Pilot: Hematology/Oncology Curriculum for the Internal Medicine and Hematology/Oncology Sub-Internships

Introduction

Cancer is the second most common cause of death in the United States. Despite its prevalence, there is limited information on best practices to educate medical students about malignancies. Medical schools are required to teach hematology/oncology (heme/onc) in the pre-clinical curriculum. However, formal teaching is often absent during clinical rotations in the third and fourth year of medical school. As a result, pre-clinical didactics are not reinforced in the clinical learning environment, leading to medical student discomfort with complex heme/onc topics. This is supported by Mattes et. al., who showed that US medical students were less confident in their knowledge of cancer treatments than work-up, diagnosis, and basic science of cancer (Journal of Cancer Education 2016). Tsai et. al. demonstrated that the implementation of a formal heme/onc lecture curriculum improved resident self-reported confidence in their knowledge of heme/onc topics (Journal of Cancer Education 2022).

We piloted a lecture-based curriculum to help medical students improve their knowledge and comfort with regard to heme/onc topics while completing clinical rotations.

Methods

Internal medicine residents and faculty developed two interactive, 60-minute lectures on multiple myeloma and lymphoma. These were delivered to fourth-year rotators on their internal medicine and heme/onc sub-internships at a tertiary care center during their third week of the rotation. The pilot was completed between April to July 2024, and all rotators were invited to participate. The curriculum was assessed via pre and post-session surveys. The survey featured questions on knowledge and comfort with regard to the respective topics. It was administered prior to and after the two lectures. Comfort level was assessed via a scale ranging from one to five, with one representing very uncomfortable and five representing very comfortable. Knowledge level was assessed via a quiz, with a maximum score of six points, that was incorporated into the survey. For data analysis, R studio was used to run Wilcoxon tests.

Results

Fifteen rotators participated in the curriculum. The pre-quiz had an average score of 3.58 and a median score of 3. The post-quiz had an average score of 4.8 and a median score of 5. Comparison of the pre and post-quiz scores showed a statistically significant improvement in the students' understanding of the material following the lectures (p=0.036).Regarding comfort level, there was a range of 0 to 4 prior to the lectures, with 88.9% of participants indicating a comfort level of either very uncomfortable, uncomfortable, or neutral and only 11.1% indicating that they were comfortable with the material. After the lecture, 38.5% of students indicated a comfort level of neutral, and 61.5% indicated a comfort level of either comfortable or very comfortable. There was a statistically significant increase in comfort level after the lectures (p<0.05).

Conclusion

Our pilot showed an improvement in our medical students' knowledge and comfort regarding heme/onc topics. Based on our results, we will make our curriculum permanent, year-round and expand the lecture series to include additional topics including solid organ malignancies, leukemia, neutropenic fever, tumor lysis syndrome, and sickle cell anemia. Our evaluation of the curriculum will continue to measure knowledge and comfort. Cancer represents a major public health risk, and physicians-in-training of any specialty should be exposed to formal teaching of heme/onc topics while rotating in the clinical learning environment.

No relevant conflicts of interest to declare.