Hematology-oncology education in postgraduate internal medicine programs in Nepal: Current status and the pressing need for improvement.

Abstract

e21020 Background: Cancer accounts for huge non-communicable disease burden in Nepal with majority of patients presenting at an advanced stage accounting for 9% of total annual deaths. Diagnosis of cancer at advanced stages can result in missed treatment opportunities, worse outcomes, and higher health care costs which needs to be addressed. Many factors contribute to the delay in diagnosis and management of cancers but gap in physician knowledge attributing to lack of hematology-oncology training appears to be one of the major causes. Adequate hematology-oncology education for trainees therefore is essential for early diagnosis and improvement in outcome of the patients with problems related to cancer or its treatment. Herein we evaluated the current status of hematology-oncology education in post graduate Internal Medicine programs in Nepal. Methods: A prospective survey was conducted across 23 medical colleges offering Internal Medicine programs in Nepal from June 2024 to November 2024. Head of departments or faculty members from these Internal Medicine programs were invited to participate by completing the survey sent through emails online. A structured, self-administered questionnaire focusing on the current status of hematology-oncology education like rotations during training, availability of hematologist/ oncologist as faculty in the department for teaching-learning and availability of multidisciplinary team involved with diagnosis and treatment related to cancer was used. The curriculum of the internal medicine program was also evaluated for hematology oncology education framework used for the program. Results: Among the 23 medical colleges surveyed, only 9 (40.9%) included a mandatory hematology rotation, while 10 (45.5%) offered a mandatory oncology rotation. Most of the colleges offered rotation of 15 days to only a month during the 3 years residency training. Hematologist was available as faculty in only 7 (31.8 %) medical colleges while oncologists (medical oncologist and/or radiation oncologist) in 14 sites. Multidisciplinary team for cancer care exposure was available at 8 centers. The curriculums were non-uniform across various universities. None of the programs offered their residents an organized oncology curriculum or suggested a reference book or other oncology-related resource. Conclusions: The need of hematology oncology education during residency training with standardized curriculum in order to prepare next generation of physician in improving cancer care in Nepal seems to be a high priority in light of increasing cancer morbidity and mortality in the country.