Cancer represents a significant public health burden in Lithuania and is a major component of clinical practice for medical graduates. According to national cancer registry data, in 2023 the crude cancer incidence was 639 new cases per 100 000 population, and the crude mortality rate was 273 deaths per 100 000 population. The most common cancers follow European epidemiological patterns: breast cancer predominates among women, whereas prostate and lung cancers predominate among men. Lung cancer remains one of the leading causes of cancer-related mortality [1, 2]. These data highlight the importance of structured oncology education within undergraduate medical training.
Lithuania, with a population of approximately 2.9 million, has two universities providing undergraduate medical education: the Lithuanian University of Health Sciences (LSMU) and Vilnius University. LSMU is the largest higher education institution for biomedical sciences in Lithuania.
Where Cancer is Taught
Undergraduate medical training at the LSMU in Kaunas takes place within a publicly funded national healthcare system in which specialized oncology services are delivered through the university hospitals and regional referral centres. Clinical oncology teaching is primarily based at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos, where the Oncology and Hematology Clinic provides secondary and tertiary inpatient and outpatient cancer care while supporting undergraduate and postgraduate education as well as research activities. This provides students with exposure to patients across the full spectrum of cancer presentations, from early-stage to advanced disease, including diagnosis, treatment, follow-up, and palliative care. National screening programmes for breast, cervical, colorectal, and prostate cancer are coordinated by the Ministry of Health and are incorporated into undergraduate teaching. While students learn the principles of cancer prevention, screening, and multidisciplinary care, direct participation in organized screening or formal multidisciplinary tumour boards (MDTs) remains limited at the undergraduate level.
The Faculty of Medicine at LSMU delivers a six-year integrated medical programme in which oncology and hematology education is vertically integrated across preclinical and clinical phases (Fig. 1). Formal oncology teaching is mandatory and embedded within core modules rather than delivered as a standalone longitudinal track.
In the preclinical phase (Years I-III), cancer-related content is introduced through foundational disciplines including genetics, cell biology and biochemistry, immunology, microbiology, pathology, and public health. These subjects provide instruction in carcinogenesis, tumour biology, cancer epidemiology, and principles of screening and prevention. Although oncology is not taught as an independent subject at this stage, these modules establish the scientific foundation for later clinical application and reflect horizontal integration across biomedical sciences.
In the clinical phase (Years IV-VI), structured oncology education is concentrated in the mandatory Hematology and Oncology module in Year IV. This module addresses solid tumours, hematologic malignancies, systemic therapy principles, radiotherapy basics, oncologic emergencies, and palliative care. Clinical training occurs within internal medicine-based rotations and builds upon prior pathology and pharmacology knowledge.
Number of Hours and Teaching Formats
The mandatory Hematology and Oncology module in Year IV comprises 49.5 contact hours, including 31.5 h of lectures and 18 h of small-group seminars, which incorporate case-based discussions and supervised ward-based clinical activities. Seminars are organized in small clinical groups of approximately 10 students, with two to three groups participating per session, while lectures are delivered to larger cohort groups. Students complete approximately 31.5 h of guided self-directed learning focused on tumour biology, systemic therapies, oncologic emergencies, and principles of palliative care. Total module learning time is 81 h.
In the preclinical years, oncology teaching is embedded within broader biomedical and public health modules; therefore, dedicated oncology contact hours are not separately quantified.
Across the curriculum, oncology teaching progresses from principles of cancer prevention and screening to diagnostic evaluation and staging, followed by foundational exposure to surgical, systemic, and radiotherapy treatment approaches. Clinical instruction further addresses hematologic malignancies, oncologic emergencies, and palliative care, while elements of psycho-oncology and patient communication skills are incorporated within clinical training.
Faculty and Resources
Teaching is delivered through the Oncology Institute, which comprises two units: the Oncology and Hematology Clinic and the Oncology Research Laboratory, and is provided by a multidisciplinary team of 15 teaching staff (professors, associate professors, assistant professors, and lecturers), including medical oncologists, radiation oncologists, and hematologists, with topic-specific input from allied disciplines when required.
Learning is supported by clinical teaching environments and visual, case-based materials (including imaging examples, pathology, laboratory data, treatment algorithms, and toxicity-management flowcharts) integrated into lectures and seminars. Assessment and materials distribution are supported via the institutional e-learning platform.
Undergraduate students do not have routine access to MDTs within this module; however, limited observational participation may be possible in selected cases. Multidisciplinary principles are primarily addressed through case-based teaching and supervised clinical discussions.
The Institute also contributes to postgraduate and doctoral training, supporting continuity across different levels of medical education [3]. This is further supported by the University’s strong research performance and international academic standing, reflected in its position in global university rankings.
Hands-On Clinical Exposure
Structured oncology and hematology education is concentrated in Year IV within the mandatory Hematology and Oncology module delivered by the Oncology Institute. The curriculum emphasizes clinically contextualized learning and includes a three-day supervised ward-based attachment integrated into the programme.
