Pediatric Hematology-oncology Fellows Research Articles

V‐SYMPHONY career development series: A collaboration to enhance professional awareness for pediatric hematology oncology trainees

A recent survey of pediatric hematology oncology (PHO) physicians identified that a majority believe fellows are struggling to find jobs that align with their goals. Career development for trainees has historically been home institution-specific, limiting fellows' exposures to career path possibilities. The "virtual-Symposium of Pediatric Hematology/Oncology of New York (v-SYMPHONY)" instituted a tristate Career Development Series for PHO trainees to better address their needs and increase awareness of the variety of PHO career opportunities. The v-SYMPHONY Career Development Series incorporated three sessions: (a) institutional perspective, (b) individual perspectives, and (c) nuts and bolts of job search. Pre- and post-series surveys were administered to participants to measure impact. Forty-one fellows registered for the series and completed a pre-survey. Over half (54%) were in their third or later year of fellowship. Careers with a clinical focus were the most commonly desired career path (59%). Most had received career development advice only from faculty within their institutions (90%). Post-surveys were completed by 11 PHO fellows. Overall, 100% of respondents reported benefiting from the career sessions and recommended the series should be repeated annually. Over 90% learned new information to prepare for the job search. The v-SYMPHONY Career Development Series for PHO fellows across multiple institutions was established and was extremely well received by its participants. PHO fellows agreed that these sessions were beneficial in helping prepare them for the job search process. An annual regional Career Development Series is feasible and is strongly suggested to support PHO fellows.

The Stressful State of Pediatric Hematology Oncology Fellow Job Search Process

Introduction: The workforce of Pediatric Hematology Oncology (PHO) has been evolving over the last decade. Recently, fellowship application volume has declined, with almost half of the programs at least partly unfilled during the previous MATCH. A perceived paucity of PHO jobs for graduating fellows may exacerbate this declining interest in the field. By surveying fellows, fellowship program directors, and PHO division chiefs, this study aims to investigate PHO fellows' preparation for, and experience with, the search for an initial faculty position.Methods: After pilot testing with faculty and fellows, all PHO division chiefs and program directors from 115 programs (N=222) were invited to complete the survey and to disseminate the instrument to their fellows. The survey included questions on demographics, job search preparation, job search experiences including barriers and helpful tools, and consequences for well-being such as stress and anxiety.Results: Some programs chose not to participate, evidenced by representation from 35 states, and many states with multiple fellowship programs only had one response from program leadership. A total of 166 individuals responded to all questions, representing approximately 24% response rate. Of the participants 83 were fellows and 83 were program leaders including fellowship program directors and division chiefs. Nearly 82% (n=136/166) of all respondents believe that PHO fellows are struggling to find a job that aligns with their goals.Program leaders identified common barriers influencing fellows' job search including geographic constraints (N=60/83, 73%) followed by only a few jobs available (N=51/83, 61%), clinical focus constraints (N=43/83, 52%), and few positions being posted (N=41/83, 49%). Fellows who have started the job search process commonly reported geographic constraints as a barrier (N=26/46, 57%), followed by partner employment opportunities (N=17/46, 37%), and their own clinical interests (N=15, 33%). Of 42 open-ended responses written by fellows, almost half (N=18/42, 43%) cited limited number of jobs available, and 21% (N=9/42) cited difficulties related to job postings.Almost half of fellows (47%, n=37/79) reported a lack of formal education on the job search process, as opposed to less than 10% of leadership (n=8/83) who agreed. When offered, education most commonly involved strategies for CV building (37%, n=31/83) and less frequently focused on the rest of the job process including negotiation, job talking, interviewing, and writing cover letters.Nearly all (N=79/83, 95%) of program leaders believe that fellows are somewhat/extremely stressed about the job search process. 75% (n=59/79) of fellows self-reported feeling somewhat/extremely stressed due to the job search process. Nearly 20% (n=15/79) of fellows self-reported severe anxiety over the job search process, and another 25% (n=21/79) reported moderate anxiety.Conclusions: This study highlights numerous shortcomings in the job search process among PHO fellows. A majority perceive difficulty securing a job which aligns with one's goals. While geography was the most cited barrier, finding a position with the optimal clinical focus was also problematic, a finding especially worrisome given the increasing popularity of additional 4 th year fellowship training in PHO. Other commonly recognized challenges surround the number of positions available as well as how those positions are publicized. Importantly, the job search may negatively impact wellness. Fellows' reports of stress and anxiety surrounding the job search, also acknowledged by program leaders should prompt change.Next steps include follow up studies including qualitative interviews to better understand the fellows' experiences, development of educational programs to prepare fellows for the job search process, enhanced career counseling, as well as improved support programs focused on the relevant stressors. Educational interventions to help prepare CVs, cover letters, and practice interviewing or negotiation may be able to help alleviate some of the stress fellows experience while undergoing the job search process. These data represent a need to further understand the PHO workforce to determine why fellows and leadership sense difficulty in securing a position that aligns with one's goals, as well as whether these perceptions represent the realities of the current workforce. DisclosuresNo relevant conflicts of interest to declare.

