bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fellow-led didactics in a hematology/oncology fellowship program.
Authors: Thawani Rajat , Cetnar Jeremy Paul 
Published: June 2023

11026 Background: The pandemic in 2020 made us used to virtual learning, but as we recover from the pandemic, we are forced to rethink how we deliver education to trainees in medicine. The pandemic has led to a significantly decreased attention span and face to face interactions, in addition to an increased screen time. In our program, this led to us noting a lower engagement in the fellowship didactics as we recovered from the pandemic. This forced us to rethink how the Oregon Health & Science University (OHSU) hematology and oncology fellowship delivers educational content. After interviewing all stakeholders, we moved to an in-person fellow led didactic approach, under the mentorship of a faculty expert who helps trainees design content and is present for discussion. The rationale behind this approach was to boost peer-to-peer learning, supply relevant content and increase engagement. The fellows and faculty were provided guidelines about length of talk, presentation of data and use of interactive tools. Methods: After 6 months of introducing fellow led didactics, we surveyed all fellows and select faculty who were mentors on more than one occasion about their opinion. A survey link was sent to all 12 fellows and 18 faculty members who regularly took part in fellowship didactics. Results: All 12 fellows responded to the survey. On a Likert scale of 1-5, they scored improvement in knowledge at 4.58 (0.64) and rated both the content and presenter at 4.25 (0.43). A third felt that this way of delivering didactics was a lot better and the rest felt it was a little better. On the negative side, they felt that they were spending more time preparing content (40% spent 7-9 hours a month) but were optimistic about lesser commitment next year as we bank the PowerPoint presentations. Nine of the 18 (50%) invited faculty responded to the survey, and on a scale of 1-5, they rated their improvement of knowledge as 4.44 (0.68). They scored the content and presenter at 4.44 (0.5) and 4.56 (0.68) respectively. 88.9% felt that the didactics were either a little or a lot better, and 11.1% felt them to be the same. On average, they spent less time on the content than they did if they were presenting. Conclusions: Overall, both faculty and fellows felt that this method of delivering didactics in a hematology oncology fellowship program was more effective. The fellows felt that they needed to put in extra hours for preparation, but this will probably go down as they build on earlier presentations.
Teaching how to navigate difficult conversations: A combined palliative care–oncology didactic simulation intervention for hematology/oncology fellows.
Authors: Dupuis Megan , Walsh Katherine Jean , Agarwal Rajiv 
Published: June 2023

11028 Background: ASCO strongly endorses the integration of palliative care to improve patient outcomes and support patients in their cancer trajectories. Developing core palliative care skills for trainees is therefore essential, with few ACGME approved pilot programs offering combined fellowship training. Our institution’s Heme/Onc fellows reported a need for additional education in leading difficult conversations. Methods: We piloted a didactic simulation (sim) session for each fellowship class, led by a faculty member who is dual board-certified in Medical Oncology and Hospice/Palliative Medicine. Trainees received a lecture on validated communication tools and oncology-specific language to help navigate difficult conversations. Trainees then role-played in small groups using sample cases, with Heme/Onc faculty supervision and real-time feedback, followed by class reflection. Pre- and post-sim surveys were electronically administered to assess knowledge of communication tools and comfort in discussing difficult topics. Comfort questions were scored on a 5-point Likert Scale, using student t-tests to detect differences pre- and post-sim, and ANOVA to compare responses among classes. Results: A total of 16/21 (76.2%) fellows completed both pre- and post-sim surveys. Knowledge of communication tools increased from 21.9% pre-sim to 79.7% post-sim. Comfort significantly increased for explaining palliative-intent chemotherapy, hospice, and discussing an uncertain prognosis (Table). There was a significant difference among classes pre-sim for addressing negative emotions (mean comfort level: 1st years 2.8, 2nd years 3.4, 3rd years 3.83; p=0.046) and for discussing an uncertain prognosis (mean comfort level: 1st years 2.6, 2nd years 3.6, 3rd years 3.83; p=0.043); however, these interclass discrepancies were eliminated post-sim. Overall, fellows reported that the sim sessions were effective for developing their knowledge and comfort in having difficult conversations. Conclusions: A novel sim intervention led by a physician who is dual board-certified in palliative care and medical oncology improves trainee competency with navigating difficult conversations. Analysis of the intervention’s durability of response and iterative refinement of its curriculum are ongoing. [Table: see text]
Hematology and oncology fellow education about sexual and reproductive health: A survey of program directors in the United States.
