Accepted Manuscript “Clinical Neuro-Oncology Formal Education Opportunities for Medical Students in the U.S. and Canada” Karan S. Dixit , MD Martin Kelly Nicholas , MD PhD Rimas V. Lukas , MD PII:
S1878-8750(14)00481-1
DOI:
10.1016/j.wneu.2014.05.022
Reference:
WNEU 2377
To appear in:
World Neurosurgery
Received Date: 31 March 2014 Accepted Date: 9 May 2014
Please cite this article as: Dixit KS, Nicholas MK, Lukas RV, “Clinical Neuro-Oncology Formal Education Opportunities for Medical Students in the U.S. and Canada”, World Neurosurgery (2014), doi: 10.1016/ j.wneu.2014.05.022. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Dixit “Clinical Neuro-Oncology Formal Education Opportunities for Medical Students in the U.S. and Canada”
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Karan S. Dixit MD1, Martin Kelly Nicholas MD PhD2,3,4, Rimas V. Lukas MD2* 1 Department of Neurology, University of Illinois-Chicago, Chicago, IL, USA; 2Department of Neurology, 3Department of Surgery-Section of Neurosurgery, 4Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Correspondence: Dr. Rimas V. Lukas 5841 S. Maryland Avenue MC 2030 Chicago, IL 60637 773-834-9026 773-702-7485 (fax) [email protected]
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ACCEPTED MANUSCRIPT Dixit Abstract Objective: Develop an understanding of the availability of the formal clinical Neuro-Oncology educational opportunities for medical students.
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Methods: The curriculum websites of all LCME accredited medical schools were reviewed for the presence of clinical Neuro-Oncology electives as well as other relevant data.
Results: Ten (6.8%) of LCME accredited medical schools offer formal Neuro-Oncology
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electives. Half are clustered in the Midwest. Forty percent are at institutions with Neuro-
Oncology fellowships. All are at institutions with Neurosurgery and Neurology residency
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programs.
Conclusions: Formal clinical Neuro-Oncology elective opportunities for medical students in the U.S. and Canada are limited. Additional such opportunities may be of value in the education of medical students.
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Keywords: medical education; neuro-oncology; clinical clerkship; neurology; medical schools; neurosurgery.
Abbreviations: Liaison Committee on Medical Education, LCME; central nervous system,
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CNS; United Council of Neurologic Subspecialties, UCNS.
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ACCEPTED MANUSCRIPT Dixit Introduction Neuro-Oncology is an interesting and dynamic subspecialty focusing on the management of patients with cancer involving the CNS. Clinical experience in Neuro-Oncology provides
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trainees exposure to neuroanatomic localization, interpretation of abnormal CNS imaging
studies, and the coordination of care of complicated patients via a multi-disciplinary team. Facility with the above composes a skill set that can be applicable to various medical and
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surgical specialties. In turn, formal clinical Neuro-Oncology exposure through clinical electives for medical students is rife with practical learning opportunities, particularly for students
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interested in pursuing careers in Neurology, Neurosurgery, Radiation Oncology, or Hematology & Oncology. While Neuro-Oncology training opportunities for fellows and residents are well described (3,4,5), an overview of similar educational opportunities for medical students has not been previously published. Additionally, tailored efforts on medical student education in specific
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specialties may be of benefit in improving recruitment into Neuroscience specialties (1).
Methods
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The LCME website was reviewed for a complete listing of accredited medical schools in the U.S. and Canada. Each medical school’s curriculum website was reviewed for the listing of a
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clinical Neuro-Oncology elective amongst the courses offered. This information was tabulated as were other relevant data points from the institutions’ websites. Additionally, a map with points for the geographic locations of institutions with Neuro-Oncology medical student electives was generated.
Results
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ACCEPTED MANUSCRIPT Dixit Amongst the 146 medical schools in the U.S. and Canada accredited by the LCME, ten schools (6.8%) in eight different cities list clinical Neuro-Oncology electives on their curriculum websites. (Table 1) Nine of these programs are in the U.S. and one is in Canada, half of which
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are clustered in the Midwest. (Figure 1) All of the institutions have Neurology and Neurosurgery residency as well as Hematology & Oncology fellowship programs. Eighty percent are at
institutions with Radiation Oncology residency programs. Forty percent are at institutions which
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have UCNS accredited Neuro-Oncology fellowship programs. Over eighty percent of
institutions with UCNS accredited Neuro-Oncology fellowships offer no formal Neuro-
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Oncology elective for medical students. Sixty percent of the Neuro-Oncology electives for medical students are run through Neurology departments with the remainder through Hematology & Oncology (n=2), Neurosurgery (n=1), and Radiation Oncology (n=1).
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The duration of the electives ranges from two to six weeks with the majority being targeted towards fourth year medical students and allowing for visiting students. A number of prominent institutions within the field of Neuro-Oncology lack a formal clinical elective for medical
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Discussion
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students.
