Abstract
Oncology education for post-graduate medical trainees is mostly clinic-based with didactic lectures. However, a 3–4-week rotation lacks full exposure to the vast field of oncology, resulting in an educational gap. We felt there is a need for a standard curriculum to educate trainees on common oncology topics and encourage self-directed learning. This study aims to improve knowledge of oncology in trainees through the use of an oncology educational tool (consisting of a handbook and website) that we developed and evaluated. Fifty-three post-graduate trainees (years 1, 2, and 3) consented to participate at the start of their oncology rotation. In phase I, four participants took part in a usability evaluation of the tool. In phase II, 39 trainees underwent a knowledge assessment with use of the tool. Baseline and post-intervention test results were compared using paired t tests. In the qualitative study (phase III), 10 trainees provided feedback on the updated tool and overall rotation experience. Issues identified from phase I were addressed prior to subsequent phases. Phase II analysis of complete sets of data found the mean post-intervention scores (9.44/10) were significantly higher (p < 0.001) than the mean baseline scores (7.47/10). In the qualitative study, feedback strongly supported the integration of the tool for improving knowledge of trainees. To our knowledge, this is the first study to show that an oncology educational tool for medical trainees improves oncology knowledge by providing a standard curriculum. Future work involves evaluating this tool to determine if effects are from the education tool or rotation experience.
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Acknowledgements
This study was funded by the University of Toronto Educational Information Technology grant, for the development of the website, and Bristol-Myers Squibb Canada, for the publication of the educational handbooks. We would like to thank the medical oncologists at St. Michael’s Hospital for their feedback on the content of the handbook and all the medical trainees for their participation. We would also like to thank Tessa DeNully (administrative assistant), Pauline Gulasingam (for editing), Sathish Pichika (for statistical analysis), and the team members for their efforts on the completion of the study. This study was presented at International Conference on Residency Education; Calgary, Alberta; September 26–28, 2013; and the Canadian Association of Medical Oncology Annual Meeting; Toronto, Ontario; May 01, 2014.
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Conflict of Disclosures
We have read and understood the policy on disclosing conflicts of interest, and we declare the following interests: RH received an honorarium for advisory committee meetings from Amgen, Novartis, Astra Zeneca, Ingelhaim Bohringer, Leo, and Pfizer. RH has received support for education and survivorship research projects from Astra Zeneca, Roche and Bristol-Myers Squibb. RH has also received support for the ambassador program to an international conference on thrombosis in cancer. AK, AJ, DD, BL, MT have no conflict of interest to declare.
Appendices
Appendix A—Usability Testing Information Retrieval Tasks
Tasks to be completed during usability testing are based on the existing oncology handbook. They will consist of following sample tasks:
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1.
Find information about adjuvant treatment for a 50-year-old female with 2-cm HER-2 + breast cancer (assuming no other complications).
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2.
Which chemotherapy drugs can be used to treat lung cancer?
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3.
What is a typical course of treatment for a 45-year-old female diagnosed with locally advanced breast cancer?
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4.
What is a typical course of treatment for prostate cancer?
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5.
Describe standard treatment for advanced Non-Hodgkins’ lymphoma.
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6.
What is a typical course of treatment for stomach cancer?
Appendix B—Usability Testing Follow-up Questions
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1.
What are your thoughts on this web site?
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2.
What do you think are the strengths of this web site?
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3.
What do you think are the weaknesses of the web site?
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4.
Is there any information that you think should be included in the web site?
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5.
Is there any information that you think should be removed from the web site?
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6.
Do you think you personally would use this site?
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7.
If yes, when would you use the web site? How would you use it?
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8.
If not, is there any reason why you would not be using the web site?
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9.
If you could change one thing about the web site, what would that be?
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10.
Do you have any other comments about the web site?
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11.
Overall, from 1 to 5, where 1 means “terrible” and 5 “excellent,” how would you rate this web site? Why did you decide on that rating?
APPENDIX C—Knowledge test questions
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1.
Anthracyclines belong to which class of cytotoxic chemotherapy?
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(a)
Mitotic spindle inhibitors
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(b)
Antimetabolites
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(c)
Antitumour antibiotics
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(d)
Alkylating agents
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2.
Chemotherapy is curative in which type of advanced cancer?
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(a)
Breast cancer
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(b)
Colon cancer
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(c)
Bladder cancer
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(d)
Hodgkins’ lymphoma
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3.
Which of the following is a dose-limiting toxicity of cisplatin?
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(a)
Hair loss
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(b)
Diarrhea
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(c)
Nephrotoxicity
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(d)
Cardiotoxicity
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(e)
Lung fibrosis
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(f)
Hand-foot syndrome
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4.
Which of the following is a dose-limiting toxicity of adriamycin?
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(a)
Diarrhea
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(b)
Nephrotoxicity
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(c)
Cardiotoxicity
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(d)
Lung fibrosis
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(e)
Hand-foot syndrome
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5.
Which of the following is a dose-limiting toxicity of Xeloda (capecitabine)?
