Background
The availability of medical cannabis (MC) is increasing across the United States,1 with combined medical and recreational cannabis sales projected to exceed >$30 billion in 2024.2–4 Studies indicate that cannabis use is prevalent in oncology populations, with usage rates ranging from 25% to 40% in US-based survey studies.5,6 Patients with cancer are showing increasing interest in exploring the potential benefits of MC for various purposes, including symptom management, quality of life improvement, and as a therapeutic intervention for cancer.7 However, evidence supporting or refuting MC for most cancer-related indications remains limited.8,9
Scientific evidence suggests that although patients with cancer would prefer to seek guidance from their oncology providers regarding MC rather than relying on other potential sources,6 oncology providers and care teams are often unaware of their patients’ cannabis use.10,11 This discrepancy may in part be explained by the fact that most oncology providers do not feel sufficiently knowledgeable on the subject.12 Recent guidelines from ASCO highlight the importance of open communication between oncology providers and their patients regarding cannabis and cannabinoid use.9
Hematology/Oncology fellows represent the future of the oncology workforce, and their required training curricula must encompass contemporary issues and practices in cancer care. In a national survey of hematology/oncology fellows, we previously demonstrated that although more than half (57%) reported discussing MC with their patients, only 13% felt knowledgeable enough to guide these clinical discussions.13 Furthermore, prior training in MC was uncommon, with only 24% of fellows reporting such training. Notably, fellows who had received prior training were 5 times more likely to feel adequately knowledgeable during subsequent clinical interactions. These findings highlight a significant unmet need for education on MC use among hematology/oncology trainees.
We compiled MC content and convened a multidisciplinary team of clinicians and medical education experts from oncology, hematology, psycho-oncology, and general medicine to develop a 1-hour webinar on MC use in patients with cancer for oncology fellows. A multicenter pretest-posttest trial was conducted to evaluate the feasibility of implementing this curriculum, including its impact on attitudes surrounding MC discussions, the curriculum’s acceptance and actionability, and changes in fellows’ self-reported confidence.
Methods
Study Design
We conducted a pilot study to evaluate the feasibility of developing and implementing an educational curriculum on the use of MC in patient care for oncology trainees.14 An invitation for training programs to participate in the study was posted on a public forum for program directors through ASCO. The curriculum was deployed as a 1-hour interactive webinar at 8 hematology/oncology fellowship programs across the United States: Beth Israel Deaconess Medical Center, Dana-Farber/Massachusetts General Brigham, Loma Linda University, University of Massachusetts, Tufts Medical Center, University of Pittsburgh Medical Center, Loyola University, and Trinity Health Ann Arbor Hospital. Three separate synchronous webinars were conducted between 2022 and 2023. Attendance of the webinar, participation in the study, and completion of study instruments were all optional for individual trainees within the participating programs. Trainees who completed the surveys were offered a $10 gift card as an incentive. This study was deemed exempt by the Institutional Review Board at Beth Israel Deaconess Medical Center.
Development of the Curriculum
The online curriculum was developed using Kern’s 6-step approach to curriculum development in medical education. Key tenets of this approach include identifying an unmet curricular need through a well-conducted needs assessment, integrating both didactic and interactive components into the curriculum through instructional design, and using pre- and post-curriculum surveys to assess the impact on users and their experience.15,16
Steps 1 and 2: Problem Identification, General and Targeted Needs Assessment
As detailed earlier, our previous needs assessment, conducted via survey of US hematology/oncology trainees13 revealed that participants emphasized the need for training on MC use in domains such as indications for use, pharmacology, and delivery logistics. Based on literature review and feedback from survey participants, we identified educational goals and learning objectives, including key topics to be covered in the proposed curriculum, with input from the content experts.
Step 3: Goals and Objectives
The curriculum was divided into 5 modules based on the key topics identified: (1) historical context, biology of the endocannabinoid system, and pharmacology and pharmacokinetics of cannabinoid administration methods; (2) critical appraisal of evidence regarding the role of MC in cancer-related symptom management; (3) role of MC in cancer-directed therapy and oncogenesis; (4) safety of MC; and (5) legal considerations relating to federal and state-specific MC policies, including strategies for communicating with patients (Supplementary Table S1, available online in the supplementary materials).
