RO Corner: The Changing Landscape of Medical Education
Unlike the core subjects that make up the medical school curriculum, the information given and time dedicated to radiation oncology is relatively sparse. It takes upfront knowledge of the field and motivation on the part of the medical student to expose themselves to radiation oncology, and the initiative to learn the basics of the field. One innovator however, is helping to change the landscape of radiation oncology education. I had the pleasure of speaking with Daniel W. Golden, MD who has spent his career working to improve radiation oncology education for medical students and residents.
When did you first take an interest in education?
My interest in education goes back to my childhood, where I first learned I liked teaching through my involvement with the Boy Scouts of America. My interest in education evolved through college into medical school where I started a tutoring program, working with classmates. It was ultimately in residency where I learned that I could make an academic career out of medical education. I had previously thought that in order to practice academic medicine one would need to do clinical or bench research, which I enjoyed. However, I realized my favorite part of academic medicine was the teaching component. In residency I had the opportunity to participate in the Medical Education Research, Innovation, Teaching, and Scholarship Fellowship and Training Program at the University of Chicago (MERITS). MERITS engages participants in a focused curriculum dedicated to research in medical education, in addition to exposing participants to a network of faculty members at the medical school with similar interests. This was a wonderful opportunity for me to meet people from across the hospital who were also interested in education as an academic endeavor and could help get me plugged in with a medical education mentors from outside radiation oncology.
Can you tell me more about one of your first projects in medical education?
During my fourth year of residency, we had a dedicated research year and one of my research projects was a national survey of medical student radiation oncology education in fourth year clerkships. I had learned in my fellowship about taking a structured approach to curriculum design and that it was important to first perform a needs assessment. My medical student survey was a national needs assessment. I found through the students I surveyed, that the majority of clerkship curriculums did not have structured didactics as would a third year core clerkship such as internal medicine or general surgery. I felt that if students were to spend 3-4 months during their fourth year of medical school rotating through radiation oncology, departments should take the educational aspect of the rotation seriously. I felt it was important to give students a foundation to learn from, which would also help ease the transition to residency. Based on the survey results, in the summer of 2012 I piloted a curriculum at the University of Chicago and Harvard in which we implemented a structured curriculum consisting of three lectures and a radiation oncology treatment-planning workshop for medical students completing their summer clerkships in radiation oncology. Students were surveyed after the clerkship and subjectively felt more confident and knowledgeable following the curriculum. This structured didactic clerkship turned into a multi-institutional collaborative project known as the Radiation Oncology Education Collaborative Study Group (ROECSG), which has now expanded to over 50 institutions with the goal of creating a permanent collaborative network by which to robustly develop, implement, and evaluate curricular innovations. After implementing the clerkship curriculum, a standardized 20-question pre/post questionnaire was added in 2016. The results were just published in the International Journal of Radiation Oncology, showing a statistically significant improvement in objective knowledge for students that completed the structured curriculum compared to students who had not received the curriculum.
I understand you’re involved in an ongoing project for residents as well, can you tell me about IROC?
For the Introductory Radiation Oncology Course (IROC), we performed a needs assessment through ROECSG. Based on the needs assessment an introductory curriculum for new radiation oncology residents was developed by Rachel Jimenez at Massachusetts General Hospital, Emma Fields at Virgina Commonwealth University, and Raphael Yechieli at the University of Miami. The curriculum was piloted in 2017 at 4 institutions (Virginia Commonwealth University, MGH, University of Chicago, and Miami University). In 2018 the curriculum expanded to 40 institutions in North America. Similar to the evaluation design for the medical student curriculum, PGY-2 residents have an objective test before and after IROC to measure objective knowledge improvement.
What changes would you like to see implemented to improve education?
I think people do great work with regards to education, however it takes some extra effort to disseminate their innovations at the national level. The criteria for scholarship includes dissemination through peer-reviewed works. If you had great clinical data for treating patients at your institution with a novel therapy, you would publish your data so that everyone could use it. A similar approach should be taken with regards to educational innovations. We must ensure that we disseminate new curricular innovations early and often so that others can adopt these methods and build on them. Also, academic faculty should not make the assumption that education is easy. There is a lot of literature that can be referenced and expertise that can tapped to facilitate robust curriculum development. Lastly, we need to put in as much time developing robust evaluation methods as we do creating goals and objectives and instructional strategies. In the end, medical educators need to ensure that they have the data to support whether or not a novel curriculum actually achieves the stated goals and objectives - which is accomplished in part by taking a methodical approach to evaluation design.
How can programs get involved in your organization?
ROESCG is a tool anyone can use. You can email me or visit https://roecsg.uchicago.edu/ and click the contact link to sign up and receive emails. We recently had a spring symposium that garnered about 40 attendees and their presentations are also available on the website. We also have an informal gathering at ASTRO and a conference call in the spring. Anyone can utilize this network if they have an idea for a curricular innovation that they would like to develop in a collaborative manner.
I believe collaboration is the key to education. To successfully develop, implement, and evaluate educational innovations you need collaborative networks like ROECSG. I encourage everyone to collaborate and disseminate their work to move the field of radiation oncology education forward.
By Chelsea Miller, MD, radiation oncology resident at Loyola University of Chicago.