Reiss Kim A, Rangachari Deepa, Cosgrove David, Wilky Breelyn, Donehower Ross
The Perelman Cancer Center at the University of Pennsylvania, Philadelphia, PA, USA.
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
J Cancer Educ. 2017 Sep;32(3):496-502. doi: 10.1007/s13187-015-0974-1.
Trainee exposure to clinical oncology during residency training is heterogeneous and often modest. The steep learning curve upon entry into fellowship can result in undue stress for fellows and their patients. Simulation-based training has been shown to be superior to classical didactic approaches. We have introduced several innovative simulation-based workshops into the curriculum for the Johns Hopkins Hematology/Oncology Fellowship Training Program in order to address this unmet need. During the first months of training, fellows were engaged in activities emphasizing essential clinical and procedural skills. Specific workshops included the following: (1) chemotherapy writing, (2) cadaveric and simulation-based bone marrow biopsy and intrathecal chemotherapy administration, and (3) simulation-based communication skills training. All first-year fellows in our program participated in these exercises. Pre- and post-workshop surveys were administered to assess knowledge, attitudes, and behaviors; additional distant post-workshop evaluations were disseminated to assess the durability/impact of the curricula and for program evaluation. Overall, participating fellows indicated that the workshops improved patient care and comfort with procedures and patient-centered communication. Continued implementation of these workshops was recommended for program improvement. To the best of our knowledge, ours is amongst the first oncology fellowship training programs to systematically implement simulation-based curricula into our schema for fellowship training. We hypothesize that proactively introducing fellows to these high-yield activities will translate into improved patient care and reduced stress for trainees. Additional investigation into the long-term impact of such curricula remains an area of ongoing need.
住院医师培训期间，实习医生接触临床肿瘤学的机会参差不齐，且通常有限。进入专科 fellowship 培训时陡峭的学习曲线可能给 fellows 及其患者带来过度压力。基于模拟的培训已被证明优于传统的讲授式方法。为满足这一未被满足的需求，我们已将多个基于模拟的创新工作坊引入约翰霍普金斯血液学/肿瘤学专科 fellowship 培训项目的课程中。在培训的头几个月， fellows 参与了强调基本临床和操作技能的活动。具体的工作坊包括：（1）化疗书写，（2）基于尸体和模拟的骨髓活检及鞘内化疗给药，以及（3）基于模拟的沟通技能培训。我们项目的所有一年级 fellows 都参加了这些练习。在工作坊前后进行了调查，以评估知识、态度和行为；还进行了额外的远程工作坊后评估，以评估课程的持久性/影响以及用于项目评估。总体而言，参与的 fellows 表示，这些工作坊改善了患者护理以及对操作和以患者为中心的沟通的舒适度。建议继续实施这些工作坊以改进项目。据我们所知，我们是首批将基于模拟的课程系统地纳入专科 fellowship 培训计划的肿瘤学专科 fellowship 培训项目之一。我们假设，主动让 fellows 参与这些高效活动将转化为改善患者护理并减轻 trainees 的压力。对此类课程长期影响的进一步研究仍然是一个持续需要关注的领域。
