Corresponding about Death: Analyzing Letters Exchanged between Patients with Cancer and Medical Students.

Medical students lack opportunities to have authentic conversations with patients with cancer in busy hospitals. An improved understanding of what such communication might look like may provide a framework for end-of-life curricula. The authors performed thematic analysis using written correspondence between patient and student participants in the University of California, San Francisco's Firefly Program whose letters discussed death or dying. Four themes emerged: (1) turmoil, (2) grief, (3) making peace, and (4) past, present, and future. Medical students expressed a fifth theme: unmet student expectations. The study provides educators with a unique perspective to help inform curriculum development and patient care.

Well-Being Intervention in General Surgery: Multicenter Study of Program Director and Resident Perspectives.

BACKGROUND: Physician well-being is critical for optimal care, but rates of psychological distress among surgical trainees are rising. Although numerous efforts have been made, the perceived efficacy of well-being interventions is not well understood. STUDY DESIGN: This qualitative thematic study included online questionnaires to Program Directors (PDs) and residents at 16 ACGME-accredited General Surgery residency programs. PDs reported active well-being interventions for surgical residents or those under consideration at their institutions. Residents shared perspectives of available well-being interventions through open-ended responses. Conventional content analysis was used to analyze responses. RESULTS: Fifteen PDs, or their proxies (94% response rate), responded. Responses revealed that a majority of available well-being interventions are focused on changing the individual experience rather than the underlying workplace. PD decision-making around well-being interventions is often not based on objective data. Three hundred residents (34% response rate) responded. Of available interventions, those that increase control (eg advanced and flexible scheduling), increase support (eg mentorship), and decrease demand (eg work hour limits) were consistently identified as beneficial, but interventions perceived to increase demand (eg held during unprotected time) were consistently identified as not beneficial. Group social activities, cognitive skills training, and well-being committees were variably seen as beneficial (increasing support) or not (increasing demand). CONCLUSIONS: Our findings underscore the prevalence of individual-based well-being interventions and the paucity of system-level changes. This may explain, in part, the persistence of distress among residents despite abundant effort, highlighting the imperative for system-level transformation.