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Oncology Teaching in Medical Schools 1

The increase in cancer incidence in the last 50 years, the large amount of knowledge acquired on the disease, the complexity of diagnostic procedures and of specific treatment programs have made oncology a well defined discipline. However, despite the increased interest in this disease, the methods and programs for training personnel at all levels are in many countries rudimentary, inadequate or even nonexistent. As a result, I) the general practitioners are often not prepared in an adequate manner to face the oncologic diagnosis in its various expressions; 2) some of the doctors who operate in the hospitals, are not in a position to render functional modern therapeutic methods, particularly if they are multidisciplinary; 3) there are macroscopic deficiencies in preventive medicine; and 4) physical and psychological programs of reeducation of the patient cured for neop1asias are largely inadequate. All this calls for a large revision of oncological educational programs at undergraduate and postgraduate levels. As regards undergraduate cancer teaching we know that the greatest obstacle is the structure of teaching, which is based either on type of treatment (medicine, surgery, radiotherapy) or on organ pathology (gynecology, pediatry, ear, nose and throat, urology, and so on). This structure is well suited to diseases that are treated mainly by a single type of therapy or that are specific to one organ. But a disease that can effect all organs and can be treated with several therapeutic means does not fit easily into this scheme. The problem has thus remained unsolved for many years and is still awaiting a rational and satisfactory solution. As things are, oncology is taught patchily in many disciplines with the inevitable gaps, overlapping and conflict of opinion (table 1). From a historical point of view, oncology attracted a certain interest by universities in the forties. It was in the United States in November 1944 that a special committee, the Government Consultive Committee, after an investigation of several years, reported that among graduates in medicine there was a «deplorable ignorance» of cancer, that they were not prepared to confront the problems of diagnosis and therapy of tumors. In particular, five specific points of specific deficiency in the teaching of oncology were cited: I) the duplication of some of the aspects of oncology, 2) the complete omission of others, 3) the diversity or conflict of opinions among the graduates of the different disciplines, 4) the lack of interdepartmental teaching, 5) the insufficient instruction in clinical