Clinical and Translational Oncology (2020) 22:1049–1058 https://doi.org/10.1007/s12094-019-02230-8 RESEARCH ARTICLE Situation, challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain M. A. Segui1 · J. J. Cruz2 · E. Alba3 · J. Feliu4 · C. Jara5 · F. Rivera6 · A. Rodriguez Lescure7 · A. Lorenzo8 · M. Martin9 Received: 13 March 2019 / Accepted: 17 October 2019 / Published online: 8 November 2019 © The Author(s) 2019 Abstract Purpose The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the undergraduate education in Medicine program and issue recommendations to improve said training, with the aim of responding better to the challenges that cancer poses to our society. Materials and methods The curricula of 42 schools of medicine were reviewed with interviews with at least one teaching medical oncologist from each faculty. The qualitative and opinion analysis was completed by means of an online question- naire targeting lecturers, resident tutors, and residents in Medical Oncology (MO), enabling the detection of needs and areas for improvement at an organizational level and in terms of skill acquisition. Results While the number of medical schools with a specific, mandatory program in MO has grown by up to 90%, it has not been accompanied by an increase in independent programs. Instead, they largely consist of programs shared with other specialties (61% of the medical faculties). In most of the undergraduate education programs, Oncology contents are frag- mented and approached from the perspective of each organ system. Conclusions Despite the positive evolution in recent years, the heterogeneity in Oncology contents during undergraduate education training continues to be remarkable. Cross-sectional programs with an integral vision, taught in the final years of undergraduate medical education would be desirable. Among the recommendations for improvement of training in Medical Oncology, the SEOM proposes that updated, theoretical content be incorporated and clinical practice in Medical Oncology departments be promoted. Keywords Undergraduate · Oncology · Education · Future · Recommendations · Spain · SEOM 6 * M. A. Segui Medical Oncology Department, Hospital Universitario msegui@tauli.cat Marqués de Valdecilla, Santander, Spain 7 1 Medical Oncology Department, Hospital General Medical Oncology Department, Parc Tauli Hospital Universitario de Elche, Elche, Spain Universitari, Universitat Autònoma de Barcelona, 8 08208 Sabadell, Spain Medical Oncology Department, Hospital Universitario de 2 Puerto Real, Cádiz, Spain Medical Oncology Department, Hospital Clínico 9 Universitario, Universidad de Salamanca, Salamanca, Spain Medical Oncology Department, Hospital General 3 Universitario Gregorio Marañón, Instituto de Investigación Medical Oncology Department, Hospital Universitario Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Virgen de La Victoria, Málaga, Spain Universidad Autónoma de Madrid, Madrid, Spain 4 Medical Oncology Department, Hospital Universitario la Paz, Universidad Autónoma de Madrid, CIBERONC, Madrid, Spain 5 Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain 13 Vol.:(0123456789) 1050 Clinical and Translational Oncology (2020) 22:1049–1058 Introduction guaranteeing a multidisciplinary approach to cancer and contributing to greater homogeneity in patient manage- Cancer, as one of the great challenges of our society, ment. The presence of the oncologist is recommended in demands physicians with solid training and skilled to pro- the academic field, as is a specific evaluation of knowledge vide the very best response at all levels, from prevention about Oncology. and early detection to the treatment of patients with cancer. The SEOM, for its part, from its very creation, has dem- In the past 20 years, the number of tumors diagnosed onstrated its concern and firm commitment to medical stu- has undergone constant growth in Spain, due, not only to dents’ training in Oncology, as attested to at the various the growth in population, but also to early detection tech- meetings of instructors held in the years 2006, 2007, 2010, niques and to the increase in life expectancy [1]. and 2011. At the first meeting, held in Salamanca in 2006, Improved prevention and early diagnosis, better patient a consensus document was drafted that included considera- follow up, guaranteed access to the most efficacious treat- tions regarding the need for an Oncology program; the docu- ments for each tumor, the practice of personalized and pre- ment was approved at the meeting held in Cordoba in 2010 cision medicine, facilitating the best treatment available [4]. The document included a proposal regarding the con- depending on the genomic and clinical characteristics of tents that had been agreed upon with medical school faculty. the patient, are mere examples of the challenges the medi- In 2013, SEOM drafted the report, “Formación de pre- cal oncologist faces. Given the magnitude and relevance of grado en Oncología. Una asignatura pendiente” [Undergrad- these challenges, different