Novel Curriculum Aims to Address Burnout and Foster Wellness Among Fellows

Thejal Srikumar, MD, MPH

Professional burnout is a well-documented issue in oncologists who are established in their careers, but it is an understudied area of need for hematology/oncology fellows, according to Thejal Srikumar, MD, MPH. In response, Srikumar and her colleagues have created a wellness and professional development curriculum at Yale School of Medicine that they hope can foster multi-institutional collaborations to expand these services for fellows.

“The foundation of [this research] is that institutions need to foster an environment in which there is open communication and trust in psychological safety for their fellows because that is [necessary] before any other work can be done,” Srikumar said in an interview with Oncology Fellows. “We need to focus as a field on destigmatizing asking for help and understanding that the people who we look up to and our leaders in the field have all had their own journeys, and those journeys have ups and downs. It’s OK to talk about them and, most importantly, ask for help.”

During the 2024 American Society of Clinical Oncology Annual Meeting, Srikumar and her coauthors presented findings from an evaluation of the longitudinal curriculum. Findings showed that fellows were interested in further discussion of work-life balance, management of scholarly expectations, and professional boundary setting. Fellows were then invited to an off-site retreat designed to address their concerns, where senior and first-year fellows connected to discuss their career inspirations, motivations, and methods to prevent professional burnout.

In the interview, Srikumar, assistant program director of the Hematology/ Oncology Fellowship Program and assistant professor of medicine (medical oncology) at Yale School of Medicine in New Haven, Connecticut, outlined the unique curriculum, the responses to its implementation by fellows, and the future of its development.

Oncology Fellows: What is the current landscape of wellness offerings for hematology/oncology fellows?

Srikumar: [In order] to understand the landscape of [wellness] training, it’s important to step back and understand the scope of the problem. We know that burnout is rampant in medicine; studies show that there’s a rate of burnout as high as 60% in US oncologists. The Accreditation Council for Graduate Medical Education recognizes that this is a huge issue and recommends that its programs be able to address these [issues].

The major problem is that it’s not being done in a streamlined, systematic way and every institution is doing something different. A core part of the problem is that even though we know that burnout is a systemic-level issue it’s treated as an individual-level problem, [as if] it’s an individual’s weakness leading them to be burnt out.

There’s also a culture in medicine where we’re not talking about it when we’re struggling, we aren’t opening up about our tough times. Specifically, when it comes to trainees and fellows, who are even more vulnerable, oftentimes if they are struggling, they may feel like they’re not able to ask for help, and they’re worried about what the repercussions for those [struggles] might be. There’s a lot of work that needs to be done, not only in the training but also in the culture of medicine in general.

What did this novel curriculum entail and how was it evaluated?

Our goal was to provide our fellows with tools to be able to navigate all these struggles, not only in fellowship, but in the years to come in their oncology careers. We focused on the concept of professional fulfillment, which is a sense of contentment, well-being, and satisfaction at work, as well as the idea that you’re on track to achieve the goals that are most important to you.

We took this concept of professional fulfillment, and we wanted to create sessions that were reflective of what the fellows wanted to do, learn, and talk about. We [conducted] a 2-part needs assessment and in-person brainstorming session, which was just a free-flowing conversation to generate topics and ideas. We also [performed] an anonymous survey to understand [fellows’] pain points.

We took that information and designed our curriculum based on it. The curriculum had 2 parts. The first part was a fellows’ retreat, a protected day for our senior fellows, and then a separate protected day for our first-year fellows. We had multiple sessions, [such as discussing] the boundaries that we choose and envisioning the future, in which fellows created vision boards about what was most important to them to hold on to moving forward into the future, [as well as] communication skills.

Separate from our retreats, we had 4 didactic sessions throughout the year, based on the topics that the fellows were interested in. We spoke about grief and awe in medicine and honoring these in oncology, shame in medicine and how we address it, and conflict styles and how we approach others who might have different conflict styles than we do. We also had a session called Truth Rounds in which senior faculty members shared the trials and tribulations they’ve had during their careers and how they overcame them.

This entire curriculum ran throughout the year. We received [survey feedback] and ended with a focus group to get summative feedback. We also obtained some corollary measures throughout. We used the Mini Z Resident survey [to assess] learning environment, a general efficacy scale, and the Patient Health Questionaire-2 to assess depression.

What were the key findings from the evaluation of the longitudinal curriculum?

It was notable how well attended and how well received [the sessions] were. For example, 27 out of our 28 fellows attended the fellows’ retreat, and 95.4% indicated that they found it helpful. When we asked them what they thought was the most meaningful [component], they [highlighted] the ability to connect with their colleagues and share their successes and failures and to get some tools to mitigate burnout.

In the summative feedback [we received] at the end of the year from the focus group, we saw the 3 themes emerge that we thought were particularly important. The first was an appreciation for the empathic connection that fellows were able to have with each other, [as well with] the faculty members, regarding their shared lived experiences and feelings. The second was this feeling that there was a longitudinal applicability of the types of skills that we were talking about and that the tools we were giving them would go on beyond just fellowship to help them in their careers. The last one, which we heard repeatedly, was that there was an appreciation for this space to freely communicate and be vulnerable with each other.

What we hear from fellows year after year is that they want to talk about the same things. They want to be having these same sessions. When we ask what they want to change, we hear that there is a real need to be able to open up with each other in this way and talk about these challenging issues. It makes us feel like they can’t address these needs elsewhere in our standard [fellowship] curriculum in oncology; there aren’t spaces for them to be vulnerable elsewhere. There’s a desire to be able to connect in this way.

What are the next steps for this curriculum and other efforts in this area?

We hope to have multi-institutional collaborations on this type of work. Our next direct step is being able to publish these materials and course guides for other institutions to implement, [and] then we can test their efficacy in different environments. Ultimately, our goal is to come together as a field to prioritize this work and determine a way for us to serve our fellows in the best way that we can and give them the skills and tools that they need to be successful and fulfilled in what they do.

What that looks like for us at our institution is continuing this work year to year and going in with an open mind at the beginning of the year to repeat that needs assessment. Even if it is the same things [our fellows] are telling us [they want], we want to make sure that we are truly listening to them and giving them what they want to hear. This is an area that is being actively developed and is in huge need. We know that burnout is a big issue, and the [current] studies are primarily [examining] physicians as a whole, or certain pockets of physicians. There are not that much [data] focusing on fellows.

There is a lot that needs to be done within this population, but we know from the studies of physicians in general that other strategies might work, such as coaching, whether it’s one-on-one or small group coaching. Studies show that virtual coaching across institutions can be helpful.

Another realm in which publications have shown benefit is in different types of communication skills training. That is not just communications with patients; it’s training that has been developed to help better communicate with your peers when you’re struggling and to focus on tools of mindfulness [such as] appreciative inquiry. There is a lot [of information] out there, but it is still something that is under development.

Reference

Srikumar T, Stempel JM, Goldberg SB, et al. Longitudinal curriculum to address wellness and professional development in a hematology/oncology fellowship program. J Clin Oncol. 2024;42(suppl16):9004. doi:10.1200/JCO.2024.42.16_suppl.9004