Classical hematology education in pediatric hematology/oncology fellowship: A national needs assessment

Abstract Introduction: Standardized content outlines exist for the education of Pediatric Hematology/Oncology (PHO) fellows during the three-year fellowship; however, education practices vary across fellowship programs. More specifically, fellowship education practices in classical hematology, and trainee opinions regarding this, are not known. The aim of this study is to investigate current practices in hematology education, in addition to PHO fellow and recent graduate perspectives on this matter. Methods: A literature search was conducted to review current knowledge about classical hematology education in PHO fellowship with a paucity of information identified. A needs assessment survey was then designed to assess clinical hematology experiences, clinical and research mentorship, educational experiences, learner attitudes, learner confidence, and demographics. The survey was composed of 26 questions, two of which were open-ended. IRB approval through the University of Michigan was obtained. The needs assessment survey was distributed across multiple electronic platforms and emailed out to 80 PHO fellowship program contacts for distribution. Target audience was any current PHO fellow or graduate within last 5 years (2018-2023) and the survey response period spanned three weeks from April-May 2024. Results: There were 124 recorded responses. Of those who provided demographic information, 49% were recent graduates (52/106), 14% were 1st year fellows (15/106), 17% 2nd year fellows (18/106), and 20% 3rd year fellows (21/106). Slightly over half of respondents (53% (63/118)) felt that the amount of time dedicated to classical hematology education was adequate, while 45% (53/118) felt it was inadequate. Overall satisfaction with classical hematology education in fellowship was mixed with 21% (25/118) reporting satisfaction, 42% (49/118) somewhat satisfied, 17% (20/118) neutral, 12% (14/118) somewhat dissatisfiedand 8% (10/118) reporting dissatisfaction. The majority of participants (73%, 82/112) reported having continuity with classical hematology patients in fellowship, however 20% (23/113) noted they did not have a hematology focused clinic or research mentor. Time spent on inpatient hematology services throughout fellowship varied widely, with a mean of 13.4 weeks the first year, 3.3 weeks the second year, and 2.7 in the third. Regarding educational practices, the most preferred method of education was teaching in clinic, with morbidity and mortality presentations noted as the least preferred. The open-ended questions inquired about factors which impacted hematology education and asked for any additional comments. Open ended responses were analyzed using thematic analysis and identified the following themes which were thought to impact education: clinical exposure, clinical demand, practice patterns, mentorship, and trainee educational demands. Discussion: This was the first needs assessment survey to report on the current educational practices and trainee perspectives on classical hematology in PHO fellowship. Analyzing both quantitative and qualitative response data highlighted the variability in hematology education practices nationally and identified factors important to trainees. The survey results provide generalized information for PHO as a specialty; however, results may be too generalized for individual programs which is a limitation. As each program is unique with respect to size and resources for education, tailored programming will still be needed to optimize classical hematology education at the institution level. The benefits of this survey have potential to extend beyond the short-term impacts of improving trainee experience and confidence in treating patients with hematologic disorders. As over half of respondents said they currently care for or plan to care for classical hematology patients after completion of training, it is plausible to hope that optimizing hematology education will inspire more into the workforce.