La compétence particulière en oncologie thoracique Le projet de curriculum Hermes (ERS) Prof. Anne-Pascale Meert, Institut Jules Bordet, Belgique

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1 La compétence particulière en oncologie thoracique Le projet de curriculum Hermes (ERS) Prof. Anne-Pascale Meert, Institut Jules Bordet, Belgique

2 HERMES Harmonizing Education in Respiratory Medicine for European Specialists Harmonised Training standards across the European Union Recognition of diplomas and certificates of qualification in medicine in EU Free access and mobility for European medical specialists

3 Thoracic Surgery Adult Respirator y Medicine Paediatric Respiratory Medicine Respiratory Infections Spirometry Physiotherap y Respiratory Sleep Thoracic Oncology Respiratory Critical Care

4 ORGANISATION OF HERMES Harmonisie d Specialty Training Continuous Professional Development/ Revalidation Adult Respiratory Medicine HERMES Diploma + National Certification Respiratory Critical Care/ Sleep & Breathing/ Thoracic Oncology/ Spirometry/ Respiratory Infections HERMES Certificate Medical Expert/ Advanced Expertise

5 Thoracic oncology status in Europe

6 Incidence of lung cancer in Europe

7 Survival of lung cancer in Europe Lung cancer

8 Provision of healthcare

9 Inequalities in lung cancer care Important differences in the infrastructure of healthcare at the national and local level Inequalities in lung cancer care across Europe and inside countries Many differences in the structure and provision of care, as well as in access to care

10 The HERMES-Thoracic oncology project A training concept that should be accessible for all physicians involved in diagnosis and treatment of thoracic tumors physicians in all European countries The certificate should be recognized in all the European countries And it should contribute to the improvement of the thoracic oncology standard of care

11 Advanced Expertise THORACIC ONCOLOGY Thoracic oncology training Specialty training Respiratory specialist Medical Oncologist Thoracic Surgeon Radiation Oncologist

12 The thoracic oncology Hermes task force Respiratory physicians Medical oncologists Thoracic surgeons Radiotherapists Pathologist Official collaboration with ESTRO Official collaboration with ESTS Members of ESMO

13 The TO Hermes task force 15 countries represented: Task force members National respondents

14 Training of TO is not well defined in the different European countries and depends on the subject-specific background of the physicians who want to become TO specialists The professional career of TO specialists is dissimilar in different countries Pharmacotherapy of lung cancer is for example mainly prescribed by respiratory medicine specialists in some European countries but by oncologists in others There is a need in Europe for a standardised training

15 Syllabus Using this information, the Task Force aimed at developing a comprehensive European Thoracic Oncology core syllabus which is consensus-based and includes the main disciplines working in the field Syllabus items were discussed keeping in mind how to raise the TO skill level of practice in Europe.

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18 A B C D E F G H I J K L M N O P Q R S T U V Thoracic Oncology HERMES Syllabus Modules General principles of the biology of thoracic cancers Aetiology and epidemiology Clinical presentations Diagnostic Procedures Imaging Diagnostic and interventional bronchoscopic techniques and medical thoracoscopy Clinical and pathological staging Pathology of intrathoracic tumors Prognostic factors /predicitive markers Principles of thoracic surgery Management of surgical complications Principles of radiation therapy Principles of systemic therapy Side effects of systemic therapy and their management Combined modality treatments Management of particular groups of patients Treatment evaluation and follow-up Supportive care Methodologies for clinical practice and research Ethics Cancer related immunology Economic considerations in lung cancer treatment

19 Curriculum I. To define who will be eligible for assessment in Thoracic Oncology II.To define the learning outcomes (knowledge, skills and attitudes) III.To give training recommendations (assessment tools, minimum requirements, teaching and learning opportunities)

20 I. Who is the TO specialist A highly specialized respiratory physician medical oncologist radiotherapist thoracic surgeon that has enough knowledge and experience in order to lead a thoracic oncology tumor board

21 II. DEFINITION OF LEARNING OUTCOMES: BLOOM S TAXONOMY Types of learning or learning domains: 1. Cognitive: knowledge (mental skills) 2. Affective: attitudes (growth in feelings or emotional areas) 3. Psychomotor: manual or physical skills

22 Syllabus item: 3 Indications and contraindications for systemic therapy including chemotherapy and targeted agents Cognitive domain: Ascertain indications according to stage, histology, and molecular alterations in consideration of the types of drugs. Ascertain contraindications related to comorbidities, age, poor performance status in consideration of the types of drugs. Affective domain: Communicate relevant information to patient and family regarding indication, potential benefit and side effects, administration modalities. Communicate trial results with patients. Demonstrate interest in staying up to date on medical advances. Psychomotor domain: Decide treatment taking into consideration benefit and cost/toxicity. Personalise the drug regimen appropriate to the patient and his/her tumour. Manage the course of the treatment according to tolerance and complications.

23 G.E. Miller, Acad Med1990 Sep;65(9 Suppl):S63-7 III. TRAINING AND ASSESSMENT RECOMMENDATIONS MILLER S PROPOSAL FOR ASSESSMENT OF CLINICAL SKILLS o Skills based assessment o Knowledge based assessment

24 Syllabus item: 3 Indications and contraindications for systemic therapy including chemotherapy and targeted agents HERMES level of assessment: 2 Clinical exposure: Attend 10 medical rounds Rotate for 2 weeks in the medical service Discuss 40 cases at MDT Assessment tools: MCQ Case based discussions

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26 Conclusions The HERMES TO syllabus is a first step in achieving harmonised training in thoracic oncology. It is the first European syllabus of Thoracic Oncology that includes the main treating disciplines. This is essential to provide patients with a comprehensive, high quality care. The curriculum recommendations are under reviewing and will be published this year Next steps: TO examination and Diploma Accreditation of training centres

27 The thoracic oncology HERMES task force Paolo Boffetta Alessandro Brunelli Dirk De Ruysscher AM Dingemans Enriqueta Felip Mina Gaga Fernando Gamarra Bogdan Dragos Grigoriu Sam Janes Charles Hugo Marquette Gilbert Massard Anne-Pascale Meert Julie-Lyn Noel Paul Martin Putora Jean-Paul Sculier Philip Schnabel