Larsen, Ashley

Introduction: The presence of integrative oncology programs in cancer care institutions is rapidly increasing globally, however specialized training in integrative oncology is still limited. In 2022, we launched the first Integrative Medicine in Hematology Oncology (IMHO) fellowship within a traditional Accreditation Council for Graduate Medical Education (ACGME) Hematology Oncology Fellowship in the US. In 2024, the fellowship received accreditation from the Academic Consortium for Integrative Medicine and Health. Here we describe the educational model and report on the fellowship experience via qualitative analysis. Methods: Fellows are recruited from Hematology Oncology Fellows at University of Arizona and Mayo Clinic Arizona. A total of 1000+ hours of Integrative medicine curriculum is completed over 3-years to fulfill American Board of Integrative Medicine requirements for board eligibility. Curriculum is a hybrid delivered via The Andrew Weil Center for Integrative Medicine Foundational Fellowship Curriculum (550 hours), dedicated Integrative Oncology curriculum of didactic and clinical training (250 hours), and research training and investigator-initiated project (200 hours).. Didactic and clinical compentecy-based assessments are required for programmatic completion. Interview-based assessments of acceptability are conducted annually throughout the fellowship duration. Results: IMHO Model Acceptability: Successful recruitment occurred annually since the program's inception (2022, 2023, 2024) of at least 2 fellows of 8 traditional ACGME matched fellows. Additionally, ACGME fellows expressed interest in IMHO fellowship exceeding IMHO recruitment goals. The optimal year of start for IMHO fellowship was determined to be post-graduate year 4 (PGY-4). Five of seven fellows met research goal milestones, and it was determined robust mentorship and research should also start in PGY-4 year. Incentives and cohort visible “dashboard” of progress was deemed necessary when online curriculum milestones were not routinely met by fellows. We received accreditation from the Academic Consortium for Integrative Medicine and Health in spring of 2024. Our first fellow graduate completed requirements in 2024 and is board-eligible in Hematology, Oncology, and Integrative Medicine. Qualitative Analysis: Fellows actively participating in the IMHO fellowship program participated in focus groups. Common themes included: 1) application of resiliency building applied to fellows lives personally and 2) providing tools that allowed them to incorporate integrative medicine to enhance the overall care of their patients. One Fellow stated, “I don't regret picking this choice (the IMHO Fellowship) because I have seen that from my own experience with the patients that I've been able to help them throughout their journey with cancer ...using aspects of Integrative Medicine.” In applying the tools clinically another stated, “I feel like we're really trying to treat the person as a whole, not just treating their condition, and we're really emphasizing their overall goals in life beyond just whatever diagnosis that they have.” One fellow pointed out in regard to their own resiliency “the fellowship program has actually helped improve my resilience and my own wellness ”and “I think it's a really good foundation to have for the future” and another stated “I think it helps me not fall off track because it's a constant reminder of things that you're already interested in, and things that you believe in, that are good coping mechanisms and good ways to kind of, find a balance in your life with your own wellbeing and the wellbeing of others around you.” Finally, “I would say that from my experience I think it's made me a well-rounded physician.” Conclusion: The IMHO Fellowship is the first accreditated Integrative Hematology Oncology training program in the nation. We found the IMHO model an acceptable and desirable model of Integrative Oncology education. Our program revealed optimal timing of initiation is the PGY-4 year, incentive and productivity dashboards are needed for online learning productivity, and research productivity is contingent on robust mentorship and productivity milestones. Ongoing assessment is necessary to continue to optimize the IMHO fellowship model.

Abstract Introduction: Integrative hematology oncology (IHO), the combination of complementary medicine in conjunction with conventional cancer treatments, is emerging as an important supportive care modality. Formal education programs, such as IHO fellowship programs, are not currently available. We conducted a national survey to gauge interest and investigate barriers to the development of IHO training programs in the US. Methods: An 18-question survey was sent to hematology/oncology, radiation oncology, and palliative care program directors, physicians, and fellows, and internal medicine residents planning to enter into any of the above fellowship programs. Recruitment was national with use of public email list servs and social media. Program directors and fellowship programs were identified through the Accreditation Council for Graduate Medical Education (ACGME). Participant informed consent was completed online and, Qualtrics survey links were shared weekly via email in two 4-week sessions. Results: Participants (n=208) included physicians from: Hematology/Oncology 65.9% (n=137), Radiation Oncology 8.6%(n=18) and Palliative Care 25.4% (n=53). Hematology oncology respondents included physicians 47.4% (n=65), fellows 33.6% (n=46), and residents planning to enter into a hematology oncology fellowship 3.6% (n=5). Program directors (n=69) from each specialty included: 15.3% (n=21) from hematology/oncology, 61.1% (n=11) from radiation oncology, and 69.8% (n=37) from palliative care. Interestingly, palliative care had the highest response rate in this category. Survey respondents were mostly aged 31-40 y (38.4%), 41-50 y (23.8%), or 51-60 y (21.5%). Participant genders were male (45.7%), female (50.9%), or prefer not to identify (3.5%). There was diverse regional participation across the United States. Overall participant responses revealed significant interest for an IHO training program, despite little (36.0%) to no (49.4%) previous training in integrative medicine (Table 1). Curriculum topics of primary interest were physician/provider wellness, stress reduction techniques, off-label use of medication, exercise/physical activity, nutrition, and lifestyle counseling. The preferred education delivery was didactic lectures and clinical practice exposure. Barriers to implementation included lack of good curriculum and inadequate budget/time/faculty experience to implement the program. Need for IHO training was based on perceived benefit to patients in 39 participants (73.6%), and patient request for services in 37 participants (68.8%). Conclusion: In this national survey of 208 physicians, the majority (64%) expressed interest in IHO education programs. Barriers included lack of curriculum, expertise, budget, and time. Education preference for fellowship track and certificate programs were similar, suggesting interest of both available options. Most participants (87%) felt fellows should participate in IHO research. In conclusion, IHO training is perceived as valuable and desirable. Thus, the development and dissemination of IHO training programs is needed. Figure 1 Figure 1. Disclosures Gowin: Incyte: Speakers Bureau.