An Increase in Medical Student Knowledge of Radiation Oncology: A Pre–Post Examination Analysis of the Oncology Education Initiative

doi:10.1016/j.ijrobp.2008.12.012

International Journal of Radiation OncologyBiologyPhysics

Volume 73, Issue 4, 15 March 2009, Pages 1003-1008.e2

https://doi.org/10.1016/j.ijrobp.2008.12.012 Get rights and content

Purpose

The Oncology Education Initiative was created to advance oncology and radiation oncology education by integrating structured didactics into the existing core radiology clerkship. We set out to determine whether the addition of structured didactics could lead to a significant increase in overall medical student knowledge about radiation oncology.

Methods and Materials

We conducted a pre- and posttest examining concepts in general radiation oncology, breast cancer, and prostate cancer. The 15-question, multiple-choice exam was administered before and after a 1.5-hour didactic lecture by an attending physician in radiation oncology. Individual question changes, overall student changes, and overall categorical changes were analyzed. All hypothesis tests were two-tailed (significance level 0.05).

Results

Of the 153 fourth-year students, 137 (90%) took the pre- and posttest and were present for the didactic lecture. The average test grade improved from 59% to 70% (p = 0.011). Improvement was seen in all questions except clinical vignettes involving correct identification of TNM staging. Statistically significant improvement (p ≤ 0.03) was seen in the questions regarding acute and late side effects of radiation, brachytherapy for prostate cancer, delivery of radiation treatment, and management of early-stage breast cancer.

Conclusions

Addition of didactics in radiation oncology significantly improves medical students' knowledge of the topic. Despite perceived difficulty in teaching radiation oncology and the assumption that it is beyond the scope of reasonable knowledge for medical students, we have shown that even with one dedicated lecture, students can learn and absorb general principles regarding radiation oncology.

Introduction

According to the American Cancer Society, an estimated one in two American men and one in three American women will develop cancer over his or her lifetime (1). Considering the enormous burden of cancer-related illness not only on the population as a whole but also specifically on physicians confronted with oncologic management decisions, broad-based oncology education becomes an important component of the medical school curriculum.

As early as 1992, the International Union Against Cancer recognized the imbalance between the prevalence of cancer and the number of physicians adequately trained in the area and advised that cancer education become a required component of medical school education (2). However, few medical schools heeded the recommendation in a comprehensive fashion (3). In fact, the need has been further amplified as a multidisciplinary approach to cancer management involving surgical, radiation, and medical oncologists working in collaboration with other health care professionals has become the recognized standard of care. Additionally, of the three main disciplines involved in managing cancer patients, radiation oncology exposure during medical training is especially limited, despite the fact that approximately 60% of all cancer patients will require radiation therapy as a part of their treatment (4). Our Oncology Education Initiative (OEI) aims to rectify this deficiency by integrating radiation oncology education into an existing required core radiology clerkship (5).

Radiology education has been identified as a vital component of the clinical medical school curriculum and has particular importance in radiation oncology education and practice 6, 7. Radiation oncology relies heavily on diagnostic imaging, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) for not only the diagnosis but also the initial radiation planning and continued management of cancer patients. Few data exist on the utility of incorporating radiation oncology education into the radiology coursework at the medical school level. The OEI was developed to advance oncology and radiation oncology education by integrating structured didactics into the existing core radiology clerkship. We previously reported on the attitudes of medical students regarding the addition of radiation oncology didactics to the radiology core curriculum as well as students' perception of their oncology education before the initiative (5). Our current study was undertaken to quantitatively measure the impact of structured didactics on medical student knowledge about radiation oncology.

Section snippets

Methods and Materials

We administered a pre- and posttest examining concepts in general radiation oncology, breast cancer, and prostate cancer to the graduating class of 2008. The 15-question, multiple-choice exams were administered before and after a 1.5-hour interactive, PowerPoint-based didactic lecture given by a radiation oncology attending physician. The pretest was offered on the first day of the rotation. The lecture itself was given on either the third or fourth Monday of the month-long rotation, and the

Results

Of the 153 fourth-year students, 137 (90%) were present for the didactic lecture and therefore included in the pre- and posttest analysis. Sixty-one (45%) of the students were male, and 76 (55%) were female.