Clinical Neuro-Oncology electives provide excellent opportunities for medical student education. These benefits can be viewed in two categories; those which are beneficial to students with plans for pursuing careers in the oncologic or neurosciences, and those which are more broadly beneficial to all medical students. For students planning to pursue further training in either the subspecialty of Neuro-Oncology or in the related specialties of Neurology, Neurosurgery,
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ACCEPTED MANUSCRIPT Dixit Radiation Oncology, or Oncology, a Neuro-Oncology elective experience can serve as an early stepping stone by providing direct exposure to the types of cases they are likely to come across as a routine component of their clinical practice. They will also have the opportunity to observe
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the way colleagues in different subspecialties collaborate with each other as they reason through these challenging cases.
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More importantly, although Neuro-Oncology is somewhat of a niche sub-specialty, the lessons learned during a student elective are more widely applicable. The very multi-disciplinary nature
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of this sub-specialty lends a framework for students to build expertise in interacting with colleagues from a number of disciplines, a skill which will have growing importance as our collective knowledge grows and the field of medicine continues to subspecialize. The opportunity for students to evaluate patients with known central nervous system lesions, review
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their imaging, and detect findings on both is a key skill in the broad Neurology education deemed a core component of medical school education. Additionally, exposure to brain tumor patients can give students an appreciation of the importance of communication with both the
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patients and their families, which is a vital skill in becoming an adept clinician.
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It is unclear the degree of exposure to Neuro-Oncology students receive during their core Neurology clerkships or Neurosurgery electives at various institutions (2). Presumably at many institutions, particularly high-volume Neuro-Oncology centers, this exposure may be substantial. It is possible that additional dedicated Neuro-Oncology electives may provide only a minimal increase in the educational experience. Numerous factors may impede the ability of medical schools to offer clinical Neuro-Oncology elective for medical students. The first is an adequate
5
ACCEPTED MANUSCRIPT Dixit patient volume or the lack of faculty interested in Neuro-Oncology. The second is a lack of time and/or administrative support for faculty to organize and administer such an elective. The final potential impediment would be a lack of interest on the part of medical students for such an
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elective.
Neuro-Oncology electives for medical students are not necessary for all medical schools to offer.
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However, an adequate number of Neuro-Oncology electives spread throughout the U.S. and Canada should be viewed as a valuable resource for medical students as they can provide a
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compelling and high-yield educational experience as well as increase interest in the
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Neurosciences and particularly Neuro-Oncology.
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ACCEPTED MANUSCRIPT Dixit References 1) Agarwal N, Norrmén-Smith IO, Tomei KL, Prestigiacomo CJ, Gandhi CD: Improving medical student recruitment into neurological surgery: a single institution's experience.
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World Neurosurg 80:745-750, 2013.
2) Albert DV, Brorson JR, Amidei C, Lukas RV: Case logs in the assessment of medical students in the outpatient neurology clinic. Neurology 2014; In press.
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3) Barrow DL: Neurosurgical Training. World Neurosurg 2014; In press.
4) Jensen R, O'Rourke D, Warnick R, Sawaya R: Resident training in neurosurgical
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oncology: results of the survey of North American training programs by the AANS/CNS Section on Tumors. J Neurooncol 77:241-246, 2006.
5) Vaillant B, Kuo SH, De Groot J: Emerging subspecialties in neurology: neuro-oncology:
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a developing subspecialty with many opportunities. Neurology 72:e51-53, 2009.
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ACCEPTED MANUSCRIPT Table 1. List of all LCME-accredited medical schools in the U.S. and Canada. RadOnc = Radiation Oncology, Neuro = Neurology, HONC = Hematology/Oncology, NSGY = Neurosurgery School
City/State
Neuro-Onc elective
Year Offered
Duration (Weeks)
Visiting students
3 and 4
2-4
Yes
Wayne State
Detroit, MI
Yes
4
4
St. Louis University
St. Louis, MO
Yes
3 and 4
3
Washington University
St. Louis, MO
Yes
4
Dartmouth
Hanover, NH
Yes
Vanderbilt University
Nashville, TN
Northwestern University