specialists, including Primary uate training in Oncology: an unresolved issue] [5], which, Care professionals also face these challenges. after reviewing the situation of training in Oncology at the The changes in the epidemiological pattern of the dis- undergraduate level, included a series of recommendations ease, the new evidence, and technological progress will for the organization of Medical Oncology programs in medi- necessarily have an impact on how to perform and organ- cal schools. ize the work and, therefore, on the training needs and The major challenges faced by Oncology make it par- competence-building of future physicians to be able to ticularly necessary that solid training for our future physi- adequately care for patients with cancer. cians be guaranteed, enhancing training in Oncology with Aware of the relevance of teaching Oncology during an integral and multidisciplinary view at the undergraduate medical training, different institutions such as the World level. SEOM seeks to contribute to this aim by conduct- Health Organization (WHO) and the International Union ing regular studies of the status of undergraduate training against Cancer (UICC) have worked on drafting recom- in Oncology and issuing recommendations for the future. mendations, from the very inception of the specialty itself SEOM’s proposal includes a global approach to Oncology in 1978 [2]. in the final years of the undergraduate education program In 1989, the European Commission, within the frame- that integrates the knowledge acquired in the various system work of the “Europe against Cancer” initiative, identifies subjects in future physicians’ clinical training so that they the need to influence training in Oncology during under- will have an integral, cross-sectional, multidisciplinary view graduate and graduate training. In addition, and together of the approach to cancer. with the European Organisation for Research and Treat- ment of Cancer (EORTC​), the Commission published the Curriculum in Oncology for Medical Students in Europe Material and methods [3], which represents a proposed common curriculum in Oncology for medical students in Europe. The proposal In order to conduct the project, a working group was des- was unanimously approved by 50 deans of medical schools ignated consisting of members of SEOM with different from 17 countries, who participated in a joint workshop of responsibilities in the field of Medical Oncology training. the European Commission (EC) and the European Organi- This group validated the study’s analytical methodology, as sation for Research and Treatment of Cancer (EORTC). well as the conclusions and recommendations included in The proposal sought to respond to the training deficits in the study. Oncology that had been detected and to the growing needs The analysis of the status of training in Oncology dur- for skills in the areas of prevention, early diagnosis, treat- ing undergraduate education in medicine was carried out ment, and palliative care in the oncology patient. by analyzing the study plans and teaching guidelines of The proposed European curriculum highlights the the subjects that included content regarding Oncology need for coordination, through a figure or system of coor- at the 42 medical schools existing in Spain during the dination for the Oncology training program, with the 2016–2017 academic year, for the purpose of understand- aim of preventing omissions in important areas and of ing the current situation and revealing trends in recent years. With this aim of analyzing their evolution, an 13 Clinical and Translational Oncology (2020) 22:1049–1058 1051 analytical structure was maintained that was similar to Results studies performed by SEOM in previous years. The list of universities that offer undergraduate edu- Diagnosis of the situation of training in Medical cation in medicine can be consulted at (https​://seom.org/ Oncology during undergraduate medical education adjun​t /Facul​t ades​_ de_Medic​i na_en_Espan​ya.pdf). The data presented correspond to 41 medical schools, since During the 2016–2017 academic year, 40 universities offered only the first 2 years of the undergraduate degree in Medi- undergraduate medical educations in Spain at 42 schools of cine are taught at the Huesca School for Health Sciences medicine (given that the University of Zaragoza and the Univer- and Sports (University of Zaragoza); training in Medi- sity of Castilla-La Mancha have two medical schools that offer cal Oncology is, therefore, not taught. This preliminary undergraduate education in Medicine). Eighty percent (33) of information was validated by means of an interview with these universities are public and 20% (nine) are private. a medical oncologist involved in teaching undergraduate education at 33 of the 41 medical schools. Modalities of specific Medical Oncology training The quantitative analysis was completed through an programs online questionnaire targeting different profiles, includ- ing medical oncologists with teaching responsibilities in