Introduction

In 1990 the WHO Collaborating Centre for Cancer Education in Groningen was requested by WHO and UICC to study the status of undergraduate cancer education in Europe. The results were meant to be the empirical basis for a discussion within a WHO/UICC working group meeting in Prague, Czechoslovakia (April 1992).

Construction of the instruments

From the beginning it was clear that a survey about cancer education would only deliver useful data if both producers and consumers were addressed. In other words, we needed two instruments: one that would apply to medical faculty, and one that would address medical students. Assistance in constructing the questionnaires (1991) was asked from and provided by several experts in medical and educational disciplines:
  Prof. R.F. Bakemeier, MD, Denver, USA
  Prof.dr. J. Battermann, MD, Utrecht, the Netherlands
  Prof. C.M. Brooks EdD, Birmingham at Alabama, USA
  Prof. S. Brown jr EdD, Birmingham at Alabama, USA
  Dr. D.W. Clarke MEd, Blunham, United Kingdom
  Dr. L. Döbrössy MD, Copenhagen, Denmark (WHO Euro)
  Prof. R. MacKie MD, Glasgow, United Kingdom
  Prof. C.D. Sherman jr MD, Rochester NY, USA (UICC)
  Dr. D.Th. Sleijfer MD, Groningen, the Netherlands
  Dr. Y. Silberberg PhD, Houston, USA
All these experts were actively involved in cancer education in several parts of the world, and they were associated either with the World Health Organization (WHO), the Union Internationale Contre le Cancer (UICC), the American Association for Cancer Education (AACE) and/or the European Association for Cancer Education (EACE).
Most helpful were the survey-instruments of the AACE that had been used in the late nineteen-seventies and around 1988 to map the status of cancer education in the United States.¹

Two questionnaires, a Faculty Questionnaire and a Student Questionnaire, were developed. The Faculty Questionnaire investigated the infrastructure, the content and the resources of cancer education in medical schools. The Student Questionnaire surveyed the student-encounters with cancer patients, and student-opinion concerning the content of cancer education in their medical school. The Student Questionnaire was pilot-tested in 1991 with a group of 10 medical students in Groningen University Faculty of Medicine, the Netherlands.

Recruiting participants

Generally, surveys suffer from lack of response. Considering this fact, and considering that surveys sometimes address the wrong persons, it was decided to follow a two-step approach. A letter was written to the deans of the medical schools in Europe which were mentioned in the WHO Directory of Medical Schools. The letter explained the why and how of the faculty-survey and requested the dean to name the person in the medical school who would be the appropriate respondent.
By following this procedure we had a double goal: we tried to catch the personal interest of the dean without asking much of his time, and we hoped to find the competent person to respond to our survey. The approach proved to be successful: of the 374 deans, 165 (44%) provided us with the requested names and addressess. Of the 165 potential respondents, 118 (71%) complied with our request and participated in the faculty-survey.

Content of the letter to the deans

Groningen, January 15th, 1991

Dear Dean,

Questionnaire-survey on undergraduate cancer education in Europe, 1991

  In 1981, the International Union against Cancer (UICC) and the World Health Organization (WHO) organized a meeting on undergraduate education in cancer in the European Region. The eight recommendations which resulted from the meeting were published in Volume 49 of the WHO/EURO Reports and Studies series, 1981 (annexed).
  Now, ten years later, a follow-up meeting is planned by UICC and WHO with the purpose of taking a "second look" at the status of undergraduate cancer education in Europe. This follow-up meeting will be attended by representatives of international organizations active in cancer education, as well as by temporary advisers invited because of their individual expertise in the field. The meeting is to revise the progress made in this area since 1981, to update the recommendations, if necessary, to advise the Deans of medical schools and faculties in Europe on educational programmes which would suit the needs of the 1990s. `
  Prior to this meeting, which is planned to take place in Prague, Czechoslowakia in April 1992 (in connection with the Fifth Annual Scientific Meeting of the European Association for Cancer Education - EACE) a questionnaire-survey on current aspects of undergraduate medical cancer education will be carried out by the WHO Collaborating Centre for Cancer Education.
  On behalf of UICC and WHO, I ask you kindly to consider your participation in this European Cancer Education Survey. If your reply is positive, would you please designate a faculty member - preferably someone directly involved in cancer education - who would represent your school or faculty in this Survey. To inform me on your decision, a form to complete with the name and address of the designated faculty member is enclosed.
  Your cooperation in this challenging area is greatly appreciated.
  Awaiting your reply, please before February 15, 1991.
  Sincerely yours,
  Prof.dr. J. Oldhoff.

The overall response rate was satisfactory in the Western part of Europe. The low response rate in the East and Central European countries was fully accounted for by the (former) Soviet Union and (former) Yugoslavia; therefore it was most probably an artefact of the political situation.
The representatives of the Medical Schools were not only requested to fill in the Faculty Questionnaire; they were also requested to play an intermediate role in recruiting respondents for the student-survey. This resulted in 383 processable Student Questionnaires.

Content of the letter to the designated representatives

Groningen, October 11, 1991

Dear colleague,

  As WHO-Collaborating Centre for Cancer Education we have been charged by WHO and UICC to trace current developments in undergraduate cancer education in Europe. Your Dean agreed that your Medical School will participate in this survey and we thank you for accepting the designation by your Dean to represent your school/faculty in this survey.
  The enclosed Faculty Questionnaiore addresses several aspects. Most of the questions can be answered easily (yes/no, etc.), so that will not take too much of your time. However, there may be some questions, that you may not be able to answer because it relates to another department than yours. We would highly appreciate it if you would be so kind as to contact the person in your medical school who would give you the answer.
  Also enclosed are 10 copies of a Student Questionnaire with return envelopes about the same subject. We would highly appreciate your collaboration in distributing these copies among 5 - 10 students who are within three months of graduation as a medical doctor.
  The results of this survey will be presented and discussed in a working group meeting of WHO/UICC April 28-29, 1992 in Prague and will be reported and discussed at the Fifth Scientific Meeting of the European Association for Cancer Education in Prague, April 29 - May 2, 1992.
  We would like you to return the questionnaire before November 15, 1991.
  Thanking you very much for your cooperation.
  Sincerly yours,
Prof.dr. J. Oldhoff

Some methodological remarks beforehand

Consultation of experts and a pilot-study could not fully cover the fact that the survey was written in a language that was neither the native language of the designers nor of most of the respondents. Moreover, the respondents were from different cultures and different health care systems. We did not want to argue that our results were seriously invalidated by these problems, but we wanted to make clear that the cool figures of this survey may have to be annotated by these observations.

References

1. Bakemeier RF et al: Cancer Education Survey: Institutional Educational Resources for cancer education in U.S. Medical Schools. Vol. 1. DHHS   Publication No. 81-2255. Bethesda, Maryland: Nat Inst of Health (1981)
2. Haagedoorn EL. Thesis: Aspects of Cancer Education for Professionals. Groningen University Faculty of Medicine, Groningen, the Netherlands. Published by Haagedoorn EL, printed by Mondeel B.V. Amsterdam. 1985