Most hands-on clinical exposure occurs during seminars, where, depending on clinical workflow, instructors incorporate bedside teaching by taking students to the ward to see patients and participate in ward rounds, using real cases for contextual discussion. Additional patient contact is supported through a structured single-patient case assignment, which reinforces clinical reasoning and is presented in a supervised discussion.
Although a minimum number of patient encounters is not formally specified, participation is ensured through required attendance in scheduled teaching, with student engagement and attendance monitored as part of continuous assessment.
Students with a stronger interest in oncology or hematology may deepen their clinical experience through extracurricular pathways, including participation in the Student Scientific Society Oncology and Hematology group, which offers additional lectures, seminars, and community-oriented initiatives. Motivated students may also undertake elective ward-based practice to gain further clinical experience beyond the required curriculum. These opportunities also provide early exposure to oncology practice and research, helping interested students explore potential careers in the specialty.
Assessment
At the end of the Year IV Hematology and Oncology module, students complete a final assessment consisting of two equally weighted components: (1) a computer-based written examination (50%) delivered via the institutional e-learning platform, and (2) a single-patient written clinical case history (50%) prepared during the supervised ward-based attachment. The written examination includes multiple-choice and short-answer formats aligned with core oncology and hematology learning outcomes.
The module applies a minimum passing standard of 5 out of 10 (50%). Attendance requirements are explicit: students missing more than 25% of contact hours must repeat the module, while smaller absences may be addressed through individualized make-up activities agreed with the responsible teacher. The written examination may be retaken once in accordance with institutional procedures and with approval by clinic leadership.
Educational Strategies and Innovations
At LSMU, oncology education is structured around progressive clinical reasoning and the integration of diagnostic and therapeutic decision-making [4]. Rather than presenting tumour entities as separate topics, teaching integrates staging, diagnostic interpretation, and treatment decision-making within clinical practice.
A key organizing principle is alignment with multidisciplinary clinical practice. Educational activities are designed to reflect the collaborative nature of oncologic reasoning, encouraging students to integrate pathology, imaging, laboratory findings, and therapeutic considerations into appropriate management strategies. In this context, evidence-based reasoning is reinforced, supporting critical appraisal of clinical information and its application to patient care.
Hybrid simulation within the LSMU curriculum complements case-based learning by translating theoretical knowledge into observable clinical performance. Breast and prostate examination skills are developed using dedicated simulators that represent both benign and malignant conditions at different stages of disease. Small-group formats promote active participation, peer observation, and structured instructor feedback, allowing students to refine examination technique alongside clinical interpretation. Cancer-related pain assessment using standardized scales (VAS/SAS), together with physician actions in pain management, is taught through applied clinical scenarios that link pain evaluation with appropriate management. Practical competencies developed during the Hematology and Oncology module include blood group determination according to the ABO system, clinical decision-making in cases of ABO-incompatible erythrocyte transfusion, lymph node and spleen palpation, clinical staging of lymphomas, and interpretation of oncologic diagnosis and TNM classification.
Overall, this approach supports the development of clinically grounded oncology competence in undergraduate medical education.
Equity, Ethics and Professional Formation
Professional formation is embedded longitudinally throughout the Medicine programme and is particularly relevant within oncology education. Ethical practice, confidentiality, and informed consent are core competencies expected of graduates and underpin responsible decision-making in complex cancer pathways. Communication skills, including patient-centred consultation and structured interaction in challenging clinical situations, are reinforced during oncology placements and assessed in real clinical settings.
Students are exposed to diverse clinical contexts through placements across multiple healthcare institutions and teaching formats, including both large clinical settings and small-group clinical teaching environments. This distributed training model supports awareness of varied patient populations and healthcare delivery contexts.
Structured student support mechanisms are available at programme level, including mentoring, tutoring, and access to psychological counselling. These supports are particularly important in oncology settings, where students may encounter emotionally demanding clinical situations. The programme is aligned with international standards, including accreditation in accordance with the WFME (World Federation for Medical Education), supporting consistency with international expectations for medical education [5].
Outcomes and Evaluation
At programme level, integrated knowledge from pre-clinical and clinical disciplines across the six-year curriculum is evaluated through a 200-item case-based single-best-answer examination delivered electronically through the institutional e-learning platform using a centralized item bank with randomized question and answer order. Approximately 70% of items derive from clinical disciplines and 30% from pre-clinical subjects, with a minimum passing threshold of 50% correct responses. The overall assessment framework is summarized in Table 1.
The Faculty of Medicine Examination Centre coordinates large-scale assessments, including the Objective Structured Clinical Examination (OSCE) [6] and the final programme examination, and oversees governance and psychometric quality monitoring.
