Background:

High-quality, equitable HO care depends on clinicians' ability to effectively communicate complex, rapidly evolving science in language patients and families understand, particularly those with limited health literacy. Yet despite communication being a core ACGME competency, CST in fellowship is limited. A multi-institutional needs assessment survey showed that HO fellows are not comfortable with key technical communication aspects of HO practice including discussing medical literature and explaining genetic testing results, revealed strong fellow endorsement for formal CST in fellowship, and explored preferred model of CST (Nassar et al, JCO 43, e21032). To address this crucial gap in training, enrich fellows' learning experience, and prepare fellows for independent practice we implemented and evaluated a four-workshop peer-led CST curriculum at an academic HO fellowship program.

Curriculum design and evaluation:

Senior fellows, with program leadership support, delivered the first iteration of the curriculum over four 60-90 minute workshops between Oct 2024 – Jan 2025. Workshop topics were the first oncology visit, medical literature/ clinical trial discussions, progression / palliative transition discussions, and hematology-specific challenges (e.g. CART, HSCT). Each session used rolling role-play; mini-scenarios in which each fellow handled a communication challenge. Faculty offered real-time feedback and practical communication pearls. Food was provided to boost attendance, direct cost was <$100 per workshop.

We designed a two-year, mixed methods evaluation using the Kirkpatrick model. Immediate reaction was captured by short paper survey administered before and after each workshop, and an electronic post-curriculum survey that replicated the baseline needs assessment survey was distributed 6 months after the workshops to capture long-term learning. Responses were graded on a Likert scale from 1 (very uncomfortable) to 4 (very comfortable). Qualitative free-text responses were also sought. Following the second iteration, behavior and impact will be assessed through graded direct observation in a clinical setting and patient satisfaction questionnaires, respectively.

Results:

13 fellows attended at least 2 workshops, 11 completed the post-curriculum survey. Workshop surveys showed immediate gains of Likert point in comfort with the day's objectives across all four workshops. 6 months later, these gains were durable and evident on the post curriculum survey. Mean comfort rose in all the assessed areas compared to the pre-curriculum baseline with notable gains in delivering complex medical information while maintaining empathy (3.5 ± 0.5; Δ +0.5), assessing patient understanding and tailoring information (3.4 ± 0.7; Δ +0.5), discussing new cancer diagnosis (3.6 ± 0.5; Δ +0.6), explaining complex test results e.g. genetic testing (3.1 ± 0.5; Δ +0.4), and discussing treatment change at progression (3.3 ± 0.5; Δ +0.5). Comfort discussing clinical trial enrollment (2.9 ± 0.7; Δ +0.6) and discussing medical literature (2.9 ± 0.7; Δ +0.3) improved but remained the lowest scoring areas which will be targets for year 2 refinement. Confidence in delivering knowledge and in proposing treatment plans also rose. All respondents found the curriculum beneficial, found the topics to be relevant to practice, and agreed that the curriculum enhanced their communication skillset and their ability to handle certain clinical scenarios. Qualitative comments were positive and provided feedback on implementation that will be incorporated in year 2 iteration.

Conclusions:

A fellow-designed, low-cost CST curriculum yielded durable improvements in fellows' self-reported comfort and confidence in communication. Persistent discomfort in medical literature and clinical trial enrollment discussions will be addressed in the second iteration which will incorporate fellow feedback, evaluate behavior change through direct observation, and measure impact through patient reported outcomes. This scalable, peer-driven, interactive model offers a practical guide for other programs to meet ACGME communication competency requirements and to advance patient-centered equitable care.

This project was conceived and carried out as part of the American Society of Hematology Medical Educators Institute (MEI). We gratefully acknowledge the mentorship and support of Dr. Erin Reid and Dr. Layla Van Doren.

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2025
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