Janice Firn, PhD, LMSW
Melissa Reimers, MD
Francis P. Worden, MD
A career in oncology can be extremely rewarding. Fast-paced advances in research and treatment, exciting changes in the practice environment, and the opportunity to build strong relationships with and provide critical support to patients can be incredibly professionally satisfying—but they can also be incredibly stressful.
“Caring for seriously ill patients and their families takes an emotional and physical toll on oncology fellows, and the health-care environment places a number of demands on clinicians,” said Janice Firn, PhD, LMSW, a clinical ethicist at the University of Michigan Medical School. “Without proper attention to well-being and self-care, oncology fellows are at risk for burnout, which has serious negative implications for providers and their patients.”
Research suggests that the majority of early-career physicians experience burnout before the completion of their residency or fellowship training1—but during that training, clinicians are rarely taught the importance of their own well-being or practical ways to maintain wellness.
“Our training, and ultimately our careers, are known to be associated with a high degree of burnout,” said Melissa Reimers, MD, a second-year hematology/oncology fellow at the University of Michigan. “This can result in not only a lower quality of life for us as providers, but more importantly, could potentially lead to suboptimal patient care. It’s important for us to understand the areas where we might be more at risk and learn appropriate preventative skills, early on in our career trajectory.”
Combating Burnout by Increasing Resilience
Resilience—your ability to adapt to and bounce back from challenges and sources of stress in your life—is an individual factor that affects your risk of burnout. It’s not a trait you either do or don’t have, but one you can increase by learning and practicing specific resiliency skills.
“These skills provide self-awareness,” said Francis P. Worden, MD, Director of the Hematology/Oncology Fellowship Program at the University of Michigan. “They provide opportunities for better self-understanding and tools to deal with stress related to patient care, as well as stress related to the demands of the training process itself.”
ASCO’s Professional Development Committee has a continued interest in developing programs to help with improving overall physician wellness. The committee has partnered with a group of palliative care physicians to create and pilot a Resiliency Skills Training Program to address burnout in oncology and palliative care fellowship programs.
Our training, and ultimately our careers, are known to be associated with a high degree of burnout. It’s important for us to understand the areas where we might be more at risk and learn appropriate preventative skills, early on in our career trajectory.— Melissa Reimers, MD
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Last year, Dr. Firn facilitated a pilot of the training program for the first-year oncology and hematology fellows at the University of Michigan. While it’s important to acknowledge that burnout is impacted by both workplace factors and individual factors, she said, the main goal of the training is to empower individuals to address burnout without placing blame on anyone who may be experiencing symptoms.
The program takes place over eight training sessions, each focused on a specific resiliency skill, with “homework” assigned between sessions to help participants practice incorporating these skills into their daily lives.
Dr. Reimers was one of the fellows who participated in the pilot program at the University of Michigan and found it beneficial. “We learned to assess our own strengths and discussed the various challenges of the first year of fellowship. I’ve become more aware of how I process busy-ness and stress, which has helped me to know when I need to pause and take a step back,” she said.
Practicing Resilience
Want to work on developing your own resiliency skills? Try starting with one of the skills below, and work on incorporating it throughout your day. When that becomes a habit, incorporate another skill. Committing to developing these skills now will help you prepare for and effectively deal with stress throughout your career.
Track your activation. Take some time at the end of each day to identify situations in which you felt positive and situations in which you felt negative. What caused those feelings? How did you react? These reflections can help you find patterns in what makes you feel stressed and how you respond. Once you spot those patterns, you can develop a plan to manage stressful situations more constructively in the future.
Reframe cognitive distortions. It is normal for everyone—including oncology professionals—to have negative thoughts sometimes. But when those thoughts become exaggerated they can lead to cognitive distortions that send you into a downward spiral. Cognitive distortions typically have an “all or nothing” quality—always needing to be right, overgeneralizing, catastrophizing, or seeing things in black and white, for example. Practice recognizing and reframing these distortions when you have them. Try one of the following strategies:
- Evaluate the negative thought objectively: Is there any evidence to support this idea? What evidence doesn’t support it?
- Think about what a friend would say to you if you told them about this situation, or what you would say to a friend if they were in your shoes. Show yourself the same compassion that you would show to others.
- Instead of placing all of the blame on yourself, acknowledge other factors that likely contributed to the stressful situation.
Practice mindfulness. Mindfulness brings you into a state of internal observation and awareness and being present in the moment. It can help you identify your feelings, making it easier to find patterns in the events and thoughts that preceded them. You can practice mindfulness while you’re sitting and waiting for a meeting to start or while walking in the hall between patients, or you can set aside time for meditation. Find some tips for getting started with mindfulness and meditation at connection.asco.org/physician-wellness.
Set healthy boundaries. For oncologists, work life and home life can often compete for your time and attention, and you can be forced to make a choice between the two in high-stress situations. Setting flexible and realistic boundaries and expectations in advance can help you stick to a plan when those situations arise.
Find meaning daily. A career in oncology can be incredibly meaningful and satisfying—and it’s surprisingly easy to take that for granted when you’re feeling burned out. Remember that meaning isn’t only found in big, dramatic moments, like saving a life. Recognize and appreciate the smaller moments of meaning in your work, such as offering guidance to a patient on a difficult decision, providing comfort to someone who is sad or afraid, or easing a patient’s pain and managing symptoms. Take time to reflect on the meaningful experiences and interactions you have each day, and reconnect with why you chose to become an oncologist. This can help you deal with stress by providing insight, inspiration, and motivation.
Resilience isn’t just another “to do” to add to your long list of tasks—developing resiliency skills is an ongoing process that takes practice, but it will serve you throughout your life and career.
“I want the best for my fellows,” said Dr. Worden. “To ensure that they have successful careers, we need to make sure that they learn how to take care of themselves both physically and emotionally during their training so this can become an integral part of their lives.”■
REFERENCE
1. Shanafelt T, Dyrbye L: J Clin Oncol 30:1235-1241, 2012.
Originally published in ASCO Connection. © American Society of Clinical Oncology. “Resilience While Caring for Seriously Ill Patients: Skills and Strategies to Prevent Burnout.” ASCO Connection, March 2018. All rights reserved.
