Abstract

The WHO-Collaborating Centre for Cancer Education - Groningen, was asked in 1990 by the World Heath Organization (WHO) and the International Union Against Cancer (UICC) to design and execute a survey on Undergraduate Cancer Education in European Medical Schools. Two instruments were constructed: a Faculty Questionnaire and a Student Questionnaire. The Faculty Questionnaire investigated the infrastructure, the content and the resources of cancer education in medical schools. The Student Questionnaire surveyed student-encounters with cancer patients; and student-opinions concerning the content of cancer education in their medical school. One hundred and eighteen faculty members participated in the faculty-survey, and 383 students in the student survey.

Some striking results of the Faculty Questionnaire.

• In 69 medical schools there was a specific cancer education course, multidisciplinary in nature, and most of the time organized by clinicians, sometimes basic scientists were involved.
• There were inpatient and outpatient oncology divisions in about two-third of the main clinical departments, students rotated through less than half of these units.
• In multidisciplinary cancer patient management conferences, student attendance was more often occasionally than regularly, and in only 25% compulsory.
• Cancer care and cancer control were considered to receive insufficient attention.
• Occasionally schools provided their students with cancer education objectives.
• Lecturing was the predominant cancer education teaching method; electives were relatively neglected.
• Oral examinations, clinical examinations and multiple choice questions were the popular cancer education evaluation methods. A specific cancer examination existed in one out of four schools.
• Cancer education reports and journals were relatively unknown.

Some striking results of the Student Questionnaire

Students, 9 months or less away from their final (MD) exam, produced 383 processable questionnaires. Remarkable was the wide range in the number of cancer patients seen by students. Moreover, there was also a wide range of variation between individual students. These findings did not correlate with medical school or with seniority of students.

The opinion of the students with respect to the attention paid to aspects of cancer control and cancer care was predominantly insufficient; this equaled the above mentioned opinion of faculty. The final question of the Student Questionnaire was an open-end question: "What three things would you suggest could be done that would improve cancer education at your medical school?" Considering only suggestions from experienced (2 months or less away from their MD-examination) respondents, the following suggestions ranked highest:

1. more psychosocial aspects and communication skills
2. more time in the curriculum
3. better teaching, teacher training
4. more patients, more bedside teaching.

Conclusion

From the Faculty Questionnaire it could be concluded that there was a lot to do with respect to cancer education. Students could encounter much more cancer patients than actually was realized. This applied to the inpatient facilities and a fortiori to the outpatient facilities. The results of the Student Questionnaire demonstrated that opportunities were unequally distributed among medical schools; generally the average number of cancer patients seen by medical students was low. Also, marked differences within individual medical schools were found between individual students. This may reflect teacher policies and/or student initiatives. It could be concluded that whether student encounters with cancer patients really take place, depends on opportunities, on teacher policies and on student initiatives.