Authors: Reese Jennifer B. , Bauman Jessica R , Sorice Kristen A. , Middleton Danny , McIlhenny Sarah , Bober Sharon L. 
Published: June 2023

11029 Background: Sexual and reproductive health (SRH) concerns are important areas of health and quality of life for patients with cancer that should be included in routine cancer care, according to clinical guidelines. Yet, oncologists often hesitate to raise SRH with their patients due to lack of training. We conducted a national survey of hematology/oncology fellowship program directors (PDs) in the U.S. to understand the state of current fellowship education on three key SRH subjects: fertility, sexual health, and safe sex practices. We assessed rates of provision of formal/informal instruction and endorsement of barriers to formal instruction. Methods: A 13-item survey of education on fertility, sexual health, and safe sex practices in adult hematology/oncology programs was sent to all PDs in the U.S. via an online link or paper survey. PD’s received a $5 gift card for participating. Descriptive statistics and McNemar tests were used. Results: One hundred-twelve PDs responded to the survey (63% response rate). Of these, 75% of PDs reported their programs offered >1 hour of formal instruction on fertility, 42% on sexual health, and 31% on safe sex practices; formal instruction was more common for fertility than either other subject (p’s < .001). Male and female fertility preservation was addressed in 62% and 59% of programs, respectively. Cancer-related sexual side effects for women and men were covered in less than one-quarter of programs (23% and 20%, respectively). Regarding informal instruction, > 73% of programs reported using clinical experience to train fellows in SRH; other informal instruction methods (i.e., case-based methods, webinars, journal clubs, grand rounds) were less common. Lack of experts/resources was the most widely endorsed barrier to providing education about fertility (55%), sexual health (75%), and safe sex practices (69%) and was more widely endorsed for sexual health and safe sex practices compared to fertility (p’s < .01). Lack of space in the curriculum and the topic not being required were also commonly endorsed barriers. Conclusions: Data from this national survey of fellowship program directors show that training in SRH is rare, particularly for sexual health. Barriers to training, especially difficulties in finding content experts, may be leading to a heavy reliance on informal methods of instruction, which are both variable and incomplete. Concerted efforts to integrate SRH into fellowship training, including novel educational curricula, are needed if SRH is to be addressed in routine cancer care.
Association between baseline radiological tumor burden and outcomes in patients with metastatic breast cancer treated with an immune checkpoint inhibitor.