Step 4: Educational Strategies
We selected an online webinar format as the educational strategy for its convenience, ability to maximize participation, and alignment with general educational oncology sessions already available at participating sites. Several principles of adult learning science were leveraged in the design of the curricular content.17 Recognizing the importance of primacy, each module was accompanied by succinct learning objectives that were presented at both the beginning and end of each module. Delivery of educational content in each model was further designed with an emphasis on limiting extrinsic cognitive load. To allow participants to practice communication skills and consolidate their knowledge,18,19 the last module included an interactive component in which participants were invited to engage with presenters in role-playing scenarios to simulate common queries related to MC that arise in oncology clinic.
Step 5: Implementation
A panel of 7 early-career hematology/oncology attending physicians from Dana-Farber/Harvard Cancer Center (<5 years since year of fellowship) was assembled as a focus group to review the curriculum before implementation. Participant feedback was used to further refine both the content and instructional design. The study instruments were pilot-tested by the focus group for length and clarity, with modifications made based on the feedback received. After implementation, the curriculum was periodically reviewed by members of the study team (R. Patell, P. Bindal, I.M. Braun, D. Rangachari) to ensure the content remained accurate and up to date. For curriculum delivery, 2 presenters (R. Patell, P. Bindal) conducted the sessions virtually using slide format. The process for vetting participating programs and delivering the curriculum was described earlier.
Step 6: Evaluation and Assessment
Three study instruments (pretest, posttest, and follow-up tests) were designed to assess the impact of the webinar. The questionnaire covered domains such as attitudes and perceived norms regarding MC discussions with patients, using 5-point Likert scales. The posttest also included questions about the perceived utility of the curriculum and the adequacy of its content. Additionally, respondents were asked if they were more likely to initiate conversations about MC for symptom management after attending the webinar.
A composite self-efficacy index was developed based on 4 survey items. These questions asked respondents to rate their confidence in conducting clinical discussions about MC regarding its (1) efficacy, (2) risks, (3) modes of use, and (4) role in symptom management in patients with cancer.
Additionally, 3 open-ended questions were included in the posttest instrument: (1) “Describe any barriers to using the educational curriculum at your training program,” (2) “Share any thoughts on the educational curriculum,” and (3) “Share thoughts on the use of MC in patients with cancer.” Follow-up surveys also included questions asking respondents how frequently they discussed and recommended MC since attending the webinar. Surveys were distributed anonymously via the web-based REDCap Survey platform (Research Electronic Data Capture).20,21
Pretest surveys assessing these factors were sent to oncology fellows 24 hours prior to the scheduled webinar, with a reminder sent immediately before the webinar. Posttest surveys were sent immediately after the webinar (with 2 weekly reminders) and follow-up surveys were sent 12 weeks later, with follow-up reminders sent a week apart.
Feasibility Outcomes
We reported participants’ attitudes and perceived norms regarding MC discussions, including need, value, and expectations from trainees and attending physicians in their practice, as measures related to culture (Supplementary Tables S2–S4). Other feasibility outcomes, assessed by the posttest survey, included acceptability—whether participants found the curriculum useful—and compatibility—whether they would recommend the curriculum to colleagues and if attending the webinar made them more likely to discuss MC with their patients.
Our primary outcome, assessing efficacy and impact, was the evaluation of self-confidence with MC content as a measure for self-efficacy. This composite outcome incorporated 4 self-reported items regarding confidence in conducting clinical discussions about MC in oncologic populations: efficacy, risks, modes of use, and role in symptom management. In secondary analyses, we also examined the curriculum’s effect on participant self-confidence in clinical counseling on MC efficacy, risks, modes of use, and symptom management separately.
Data Analyses
We summarized data as median (IQR) and count (proportion). A chi-square test was used to compare self-reported knowledge in domains of MC use in oncology populations between pretest and posttest surveys. A 2-sided P value of <.05 was considered statistically significant. All analyses were performed using SAS 9.4 (SAS Institute) and GraphPad Prism for Windows (GraphPad Software). A thematic analysis was conducted to identify themes in participants’ responses to the 3 open-ended questions.22,23 Two investigators (R. Patell, P. Bindal) reviewed the text responses from the first 15 participants and generated a codebook, including both deductive codes (determined a priori) and inductive codes (emerging from the text). These investigators then coded the text in detail using the codebook. Any disagreements about the meaning of themes or codes were resolved by consensus within the research group. Selected quotes are presented to illustrate themes directly.
