Journal of Cancer Education
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
A survey in general practice about undergraduate cancer education: Results from gironde (france) Alain Ravaud MD , Bernard Hœrni MD , Yves Bécouarn MD , Philippe Lagarde MD , Pierre Soubeyran MD & Françoise Bonichon MD To cite this article: Alain Ravaud MD , Bernard Hœrni MD , Yves Bécouarn MD , Philippe Lagarde MD , Pierre Soubeyran MD & Françoise Bonichon MD (1991) A survey in general practice about undergraduate cancer education: Results from gironde (france) , Journal of Cancer Education, 6:3, 153-157 To link to this article: http://dx.doi.org/10.1080/08858199109528112
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 2
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [Australian Catholic University]
Date: 31 August 2017, At: 21:20
J. Cancer Education. Vol. 6, No. 3, pp. 153-157, 1991 Printed in the U.S.A. Pergamon Press pic
0885-8195/91 $3.00 + .00 ©1991 American Association for Cancer Education
A SURVEY IN GENERAL PRACTICE ABOUT UNDERGRADUATE CANCER EDUCATION: RESULTS FROM GIRONDE (FRANCE)** ALAIN RAVAUD, MD*;
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
PHILIPPE LAGARDE, MD†;
BERNARD HŒRNI, MD*;
YVES BÉCOUARN,
PIERRE SOUBEYRAN, MD*;
MD*;
FRANÇOISE BONICHON,
MD‡
Abstract — In Bordeaux University (France), oncology teaching was individualized in 1972, and an optional oncology course devoted to general practice was created in 1980. To evaluate the adequacy of these two oncology classes for general practitioners and so to adapt our current teaching, we sent to each of 1,219 general practitioners (GP's) of Gironde (county of the southwest of France) an anonymous questionnaire about oncology teaching in prevention, screening and cancer detection, cancer management, and curriculum balance. We received 688 (56.4%) responses. GPs said that as undergraduates, they were insufficiently instructed about screening programs (65%), pain control (80%), palliative care (50%) and fundamental or biological data (> 55%). This situation, which showed signs of improvement from 1975 on, has improved even more since 1985. General practitioners, as well as undergraduates, are not yet adequately educated about cancer for general practice, so we have to adapt better our current teaching for undergraduates and those in continuing medical education.
INTRODUCTION In France, as in other western countries, 25% of the population die from cancer. The annual incidence of cancer is close to 200,000 for 55 million inhabitants. General practitioners (GPs) are becoming more and more important as providers of cancer care, especially in cancer prevention, early diagnosis, symptomatic treatment, rehabilitation, and palliative care. On the other hand, oncology changed considerably in the past 10 to 20 years for GPs: eg, introduction of chemotherapy, taking charge of outpatients. So, the greater the role of GPs, the more they have to be taught oncology focused on general practice. Nevertheless, in France, oncology teaching was restricted for a long time to specialities of pa-
**This paper was presented at the Second Annual Scientific Meeting of the European Association for Cancer Education, Athens 1989. *Department of Medical Oncology, Fondation Bergonié, Bordeaux, France. †Department of Radiotherapy, Fondation Bergonié, Bordeaux, France. ‡Department of Biostatistics, Fondation Bergonié, Bordeaux, France. Reprint requests to: Dr. Alain Ravaud, Department of Medical Oncology, Fondation Bergonié, 180 rue de SaintGenès, 33076 Bordeaux Cedex - FRANCE.
