Canadian Association Research Articles

Perceived Factors That Enable Resident Entry to the Specialty of Radiation Oncology.

The field of radiation oncology (RO) has experienced large fluctuations in the number of applicants to residency programs. It is essential to understand the modifiable factors which influence entry. The objective of this project is to identify factors (i.e., "enablers") that motivate prospective medical students to apply to RO. A survey was developed to characterize RO enablers and barriers as perceived by current RO residents. An existing conceptual framework of why medical students choose primary care was used as the foundation of the survey and was modified for relevance towards RO. The final mixed-methods survey was administered to Canadian RO residents (2015-2019 match years) via Program Directors and the Canadian Association of Radiation Oncologists resident member database. Medical students are most likely to select a career in RO during or after a clerkship experience. Extrinsic factors strongly motivating interest in RO were (% rating as very important or extremely important on a 5-point scale) as follows: positive feedback from radiation oncologists (86%) and RO residents (66%), clinical rotations in RO (84%) and mentorship (77%). Intrinsic factors include perceived fulfillment (95.2%), commitment to patient care (85.3%), and intellectual challenge (67.7%). Qualitative data highlighted the importance of mentorship, the "hand-heart" connection, career variability/flexibility, career satisfaction/lifestyle, and personal connections with cancer/cancer care in motivating students to pursue RO. Increased preclinical exposure such as mentorship may encourage students to seek clerkship opportunities in RO. These findings inform strategies to recruit medical students to a career in RO.

Technology and Teacher Education in Canada

Technology and Teacher Education is part of the Canadian Association of Teacher Education (CATE), a constituent of the Canadian Society for the Study of Education (CSSE). Its mission is to foster a collaborative network of educational researchers dedicated to exploring the intersections of technology and teacher education in Canada. Aligning with this mission, this special issue showcases Canadian scholar expertise and amplifies the diverse voices of the TATE community. Inspired by discussions held during our annual TATE conference, where we focused on lessons learned from emergency remote teaching during the COVID-19 pandemic and the rapid technological advancements that teacher education programs are navigating, this issue offers a collection of studies from Canadian researchers working to make teaching and learning with digital technologies more effective, inclusive, and equitable for all Canadians.

Postpartum Hemorrhage Management in Canadian Emergency Nursing Practice

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally, claiming approximately 70,000 lives annually. Despite preventive efforts, high-income countries, including Canada, have reported increasing rates of PPH. The rising incidence and associated complications indicate improved emergency nursing practices in managing PPH are needed. Methods: PPH guidelines from the Society of Obstetricians and Gynecologists of Canada, Federation of International Gynecologists and Obstetricians, and the Canadian Association of Perinatal, and Women’s Health Nurses were compared to National Emergency Nurses Association guidelines. The competencies, medications, and obstetric maneuvers for PPH that may be relevant to emergency nurses were extracted and categorized for the emergency nursing HIRAID (History & Red flags, Assessment, Interventions, & Diagnosis) framework. Findings/Results: We found 13 discrete skills across the PPH guideline recommendations that are applicable to emergency nurses. There is near perfect overlap in medical recommendations, but gaps exist between FIGO and SOGC guidelines and NENA and CAPWHN guidelines. There are SOGC and FIGO guidelines that apply to emergency nurses that are not addressed in NENA guidelines, Discussion: There was significant overlap on treatment recommendations from maternal health bodies such as uterotonic drugs, hemorrhage control, and hemostatic resuscitation. There were significant gaps in NENA recommendations. Conclusion: The comparison of PPH guidelines highlights where NENA guidelines need further detail. These skills are particularly significant for providing nursing care in rural and remote areas. Standardized protocols for PPH management, interprofessional collaboration, and regular competency assessments are included in most guidelines but are conspicuously absent for emergency nurses. To address the gap, NENA could integrate national emergency nursing PPH competencies standards or develop recommendations for the care of maternal emergencies.

