Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

Purpose

Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum.

Methods and Materials

In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students’ knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation.

Results

The students’ prerotation test scores had an average of 64% (95% confidence interval [CI], 61–66%). The postrotation test scores improved to an average of 82% (95% CI, 80–83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1–9; 95% CI, 7.3–9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5–9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6–9.0).

Conclusions

Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

Introduction

Cancer is a frequent cause of morbidity and mortality in the United States and throughout the world (1). It is important for all medical practitioners to have knowledge of the basic aspects of oncology. In 1994, the International Union Against Cancer recognized an imbalance between cancer prevalence and the number of oncologists (2). It advised further integration of oncology into medical school curricula 2, 3, 4. However, recent literature has shown that medical students’, residents’, and general practitioners’ knowledge of core oncology information is relatively low in the United States (5) and abroad 6, 7. Furthermore, radiation oncology is underrepresented in the curricula of most medical schools 8, 9, despite the observation that around 60% of all cancer patients receive radiation therapy at some point during their disease course (10). A recent survey of physicians in the United Kingdom revealed that recent medical school graduates report low rates of prior exposure to cancer patients and that only 15% of respondents thought they knew enough about radiation therapy and chemotherapy (11). There are few studies about integrating teaching of radiation oncology into the medical school curriculum 8, 12, 13, 14.

Selected medical schools have chosen to emphasize oncology in their curricula (2), and Dennis and Duncan recently reviewed reports of radiation oncology in undergraduate medical education (15). Boston University has reported the implementation of an Oncology Education Initiative, which included a course with structured didactics by an attending physician, delivered in a lecture format. In the system at Boston University, all students are exposed to radiation oncology before graduation through a series of lectures during a core radiology clerkship 8, 13. The program improved trainee oncology knowledge, was well received by graduates, and influenced a change in the institutional curriculum 16, 17.

At Jefferson Medical College, as may be the case in many institutions, the faculty in radiation oncology recognized a potential gap in basic understanding of radiation oncology among resident and attending physicians engaged in inpatient care and other specialties. Based on the desire to improve general knowledge of radiation oncology within the broader medical community, a clinical rotation was developed for inclusion in the third-year medical school curriculum, as a choice within the core clinical clerkships at our institution. This new course was approved by the curriculum committee at our institution for inclusion as an optional component of the 12-week clerkship in surgery. Jefferson Medical College students are required to complete a 6-week rotation in general surgery and then to choose two additional 3-week rotations from among several surgical subspecialties and selected nonsurgical rotations (e.g., radiation oncology or physical medicine and rehabilitation). The first cohort of students started in July 2010.

The purpose of this report is to evaluate the impact of an optional clinical rotation in radiation oncology during the core third-year medical school surgery clerkship on students’ knowledge of essential general oncology and radiation oncology information.