Ninety-five percent (95%) of the medical schools have a spe- undergraduate education in medicine, resident tutors, and cific training program in Medical Oncology. In the sphere residents, in addition to the members of the project work- of this study, specific training program were considered to ing group. be those that include a syllabus and well-defined, specific The opinion poll made it possible to collect informa- Oncology content. This specific program is taught through tion about the main deficits identified as regards under- a mandatory subject in 90% of the medical schools (Fig. 1). graduate education in Oncology, respondents’ opinion as Only 14 of the 39 specific Medical Oncology programs to the optimal organization of teaching Medical Oncology (36%) structured their content into independent subjects. in the future, type of key competences to be acquired In the case of subjects in which Oncology shares content during undergraduate education, and leading deficits with other specialties, the most common situation is that of perceived by residents in Medical Oncology, in addition a subject that shares content about Hematology (54%) and to the factors during undergraduate training that had the Radiation Oncology (33%). biggest impact on their decision to specialize in Medical The various teaching modalities of Medical Oncology at Oncology. the different medical schools were analyzed, insofar as the The questionnaires used are available at (General data: subject typology (compulsory or elective), content shared https​://bit.ly/2TbCs​sA; Teachers: https​://bit.ly/2R5lT​wk; with other specialties, and the number of credits. The most OM residents: https​://bit.ly/2Czd7​Se: Other esidents: https​ common modality of the specific Medical Oncology curricu- ://bit.ly/2HAhV​fA). lum (which corresponds to 39% of the subjects) consists of All told, 65 people responded to the survey, 28 of incorporating Oncology content into a subject that is shared whom were instructors, resident tutors, and other pro- with other specialties, with a dedication of between 3 and files; the remaining 37 questionnaires were answered by 4.5 credits dedicated to Oncology (Table 1). residents. Although during the 2016–2017 academic year, six medi- Finally, based on the results of the analysis, a pro- cal schools had a specific, mandatory Medical Oncology posal of recommendations was drafted that was agreed subject, this subject accounted for six credits only at the upon during an in-person meeting of the project working University of Salamanca School of Medicine. group. Fig. 1  Percentage of medical Medical schools with Medical schools without schools with a specific program specific training specific training program in Oncology, with or without an program in MO in MO independent subject Elective subject 2 2 5% 5% Independent subject Shared 14 subject 36% Mandatory subject 25 37 64% 90% 13 1052 Clinical and Translational Oncology (2020) 22:1049–1058 Table 1  Teaching modalities of Modality No. medical % the specific Medical Oncology schools program Independent compulsory subject with six credits 1 2 Independent compulsory subject with fewer than six credits 5 12 Independent elective subject 2 5 Joint subject with another specialty, with between three and four credits dedi- 6 15 cated to Medical Oncology, but with an independent examen Joint subject with another specialty, with between three and 4.5 credits 16 39 Joint subject with another specialty and FEWER than three MO credits 9 22 No specific program in Medical Oncology 2 5 Total 41 100 Shared subject Table 2  Average number of credits dedicated to Medical Oncology with other Specific subject according to the type of subject medical 12 pathologies 29% 3 Average credits overall Average 7% subject credits in MO* Same subject as MO Independent subjects 3.81 3.81 26 64% Joint subjects 7.21 2.96 Overall 6.51 3.16 *Estimated according to the hours of teaching dedicated to Medical Oncology Fig. 2  Organization of the contents of palliative care in undergradu- ate medical education the average number of credits dedicated to Medical Oncol- ogy was 2.96 (Table 2). In most cases, the subjects with Medical Oncology con- tent are taught in the final years of the undergraduate educa- tion program. In 51.3% of the cases, the subjects with Medi- Participation of Medical Oncologists in teaching cal Oncology content are taught during the final two years undergraduate programs in Medicine of undergraduate education; 35.9%, in the fourth year, and 12.82% of the subjects are taught in the third year. A medical oncologist is involved in teaching at 90% of the medical schools. Within the framework of this project, a Oncology and Palliative care total of 139 oncologists have been identified as teaching sub- jects with Medical Oncology content. On average, this figure Content regarding Palliative Care is taught in the same sub- accounts for 3.56 instructors who are specialists in Medical ject as Medical Oncology at 63% of the medical schools. Oncology at each medical school. Taking