Optimizing hematology/oncology (H/O) curricula for internal medicine (IM) residents: A two-institution Delphi survey.

person Jordyn Silverstein University of California, Los Angeles, Los Angeles, CA info_outline Jordyn Silverstein, Laura Ann Huppert, Matthew Schwede, Sarah Goglin, Tyler Paul Johnson, Jennifer Babik, Sam Brondfield

Authors person Jordyn Silverstein University of California, Los Angeles, Los Angeles, CA info_outline Jordyn Silverstein, Laura Ann Huppert, Matthew Schwede, Sarah Goglin, Tyler Paul Johnson, Jennifer Babik, Sam Brondfield Organizations University of California, Los Angeles, Los Angeles, CA, University of California, San Francisco, San Francisco, CA, Stanford, Menlo Park, CA, UCSF, San Francisco, CA, Stanford University Hospital, Palo Alto, CA, The Regents of the University of California, San Francisco, San Francisco, CA Abstract Disclosures Research Funding No funding sources reported Background: Although H/O topics are essential for primary care physicians, internists and subspecialists, the H/O curriculum is not standardized across IM residency programs. We aimed to identify the most important H/O topics for IM residents to learn, according to IM generalists and H/O specialists. Methods: We used a modified Delphi approach to conduct a 2-round cross-sectional survey of IM generalists and H/O specialists at the University of California, San Francisco and Stanford University. Participants rated the importance of H/O curricular topics gathered from national H/O and IM organizations on a 1-5 scale (very unimportant to very important). Participants then viewed their own ratings compared to the group mean and standard deviation (SD) for each topic from round 1 and could change their ratings in round 2 if they wished. We used a content validity index (CVI, the percentage of respondents who rated the topic ≥4) of >75% to identify the most important topics. We compared the effect sizes of the differences between mean generalist and specialist ratings for each topic using Cohen’s d. Results: The survey included 239 topics (75 classical hematology, 52 malignant hematology, 112 solid oncology). The round 1 survey was sent to 132 clinicians (68 generalists, 64 H/O specialists), with 92 round 1 responses (response rate [RR] 69.7%) and 77 round 2 responses (RR 83.7%). The average variance decreased from round 1 to round 2 (1.00 to 0.86), indicating increasing agreement. Ninety-two topics met the CVI threshold: 41 from classical hematology, 15 from malignant hematology, and 36 from solid oncology. The Table shows the highest rated topics as examples. Most effect sizes were small (58.6%), indicating agreement between generalists and specialists across most topics. Conclusions: With input from both generalists and H/O specialists, we identified the most important H/O topics for IM residents, which can guide curriculum development for IM residency programs. Examples of highly rated H/O curricular topics for IM residents. Domain Topics CVI Total Mean (SD) Specialist Mean (SD) Generalist Mean (SD) Effect Size Classical Hematology 1. Acute DVT/PE 2. Disseminated intravascular coagulation 3. Antiphospholipid antibody syndrome 100% 100% 100% 5.00 (0.00) 4.80 (0.41) 4.47 (0.52) 5.00 (0.00) 4.75 (0.50) 4.75 (0.50) 5.00 (0.00) 4.82 (0.40) 4.36 (0.50) 0.00* 0.16* 0.75** Malignant Hematology 1. Neutropenic fever 2. Acute myelogenous leukemia 3. Acute lymphocytic leukemia 92% 88% 88% 4.69 (0.62) 4.42 (0.70) 4.27 (0.67) 4.71 (0.59) 4.47 (0.62) 4.29 (0.69) 4.67 (0.71) 4.33 (0.87) 4.22 (0.67) 0.06* 0.20* 0.11* Solid Oncology 1. Advance care planning 2. Management of end-of-life issues 3. Malignant pleural effusion 100% 100% 97% 4.80 (0.41) 4.80 (0.41) 4.70 (0.53) 4.76 (0.44) 4.71 (0.47) 4.65 (0.61) 4.85 (0.38) 4.92 (0.28) 4.77 (0.44) 0.20* 0.53** 0.23* *small (<0.5) **moderate (0.5-0.8).