Tumor Board Simulation Improves Interdisciplinary Decision-making in Medical Students

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2024 Aug 30

PMID 39212783

Authors

Kevin Fink

Marie Forster

Matthias Oettle

Marcel Buttner

Chukwuka Eze

Lukas Kasmann

Amanda Tufman

Diego Kauffmann-Guerrero

Toki A Bolt

Julia Kovacs

Jens Neumann

Johannes Mucke

Sonja Heuser

Stefanie Corradini

Franziska Walter

Maximilian Niyazi

Claus Belka

Martin Dreyling

Martin R Fischer

Daniel F Fleischmann

Affiliations

Soon will be listed here.

Abstract

Introduction: Training of interdisciplinary clinical reasoning and decision-making skills, essential in daily clinical practice in oncological specialties, are still underrepresented in medical education. Therefore, at LMU University Hospital Munich, we implemented a didactically modified tumor board simulation with experts from five different disciplines (medical oncology, pathology, radiation oncology, radiology, and surgery) presenting patient cases into a one-week course on the basic principles of oncology. In this survey, we examined the self-assessed impact of our course on the interdisciplinary decision-making skills of medical students.

Methods: Between November-December 2023 and January-February 2024, we surveyed two cohorts of medical students in the third year of medical school in our one-week course before and after participating in the tumor board simulation. The objective was to evaluate the self-assessed knowledge in interdisciplinary clinical decision-making, in integrating ethical considerations into clinical reasoning, and in comprehension of various professional viewpoints in interdisciplinary decision-making. Knowledge was assessed using a five-step Likert scale from 1 (no knowledge) to 5 (complete knowledge).

Results: The survey was answered by 76 students before and 55 after the simulation, equaling 60-70% of all 100 course participants. Mean knowledge level regarding principles of interdisciplinary clinical decision-making improved significantly in all of the following exemplary aspects: purpose and procedure of tumor boards in clinical practice (from 2.4 ± 1.1 to 4.0 ± 1.0, Spearman's ρ = 0.6, p < 0.001), principles of dealing with ethical challenges in oncology (from 2.4 ± 1.1 to 3.4 ± 1.0, ρ = 0.4, p < 0.001), and principles of shared decision-making in oncology (2.7 ± 1.1 to 3.7 ± 1.0, ρ = 0.4, p < 0.001). Students reported that their skills in clinical decision-making and ability to discuss oncological patient cases from different professional viewpoints improved due to the teaching course.

Conclusion: By employing our interdisciplinary one-week course and a didactically modified tumor board simulation featuring experts from various oncological disciplines, medical students' comprehension of interdisciplinary clinical decision-making in oncology improved significantly.

References

Lee B, Chiu N, Li C . Value of case-based learning in a nuclear medicine clerkship. J Am Coll Radiol. 2013; 10(2):135-41. DOI: 10.1016/j.jacr.2012.07.015. View

Mateo J, Steuten L, Aftimos P, Andre F, Davies M, Garralda E . Delivering precision oncology to patients with cancer. Nat Med. 2022; 28(4):658-665. DOI: 10.1038/s41591-022-01717-2. View

de Haes H, Koedoot N . Patient centered decision making in palliative cancer treatment: a world of paradoxes. Patient Educ Couns. 2003; 50(1):43-9. DOI: 10.1016/s0738-3991(03)00079-x. View

Kocarnik J, Compton K, Dean F, Fu W, Gaw B, Harvey J . Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2021; 8(3):420-444. PMC: 8719276. DOI: 10.1001/jamaoncol.2021.6987. View

Hassoulas A, Forty E, Hoskins M, Walters J, Riley S . A case-based medical curriculum for the 21st century: The use of innovative approaches in designing and developing a case on mental health. Med Teach. 2017; 39(5):505-511. DOI: 10.1080/0142159X.2017.1296564. View

Andersson H, Svensson A, Frank C, Rantala A, Holmberg M, Bremer A . Ethics education to support ethical competence learning in healthcare: an integrative systematic review. BMC Med Ethics. 2022; 23(1):29. PMC: 8933936. DOI: 10.1186/s12910-022-00766-z. View