Neuro-Onc fellowship
Neuro residency
NSGY residency
RadOnc residency
HONC fellowship
RadOnc
No
Yes
Yes
Yes
Yes
Yes
Neuro
No
Yes
Yes
Yes
Yes
Yes
Neuro
No
Yes
Yes
No
Yes
4
Yes
Neuro
No
Yes
Yes
Yes
Yes
4
4
Yes
HONC
No
Yes
Yes
No
Yes
Yes
4
4
Yes
Neuro
No
Yes
Yes
Yes
Yes
Chicago, IL
Yes
4
4
No
Neuro
Yes
Yes
Yes
Yes
Yes
University of Chicago
Chicago, IL
Yes
4
2
Yes
Neuro
Yes
Yes
Yes
Yes
Yes
Duke University
Durham, NC
Yes
4
4
No
NSGY
Yes
Yes
Yes
Yes
Yes
University of Toronto
Toronto, ON
Yes
4
2-6
Yes
Yes
Yes
Yes
Yes
Mobile, AL
No
x
x
Little Rock, AR
No
x
x
USC
Los Angeles, CA
No
x
x
Loma Linda
Loma Linda, CA
No
x
x
UC-Davis
Sacramento, CA
No
x
x
UC-Irvine
Irvine, CA
No
x
UC-San Diego
San Diego, CA
No
x
University of Connecticut
Farmington, CT
No
x
George Washington University
Washington DC
No
x
Georgetown University
Washington DC
No
Howard University
Washington DC
No
Florida International University
Miami, FL
Florida State University
Tallahasee, FL
University of Central Florida
Orlando, FL
University of Florida
Gainesville, FL
University of Miami
University of South Florida
Yes
HONC
x
x
No
Yes
No
No
No
x
x
No
Yes
Yes
No
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
No
No
Yes
x
x
x
No
Yes
Yes
No
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
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University of South Alabama University of Arkansas
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Yes
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Tuscon, AZ
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University of Arizona
Dept. involved
x
x
x
No
Yes
No
No
Yes
x
x
x
x
No
No
No
No
No
No
x
x
x
x
No
No
No
No
No
No
x
x
x
x
No
No
No
No
No
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Miami, FL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Tampa, FL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
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x
No
Atlanta, GA
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Medical College of Georgia
Augusta, GA
No
x
x
x
x
No
Yes
Yes
No
Yes
Mercer University
Macon, GA
No
x
x
x
x
No
No
No
No
No
Morehouse
Atlanta, GA
No
x
x
x
x
No
No
No
No
No
University of Hawaii
Honolulu, HI
No
x
x
x
x
No
No
No
No
No
Rosalind Franklin
North Chicago, IL
No
x
x
x
x
No
No
No
No
No
Rush University
Chicago, IL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Illinois at Chicago
Chicago, IL
No
x
x
x
x
No
Yes
Yes
No
Yes
Loyola University
Maywood, IL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
South Illinois University
Springfield, IL
No
x
x
x
x
No
Yes
Yes
No
No
Indiana University
Indianapolis, IN
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Iowa
Iowa City, IA
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Kansas
Kansas City, KS
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Kentucky
Lexington, KY
No
x
x
University of Louisville
Louisville, KY
No
x
x
LSU in New Orleans
New Orleans, LA
No
x
x
LSU in Shreveport
Shreveport, LA
No
x
x
Tulane University
New Orleans, LA
No
x
x
Uniformed Services
Bethesda, MD
No
x
University of Maryland
Baltimore, MD
No
x
Boston University
Boston, MA
No
x
Tufts University
Boston, MA
No
x
University of Massachusetts
Worcester, MA
No
x
Michigan State University
East Lansing, MI
No
University of Minnesota
Minneapolis, MN
No
University of Mississippi
Jackson, MS
University of Missouri-Columbia
Columbia, MO
University of Missouri-Kansas City
Kansas City, MO
Creighton University
Omaha, NE
University of Nebraska University of Nevada
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Emory University
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x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
No
Yes
x
x
No
Yes
Yes
No
Yes
x
x
No
Yes
Yes
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
No
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
No
Yes
x
x
x
x
No
Yes
No
No
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
No
Yes
No
x
x
x
x
No
No
No
No
Yes
No
x
x
x
x
No
No
No
No
No
Omaha, NE
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Reno, NV
No
x
x
x
x
No
No
No
No
No
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x
Newark, NJ
No
x
x
x
x
No
Yes
Yes
No
No
Rutgers, Robert Wood Johnson
Piscataway, NJ
No
x
x
x
x
No
Yes
No
Yes
Yes
University of New Mexico
Albuquerque, NM
No
x
x
x
x
No
Yes
Yes
No
Yes
Albany Medical College
Albany, NY
No
x
x
x
x
No
Yes
Yes
No
No
Albert Einstein
New York, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Columbia
New York, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Mount Sinai
New York, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
New York Medical College
Valhalla, NY
No
x
x
x
x
No
Yes
Yes
No
Yes
New York University
New York, NY
No
x
x
x
x
No
Yes
Ye
Yes
Yes
Stony Brook University
Stony Brook, NY
No
x
x
x
x
No
Yes
No
No
Yes
SUNY-Downstate
Brooklyn, NY
No
x
x
x
x
No
Yes
No
Yes
No
SUNY-Upstate
Syracuse, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Buffalo
Buffalo, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Weill Cornell
New York, NY
No
x
x
East Carolina University
Greenville, NC
No
x
x
University of North Carolina
Chapel Hill, NC
No
x
x
Wake Forest
Winston-Salem, NC
No
x
x
University of North Dakota
Grand Forks, ND
No
x
x
Wright State University
Dayton, OH
No
x
Case Western Reserve
Cleveland, OH
No
x
Northeast Ohio University
Rootstown, OH
No
x
Ohio State University
Columbus, OH
No
x