thology and surgery. In Bordeaux, oncology teaching changed during the two last decades, and was individualized in 1972. More innovative for France was the creation in 1980 of an optional oncology course devoted to general practice, under the leadership of Bernard Hœrni (Fondation Bergonié and University of Bordeaux II). In order to explore the current adequacy of undergraduate cancer education with general practice, we undertook a survey of GPs in the county of Gironde around Bordeaux University, inquiring about cancer education. The aim of the study was to highlight areas that require further emphasis in oncology teaching for general practice, to better current undergraduate oncology teaching, and to improve the GPs ability by adequate continuing medical education (CME). We employed a questionnaire used by Tattersall et al. 1 for a survey of Australian medical students about their cancer education. MATERIAL AND METHODS When Tattersall used his questionnaire, he focused the results and conclusions on substantial differences between the medical schools and discord within the faculty, and between the medical schools and students in terms of what is
153
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154
A. RAVAUD et al
thought to be important and what the students have, in fact, experienced. Our aims were differently focused on results of each question of the questionnaire and on trends since the year of graduation to point out failures of cancer education and improvement during the last decade. The questionnaire, close to Tattersall's, included 26 questions: 4 general questions and 22 questions about cancer. The general questions were about the year of graduation, the University of medical studies, the participation in CME, and the size of the city of practice ( < 3,000; 3,000 to 10,000; 10,000 to 50,000; > 50,000 inhabitants). The questions about cancer (Table 1) had the 4 following topics: prevention, screening and cancer detection (questions 1 to 7), cancer management (questions 8 to 14), curriculum balance (questions 15 to 22). For each question, under- and postgraduate periods were considered separately. For each period, the possible answer was " y e s " or " n o " and needed only to be checked. We sent this anonymous questionnaire, with an explanatory letter and prepaid return envelope, to each of the 1,219 general practitioners (GP) of the county of Gironde, where the University of Bordeaux is located. We have considered the answers received during the first two months. We computed the results of each question; the questions were grouped according to subject. We used the Chi-square test to compare results according to the size of the city of practice and the year of graduation. The years of graduation 1975 and 1985 were considered according to the delay between the period of oncology teaching and the time of entering general practice. RESULTS We had 703 answers (57.6%); 15 were not évaluable; 10 were sent to a specialist; 5 letters were returned without any answer. So we had 688 évaluable answers (56.4%). The rate of answers was homogenous according to the year of graduation ( s 1964: 56.3%; 1965-1974: 51.4%; 1975-1984: 52.2%; > 1985: 68.5%). On the other hand, we had significantly more answers from the GPs practicing in the smallest cities: ( < 3,000: 64.5%; 3,000 to 10,000: 52.2%;
10,000 to 50,000: 52.5%; > 50,000: 50%) (p < 0.01). Ninety percent of the GPs did their medical studies in the University of Bordeaux. Seventy-one percent claimed to participate regularly in CME.
Cancer prevention (questions 4, 5 and 13, Table 1) More than a half of GPs said that they had not learned the technique for a cervical smear as students. There has been a significant improvement (p < 0.01) since 1975 with 45.5% positive answers, confirmed since 1985 with 57% positive answers. Among postgraduates there was a significant improvement (p < 0.01) for country GPs (cities < 10,000: 70% positive answers; > 50,000: 52% positive answers).
Screening and cancer detection (questions 1 to 7, Table 1) GPs said that they were taught herald signs and examination of the main cancer, but they also pointed out the lack of screening information during the undergraduate period. There has been an improving trend since 1985 about breast screening programs.
Cancer management (questions 8 to 14 and 19, Table 1) The positive answers on the subject of palliative care and pain control, were significantly more numerous for the youngest GPs ( > 1985), 68% (p = 0.01) and 33.8% (p < 0.01), respectively. About pain control, other than the use of analgesics, 39.3% of all GPs said they had never been instructed about it.
Curriculum balance (questions 15 to 22, Table 1) GPs said that as undergraduates they were not taught enough about fundamental research (from 21.6% to 44.4% positive answers). Half of them said they were adequately taught as undergraduates, but 73.5% said that the time devoted to oncology teaching, focused on general practice, was inadequate.
Undergraduate cancer education for general practitioners
155
Table 1. Questionnaire and positive answers from general practitioners about the undergraduate period Positive answers
Questionnaire
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
1. Were you taught the alarm signs fon
a) breast cancer b) cervical cancer c) head and neck cancer d) colorectal cancer e) skin cancer 2. Were you taught the technique for breast self examination? 3. Were you taught screening programs for breast cancer? 4. Were you shown the techniques for obtaining a cervical smear? 5. Were you taught the recommended frequency of cervical smear examinations? 6. Were you taught screening programs for colorectal cancer? 7. Have you personally examined a case of: a) breast cancer b) cervical cancer c) head and neck cancer d) carcinoma of the lung e) a colorectal cancer f) a melanoma 8. Have you ever visited a medical oncology or a hématologie department? 9. Have you ever visited a department of radiation oncology? 10. Have you ever watched an operation for cancer? 11. Were you taught about palliative care in oncology? 12. Did you receive instruction in techniques of pain control in oncology other than the use of analgesics? 13. Were you taught the treatment of hyperkeratosis and skin cancers? 14. Have you been in contact with support associations (colostomy association, mastectomy association. Lost Cord association . . . )? 15. Have you ever been present at a post mortem examination of one who died of cancer? 16. Did you receive explanations for the following terms: a) chemo or radio sensitivity b) chemo or radio curability c) adjuvant treatment d) palliative treatment e) median survival f) relapse free survival? 17. Have you been instructed on the importance of the pathological diagnosis? 18. Did you receive information about the main biological data in oncology: a) oncogenes b) tumor cell kinetics c) growth factors 19. Were you instructed in the main therapeutics of: a) cancer surgery . b) chemotherapy c) radiotherapy d) clinical trial 20. Did you see any aspect of fundamental research? 21. Do you believe that you were adequately instructed in oncology for general practice? 22. Do you believe that the time devoted to oncology is adequate?