Quality assurance is maintained through a structured feedback and monitoring framework. A short-cycle student module evaluation tool integrated within the institutional study information system enables timely collection of student feedback. Formal procedures provide a pathway for translating feedback into documented improvement actions, and commission agendas and official minutes reflect regular review of quality processes. Moodle-based statistical analysis is routinely applied to monitor item difficulty and discrimination indices, allowing systematic revision of underperforming questions. Committee communication further requires correction and resubmission of items demonstrating negative discrimination. These mechanisms support a continuous quality improvement cycle in undergraduate oncology education.
Brief Overview of Cancer in the Post-Graduate Disciplines of Fields
Cancer education at the Lithuanian University of Health Sciences is delivered through three integrated post-graduate (residency) programs: Medical Oncology, Radiation Oncology, and Hematology. These programs are coordinated by the Oncology institute, Oncology and Hematology department, and are primarily based at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, the largest tertiary care centers in the Baltic states. Together, they provide comprehensive specialist training across the spectrum of cancer diagnosis, treatment, and research.
All three disciplines start with the same foundation: 2 years of internal medicine training ensuring that future oncologists and hematologists can manage complex patients independently. The following 3 years are dedicated to developing a deep understanding of the respective specialties.
The Medical Oncology residency focuses on systemic anticancer therapies and the comprehensive management of solid tumours. From the first year, residents combine theoretical studies with supervised clinical practice. Training includes clinical diagnostics, systemic treatments, principles of surgical oncology, tumour morphology, oncogenetics, and radiology. Research skills are developed alongside clinical competencies, in line with European Union training standards.
The Radiation Oncology residency is a full-time programme designed to prepare specialists capable of independently delivering radiotherapy. Training is structured around clearly defined competencies in radiotherapy planning and delivery across a range of clinical scenarios. Residents gain experience in treatment planning, multidisciplinary case discussions, and daily clinical decision-making, with hands-on exposure to modern radiotherapy technologies, including linear accelerators, Gamma Knife, and MR-guided radiotherapy systems. Teaching methods include lectures, seminars, supervised practical work, and structured case presentations, ensuring integration of scientific knowledge with technical precision.
The Hematology residency combines the management of malignant and non-malignant blood disorders, with particular emphasis on hematologic cancers such as leukemias and lymphomas. The curriculum integrates laboratory hematology, genetic diagnostics, radiology, and modern therapeutic approaches. Residents are trained in both inpatient and outpatient settings, developing expertise in diagnostic interpretation, systemic therapies (including Hematopoietic Stem Cell Transplantation (HSCT) and Chimeric Antigen Receptor (CAR) T-cell therapy), and supportive care. Opportunities for research and up to one year of international clinical training further strengthen professional development.
Across all three specialties, LSMU’s postgraduate cancer education is characterized by early clinical immersion, multidisciplinary collaboration, research integration, and EU-recognized specialist qualifications. This structure ensures that graduates are well prepared for independent clinical practice, academic careers, and doctoral-level studies in oncology.
The multidisciplinary nature of oncology practice is reflected in teaching. Although undergraduate participation in formal MDTs is observational, students are introduced to collaborative decision-making and evidence-based management strategies. This prepares them for the realities of modern cancer care, where integration across specialties is essential.
Future Directions
Several developments could further strengthen the programme. Increased structured patient contact would enhance experiential learning. While current ward exposure is valuable, expanding the duration or frequency of supervised oncology rotations could deepen students’ understanding of longitudinal cancer care, including treatment toxicity management. Greater opportunities for direct mentorship with practicing oncologists and hematologists could further support professional identity formation.
Although oncology teaching is delivered through an integrated modular curriculum, introducing interdisciplinary team teaching involving both preclinical and clinical faculty could further strengthen the integration of foundational and clinical sciences. Expanding opportunities for community-based oncology education and research, particularly through cancer prevention and screening initiatives, could enhance students’ understanding of population-level cancer control.
Simulation-based training also offers significant potential. Expanding hybrid simulation, particularly in communication scenarios such as breaking bad news, discussing prognosis, and addressing end-of-life decisions, would better prepare students for emotionally complex encounters. High-fidelity simulation of oncologic emergencies could further support rapid clinical decision-making in a safe learning environment.
The integration of artificial intelligence (AI) into oncology education represents an additional area for development. Teaching students how AI supports radiologic interpretation, pathology image analysis, risk stratification, and treatment personalization would align training with evolving clinical practice. Equally important is fostering critical appraisal skills so that future physicians understand both the capabilities and limitations of AI-driven tools.
Strengthening patient-centred exposure, expanding simulation, and integrating emerging technologies will support continued development of the programme while maintaining its strong clinical and academic foundation.
Several elements of the LSMU curriculum, including its vertically integrated structure, early clinical exposure, and emphasis on simulation and research, may be relevant to other medical schools seeking to further strengthen undergraduate cancer education.