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Every physician should be comfortable caring for cancer patients, yet medical education in oncology is known as inadequate. Our study explored this issue from an assessment perspective, by determining the representation of oncology and other health priorities in the clinical learning objectives for the Medical Council of Canada Qualifying Examination Part 1 (MCCQE Part 1). The Medical Council of Canada lists objectives for the MCCQE Part 1, based on CanMEDS roles for medical graduate competency. These objectives guide exam question development and can be used as a study guide for learners. Our study focused on the Medical Expert role and mapped the clinical objectives for oncologic, cardiovascular, cerebrovascular and chronic lower respiratory disease. The clinical objectives contained 190 topics under the Medical Expert role. Oncology content was found in 57 (30%), cardiovascular disease in 56 (29.5%), cerebrovascular disease in 21 (11%) and chronic lower respiratory disease in 7 (3.7%). In objectives with oncology content, gastrointestinal cancer (16, 28%), non-specific indicators of cancer (7, 12%) and genitourinary/musculoskeletal cancers (6, 10.5%) were most frequent. Content coding had inter-rater agreement greater than 99%, with kappas from 0.73 to 1.00. Oncology was highly represented in the clinical objectives listed for the MCCQE Part 1. With existing research showing limited oncology content on examinations and in medical curricula, our results were unexpected. This finding could signal the efficacy of initiatives seeking to improve oncology education and emphasizes the importance of continuing improvements in oncology education to meet patient and healthcare system needs.

Feedback delivery and training have not been characterized in the context of academic cancer centres. The purpose of this study was to assess the feasibility and utility of a microlearning course based on the R2C2 (Relationship, Reaction, Content, Coaching) feedback model and characterize multidisciplinary healthcare provider (HCP) perspectives on existing feedback practices in an academic cancer centre. Five HCP (two radiation oncologists, one medical oncologist, and two allied health professionals) with supervisory roles were selected by purposive sampling to participate in a prospective longitudinal qualitative study. Each participant completed a web-based multimedia course. Semi-structured one-on-one interviews were conducted with each participant at four time points: pre- and immediately post-course, and at one- and three-months post course. All participants found the course to be time feasible and completed it in 10-20 min. Participants expressed that the course fulfilled their need for feedback training and that its adoption may normalize a feedback culture in the cancer centre. Three themes were identified regarding perceptions of existing feedback practices: (1) hierarchical and interdisciplinary relationships modulate feedback delivery, (2) interest in feedback delivery varies by duration of the supervisory relationship, and (3) the transactionality of supervisor-trainee relationships influences feedback delivery. This study demonstrates the perceived feasibility and utility of a digital microlearning approach for development of feedback competencies in an academic cancer centre, perceptions of cultural barriers to feedback delivery, and the need for organizational commitment to developing a feedback culture.

The study aim was to evaluate the costs associated with developing and reviewing patient education materials (pamphlets) across Ontario cancer centers. While patient education often produces a positive return on investment, limited efforts have been dedicated to optimizing the personnel, time, and capital dedicated to this feat across healthcare systems. Patient education leaders at 14 cancer centers completed a survey measure, estimating the number of hours spent developing and reviewing pamphlets and identifying the personnel involved in each procedural step. The time expended per center in each step was then combined with average salary data for the identified personnel to derive total cost estimates. Cancer centers spend on average $5672 (SD = $3180) developing (M = $4560, SD = $2620) and reviewing (M = $1112, SD = $654) one pamphlet. This cumulates to an average per annum spending of $65,401 (SD = $75,494) for pamphlet development and $19,819 (SD = $28,524) for annual pamphlet review at each cancer center. The cost and number of hours spent developing and reviewing pamphlets varied substantially between cancer centers. While the security of budgets for patient education varies across cancer centers, opportunities to optimize human capital and monetary resources should be considered. Results of the study can be used to advocate for sustainable investment into cancer education programs, improve the coordination of educational materials production and review, and ensure that resource quality and access are consistent across the province.

Several studies have examined the informational needs of patients undergoing the breast diagnostic process where needs are highest during testing and prior to receiving a diagnosis. To aid in the development of an education pathway, we identified patient information needs. A multi-method approach to identify areas of need and to understand when and how information should be provided to patients was undertaken. The methods included an environmental scan of consumer health information, ethnographic observation of the patient clinical experience, key informant interviews, and a needs assessment survey. The data collected from the environmental scan, ethnography, and interviews were used to develop the items in the survey. The survey was developed around four domains: (1) Medical Procedures and Tests, (2) Understanding the Rapid Diagnostic Process, (3) Breast Cancer and Other Breast Conditions, and (4) Support and Coping. A total of 101 patients completed the survey. Mean importance scores were significantly different between domains of information need (p .0001) and significantly higher for the 'Medical Procedures and Tests' domain compared with all others. Multivariate analysis suggested that participants with higher levels of education (p = .02) and a preference to speak English at home (p = .009) tended to rate the importance of 'Support and Coping' information lower than other participants. Information about medical procedures and tests are most important for the patients undergoing rapid diagnostic testing in our sample. Education materials that are tailored to patient needs should be provided to patients during this stage of the cancer journey to help meet informational needs.

Effective communication between healthcare providers (HCPs) and patients is important for HCP well-being, patient engagement, and health outcomes. Yet, HCPs do not receive adequate communication skills training and report feeling unprepared for difficult conversations. A needs assessment of 64 cancer HCP trainees in Toronto, Canada, found that a majority of trainees rated themselves with low competency in communication skills to support patients through difficult conversations, while nearly all rated these skills as important to their practice. A blended multiprofessional communications program was developed including online theoretical learning and reflective practice in addition to in-person simulation with standardised patient actors. Since communication skills mastery is highly unlikely to occur at the termination of a single training program, the goal of the program was to stimulate participants' motivational beliefs about difficult conversations communication skills in order to deepen their commitment to learning and mastery. The motivational beliefs assessed included self-efficacy (self-perceived competence), intent to use techniques learned, and confidence in task mastery. After completing the course, participants' self-perceived competence in dealing with difficult conversations significantly increased by an average of 25 points (p 0.001) on a rating scale of 1-100 (n = 40). Participants' intent to use techniques did not change significantly and remained high with an overall average of 89 points. After the course, participants rated their confidence in mastering techniques learned at an average score of 71 points. Multiprofessional, simulation-based training is an effective way to improve HCP trainees' motivational beliefs around having difficult conversations.

Continued smoking at the time of a cancer diagnosis can severely impact the efficacy of cancer patient treatment and survival. The time of diagnosis can serve as a “teachable moment” for smoking cessation education, since patients may be receptive to discussions about quitting. Caregivers may have a pivotal role in supporting patients with their cessation efforts. The purpose of this study was to identify the smoking cessation informational needs of cancer patients and their caregivers. A needs assessment survey was administered to both patients and caregivers that assessed information needs across five domains: (1) General Information and Support; (2) Smoking, Health and Disease; (3) Relationships; (4) Testimonials; (5) Interventions. Mean importance scores were determined based on the proportion of respondents who ranked how important individual items were within the broader domains. Forty patients and twenty-two caregivers completed the survey. Among patients, the mean age was 61 years, with 35% diagnosed with a head and neck malignancy and 62% reporting as current smokers. Among caregivers, the mean age was 58 years, with 81% reporting to be the patient’s immediate family member and 50% as current smokers. The General Information and Support domain was rated as the most important domain for both cancer patients and caregivers. The top preferred modality for receiving smoking cessation education across all domains was pamphlets for both groups. This study identifies the key informational elements that should be considered in the development of smoking cessation resources to meet the informational needs of cancer patients and caregivers.