University of Cincinnati
Cincinnati, OH
No
x
University of Toledo
Toledo, OH
No
University of Oklahoma
Oklahoma City, OK
No
Oregon Health and Science
Portland, OR
Drexel University
Philadelphia, PA
Thomas Jefferson
Philadelphia, PA
Pennsylvania State University
Hershey, PA
Temple University University of Pittsburgh
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Rutgers
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x
No
Yes
Yes
Yes
Yes
x
x
No
No
No
No
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
No
Yes
x
x
No
No
No
No
No
x
x
x
No
Yes
No
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
No
No
No
No
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
x
No
Yes
No
No
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
No
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
No
No
No
No
Philadelphia, PA
No
x
x
x
x
No
Yes
Yes
No
Yes
Pittsburg, PA
No
x
x
x
x
No
Yes
Yes
Yes
Yes
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x
Bayamon, PR
No
x
x
x
x
No
No
No
No
No
Ponce School of Medicine
Ponce, PR
No
x
x
x
x
No
No
No
No
No
University of Puerto Rico
San Juan, PR
No
x
x
x
x
No
Yes
Yes
No
Yes
Brown University
Providence, RI
No
x
x
x
x
No
Yes
Yes
No
Yes
Medical University of South Carolina
Charleston, SC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of South Carolina
Columbia, SC
No
x
x
x
x
No
Yes
No
No
No
University of South Dakota
Vermillion, SD
No
x
x
x
x
No
No
No
No
No
Meharry Medical College
Nashville, TN
No
x
x
x
x
No
No
No
No
No
East Tennessee State University
Johnson City, TN
No
x
x
x
x
No
No
No
No
No
University of Tennessee
Memphis, TN
No
x
x
x
x
No
Yes
Yes
No
Yes
Baylor
Houston, TX
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Texas A&M
College Station, TX
No
x
x
x
x
No
Yes
No
Yes
No
Texas Tech - Foster
El Paso, TX
No
x
x
x
x
No
No
No
No
No
Texas Tech
Lubbock, TX
No
x
x
University of Texas Galveston
Galveston, TX
No
x
x
University of Texas San Antonio
San Antonio, TX
No
x
x
University of Utah
Salt Lake City, UT
No
x
x
University of Vermont
Burlington, VT
No
x
x
Eastern Virginia Medical School
Norfolk, VA
No
x
Virginia Commonwealth
Richmond, VA
No
x
Marshall University
Huntington, WV
No
x
West Virginia University
Morganstown, WV
No
x
Medical College of Wisconsin
Milwaukee, WI
No
x
University of Wisconsin
Madison, WI
No
University of Alberta
Edmonton, AB
No
University of British Columbia
Vancouver, BC
University of Mannitoba
Winnipeg, MB
M AN U
x
No
No
No
No
No
x
x
No
Yes
Yes
Yes
No
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
No
Yes
x
x
x
No
No
No
No
No
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
No
No
No
No
x
x
x
No
Yes
Yes
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
No
No
No
No
x
x
x
x
No
Yes
Yes
Yes
Yes
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x
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Memorial University of Newfoundland St. John's, NL
SC
Universidad Central del Caribe
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Dalhousie University
Halifax, NS
McMaster University
Hamilton, ON
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Northern Ontario School of Medicine
Thunderbay, ON
No
x
x
x
x
No
No
No
No
No
Kingston, ON
No
x
x
x
x
No
Yes
No
Yes
Yes
University of Ottawa
Ottawa, ON
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Laval University
Quebec City, QC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
McGill University
Montreal, QC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Montreal
Montreal, QC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Sherbooke
Sherbooke, QC
No
x
x
x
x
No
Yes
Yes
No
Yes
University of Saskatchewan
Saskatoon, SK
No
x
x
x
x
No
Yes
Yes
No
No
University of Alabama at Birmingham
Birmingham, AL
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
UCLA
Los Angeles, CA
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
Stanford
Palo Alto, CA
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
UC-San Francisco
San Francisco, CA
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
University of Colorado
Denver, Colorado
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
Yale University
New Haven, CT
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
Johns Hopkins
Baltimore, MD
No
x
x
Harvard University
Boston, MA
No
x
x
University of Michigan
Ann Arbor, MI
No
x
x
Mayo
Rochester, MN
No
x
x
University of Rochester
Rochester, NY
No
x
x
University of Pennsylvania
Philadelphia, PA
No
x
Univeristy of Texas Southwestern
Dallas, TX
No
x
University of Virginia
Charlottesville, VA
No
x
University of Calgary
Calgary, AB
No
x
University of Western Ontario
London, ON
No
x
University of Texas Houston
Houston, TX
No
University of Washington
Seattle, WA
No
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x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
x
Yes
Yes
Yes
Yes
Yes
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x
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Queen's University
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Figure 1 Map of North America showing the geographic distribution of institutions offering formal neuro-oncology electives for medical students.
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Abbreviations: Liaison Committee on Medical Education, LCME; central nervous
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system, CNS; United Council of Neurologic Subspecialties, UCNS.
