Pediatric Hematology-Oncology Fellows’ Physician Well-Being Sessions

Claire M. De Souza BSc MD FRCP(C) Hospital for Sick Children, University of Toronto, Toronto, Canada

Burnout amongst physicians has been well described as

have supportive programs for Hematology-Oncology

Fellows. At the Chief Fellows’ request, a workshop on

coping strategies was given in 2005 followed by monthly

well-being sessions at the Hospital for Sick Children

beginning in 2006. The initiative was supported by the Chief

and Fellowship Director for the Division of Pediatric

Hematology-Oncology.

Background

To develop a curriculum on the topic of Physician Well-Being

for Pediatric Hematology-Oncology Fellows through which

sources of stress can be discussed

Purpose

Methods

Conclusions

References

• Needs assessment

• focus group (2006): 9 interdisciplinary team members

(staff MDs, RNs, resident, SW) + 2 parents

• survey of fellows: informal (2006/7), formal (2008)

• Sessions – 1 hr / month

• topics advertised

• mixed didactic and interactive teaching methods

• articles referenced

• Staff Oncologists present to emphasize importance

• refreshments provided

• Session Evaluation

• Physician Well-Being sessions were valued by those in attendance. Participating fellows represented a diverse group with varied needs. Attendance was limited and barriers to participation need further exploration. • The collaboration can be a rewarding experience for a consulting psychiatrist.

Results: Needs Assessment (Topics)

• Armstrong J, Lederberg M, Holland J. Fellows' forum: a workshop on the stresses of being an oncologist. J Cancer Educ. 2004: 19(2):88-90.

• Armstrong, J and Holland, J Surviving the Stresses of Clinical Oncology by Improving Communication. Oncology. 2004: 18(3):p363-375.

• Grunfeld E, Zitzelsberger L, Coristine M, Whelan TJ, Aspelund F, Evans WK. Job stress and job satisfaction of cancer care workers. Psychooncology. 2005; 14(1):61-9.

• Sekeres MA, Chernoff M, Lynch TJ Jr, Kasendorf EI, Lasser DH, Greenberg DB. The impact of a physician awareness group and the first year of training on hematology-oncology fellows. J Clin Oncol. 2003; 1;21(19):3676-82.

•Spinetta JJ, Jankovic M, Ben Arush MW, Eden T, Epelman C, Greenberg ML, Gentils Martins A, Mulhern RK, Oppenheim D, Masera G. Guidelines for the recognition, prevention, and remediation of burnout in health care professionals participating in the care of children with cancer: report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Med Pediatr Oncol. 2000 ;35(2):122-5.

AcknowledgementsDrs. Ahmed Naqvi, Angela Punnett, Michael Capra, Victor Blanchette, and Tony Truong

• n=14 Respondents: 70% female, 64% 1st year, Grad Yr: 91-03, 86% Internationally trained (Europe, Middle East, India, Africa)• 92% were in favour of Well-Being sessions• 71% attended Well-Being sessions at SickKids• 62% felt the topic of Well-Being is important• Majority preferred: case based discussion, every 1-2 months

Results: Needs Assessment / Evaluation (2008)

Year # Sessions Educational Climate 2006/7 9 Preference for interactive over didactic, fellows

only

2007/8 11 Preference for more structure & less focus on ‘personal’ experience, topics advertised, staff oncologists present; cultural differences noted

2008/9 2 Change in Fellowship director: focus on integrating well-being sessions into existing curriculum

2009/10 6 Fellowship curriculum: modified to academic half-days (from weekly 1 hour sessions) to enhance attendance with the plan to integrate 6 well-being sessions

Results: Session Evaluations“What I Liked” • facilitated interactive discussion

• brainstorming, reflection• relaxed and open approach• relevant topics matching needs• communication skill development • hearing from group including staff oncologists• references

“What I Didn’t Like” • need more time for topics• poor attendance by fellows

“What I Will Apply” • relationship with patient, care for self, structured approach, reflection

• Disclosing Medical Error · Team Communication

• Breaking Bad News · Talking with Kids about Death/Dying

• Collegiality ∙ Caring for Self

• Challenging Families · 1st 24 hours

• Mentorship · Transition to Practice

• Cited as a strength of the Fellowship program during the Royal College of Physicians and Surgeons On-Site Survey (2007)

• National Videoconference on topic to 10 Pediatric Hematology-Oncology centers in Canada

• Hematology-Oncology Nurses requested well-being sessions

Impact

• Sessions: 5 to 10 fellows on average (N.B. 20-25 clinical fellows in program; more than half are internationally trained)• Needs Assessment (2008): 14 fellows completed survey

Results: Participation