Impact of an educational activity on the competence of oncologists and gastroenterologists regarding the application of molecular-guided therapies for the treatment of advanced cholangiocarcinoma

Abstract

Background: Cholangiocarcinoma (CCA) is a rare, aggressive cancer of the biliary tract with patients often having a poor prognosis and complex genetic heterogeneity. Following recent approvals of targeted therapies for the treatment of advanced CCA, the objective of this online, continuing education activity was to determine whether improvements in competence could be made regarding the identification of patients and application of molecularly guided therapy to advanced CCA through the use of interactive and engaging patient cases. Methods: Oncologists and gastroenterologists participated in an online, interactive clinical case based educational activity focusing on the identification of patients for molecular guided therapy, clinical decision making and management while on therapy for patients with advanced cholangiocarcinoma. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed competence, and 1 question rated on a Likert-type scale assessed confi- dence. Data were collected from 11/01/21 to 02/03/22. A paired samples t-test was conducted for significance testing on overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (5% significance level, P < .05). Improvements were defined as a learner answering the question correctly in the post-assessment after they previously answered it incor- rectly in pre-assessment. Reinforcements were when the learner answered the question correctly in both instances of assessment. Results: The responses of 42 oncologists and 44 gastroenterologists, who answered all questions as part of the pre- and post-activity assessment during the study period were included in the analysis. Overall, 71% and 70% of oncologists and gastroenterologists, respectively, improved their competence across the activity. Specific areas of improvement included (all P < 0.001): 26% and 32% of oncologists and gastroenter- ologists, respectively, improved and 67% and 66% of oncologists and gastroenterolo- gists, respectively, reinforced their competence regarding the identification of patients eligible for molecular targeted therapy. Regarding the application of molecularly guided therapy in routine practice, a relative change of 53% in competence was observed for oncologists and 61% for gastroenterologists. As a result of the education, 55% of the oncologists and 64% of gastroenterologists had a measurable improvement in confi- dence in their ability to apply molecular testing results to treatment selection in pa- tients with CCA (P < 0.001 for both specialties), which led to an average positive confidence shift of 82% for oncologists and 105% for gastroenterologists. Conclusions: This study demonstrated the effectiveness of an online, interactive, case-based educational activity on improving the competence and confidence of oncologists and gastroenterologists regarding the application of molecular targeted therapy to clinical cases with advanced CCA. It will be critical to focus future edu- cation on building upon these improvements and increasing exposure of physicians to more opportunities of clinical simulation.