DISCUSSION Tattersall's questionnaire was reproducible, given 58% of answers, which is better than two of our preceding studies for GPs about "cancer and general practice" and "chemotherapy and general practice" performed in the same way (50% and 55%) .2>3 If the distribution was homogenous according to the year of graduation
95.7 94 93.2 93.4 86.3 64.3 32.9 42.1 64 34.4 67.1 50.8 66.7 79.5 67.1 48.5 53.4 47.1 68 49 18.4 36.4 5.2 20.3 71.5 67.1 69.1 70 43.5 62.2 67.5 44.4 43.2 41.8 74.2 73.9 75.9 35.8 26.1 42.5 26.4
and the size of the city of practice, we are not able to extend our results to the GPs who did not answer. We do not know and we cannot evaluate if those who responded are the most interested about cancer, the most educated, or the most up-to-date. The criticism, exposed in free commentaries, was that the questionnaire was too superficial, without any questions about psychological approach, with not enough ques-
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
156
A. RAVAUD et al
tions about specific treatment, pain control, or palliative treatment. We agree with these criticisms, but we preferred to keep framework of Tattersall's questionnaire,1 which is short and easy to complete, even if the aims were quite different. Because they were inappropriate for the French health organisation our questionnaire left out four of Tattersall's questions: those about the visit of a screening clinic for breast or cervical cancer and the role and function of the State Cancer Council because they do not apply; those about the visit to a palliative care facility and discussion of palliative care with medical social workers, since the first palliative care unit opened in our area (Aquitaine) only in 1989 and few medical social workers are integrated in the health system. If we compare results of TattersalFs survey with ours, some differences are very important, pointing out our failure especially in cancer prevention, screening, and palliative care. Thus 75% and 56% of Australian medical students were instructed in screening programmes for breast and colorectal cancer, respectively. Yet, there are still no French national or regional screening programmes. About the technique of cervical smear, 98% of Australian medical students said they were informed. One may consider three reasons for this discrepancy: (1) only half of French medical students spend a 4-month period in an oncology department; (2) GPs working in the cities tend to leave gynecological examinations to gynecologists; and (3) in some medical or surgery departments, rectal or vaginal examination is forbidden for medical students. Considering palliative care, especially pain control, 65% of Australian medical students were informed about other methods than the use of analgesics. This points out the fact that medical doctors in many of medical or surgical departments are not sufficiently instructed in pain control, especially chronic pain treatment. These negative results are not consistent with what the GPs were expecting. A national survey of 300 GPs about this topic pointed out that GPs wanted to be more involved in cancer prevention, screening, and symptomatic treatment. Nevertheless, it is necessary to exercise some caution in attempting to compare results, because the answers of this French survey express
the disagreement of GPs with oncology teaching for general practice rather than the lack of information. The positive results are about the trend or the significant improvement since 1975 and 1985. As there was no question about periods of 4 to 6 months in an oncologic department, we could not evaluate their benefit, even when we know that the attitude of these students changed during this period.5"8 Our current teaching includes at one and the same time for all the students theoretical oncology courses at the University. For the students who spend a period in our institution there are theoretical oncology courses different from those in the University, mainly practical teaching, weekly discussions of clinical charts, free discussions of psychosocial approach, and presence at consultations.9"12 Looking at our results shows that as oncology teachers we need to give more attention to cancer education for general practice, and for both the undergraduate period and the postgraduate one. The ability to have a period in an oncology department with a teaching approach quite different than in the University will be of great interest. The presence of a coordinator will be necessary to foster this goal and to harmonize the teaching among specialists. French GPs found information in the medical press (85%), CME (52%), medical discussions with specialists (45%), and laboratory documentation (21%). In waiting for mandatory CME in France, we have proposed to GPs a short period (5 days) at Fondation Bergonié with the Regional League Against Cancer, where appropriate topics are chosen and attendance at consultations is encouraged. It is not a surprise that the most discussed topics are cancer prevention, screening programs, and palliative care, especially psychosocial approaches and pain control.