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(a)
Alopecia
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(b)
Nephrotoxicity
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(c)
Cardiotoxicity
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(d)
Lung fibrosis
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(e)
Hand-foot syndrome
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6.
Combination chemotherapy with Herceptin is used in:
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(a)
ER/PR-negative breast cancer
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(b)
ER/PR-positive breast cancer
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(c)
HER2/neu-positive breast cancer
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(d)
EGFR-positive Lung cancer
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7.
Trastuzamab (Herceptin) is used for:
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(a)
Metastatic breast cancer
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(b)
HER2/neu-positive Breast cancer
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(c)
Adjuvant breast cancer
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8.
Rituximab does/is the following:
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(a)
Monoclonal antibody against CD20
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(b)
Improves overall and disease-free survival in diffuse large B cell lymphoma
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(c)
Used with CHOP for DLBCL
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(d)
Can cause allergic reactions
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(e)
All of the above
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9.
Resistance to chemotherapy is due to:
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(a)
Acquired multi-drug resistance
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(b)
Proliferative state of the cell
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(c)
Decreased dose intensity
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(d)
Poor drug delivery
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(e)
All of the above
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10.
In colorectal cancer, benefit of cetuximab or panitumumab is seen in:
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(a)
Wild-type K-Ras
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(b)
Mutated K-Ras
APPENDIX D—SMH Oncology Rotation Qualitative Survey—Feedback on Educational Tool
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1.
What is your level of training?
PGY1PGY2 PGY3
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2.
Did you use the handbook? If yes, rate how relevant the information presented in the handbook was to your oncology rotation (i.e. applying to a clinical setting). (10 = Excellent, 1 = Poor)
10 9 8 7 6 5 4 3 2 1
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Did not use
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3.
Was the information clearly presented in the handbook (easy to read and understand)? (10 = Strongly agree, 5 = Neutral, 1 = Strongly disagree)
10 9 8 7 6 5 4 3 2 1
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4.
Rate how useful the handbook was compared to other educational tools/material. (10 = Very useful, 1 = Not useful)
10 9 8 7 6 5 4 3 2 1
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5.
Did you use the website? If yes, rate how relevant the information presented in the website was to your oncology rotation (i.e. applying to a clinical setting). (10 = Excellent, 1 = Poor)
10 9 8 7 6 5 4 3 2 1
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Did not use
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6.
Rate how useful the website was compared to other online resources. (10 = Very useful, 1 = Not useful)
10 9 8 7 6 5 4 3 2 1
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7.
Did you use the case studies (on the website)? If yes, rate how useful the cases were in applying to cases seen in the clinics. (10 = Excellent, 1 = Poor)
10 9 8 7 6 5 4 3 2 1
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Did not use
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8.
Rate how relevant the information presented in didactic lectures/seminars were for your oncology rotation (i.e. applying to a clinical setting). (10 = Excellent, 1 = Poor)
10 9 8 7 6 5 4 3 2 1
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9.
Do you have a preference between the handbook and the website? (Circle one)
HandbookWebsiteNo Preference
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10.
Which would you recommend to other residents in rotating through oncology? (Circle one)
Both Handbook WebsiteNeither
If NOT both, please explain why:
_____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________
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11.
How much did the handbook and/or website add to your knowledge of cancer prevention, screening, diagnostic methods, staging, and management of common cancer (breast, lung, GI, GU)?
(10 = Significantly, 1 = Not at all)
10 9 8 7 6 5 4 3 2 1
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12.
How much did the didactic lectures add to your oncology knowledge (of cancer prevention, screening, diagnostic methods, staging, and management of common cancers)?
(10 = Significantly, 1 = Not at all)
10 9 8 7 6 5 4 3 2 1
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13.
How much did the ambulatory clinics add to your oncology knowledge (of cancer prevention, screening, diagnostic methods, staging, and management of common cancers)?
(10 = Significantly, 1 = Not at all)
10 9 8 7 6 5 4 3 2 1
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14.
Please rank the following cancer sections of the handbook from most helpful (9) to least helpful (1)?
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Breast ____
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Colorectal____
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Noncolorectal gastrointestinal ____
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Kaposi’s Sarcoma ____
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Lung ____
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Lymphoma & Multiple Myeloma ____
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Melanoma ____
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Ovarian ____
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Genitourinary ____
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15.
Rate how much you believe the integration of the handbook/website will improve and increase knowledge of oncology trainees. (10 = Significantly, 1 = No improvement)
10 9 8 7 6 5 4 3 2 1
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16.
What suggestions do you have to improve the handbook and website?
_____________________________________________ _____________________________________________ _____________________________________________
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17.
Other comments regarding your overall oncology rotation experience:
_____________________________________________ _____________________________________________ _____________________________________________
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Haq, R., Li, B., Jovicic, A. et al. Web-based Oncology Educational Tool for Medical Trainees on Oncology Rotation—Results of a Pilot Study. J Canc Educ 33, 788–797 (2018). https://doi.org/10.1007/s13187-016-1151-x
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DOI: https://doi.org/10.1007/s13187-016-1151-x