Development and implementation of a student tumor board as a teaching format for medical students

Modern personalized oncological treatment concepts require interdisciplinary and multi-professional collaboration (Soukup et al. 2018; Selby et al. 2019). The development of individual therapy plans for cancer patients must be based on scientifically evaluated and evidence-based sources (Schirrmacher et al. 2023). In the absence of such sources, therapy recommendations should be based on best medical practice. Currently, complex therapy concepts for cancer patients are not formulated by individual specialists but by teams of experts from various disciplines. The performance of these well-coordinated specialist teams surpasses the individual contributions of each team member (Mäurer et al. 2022).

Interdisciplinary case reviews, also known as tumor boards, provide the panels of for specialists from different disciplines to collectively develop treatment recommendations for individual patients. These interdisciplinary discussions with creation of individualized therapy plans are independent quality indicators and essential requirements for successful certification as oncology centers (Brucker et al. 2009; Griesshammer et al. 2023; Roessler et al. 2022). Discussions of oncological patient cases in an interdisciplinary setting encourage evidence-based treatment and often lead to a change in diagnostic procedures or therapeutic management, potentially improving patient outcomes (Munro et al. 2015; Pillay et al. 2016; Algwaiz et al. 2020). Moreover, effective case discussion requires thorough preparation and focused knowledge of the literature, as well as research by the involved physicians. Apart from evidence-based therapy plans, it is equally important to consider patients' wishes, ideas, needs, and expectations. Additionally, oncological treatment raises numerous ethical issues that require consideration (Kuroki et al. 2010).

Medical schools are responsible to adequately prepare and equip students for the requirements of their future profession (Frank et al. 2015). Students rely on acquiring the necessary competencies to meet professional demands and fulfill the various roles required of physicians (McGaghie et al. 2011). These roles encompass being amongst others a medical expert, a member of an interdisciplinary and multi-professional team, a communicator, a health advisor and an advocate who encourages patients and their families to deal with life-threatening conditions (Frenk et al. 2010). Integrating the acquirement of these different competencies into medical education is crucial for future physicians to empower them to deliver excellent patient-centered care that accounts for unique needs of each individual.

To date, mandatory participation in interdisciplinary tumor boards is not foreseen in the curricula of many medical faculties. There is a lack of conceptual foundations to teach medical students the key skills necessary for successful participation in interdisciplinary case discussions. These specifically include interdisciplinary communication, presentation skills, and understanding of joint benefit-risk assessments. As a result of this weakness in the training of medical students, young physicians may struggle with the mechanisms and procedures of an interdisciplinary tumor board in their professional routine.

From our perspective, the sub-specialty of neuro-oncology is particularly suitable for teaching medical students the above-mentioned key skills (Mäurer et al. 2022). Neuro-oncology encompasses several disciplines including hemato-oncology, neurosurgery, neurology, and radiation oncology together with a high involvement of further organ-specific specialties, such as dermatology, gynecology and urology. Intensive interaction with palliative care medicine, psycho-oncological support and trained nursing staff makes neuro-oncology a highly multifaceted and multi-professional medical field. Ethical aspects of oncological practice are particularly relevant in this field, given the tension between prolonging life and maintaining quality of life, and considering the presumed will of patients who are unable to consent (Doukas et al. 2015).

Therefore, we have established a neuro-oncological student tumor board to teach medical students how a tumor board functions including interdisciplinary communication mechanisms, the weighting of pros and cons, evidence-based therapy plan creation, discussion of ethical issues and consideration of individual patients' wishes and needs.

The pilot phase of the described teaching format lead to the following main conclusions: (1) A neuro-oncological student tumor board is a suitable option to introduce neuro-oncology and associated disciplines in an constructive manner at an early stage of medical training. (2) The course imparts an interdisciplinary mindset, effective communication strategies, oncological decision making in an interdisciplinary team and teaches the importance of considering ethical and social issues in treatment decisions. (3) The problem-oriented learning format is feasible, can be converted to a completely virtual format and adapted to other educational fields. (4) The interactive, case-centered format fosters an appreciative learning atmosphere, generates interest in oncological disciplines, and provides students with a forum to practice interdisciplinary communication skills in a supportive environment.

Modern adult educational concepts aim at empowering individuals and imparting competencies rather than just transferring knowledge (Epstein and Hundert 2002). In this context, the teaching of competencies comprises the integration of knowledge, skills and attitudes required for successful and responsible problem-solving in different situations and focuses on individuals with specific knowledge levels, interests and capabilities. (Epstein and Hundert 2002).

In the current reform efforts of medical teaching in Germany, which are reflected in the "Masterplan Medizinstudium 2020" and in the revision of the National, there is a concrete demand for a consistent practice and competence orientation of teaching with a special focus on the understanding of an interdisciplinary effective cooperation of the different professions in the health care system(MFT Medizinischer Fakultätentag 2021; Bundesministerium für Forschung und Bildung 2020). In the model curriculum proposed by Dapper et al. visits to "real" tumor boards are suggested as elective teaching formats. Since the series event we have developed includes participation in a real tumor board, this directly addresses the aspect of practical learning experience. Whether as an elective course or as a mandatory curricular teaching format, participation in a real tumor board should be part of the basic educational training for all medical students.