Results
Participant Characteristics
A total of 103 trainees attended the webinar. Of these, 75 (response rate, 72.8%) participated in the pretest survey (Table 1). The median year of medical school graduation was 2017 (range, 2011–2019). Most respondents attended medical school in the United States (n=58; 77.3%). Most participants reported training in academic hospitals (n=60; 80.0%), and reported their focus as solid tumor oncology (76.0%), malignant hematology (49.3%), and benign hematology (38.7%). Respondents reported seeing a median of 30 (IQR, 20–34) oncology patients per week, and a majority (n=45; 60.8%) reported seeing patients with cancer for >30 hours per week. Sixteen (21.3%) reported an institutional policy against recommending MC for symptom management in patients with cancer.
Participant Characteristics at Baseline (N=75)
| Characteristic | n (%) |
|---|---|
| Years since medical school graduation | |
| <5 | 32 (42.7) |
| 5–9 | 38 (50.7) |
| ≥10 | 2 (2.7) |
| Location of medical school | |
| United States | 58 (77.3) |
| Outside the US | 17 (22.7) |
| Area of focusa | |
| Benign hematology | 29 (38.7) |
| Malignant hematology | 37 (49.3) |
| Solid tumor oncology | 57 (76.0) |
| Supportive/Palliative care | 0 (0.0) |
| Unsure | 3 (4.0) |
| Patients seen per week | |
| <20 | 14 (18.6) |
| 20–29 | 19 (25.3) |
| 30–39 | 20 (26.7) |
| ≥40 | 17 (22.7) |
| Hours per week spent seeing patients | |
| <10 | 5 (6.7) |
| 10–20 | 12 (16.0) |
| 21–30 | 12 (16.0) |
| 31–40 | 27 (36.0) |
| >40 | 18 (24.0) |
| Location of training | |
| Academic hospital | 60 (80.0) |
| VA hospital | 10 (13.3) |
| Community practice | 4 (5.3) |
| Number of oncology patients for whom respondent completed MC paperwork in past year | |
| 0 | 68 (90.7) |
| 3 | 1 (1.3) |
| Unknown | 6 (8.0) |
| Institutional policy against recommending MC for symptom management in oncology patients | |
| No | 56 (74.7) |
| Yes | 16 (21.3) |
| Type of institutional policy against recommending MC | |
| Formal | 4 (5.3) |
| Informal | 1 (1.3) |
| Unsure | 11 (14.7) |
Abbreviation: MC, medical cannabis.
Respondents were allowed to select multiple responses; therefore, totals may exceed 100%.
Feasibility Outcomes
Cultural Attitudes and Perceived Norms
Most respondents in the pretest survey believed that engaging patients in discussions about MC for symptom management is necessary (n=47; 62.7%) and valuable (n=56; 74.7%), whereas 4 (5.3%) considered such discussions to be harmful. Additionally, 5 (6.7%) participants believed that most colleagues in their practice engage in discussions with patients regarding the use of MC for symptom management. Regarding perceptions of expectations, 11 (14.7%) respondents believed their colleagues expect trainees to engage in these discussions, and 14 (18.7%) believed this expectation is held by experts in the field. These rates were not significantly influenced by the webinar (all P≥.06).
Acceptability and Compatibility
Of the 66 respondents to the posttest questionnaire (response rate, 64.1%), 92.4% (n=61) reported finding the curriculum helpful. Most believed that hematology/oncology trainees would derive benefit from the curriculum (n=56; 84.8%) and indicated they would recommend it to colleagues (n=58; 87.9%). The majority did not feel that any information was missing (n=60; 90.9%) or that any content included in the curriculum was superfluous (n=60; 90.9%). Furthermore, most (n=52; 78.8%) trainees reported being more likely to initiate conversations about MC for symptom management in patients with cancer after attending the webinar.
Self-Efficacy: Confidence in Conducting Clinical Discussions About MC
Following the webinar, there was a significant improvement in the self-reported confidence in conducting MC discussions, as measured by the composite outcome, increasing from 2.7% pretest to 65.2% posttest (P<.001). This increase in self-confidence was observed across all 4 domains for clinical discussions about MC: efficacy (5.3% vs 84.8%; P<.001), risks (8.0% vs 78.8%; P<.001), modes of use (17.6% vs 81.8%; P<.001), and indications for symptom management (9.3% vs 90.8%; P<.001) (Table 2, Figure 1).