S1878-8750(14)00481-1
DOI:
10.1016/j.wneu.2014.05.022
Reference:
WNEU 2377
To appear in:
World Neurosurgery
Received Date: 31 March 2014 Accepted Date: 9 May 2014
Please cite this article as: Dixit KS, Nicholas MK, Lukas RV, “Clinical Neuro-Oncology Formal Education Opportunities for Medical Students in the U.S. and Canada”, World Neurosurgery (2014), doi: 10.1016/ j.wneu.2014.05.022. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Dixit “Clinical Neuro-Oncology Formal Education Opportunities for Medical Students in the U.S. and Canada”
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Karan S. Dixit MD1, Martin Kelly Nicholas MD PhD2,3,4, Rimas V. Lukas MD2* 1 Department of Neurology, University of Illinois-Chicago, Chicago, IL, USA; 2Department of Neurology, 3Department of Surgery-Section of Neurosurgery, 4Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Correspondence: Dr. Rimas V. Lukas 5841 S. Maryland Avenue MC 2030 Chicago, IL 60637 773-834-9026 773-702-7485 (fax) [email protected]
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ACCEPTED MANUSCRIPT Dixit Abstract Objective: Develop an understanding of the availability of the formal clinical Neuro-Oncology educational opportunities for medical students.
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Methods: The curriculum websites of all LCME accredited medical schools were reviewed for the presence of clinical Neuro-Oncology electives as well as other relevant data.
Results: Ten (6.8%) of LCME accredited medical schools offer formal Neuro-Oncology
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electives. Half are clustered in the Midwest. Forty percent are at institutions with Neuro-
Oncology fellowships. All are at institutions with Neurosurgery and Neurology residency
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programs.
Conclusions: Formal clinical Neuro-Oncology elective opportunities for medical students in the U.S. and Canada are limited. Additional such opportunities may be of value in the education of medical students.
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Keywords: medical education; neuro-oncology; clinical clerkship; neurology; medical schools; neurosurgery.
Abbreviations: Liaison Committee on Medical Education, LCME; central nervous system,
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CNS; United Council of Neurologic Subspecialties, UCNS.
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ACCEPTED MANUSCRIPT Dixit Introduction Neuro-Oncology is an interesting and dynamic subspecialty focusing on the management of patients with cancer involving the CNS. Clinical experience in Neuro-Oncology provides
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trainees exposure to neuroanatomic localization, interpretation of abnormal CNS imaging
studies, and the coordination of care of complicated patients via a multi-disciplinary team. Facility with the above composes a skill set that can be applicable to various medical and
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surgical specialties. In turn, formal clinical Neuro-Oncology exposure through clinical electives for medical students is rife with practical learning opportunities, particularly for students
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interested in pursuing careers in Neurology, Neurosurgery, Radiation Oncology, or Hematology & Oncology. While Neuro-Oncology training opportunities for fellows and residents are well described (3,4,5), an overview of similar educational opportunities for medical students has not been previously published. Additionally, tailored efforts on medical student education in specific
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specialties may be of benefit in improving recruitment into Neuroscience specialties (1).
Methods
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The LCME website was reviewed for a complete listing of accredited medical schools in the U.S. and Canada. Each medical school’s curriculum website was reviewed for the listing of a
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clinical Neuro-Oncology elective amongst the courses offered. This information was tabulated as were other relevant data points from the institutions’ websites. Additionally, a map with points for the geographic locations of institutions with Neuro-Oncology medical student electives was generated.
Results
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ACCEPTED MANUSCRIPT Dixit Amongst the 146 medical schools in the U.S. and Canada accredited by the LCME, ten schools (6.8%) in eight different cities list clinical Neuro-Oncology electives on their curriculum websites. (Table 1) Nine of these programs are in the U.S. and one is in Canada, half of which
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are clustered in the Midwest. (Figure 1) All of the institutions have Neurology and Neurosurgery residency as well as Hematology & Oncology fellowship programs. Eighty percent are at
institutions with Radiation Oncology residency programs. Forty percent are at institutions which
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have UCNS accredited Neuro-Oncology fellowship programs. Over eighty percent of
institutions with UCNS accredited Neuro-Oncology fellowships offer no formal Neuro-
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Oncology elective for medical students. Sixty percent of the Neuro-Oncology electives for medical students are run through Neurology departments with the remainder through Hematology & Oncology (n=2), Neurosurgery (n=1), and Radiation Oncology (n=1).
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The duration of the electives ranges from two to six weeks with the majority being targeted towards fourth year medical students and allowing for visiting students. A number of prominent institutions within the field of Neuro-Oncology lack a formal clinical elective for medical
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Discussion
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students.
Clinical Neuro-Oncology electives provide excellent opportunities for medical student education. These benefits can be viewed in two categories; those which are beneficial to students with plans for pursuing careers in the oncologic or neurosciences, and those which are more broadly beneficial to all medical students. For students planning to pursue further training in either the subspecialty of Neuro-Oncology or in the related specialties of Neurology, Neurosurgery,
4
ACCEPTED MANUSCRIPT Dixit Radiation Oncology, or Oncology, a Neuro-Oncology elective experience can serve as an early stepping stone by providing direct exposure to the types of cases they are likely to come across as a routine component of their clinical practice. They will also have the opportunity to observe
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the way colleagues in different subspecialties collaborate with each other as they reason through these challenging cases.