In the context of the increasing complexity across all medical sub-disciplines, and oncology in particular, interdisciplinary cooperation and the development of nuanced treatment concepts represent crucial skills for future physicians (Lamb et al. 2011). Interdisciplinarity is now considered an essential necessity in medical care and a quality criterion, not limited to tertiary care centers (Brannstrom et al. 2015; Winters et al. 2021). The demand for interdisciplinary cooperation is not a new aspect (Hall and Weaver 2001; Singleton and Green-Hernandez 2023), however, the corresponding competencies have not yet been anchored in the curricula of many medical faculties. Previously published literature has repeatedly emphasized the need for the transfer of competencies for interdisciplinary cooperation (Mäurer et al. 2022; Ha and Parakh 2018; Kamp et al. 2021; Mann et al. 1996; Williams et al. 2002; Gerlach et al. 2023; Karsai et al. 2011). Nevertheless, there are almost no concepts described that convey interdisciplinary cooperation, particularly in student tumor board simulations. The assignment of specific clinical roles and case discussions of breast cancer patients were already implemented in the 1990s to show psychosocial aspects of oncological diseases. In addition, role-playing is occasionally used in other areas of medicine, such as palliative medicine or geriatrics, to practice interdisciplinary and multi-professional interaction (Williams et al. 2002). Role-playing games are used more frequently to mediate doctor-patient communication, especially to simulate the breaking of bad news (Colletti et al. 2001; Cushing and Jones 1995; Rosenbaum and Kreiter 2002). Other interdisciplinary teaching programs for students convey communication competencies, including concepts such as shared decision making, de-escalation or breaking bad news in an interdisciplinary team or multidimensional treatments (e.g., in palliative care) (Gerlach et al. 2023; Bachmann et al. 2013, 2017). However, they do not address mechanisms of interdisciplinary communication, or the creation of a patient-centered therapy plan.

Our teaching format is an approach that could rouse the interest in multidisciplinary fields, such as neuro-oncology, with reference to imparting and practicing the skills of interdisciplinary cooperation and therapy plan creation, as well as for discussing relevant ethical aspects.

We see numerous advantages of the format presented herein: (1) The seminar structure facilitates the teaching and practical application of all competencies defined by the learning objectives, while the teaching materials support independent problem-based learning. (2) The format is highly authentic and allows students to focus on relevant facts for individual patient cases and learn to manage their time resources wisely. (3) Practical implementation, as demonstrated in our pilot phase, is feasible. (4) The feedback from the pilot phase shows good results, especially with regard to the achievement of the learning goals, the enthusiasm for at least one specialist discipline and the appreciative learning atmosphere. However, the evaluation of our cohort is not significant due to its small number and requires validation by further participating student groups. Furthermore, a selection bias must be taken into account, which could have distorted the evaluation results, since the participating students may have been particularly interested in the topic and showed above-average motivation. (5) The format can be easily adapted as needed: The student tumor board need not be limited to the flipped-classroom format but can be used as part of a series of lectures or seminars to monitor learning success. Interdisciplinary communication strategies can also be integrated in other formats, such as seminars with practical exercises or as part of crew resource management (Mäurer and Interdisziplinäre tumorkonferenz. 2023; Maurer et al. 2023). (6) The learning format could arouse interest in oncology or even help to recruit residents for oncological disciplines. Through the identification of the participants with their own role, the interest in the respective discipline could increase. The extent to which students undertake an internship in this discipline (clinical traineeship, internship year) or even start their professional career in this field could be the purpose of future assessments. (7) The course format can be applied to other oncological or medical disciplines and adapted to other fields where multi-professional solution-oriented approaches are critical for successful teamwork.

We acknowledge the following limitations and challenges: (1) Our teaching format required significant time and resources. Several clinical specialists were involved throughout the course, along with various student tutors. This input was disproportionately large compared to the number of students who participated in the pilot phase. Additionally, new teaching materials, including presentations and videos, had to be designed and approved by all involved disciplines in preparation for the course. (2) The feasibility of the format depends, among other things, on the availability of preparatory courses in the field of neuro-oncology. An analysis of radiation oncology teaching at medical faculties in Germany showed that only 2/3 of all curricula cover this topic (Oertel et al. 2020). Although the basic principle of our teaching format is easily applicable to other oncological subfields, the heterogeneous training in the field of neuro-oncology limits the transferability to other faculties. (3) The flipped classroom format, described and introduced several years ago, is now well established (Lage et al. 2000). There is a potential risk of rejection of the flipped classroom format by individual participants. In our pilot student cohort, not a single student expressed criticism of the format, but nevertheless the lack of or inadequate preparation of the teaching materials provided in advance could impair learning success. We countered this risk by motivating the students and explaining the need for preparation before engaging in the interactive exchange with regard to joint learning success of the group. Although self-study can save on the teaching of basic knowledge, adequate motivation of individual participants becomes more important, as inadequate preparation can impair learning success. Based on our experience from the pilot phase, we recommend that students engage in discussions with their assigned consultant with regard to any arising questions related to the case vignettes. This approach can provide the students with additional confidence and ensure the success of the student tumor board. An additional collaborative self-study learning session through dyadic peer-to-peer interaction could potentially enhance the learning effects. (4) There is no clear consensus on the ideal timing of an interdisciplinary educational intervention. (5) Future research must determine whether conveying the concept of interdisciplinarity provides young medical professionals with the ability to participate more effectively in interdisciplinary treatment discussions and gain more confidence to participate in tumor board conferences.

Student tumor board seminars, as presented in this study, have demonstrated feasibility and effectiveness in imparting interdisciplinary competencies. However, it is important to acknowledge that these seminars can be resource-intensive in terms of personnel and time. The concept of student tumor boards, where students assume medical professional roles, represents an innovative approach to teach interdisciplinary communication strategies, practice creating therapy plans, and engage in discussions about ethical issues in medical practice. Moreover, the interactive nature of simulating specialist roles in the seminar setting may empower future physicians to communicate more effectively with patients and gain confidence in navigating professional interdisciplinary teamwork.