REFERENCES 1. Tattersall MHN, Langland AO, Simpson JS, et al: Undergraduate education about cancer A survey in Australian medical schools. EUR J Clin Oncol 24:467-471, 1988. 2. Provost JC: Chimiothérapie anticancéreuse et omnipraticien. Thèse Méd, Bordeaux, n° 332, 1975. 3. Gourbat JP: Omnipracticiens, cancers et cancérologues. Thèse Méd, Bordeaux, n° 239, 1976.
Undergraduate cancer education for general practitioners
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
4. Anonyme: Médecin généraliste et cancer. Rev Prat 33: 2929-2984, 1983. 5. Haley HB, Juan IR, Gagan JF: Factor analytic approach to attitude scale constriction. J Med Educ 43: 331-336, 1968. 6. Blanchard CG, Ruckdeschel JC, Cohen RE, et al: Attitudes towards cancer The impact of a comprehensive oncology course on second year medical students. Cancer 47:2756-2762, 1981. 7. Lebovits AH, Croen LG, Goetzel RZ: Attitudes towards cancer. Cancer 54: 1124-1129, 1984. 8. Hœrni B, Marée D: Value of attitude questionnaires for assessing oncology teaching of medical students: Expe-
9.
10.
11.
12.
157
rience of Fondation Bergonié Bordeaux. J Cancer Educ 4:91-95, 1989. Tattersall MHN, Simpson JS, Langland AO: The education of medical students about cancer. Time for change. Eur J Clin Oncol 19:303-306, 1983. Association des enseignants de cancérologie (AEC): Objectifs d'un stage hospitalier de cancérologie. Rev Educ Med 6:176-180, 1983. Commission de formation en cancérologie de la communauté européenne: rapports de synthèse. Extraits, Nov. 1977. Hœrni B, Vrousos C: Enseignement hospitalier de la cancérologie. Bull Cancer 72:1-5, 1985.
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: http://www.tandfonline.com/loi/hjce20
A survey in general practice about undergraduate cancer education: Results from gironde (france) Alain Ravaud MD , Bernard Hœrni MD , Yves Bécouarn MD , Philippe Lagarde MD , Pierre Soubeyran MD & Françoise Bonichon MD To cite this article: Alain Ravaud MD , Bernard Hœrni MD , Yves Bécouarn MD , Philippe Lagarde MD , Pierre Soubeyran MD & Françoise Bonichon MD (1991) A survey in general practice about undergraduate cancer education: Results from gironde (france) , Journal of Cancer Education, 6:3, 153-157 To link to this article: http://dx.doi.org/10.1080/08858199109528112
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 2
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjce20 Download by: [Australian Catholic University]
Date: 31 August 2017, At: 21:20
J. Cancer Education. Vol. 6, No. 3, pp. 153-157, 1991 Printed in the U.S.A. Pergamon Press pic
0885-8195/91 $3.00 + .00 ©1991 American Association for Cancer Education
A SURVEY IN GENERAL PRACTICE ABOUT UNDERGRADUATE CANCER EDUCATION: RESULTS FROM GIRONDE (FRANCE)** ALAIN RAVAUD, MD*;
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
PHILIPPE LAGARDE, MD†;
BERNARD HŒRNI, MD*;
YVES BÉCOUARN,
PIERRE SOUBEYRAN, MD*;
MD*;
FRANÇOISE BONICHON,
MD‡
Abstract — In Bordeaux University (France), oncology teaching was individualized in 1972, and an optional oncology course devoted to general practice was created in 1980. To evaluate the adequacy of these two oncology classes for general practitioners and so to adapt our current teaching, we sent to each of 1,219 general practitioners (GP's) of Gironde (county of the southwest of France) an anonymous questionnaire about oncology teaching in prevention, screening and cancer detection, cancer management, and curriculum balance. We received 688 (56.4%) responses. GPs said that as undergraduates, they were insufficiently instructed about screening programs (65%), pain control (80%), palliative care (50%) and fundamental or biological data (> 55%). This situation, which showed signs of improvement from 1975 on, has improved even more since 1985. General practitioners, as well as undergraduates, are not yet adequately educated about cancer for general practice, so we have to adapt better our current teaching for undergraduates and those in continuing medical education.
