Beyond Acute Leukemia: Learner Perceptions of Inpatient Hematology Education and Deficiencies in Non-Malignant Topics

Introduction

The inpatient hematology service at the Indiana University Hospital provides learners with an experience heavily dominated by aggressive malignancies. This service is staffed by a hematology faculty and fellow overseeing one resident, two interns, and a third year medical student. As this is a consistent set of learners, there is an opportunity to reach a large number of students and residents. The inpatient population is dominated by malignant hematology with inpatient admissions consisting mostly of chemotherapy and consequences thereof. Non-malignant conditions are not well represented in this patient mix. The internal medicine board certification exam, however, lists 14 different categories in hematology, only 5 of which are malignant hematology. Based on the most recent American Board of Internal Medicine Certification(ABIM) exam, the Internal Medicine residents at Indiana University performed worst in hematology among all the subspecialties. We sought to evaluate learner perceptions about their educational experience to better understand the deficiencies and how best to address them. We hypothesized that the educational focus would be skewed towards aggressive malignancies and that learners would prefer online supplemental educational resources.

Methods

We surveyed residents and students that rotated on the inpatient service to assess their perceptions of hematology education on the service. Electronic surveys were collected using REDCap. Learners were asked to rate the amount of teaching they received on various hematology topics on a Likert scale (1-Not at all to 5-Very much). We also assessed learners' interest in hematology/oncology as a career before and after their rotation. Finally, we asked about learners preference for various methods of supplementing their education.

We compared ABIM categories by grouping them into three categories: non-malignant (hypoproliferative/hemolytic anemia, thrombocytopenia, clotting and bleeding disorders, sickle cell disease/hemoglobinopathies, transfusion medicine, and porphyria), indolent malignancies (myeloproliferative disorders, chronic leukemia, indolent lymphoma, and multiple myeloma), and aggressive malignancies (acute leukemia and aggressive lymphoma). These categories were compared using Student's t-test(Norman Adv in Health Sci Educ 2010).

Results

Twenty three responses were received (49% response rate). Medical students comprised 30% of respondents, PGY1 30%, PGY2 21%, PGY3 13%, and PGY4 4%. Mean Likert responses were significantly lower for nonmalignant conditions (mean 2.07, p = <0.01) and indolent malignancies (mean 2.62, p = <0.01) compared with aggressive malignancies (mean 3.48). Reported interest in hematology/oncology as a career only changed in 1 learner beyond PGY1. Of medical students and interns, 6 reported a decrease in their interest, 3 an increase, and 3 no change. When asked about their preferred education format, 95% and 82% reported wanting in person lectures or case discussions respectively. Only 17% reported wanting recorded lectures and/or online case studies. Finally, learners strongly favored having pre-scheduled times during the rotations (95%); wanted didactics either immediately after rounds or in the middle of the afternoon, 26% and 56% respectively; and preferred 15-30 minutes sessions (78%).

Conclusion

Our primary inpatient Hematology service is one of the primary venues for exposing learners to hematology topics. Our data demonstrate there is a heavy focus on aggressive hematologic malignancies with significantly less teaching on nonmalignant or indolent conditions. As previously seen, we demonstrate that it is essential to foster interest in hematology early in a learner's education. Unfortunately, we saw more of our early stage learners reporting a decreased interest in hematology/oncology as a career after their rotation. Finally, despite current trends that emphasize online learning, our sample of learners overwhelming preferred in-person lectures and discussion over online materials. Some of our most compelling data about learner preferences was that they wanted in-person interactions with educators. Further directions include developing and assessing a supplementary curriculum to address the above deficiencies and further assessing why early learners tend to lose interest in hematology/oncology as a career during our rotation.