Palliative Care Training for Pediatric Hematology/Oncology Fellows: a Canadian Perspective.

Children with cancer experience suffering, particularly at the end of life. Pediatric hematology/oncology (PHO) fellows need dedicated palliative care (PC) training in order to adequately manage this suffering. Our objectives wereto understand (1) the PC training needs of Canadian PHO fellows and (2) experiences in providing PC, from the perspectives of fellows and their training program directors (PDs) and to describe (1)our experience in enhancing our institutional PC curriculum and (2)the preliminary evaluation of this curriculum. Electronic surveys were sent to all Canadian PHO fellows and PDs. Fellows participating in our curriculum were also sent post-course surveys. All 9/9 of the PDs and 63% (29/46) of the fellows completed our pre-course surveys. The majority of survey participants agreed that PHO fellows require dedicated PC training. All programs provided some PC education, but 45% of programs offered 3 or fewer hours of training per year. Only 55% (5/9) of the PDs believed that their trainees had adequate PC skills on completion of training. Fellows perceived a range of PC skills to be important but expressed low levels of comfort across these skills. Many fellows had experienced distress as a result of managing PC clinical situations, and many cited a lack of training as contributing to their distress. Despite increasing awareness of the importance of PC education for PHO fellows, this subject does not receive adequate attention in training curricula. The introduction of a Canadian national curriculum may improve the provision of PC training in education programs.

Creating a cancer genomics curriculum for pediatric hematology-oncology fellows: A national needs assessment.

BackgroundWith the advent of next generation sequencing, tumor and germline genomic testing are increasingly being used in the management of pediatric cancer patients. Despite this increase in testing, many pediatric hematology–oncology (PHO) providers are not confident interpreting or utilizing tumor or germline genomic results to care for their patients.MethodsWe developed and delivered a needs assessment survey to PHO program directors, attendings, and fellows in the United States to understand this deficiency, gather data on existing cancer genomics educational initiatives, and query preferences for creating a future curriculum.ResultsThe survey includes 31 (41%) of 74 invited PHO program directors, 110 (11%) of 1032 invited attendings, and 79 fellows. The majority of attending physicians and fellows responding to the survey agree that understanding tumor (95% attending physicians; 95% fellows) and germline (86% attending physicians; 94% fellows) genomic information is essential for their practice. However, only 9 of 31 (29%) responding programs report that they have an existing cancer genomics curriculum. Most program directors indicated that the ideal genomics curriculum would occur during the first year of fellowship and incorporate direct patient care, online modules, and problem‐based learning. Attending physicians and fellows identified that addressing indications for ordering tumor and germline genomic testing, counseling about the risks and benefits of such testing, and interpreting and individualizing clinical management based on tumor and germline results should be included in a future curriculum.ConclusionThe results of this study reveal a great need to develop a curriculum that can be offered across PHO fellowship programs to expand knowledge in the area of cancer genomics.

Burnout in pediatric hematology oncology fellows: Results of a cross-sectional survey.