Authors: Brown Lauren Claire , Moodie Kate , VanGeelen Courtney , Dixon-Douglas Julia , David Steven Philip , Francis Prudence A. , Savas Peter , Loi Sherene 
Published: June 2023

1103 Background: Lower baseline radiological tumor burden is associated with more favorable outcomes for patients with metastatic non-small cell lung cancer and melanoma treated with immunotherapy. However, minimal data is available for metastatic breast cancer patients. This is despite immunotherapy, in combination with chemotherapy, now being standard-of-care for a subset of metastatic breast cancer patients who have triple-negative disease and are PD-L1 positive. Methods: We reviewed data of 82 patients with metastatic breast cancer consecutively treated at our institution from August 2015 to October 2021, who received > 1 dose of an immune checkpoint inhibitor (anti-PD-1 or -PD-L1) within the context of a clinical trial. Baseline tumour burden was assessed by a single radiologist and calculated as sum of Response Evaluation Criteria in Solid Tumours 1.1 baseline target lesions (baseline tumour size [BTS]) or as sum of all measurable baseline lesions (total tumour burden [TTB]); the impact of both parameters on treatment outcomes was investigated. Treatment outcomes assessed were clinical benefit rate (complete response, partial response or stable disease for 6 months or more [CBR6]), disease free survival (DFS) and overall survival (OS). Multivariate analysis adjusted for ECOG status, line of treatment (first line vs second line or beyond), and whether immunotherapy was given in combination with chemotherapy or as monotherapy. Results: A total of 82 patients were included in the analysis. 43 patients (52%) received combination chemotherapy with immunotherapy, 39 patients (48%) received immune checkpoint inhibitor monotherapy. Median BTS and TTB were 36.5mm (range 0 -204mm) and 43mm (range 0 – 1123mm) respectively. CBR6 was significantly associated with BTS (p=0.004) and TTB (P=0.002) quartiles, with clinical benefit time progressively increasing with decreasing tumor burden quartiles. Both increasing BTS (p<0.001) and TTB (p<0.001) across quartiles were significantly associated with shorter OS. There was a numerical, but not statistically significant, association between both parameters as quartiles (BTS, p=0.25; TTB, p=0.07) and PFS. In the bottom BTS quartile, 32% of patients were progression-free and 95% alive at 12 months, compared with 15% and 40% respectively in the top quartile. Similar results were seen when TTB was used as the baseline measurement: 32% progression-free and 95% alive at 12 months in the bottom quartile compared with 1% and 33% in the top quartile. Multivariate analysis confirmed that both BTS and TTB, considered as continuous variables, are independently associated with OS. Conclusions: Lower baseline radiological tumor burden is associated with better outcomes in patients with metastatic breast cancer treated with immune checkpoint inhibitors.
Recommendations for medical cannabis use in cancer patients by US oncology fellows and the impact of receiving prior training.
Authors: Tehranchi Kian , Patell Rushad , Bindal Poorva , Dodge Laura E. , Freed Jason , Buss Mary K. , Schonberg Mara A. , Braun Ilana Monica , Rangachari Deepa 
Published: June 2023

11030 Background: Despite the rising use of medical cannabis, limited evidence informs the safety and efficacy of cannabis use in cancer patients. A national survey of oncology fellows found that fellows felt insufficiently informed to make clinical recommendations about cannabis. In this secondary analysis of that survey, we aimed to measure how frequently trainees recommend cannabis and determine factors that influence this practice. Given the lack of evidence, we hypothesized that fellows who had been trained in medical cannabis use would be less likely to recommend cannabis to their patients. Methods: An online survey assessing trainee practices on medical cannabis was sent to 155 oncology fellowship program directors between January - March 2021 and directors were asked to distribute it to their fellows. The primary outcome was the number of times oncology fellows recommended cannabis in the prior year. Log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI) to evaluate whether the number of cannabis recommendations varied by participant age, gender, legality of cannabis in the state of practice, and prior training in medical cannabis. Results: Nationally, 40 programs from 25 states participated, with 189 of 462 trainees across these programs responding (40% response rate). Twenty-two percent (95% binomial CI: 16.3-29.0%) of participants reported recommending medical cannabis to >5 patients in the past year. Twenty-four percent (95% binomial CI: 18.4-30.5%) of participants had prior training in medical cannabis. Among participant characteristics, only prior training in medical cannabis was associated with recommending cannabis to >5 patients (RR: 2.42; 95% CI: 1.39–4.20). Conclusions: Despite limited evidence to support medical cannabis use among cancer patients, one in five oncology fellows participating in our study recommended it to >5 patients in the past year. Prior training was associated with doubling of rates of recommending medical cannabis in this group. It is thus of critical importance that fellowship training on this subject reflects best available evidence to guide trainees in well-informed decision-making. Factors associated with trainees recommending medical cannabis to >5 patients. [Table: see text]
The brown university cancer prevention and survivorship curriculum: A case study on program development in an internal medicine residency.
