Integrative Hematology Oncology Fellowship: A Descriptive Analysis of the First Accredited Program in the United States

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.