Junior doctors are deterred from pursuing careers in oncology and palliative medicine after being thrown unprepared into managing complex cancer patients during their intern years, a WA doctor says.
Dr Kristyn Langworthy a West Australian medical graduate says the lack of oncology education and clinical exposure in the undergraduate curriculum means that junior doctors are not being equipped to manage the cancer patients they commonly see during their first years of work.
Despite being ‘passionate’ about oncology and palliative medicine as an intern, she says she felt overwhelmed and unskilled when faced with caring for cancer patients who often had complex medical and psychosocial needs.
Writing in the Journal of Cancer Education, she her experience of oncology teaching was “contradiction, overlap and overall confusion. The basic principles were not a core part of my teaching, with emphasis on specifics and assessment plans that did not encourage broad knowledge.”
“I felt underprepared to handle many of circumstances that I faced, including certifying my first death and managing patients post-cancer treatment including surgical and chemotherapy treatments”.
She describes one situation on an emergency rotation when she struggled to manage a patient with ovarian cancer and abdominal pain after surgery, lacking confidence in taking a basic history and not knowing which medications and postoperative complications were relevant.
“It is disappointing to think that a junior doctor is expected to manage these complex patients with little understanding of cancer biology or disease management,” she writes.
Dr Langworthy notes there is already an “Ideal Oncology Curriculum” and this could be used with an oncologic-specific exit exam to improve medical students’ knowledge and preparedness for practice.
Her suggestions for potential solutions to improve oncology skills include arranging for the long-term follow-up of a patient, using student societies to augment learning and practicing the non-technical skills related to palliative medicine, such as breaking bad news with patients who are cancer survivors.
“Utilising the community-based resources involved in cancer screening, general practice opportunities (particularly around women’s health practice) and improving the overall coordination of teaching, without necessarily adding content, would go a long way to establish and cement a knowledge base,” she writes.