Daniel C McFarland1, Robert G Maki1, Jimmie Holland2. 1. Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L Levy Place, Box 1079, New York, NY 10029, USA. 2. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
OBJECTIVE: Effectively managing patient distress in oncology is challenging. Trainees in oncology experience distress along with their patients and patients' families, especially during an inpatient admission. This study evaluated the physician-in-training experience while working on an inpatient hematology-oncology ward. METHODS: We collected a survey from internal medicine interns and residents at the end of a 2- or 4-week-long rotation on a hematology-oncology ward. It included the Impact of Events Scale-Revised (IES-R), a measure of distress, information about resident demography, rotation experiences with death, and personal circumstances that could affect distress levels. House officers were asked to provide comments regarding their most stressful experiences or how they were affected by dying patients. RESULTS: Fifty-six residents completed questionnaires (58 % overall response rate) and scored IES-R 18.7 (SD 14.2) indicating that the majority (80 %) experienced significant clinical distress (IES-R ≥8) and 20 % experienced posttraumatic stress disorder (PTSD) levels of distress (IES-R ≥33). Comment themes are highlighted and included general frustration and death-related events. Forty-one (73 %) reported that their IESR event was a death-related experience, and 39 (69.6 %) reported that attending to dying patients was the most stressful part of the rotation. Residents cared for 4.28 patients at the end of life on average during the rotation, and 68 % derived a sense of meaning from such work. CONCLUSIONS: This study suggests that physician-trainee distress is significantly elevated while working on a hematology-oncology ward and may relate to general frustration and death-related events. Further study should evaluate the etiology of medical trainee distress in oncology.
OBJECTIVE: Effectively managing patient distress in oncology is challenging. Trainees in oncology experience distress along with their patients and patients' families, especially during an inpatient admission. This study evaluated the physician-in-training experience while working on an inpatient hematology-oncology ward. METHODS: We collected a survey from internal medicine interns and residents at the end of a 2- or 4-week-long rotation on a hematology-oncology ward. It included the Impact of Events Scale-Revised (IES-R), a measure of distress, information about resident demography, rotation experiences with death, and personal circumstances that could affect distress levels. House officers were asked to provide comments regarding their most stressful experiences or how they were affected by dying patients. RESULTS: Fifty-six residents completed questionnaires (58 % overall response rate) and scored IES-R 18.7 (SD 14.2) indicating that the majority (80 %) experienced significant clinical distress (IES-R ≥8) and 20 % experienced posttraumatic stress disorder (PTSD) levels of distress (IES-R ≥33). Comment themes are highlighted and included general frustration and death-related events. Forty-one (73 %) reported that their IESR event was a death-related experience, and 39 (69.6 %) reported that attending to dying patients was the most stressful part of the rotation. Residents cared for 4.28 patients at the end of life on average during the rotation, and 68 % derived a sense of meaning from such work. CONCLUSIONS: This study suggests that physician-trainee distress is significantly elevated while working on a hematology-oncology ward and may relate to general frustration and death-related events. Further study should evaluate the etiology of medical trainee distress in oncology.
Entities:
Keywords:
Attributed meaning; Conservation of Resources; Coping reserve; Death; Distress; Hematology-oncology; IES-R (impact of events scale revised); Meaning; Medical education; Patient safety; Personal stress; Posttraumatic stress disorder; Professionalism; Resident medical education; Vicarious trauma
Authors: Christopher S Parshuram; Andre C K B Amaral; Niall D Ferguson; G Ross Baker; Edward E Etchells; Virginia Flintoft; John Granton; Lorelei Lingard; Haresh Kirpalani; Sangeeta Mehta; Harvey Moldofsky; Damon C Scales; Thomas E Stewart; Andrew R Willan; Jan O Friedrich Journal: CMAJ Date: 2015-02-09 Impact factor: 8.262
Authors: Celeste Alvaro; Renée F Lyons; Grace Warner; Stevan E Hobfoll; Patricia J Martens; Ronald Labonté; Richard E Brown Journal: Implement Sci Date: 2010-10-20 Impact factor: 7.327