Do we care about caring for older adults? Exploring the resistance to uptake of geriatric training in medical oncology training - a qualitative study.

INTRODUCTION: The population is aging, driving a rise in disease prevalence and healthcare utilization. While oncologists increasingly care for older patients, trainees in subspecialty programs such as oncology rarely receive training in geriatrics. Despite increasing recognition about the importance of learning to care for older patients, progress is slow and the reason for lack of uptake of geriatric curriculum is unclear. We thus sought to explore the experiences and perspectives of trainees and recent graduates to develop a richer understanding of barriers impeding uptake of geriatric curriculum and to identify opportunities to address them. MATERIALS AND METHODS: We interviewed subspecialty trainees, fellows and recent graduates from Canadian medical oncology programs (n = 22) using semi-structured interviews. Data analysis was done using thematic analysis of the transcripts. RESULTS: Lack of faculty with expertise in geriatric oncology limited uptake of geriatric curriculum and impeded meaningful integration of geriatrics into assessment and clinical care. However, participants suggested a "hidden curriculum"- a divergence between what is taught and what actually happens in practice-was also important. The perception of insufficient high-level evidence to support geriatric oncology and challenges related to integration of geriatric content into subspecialty training were also identified as potential barriers. DISCUSSION: While participants endorsed the importance of learning about geriatric oncology, the lack of integration of geriatric oncology into practice and testing appears to propagate the belief that geriatrics is not essential to subspecialty practice and that geriatrics care should be referred on. Additionally, our results indicate that the perceived scarcity of data in older adults likely contributes to the dissonance between stated values (that caring for older patients is important) and what trainees see practiced (that older patients are often excluded from pivotal studies). Uptake and integration of geriatric training into subspecialty training thus requires both faculty with geriatric expertise, as well as official recognition and integration into national subspecialty training objectives and assessments. As a qualitative study, these results reflect the perspectives of Canadian medical oncology trainees and recent graduates and thus findings may not be transferable to other contexts.