March 27, 2017

In depth - better oncology teaching

My little piece on the way cancer is taught at medical school triggered an invitation from the ABC Radio National program Ockham's Razor to provide some extra info and research into what medical students actually understand about cancer.






Better oncology education for doctors

I was diagnosed with bowel cancer at the age of 28.

In 2014, a few years after I was given the all-clear, I made the decision to become a doctor.

One of my reasons for taking up medicine was to learn more about cancer, and to use that knowledge and my experience to help people with the disease.

Since my own diagnosis five years ago, cancer has struck several members of my family and a number of close friends.

Cancer seems to be everywhere I look. That is, except the one place where I expected to find lots of it — medical school.

I've just completed two years of a medical degree and will spend the next two years in hospitals and clinics applying what I've learned.

I'll walk into hospitals generally comfortable with cancer and its often compromising and distressing treatment, mainly because of the radiation, chemotherapy and surgery that helped save my life, as well as my subsequent involvement with the cancer community.

But that's more than I can say for my fellow classmates.

It seems many medical students and newly graduated doctors are still uncomfortable with cancer.

An alarming number report they lack the knowledge and skills needed to spot the signs of cancer, or the confidence to chat to people living with cancer.

In a survey of Australian medical graduates published in 2003, 40 per cent reported they had little or no skill in discussing death, one in four didn't have the know-how to spot a melanoma, and more than one third weren't confident doing a pap smear.

If you're thinking that data is a little old — it is. However, there simply is no more recent Australian data measuring the oncology knowledge, skills and attitudes of Australian medical graduates.

Quite simply, we just don't know what our junior doctors know and think about cancer.

But do a little probing in medical universities today, and little seems to have changed.

This is surprising — and deeply concerning — when you look at the scale and impact of the disease.

This year alone, it is estimated 134,174 new cases of cancer will be diagnosed in Australia — an average of 367 diagnoses each day.

Cancer is a leading cause of death and disability worldwide. Of the more than half of people who survive the disease, many live with chronic side effects.

Such a gaping hole in our training is no secret. And it is not just restricted to Australia — the same issues show up among medical students trained around the world, including in the UK, Canada, Saudi Arabia and China.

So why do medical students graduate as doctors with significant gaps in their cancer knowledge?

Part of the reason is that the medical curriculum is already crowded.

There is a great deal for students to wrap their heads around in the first few years of study — everything from genetics and how the heart works to disability policy and the ethics of blood transfusion.

The sheer size of such a curriculum means it can be slow to incorporate change. We are, after all, inheriting hundreds of years of medical knowledge.

Along with the overcrowding, there is often no one set cancer textbook for students. Nor is there a standardised list of facts, figures, and treatments students should know about cancer by the time they graduate.

At my university, every medical student is required to spend time with patients in aged or palliative care, many of whom will have cancer. But we are one of the few medical schools in Australia to make this a priority.

The biggest problem when it comes to a lack of cancer knowledge for young doctors is lack of contact with people affected by cancer.

During my first year of medical school, I was surprised to not once encounter a cancer advocate or person with cancer as part of my learning.

Medical students spending time with, and learning from people with cancer should be fundamental to the teaching of medicine. Research shows the more time students spend with cancer patients and in hospices, the more prepared and confident they are in their first year as a doctor.

When the disease was covered during my studies, my tutorial group learnt about cancer alongside someone who had experienced it: me.

I'm open about my stage-three bowel cancer journey, so it felt natural to share this lived experience in my tutorials.

My peers asked blunt questions: Was I afraid of death? How did it feel to poo into a bag? What do you think caused your cancer? And what does chemo actually feel like?

These are questions they otherwise would not have had the opportunity to ask.

One student described it as an "irreplaceable learning experience". Another said it had made them go beyond the tumour and consider the "wider impact on the person and their community".

It was, admittedly, an unusual situation. But this kind of patient contact is known to help medical students develop their skills, knowledge and empathy.

Medical schools need to take a closer look at how prepared their students are to tackle what is perhaps the biggest menace of our time.

Yes, there is a truckload to learn at medical school. But that does not mean we should shy away from teaching future doctors how to prepare for real and meaningful interaction with those living with cancer.

After all, one in two Australians will be diagnosed with cancer before the age of 85. In the so-called 'war on cancer', surely we cannot afford to be sending out such an unprepared and uninformed army into the battle field.

Originally published on ABC Health & Wellbeing, 4 March 2017