Self-Reported Confidence, Attitudes, and Norms Reported by Survey Participants
| Domain | Pretest (n=75) n (%) |
Posttest (n=66) n (%) |
Follow-Up (n=36) n (%) |
|---|---|---|---|
| Self-efficacy | |||
| Confident in conducting discussions on efficacy of MC | 4 (5.3) | 56 (84.8) | 31 (86.1) |
| Confident in conducting discussions on risks of MC | 6 (8.0) | 52 (78.8) | 24 (66.7) |
| Confident in conducting discussions on modes of delivery of MC | 13 (17.3) | 54 (81.8) | 28 (77.8) |
| Confident in conducting discussions about use of MC for symptom management | 7 (9.3) | 59 (89.3) | 32 (88.9) |
| Attitudes | |||
| Believe that discussions about use of MC for symptom management are valuable | 56 (74.7) | 49 (74.2) | 30 (83.3) |
| Believe that discussions about use of MC for symptom management are necessary | 47 (62.7) | 46 (69.7) | 26 (72.2) |
| Believe that discussions about use of MC for symptom management are harmful | 4 (5.3) | 12 (18.2) | 10 (27.8) |
| Norms | |||
| Most colleagues engage patients with cancer in discussions about use of MC for symptom management themselves | 5 (6.7) | 8 (12.1) | NA |
| Most colleagues believe that respondent/trainee should engage patients with cancer in discussions about use of MC for symptom management | 11 (14.7) | 15 (22.7) | NA |
| Experts think I should engage patients with cancer in discussions about use of MC for symptom management | 15 (20.0) | 20 (30.3) | NA |
| Patients with cancer feel their providers should engage in discussions about use of MC for symptom management | 46 (61.3) | 50 (75.7) | NA |
| Self-reported behavior | |||
| Discussed MC at least 1–2 times in the past month | NA | NA | 30 (83.3) |
| Recommended MC at least 1–2 times in the past month | NA | NA | 22 (61.1) |
Abbreviations: MC, medical cannabis; NA, not asked on this survey.
Oncology trainees’ self-perceived comfort in engaging patients in discussions about (A) efficacy, (B) risks, (C) modes of use, and (D) role in symptom management of medical cannabis, measured at baseline and post-curriculum.
a1 trainee did not respond to the question.
Citation: Journal of the National Comprehensive Cancer Network 23, 3; 10.6004/jnccn.2024.7084
Qualitative Analysis of Open-Ended Responses
Several respondents described the potential usefulness of the curriculum in their practice and offered suggestions for improvement, including adjustments to its length, the provision of follow-up materials or sessions, and expanding the interactive component (Table 3). Potential barriers to implementation were identified, including lack of content experts on faculty at the trainee institution and competing priorities during hematology/oncology fellowship training. Participants emphasized that although discussions of MC in their oncology practice were deemed important and occurred frequently, stigma surrounding cannabis and legal barriers were cited as challenges to incorporating these discussions in their clinical practice.
Themes With Representative Quotes From Descriptive Responses in Posttest Survey
| Utility of curriculum | |
| Divergent opinion on usefulness | “I feel like this tripled my knowledge!” (Participant #3) “I think this is an important topic that patients ask us a lot about and would be extremely useful to have incorporated into hematology/oncology fellowships.” (Participant #32) “I still feel the benefits are minimal. I feel more prepared/engaged to have the conversation if patients bring it up but am not sure it is a priority in limited time if my result is that I would likely recommend against or be neutral at best in most cases.” (Participant #10) |
| Needs to be longer | “A one-off lecture might not have robust impact.” (Participant #7) |
| Content of curriculum | |
| Interactive component useful | “I thought it was thorough and presented to the data in an easy to digest manner, while providing the background scientific evidence. The interactive part at the end was helpful in thinking about phrasing the information with patients – would be helpful to have more time to practice that/listen to how faculty/experts do that.” (Participant #5) |
| Helpful content | “Discussing the evidence around certain recommendations, and the limitations of each trial was incredibly helpful.” (Participant #39) |
| Data-driven | “It was full of data instead of opinions which was helpful to objectively frame the conversation….” (Participant #16) “It was apparent that we need better trials. It could be a useful addition to standard of care.” (Participant #53) |
| Mode of delivery of curriculum | |
| In-person training preferred | “In-person is better for practicing conversations, which you could not control this time around.” (Participant #14) |
| Asynchronous training preferred | “Streaming was too early (7 am); maybe prerecorded sessions would be ideal.” (Participant #66) |
| Suggestions to enhance retention | |
| Include example cases | “I think a repeat curriculum with example cases would be helpful. Patients that were actually prescribed and symptoms – case studies.” (Participant #46) |
| Provide review materials | “A summary of the presentation that can be shared or perhaps a guidebook created for oncologists based on your thorough review of existing literature [would be useful].” (Participant #28) |
| Barriers to curriculum implementation | |
| Time constraints | “Having enough time in the curriculum and faculty to run it.” (Participant #50) |
| Lack of faculty expertise | “[Better if] implemented earlier in fellowship – but might have difficulty moving it earlier in the year with all the other necessary lectures.” (Participant #5) |