Practice patterns for eosinophilic esophagitis vary widely among Canadian gastroenterologists: a nationwide survey

Abstract Introduction Eosinophilic esophagitis (EoE) is a chronic allergic, type 2, immune-mediated condition of the oesophagus, resulting in dysmotility and oesophageal stricturing. This study aims to identify practice variation among Canadian gastroenterologists treating adults with EoE. Methods A cross-sectional, web-based survey was distributed to Canadian gastroenterologists through the Canadian Association of Gastroenterology and administrations of Canadian universities. Results Seventy gastroenterologists completed the survey, with 59% working in academic practice or research. Overall, 90% of gastroenterologists require histological evidence of EoE to establish a diagnosis of EoE, while 50% require clinical symptoms of oesophageal dysfunction; 39% of gastroenterologists take less than 5 biopsies when assessing for EoE, with variability in biopsy location. Only 51% of respondents took biopsies in every case presenting with acute food bolus. Proton pump inhibitors were the initial therapy of 70% of gastroenterologists, with 11% using topical steroids. The preferred dietary approach was the 6-food elimination diet in 36%, followed by the 2-food elimination diet in 26%. Overall, 27% of participants did not use histologic improvement and 63% did not use endoscopic improvement to evaluate treatment response. Use of EoE Endoscopic Reference Score (EREFS) is low, with 56% being either unaware of what EREFS is or never using it. Most respondents feel Canadian guidelines would be helpful in their practice. Conclusions Eosinophilic esophagitis practice patterns among Canadian gastroenterologists are variable and differ from consensus guidelines. The development of Canadian guidelines and continuing medical education content can be considered to improve the management of EoE in Canada.

Molecular Testing of Central Nervous System Tumours - Recommendations of the Canadian Association of Neuropathologists.

Molecular Testing of Central Nervous System Tumours - Recommendations of the Canadian Association of Neuropathologists.

Canadian Association of Radiologists Spine Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Spine Expert Panel is made up of physicians from the disciplines of radiology, emergency medicine, neurology, neurosurgery, physiatry, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 10 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 23 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 22 recommendation statements across the 8 scenarios (one scenario points to the CAR Trauma Referral Guideline and one scenario points to the CAR Musculoskeletal Guideline). This guideline presents the methods of development and the referral recommendations for myelopathy, suspected spinal infection, possible atlanto-axial instability (non-traumatic), axial pain (non-traumatic), radicular pain (non-traumatic), cauda equina syndrome, suspected spinal tumour, and suspected compression fracture. Spondyloarthropathies and spine trauma point to other CAR Diagnostic Imaging Referral Guidelines, Musculoskeletal and Trauma, respectively.

Canadian College of Medical Geneticists: clinical practice advisory document – responsibility to recontact for reinterpretation of clinical genetic testing

BackgroundAdvances in technology and knowledge have facilitated both an increase in the number of patient variants reported and variants reclassified. While there is currently no duty to recontact for reclassified...

Canadian Association of Radiologists Statement on Planetary Health Education in Radiology.

The health of Canadians is already impacted by climate change due to wildfire smoke, heat domes, floods, droughts, and the changing distribution of vector borne disease. The healthcare sector contributes to climate change, accounting for approximately 4.6% of annual greenhouse gas emissions in Canada. Healthcare teams have a responsibility and opportunity to reduce harm by limiting emissions and waste, and engaging the public in understanding the planetary health links between clean air and water, a stable climate, a healthy planet and human health. Transformation of Canadian healthcare to a low carbon, climate resilient system will be enhanced by physician engagement and leadership. Cornerstones to physician participation include knowledge of the anthropogenic etiology of the climate crisis, the human health impacts, and the contribution providing healthcare makes to the climate crisis. Integration of climate change knowledge into the Canadian Radiology educational curricula is essential to position radiologists to lead transformative change in mitigation and adaptation of the healthcare system to the climate crisis. This statement is intended to provide guidelines to optimize education and research for current and future Canadian radiologists, and builds on existing planetary healthcare education publications and the Canadian Association of Radiologists Statement on Environmental Sustainability in Medical Imaging.

Canadian Association for the Study of the Liver Single Topic Conference on Hepatitis B Virus: ‘Progress toward hepatitis B elimination in Canada’

