Published on in Vol 10 (2024)

Preprints (earlier versions) of this paper are available at, first published .
Web-Based Scaffolds: The Feasibility of a Constructivist Approach to Oncology Fellow Learning

Web-Based Scaffolds: The Feasibility of a Constructivist Approach to Oncology Fellow Learning

Web-Based Scaffolds: The Feasibility of a Constructivist Approach to Oncology Fellow Learning

Research Letter

1Department of Medicine, University of California, San Francisco, San Francisco, CA, United States

2Department of Medicine, Stanford University, Palo Alto, CA, United States

Corresponding Author:

Sam Brondfield, MAEd, MD

Department of Medicine

University of California, San Francisco

505 Parnassus Ave

Room M1286, Box 1270

San Francisco, CA, 94143

United States

Phone: 1 4155144783


Succinct and updated oncology fellow learning materials are lacking. Additionally, fellow didactic learning often takes the form of passive lectures, which is undesirable [1,2]. Constructivist learning, wherein learners construct their own knowledge, is rare for fellows.

We piloted “scaffolds”—succinct slide sets shared across oncology trainees—and evaluated feasibility [3,4]. Throughout training, fellows can update the shared scaffolds in a constructivist fashion, thereby providing updated resources for themselves and colleagues.

Study Design

Two institutions participated—University of California, San Francisco (UCSF), and Stanford University. From 2018 to 2019, SB—a UCSF oncologist—designed 12 scaffolds, using Google Slides covering the solid tumor chapters from the American Society of Clinical Oncology’s Self-Evaluation Program (ASCO-SEP) textbook [5]. Hematology, gynecologic oncology, and neuro-oncology were omitted for this pilot. Scaffolds included text and images synthesized from ASCO-SEP and National Comprehensive Cancer Center guidelines. For brevity, the slides instructed fellows to adhere to length limits when making edits.

We emailed scaffold links to all first- to third-year UCSF (n=21) and Stanford University (n=27) oncology fellows in July 2019 and July 2020. Use was optional, and fellows could access and update the scaffolds anonymously at any time. Updates were audited by SB.

In December 2021, to evaluate feasibility outcomes (fidelity: degree to which the innovation was implemented as intended; appropriateness: perceived fit of the innovation; self-efficacy: belief in the ability to execute the innovation’s goals) [6], we reviewed updates tracked in Google Slides and conducted 2 voluntary feedback focus groups (UCSF: facilitated by SB; Stanford University: facilitated by MS—a Stanford University oncology fellow) with 4 fellows each. Focus group size was determined by responses to recruitment emails. Consent and demographic information were obtained. Participants did not need to use the scaffolds, as we were also exploring barriers to use. Focus groups were recorded and professionally transcribed. SB and MS independently reviewed the transcripts and generated themes through iterative discussion [7].

The scaffolds were updated in 2023 by SB (available on Google Drive) [8].

Ethical Considerations

UCSF and Stanford University institutional review boards granted exemption (#20-31645) and approval (#57766), respectively. Participants received an information sheet and verbally consented before each focus group. Transcripts omitted personal identifiers, and interviewers never revealed participant identities to the rest of the study team. Participants received a US $10 electronic gift card.


From July 2019 to December 2021, fellows made 60 updates (Table 1), ranging from new trials to changes in management; none were erroneous. SB made 9 edits for brevity.

Table 1. Number of updates to solid oncology scaffolds during the pilot period (July 2019 to December 2021).
ScaffoldsUpdates by fellows (N=60), nUpdates by auditor (N=9), n
Gastrointestinal (lower)50
Gastrointestinal (upper)91
Germ cell22
Lung (nonsmall cell)31
Lung (small cell/other thoracic)11


Focus group participants (N=8) were women and included Asian (n=3, 37.5%), White (n=3, 37.5%), Black (n=1, 12.5%), mixed-race (n=2, 25%), first-year (n=5, 62.5%), second-year (n=2, 25%), and third-year (n=1, 12.5%) fellows. Most (n=7, 87.5%) used the scaffolds. Qualitative analysis (Table 2) revealed that fellows felt the scaffolds were accessible and succinct learning tools, addressed the dearth of similar resources, served as effective preparation materials for clinical work and examinations, provided structured information for rapid reviews, and made interactions with complex resources easier.

Table 2. Qualitative analysis of transcripts from 2 oncology fellow focus groups (1 at the University of California, San Francisco, and 1 at Stanford University) that evaluated a pilot of solid oncology scaffolds (July 2019 to December 2021).
ThemeSupportive quotation

Accessible, succinct resource“[The scaffolds were] online and quickly accessible, for example on the shuttle on the way to work.”

Addressed the dearth of similar resources“There are few resources currently available for oncology fellows. [The scaffolds] filled a niche not currently filled by other resources.”

Effective preparation materials for clinical work and examinations“[The scaffolds] were a security blanket…helpful for clinic prep and inpatient consults.”

Structured information for rapid reviews“[The scaffolds] were helpful in that they provided frameworks…and approaches.”

Easier subsequent use of more complex resources“The guidelines felt less ‘foreign’ after reviewing the scaffolds…[the scaffolds] helped with knowledge retention from more complex resources.”

Lack of fellow confidence in updating the scaffolds“I wasn’t sure whether my learning points were important enough to add to the scaffold.”

Lack of fellow ownership over the scaffolds“I think fellows are probably less likely to update the scaffolds if they don’t feel responsible for them.”

Too simple and broad to help with nuanced patient care“Clinical care is so nuanced…the scaffolds may be too broad to help with some clinical situations.”

