On January 1, 1990, the University of
Texas Medical Branch (UTMB) at Galveston received a contract from the Texas Cancer Council
to identify ways that medical schools in Texas and the Texas Cancer Council might
collaborate to achieve the goals of the Texas Cancer Plan (Table 2). Bringing together the
deans of these schools was the starting point.
The political climate in the state contributed to the initial cooperation
among the deans. House Bill 18, which had been enacted recently, mandated
requirements for family practice components, third-year rotations, and additional
documentation in the curriculum [12].
The deans were disturbed over the legislature's intervention in the domain of medical
education and, therefore, were grudgingly receptive to the efforts to bring them to
consensus.
Staff at the UTMB Cancer Center
used the Delphi technique, a method of structuring group communication to reach consensus
on goals, plans, and positions, to survey the deans of the 8 schools in Texas.
Although the Delphi technique had been used to study issues in medicine and medical
education, it had not been used before to gather information from deans of medical schools
in the United States. The purposes of this approach were to familiarize the deans with the
Texas Cancer Plan and the Texas Cancer Council, to gain the collective opinions of the
deans concerning strengths and deficits of cancer education in the medical schools, and to
enlist the deans' active support in forming a network of medical schools to enhance cancer
education [13].
From each school, the Dean of
Medicine and a faculty member considered to be the leading cancer expert in the curriculum
participated. A 3-generation Delphi study was conducted with the deans,
consisting of a telephone interview, a personal interview, and a consensus conference,
attended by the deans together with the faculty members with cancer expertise and
representatives of the Texas Cancer Council. Telephone interviews: The first step,
exploring the subject with the deans, consisted of a self-administered questionnaire
followed up by a telephone interview with each dean. An interview instrument was developed
and pilot tested on several members of the UTMB administration. The telephone interviews
were conducted from March 20 through April 18, 1990. Deans were asked about their
familiarity with the Texas Cancer Plan, the feasibility of its 4 goals, how well their
schools addressed the plan's 13 objectives, familiarity with the report of the Physician
Oncology Education Work Group as summarized in the plan, and approaches to involving
medical schools in the plan.
Results of the telephone interviews
indicated that only 3 of the 8 deans were aware of or had read the Texas Cancer Plan;
half of the deans knew of the Texas Cancer Council. All the deans considered Goals I, II,
and IV feasible or somewhat feasible in general within medical education at their medical
schools by the year 2000, or to be addressed at their medical schools by August 31, 1993.
A couple of deans expressed reservations about the feasibility of Goal III.
The deans were asked to
assess how well the plan's 13 objectives were addressed at their schools by ranking them
on an Excellent-to-Poor scale of 1 to 4. The highest number of responses in
the Excellent category (only 3 of 7 deans) covered the objective of assisting cancer
patients to identify necessary cancer care and supportive services. All 7 deans responding
indicated their schools addressed well (1) or adequately (6) the promotion of availability
of current technology and information in cancer control and the promotion of opportunities
for research in cancer. Most felt they were adequately addressing the promotion of good
habits and of early detection programs for the public and encouraging patients at high
risk to participate in cancer detection. Only half of the deans felt their
schools were doing an adequate job regarding the communication of risk
information to the public, the provision of information to the public regarding
availability of cancer detection and diagnostic services, the enhancement of the quality
of existing resources, services, and programs, the assistance to cancer patients in
identifying necessary care and support, and the acceleration of development of new
measures to control cancer in Texas. Enhancing the availability of cancer detection and
diagnostic services was the least well-met objective (4 deans scored 3).
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