Apr 17, 2013
Program Director's Perspective: Addressing the Complex and Changing Field of Oncology
By Gregory A. Masters, MD, FACP
ASCO's In-Training Exam (ITE) for medical oncology is used by fellowship programs for evaluation of fellows at various stages in their training. I have been asked by the Society to comment on the ways in which my participation on the ITE Test Materials Development Committee (TMDC) can influence clinical practice and how working on the ITE development can help to have a positive impact on patient care.
For oncologists participating in clinical practice who have completed oncology training, we recognize that continuing medical education (CME) is crucial to maintaining an up-to-date understanding of the complex field of oncology and the changing environment for evaluating and treating neoplastic disease. Educational activities include conferences, lectures, meetings, literature review, online programs, and independent study. For medical oncologists involved in the training of fellows, the evaluation and monitoring of CME activities is also crucial to ensure the value and integrity of the education process.
Active, ongoing learning
Some of us learn through passive techniques such as reading or attending lectures. Others have more success through active participation and interactive programs. Development of the ITE is an example of the latter, in which we have recruited practicing medical oncologists, including those in academic settings and clinical practice environments, to develop a set of clinical vignettes and associated multiple-choice questions regarding basic science, clinical competencies, legal and ethical issues, pharmacology, and various hematologic and solid tumor oncology questions. These questions can relate to the natural history of a disease, evaluation, lab testing, pathology, radiology, or direct clinical care, including chemotherapy, radiation, surgery, and supportive care measures.
It is through ongoing introspection and self-evaluation that we learn the most regarding our proficiencies and deficiencies. Participating in the ITE development has provided me an opportunity to examine my own strengths and weaknesses in medical oncology and to continue to build on my understanding of the field.
Staying up to date in a broad field with frequent, often dramatic, and practice-changing research developments that occur on a regular basis has been a challenge since the start of my career, and it remains an ongoing imperative to continue to maintain a sufficient and accurate fund of knowledge as well as an appropriate perspective on putting that knowledge to clinical use in the best way possible.
Fellows may be required at their institution to take the ITE not only for their own edification but also to help program directors understand their program's own needs for improvement and development. Those of us active in clinical practice can benefit from continuing education not only as it relates to maintaining Board certification but also for establishing a program for self-review.
The fine and devoted members of the TMDC with whom I have had a chance to work over the last several years demonstrate to me the ongoing excellence to which we all strive in maintaining our understanding of a complex and changing field of medical oncology.
Trying to develop a test that is relevant, challenging, and fair has been a worthwhile endeavor. My continued participation in ASCO committees, including the TMDC, has been rewarding, although time-consuming. Nevertheless, the distraction of extracurricular efforts such as this can help us continue to grow. Over time, the requirements for certification, recertification, and practice improvement as well as demonstration of self-development will continue to push medical oncologists toward these types of self-assessment and self-education projects.
I invite your input on this process and welcome additional contributions to the ASCO ITE questions, review, development, implementation, and critique.
Fellow's Perspective: An Extremely Useful Self-Evaluation Tool
By Paul T. Mehan, MD
Earlier this year, many oncology fellows, including myself, participated in the ASCO Medical Oncology In-Training Exam. The test was a long one, lasting nearly six hours, and was comprised of 200 multiple-choice questions. The proctored exam was held at my institution, but it was Web-based and the format was very similar to the United States Medical Licensing Examination (USMLE) and American Board of Internal Medicine (ABIM) board examination.
This is my final year of fellowship, and this was the second ASCO Medical Oncology In-Training exam I have taken. The first time I took the test, as a second-year fellow, I initially dreaded receiving the results from what I thought had been a fair but difficult test. I suppose after years of studying exhaustively for tests and board exams, the prospect of being judged by my program leadership based upon a test for which I didn't extensively prepare was quite scary.
Interpreting the results
When the results became available in mid-April, around two months after completing the exam, each fellow was asked by our fellowship coordinator to set up a time to individually review our test results with our program director. My trepidation proved misguided as the meeting turned out to be very supportive and interactive. We reviewed the test results, which were formatted much like board exams with percentiles and content areas. Interpreting the results was straightforward, and I was able to quickly identify my strengths and weaknesses.
Because there were still several months left before the start of the next fellowship year, my program director and I were able to use the results to aid in scheduling my next year of training. For instance, I was relatively weak inlymphoma, so we ensured that I scheduled a lymphoma clinic for the following year. I also increased my reading about lymphoma and my attendance
at multidisciplinary lymphoma conferences.
Aside from changing my schedule, the test also identified broader areas that I needed to improve. For instance, I did not perform as well as hoped in "basic science principles." In an effort to improve my knowledge in this area, I have attempted to increase my basic science reading as it pertains to the diseases I am treating in clinic. I have also made more of an effort to attend conferences and seminars discussing basic science topics such as cancer biology.
The bottom line is that after I shook my concerns about being judged based upon my performance, I found this test to be an extremely useful self-evaluation tool. Last year's test aided in shaping my fellowship training and my continuing medical education. This year, I intend to use the test to gauge my knowledge as compared to my peers and to identify content areas upon which I will need to focus when preparing for my upcoming oncology board exam.
Based upon my positive experience, I encourage all oncology fellows to consider taking this test each year during fellowship. I hope that they also find this test to be a valuable educational tool.