key: cord-1002885-am74g13h authors: Pavlidis, Nicholas; Peccatori, Fedro A.; Apro, Matti; Eniu, Alex; Rassy, Elie; Cavalli, Franco; Rolfo, Christian; Costa, Alberto title: Eight-Year Experience of the Certificate of Competence and Advanced Studies Program Organized by the European School of Oncology date: 2021-10-16 journal: J Cancer Educ DOI: 10.1007/s13187-021-02105-z sha: 4716c5fb8439b593b8213f9fe192b482e497ce89 doc_id: 1002885 cord_uid: am74g13h The Certificate of Competence and Advanced Studies Program is an academically recognized postgraduate program that is organized by the European School of Oncology in collaboration with the University of Ulm and the University of Zurich. It is a part-time educational activity that aims to provide physicians and scientists with advanced knowledge in the management of patients with breast cancer, lymphoma, and lung cancer. The program encloses three attendance seminars and four to five e-learning modules that extend over 12 to 14 months. To be certified, participants have to pass an online test after each module followed by a final certification exam at the end of the program. This article reports on the 8-year experience of the 166 graduated fellows who have attended the program. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13187-021-02105-z. The advantages of e-learning and distant teaching quality, time flexibility, and cost logistical issues have raised interest in many online masters organized by various European Faculties [1] [2] [3] . The European School of Oncology (ESO) provides online and in-person oncology education to undergraduate and postgraduate participants to answer the growing demand for cancer education in the international oncology community. It offers a wide range of educational activities that include courses, seminars, masterclasses, e-learning sessions, clinical training centers fellowships, and Certificates of Competence and Advanced Studies Program (CCASP) [4] [5] [6] [7] [8] . The CCASPs were developed by ESO to provide a blended educational activity that encloses several seminars and e-learning modules. Three programs were tailored in collaboration with the Universities of Ulm and Zurich to present an updated comprehensive management of breast cancer, lung cancer, and lymphoma. The CCASPs were dedicated to supporting oncologists (medical, clinical, radiation, and hematology), internists, pathologists, and scientists in their research and daily clinical practice. Participants that pass the interim exams undergo a certification exam at the end of the program. In this article, we report on the eightyear experience of the ESO's CCASP as an academically recognized postgraduate program. The certificate programs are postgraduate degrees that require a prerequisite of bachelor's or master's degree. The CCASP commonly begins at the beginning of the winter semester in October of every year and lasts for 12 to 14 months. These programs enclose a combination of four to five e-learning modules and three face-to-face seminars. The teaching curriculum consists of 381, 420, and 405 h of breast cancer, lung cancer, and lymphoma, respectively, and yields 13 to 14 European Credit Transfer and Accumulation System points (ECTS). The extensiveness of the modules is expressed in units; one unit equates to 3 h of workload which consisted of a 30-min lecture and 2.5 h of additional reading. All of the module lectures are pre-recorded video lectures that the participants can attend at their convenience. The platform contains a chat function in case a student has a question for the lecturer. Tables 1 and 2 detail the didactic structure of CCASPs and Supplementary Table 1 provides a curriculum overview (content, seminars, and number of hours) of each CCASP. The CCASP is a part-time educational activity that covers the theoretical basis and updated management of patients with breast cancer, lymphoma, and lung cancer. The logistics of the three programs were consistently similar throughout the years with an upgrade of the online learning platform. Concerning the content, the ESMO breast cancer congress placed the San Gallen Breast Cancer Conference for the breast cancer program and the International Conference on Malignant Lymphoma replaced the ESO lymphoma course for the lymphoma program. The breast cancer program included five modules. Module 1 detailed the epidemiology and prevention, biology and clinical trials of breast cancer, module 2 discussed the principles of diagnostics, ductal carcinoma in situ and gene predisposition, module 3 explained the breast unit and locally advanced breast cancer, and modules 4 and 5 elaborated on the management of early and advanced breast cancer, respectively. The lung cancer program combined four modules. Module 1 detailed the epidemiology, prevention, biology, and pathology of lung cancer and other thoracic malignancies; module 2 discussed the principles of lung cancer research; module 3 explained the principles of non-small cell lung cancer, diagnosis, and treatment; and module 4 elaborated on the management small-cell lung cancer, mesothelioma, thymoma, and thymic cancer. The lymphoma program included four modules. Module 1 detailed basic research, epidemiology, and pathology; module 2 discussed the principles of diagnostics, management, and clinical trials; and modules 3 and 4 elaborated on mature B-cell neoplasms and PTLD, T-cell, NK-cell neoplasms, and Hodgkin's lymphoma. The examination regulations require that participants answer correctly more than 60% of a written multiple-choice test to pass the module exams. Participants can retake each module test several times until they pass the exam. Only those that pass all the online tests at the end of each module are eligible for the certification exam. The certification exam can be performed only during the third seminar of each program. Participants that scored correctly more than 60% of the test are certified in the corresponding program. Those who failed the certification exam may undergo the test again during the third seminar or the following program seminar. Participants are categorized according to their scores into 5 subsets: Very Good (90% or more), Good (80%-90%), Satisfactory (70-80%), Sufficient (60-70%), and 5 = Insufficient (< 60%). The tuition fee includes (a) access to seminars, modules, materials, and exams; (b) accommodation, lunches, and coffee breaks during the seminars; and (c) the administrative fee for the enrolment at the Universities. Travel and dinners are not included. All information and evaluation material deriving from the CCASP during the last 8 years were retrieved from the electronic archives of ESO. The demographic details, results of module tests, and certification exams were collected for analysis. Descriptive statistics were used to describe the participants' demographic characteristics and test results: qualitative data were reported by frequency and proportion and quantitative data by median and range. To date, 245 applicants have applied for the CCASP of whom 179 candidates were accepted for participation in the respective programs: 75 of 117, 84 of 108, and 20 of 20 applicants to the breast cancer, lymphoma, and