| Policy prohibitions | “Our institution does not allow the prescription of cannabis as it is still not legal federally.” (Participant #39) “I think we should be more liberal with its use. It is a shame that the fear of retribution from the federal government ties our hands with administration and that more research is not being done around it.” (Participant #14) |
| Stigma | “...stigma around scheduled substances.” (Participant #15) |
| General opinions about cannabis use in oncology populations | |
| “I think we should be more liberal with its use. It is a shame that the fear of retribution from the federal government ties our hands with administration and that more research is not being done around it.” (Participant #14) | |
Follow-Up Survey
A total of 36 trainees (response rate, 34.9%) completed the 12-week follow-up survey. Most reported continued confidence in conducting clinical discussions about MC with their patients, including its efficacy (n=31; 86.1%), risks (n=24; 66.7%), modes of use (n=28; 77.8%), and role in symptom management (n=32; 88.9%). Additionally, the majority reported discussing MC with patients (n=26; 72.2%) and recommending its use (n=22; 61.1%) at least 1 to 2 times in the past month. Nearly all respondents (n=35; 97.2%) believed that incorporating the MC curriculum into their fellowship training would be beneficial.
Discussion
In this pilot feasibility pretest-posttest study, we developed and conducted a virtual curriculum on MC use in patients with cancer for hematology/oncology fellows at 8 training programs across the United States. Nearly all (92%) found the curriculum helpful and 88% were likely to recommend it to their colleagues. Following participation in the curriculum, trainees also reported increases in self-confidence to discuss MC efficacy, its risks, modes of use, and indications for symptom control. Among the third of participants who completed a follow-up questionnaire 12 weeks after the training, self-reported confidence in conducting clinical discussions about MC was sustained, and respondents reported conducting cannabis-related clinical conversations with patients regularly.
Despite recognition that MC training for health care providers is needed across the breadth of medical specialties and its allied disciplines at all levels of training,24 structured curricula on MC remain sparse. Although training programs have been developed for emergency care physicians25 and psychiatry trainees,26 these programs lack details pertaining to MC use, indications, and toxicities for individuals with cancer.27 Recent national oncology guidelines recommend that clinicians provide patients with unbiased educational resources about MC and guide care as appropriate.9 Our curriculum—the first of its kind for hematology/oncology trainees—addresses these needs. This 1-hour interactive webinar covered various aspects of MC use that have been previously identified as priorities in oncology, including basic pharmacology/pharmacokinetics, its role in supportive care, efficacy and toxicity of cannabis in the presence of malignancy, conducting patient discussions, and regulatory aspects.28 As shown in a prior cross-sectional survey of hematology/oncology trainees,13 almost all participants who had received formal MC education at some point in their training perceived this topic as important. Our positive posttest evaluations highlight that most participants found the training useful and would recommend it to peers. Moreover, there were striking and sustained improvements in self-reported confidence in conducting clinical discussions across the covered domains, highlighting the low self-assessed baseline knowledge of MC among oncology providers, consistent with previous research.12,13,29,30
There are specific challenges to developing training modules for MC education, including creating evidence-based content in the context of limited clinical data.9,27 Research to expand this knowledge is hindered by cannabis being classified federally as a Schedule 1 agent, the lack of currently accepted medical indications for its use in the United States, and a lack of accepted safety under medical supervision. Despite these limitations, the expanding availability of MC and its increasing use among oncology patients6,31 necessitate that oncology providers educate themselves on its known and unknown benefits and risks in order to engage patients in effective and more informed decision-making regarding their care.9,32 Given rapid advancements in the field, training programs must continuously revise curricula to reflect contemporaneous standards, evidence, and practices. For instance, updates to the curriculum were required even over the relatively short period during which our study was conducted, particularly regarding emerging evidence showing interactions between cannabis and cancer immunotherapies.33 The highly varied and nuanced regulatory and operational procedures surrounding MC by country, state, and institution present further challenges to creating a universally applicable curriculum. Finally, MC is still considered controversial, and cancer survivors have identified stigma as a significant barrier to both its use and open discussions about it with their clinical teams.34,35 Not surprisingly, participants in our study also identified this as a barrier to widespread uptake of our curriculum, even though most felt it was important for training and patient care.
