The disconnect between hematology/oncology fellowship training and real-world practice requirements has come into sharp focus, as new research reveals significant gaps in preparing fellows for community-based careers. This disparity is particularly concerning given that 80-85% of cancer patients receive their treatment in community settings.
A comprehensive national assessment, published in JCO Oncology Practice, examined the training needs of hematology/oncology providers in community and academic-community hybrid settings. The study, led by Dr. Shubham Agrawal from the University of Minnesota Medical School, surveyed practicing oncologists across the United States from March 2022 to February 2023.
Current Training Landscape
The survey findings paint a stark picture: only 41.8% of respondents received specific training for community-based careers during their fellowship. Among the high-impact experiences reported, rotations in community clinic settings (44.8%) and exposure to community-based clinical trials (20.8%) were most frequently cited.
"Currently, most fellowship training programs are based in major academic centers, and few, if any, offer specific pathways tailored to community-based hematology/oncology," notes Dr. Agrawal. This limitation forces fellows interested in community-based careers to independently seek relevant experience.
Identified Training Needs
Healthcare professionals identified several key areas where additional training would better prepare fellows for community practice:
- Clinical operations and healthcare administration (63.2%)
- Health policy issues (35.2%)
- Quality improvement initiatives (27.2%)
- Palliative care education (28%)
- Direct mentorship from community-based physicians (40%)
Program Directors' Perspective
A parallel survey of fellowship program directors revealed that while 96% of programs have graduates pursuing community-based careers, only 74% offer clinical community-based experiences. Even more concerning, just 32% provide nonclinical experiences in community settings.
Future Directions
The research team is now focused on developing evidence-driven training pathways for fellows interested in community-based careers. "Given the changing landscape of community-based hematology/oncology care models, it is imperative to incorporate these experiences in fellowship training to adequately prepare current trainees for their future roles," emphasizes Dr. Agrawal.
The study found that practitioners with less than 10 years of experience were more likely to have received community-based training during fellowship, suggesting a gradual shift in training approaches. However, the findings underscore the urgent need for more comprehensive preparation for community practice, where the majority of cancer care is delivered.