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More importantly, although Neuro-Oncology is somewhat of a niche sub-specialty, the lessons learned during a student elective are more widely applicable. The very multi-disciplinary nature
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of this sub-specialty lends a framework for students to build expertise in interacting with colleagues from a number of disciplines, a skill which will have growing importance as our collective knowledge grows and the field of medicine continues to subspecialize. The opportunity for students to evaluate patients with known central nervous system lesions, review
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their imaging, and detect findings on both is a key skill in the broad Neurology education deemed a core component of medical school education. Additionally, exposure to brain tumor patients can give students an appreciation of the importance of communication with both the
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patients and their families, which is a vital skill in becoming an adept clinician.
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It is unclear the degree of exposure to Neuro-Oncology students receive during their core Neurology clerkships or Neurosurgery electives at various institutions (2). Presumably at many institutions, particularly high-volume Neuro-Oncology centers, this exposure may be substantial. It is possible that additional dedicated Neuro-Oncology electives may provide only a minimal increase in the educational experience. Numerous factors may impede the ability of medical schools to offer clinical Neuro-Oncology elective for medical students. The first is an adequate
5
ACCEPTED MANUSCRIPT Dixit patient volume or the lack of faculty interested in Neuro-Oncology. The second is a lack of time and/or administrative support for faculty to organize and administer such an elective. The final potential impediment would be a lack of interest on the part of medical students for such an
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elective.
Neuro-Oncology electives for medical students are not necessary for all medical schools to offer.
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However, an adequate number of Neuro-Oncology electives spread throughout the U.S. and Canada should be viewed as a valuable resource for medical students as they can provide a
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compelling and high-yield educational experience as well as increase interest in the
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Neurosciences and particularly Neuro-Oncology.
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ACCEPTED MANUSCRIPT Dixit References 1) Agarwal N, Norrmén-Smith IO, Tomei KL, Prestigiacomo CJ, Gandhi CD: Improving medical student recruitment into neurological surgery: a single institution's experience.
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World Neurosurg 80:745-750, 2013.
2) Albert DV, Brorson JR, Amidei C, Lukas RV: Case logs in the assessment of medical students in the outpatient neurology clinic. Neurology 2014; In press.
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3) Barrow DL: Neurosurgical Training. World Neurosurg 2014; In press.
4) Jensen R, O'Rourke D, Warnick R, Sawaya R: Resident training in neurosurgical
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oncology: results of the survey of North American training programs by the AANS/CNS Section on Tumors. J Neurooncol 77:241-246, 2006.
5) Vaillant B, Kuo SH, De Groot J: Emerging subspecialties in neurology: neuro-oncology:
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a developing subspecialty with many opportunities. Neurology 72:e51-53, 2009.
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ACCEPTED MANUSCRIPT Table 1. List of all LCME-accredited medical schools in the U.S. and Canada. RadOnc = Radiation Oncology, Neuro = Neurology, HONC = Hematology/Oncology, NSGY = Neurosurgery School
City/State
Neuro-Onc elective
Year Offered
Duration (Weeks)
Visiting students
3 and 4
2-4
Yes
Wayne State
Detroit, MI
Yes
4
4
St. Louis University
St. Louis, MO
Yes
3 and 4
3
Washington University
St. Louis, MO
Yes
4
Dartmouth
Hanover, NH
Yes
Vanderbilt University
Nashville, TN
Northwestern University
Neuro-Onc fellowship
Neuro residency
NSGY residency
RadOnc residency
HONC fellowship
RadOnc
No
Yes
Yes
Yes
Yes
Yes
Neuro
No
Yes
Yes
Yes
Yes
Yes
Neuro
No
Yes
Yes
No
Yes
4
Yes
Neuro
No
Yes
Yes
Yes
Yes
4
4
Yes
HONC
No
Yes
Yes
No
Yes
Yes
4
4
Yes
Neuro
No
Yes
Yes
Yes
Yes
Chicago, IL
Yes
4
4
No
Neuro
Yes
Yes
Yes
Yes
Yes
University of Chicago
Chicago, IL
Yes
4
2
Yes
Neuro
Yes
Yes
Yes
Yes
Yes
Duke University
Durham, NC
Yes
4
4
No
NSGY
Yes
Yes
Yes
Yes
Yes
University of Toronto
Toronto, ON
Yes
4
2-6
Yes
Yes
Yes
Yes
Yes
Mobile, AL
No
x
x
Little Rock, AR
No
x
x
USC
Los Angeles, CA
No
x
x
Loma Linda
Loma Linda, CA
No
x
x
UC-Davis
Sacramento, CA
No
x
x
