the training of young oncologists. These trainee’s/trainer’s meetings were scheduled over the three-day course. At the end of the course, four scholarships were awarded to the four most innovative projects in oncology. Through these grants, we want to encourage and support scientific research, linking national and international networks of researchers and gathering young interns and basic research institutions.

The Supportive and Palliative Care Course is a partnership with the Portuguese Association of Palliative Care and counts with the participation of a representative of ESMO Designated Centres Working Group (DCWG). This course offers an overall perspective of important topics on supportive and palliative care, an area of extreme importance in all oncology specialties lacks integrated training during the internship. Training in supportive therapies is crucial in medical training in oncology, namely, the approach to pain, as well as the early integration of palliative care. Thus, union and representation of the various associations are essential to encompass the complexity and multidisciplinary teamwork that this topic requires in two days of full sharing of knowledge.

Online Initiatives

Moreover, several online initiatives took place in order to support our motto of formation “anytime anywhere.” The webinars of clinical cases in oncology were streaming webinars with clinical discussion between a NIJE member and an invited oncologist and encouraged the debate of daily practice clinical cases. The NIJE member and the specialist discuss the various steps in the diagnosis staging and treatment of the various oncological pathologies. The video teaser was available online, but only SPO members can watch the webinar in its entirety.

Also, in innovation of the SPO, a website was introduced by the Young Oncologists Corner. The narrowing of NIJE/Young Oncologists links with ESMO and the creation of the platform “Portuguese oncologists around the world” were other important steps. The platform on the SPO website of the “Portuguese oncologists around the world” allows the dissemination of information for health professionals or Portuguese researchers in oncology who are working outside our country, with the objective of sharing experiences between peers and colleagues who wish to undertake fellowships outside Portugal. A form was sent to the subscribers to agree to make available, allowing, in accordance with confidentiality rules, to provide the name, institution, and areas of oncology in which they are working abroad. Those interested in contact with the listed elements contact the SPO, which will provide (after permission from the international party) the email address, thereby promoting network and involving the stakeholders abroad in a national project.

COVID-Related Adjustments

The online extension of the courses, having been planned before, was accelerated with the current global status due to the pandemic of COVID-19. After the months of March 2020, an online training platform (Moodle platform) was designed, from young people for young people, to continue the training for the youngest in oncology, since all the clinical activities and internships must continue despite the huge impact of COVID-19 pandemic in our professional and personal lives. Underlining that the objective of these courses is always networking, reinforcing physical presence (as soon as possible again), the first e-learning Course on Support and Palliative Care and the first e-learning Investigation Course were launched. We also counted on the partnership with PALOPS (Portuguese-speaking African countries) interns and young specialists with free enrollment in the courses. Privileging the “continuous learning model, without losing the networking component,” the training blocks were made available to the trainees during a week, with a “live” session via videoconference with some of the speakers answering questions and discussing hot topics on the last day of the course.

In addition, there is an enormous commitment to involve all specialties related to oncology—medical oncology, radio-oncology, and surgical oncology—and to link SPO to ESMO by linking NIJE to ESMO Young Oncologists Committee, representing and uniting young interns and international specialists (ESMO 2021).

Conclusion

In short, NIJE and SPO aim to be a reference in the training of young residents in the various specialties in oncology through “continuous learning,” as well as to encourage and support scientific research, contributing to network among young oncologists in Portugal.

Above all, this recent Young Oncologists group aims to unite interns and young specialists in oncology, encouraging teamwork and interrelationship and sharing of clinical, training, and investigative experiences, thus promoting emotional wellness during residency and enlarging the quality of oncology in Portugal.

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Acknowledgments

NIJE is grateful to the ongoing support by the SPO and unconditional educational grants from the pharmaceutical industry. Without this financial support, the training would not have been possible.

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de Paulo, J.V. (2022). Continuing Education for the Young Oncology Workforce in Portugal. In: Schmidt-Straßburger, U. (eds) Improving Oncology Worldwide. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-030-96053-7_4

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