Authors: Francis Elizabeth , Pounardjian Tamar , Li Jennifer , Moku Prashanth , Avidan Olivia , DeCarli Kathryn , Manzullo Ellen F. , Sanft Tara B. , McGarry Kelly , Dizon Don S. , Duffy Christine Mary 
Published: June 2023

11031 Background: Advances in screening, early detection, and treatment have increased the number of cancer survivors. Cancer survivors have a unique set of medical, psychosocial, physical, and financial challenges. Though it is critical for provider teams to be attuned and equipped to address these issues, we identified two training programs in this discipline. Medical residency clinical education does not fully explore the role of cancer preventative services and survivorship experiences available to patients and their families. We developed an elective at Alpert Medical School at Brown University/Lifespan Internal Medicine Residency Program (Brown) to improve medicine residents’ knowledge and clinical skills on different aspects of the cancer control continuum, with a focus on prevention, early detection, survivorship and surveillance. Methods: In 2020, a team of Brown internal medicine (IM) residents, faculty and one hematology oncology (heme/onc) fellow examined the existing cancer prevention and survivorship infrastructure, identified key faculty and clinics, and examined existing programs at peer institutions. A needs assessment was completed by Brown IM residents and heme/onc fellows. We then designed the Cancer Prevention & Survivorship Elective, an innovative and novel educational elective for medical residents to promote interest, awareness, and understanding of cancer prevention and survivorship. The 6 module one month elective features didactics and clinical experiences offered via a live and independent study fashion. The elective brought together 27 disciplines, 64 faculty lecturers from 10 peer institutions across the United States and included 20 unique clinics. Residents completed anonymous pre- and post-course surveys to measure their understanding and degree of confidence in different aspects of cancer prevention and survivorship, not limited to surveillance, health disparities and global perspective, primary and secondary prevention, late and long-term effects, and quality of life. Results: In January 2023, ten residents, ranging from first- to third-year IM and medicine-pediatrics, participated in the live elective. Two IM residents have registered to complete the elective via independent study in 2023. To date, the Cancer Prevention and Survivorship Elective has improved IM residents’ confidence, comfort and clinical skills in treating patients along the cancer care continuum. Conclusions: This curricula serves as an example for inter-institutional collaboration, and highlights the need for a multidisciplinary approach when caring for patients at high-risk of developing cancer and surviving cancer.
Mapping objectives of a new interprofessional morbidity and mortality conference to ACGME core competencies in hematology/oncology.
Authors: Sharma Aditya , Dhawan Natasha , Hayes Christi Ann , Silvius Katherine C , Lansigan Frederick 
Published: June 2023

11032 Background: Safety and quality improvement requirements are a part of the core competencies for ACGME-accredited hematology/oncology fellowships. The morbidity and mortality conference (MM) is a tool that has been used to identify safety issues and areas for improvement. The traditional format primarily includes an audience of clinicians. We sought to develop an interactive, interprofessional MM (i-MM), including institutional leadership, physicians, fellows, residents, advanced practice providers, nursing, and pharmacy, while meeting the ACGME Core competencies for Patient Safety and Quality Improvement in Hematology and Medical Oncology. Methods: A pilot i-MM was designed to create an enriching, interprofessional discussion regarding patient safety and quality improvement. We implemented a Plan-Do-Study-Act (PDSA) design to create the i-MM model that map to the core competencies. The first session was focused on two mortality events in immunocompromised hosts that triggered the sepsis bundle, one of which was due to toxic megacolon. The i-MM objectives were aligned with ACGME hematology/oncology fellowship requirements of quality and safety. The effectiveness of the pilot session was gauged via an anonymous post-session survey using a 4-point Likert scale. Results: A total of 32 people attended the pilot i-MM, including quality and safety leaders, faculty, fellows, medical residents, pharmacy, and nursing. A total of 10 participants across professions completed the post-i-MM survey. The survey demonstrated an average of 3.8/4 for all interprofessional educational goals, which included demonstration of mutual respect between healthcare professionals, engaging in effective interprofessional communication, and working within an interprofessional team. Content-specific aspects of the survey were rated with an average effectiveness of 3.60/4. Feedback on the survey recommended limiting i-MM to one case presentation instead of multiple. During the debrief session, it was reported that several nurses felt the moderated session was “inclusive and empowering”. Conclusions: The i-MM was an effective approach to meeting ACGME requirements for safety and quality learning objectives while creating an inclusive environment for all team members. Future PDSA cycles will continue to map i-MM learning objectives to ACGME hematology/oncology fellowship program core competencies in Section VI.A.1 and the section on Professionalism. Core competency mapping will guide future presentations that address issues on quality, safety, and health care disparities. Specific presenters and moderators from different professions will be chosen to lead each i-MM, with the goal of examining each case from different perspectives to provide a holistic interprofessional view of delivering quality medical care to patients.