Hepatitis B virus (HBV) infection affects >290 million people worldwide, including ∼250,000 Canadians, and it stands as a leading cause of end-stage liver disease and liver cancer. The World Health Assembly has set goals for HBV elimination by 2030, aiming for a >90% reduction in incidence and a 65% reduction in deaths compared to 2015. However, as of 2023, no countries were on track to achieve these targets. In Canada, challenges in HBV elimination persist due to the lack of a universal birth dose vaccine and interprovincial disparities in screening and care linkage. The Canadian Association for the Study of the Liver (CASL) and the Canadian Hepatitis B Network hosted the Inaugural Progress toward Hepatitis B Elimination Meeting in Calgary, Alberta, Canada (September 29, 2023 to October 1, 2023). This collaborative platform brought together national and international clinicians, laboratory providers, public health researchers, policymakers, and community-based organizations interested in HBV and hepatitis Delta virus (HDV) / HBV coinfection. The workshop was held during the National Day of Truth and Reconciliation (September 30, 2023) to commemorate the tragic legacy of residential schools in Canada, and it highlighted the need to promote meaningful reconciliation with Indigenous peoples. Key outcomes of the summit included establishing objectives for HBV elimination, advocating for adherence to global targets, universal screening and birth dose vaccination, equitable access to antiviral treatment across all provinces/territories, and addressing special populations. This overview highlights the presentations and emphasizes the importance of collaboration among stakeholders, public health agencies, and government entities to strive for HBV elimination in Canada.

Facilitators, Barriers, Conditions, and Recommendations of Pediatric Nurses Reassigned to Adult Care During COVID-19 Pandemic: A Mixed Methods Study

Aims To describe the conditions, facilitators, barriers, and recommendations of pediatric nurses reassigned to adult care during the COVID-19 pandemic. Background During COVID-19 pandemic, nurses who were certified, received advanced education, and with years of experience in their fields were asked to, or mandated to, care for adult patients, often with COVID-19 and in intensive care units. Introduction Nurses struggled with this transition worldwide. Literature searches reflected no guidance in specialty reassignment during a pandemic. Methods International, mixed method, convergent study using GRAMMS Mixed Methods framework. Two instruments disseminated internationally during 2021 on Survey Monkey© in three languages: (1) Researcher-developed, validated, feelings, beliefs, circumstances, and recommendations survey, (2) Medical-surgical skills survey from Canadian Association of Schools of Nursing. Integrated quantitative and qualitative design for investigatory depth. Analysis using SocialSciences calculator© and Narrative Inquiry methodology. Meleis's Transitions theory provided framework. Results A total of 122 nurses from 12 countries responded. Sixty-four percent of pediatric nurses reported they were mandated to work with adults with no choice; 64% received no preparation for change in specialty. Respondents reported suffering, absence of training to care for adults, lack of COVID-19 related skills such as care of ventilated patient, proning, mental health support, palliative care, or comforting families of the dying. Ninety-two percent recommended improvement, advising advance planning for transition in assignments, making transitions smoother, and diminishing number of transitions. National and international policies on floating supported the participants’ recommendations. Discussion Study reports challenges experienced by nurses reassigned outside of their specialties without training or preparation and offers critical recommendations to ensure both nurse and patient safety during future disasters or pandemics. Conclusion/Implications Nursing and Health Policy Planning for quality nursing care during transitions between specialties is possible. Staff nurses must be included, trained, and prepared. Literature on floating provides solid background for moving nurses between specialties.

POCUS literature primer: key papers on cardiac and lung POCUS.

Although point of care ultrasound (POCUS) use has become prevalent in medicine, clinicians may not be familiar with the evidence supporting its utility in patient care. The objective of this study is to identify the top five most influential papers published on the use of cardiac POCUS and lung POCUS in adult patients. A 14-member expert panel from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative used a modified Delphi process. Panel members are ultrasound fellowship trained or equivalent, are engaged in POCUS scholarship, and are leaders in POCUS locally and nationally in Canada. The modified Delphi process consisted of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers on cardiac POCUS and lung POCUS. A total of 66 relevant papers on cardiac POCUS and 68 relevant papers on lung POCUS were nominated by the panel. There was 100% participation by the panel members in all three rounds of the modified Delphi process. At the end of this process, we identified the top five most influential papers on cardiac POCUS and lung POCUS. Papers include studies supporting the use of POCUS for accurately assessing left ventricular systolic function, diagnosing pericardial effusion, clarifying its test characteristics for pulmonary embolism, identifying pulmonary edema and pneumonia, as well as consensus statements on the use of cardiac and lung POCUS in clinical practice. We have created a list of the top five influential papers on cardiac POCUS and lung POCUS as an evidence-based resource for trainees, clinicians, and researchers. This will help trainees and clinicians better understand how to use POCUS when scanning the heart and lungs, and it will also help researchers better understand where to direct their scholarly efforts with future research.

