Finding the Gaps: Perceived and Unperceived Needs in Malignant Hematology Training in Canadian Hematology Residents
Authors: Lam Wilson , Law Arjun , Najeeb Umberin , Panisko Danny , Jang Raymond , Sibai Hassan 
Published: October 2019

Abstract
Background
Malignant Hematology is in a new era of exciting novel treatment regimens and modalities, including CAR-T (Chimeric Antigen Receptor T-cells) and BiTE (Bi-specific T-cell Engaging) antibodies. Current trainees require an ever-increasing knowledge and skillset to deliver high quality care to more complex patients. There is limited evidence on the educational needs of hematology residents with these emerging complexities. Moreover, these educational needs themselves are poorly-defined. As a first step, we sought to perform a detailed needs assessment to identify knowledge gaps in our learners. It is our intention to use this information to aid in developing a curriculum incorporating these novel elements.
Methods
Every year Hematology residents in Canada (Post Graduate Year [PGY] 4 and above) attend the National Hematology Retreat in Toronto, Ontario for a weekend of educational activities, which also serves as preparation for the Royal College of Physicians and Surgeons Hematology certification exam. This past year, residents were invited to participate in a questionnaire to identify perceived and unperceived needs. They were asked to select topics of perceived needs from a pre-selected list. This was followed by a knowledge assessment using case-based questions in leukemia, myeloma, lymphoma, and Blood and Marrow Transplantation [BMT]. The study is approved by the University of Toronto Research Ethics Board. Data were analyzed descriptively as needed. Mean total scores from the case-based questions were compared between post-graduate years using one way ANOVA. All statistical calculations were performed using SPSS version 24.
Results
35 of 70 Canadian Hematology residents attending the retreat responded to our survey. Among the respondents, seven were PGY-4, nine were PGY-5, and 19 were PGY-6.
Of our pre-selected topics list, residents perceived the most common knowledge gaps existed in management of BMT complications, followed by molecular testing (especially genomics), and novel immune and cellular therapies. The top choices differed in the PGY-4 year (BMT complications, novel immune and cellular therapies and emergency AML complications, Figure 1).
Among the respondents answering case-based questions, there was a significant difference in mean scores with increasing length of training (PGY-4: 53%, PGY-5: 70%, PGY-6: 79%, p=0.009). There was a knowledge gap in BMT among all levels of residents, which correlated with their perceived knowledge gaps. However, a majority of them correctly answered the questions on molecular testing and novel immune and cellular therapies.
Conclusions
Needs assessments are useful in assessing background knowledge and identifying perceived and unperceived needs of trainees. These can be used towards creating a resource that accounts for learning priorities. Our needs assessment of hematology residents across Canada demonstrated that:Knowledge gaps exist among residents at different levels of training, particularly in BMT, compared to other areas of Malignant Hematology. Moreover, this was perceived by residents themselves.Learning priorities of residents may change over the course of their training.Educational curricula should incorporate recent advances in hematology (molecular testing and novel immune and cellular therapies); however more emphasis should also be placed on BMT in general.

Disclosures
No relevant conflicts of interest to declare.