Fortifying the workforce: A national survey of hematology/oncology fellowship program directors and training fellows for community-based careers.
Authors: Anthony Iacoviello, Shubham Agrawal, Jonathan L Berry, Page Widick, Daniel Aaron Roberts, Rushad Patell, Deepa Rangachari
Journal: Journal of Clinical Oncology (2024)

9028 Background: Most hematology/oncology (HO) care occurs in community settings. In a recent national survey of currently practicing community oncologists, we highlighted areas of unmet need regarding preparation for community-based (CB) careers during fellowship [Agrawal et al, JCO OP 2024]. Our study aims to explore attitudes of HO fellowship program directors (PDs) relating to CB HO training. Methods: We conducted a cross-sectional email survey of 185 HO fellowship PDs in the United States. The primary outcome was assessing PDs’ attitudes regarding inclusion of CB HO training during fellowship. Secondary outcomes included assessing whether programs currently have clinical and/or non-clinical training experiences specifically addressing skills relevant to community practice. Participants were also surveyed to assess PDs’ attitudes regarding what motivates fellows to choose careers in community practice. Demographics pertaining to program leadership and fellows were also obtained. Results: We received a total of 53 responses (29% response rate). The majority of respondents’ programs were in academic tertiary care hospitals (76%) with a plurality in the Northeast (32%), had a median of 5 trainees per class, and had roughly equal Male and Female (including transgender men and women) trainees (70%). The majority of PDs had been in clinical practice for ≥10 years (68%) and in their program leadership position for ≤10 years (83%). Almost all PDs (96%) reported having graduates who pursue careers in CB settings, with financial compensation cited most frequently in making this decision (98%). The majority of PDs (83%) agreed that training experiences in CB HO should be available for their trainees during fellowship. A multivariate regression analysis demonstrated that there were no significant factors associated with this outcome (p&gt;.05). Training experiences relevant to community practice were not uniformly available amongst programs, with 74% of programs offering clinical experiences, but only 32% offering non-clinical experiences. The most cited clinical experience was the option to rotate in a CB setting (80%), and the most common non-clinical experience was exposure to training in quality improvement/patient safety (88%). Conclusions: While most HO training programs in the U.S. are embedded within academic centers, nearly all PDs indicated their programs train fellows who pursue careers in the community. PDs believe that experiences tailored to CB HO practice should be available to their fellows. Although many respondents’ programs offer CB clinical rotations, relevant extra-clinical skill development opportunities are lacking. Goal-concordant pathways for career development during HO fellowship can be optimized, particularly as they relate to training individuals for practice in CB settings, a growing need within the HO workforce.