Artful oncology: A comprehensive psychosocial oncology curriculum for hematology/oncology fellows.
Authors: Jafar Al-Mondhiry, Kimberly Lowery Walker, Jennifer Bires, Leigh Ann Caulkins, Cheryl Hughes, Denise Mohess, Raymond Couric Wadlow
Journal: Journal of Clinical Oncology (2024)

9008 Background: Of patients with cancer, 46% experience significant psychosocial distress, a factor linked to higher morbidity, mortality and costs of care. Oncologists themselves face psychosocial distress, particularly during their fellowship training, with as many as 38% of hematology/oncology (H/O) fellows reporting burnout during training. The ACGME recognizes this risk and has recently included well-being skills in their professional milestones, in addition to milestones for assessing psychosocial issues and communication skills for addressing these complex patient needs, which are often a source of distress among clinicians. Very few published curricula are available to address these layered learning needs among H/O fellows. Methods: “Artful Oncology” is a multifaceted curriculum for H/O fellows focusing on four pillars: 1) monthly didactic lectures about psychosocial issues within cancer care; 2) bimonthly narrative medicine seminars reflecting on didactic themes; 3) quarterly communication skills training conducted with standardized patients; and 4) monthly cancer survivorship support group facilitation. This curriculum was instituted with the inaugural class of H/O fellows at Inova Schar Cancer Institute in 2021 (total 6 fellows to date) with iterative improvements. Outcomes were measured through self-assessed communication skills, scored feedback for each didactic, annual Physician Belief Scale (PBS) surveys, quarterly Professional Quality of Life (ProQOL)-Health and abbreviated Maslach Burnout Inventory (MBI) surveys. Results: Fellows rated didactics as being relevant to their work, prepared to implement the skills learned into clinical practice, and would recommend these sessions to others (average 4.58, 4.59, and 4.67 out of 5-point Likert scale). Among 19 evaluated didactic topics evaluated to date, the most highly rated sessions included Oncology Psychiatry, Integrative Approaches to Symptom Management, Hospice Behind the Scenes, and Moral Injury/Moral Distress (average 5.0); lowest rated included Mindfulness, Sexual Health, Recognizing Depression, Grief, and Adolescents/Young Adults (average 4.29). PBS scores numerically improved from 2022 to 2023 (78 to 68.8 out of 160, lower being associated with a more psychosocial approach to patient care). MBI and ProQOL Health scores were largely unchanged (&lt;2 point difference on average). Self-assessed communication skills averaged across rising fellows increased from 4.38 to 7.44 out of 10 between 2022 and 2023. Conclusions: The Artful Oncology curriculum numerically improved self-assessed communication skills and attitudes regarding the physician role within psychosocial aspects of patient care. Didactic sessions were rated as highly relevant, actionable, and recommended by H/O fellows. Study of this curriculum over a longer timeframe with larger numbers of fellows is ongoing to better evaluate effects.