into account a total Twelve medical schools (30%) had a specific subject ded- of 1216 clinical Medical Oncologists in Spain, as estimated icated to Palliative Care. Palliative Care was included in in the latest census performed by SEOM, corresponding to subjects containing other medical pathologies (other than the year 2014 in Spain [6], only 11.43% would be involved Medical Oncology) at only three medical schools (7%). At in teaching undergraduate education in medicine. five medical schools that have a specific subject dedicated As for distribution by teaching position, of the 139 medi- to Palliative Care, content about Medical Oncology is also cal oncologists, only eight are department chairs and 15 are included in this course (Fig. 2). full professors. A medical oncologist participates in the coordination Credits dedicated to Medical Oncology of the subject, either exclusively or together with faculty members from other specialties in 59% of the subjects with During the academic year studied, 3.16 was the overall aver- specific medical oncology content. In the case of subjects age of credits dedicated to Medical Oncology. In the inde- in which there is no medical oncologist involved in coordi- pendent subjects, the average number of credits was slightly nation, more often than not, the subject is coordinated by a higher − 3.81. In the subjects shared with other specialties, hematologist (46%) or radiation oncologist (23%). 13 Clinical and Translational Oncology (2020) 22:1049–1058 1053 Theoretical and practical teaching Table 3  Subjects with Medical Oncology content that offer the option of carrying out clinical practice on a Medical Oncology service Teaching continues to be in the form of master classes in Practicum on Medical Oncology No. of subjects % most cases in practically all of the subjects. Different types service of practica and seminars are also usual with greater or lesser Yes 27 69 theoretical or practical content (Fig. 3). A classification of Possible 3 8 teaching activities was made on the basis of their theoretical No 6 15 or practical nature. Based on this distribution, the ratio of Lacking information 3 8 theoretical: practical hours is 1:0.8 h in the case of subjects Total 39 100 shared with other specialties and slightly greater, 1:0.94 h, in independent subjects. Sixty-nine percent (69%) of the subjects with Medical Oncology content offer clinical practice in a medical oncol- This ratio is 2.44, in the case of public medical schools, ogy service, with a mean of 22.67 h (Table 3). and slightly higher, 2.89, in the case of private medical At practically all the universities, there is the possibility schools, bearing in mind that there are some medical of participating in clinical practica in the Medical Oncology oncology services that are involved in teaching at more Department as part of the clinical rotations during the fifth than one. or sixth year. Of the services that participate in the clinical practi- In total, 158 centers have been identified as being asso- cum of subjects with medical oncology content analyzed, ciated to or collaborating with medical schools in Spain. all the medical oncologists belonging to the service are Of them, 98 have been identified as having a medical involved in its teaching at only 48% of the cases. oncology service, which means that a mean of 2.33 medi- cal oncology services linked to each school of medicine. 100% 38 87% 84% THEORY 33 32 PRACTICES 37% 14 11% 4 5% 5% 5% 5% 5% 5% 3% 3% 3% 3% 3% 2 2 2 2 2 2 1 1 1 1 1 LABORATORY OF CLINICAL SKILLS PRACTICES IN SMALL GROUPS PROBLEM-BASED LEARNING SEMINARS ORAL PRESENTATION MASTER CLASSES ACTIVITIES ONLINE WORKSHOPS PRACTICES INTRODUCTION OF THE SUBJECT COMMUNICATIVE ORAL PRACTICES WRITTEN WORK CLINICAL CASES THEMATIC CONFERENCES TUTORIES CASE METHOD The School of Medicine belonging to the University of the Balearic Islands (UIB) has not been counted, given that the teaching plan has not yet been established for the subject. Fig. 3  Percentage of subjects with different training modalities 13 1054 Clinical and Translational Oncology (2020) 22:1049–1058 97% 32 30% 10 15% 15% 12% 5 5 4 6% 6% 3% 2 2 1 SHORT ANSWER QUESTIONS PROBLEM-BASED LEARNING (PBL) ESSAY QUESTIONS OBJECTIVE STRUCTURED MULTIPLE CHOICE TEST (MCT) CLINICAL CASES PREPARATION AND DEFENSE OF COMMENT AN ARTICLE CLINICAL EXAMINATION (OSCE)/SIMULATION A WORK MCQ: Mulple choice quesons PBL: Problem-based learning OSCE: Objecve structured clinical examinaon % of a total of 33 subjects; in 6 of the subjects with MO content, the type of evaluaon was not idenfied Fig. 4  Evaluation methodology applied in subjects with MO content (%) Systems of evaluation hand-in-hand with an increment in independent programs with most of the programs being common to other specialties. The most common system of evaluation for subjects with The greater number of medical schools has been accompa- medical oncology contents continues to be the multiple choice nied by more professors in Medical Oncology versus previous type of exam (97% of the cases), followed by clinical case studies. The trend is toward maintaining a joint exam with studies (30%). Short questions and essay questions are like- the other specialties with which a subject is shared. Given wise commonly used (15%). The most innovative methods of the tendency toward teaching oncology content together with evaluation, such as simulation systems or objective structured other specialties, the percentage of medical schools at which clinical evaluation (OSCE), is only applied in 12% of the sub- a final evaluation has decreased and grading is performed jects having medical oncology content (Fig. 4). independently. Clinical practice is largely evaluated solely on the basis The mean number of credits dedicated to Medical Oncol- of attendance and direct observation of the student’s partici- ogy has remained relatively constant or slightly lower from pation. In 23% of the cases, a dossier is also created during 3.5 according to the 2013 study to 3.2 ECTS credits on aver- the practicum. OSCEs are only used in 18% of the cases to age in 2016. Be that as it may, it has remained far from evaluate the practicum. the recommended 6 ECTS dedicated to medical oncology recorded in the 2013 report. Comparison with the situation in 2013 Due, at least in part, to the decrease in theoretical con- tent in the 6th year in the new study plans, an increase is Overall, with respect to the analysis conducted for SEOM’s observed in the programs that include Medical Oncology in 2013 report, “Formación de pregrado en Oncología. Una 3rd and 4th years. asignatura pendiente”, the number of medical schools with a specific, mandatory program in Medical Oncology has risen (Table 4). Nonetheless, this increase has not gone 13 Clinical and Translational Oncology (2020) 22:1049–1058 1055 Table 4  Comparison between the 2013 analysis of the “Formación de pregrado en Oncología Una asignatura pendiente” and the current analysis Criterium 2003 2013 2013 Recommendation 2016 Specific, independent, compulsory program 33.33% 41.66% Specific, distinct curriculum 29% Specific, non-independent, compulsory program 12.50% 25% for Medical Oncology. 61% Core/ mandatory subject Specific, compulsory program 45.83% 66.66% 90% Specific, independent, elective program 29% 13.88% 5% Total credits (mean) Five cred. LOU 3.5 ECTS Six ECTS 3.2 ECTS Academic year for the 5–6 years program/3 years 5th or 6th 4th, 5th, or 6th 5th or 6th 3th, 4th, 5th, or 6th educational program Medical Oncology instructor 40% 69% Promote instructors having a 90% specific profile and clinical dedication to Oncology Independent examination 66% 72% Independent grading 34% Results of the “Situation of the teaching of Oncology patient, increasing content about the molecular biology of in undergraduate education in Medicine” opinion cancer, and regarding research methodology. poll In the opinion of the residents polled, the credits dedicated to Medical Oncology during undergraduate training were Ninety-two percent (92%) of the faculty who participated in insufficient and, in particular, they detected gaps in knowl- the online poll felt that teaching oncology at the undergradu- edge about the treatment and management of complications. ate level exhibits areas for improvement. The main deficits related with the insufficient number of credits dedicated to SEOM’s recommendations to improve Medical Oncology, teaching content in an uncoordinated undergraduate training in Oncology in Spain way, the lack of systems of evaluation that suit the practical competences involved, and the excessive weight of theoreti- As a result of the analysis and the opinion poll conducted, cal content in the evaluation. the project working group put forth four recommendations The instructors who participated in this poll felt that to contribute to medical school graduates acquiring the Medical Oncology should be taught as a subject that is inte- necessary competences in medical oncology to practice the grated or coordinated with other areas of medical pathology, profession with the utmost guarantees of quality (Table 5). mandatory in the final years of undergraduate training, and Implementing a specific program dedicated to Oncology in endowed with sufficient credits. all undergraduate training in medical programs with an inte- As regards the distribution of hours dedicated to theory grative, cross-sectional view of the subject, including a spe- and practice, most of the instructors agreed that the number of cific evaluation is the leading recommendation. In light of the hours of learning by practice should lean toward being equal data regarding the situation in the 2016–2017 academic year, to the number of hours dedicated to theoretical content. the project’s working group felt the proposal made by SEOM A fundamental element to enhancing training in oncol- at their meeting of faculty in 2010 for a Medical Oncology ogy during undergraduate education in medicine, the sub- program to be totally valid and adaptable (Table 6). ject must include updated theoretical