The average student test grade improved from 59% on the pretest to 70% on the posttest, representing an absolute improvement of 11% (p = 0.011). For the entire cohort, improvement was seen on all questions except the two clinical vignettes involving correct identification of TNM staging.

Discussion

The emergence of multidisciplinary management of cancer serves as an impetus to improve integration of the oncology learning experience within the medical school curriculum (8). In addition, given the prevalence of cancer in the United States and the fact that a significant number of these patients will receive radiation as part of their treatment regimen (4), it is imperative that graduating medical students have at least basic knowledge about radiation oncology. Although surgical oncology

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Integration of Radiation Oncology Into the Preclinical Curriculum Through Problem-Based Learning
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Early exposure to oncology care during the preclinical years of medical school may translate to increased student interest in oncology-related fields and improved understanding of oncologic treatment modalities, including radiation oncology. Many schools incorporate problem-based learning (PBL) into the medical school curriculum; this is an opportunity to immerse students in oncologic case management. We describe the effective incorporation of one course into the medical school curriculum that may be replicated at other institutions.
A PBL case regarding pancreatic cancer was created by a radiation oncology resident and faculty member in collaboration with the gastrointestinal course director for first-year medical students at a single institution. Pancreatic cancer was chosen based on curricular needs. Learning objectives were discussed to guide the creation of the case.
All 140 first-year medical students participated in the 1-hour small group case focused on oncologic work up, multidisciplinary care, and radiation therapy concepts. Students were provided with a case prompt and resources to review prior to the PBL session. Volunteer radiation oncology facilitators attended a 30-minute educational meeting and were provided a detailed case guide 1 week before the PBL session. During the PBL case, facilitators guided students to achieve desired learning objectives. Among the 76 (54%) medical students who completed an optional post-PBL survey, the majority reported that the case motivated them to learn more about oncology (89%) and radiation oncology (82%). There was an increase in the number of subscribers to the Oncology Interest Group (43% increase from previous year) and preclinical students shadowing in the radiation oncology department. The PBL case was continued in future years for all first-year students and extended to 2 hours to promote additional discussion in response to student and facilitator feedback.
A cancer-specific PBL case facilitated by radiation oncology educators is an effective avenue to integrate radiation oncology into the preclinical curriculum and stimulate interest in oncology among first-year medical students.
In response to: The declining residency applicant pool: A multi-institutional medical student survey to identify precipitating factors
2021, Advances in Radiation Oncology
The status of radiation oncology (RO) teaching to medical students in Europe
2019, Clinical and Translational Radiation Oncology
Citation Excerpt :
This insufficiency of education in RO during undergraduate curriculum may lead to inadequate patient management, an undervaluation of the toxicity of treatments, a suboptimal communication between patients and general practitioners, radiation oncologists, medical oncologists and palliative or supportive care specialists [10]. As a consequence, recent publications have focused on the potential interest of increasing medical student exposition to RO during their undergraduate education [6–9,12–14], even if the real impact of RO teaching to medical student to lastingly improve their clinical skills is a matter of debate [15]. These studies were designed by RO academic teachers and addressed to medical students to assess different structured core curricula [3,4,16].
To provide an overview of Radiation Oncology (RO) teaching to medical students around Europe.
An electronic survey was sent to European academic teachers of RO. The survey focused on the teaching of RO to medical students throughout their undergraduate education.
A total of 87 academic RO teachers from 29 countries were invited to participate in the electronic survey. Thirty-two surveys were completed by respondents from 19 European countries (response rate: 37%). The median number of hours devoted to RO teaching was 10 h (mean 16 h, range 2–60). The number of hours assigned to RO teaching was equal or inferior compared to medical oncology. In two institutions (6%) RO was delivered as a stand-alone course with an individual knowledge assessment. In 30 institutions (94%), the RO course was taught and/or assessed in a modular curriculum with other disciplines. Radiobiology, breast, lung, gastrointestinal, gynecologic malignancies, RO adverse events and palliative RO were taught in 80% of institutions. Pediatric RO, RO for benign conditions and economic topics were taught in less than 30% of institutions. In most institutions, classical written and oral examinations were used. Computer-based examinations and/or objective structured clinical examinations (OSCE) were seldom used. E-learning methods were available in less than 10% of institutions. A clerkship in RO department was available in 28 out of 32 institutions (87%), less than 5% of medical students were involved in research in RO during their undergraduate education. Strategies to encourage medical students to consider RO as a future career were offered in 53% of institutions.
