Implementation and Evaluation of a Cancer Immunotherapy Elective for Medical Students: Mixed Methods Descriptive Study.

Background: Cancer immunotherapy represents a transformative advancement in oncology, offering new avenues for treating malignancies by harnessing the immune system. Despite its growing clinical relevance, immunotherapy remains underrepresented in undergraduate medical education, particularly in curricula integrating foundational immunology with clinical application. To address this gap, we developed and implemented a fully online elective for fourth-year medical students focused on core immunology concepts, immunotherapy mechanisms, Food and Drug Administration-approved treatments, immune-related adverse events, and patient-centered therapeutic decision-making. Objective: This study aimed to evaluate the effectiveness of an asynchronous-synchronous online cancer immunotherapy elective in improving medical student knowledge, engagement, and critical-thinking skills. We hypothesized that participation in the elective would be associated with perceived improvements in knowledge and clinical preparedness and inform future strategies for integrating cancer immunotherapy into medical curricula. Methods: We conducted a mixed methods study with fourth-year medical students enrolled in a 2-week elective at a US medical school. The curriculum included a self-paced foundational module, online discussion board, and a capstone oral presentation requiring students to propose a novel immunotherapy approach. Participants completed pre- and postcourse quizzes assessing immunotherapy knowledge and an anonymous postcourse Likert-scale survey. Quantitative data were summarized descriptively, and Likert responses were reported using medians and IQRs. Due to the small sample size, 2-tailed unpaired t tests comparing pre- and postcourse quiz averages were underpowered to detect statistically significant differences. Qualitative data were analyzed using inductive thematic analysis with investigator triangulation. Results: A total of 35 students completed the elective, and 20 submitted the postcourse survey (response rate: 57%). Across all Likert-scale items, students reported a median response of 5 (Strongly Agree), with IQR values ranging from 0 to 1, indicating uniformly positive perceptions and minimal variability in their evaluation of the course. Descriptively, average postcourse quiz scores were higher than precourse scores, suggesting improved conceptual understanding. Qualitative thematic analysis revealed three major themes: (1) increased confidence engaging with complex immunotherapy mechanisms, (2) appreciation for the flexibility and interactivity afforded by the hybrid asynchronous-synchronous model, and (3) enhanced understanding of the real-world clinical application of immunotherapy across interdisciplinary settings. Conclusions: Descriptive quantitative and qualitative findings suggest that a targeted online cancer immunotherapy elective may enhance learners' perceived knowledge and critical-thinking capacity related to emerging cancer therapies. The course's hybrid structure offered flexibility, accessibility, and potential scalability. As immunotherapy continues to expand in clinical practice, this model provides a promising framework for integration into medical curricula. Future work should include larger cohorts and longitudinal follow-up into residency to more rigorously assess educational impact.