INTRODUCTION In France, as in other western countries, 25% of the population die from cancer. The annual incidence of cancer is close to 200,000 for 55 million inhabitants. General practitioners (GPs) are becoming more and more important as providers of cancer care, especially in cancer prevention, early diagnosis, symptomatic treatment, rehabilitation, and palliative care. On the other hand, oncology changed considerably in the past 10 to 20 years for GPs: eg, introduction of chemotherapy, taking charge of outpatients. So, the greater the role of GPs, the more they have to be taught oncology focused on general practice. Nevertheless, in France, oncology teaching was restricted for a long time to specialities of pa-
**This paper was presented at the Second Annual Scientific Meeting of the European Association for Cancer Education, Athens 1989. *Department of Medical Oncology, Fondation Bergonié, Bordeaux, France. †Department of Radiotherapy, Fondation Bergonié, Bordeaux, France. ‡Department of Biostatistics, Fondation Bergonié, Bordeaux, France. Reprint requests to: Dr. Alain Ravaud, Department of Medical Oncology, Fondation Bergonié, 180 rue de SaintGenès, 33076 Bordeaux Cedex - FRANCE.
thology and surgery. In Bordeaux, oncology teaching changed during the two last decades, and was individualized in 1972. More innovative for France was the creation in 1980 of an optional oncology course devoted to general practice, under the leadership of Bernard Hœrni (Fondation Bergonié and University of Bordeaux II). In order to explore the current adequacy of undergraduate cancer education with general practice, we undertook a survey of GPs in the county of Gironde around Bordeaux University, inquiring about cancer education. The aim of the study was to highlight areas that require further emphasis in oncology teaching for general practice, to better current undergraduate oncology teaching, and to improve the GPs ability by adequate continuing medical education (CME). We employed a questionnaire used by Tattersall et al. 1 for a survey of Australian medical students about their cancer education. MATERIAL AND METHODS When Tattersall used his questionnaire, he focused the results and conclusions on substantial differences between the medical schools and discord within the faculty, and between the medical schools and students in terms of what is
153
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
154
A. RAVAUD et al
thought to be important and what the students have, in fact, experienced. Our aims were differently focused on results of each question of the questionnaire and on trends since the year of graduation to point out failures of cancer education and improvement during the last decade. The questionnaire, close to Tattersall's, included 26 questions: 4 general questions and 22 questions about cancer. The general questions were about the year of graduation, the University of medical studies, the participation in CME, and the size of the city of practice ( < 3,000; 3,000 to 10,000; 10,000 to 50,000; > 50,000 inhabitants). The questions about cancer (Table 1) had the 4 following topics: prevention, screening and cancer detection (questions 1 to 7), cancer management (questions 8 to 14), curriculum balance (questions 15 to 22). For each question, under- and postgraduate periods were considered separately. For each period, the possible answer was " y e s " or " n o " and needed only to be checked. We sent this anonymous questionnaire, with an explanatory letter and prepaid return envelope, to each of the 1,219 general practitioners (GP) of the county of Gironde, where the University of Bordeaux is located. We have considered the answers received during the first two months. We computed the results of each question; the questions were grouped according to subject. We used the Chi-square test to compare results according to the size of the city of practice and the year of graduation. The years of graduation 1975 and 1985 were considered according to the delay between the period of oncology teaching and the time of entering general practice. RESULTS We had 703 answers (57.6%); 15 were not évaluable; 10 were sent to a specialist; 5 letters were returned without any answer. So we had 688 évaluable answers (56.4%). The rate of answers was homogenous according to the year of graduation ( s 1964: 56.3%; 1965-1974: 51.4%; 1975-1984: 52.2%; > 1985: 68.5%). On the other hand, we had significantly more answers from the GPs practicing in the smallest cities: ( < 3,000: 64.5%; 3,000 to 10,000: 52.2%;
10,000 to 50,000: 52.5%; > 50,000: 50%) (p < 0.01). Ninety percent of the GPs did their medical studies in the University of Bordeaux. Seventy-one percent claimed to participate regularly in CME.