Burnout is a significant problem in the medical community, including among pediatric hematology/oncology (PHO) faculty. However, the prevalence of burnout, its associated risk factors, and outcomes within PHO fellows are unknown. We present the results of a cross-sectional study of PHO fellows from 21 training programs. A total of 45/115 fellows (39.1%) met criteria for high level of burnout. Fellows who met criteria for high burnout also demonstrated poor outcomes including decreased empowerment, increased doctor-centered care, decreased self-assessed humanism, and decreased satisfaction with training. Further longitudinal investigation is needed to better understand burnout and the causative factors affecting PHO fellows.

9. BURNOUT IN PEDIATRIC HEMATOLOGY ONCOLOGY FELLOWS, CROSS-SECTIONAL EXTENT AND OUTCOMES

Background Burnout is plaguing doctors at all levels with severe consequences. Despite high emotional intensity, burnout rates among pediatric hematology-oncology (PHO) faculty have been less than previously described (Roth, PBC, 2011). The landscape of burnout among PHO fellows remains unknown. Objectives Describe the prevalence, determinants, and associated outcomes of burnout among PHO fellows. Methods 115 PHO fellows enrolled in a humanism curriculum study were administered the Maslach burnout inventory, empowerment at work scale, patient-provider orientation scale (PPOS), and satisfaction in training scale. Secondary analyses were performed using chi square analysis for demographic risk factors, and t-test for the continuous outcome variables. Results A total of 45/115 fellows (39.1%) met criteria for high level of burnout. No demographic variables were identified as statistically significant risk factors to predict high levels of burnout, including year of fellowship. The prevalence of high-level burnout among 2nd and 3rd year fellows was not significantly lower than that of 1st year fellows (36% vs 46%, p=0.3), revealing burnout to be an issue across the full fellowship experience. Program size was not significantly associated with level of burnout, though there was a trend towards large programs contributing a higher proportion of fellows with high levels of burnout (62.2% of fellows with high burnout trained in large programs vs 47.1% of those without high burnout). Those who met criteria for high burnout were associated with poor outcomes (Table 1). Conclusions This study identified more than 1/3 of current PHO trainees experiencing high levels of burnout. Interestingly, research years may not be as protective as thought and those at larger programs might be at higher risk, though more data are required. High level burnout is associated with decreased satisfaction with training, poor empowerment, and less patient-centered care. These data beg the need for longitudinal investigation of burnout in PHO fellows, both for their own well-being but also for the possible impact on patient care.

Using standardized patients to improve delivery of bad news by pediatric hematology-oncology fellows.

29 Background: First-year pediatric hematology-oncology fellows frequently must deliver difficult news to patients and families, possibly with little prior experience. Training in this area is often via didactic lectures and by “trial and error”. This can lead to significant discomfort on the part of fellows and potentially increased distress on the part of families if information is poorly communicated. Standardized patient (SP) encounters provide a safe environment for fellows to practice effective and compassionate communication skills. SPs can provide feedback to the fellows that may not otherwise be available from patients, families or peers. Methods: During the 4 hour course, fellows receive didactic sessions on delivery of bad news, disclosure of medical errors, and discussion of prognosis and goals of care. Half of the fellows receive the didactic sessions, while the other half participate in the SP cases involving 7-10 minute encounters followed by 10-15 minute confidential debriefings including the fellow, SP and a faculty member. Three cases are completed by each fellow: new diagnosis of an incurable brain tumor, tumor progression and goals of care discussion regarding the same patient 6 months later, and disclosure of a chemotherapy error. At the end, fellows complete an evaluation of the course and their perceived post-course skills. Results: Fellows in the first course (n = 8) strongly agreed that the course improved their ability to deliver bad news (mean = 5 on 5 point scale), was an appropriate method for this material (mean = 4.6) and that the confidential debriefing was useful without being stressful (mean = 4.7). Most comments supported the utility of receiving immediate feedback from the SPs and faculty. The didactic sessions were listed as the least helpful part of the course. Conclusions: Simulated encounters with immediate feedback from SPs and faculty can improve perceived competence in the delivery of bad news. Like many adult learners, course participants did not find the didactic sessions to be as helpful as interactive experiences. Follow-up surveys after the fellows complete the first year of training will further assess the utility of this instructional method.

Humanism and professionalism education for pediatric hematology-oncology fellows: A model for pediatric subspecialty training.

