Survey reveals unmet needs in training hem/onc fellows for community-based careers
Click Here to Manage Email Alerts
A national survey identified considerable unmet needs when it comes to training hematology/oncology fellows for careers in community-based practice.
Researchers sent an electronic questionnaire to 125 community-based hematologists/oncologists from 25 states.
Fewer than half of respondents (41.6%; binomial 95% CI, 32.8-50.7) reported receiving any training for a career in a community setting.
“The key findings were eye-opening,” Deepa Rangachari, MD, director of hematology/oncology graduate medical education and the hematology/oncology fellowship program at Beth Israel Deaconess Medical Center and Harvard Medical School, told Healio.
“By and large, our survey participants told us that they were very satisfied with their fellowship training and the current state of their careers,” Rangachari added. “However, they also affirmed that there are specific experiences during fellowship training, which — had they had them — might have enabled them to feel even more prepared for their current careers.”
Healio spoke with Rangachari about the findings and how they might inform goal-concordant training for community-based hematologists/oncologists.
Healio: What motivated your group to conduct this study?
Rangachari: A considerable proportion of cancer care in the United States is delivered in community-based settings. However, most fellowship training programs are embedded in academic settings. Our team has been reflecting on the fact that many fellowship programs are training individuals in a setting that is likely very different from where our graduates will ultimately practice. We wanted to acknowledge this discordance and define the scope of the challenge as well as opportunities for innovation. In my own daily work, I lead an academic hematology/oncology fellowship training program and have also served as chair of the oncology training program committee for ASCO, so I have spent a good part of my career thinking about how we can optimally train fellows. We wanted to conduct a national needs assessment to understand what providers now practicing in the community need or want that they did not have exposure to during their fellowship training.
Healio: How did you conduct this study?
Rangachari: We collaborated with several national groups that represent community-based hematology/oncology providers and asked for their collaboration to share the survey with their providers. We also used social media to invite participation from relevant providers.
Healio: What did you find?
Rangachari: One consistent theme in our participants’ responses was the importance of direct exposure to patients and providers in community-based settings, including longitudinal patient care experiences and mentorship. Participants highlighted the importance of interacting directly with mentors and health care providers who are actually working in community-based settings. They also told us that concrete exposure to health care administration and the business of health care delivery would be beneficial, and they expressed interest in gaining skills relating to patient safety and quality improvement. Training and preparation in palliative care and symptom management was also identified as being of great importance, as access to palliative care consultants can be limited. In aggregate, our participants expressed overall satisfaction with their training, but they also identified multiple specific domains that are ripe for intervention and innovation at the level of fellowship training structure and design.
Healio: What are the potential implications of these findings?
Rangachari: Our hope is that investigations of this kind will lead to more discussion about the diversity of hematology/oncology workforce needs and ways in which training paradigms can evolve to better support them. We need all kinds of providers with different skill sets and expertise to meet the needs of people with cancer in an increasing array of patient care settings. The more diverse the career paths our trainees pursue, the more we have to scrutinize the training pathways and opportunities to maximize concordance between the training experience and trainees’ long-term career goals. It is important to think about how we can prospectively create intentional, goal-concordant pathways for diverse careers within hematology/oncology. Certain requisite core elements should be the common denominator in all of hematology/oncology fellowship training; however, depending on a given trainee’s career aspirations, we should identify strategies that allow us to personalize the training experience and substantiate individual career goals with well thought out mentorship, experiences and curricula. We hope this creates opportunities for more impactful and scalable personalization and to do so in a prospective manner, rather than as a “one-off” for a specific trainee.
Healio: What strategies can be implemented to ensure that future trainees receive relevant and beneficial training?
Rangachari: What many fellowship training programs — ours included — are doing is to establish a training structure that supports achieving individual career goals while ensuring training in required elements pursued by all trainees. In our own program, all fellows have a shared and uniform experience that emphasizes longitudinal outpatient care in hematology/oncology during the first year of fellowship training. By the end of that first year, we ask fellows to define their desired area(s) of clinical and scholarly focus. Once they articulate this, we work with them using a number of defined “professional development pathways” to design individualized experiences that deepen their growth in several domains: clinical development, skill development/course work and independent scholarship. This is embedded within a framework that provides longitudinal, team-based mentorship from faculty mentors with aligned interests. Trainees of today have innumerable ways in which they can choose to define their careers within hematology/oncology. To find innovative and impactful ways to support them in doing so is both an opportunity and a challenge.
Reference:
For more information:
Deepa Rangachari, MD, can be reached at Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston MA 02215-5400; email: drangach@bidmc.harvard.edu.
Collapse
Healio Interviews
Click Here to Manage Email Alerts