Wright F, De Vito C, Langer B, Hunter A . Multidisciplinary cancer conferences: a systematic review and development of practice standards. Eur J Cancer. 2007; 43(6):1002-10. DOI: 10.1016/j.ejca.2007.01.025. View

Kanan D, Kanan T, Kalyenci N, Nanah A, Tarbaghia M, Ekmekci B . A Successful Model for an Introductory Oncology Teaching Conference and Its Impact on Preclinical and Clinical Medical Students. JCO Oncol Pract. 2022; 18(6):e907-e914. DOI: 10.1200/OP.21.00463. View

Blazeby J, Wilson L, Metcalfe C, Nicklin J, English R, Donovan J . Analysis of clinical decision-making in multi-disciplinary cancer teams. Ann Oncol. 2005; 17(3):457-60. DOI: 10.1093/annonc/mdj102. View

10.

Maurer I, Drescher R, Hammersen J, Dieckmann N, Gremme Y, Sturm M . Development and implementation of a student tumor board as a teaching format for medical students. J Cancer Res Clin Oncol. 2023; 149(17):16087-16096. PMC: 10620267. DOI: 10.1007/s00432-023-05336-3. View

11.

Mattes M . Multidisciplinary Oncology Education: Going Beyond Tumor Board. J Am Coll Radiol. 2016; 13(10):1239-1241. PMC: 5517077. DOI: 10.1016/j.jacr.2016.06.005. View

12.

Wilson A, Brooks W, Edwards D, Deaver J, Surd J, Pirlo O . Survey response rates in health sciences education research: A 10-year meta-analysis. Anat Sci Educ. 2023; 17(1):11-23. DOI: 10.1002/ase.2345. View

13.

de Koning R, Egiz A, Kotecha J, Ciuculete A, Ooi S, Bankole N . Survey Fatigue During the COVID-19 Pandemic: An Analysis of Neurosurgery Survey Response Rates. Front Surg. 2021; 8:690680. PMC: 8388838. DOI: 10.3389/fsurg.2021.690680. View

14.

Soukup T, Lamb B, Arora S, Darzi A, Sevdalis N, Sa Green J . Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J Multidiscip Healthc. 2018; 11:49-61. PMC: 5783021. DOI: 10.2147/JMDH.S117945. View

15.

Lanceley A, Savage J, Menon U, Jacobs I . Influences on multidisciplinary team decision-making. Int J Gynecol Cancer. 2007; 18(2):215-22. DOI: 10.1111/j.1525-1438.2007.00991.x. View

16.

Prades J, Remue E, Van Hoof E, Borras J . Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes. Health Policy. 2014; 119(4):464-74. DOI: 10.1016/j.healthpol.2014.09.006. View

17.

Ferlay J, Colombet M, Soerjomataram I, Dyba T, Randi G, Bettio M . Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018; 103:356-387. DOI: 10.1016/j.ejca.2018.07.005. View

18.

Ma A, OShea R, Wedd L, Wong C, Jamieson R, Rankin N . What is the power of a genomic multidisciplinary team approach? A systematic review of implementation and sustainability. Eur J Hum Genet. 2024; 32(4):381-391. PMC: 10999446. DOI: 10.1038/s41431-024-01555-5. View

19.

Berman N, Durning S, Fischer M, Huwendiek S, Triola M . The Role for Virtual Patients in the Future of Medical Education. Acad Med. 2016; 91(9):1217-22. DOI: 10.1097/ACM.0000000000001146. View

20.

Heinrich K, Miller-Phillips L, Ziemann F, Hasselmann K, Ruhlmann K, Flach M . Lessons learned: the first consecutive 1000 patients of the CCCMunich Molecular Tumor Board. J Cancer Res Clin Oncol. 2022; 149(5):1905-1915. PMC: 9261163. DOI: 10.1007/s00432-022-04165-0. View