Humanism and professionalism are virtues intrinsic to the practice of medicine, for which we lack a standard, evidence-based approach for teaching and evaluation. Pediatric hematology-oncology (PHO) fellowship training brings new and significant stressors, making it an attractive setting for innovation in humanism and professionalism training. We electronically surveyed a national sample of PHO fellows to identify fellows' educational needs in humanism and professionalism. Next, we developed a case-based, faculty-facilitated discussion curriculum to teach this content within pilot fellowship programs. We assessed whether fellowships would decide to offer the curriculum, feasibility of administering the curriculum, and satisfaction of fellow and faculty participants. Surveys were completed by 187 fellows (35%). A minority (29%) reported that their training program offers a formal curriculum in humanism and/or professionalism. A majority desires more formal teaching on balancing clinical practice and research (85%), coping with death/dying (85%), bereavement (78%), balancing work and personal life (75%), navigating challenging relationships with patients (74%), and depression/burn out (71%). These six topics were condensed into four case-based modules, which proved feasible to deliver at all pilot sites. Ten fellowship programs agreed to administer the novel curriculum. The majority (90%) of responding fellows and faculty reported the sessions touched on issues important for training, stimulated reflective communication, and were valuable. Pediatric hematology-oncology fellows identify numerous gaps in their training related to humanism and professionalism. This curriculum offers an opportunity to systematically address these educational needs and can serve as a model for wider implementation. Pediatr Blood Cancer 2015;62:335-340. © 2014 Wiley Periodicals, Inc.

Humanism and Professionalism for Pediatric Hematology-Oncology Fellows (HP-PHO)

Abstract Humanistic physicians display attributes including integrity, excellence, compassion, altruism, respect, empathy, and commitment to service. Even though humanism and professionalism are ti...

Do pediatric hematology/oncology (PHO) fellows receive communication training?

The Accreditation Council for Graduate Medical Education (ACGME) has established communication as a core competency for physicians in training. However, data suggest that most pediatric residents perceive inadequate training in the delivery of bad news and the majority of former trainees in pediatric oncology received no formal training in the delivery of bad news during fellowship. The study examines communication training in ACGME accredited US pediatric hematology-oncology (PHO) fellowship programs. An online survey was distributed to 315 PHO fellows in training via the American Society of Pediatric Hematology/Oncology (ASPHO) fellow email registry. Each fellow received an initial request to participate and 2 reminders, while participation was encouraged through a random incentive drawing. One hundred and ten fellows (35%) responded. Eighty percent of respondents perceived communication training to be important to fellow education, however only 32% reported receiving communication training (other than direct observation). The most common reported teaching method of fellowship communication training was formal lecture (42%). Twenty-three percent of respondents reported neither communication training nor frequent feedback on their communication skills from faculty observation. This same group was the least satisfied with their programs' approach to teaching communication (P < 0.001). There is limited communication training in PHO fellowships despite ACGME requirements and fellows' interest in this training. Didactic learning remains the most frequently described training method, yet educational theory identifies the limitation of didactic lectures alone. Communication training employing novel teaching methods and emphasizing communication challenges identified by fellows should be developed and evaluated.

Leadership: “They Never Taught Me This in Medical School”

Pediatric hematologist/oncologists lead in a variety of roles and settings: at the bedside, in private or academic practice, in the laboratory, and in wider society. Whether their leadership is the result of innate ability, technical expertise, or educational experience, patients, colleagues, academic centers, and communities turn to physicians for leadership. But where do these physicians learn this complex skill? Physicians do acquire leadership skills, but mainly through interaction with role models and in a hit or miss fashion. This article provides a theoretical framework for medical leadership education and describes a leadership-focused educational seminar that has been offered to pediatric hematology-oncology fellows at Texas Children's Cancer Center since 1995. Retrospective pre/post evaluations by fellows indicated significant improvement in self-rated ability for all 24 dimensions assessed, including a variety of items drawn from the roster of the Accreditation Council for Graduate Medical Education Core Competencies. In this article we extend the concept of physician leadership from its roots in practice and present a comprehensive model that prepares pediatric hematologist/oncologists for leadership in clinical, research, and educational arenas.