content and make it The remaining recommendations include promoting under- possible to perform clinical practice in medical oncology graduate student participation in the activity of the Medical services. The main impediment to implementing an oncol- Oncology services, the incorporation of content about innova- ogy training program perceived by the faculty polled is the tive diagnostic and treatment procedures and their perspective current inertia and inflexibility of university structures at all looking toward the future. Finally, at SEOM we support the levels, including personnel, subjects, or departments. role of the Medical Oncologist in teaching undergraduate edu- Sixty-two percent (62%) of the respondent believe that cation and recommend promoting actions that make it easier basic competences are not adequately collected in the train- for physicians to develop teaching careers. ing programs. The primary shortcoming in competences among undergraduates is the lack of the fundamental con- cepts of management of the oncological patient (symp- Discussion tomatology, toxicities, support treatment, etc.), and patient- related competences as to communication skills and the need Aware of the importance of undergraduate education in Oncol- to reinforce the acquisition skills in communicating with the ogy, SEOM has proven its commitment to the improvement of said training by organizing meetings and monographic fora, 13 1056 Clinical and Translational Oncology (2020) 22:1049–1058 Table 5  SEOM’s recommendations for the organization of Medical Oncology programs Recommendation 1: implement a specific program dedicated to Oncology in all undergraduate medical education programs with an integrative, cross-sectional view of the subject, including a specific evaluation Program integrated in a mandatory subject Having at least 4–6 specific ECTS, depending upon whether palliative care content is included In a subject taught in the last years of the undergraduate education program, preferably in the 5th year, when the student already has a general view of the disease Having an instructor who is a medical oncologist in 100% of the cases, who imparts knowledge about the clinical approach to the patient in routine practice (symptomatology, toxicities, support treatment, etc.) and contributes an integral view of cancer treatment Having aims specifics for the training of competences appropriate to primary care physicians and future specialists in different diseases having greater contact with patients with cancer, avoiding an excessive workload of highly specialized knowledge Coordinated with the content about cancer in other Medical Pathology and Surgical Pathology subjects, thereby preventing redundancies or commissions Reinforce the importance of the clinical content of Oncology, with a specific system and the aim of evaluating competences With the option of practical in Medical Oncology services in 100% of the subjects or rotations Recommendation 2: promote undergraduate student involvement in practica out-patient and in-patient activity, contact with the patient in fol- low up, long-term survivor, on tumor boards, genetic counseling, and research units, in MO services Recommendation 3: promote content aimed at training for use in clinical practice, avoiding the overload of knowledge specific to an Oncology super specialist. Promote the incorporation of content regarding innovative diagnostic and treatment procedures, including their perspective of evolution in the future Recommendation 4: SEOM believes that the Medical Oncologist must play a relevant role in teaching Medical Oncology at the undergraduate level of education. SEOM will dedicate special effort to promoting Medical Oncologists’ participation in the teaching of undergraduate educa- tion, as well as in facilitating Medical Oncologists’ access to accreditation by ANECA as instructors as well as putting forth proposals and recommendations for undergraduate education in Medicine, must renew their specific Medical Oncology programs to be carried out. accreditation within a maximum period of 8 years from the Royal Decree 1393/2007, dated 29 October, which pro- date of degree verification or from the date of their latest vides for the organization and planning of official university accreditation. When evaluating the proposed study plans education [7] made it possible to develop the procedure by for degrees that have been designed, ANECA has con- which to design and establish requirements for university cur- firmed that they are in line with the European Higher Edu- ricula. By virtue of the [principle of] university autonomy, the cation Area and that the results of the degree are adequate universities themselves are responsible for creating and pro- and enable the students to acquire the skills established. posing the education to be taught and the degrees to be issued On the basis of the review carried out, providing data regard- and, with the aim of promoting curricular diversification, the ing the situation during the 2016–2017 academic