Creating Educational Opportunities During Fellowship: Board Exam Prep, Live Meetings, and Beyond With Samuel Kareff, MD, MPH, and Matthew Hadfield, DO

Samuel Kareff, MD, MPH: Hi, everyone. Welcome to the next episode of the Oncology Data Advisor Fellows Forum. Today, I'm joined by Dr. Matthew Hadfield of Brown University. He's finishing his third year of Hematology and Medical Oncology Fellowship, and today we're going to have a continuation of last week's episode discussing educational initiatives and opportunities during fellowship. Welcome, Matt.

Matthew Hadfield, DO: Thank you so much, I'm really excited to be talking with you today.

Dr. Kareff: I want to go over a couple of questions reflecting on last week's episode, looking at educational resources and initiatives during fellowship. We can open with our first question here: what educational resources are you using to prepare for the hematology or medical oncology board exams?

Dr. Hadfield: I think fellowship has been a little bit of a different experience than residency was, and honestly, that was even different than medical school. I'm not sure if you feel the same way, but as I've progressed through training, I feel as though the well-delineated resources that we're so used to utilizing become less and less clear as you get further into training. In med school, there was the First Aid for the United States Medical Licensing Examination (USMLE) textbook, and there was Pathoma, and these are the resources you used. In residency, there was the Medical Knowledge Self-Assessment Program (MKSAP^®).

Then in fellowship, I feel as though I've been using a combination of primary literature, going through, for instance, the trial papers that delineate the National Comprehensive Cancer Network (NCCN) guidelines and things like that. But also, just as a scaffolding to work off, I've been using the American Society of Clinical Oncology (ASCO) Question Bank. I feel like that's been a good way to learn the material in real time and then supplement it with those other things that I've been using.

Dr. Kareff: I think you really hit the nail on the head there. As we're in medical school, especially in those preclinical years, there's an array of resources that are kind of passed down informally and formally from year to year. Then step two seemed a little bit less so, even in residency. Like you said, you've got the American Board of Internal Medicine (ABIM) practice questions, and after that, there's not a whole lot. It's really up to each learner, I think, to kind find her or his best path forward.

Two resources that I've really enjoyed using—and with no affiliation to either of them, just knowing that they're quite prevalent in the field—are the MD Anderson Board Review Series and then the George Washington (GW) Board Review Series as well. I've seen clippings from both of them and think they're both super helpful. I know there are other sorts of informal question banks out there that a lot of fellows will use, like you mentioned, and those can be helpful. But yes, it's really kind of up to fellowship culture and making sure that each successive class becomes aware. It's certainly been a challenge, but a rewarding one, I think, thankfully.

Dr. Hadfield: Absolutely.

Dr. Kareff: Going on to our next question, and this is changing the theme a little bit, how do you best teach other learners on your team, such as medical students and residents, when they rotate with you?

Dr. Hadfield: I feel like in Heme/Onc especially, the amount of knowledge that you can go over is quite vast, especially, for instance, if you have a medical student or a resident with you in clinic with an attending and you see a patient with stage III lung cancer. I mean, that in and of itself could be a several-hour conversation. You could go over the PACIFIC trial and all of the nuances—who was included, who wasn't included. It's valuable to take patient cases—for instance, that patient with stage III lung cancer or a patient with metastatic melanoma—and then talk about how BRAF mutations are most prevalent in metastatic melanoma and how that was really the basis for BRAF combination therapy in that patient population, just trying to highlight the relevant points for their level of training.

I think for a medical student, knowing the subgroup analysis of the DREAMseq trial isn't necessarily going to help them at all, but knowing how to diagnose immunotherapy-related pneumonitis will, as well as trying to tie it back to some type of board-relevant material for them. I try really hard when I have medical students or residents to figure out what their level of training is, what's going to help them with whatever tests they're going to be taking, and ultimately, what is going to help them in clinical practice in the future. That changes a little bit if someone is particularly interested in Heme/Onc or has expressed an interest in applying for oncology fellowship in the future; maybe you go a little bit more in depth with them. I'd be interested to hear how you approach teaching learners on your team.

Dr. Kareff: Again, that's a really great answer. You've really got to meet folks where they are, right? When I'm dropping in trials like PACIFIC and DREAMseq, I've already got my fellow/almost-attending mind on thinking about those subgroups like you were mentioning—talking about eligibility, applicability, generalizability, et cetera, and that's certainly way too high for the majority of trainees, either at the student or resident level. Two things that I like to do when I'm teaching on my team are to employ the cognitive load theory and then also do chalk talks, if possible.

