Finding the sweet spot: Developing, implementing and evaluating a burn out and compassion fatigue intervention for third year medical trainees.

Medical trainees are at high risk for developing burnout. Introducing trainees to the risks of burnout and supporting identification and proactive responses to their 'warning' signs of compassion fatigue (CF) is critical in building resiliency. The authors developed and evaluated a burnout and CF program for third year trainees at a Canadian Medical School. Of 165 medical trainees who participated in the burnout and CF program, 59 (36%) provided evaluation and feedback of the program and its impact throughout their year. Participation included self-utilization of a validated CF and burnout tool (ProQOL) across three time-points, workshop feedback, and focus group participation. Results highlighted the importance of 1) Recognizing Individual Signs & Symptoms of Stress, CF and Burnout; 2) Normalizing Stress, CF and Burnout for Students and Physicians; 3) Learning to Manage One's Own Stress. A decrease in compassion satisfaction and increase in burnout between beginning and end of third year were found. Further outcomes highlighted the importance of learning, living and surviving CF and burnout in clerkship. Emergent theory reveals the important responsibility educators have to integrate CF and burnout programs into 'the sweet spot' that third year offers, as trainees shift from theoretical to experiential practice as future clinicians.

Development and Validation of a Set of Palliative Medicine Entrustable Professional Activities: Findings from a Mixed Methods Study.

BACKGROUND: Entrustable professional activities (EPAs) are routine tasks considered essential to a professional practice. An EPA can serve as a performance-based outcome that a clinical supervisor would progressively entrust a learner to perform. OBJECTIVE: Our aim was to identify, develop, and validate a set of EPAs for the palliative medicine discipline. METHODS: The design was a sequential qualitative and quantitative mixed methods study. A working group was convened to develop a set of EPAs. Focus groups and surveys were used for validation purposes. Palliative medicine educators and content experts from across Canada participated in both the working group as well as the focus groups. Attendees of the 2014 Canadian Society of Palliative Care Physicians (CSPCP) annual conference completed surveys. A questionnaire was used to collect survey participant sociodemographic, clinical, and academic information along with ratings of the importance of the EPAs individually and collectively. Cronbach's alpha examined internal consistency of the set of EPAs. RESULTS: Focus group participants strongly endorsed the 12 EPAs. Virtually all survey participants rated the individual EPAs as being "fairly/very important" (range 94% to 100%). Of the participants, 97% agreed that residents able to perform the set of EPAs would be practicing palliative medicine and 87% indicated strong agreement that this collective set of EPAs captures activities that all palliative medicine physicians must be able to perform. A Cronbach's alpha of 0.841 confirmed good internal consistency. CONCLUSIONS: Near uniform agreement from a national group of palliative medicine physicians provides strong validation for the set of 12 EPAs.

Oncology residents' perspectives on communication skills and shared decision making.

Shared decision making (SDM) and effective communication are essential components of cancer care. Residents in oncology-related specialties were surveyed about communication skills and SDM. The response rate was 77% (17/22), and 93% stated that communication skills were very important for their specialty. Most (76%) thought their communication skills were adequate, but areas of difficulty included discussing end-of-life issues, giving hope when the prognosis was bleak and dealing with hostile patients. Only 58% of respondents had heard the term SDM, and 29% were aware of its meaning. More SDM and communication training are required for future oncology physicians.

Analysis of cigarette smoking habits of cancer patients referred to the Northeastern Ontario Regional Cancer Centre.

PURPOSE: To review cigarette smoking among patients referred to the Northeastern Ontario Regional Cancer Centre (NEORCC). METHODS: Database analysis of the smoking history information for patients referred to the NEORCC from 1991-1999 was performed. RESULTS: Data was available for 15,850 patients and 72.7% reported being either current or previous smokers. Approximately 24.5% of patients were still smoking and 7.8% had quit within the last year. Smoking rates and total consumption were highest among those patients with cancers arising in the lung, bladder, esophagus and head & neck regions. The percentage of patients reporting a history of smoking remained consistently high over the time period studied. CONCLUSIONS: Cigarette smoking rates are high among NEORCC patients and strategies to improve the situation are required.