The cognitive load of inpatient consults involving immune-related adverse events.
Authors: Brondfield Sam , Silverstein Jordyn , de Dios Kimberly , Quandt Zoe 
Published: June 2023

11033 Background: Immune-related adverse events (irAE) requiring hospitalization involve complex, multidisciplinary management. Expertise in oncology and/or the affected organ(s) may be required in the form of inpatient consults. Trainees (fellows and residents) often provide such consults. irAE consults may be rich learning opportunities, but it is unclear whether the cognitive load, or mental effort, required for these complex cases may overwhelm trainees and impair learning. To investigate the cognitive load of irAE consults, we surveyed trainees who had recently completed an irAE consult and compared the results to a control dataset. Methods: Between October 2021 and January 2023, we identified patients hospitalized due to irAEs at the University of California, San Francisco by reviewing patient lists (oncology consults and hospital medicine admissions) daily. We emailed the published Consult Cognitive Load (CCL) survey to any residents or fellows who had signed initial consult notes in the charts of identified patients. The CCL uses 4-point scales to measure three types of cognitive load related to one consult: intrinsic load (IL) related to the consult task itself, extraneous load (EL) related to distractions during the consult, and germane load (GL), the mental effort left over for learning after IL and EL are accounted for. IL, EL, and GL scores range from 4 to 16. Using two-tailed t tests, we compared mean IL, EL, GL, and total cognitive load (the sum of IL, EL, and GL) between the irAE group and a control group of fellows and residents who performed a variety of consults at five University of California hospitals during a 2018-2019 study (n = 142). Detecting a difference of 0.5 with a variance of 0.5 (calculated for the control group), 80% power, and 95% confidence required an irAE group sample size of 18. Results: Of 36 trainees contacted for the irAE group, 18 completed the CCL (50% response rate, 61% fellows, 39% residents). The irAE group and the control group (80% fellows, 17% residents, 3% not reported) spanned multiple specialties. Total cognitive load (p = 0.49) and IL (p = 0.95) did not differ. EL was significantly lower (8.4 vs 10.3, p = 0.002) and GL higher (11.9 vs 10.8, p = 0.04) in the irAE group. Conclusions: Trainees experienced similar cognitive load when performing irAE consults as compared to other consults, but the sources of cognitive load differed. Trainees performing irAE consults expended less mental effort on distractions (EL) and more on learning (GL) as compared to other consults. The consult task itself (IL) imposed a similar amount of cognitive load whether or not it was an irAE consult. Complex irAE cases did not overwhelm trainees or preclude learning; rather, trainees performing irAE consults exhibited a sharpened focus on the task at hand and extracted more learning than trainees performing other consults. Educators should foster trainee exposure to inpatient irAE consults to promote worthwhile learning.