year, the organization of university education is made more flexible. project working group proposes a series of recommendations Study plans are understood as a project of implementa- aimed at improving undergraduate education in Oncology. tion for university education, for the purpose of students’ The first one is the implementation of a specific program acquiring competences. This same Royal Decree establishes dedicated to Oncology in all undergraduate medical degree the verification system for the study plans that are elaborated programs. After reviewing the proposal that was agreed upon by the universities, through the University Governing Board at the meeting of SEOM instructors in 2010 to design Medi- and authorized by the corresponding Autonomous Commu- cal Oncology teaching programs, the project working group nity. Their evaluation is the responsibility of the assessment deemed it fully valid and adaptable to different realities. The agencies (the National Quality Assessment and Accreditation competences defined insofar as knowing and knowing how are Agency of Spain (ANECA for its Spanish acronym) or the concerned can serve as a basis for both designing programs, evaluation bodies determined in the Law regarding Autono- as well as in the processes of accreditation and reaccredita- mous Communities). tion of undergraduate education programs. Likewise, they are In the Clinical Practice in Humans training module, considered to be an adequate foundation upon which to define Order ECI/ 332/ 2008, dated 13 February, that sets forth student evaluation systems, in different modalities, including the requirements that must be fulfilled to verify official innovative methodologies, such as ECOEs. university degrees, that determine that a person can prac- Consequently, it is regarded as being a flexible and tice medicine [8], reflects two skills that are directly linked adaptable proposal that, in addressing the autonomy of with Oncology: understand tumor disease, their diagnosis the university, responds to the evolution of the specialty, and management, and palliative medicine. Moreover, the inasmuch as there are more and more tumors for which official university degrees corresponding to undergradu- medical treatment is key and in practically all the cases, ate education, consisting of 360 credits, as is the case of integral or multidisciplinary treatment is essential. 13 Clinical and Translational Oncology (2020) 22:1049–1058 1057 Table 6  Program of Medical Oncology proposed by SEOM Medical Oncology KNOW Recognize, diagnose, and guide management Only know about 1. Tumor disease: Gnoseologic diagnosis and diagnosis of extension. Prognostic factors and 1. Cell and molecular biology of cancer staging factors 2. Epidemiology of cancer and risk factors 2. Carcinogenesis 3. Primary and secondary prevention 3. Growth of the tumor cell 4. Hereditary cancer and genetic counseling 4. Mechanisms of tumor invasion and metastasis 5. Acute tumor complications: superior vena cava syndrome. Spinal cord compression syn- drome. Intracranial hypertension syndrome. Hypercalcemia 6. Paraneoplastic syndromes (endocrine, neurological, hematological, dermatological, osteoar- ticular, and other manifestations) 7. Systemic treatment for cancer: chemotherapy 8. Systemic treatment for cancer: hormonotherapy 9. Systemic treatment for cancer: immunotherapy and biological therapies 10. Evaluation of response to treatment and effects on quality of life (e.g., RECIST, WHO). Clinical trials in Oncology 11. Acute toxicity of antineoplastic treatment 12. Support treatment for the patient with neoplasia: general concepts 13. Support treatment for the patient with neoplasia. Infections in the patient with cancer 14. Support treatment for the patient with neoplasia. Pain treatment 15. Support treatment for the patient with cancer. Anemia. Cachexia 16. Control of syndromes in terminal disease. Sedation 17. Lung cancer. Natural history, prognostic factors, staging, and treatment strategy 18. Breast cancer. Natural history, prognostic factors, staging, and treatment strategy 19. Cancer of the stomach, pancreas, and bile ducts. Natural history, prognostic factors, stag- ing, and treatment strategy 20. Colorectal cancer. Natural history, prognostic factors, staging, and treatment strategy 21. Ovarian cancer. Natural history, prognostic factors, staging, and treatment strategy 22. Head and neck cancer. Natural history, prognostic factors, staging, and treatment strategy 23. Prostate cancer. Natural history, prognostic factors, staging, and treatment strategy 24. Bladder, urinary tract, and kidney cancers. Natural history, prognostic factors, staging, and treatment strategy 25. Germ cell tumors. Natural history, prognostic factors, staging, and treatment strategy 26. Cancer of the cervix and endometrium. Natural history, prognostic factors, staging, and treatment strategy 27. Sarcomas. Natural history, prognostic factors, staging, and treatment strategy 28. Melanomas. Natural history, prognostic factors, staging, and