UC-Irvine
Irvine, CA
No
x
UC-San Diego
San Diego, CA
No
x
University of Connecticut
Farmington, CT
No
x
George Washington University
Washington DC
No
x
Georgetown University
Washington DC
No
Howard University
Washington DC
No
Florida International University
Miami, FL
Florida State University
Tallahasee, FL
University of Central Florida
Orlando, FL
University of Florida
Gainesville, FL
University of Miami
University of South Florida
Yes
HONC
x
x
No
Yes
No
No
No
x
x
No
Yes
Yes
No
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
No
No
Yes
x
x
x
No
Yes
Yes
No
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
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University of South Alabama University of Arkansas
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Yes
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Tuscon, AZ
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University of Arizona
Dept. involved
x
x
x
No
Yes
No
No
Yes
x
x
x
x
No
No
No
No
No
No
x
x
x
x
No
No
No
No
No
No
x
x
x
x
No
No
No
No
No
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Miami, FL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Tampa, FL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
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x
No
Atlanta, GA
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Medical College of Georgia
Augusta, GA
No
x
x
x
x
No
Yes
Yes
No
Yes
Mercer University
Macon, GA
No
x
x
x
x
No
No
No
No
No
Morehouse
Atlanta, GA
No
x
x
x
x
No
No
No
No
No
University of Hawaii
Honolulu, HI
No
x
x
x
x
No
No
No
No
No
Rosalind Franklin
North Chicago, IL
No
x
x
x
x
No
No
No
No
No
Rush University
Chicago, IL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Illinois at Chicago
Chicago, IL
No
x
x
x
x
No
Yes
Yes
No
Yes
Loyola University
Maywood, IL
No
x
x
x
x
No
Yes
Yes
Yes
Yes
South Illinois University
Springfield, IL
No
x
x
x
x
No
Yes
Yes
No
No
Indiana University
Indianapolis, IN
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Iowa
Iowa City, IA
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Kansas
Kansas City, KS
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Kentucky
Lexington, KY
No
x
x
University of Louisville
Louisville, KY
No
x
x
LSU in New Orleans
New Orleans, LA
No
x
x
LSU in Shreveport
Shreveport, LA
No
x
x
Tulane University
New Orleans, LA
No
x
x
Uniformed Services
Bethesda, MD
No
x
University of Maryland
Baltimore, MD
No
x
Boston University
Boston, MA
No
x
Tufts University
Boston, MA
No
x
University of Massachusetts
Worcester, MA
No
x
Michigan State University
East Lansing, MI
No
University of Minnesota
Minneapolis, MN
No
University of Mississippi
Jackson, MS
University of Missouri-Columbia
Columbia, MO
University of Missouri-Kansas City
Kansas City, MO
Creighton University
Omaha, NE
University of Nebraska University of Nevada
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Emory University
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x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
No
Yes
x
x
No
Yes
Yes
No
Yes
x
x
No
Yes
Yes
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
No
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
No
Yes
x
x
x
x
No
Yes
No
No
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
No
Yes
No
x
x
x
x
No
No
No
No
Yes
No
x
x
x
x
No
No
No
No
No
Omaha, NE
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Reno, NV
No
x
x
x
x
No
No
No
No
No
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x
Newark, NJ
No
x
x
x
x
No
Yes
Yes
No
No
Rutgers, Robert Wood Johnson
Piscataway, NJ
No
x
x
x
x
No
Yes
No
Yes
Yes
University of New Mexico
Albuquerque, NM
No
x
x
x
x
No
Yes
Yes
No
Yes
Albany Medical College
Albany, NY
No
x
x
x
x
No
Yes
Yes
No
No
Albert Einstein
New York, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Columbia
New York, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Mount Sinai
New York, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
New York Medical College
Valhalla, NY
No
x
x
x
x
No
Yes
Yes
No
Yes
New York University
New York, NY
No
x
x
x
x
No
Yes
Ye
Yes
Yes
Stony Brook University
Stony Brook, NY
No
x
x
x
x
No
Yes
No
No
Yes
SUNY-Downstate
Brooklyn, NY
No
x
x
x
x
No
Yes
No
Yes
No
SUNY-Upstate
Syracuse, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Buffalo
Buffalo, NY
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Weill Cornell
New York, NY
No
x
x
East Carolina University
Greenville, NC
No
x
x
University of North Carolina
Chapel Hill, NC
No
x
x
Wake Forest
Winston-Salem, NC
No
x
x
University of North Dakota
Grand Forks, ND
No
x
x
Wright State University
Dayton, OH
No
x
Case Western Reserve
Cleveland, OH
No
x
Northeast Ohio University
Rootstown, OH
No
x
Ohio State University
Columbus, OH
No
x
University of Cincinnati
Cincinnati, OH
No
x
University of Toledo
Toledo, OH
No
University of Oklahoma
Oklahoma City, OK
No
Oregon Health and Science
Portland, OR
Drexel University
Philadelphia, PA
Thomas Jefferson
Philadelphia, PA
Pennsylvania State University
Hershey, PA
