Revolutionizing hematology/oncology education through visual storytelling and gamification for internal medicine residents

Abstract Introduction: Hematology/oncology (heme/onc) is an often-overlooked specialty among internal medicine didactic curricula. In one residency program, in-service examination scores consistently demonstrated a relative weakness in heme/onc, often ranking as the lowest-scoring subsection. Preliminary resident feedback also suggested opportunities for growth within the current curriculum, specifically regarding the development of heme/onc lectures that were applicable to internal medicine residents and board examinations. To meet this goal, we sought to enhance the current curriculum through multimodal education by integrating traditional didactic presentations along with specific lectures utilizing visual storytelling, memory palaces, and gamification. Methods: Prior to the start of the curriculum, participants completed a survey consisting of 5-point Likert scale questions from 1 - strongly disagree to 5 - strongly agree regarding their perceptions of heme/onc, including confidence, passion, perceived knowledge, and perception of the field. A free response section was also included to assess areas of improvement within the program's heme/onc didactic curriculum and rotations. The end of this survey included a 16-question quiz to assess baseline knowledge. Over the course of the year, residents were provided the standard number of heme/onc didactic lectures from specialists, in addition to ten separate heme/onc lectures delivered by internal medicine residents. One lecture was formatted to teach hemolytic anemia through visual storytelling of a “murder mystery” and “jewel heist,” where the clues were common diagnoses for extrinsic and intrinsic hemolytic anemias. Another lecture was formatted as a team-based game to review commonly tested heme/onc topics on the American Board of Internal Medicine Exam. Following this curriculum, residents were provided the same survey to reassess whether attitudes or knowledge base had changed with the development of this curriculum. An unpaired t-test was used for data analysis. Results: 20 pre-curriculum and 14 post-curriculum surveys were collected from medical students, residents, and faculty. Residents had a significant improvement in the number of correct responses between the pre-quiz to post-quiz (mean 52.5% vs 80%, p = 0.00015); however, individual perception of heme/onc knowledge did not differ significantly between the pre and post-test Likert surveys. Confidence regarding addressing real-world heme/onc clinical scenarios increased from 20% of participants in pre-test surveys to 86% on post-test responses. Enjoyment with learning heme/onc topics increased from 60% to 92%. Thematic analysis of free responses pre- and post- consistently emphasized a desire to tailor future didactics and heme/onc rotations toward relevant board review topics and applicable general medicine content. Several responses also requested access to condensed reference sheets to facilitate continued learning. Conclusion: This pilot curriculum demonstrated that using a variety of modalities to teach hematology and oncology can improve internal medicine residents' knowledge on commonly tested topics. Resident confidence in encountering heme/onc scenarios and enjoyment in the specialty also increased with this format. Free responses suggested tailoring didactics toward board examinations and general medicine content was especially helpful, and condensed reference sheets on heme/onc topics may further enhance ongoing learning. Based on these findings, we aim to design a year-long, multimodal curriculum to elevate interest in heme/onc and improve internal medicine resident knowledge in this field.