Reimagining recipes for food studies:

This perspective is a continuation of a conversation started during “Reimagining Food, Food Systems, and Food Studies,” a plenary session in which we, the authors, participated at the eighteenth annual assembly of the Canadian Association for Food Studies (CAFS). Assessing current opportunities and limitations for food studies in Canada from our perspectives as emerging scholars, the CAFS panel presented our individual and collective proposals for evolving the field. This article builds on the resonances and dissonances from our discussion to craft a provisional “recipe” for reimagining food studies. Recognizing the shortcomings of the format in terms of its prescriptive connotations, we position recipes not as rigid guidelines for achieving predefined outcomes, but as creative models for generating improvisations. We begin with an overview of the ingredients that have come together to create food studies in Canada. Next, we offer some revisions in the margins of this recipe based on the work in which we are engaged as food scholars and practitioners. Finally, we consider next steps for the work of evolving the field, and we invite readers to share in this exchange. Overall, we observe and participate in an unfinished trajectory that extends from previous questions on why food studies should exist and what food studies is, to consider more deeply how food studies could be done.

Patient and Provider Experiences With Compassionate Care in Virtual Physiatry: Qualitative Study.

Telemedicine in the realm of rehabilitation includes the remote delivery of rehabilitation services using communication technologies (eg, telephone, emails, and video). The widespread application of virtual care grants a suitable time to explore the intersection of compassion and telemedicine, especially due to the impact of COVID-19 and how it greatly influenced the delivery of health care universally. The purpose of this study was to explore how compassionate care is understood and experienced by physiatrists and patients engaged in telemedicine. We used a qualitative descriptive approach to conduct interviews with patients and physiatrists between June 2021 and March 2022. Patients were recruited across Canada from social media and from a single hospital network in Toronto, Ontario. Physiatrists were recruited across Canada through social media and the Canadian Association for Physical Medicine and Rehabilitation (CAPM&R) email listserve. Interviews were recorded and transcribed. Data were analyzed thematically. A total of 19 participants were interviewed-8 physiatrists and 11 patients. Two themes capturing physiatrists' and patients' experiences with delivering and receiving compassionate care, especially in the context of virtual care were identified: (1) compassionate care is inherently rooted in health care providers' inner intentions and are, therefore, expressed as caring behaviors and (2) virtual elements impact the delivery and receipt of compassionate care. Compassionate care stemmed from physiatrists' caring attitudes which then manifest as caring behaviors. In turn, these caring attitudes and behaviors enable individualized care and the establishment of a safe space for patients. Moreover, the virtual care modality both positively and negatively influenced how compassion is enacted by physiatrists and received by patients. Notably, there was large ambiguity around the norms and etiquette surrounding virtual care. Nonetheless, the flexibility and person-centeredness of virtual care cause it to be useful in health care settings.

Recommendations for patient-centered emergency care.

Patient-centred care is more than just an aspiration, it represents a fundamental shift in the way healthcare must be delivered. Patient-centred emergency care is important for improving the patient and clinician experience and is essential for optimizing health outcomes. Creating a patient-centred emergency department emphasizes the importance of the patient's experience, preferences, and values. To formulate recommendations for patient-centred care, we synthesized a literature review, stakeholder interviews, consensus from an expert panel of diverse healthcare professionals and a patient advocate, andreviewed our recommendations for feedback with a presentation at the Canadian Association of Emergency Physicians (CAEP) 2023 Annual Conference Academic Symposium. This paper gives practical recommendations for areas and strategies to improve patient-centredness in Emergency Medicine. It delves into the various dimensions of this approach, including the role of the physical environment, communications and interpersonal interactions, systems of care, and measurement, all of which are essential in providing optimal care to match the patients' needs. We seek to inspire a renewed commitment of placing the patient at the heart of emergency care, recognizing that patient-centredness is not merely an option but a fundamental aspect of delivering highquality, compassionate and effective healthcare in the emergency setting. In an era marked by technological advancements and evolving healthcare paradigms, the essence of medicine as a deeply human endeavour is becoming in some ways more possible, if we seize the opportunities.