lung cancer programs, respectively. A total of 166 participants have attended the ESO CCASPs between inception and 2021 ( Table 3 ). The selection process for the 2021/2022 candidates of breast cancer, lung cancer, and lymphoma is ongoing. Up to now, three breast cancer programs (2015-2020), one lung cancer program (2018-2021), and four lymphoma programs (2013-2020) were conducted. Sixty-seven participants attended the breast cancer program of whom 46% were medical oncologists. The median age at the time of enrolment was 39 years (range 31-59). Almost half the participants originated from European countries (58%) and 66% were females. The mean percentage pass of the five-module tests was 79.3% (range 79-80%), and that of the certification exam was 83% (range 75-87%). The scoring categories were "Very Good," "Good," and "Satisfactory" in 41%, 39%, and 12%, respectively; 7% of participants failed the exam (Table 4 ). During the first organized breast cancer program, one person failed the certification exam on his first attempt but passed thereafter. Another person was disqualified during the third organized breast cancer program, she retook the exam and passed it. Sixteen participants have attended the lung cancer program of whom 63% were medical oncologists. The median age at the time of enrolment was 38 years (range 33-60). Almost half the participants originated from European countries (56%) and 69% were females. The mean percentage pass of the four-module tests was 81% (range 79-82%), and that of the certification exam was 100% ( Table 5 ). The grading categories showed that participants scored "Very Good," "Good," and "Satisfactory" in 56%, 31%, and 13%, respectively. All participants passed the final certification exam. Eighty-three participants have attended the lymphoma program of whom 51% were hematologists-oncologists. The median age at the time of enrolment was 40 years (range 30-64). Participants were predominantly from Europe (75%), and 57% were females. The mean percentage pass of the five-module tests was 83% (range 81.5-84%), and that of the certification exam was 88.5%% (range 84-95%). The grading categories showed that participant scores were mainly "Very Good" and "Good" in 41% and 48%, respectively ( Table 6 ). All participants passed the final certification exam. The COVID-19 pandemic has turned telemedicine and e-learning into essential tools in medical education and patients care. Telemedicine provides health care to patients via communication technologies. E-learning offers the advantage of direct contact between the students and lecturers in a didactic environment with flexible time organization and access to learning material. For instance, several online masters were already organized by different European academic faculties to address fellows and consultants [1] [2] [3] [9] [10] [11] [12] . During the last 8 years, 166 participants were enrolled in the CCASP and graduated from the ESO CCASPs. Ninety percent have attended the breast cancer and lymphoma programs, while only 16 students participated in the recently established lung cancer program. Most of the fellows were medical or hematologist oncologists. More than 60% originated from Europe, and the rest were mainly from the Middle East/Africa, Latin America and Asia, and very few from the USA and Australia. All the participants who took the final exam passed it. In total, 43% have scored "Very Good" and 45% "Good Score." ESO CCASP builds on e-learning, at least partly, to engage students and teaches the latest developments in managing patients with malignant tumors by novel drugs, modern equipment, or recent surgical methods. It focuses on the clinical and scientific competencies required for improving quality in the management of these cancer patients. Blended e-learning training for postgraduate health professionals is relatively new and integrates online and face-to-face learning experiences. It is getting more popular and improves the participants' clinical competencies through shifting the education orientation from teacher-centered to student-centered [13] [14] [15] . In 2018, University of Ulm published the first findings on the second cohort of ESO CCASP in breast cancer [16] . Most of the participants were medical or radiation oncologists and originated from low-middle, upper-middle-, and high-income countries. Surgeons as well as radiation and medical oncologists considered the program highly educational and well organized [16] . The ESO CCASP is an academically recognized postgraduate program that seems to successfully develop the knowledge of the participants in the fields of breast cancer, lymphoma, and lung cancer. The contribution of the education offered by the Ulm and Zurich Universities was highly rated among the participants. Moreover, these programs favor interprofessional collaborations through yearly alumni dinners organized for the current and former participants. During the coming years, ESO will continue to develop these programs and will strongly recommend it to oncologists and other physicians involved in the care of cancer patients. Future perspectives include the launching of CCASP in gastrointestinal cancers and the development of CCASP in prostate cancers and gynecological cancers. Competing Interests The authors declare no competing interests. No writing assistance has been used in the creation of this manuscript. Table 6 Exam results of the lymphoma program (CCL1-CCL4) Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomised controlled trial Computer assisted learning in undergraduate medical education The impact of E-learning in medical education Oncology for medical students: a European School of Oncology contribution to undergraduate cancer education 2010) The masterclass of the european school of oncology: the "key educational event" of the school Undergraduate training in oncology: an ESO continuing challenge for medical students Changing the education paradigm in oncology: ESO masterclass, 17 years of continuous success The clinical training centers fellowships: a European School of Oncology career development program (2013-2019) Distance learning improves attainment of professional milestones in the early years of surgical training Training the oncoplastic breast surgeon-current and future perspectives E-Health, another mechanism to recruit and retain healthcare professionals in remote areas: lessons learned from EQUI-ResHuS project in Mali Telemedicine and e-learning in a primary care setting in Sudan: the Experience of the Gezira Family Medicine Project Creating a blended learning module in an online master study programme in oncology Blended learning' as an effective teaching and learning strategy in clinical medicine: a comparative cross-sectional university-based study The effectiveness of blended learning in health professions: systematic review and meta-analysis How to become a breast cancer specialist in 2018: the point of view of the second cohort of the Certificate of Competence in Breast Cancer (CCB2) We would like to thank Mrs. Alexandra Zampetti and Dolores Knupfer for their valuable support. The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s13187-021-02105-z.