treatment strategy 29. Tumors of the central nervous system. Natural history, prognostic factors, staging, and treatment strategy 30. Cancer of unknown origin. Natural history, prognostic factors, staging, and treatment strategy Medical Oncology Know how to do Know how to do competently (routinely and without Have practiced with supervision (under the tutor’s Have seen it practiced by an expert supervision) supervision) 1. Clinical history oriented toward cancer 1. General management of tumor syndromes 1. Interventional procedures in the diagnosis and treatment of cancer patients 13 1058 Clinical and Translational Oncology (2020) 22:1049–1058 Table 6  (continued) Medical Oncology Know how to do Know how to do competently (routinely and without Have practiced with supervision (under the tutor’s Have seen it practiced by an expert supervision) supervision) 2. By means of physical examination, recognize the 2. Management of the most common tumors and existence of the most common tumors and their com- their complications plications, oriented towards their natural history 3. Indicate and interpret complementary testing to diagnose the nature and extension of different tumors 4. Indicate early detection and screening procedures 5. Indicate diagnostic procedures for tumors when facing syndromes and warning signs With respect to its implementation and in light of the Research involving human participants and/or animals Consent is not results of the analysis and the evolution experienced since required for this type of study. This article does not contain any studies with human participants or animals performed by any of the authors. 2013, the working group identified a series of characteris- tics it deems fundamental with respect to the obligation, Informed consent Informed consent was obtained from all individual structure, and minimum time dedicated to the program, so participants included in the study. as to guarantee the minimum quality in keeping with the relevance of the pathology. Open Access This article is distributed under the terms of the Crea- Finally, the timing for initiating the formalities to renew tive Commons Attribution 4.0 International License (http://creat​iveco​ the accreditation of undergraduate medical degrees by mmons​.org/licen​ses/by/4.0/), which permits unrestricted use, distribu- tion, and reproduction in any medium, provided you give appropriate ANECA is identified as being an outstanding opportunity credit to the original author(s) and the source, provide a link to the to revise how Medical Oncology programs are organized in Creative Commons license, and indicate if changes were made. undergraduate educations of medicine. References Conclusions 1. SEOM. Las Cifras del Cáncer en España 2017. [Online] 2017. Training in Medical Oncology still has a long way to go to 2. UICC/WHO. Undergraduate education in cancer in the European Region. 1981. become an independent, compulsory subject of at least four 3. Peckham M. A Curriculum in Oncology for Medical Students in ECTS taught by a medical oncologist at all medical schools, Europe. Acta Oncol. 1989;28(1):141–7. which have a growing presence at said medical schools. The 4. SEOM. Reunión de Docentes Universidades de España 2010. evaluation model continues to be linked to the lack of independ- Córdoba: s.n., 2010. 5. SEOM. Formación de pregrado en Oncología. Una asignatura ence from other subjects; hence, few medical schools evaluate pendiente. 2013. it as an independent element. Training activities that include 6 Rivera F, Andres R, Felip E, Garcia Campelo R, Lianes P, Llom- clinical practice at all levels and stages of the care process must bart A, Piera JM, Puente J, Rodriguez CA, Vera R, Virizuela JA, still be promoted, as well as elements that incorporate the per- Martin M, Garrido P. Medical oncology future plan of the Span- ish Society of Medical Oncology: challenges and future needs spective of integral, innovative treatment of the future. of the Spanish oncologists. Clin Transl Oncol. 2016. https​://doi. org/10.1007/s1209​4-016-1595-9. Acknowledgements The authors are pleased to acknowledge all profes- 7. Real Decreto 1393/2007, de 29 de octubre, por el que se establece sionals who participated in the personal interviews and online survey la ordenación de las enseñanzas universitarias oficiales. BOE-A- and provided support for the development of the study. 2007-18770. 2007. 8. Orden ECI/ 332/ 2008 de 13 de febrero de 2008, por la que se Funding This study was funded as an unrestricted grant by Janssen. establecen los requisitos para la verificación de los títulos Uni- Janssen did not have any intervention in the discussion and outcomes versitarios oficiales que habiliten para el ejercicio de la profesión of this report. de médico. BOE-A-2008-2674. 2008. Publisher’s Note Springer Nature remains neutral with regard to Compliance with ethical standards jurisdictional claims in published maps and institutional affiliations. Conflict of interest The authors declare that they have no conflicts of interest. 13