Cancer prevention (questions 4, 5 and 13, Table 1) More than a half of GPs said that they had not learned the technique for a cervical smear as students. There has been a significant improvement (p < 0.01) since 1975 with 45.5% positive answers, confirmed since 1985 with 57% positive answers. Among postgraduates there was a significant improvement (p < 0.01) for country GPs (cities < 10,000: 70% positive answers; > 50,000: 52% positive answers).
Screening and cancer detection (questions 1 to 7, Table 1) GPs said that they were taught herald signs and examination of the main cancer, but they also pointed out the lack of screening information during the undergraduate period. There has been an improving trend since 1985 about breast screening programs.
Cancer management (questions 8 to 14 and 19, Table 1) The positive answers on the subject of palliative care and pain control, were significantly more numerous for the youngest GPs ( > 1985), 68% (p = 0.01) and 33.8% (p < 0.01), respectively. About pain control, other than the use of analgesics, 39.3% of all GPs said they had never been instructed about it.
Curriculum balance (questions 15 to 22, Table 1) GPs said that as undergraduates they were not taught enough about fundamental research (from 21.6% to 44.4% positive answers). Half of them said they were adequately taught as undergraduates, but 73.5% said that the time devoted to oncology teaching, focused on general practice, was inadequate.
Undergraduate cancer education for general practitioners
155
Table 1. Questionnaire and positive answers from general practitioners about the undergraduate period Positive answers
Questionnaire
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
1. Were you taught the alarm signs fon
a) breast cancer b) cervical cancer c) head and neck cancer d) colorectal cancer e) skin cancer 2. Were you taught the technique for breast self examination? 3. Were you taught screening programs for breast cancer? 4. Were you shown the techniques for obtaining a cervical smear? 5. Were you taught the recommended frequency of cervical smear examinations? 6. Were you taught screening programs for colorectal cancer? 7. Have you personally examined a case of: a) breast cancer b) cervical cancer c) head and neck cancer d) carcinoma of the lung e) a colorectal cancer f) a melanoma 8. Have you ever visited a medical oncology or a hématologie department? 9. Have you ever visited a department of radiation oncology? 10. Have you ever watched an operation for cancer? 11. Were you taught about palliative care in oncology? 12. Did you receive instruction in techniques of pain control in oncology other than the use of analgesics? 13. Were you taught the treatment of hyperkeratosis and skin cancers? 14. Have you been in contact with support associations (colostomy association, mastectomy association. Lost Cord association . . . )? 15. Have you ever been present at a post mortem examination of one who died of cancer? 16. Did you receive explanations for the following terms: a) chemo or radio sensitivity b) chemo or radio curability c) adjuvant treatment d) palliative treatment e) median survival f) relapse free survival? 17. Have you been instructed on the importance of the pathological diagnosis? 18. Did you receive information about the main biological data in oncology: a) oncogenes b) tumor cell kinetics c) growth factors 19. Were you instructed in the main therapeutics of: a) cancer surgery . b) chemotherapy c) radiotherapy d) clinical trial 20. Did you see any aspect of fundamental research? 21. Do you believe that you were adequately instructed in oncology for general practice? 22. Do you believe that the time devoted to oncology is adequate?
