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From Cancer Patient to Cancer Survivor: Lost in Transition
Undergraduate Medical Education
Cancer survivorship has not yet been well represented in medical school curricula. Only a few schools were identified as having courses or clerkships pertaining to cancer survivorship when the online database on medical school curriculum maintained by the American Association of Medical Colleges was searched (AAMC, 2005a).5 Some medical schools have, however, incorporated survivorship issues into the curriculum by including cancer survivors as “standardized patients” in what are referred to as “structured clinical instruction modules” (Plymale et al., 1999). These instruction modules involve medical students interacting with cancer survivors who have been trained to describe their medical history, symptoms, and concerns in a standardized way. Students interview and assess cancer survivors in this simulated, but realistic, clinical setting under the supervision of the faculty. Both the faculty instructor and the cancer survivor provide feedback to the trainees about their performances and, as time allows, the cancer survivor shares additional personal experiences with the trainees. An evaluation of one of these programs found that this method of instruction was considered beneficial for trainees and faculty members alike (Plymale et al., 1999). Emory University has added an educational program, “Survivors Teaching Students: Saving Women’s Lives” to the third-year medical students’ 6-week gynecology and obstetrics rotation. Survivors from the Georgia Ovarian Cancer Alliance volunteer to discuss their experiences, giving students an opportunity to understand the diagnosis of cancer from the patient’s perspective (Emory University, 2004).
A 4-year integrated curriculum in cancer survivorship is being developed under an NCI R25 grant for students at University of California Schools of Medicine (Los Angeles and San Francisco) and the Charles R. Drew University of Medicine and Science. Core competencies have been established and instructional material is being developed on topics such as the epidemiology of survival, risk assessment, treatment of late effects, psychosocial concerns, prevention strategies, and resources for cancer survivors (Box 5-2) (Stuber et al., 2003, 2004). Curricular materials include problem-based learning cases, multimedia web-based problems, a targeted preceptorship experience, and exercises to develop skills in behavior change
The online database maintained by the American Association of Medical Colleges is called the Curriculum Management and Information Tool (CurrMit®). The database was searched using the following terms: Cancer AND (rehab OR quality of life OR late-effects OR late effect OR long-term effect OR long term effect OR patient surveillance OR follow-up OR follow up OR surviv OR chronic). The names of required courses and clerkships are available for all medical schools, but only 60 percent of schools have provided additional detail about the coursework.