To the best of our knowledge, this is the first and only multicenter study to develop and test an MC curriculum for oncology providers. However, results must be interpreted in the context of the study’s limitations. Our study was limited to hematology/oncology trainees, but several studies have shown that similar educational interventions are needed for practicing oncologists and allied health care providers caring for patients with cancer.12,36,37 The curriculum and format would need to be refined for each audience and tested to ensure that our findings are generalizable to other target learners. Response rates to the pretest and posttest surveys were relatively high, even though participation in the program was not mandatory for all trainees at participating institutions. Thus, it is possible that our results reflect an inherent bias in favor of MC training by attracting those most interested in the topic. Although we designed the follow-up surveys to assess relative efficacy and impact of the webinar on behavior, these surveys had comparatively lower responses. It remains unclear if knowledge gained from the curriculum results in actionable and sustainable changes in participants’ behaviors. Moreover, we did not measure the self-reported frequency of MC discussions with patients in pretest surveys, which further limits the validity of measuring the impact of the curriculum on clinician behavior.
We attempted to include institutions from diverse regions and varying program size, but most were academic centers in major metropolitan areas, potentially impacting the results, given that regional, religious, and legal factors are known to be associated with variations in attitudes to MC.38 Additionally, we did not collect data on gender, race, or ethnicity of participants and thus cannot ascertain the impact of these on our outcomes. Moreover, because the surveys were anonymized, we were unable to compare results across the participating sites. We designed the educational session as a virtual seminar for feasibility and ease of participation for trainees across the country; however, feedback from qualitative comments included a desire to expand interactive components in order to facilitate further consolidation of learning and ability to practice skills. Although we found that most participants who completed the follow-up survey reported sustained benefit, it is likely that a longitudinal curriculum would enhance knowledge retention and lead to more sustained impacts on practice. Finally, we relied on self-reported outcomes, which could be biased and lead to inaccuracies. Future studies should examine other outcomes, including participant knowledge, patient perceptions of these conversations, and whether training affects frequency of these conversations being documented in medical records, which may be more objective measures.
As outlined in recent national clinical guidelines, oncology physicians should be prepared to engage in open, nonjudgmental conversations with their patients about MC consumption, informed by existing data and expert consensus.9 Based on our experience with developing and deploying these curricula, we plan to create a virtual platform that can be accessed broadly and longitudinally by oncology training programs. One of the barriers identified for MC curricula by several participants in this study was the lack of local subject matter expertise. Shared educational resource models have been developed and used successfully in hematology/oncology education,39 and we believe a similar structure would be necessary to allow broad access to fill this recognized educational gap. Given the feedback that suggested enhancing interactive components within the curricula and the increasing data supporting inclusion of interactive visual learning in electronic courses,40 we plan to leverage learner–course and learner–learner interactive tools to facilitate dynamic delivery of content in future iterations. Finally, as professional societies continue to establish consensus guidelines on MC,9 there will be further need for curricula like ours to ensure trainees and practicing oncology providers can update their knowledge and skills to best serve their patients. Further work will be needed to develop such curricula in a prospective multi-institutional study, testing its effectiveness using objective outcomes, including knowledge expansion, retention, and behavioral change, and ensuring broad distribution and availability for oncology trainees.
Conclusions
Our prior work demonstrated that training in MC use for patients with cancer is an area of unmet need among hematology/oncology trainees. The current study demonstrated the feasibility and acceptability of developing and delivering a virtual webinar curriculum on MC for hematology/oncology fellows. Most trainees enjoyed the format and found the content useful and applicable to their practice and education. We observed sustained improvements in self-reported confidence in conducting clinical discussions across all domains included in the curriculum. Furthermore, participants reported increased discussions about MC with patients following the training, aligning with recent expert consensus guidelines. Future efforts should focus on refining this curriculum based on emerging data in the field, developing similar interventions for other oncology health care professionals, and exploring strategies to sustain these educational initiatives. Such efforts are essential to ensure broad implementation, maximize knowledge retention, and facilitate meaningful behavioral changes in real-world clinical practice.
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