Improve visual appeal“Maybe make them more visually appealing by including more figures or tables.”

Clarify purpose and the fact that scaffolds can be updated“I would make it clear that the slides are editable and that fellows should update them.”

Facilitate opportunities for fellows to update scaffolds“Asking fellows to update these might be good for their learning.”


Qualitative analysis revealed barriers to updating the scaffolds—fellows’ lack of ownership over the scaffolds and low confidence regarding appropriate updates.

Principal Results

This pilot explored the feasibility of implementing constructivist scaffolds for oncology fellows. We found evidence of fidelity and appropriateness and delineated next steps to optimize self-efficacy. The scaffolds [8] can be downloaded and modified to avoid generating institution-specific scaffolds from scratch. To promote ownership and confidence, we recommend assigning fellows to update the scaffolds under faculty mentorship.

Despite demonstrating superior outcomes when compared to passive lectures, constructivist learning is rarely studied at the fellowship level [9-11]. We recommend evaluating constructivist learning modalities, such as scaffolds, in graduate medical education to enhance learning outcomes.


Though the focus groups suggested that multiple fellows used the scaffolds, Google Slides did not track how many fellows accessed or updated them. We did not incorporate multimedia components beyond images and tables (some needed to be removed before publication to respect copyright), nor did we include assessments in this pilot. We recommend that institutions consider incorporating multimedia content and assessments into the scaffolds. The number of focus group participants was small and not gender-diverse. Future studies should quantitatively evaluate usage patterns and user satisfaction to examine what factors drive utilization.


We piloted a novel constructivist approach to fellow learning and found evidence of feasibility. Oncology educators may use and modify the scaffolds [8] to jump-start constructivist education for fellows at their institutions. Educators in other fields may wish to apply this model to their specialties.


This study was funded by a University of California, San Francisco (UCSF), Academy of Medical Educators Education Innovations grant. The funder did not have a role in the study’s design, data collection, data analysis, data interpretation, manuscript writing, or decision to submit the manuscript for publication.

Data Availability

The data sets analyzed during this study are not publicly available due to institutional review board restrictions but are available from the corresponding author on reasonable request.

Authors' Contributions

SB designed the scaffolds, conceived the study, conducted the quantitative analysis, and wrote the manuscript. SB and MS each conducted 1 focus group. SB and MS conducted the qualitative analysis. All authors contributed manuscript edits and approved the final manuscript for submission.

Conflicts of Interest

None declared.

  1. Chi MTH, Wylie R. The ICAP framework: linking cognitive engagement to active learning outcomes. Educ Psychol. Oct 28, 2014;49 (4):219-243. [CrossRef]
  2. Lim J, Ko H, Yang JW, Kim S, Lee S, Chun MS, et al. Active learning through discussion: ICAP framework for education in health professions. BMC Med Educ. Dec 30, 2019;19 (1):477. [FREE Full text] [CrossRef] [Medline]
  3. Masava B, Nyoni C, Botma Y. Scaffolding in health sciences education programmes: an integrative review. Med Sci Educ. Dec 7, 2022;33 (1):255-273. [FREE Full text] [CrossRef] [Medline]
  4. McConnaughey S, Freeman R, Kim S, Sheehan F. Integrating scaffolding and deliberate practice into focused cardiac ultrasound training: a simulator curriculum. MedEdPORTAL. Jan 19, 2018;14:10671. [FREE Full text] [CrossRef] [Medline]
  5. American Society of Clinical Oncology. ASCO-SEP Medical Oncology Self-Evaluation Program Sixth Edition. Alexandria, Virginia. ASCO University; 2018. .
  6. Pearson N, Naylor PJ, Ashe MC, Fernandez M, Yoong SL, Wolfenden L. Guidance for conducting feasibility and pilot studies for implementation trials. Pilot Feasibility Stud. Oct 31, 2020;6 (1):167. [FREE Full text] [CrossRef] [Medline]
  7. Creswell JW, Poth CN. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. 4th edition. Thousand Oaks, CA. SAGE Publications; 2017. .
  8. Brondfield S. Scaffolds updated 1.2023. Google Drive. URL: [accessed 2024-02-13]
  9. Martin A, Weller I, Amsalem D, Adigun A, Jaarsma D, Duvivier R, et al. From learning psychiatry to becoming psychiatrists: a qualitative study of co-constructive patient simulation. Front Psychiatry. Jan 8, 2021;11:616239. [FREE Full text] [CrossRef] [Medline]
  10. Patel SM, Singh D, Hunsberger JB, Lockman JL, Taneja PA, Gurnaney HG, et al. An advanced boot camp for pediatric anesthesiology fellows. J Educ Perioper Med. Apr 1, 2020;22 (2):E641. [FREE Full text] [CrossRef] [Medline]
  11. Lim MY, Greenberg CS. Impact of benign hematology didactic lectures on in-service exam in a hematology-oncology fellowship program: a cross-sectional longitudinal study. J Cancer Educ. Aug 2020;35 (4):705-708. [CrossRef] [Medline]

ASCO-SEP: American Society of Clinical Oncology’s Self-Evaluation Program
UCSF: University of California, San Francisco

Edited by T de Azevedo Cardoso; submitted 05.09.23; peer-reviewed by S Lee; comments to author 06.12.23; revised version received 05.02.24; accepted 06.02.24; published 23.02.24.


©Sam Brondfield, Matthew Schwede, Tyler P Johnson, Shagun Arora. Originally published in JMIR Cancer (, 23.02.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cancer, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.