Diverse Contributing Body

In 1962, the CCCC released a report titled “The Freshman Whose Native Language is Not English.” In this report, the chair argued for separate courses dedicated to teaching language-diverse students and staffed by instructors specially trained in Linguistics. Paul Kei Matsuda (1999; 2013) argues that this moment marks the institutional divide between U.S. Composition and Applied Linguistics that would go on to create a vacuum of knowledgeable peers in Composition. This vacuum meant that new composition theories interested in language learning were not held accountable by scholarship in Applied Linguistics. If Matsuda’s assessment of this division of labour is correct, it begs the question: does the same division of labour exist in a Canadian context between Writing Studies and L2 writing? How have these two fields related historically, and what implications does this relationship (or lack thereof) have on the future of writing instruction in Canada’s increasingly language-diverse classrooms? The purpose of this paper is to construct a narrative of the history of the relationship between Writing Studies and L2 Writing as it pertains to one of Canada’s two writing organizations: the Canadian Association for Studies in Language and Literature, also known as Inkshed. To that end, this paper excavates the Inkshed newsletters and conference programs from 1980 onward for archival research elucidating any potential cross-pollination between Writing Studies and L2 Writing. To further explore the relationship between these two fields in Inkshed’s past, this research builds on the work of Miriam E. Horne who composes a rich picture of Inkshed’s development in her book, Writing in a Community of Practice: Composing Membership in Inkshed. The findings from this paper reveal that not only did Writing Studies and L2 Writing scholarship “cross-fertilize” during the tenure of Inkshed, these two fields remained closely linked through the decades. In other words, at the writing of this paper, there does not appear to have ever been an institutional division of labour between Writing Studies and L2 Writing in the Canadian context. Ultimately, these findings contribute to the broader narrative of how Writing Studies has professionalized in a Canadian context. They also contribute to the ongoing conversation regarding how writing instructors, writing program administrators, and writing centre professionals can best support culturally and linguistically diverse writers in Canadian classrooms. By drawing on this longstanding relationship with L2 Writing, Writing Studies scholars and practitioners are uniquely situated to move into the future of higher education equipped with language-based writing theories that are rooted in a community of knowledgeable L2 Writing peers.

Genetic Testing for Familial Hypercholesterolemia: The Current State of Its Implementation in Canada

BackgroundFamilial hypercholesterolemia (FH) is a common genetic disorder, yet it remains largely underdiagnosed in Canada. Multiple national and international guidelines recommend the use of clinical genetic testing for FH. However, the level of its accessibility and use within Canada is unclear. This study aims to describe the current state of clinical FH genetic testing in Canada and barriers to its implementation. MethodsWe conducted a cross-sectional survey of 23 genetic counsellors across 8 provinces, through the Canadian Association of Genetic Counsellors Cardiac Communities of Practice, to obtain information about the accessibility of genetic testing for FH and the use of genetic-counselling services. ResultsResponses were obtained from 12 genetic counsellors (52%). Of the 8 provinces surveyed, clinical FH genetic testing is available in 7, with British Columbia being the exception. The Simplified Canadian Definition for FH is the diagnostic criterion most commonly utilized to determine genetic-testing eligibility, and it is used in 5 of the 8 provinces. Notably, the referral rate to genetic counsellors typically is low, with most genetic-counselling programs receiving ≤ three referrals per site per month. Quebec is the only province to report a higher rate of genetic-counsellor referrals for FH. ConclusionsClinical FH genetic testing is not available widely in Canada and its implementation varies significantly by province; this includes the eligibility criteria to qualify for testing as well as the utilization of genetic counsellors. A harmonized national approach to FH diagnosis could improve the rates of diagnosis and treatment.

Global emergency medicine: four part series : Paper 4: Global EM education and professionalization.

In 2018, the Canadian Association of Emergency Physicians (CAEP) academic symposium included developing recommendations on supporting global emergency medicine (EM) in Canadian departments and divisions. Members of CAEP's Global EM committee created a four-part series to be published in CJEM that would build upon the symposium recommendations. The objective is to offer practical tools to EM physicians interested in becoming involved in Global EM, as well as provide departments with successful Canadian case examples that foster, facilitate, and grow Global EM efforts. This submission is the fourth paper of the series which focuses on education and continuing professional development for Global EM. It includes resources for resident global EM electives, fellowship training and ongoing or additional CPD training for practicing EM physicians. It also highlights the importance of pre-departure training and other required elements of engaging responsibly in Global EM work.

