Debriefing initiative on the oncology firm.

Abstract

e21001 Background: Medical oncology is a core internal medicine residency rotation at Yale New Haven Hospital (YNHH). In addition to providing medically complex care, residents support patients facing significant psychosocial distress, challenging palliative needs, and end-of-life care. Furthermore, research suggests that trainees rotating on an inpatient hematology-oncology ward rotation may have subsequent decreased interest in the field, while increased empathy and resilience may be associated with maintaining or improving interest in medical oncology (McFarland et al. 2015). Thus, we implemented formal debriefing sessions for residents on the oncology rotation with the goal of decreasing emotional burden and improving trainee satisfaction. Methods: Formal IRB approval was obtained. A reflection and debriefing session was designed and scheduled for the end of each oncology rotation. Sessions were led by a senior resident, oncology fellow, or medical oncology attending leader. Participants (residents on the oncology service at YNHH) filled out pre- and post-surveys that posed questions in the form of Likert scales that assessed resident perception of burnout, current support, value of debriefing, and comfort in conducting debriefing. The pre- and post-surveys were compared using Fisher-Freeman-Halton exact test (alpha = 0.05) to look for differences in responses between pre- and post-intervention. Results: 60% of residents surveyed (N=20) stated that work left them emotionally drained. While 90-95% of residents answered that debriefing is essential for team member well-being, when residents were asked about their personal experience, on average only 33% of critical incidents were followed by a debriefing session. Post-intervention, participants who denied “feeling alone in processing emotionally challenging patient care experiences” rose from 30% to 55%. Those who answered “strongly agree” or “agree” to the question of feeling confident in initiating a debriefing session rose from 70% to 90% post intervention, while confidence in leading a debriefing session rose from 60% to 80%. 85% of residents felt like the debriefing session helped them process recent difficult patient care experiences. Conclusions: While no significant differences in pre- and post-surveys were found, likely partly due to sample size, the data above suggests that residents experience significant emotional challenges during their oncology rotation while also experiencing a gap in current support following critical incidents. Meanwhile, debriefing sessions were shown to be well-received overall and emotionally supportive for residents. Finally, residents increased in comfort in using debriefing skills in the future, making this intervention a solid investment in future well-being at work. We are hopeful that the continuation of the project will result in more conclusive data in support of this initiative.