RO teaching to medical students was not uniform in Europe. RO teaching during undergraduate education in Europe was undervalued, and its knowledge and learning tools could be broadened and updated in the core curricula of medical students
In Reply to Mattes et al
2018, Journal of the American College of Radiology
Objective Evaluation of a Didactic Curriculum for the Radiation Oncology Medical Student Clerkship
2018, International Journal of Radiation Oncology Biology Physics
Citation Excerpt :
However, students who completed clerkships with formal didactic components reported greater self-perceived preparedness to function as radiation oncology residents (8). Radiation oncology curricula exist for the third year of medical school (9-12), and student primers are available (13). However, no structured didactic curriculum was publicly available or reported in the literature in 2012.
A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment.
Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6 months after receiving the curriculum.
One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P < .01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values < .01). Post-scores for students rotating de novo at ROECSG institutions (n = 30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n = 55) (77.3% vs 68.8%, P = .01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6 months after curriculum exposure (70.5% vs 65.6%, P = .11).
Objective evaluation of a structured didactic curriculum for the radiation oncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completed clerkships at non-ROECSG institutions. These results support including a structured didactic curriculum as a standard component of the radiation oncology clerkship.
Radiation oncology residency selection: A postgraduate evaluation of factor importance and survey of variables associated with job securement
2017, Practical Radiation Oncology
Medical students often choose to pursue a career in radiation oncology with limited meaningful exposure to the field. We previously identified factors that were most influential to an applicant’s rank list order. Here, we sought to assess if residency graduates had differing views regarding those factors. We also polled recent graduates’ attitudes of the current job market.
An anonymous, internet-based survey was developed and distributed to graduates of radiation oncology residencies from 2003 through 2006 and 2012 through 2015 to assess the importance of factors with regard to residency selection, training, and job securement and attitudes toward the job market within the United States.
Responses were received from 198 of 848 (23%) of those invited to participate. The respondents were divided into 2 cohorts for analysis, an “early” cohort (2001-2009) and a “contemporary” cohort (2010-2016). Respondents recalled “quality of clinical training,” “perceived happiness of residents,” and “sense of community among faculty and residents” as the 3 most important factors influencing the rank list. Postresidency, the most valued factors of the residency experience were “quality of clinical training,” “geographic location,” and “faculty mentorship.” Factors that were assigned the greatest differential value in hindsight to influence the rank list included “faculty mentorship,” “willingness of faculty to call employer,” and “quality of alumni base.” Sixty-four percent of respondents reported the job market to be difficult or very difficult. This perception was more common among contemporary graduates (P < .05). Sixty percent of respondents reported “far too many” or “somewhat too many” residency positions for the actual job needs in the United States.
After training, residency graduates place higher value on factors in residency that can directly improve job procurement. This finding is more common among more recent graduates, potentially a result of the perception of a tightening job market with too many radiation oncologists in training.

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: Presented in part at the 50th Annual American Society for Therapeutic Radiology and Oncology meeting, September 21–25, 2008.

: Supplementary material for this article can be found at www.redjournal.org.

: Drs. L. Dad, D. Singh, and P. Slanetz were formerly at Boston University School of Medicine.

: Conflict of interest: none.

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ReportAn Increase in Medical Student Knowledge of Radiation Oncology: A Pre–Post Examination Analysis of the Oncology Education Initiative

Purpose

Methods and Materials

Results

Conclusions

Introduction

Section snippets

Methods and Materials

Results

Discussion

J Am Coll Radiol

J Am Coll Radiol

Lancet Oncol

Facts and figures

Undergraduate cancer education around the world

Clinical oncology clerkship for third-year medical students

J Cancer Educ

Report
An Increase in Medical Student Knowledge of Radiation Oncology: A Pre–Post Examination Analysis of the Oncology Education Initiative