Choosing Wisely in Physical Medicine and Rehabilitation: Developing Canadian Recommendations for Resource Stewardship

ABSTRACT Choosing Wisely Canada (CWC) aims to reduce potentially harmful or unnecessary diagnostic investigations and practices in health care delivery. A committee of the Canadian Association of Physical Medicine & Rehabilitation (PM&R) surveyed the general membership seeking suggestions on new or revised PM&R CWC recommendations. Draft recommendations were revised and refined with an emphasis on resource stewardship and alignment with the CWC mission. The updated 2023 CWC recommendations for PM&R are to avoid: (1) investigating and treating asymptomatic bacteriuria in patients with neurogenic bladder; (2) recommending more than a brief period of physical and cognitive rest after mild traumatic brain injury; (3) starting opioid treatment for chronic noncancer pain without exhausting other approaches; (4) ordering diagnostic imaging for low back pain in the absence of red flags; (5) repeating injections without evaluating patients’ responses to them; and, (6) recommending carpal tunnel release without first confirming nerve entrapment with electrodiagnostic studies or ultrasonography. We present unique implementation tools to equip practitioners with quality improvement strategies to adopt these recommendations into their practices. Future work will include developing recommendations that consider planetary health co-benefits, creating knowledge translation tools, and assessing the impact of recommendation adoption into clinical practice.

Canadian Association of Radiologists Statement on Environmental Sustainability in Medical Imaging.

Immediate and strategic action is needed to improve environmental sustainability and reduce the detrimental effects of climate change. Climate change is already adversely affecting the health of Canadians related to worsening air pollution and wildfire smoke, increasing frequency and intensity of extreme weather events, and expansion of vector-borne and infectious illnesses. On one hand, radiology contributes to the climate crisis by generating greenhouse gas emissions and waste during the production, manufacture, transportation, and use of medical imaging equipment and supplies. On the other hand, radiology departments are also susceptible to equipment and infrastructure damage from flooding, extreme temperatures, and power failures, as well as workforce shortages due to injury and illness, potentially disrupting radiology services and increasing costs. The Canadian Association of Radiologists' (CAR) advocacy for environmentally sustainable radiology in Canada encompasses both minimizing the detrimental effects that delivery of radiology services has on the environment and optimizing the resilience of radiology departments to increasing health needs and changing patterns of disease on imaging related to climate change. This statement provides specific recommendations and pathways to help guide radiologists, medical imaging leadership teams, industry partners, governments, and other key stakeholders to transition to environmentally sustainable, net-zero, and climate-resilient radiology organizations. Specific consideration is given to unique aspects of medical imaging in Canada. Finally, environmentally sustainable radiology programs, policies, and achievements in Canada are highlighted.

Is the Medical Oncology Workforce in Canada in Jeopardy? Findings from the Canadian Association of Medical Oncologists' COVID-19 Impact Survey Series.

The COVID-19 (C19) pandemic introduced challenges in all areas of the Canadian healthcare system. Along with adaptations to clinical care environments, there was increasing concern about physician burnout during this time. The Canadian Association of Medical Oncologists (CAMO) has examined the effects of the pandemic on the medical oncology (MO) workforce. A series of four multiple choice web-based surveys distributed to MOs who were identified using the Royal College of Physicians and Surgeons directory and CAMO membership in May 2020 (S1), July 2020 (S2), December 2020 (S3), and March 2022 (S4). Descriptive analyses were performed for each survey, and a Chi-square test (α = 0.05) was used to assess factors associated with planned change in practice in S4. The majority of respondents work in a comprehensive cancer center S1/S2/S3/S4 (87%/86%81%/88%) and have been in practice >10 years (56%/61%/50%/64%). The most commonly reported personal challenges were physical (60%) and mental (60%) wellness. In S4, 47% of MOs reported dissatisfaction with their current work-life balance. In total, 83% reported that their workload has increased since the beginning of C19, and 51% of MOs reported their future career plans have been impacted by C19. In total, 56% of respondents are considering retiring or reducing total working hours in the next 5 years. Since the onset of the C19 pandemic, there are concerns identified with wellness, increasing workload, and job dissatisfaction among MOs, associated with experienced staff who have >10 years in practice. As rates of cancer prevalence rise and treatments become more complex, it is crucial to address the concerns raised in these surveys to ensure that we have a stable MO workforce in the future.