Temple University University of Pittsburgh
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Rutgers
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x
No
Yes
Yes
Yes
Yes
x
x
No
No
No
No
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
No
Yes
x
x
No
No
No
No
No
x
x
x
No
Yes
No
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
No
No
No
No
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
x
No
Yes
No
No
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
No
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
No
No
No
No
Philadelphia, PA
No
x
x
x
x
No
Yes
Yes
No
Yes
Pittsburg, PA
No
x
x
x
x
No
Yes
Yes
Yes
Yes
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x
Bayamon, PR
No
x
x
x
x
No
No
No
No
No
Ponce School of Medicine
Ponce, PR
No
x
x
x
x
No
No
No
No
No
University of Puerto Rico
San Juan, PR
No
x
x
x
x
No
Yes
Yes
No
Yes
Brown University
Providence, RI
No
x
x
x
x
No
Yes
Yes
No
Yes
Medical University of South Carolina
Charleston, SC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of South Carolina
Columbia, SC
No
x
x
x
x
No
Yes
No
No
No
University of South Dakota
Vermillion, SD
No
x
x
x
x
No
No
No
No
No
Meharry Medical College
Nashville, TN
No
x
x
x
x
No
No
No
No
No
East Tennessee State University
Johnson City, TN
No
x
x
x
x
No
No
No
No
No
University of Tennessee
Memphis, TN
No
x
x
x
x
No
Yes
Yes
No
Yes
Baylor
Houston, TX
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Texas A&M
College Station, TX
No
x
x
x
x
No
Yes
No
Yes
No
Texas Tech - Foster
El Paso, TX
No
x
x
x
x
No
No
No
No
No
Texas Tech
Lubbock, TX
No
x
x
University of Texas Galveston
Galveston, TX
No
x
x
University of Texas San Antonio
San Antonio, TX
No
x
x
University of Utah
Salt Lake City, UT
No
x
x
University of Vermont
Burlington, VT
No
x
x
Eastern Virginia Medical School
Norfolk, VA
No
x
Virginia Commonwealth
Richmond, VA
No
x
Marshall University
Huntington, WV
No
x
West Virginia University
Morganstown, WV
No
x
Medical College of Wisconsin
Milwaukee, WI
No
x
University of Wisconsin
Madison, WI
No
University of Alberta
Edmonton, AB
No
University of British Columbia
Vancouver, BC
University of Mannitoba
Winnipeg, MB
M AN U
x
No
No
No
No
No
x
x
No
Yes
Yes
Yes
No
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
Yes
Yes
x
x
No
Yes
Yes
No
Yes
x
x
x
No
No
No
No
No
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
No
No
No
No
No
x
x
x
No
Yes
Yes
No
Yes
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
Yes
Yes
Yes
No
x
x
x
x
No
Yes
No
No
No
No
x
x
x
x
No
Yes
Yes
Yes
Yes
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Memorial University of Newfoundland St. John's, NL
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Universidad Central del Caribe
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Dalhousie University
Halifax, NS
McMaster University
Hamilton, ON
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Northern Ontario School of Medicine
Thunderbay, ON
No
x
x
x
x
No
No
No
No
No
Kingston, ON
No
x
x
x
x
No
Yes
No
Yes
Yes
University of Ottawa
Ottawa, ON
No
x
x
x
x
No
Yes
Yes
Yes
Yes
Laval University
Quebec City, QC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
McGill University
Montreal, QC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Montreal
Montreal, QC
No
x
x
x
x
No
Yes
Yes
Yes
Yes
University of Sherbooke
Sherbooke, QC
No
x
x
x
x
No
Yes
Yes
No
Yes
University of Saskatchewan
Saskatoon, SK
No
x
x
x
x
No
Yes
Yes
No
No
University of Alabama at Birmingham
Birmingham, AL
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
UCLA
Los Angeles, CA
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
Stanford
Palo Alto, CA
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
UC-San Francisco
San Francisco, CA
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
University of Colorado
Denver, Colorado
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
Yale University
New Haven, CT
No
x
x
x
x
Yes
Yes
Yes
Yes
Yes
Johns Hopkins
Baltimore, MD
No
x
x
Harvard University
Boston, MA
No
x
x
University of Michigan
Ann Arbor, MI
No
x
x
Mayo
Rochester, MN
No
x
x
University of Rochester
Rochester, NY
No
x
x
University of Pennsylvania
Philadelphia, PA
No
x
Univeristy of Texas Southwestern
Dallas, TX
No
x
University of Virginia
Charlottesville, VA
No
x
University of Calgary
Calgary, AB
No
x
University of Western Ontario
London, ON
No
x
University of Texas Houston
Houston, TX
No
University of Washington
Seattle, WA
No
M AN U
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
x
Yes
Yes
Yes
Yes
Yes
x
x
x
x
Yes
Yes
Yes
Yes
Yes
TE D
x
EP
AC C
SC
Queen's University
RI PT
ACCEPTED MANUSCRIPT
TE D
M AN U
SC
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ACCEPTED MANUSCRIPT
AC C
EP
Figure 1 Map of North America showing the geographic distribution of institutions offering formal neuro-oncology electives for medical students.
ACCEPTED MANUSCRIPT
Abbreviations: Liaison Committee on Medical Education, LCME; central nervous
AC C
EP
TE D
M AN U
SC
RI PT
system, CNS; United Council of Neurologic Subspecialties, UCNS.