DISCUSSION Tattersall's questionnaire was reproducible, given 58% of answers, which is better than two of our preceding studies for GPs about "cancer and general practice" and "chemotherapy and general practice" performed in the same way (50% and 55%) .2>3 If the distribution was homogenous according to the year of graduation
95.7 94 93.2 93.4 86.3 64.3 32.9 42.1 64 34.4 67.1 50.8 66.7 79.5 67.1 48.5 53.4 47.1 68 49 18.4 36.4 5.2 20.3 71.5 67.1 69.1 70 43.5 62.2 67.5 44.4 43.2 41.8 74.2 73.9 75.9 35.8 26.1 42.5 26.4
and the size of the city of practice, we are not able to extend our results to the GPs who did not answer. We do not know and we cannot evaluate if those who responded are the most interested about cancer, the most educated, or the most up-to-date. The criticism, exposed in free commentaries, was that the questionnaire was too superficial, without any questions about psychological approach, with not enough ques-
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
156
A. RAVAUD et al
tions about specific treatment, pain control, or palliative treatment. We agree with these criticisms, but we preferred to keep framework of Tattersall's questionnaire,1 which is short and easy to complete, even if the aims were quite different. Because they were inappropriate for the French health organisation our questionnaire left out four of Tattersall's questions: those about the visit of a screening clinic for breast or cervical cancer and the role and function of the State Cancer Council because they do not apply; those about the visit to a palliative care facility and discussion of palliative care with medical social workers, since the first palliative care unit opened in our area (Aquitaine) only in 1989 and few medical social workers are integrated in the health system. If we compare results of TattersalFs survey with ours, some differences are very important, pointing out our failure especially in cancer prevention, screening, and palliative care. Thus 75% and 56% of Australian medical students were instructed in screening programmes for breast and colorectal cancer, respectively. Yet, there are still no French national or regional screening programmes. About the technique of cervical smear, 98% of Australian medical students said they were informed. One may consider three reasons for this discrepancy: (1) only half of French medical students spend a 4-month period in an oncology department; (2) GPs working in the cities tend to leave gynecological examinations to gynecologists; and (3) in some medical or surgery departments, rectal or vaginal examination is forbidden for medical students. Considering palliative care, especially pain control, 65% of Australian medical students were informed about other methods than the use of analgesics. This points out the fact that medical doctors in many of medical or surgical departments are not sufficiently instructed in pain control, especially chronic pain treatment. These negative results are not consistent with what the GPs were expecting. A national survey of 300 GPs about this topic pointed out that GPs wanted to be more involved in cancer prevention, screening, and symptomatic treatment. Nevertheless, it is necessary to exercise some caution in attempting to compare results, because the answers of this French survey express
the disagreement of GPs with oncology teaching for general practice rather than the lack of information. The positive results are about the trend or the significant improvement since 1975 and 1985. As there was no question about periods of 4 to 6 months in an oncologic department, we could not evaluate their benefit, even when we know that the attitude of these students changed during this period.5"8 Our current teaching includes at one and the same time for all the students theoretical oncology courses at the University. For the students who spend a period in our institution there are theoretical oncology courses different from those in the University, mainly practical teaching, weekly discussions of clinical charts, free discussions of psychosocial approach, and presence at consultations.9"12 Looking at our results shows that as oncology teachers we need to give more attention to cancer education for general practice, and for both the undergraduate period and the postgraduate one. The ability to have a period in an oncology department with a teaching approach quite different than in the University will be of great interest. The presence of a coordinator will be necessary to foster this goal and to harmonize the teaching among specialists. French GPs found information in the medical press (85%), CME (52%), medical discussions with specialists (45%), and laboratory documentation (21%). In waiting for mandatory CME in France, we have proposed to GPs a short period (5 days) at Fondation Bergonié with the Regional League Against Cancer, where appropriate topics are chosen and attendance at consultations is encouraged. It is not a surprise that the most discussed topics are cancer prevention, screening programs, and palliative care, especially psychosocial approaches and pain control.
REFERENCES 1. Tattersall MHN, Langland AO, Simpson JS, et al: Undergraduate education about cancer A survey in Australian medical schools. EUR J Clin Oncol 24:467-471, 1988. 2. Provost JC: Chimiothérapie anticancéreuse et omnipraticien. Thèse Méd, Bordeaux, n° 332, 1975. 3. Gourbat JP: Omnipracticiens, cancers et cancérologues. Thèse Méd, Bordeaux, n° 239, 1976.
Undergraduate cancer education for general practitioners
Downloaded by [Australian Catholic University] at 21:20 31 August 2017
4. Anonyme: Médecin généraliste et cancer. Rev Prat 33: 2929-2984, 1983. 5. Haley HB, Juan IR, Gagan JF: Factor analytic approach to attitude scale constriction. J Med Educ 43: 331-336, 1968. 6. Blanchard CG, Ruckdeschel JC, Cohen RE, et al: Attitudes towards cancer The impact of a comprehensive oncology course on second year medical students. Cancer 47:2756-2762, 1981. 7. Lebovits AH, Croen LG, Goetzel RZ: Attitudes towards cancer. Cancer 54: 1124-1129, 1984. 8. Hœrni B, Marée D: Value of attitude questionnaires for assessing oncology teaching of medical students: Expe-
9.
10.
11.
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