Cognitive load theory, for those who might not have heard of it before, refers to the extrinsic or the intrinsic cognitive load that's associated with new topics. The way you can mitigate both of these is by presenting material in a very straightforward manner and making sure you cut out any extraneous or supplementary information. Like you just said, we don't want to be talking about subgroups for the PACIFIC trial because that's probably not relevant at the level even of an advanced trainee, like an internal medicine resident, but it's certainly relevant to discuss how it's changed standard of care and how that practice will be informed in years to come.

The other great example that I think we all do informally when we're teaching are these chalk talks. We take a lesson, like the example you gave of the inpatient case. If we've got a patient with a new diagnosis of acute leukemia and we want to teach trainees about the scary things—tumor lysis syndrome, disseminated intravascular coagulation—we can just go over brief mechanisms of these pathways and then review high-yield management topics. I think those are the best ways to tailor it to their level. But certainly, like you mentioned, you've really got to see where the trainee is at. I'll obviously assess his or her interest. That's crucial, of course, as well as making sure that the person is prepared for their board exam, certainly. I couldn't agree more with that.

All right, to close today's session, are there any other resources you'd like to highlight today that weren't mentioned during the last session related to these educational initiatives or topics?

Dr. Hadfield: You know, one thing that I've really done much more in fellowship than I did in residency is sought out social media as a jumping point for learning about new topics in oncology. There are several websites that do interviews, articles with primary investigators on studies, or point/counterpoint commentaries on trials. I think it's really, really helpful to hear some of the leaders in each field talk about different studies and maybe their critiques or how they'll adopt that into their clinical practice. I feel like it's just a good way to start greasing the wheels of thinking about my own opinions on a trial and maybe give me some starting points to start thinking about what I agree with and don't agree within a trial, or will I adopt this into my practice or will I not? I think those are much more prevalent and available in oncology than they were in residency, and it has certainly been helpful to augment some of those other materials that we've talked about.

Dr. Kareff: Absolutely. Twitter, of all the social media channels, is huge in the fields of hematology and oncology. One of my clinical and research mentors in residency pushed me a little bit, with my grinding teeth, to make sure that I created that account, and now I'm very happy that I have it. I feel like part of the community. I'm able to see those trial previews, like you mentioned, and really leave my mark on the field, which I think is wonderful and important as we ascend the ranks of our training.

Another resource I want to highlight—and I do believe this requires mandatory disclosure as i3 Health and Oncology Data Advisor are similarly aligned—is that i3 Health has wonderful live meetings, especially for fellowship programs, that I encourage you all to take a look at. We've adopted it here at the University of Miami into our curriculum, and we've really had great success with it. Essentially, they'll organize onsite or virtual CME discussions for you, your fellows, advanced practice providers (APPs), and even attendings if they wish to join the series.

At our institution, we've hosted one on thrombotic thrombocytopenic purpura (TTP), and we're soon to host one on another similar classical hematology topic. We've gotten great feedback from our fellows related to the relevancy and the urgency of the topics from national leaders. Definitely take a look at those if you're interested in adopting something new and novel, especially for connecting with experts who may or may not be outside your institution.

Dr. Hadfield: I agree.

Dr. Kareff: Awesome. Dr. Hadfield, do you have any other closing thoughts before we wrap up the session?

Dr. Hadfield: This was a fun conversation. I think, like we mentioned earlier, it's harder as you go through your training to find the scaffolding to work off of for studying for boards. Ultimately, that's something you have to do, but what we have to really grasp is how are we going to manage patients appropriately and master the vast amount of knowledge we have. I think highlighting some of these resources is important. As you mentioned, these onsite i3 Health CME events and podcasts, things that tie in national or international leaders on these subjects, really help solidify those concepts so that you can not only manage patients better, but so you can do better on things like standardized tests. It's important to incorporate all those types of resources.

Dr. Kareff: Absolutely, absolutely. As I gear up for the first half of my board exams just a few weeks from now, I'll let you know how successful these avenues were towards my passing.

Dr. Hadfield: Absolutely, the best of luck with that.

Dr. Kareff: Thank you, same to you, and thanks to all for listening today. That will wrap up our session on education in fellowship. Thanks a lot.

About Dr. Kareff and Dr. Hadfield

Samuel Kareff, MD, MPH, is a Medical Oncologist and a Hematology/Oncology Fellow at the University of Miami's Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital in Florida. He has special research interests in health advocacy, public policy, and the development of cancer therapies.

Matthew Hadfield, DO, is a Hematology/Oncology Fellow at Brown University/Legoretta Cancer Center in Providence, Rhode Island. His research focuses on melanoma and early-phase clinical trials, and his main areas of interest include early-phase drug development, novel immunotherapeutic combinations to overcome therapeutic resistance, and predictive biomarkers for immunotherapy toxicities.

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.