Forming an ideal model for medical oncology education might be considered a foolhardy endeavour. Those of us who work in the field know that it is a complex and ever-expanding specialty. A paradigm built on the materials, methods and conditions of today’s healthcare standards will inevitably lose its value over time. Any proposed model must accommodate this constant progress, while also providing useful answers to the questions that surround all educational issues – how information can best be conveyed in a memorable and interesting way, what fundamental knowledge must be taught, and who is best positioned to teach it?

For medical oncology in particular, an ideal model of education must be comprehensive, relevant and continuous. Several different areas need to be considered. First is the formal education of healthcare professionals in the field, which must be focused not only on lifelong clinical, scientific and research education but also on the managerial and communication skills that are necessary to effectively treat patients. Supplementing this, the ideal model should also integrate informal education – the sharing of knowledge and practical experience between colleagues. Finally, all education must account for the experience of patients, at the centre of all medical care.

Formal education

Medical oncologists need to remain up to date on new drugs, treatment strategies, research techniques and methodologies, as well as continuing to improve their clinical practice and advance in their careers, all while maintaining a full-time job caring for patients. This means that time constraints may limit the number of educational opportunities availed of. However, formal training is essential to impart factual knowledge. 

While current practice will fulfil immediate need, consideration should be given to the historical context of clinical practice, such as the development of a chemotherapeutic regimen from its origins as an antimetabolite and antihelminthic medication; or how a deadly condition afflicting young men evolved into the hallmark of a curable cancer, as in the case of germ cell tumours. This background can inspire us to new developments that may inform the way we will practice in the future. 

Formal lectures and tutorials can also give insight into the diversity of career options that are open to oncologists – clinical oncology, translational research or basic science, among others – and the advantages and disadvantages of each. 

Medical oncology is one of the few medical disciplines with increasing integration with laboratory sciences, as evidenced by the evolving role of genomic medicine and precision oncology. Therefore, it is essential that the next generation of medical oncologists is fluent in the language of science to ensure that patients are best matched with the most appropriate therapies. Parallel with this is the development of clinical trials, with early exposure to clinical trial methodologies an important component of medical oncology education.

Management training is an aspect of medical oncology training that increases in importance throughout a trainee’s career though it is frequently overlooked. Becoming a consultant involves significant amounts of administrative, business and organisational skill, which are often not specifically addressed during basic degrees. These skills are also essential for the translational or academic oncologist involved in managing clinical trials, research and support staff. In medical oncology, the art of communicating and negotiating difficult situations with patients is paramount. Formal education should also include communication skills training for staff, which can improve attitudes towards patients’ psychosocial needs, confidence, team functioning and clinical trial recruitment.^1,2,3

Informal education

Informal education is a general term for education outside of a standard school setting; the wise, respectful and spontaneous process of cultivating learning through conversation and the exploration and enlargement of experience. An ideal model for medical oncology education will take this into account. Indeed, informal education is part of the daily life of medical oncology professionals. Informal clinical education takes place during debates in multidisciplinary meeting and during ward rounds and clinics.^4,5,6

Training on communication and management can occur by observing colleagues, for example dealing with an upset patient or staff member or the initiation of a clinical trial, and subsequent discussion. Advice on career choices, stress and burnout management is passed on from one physician to another. 

Informal learning can take place between doctors, nurses, patients and the general public, as all have contributions to make to the knowledge base of medical oncology.^7,8 Seemingly casual exchanges of ideas about patient care can contribute to new ideas and understanding. A conversation with a patient about the side effects they are experiencing from chemotherapy teaches a physician much about the ‘real-world’ consequences of the treatment they prescribe. 

Online forums and social media should also be harnessed so that medical oncologists can use public input to explore aspects of cancer care, such as prioritising quality versus quantity of life. This exploration can help to understand what patients’ expectations of the medical oncology service are and to make suggestions together to improve practice.^9,10,11 An ideal model not only allows for these informal aspects of education, but also encourages, accommodates and incorporates them. 

Social media is now one of the primary sources of information for both oncologists and patients, with countless online groups and forums allowing interaction and debate. Official institutions such as the Centre for Disease Control and Prevention have launched social media-based health education initiatives which have proved to be effective.¹² Social media is also used in educational initiatives for healthcare professionals, with most of the major organisations such as ASCO and ESMO using Twitter and Facebook during conferences to provide updates and informal discussion groups.¹³

Patient education

Of course, at the centre of all medical oncology education is the patient and their treatment. As information becomes more easily accessed in a globalised world and we move from paternalistic to patient-centred medical practice, patients want to have a part in decision making relating to their care and treatment.¹⁴ As a result, educating patients about their treatment and the reasoning behind it is vital to ensuring satisfaction with the care that they receive. 

The majority of patients undergoing systemic cancer treatments have formal education about the practicalities of their treatment. This is usually done in both group and individual settings, often using information leaflets, videos and practical sessions and has been shown to improve patient knowledge and trust in treatment.^15,16,17 Structured education for patients with incurable disease leads to better understanding about the terminal nature of their illness and improved quality of life during the final stages of disease.¹⁸

Informal structures for patient education are also in place. Cancer support centres are widely available to patients undergoing and recovering after treatment – these centres provide a relaxed atmosphere where patients and their families meet people who are having or have had similar experiences. 

Survivorship groups facilitate conversation about how people who have had cancer can move on with their lives and deal with long-term consequences of cancer treatments, including psychosocial and financial sequelae – topics that are also of interest to oncologists caring for patients in follow-up.¹⁹

The value of patients as educators themselves is frequently overlooked. With the focus on overall survival as an outcome in clinical trials, it is easy for medical oncologists to lose focus on what patients with incurable cancer in particular really hope for. This has led to the inclusion of quality of life data collection in many trials. It has been reported many times that patients wish to communicate and learn about the end of life, although there is still a strong stigma attached to palliative care.^20,21,22

Directed educational meetings with patients and their families could help to give physician and patient a better understanding of each other’s thoughts on this topic. 

Ideal model

The ideal model of medical oncology education emphasises not just the formal education of medical oncologists as professionals, but also the community of knowledge that exists between healthcare professionals, patients and the public. Formal teaching, in the form of lectures and conferences, is essential for healthcare professionals; team- or group-based learning can enhance this by adding to both knowledge and insight. 

Each person or group will have a different perspective on issues debated; often in oncology there are no correct answers, but views on how best to serve each patient’s needs. The benefit of formal education should be supplemented by a strong informal sharing culture, which reinforces education continuously and integrates it into the patient care experience. 

The ideal model of oncology education embraces these shared learning strategies and shared areas of knowledge. As well as the formal teaching that forms the backbone of medical oncology education, informal knowledge and patient experience must become a central part of the model. 

Perhaps there is no ideal model, but rather a platform that involves many groups of people which allows medical oncologists, while basing their decisions on sound clinical knowledge, to learn and make choices alongside patients about how to achieve the goal of best care. Exploring each other’s point of view and experiences will help to develop more rounded, thoughtful and educated oncologists, more informed and satisfied patient and a more aware and healthy general population.

References

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