Cancer Topics - COVID-19’s Impact on Oncology Trainees

05/26/21 • 34 min

In this episode of the ASCO Education Podcast, moderator Dr. Annie Im speaks with fellows and training program directors about oncology training during the COVID-19 pandemic. Featuring Drs. Kathryn Bollin (director), Farah Nasraty (fellow), Jonathan Berry (fellow), Nino Balanchivadze (fellow), and Nishin Bhadkamkar (director). Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us

Air Date: 5/26/2021

TRANSCRIPT

[MUSIC PLAYING]

SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

ANNIE IM: Hello, and welcome to ASCO's podcast episode focused on the impact of the COVID-19 pandemic on oncology fellows and training programs. My name is Dr. Annie Im. And I'm an associate professor of medicine and the Fellowship Program Director at the University of Pittsburgh. I am pleased to be joined by our five guest speakers today.

NINA BALANCHIVADZE: Hello my name is Nina Balanchivadze. I'm a second year fellow at Henry Ford Hospital in Detroit, Michigan.

JONATHAN BERRY: Hi, my name is Jonathan Berry. I'm a first year fellow at Beth Israel Deaconess in Boston, Massachusetts.

NISHIN BHADKAMKAR: Hi, I'm Nishin Bhadkamkar. I'm an associate professor in the departments of general oncology and gastrointestinal medical oncology. I'm at MD Anderson Cancer Center. And I'm the Program Director of the Hematology Oncology Fellowship Program.

KATHERINE BOLLIN: Hello, everyone. I'm Katherine Bollin. I'm the Associate Program Director for Hematology Oncology at Scripps MD Anderson Cancer Center in San Diego. And I'm also the Wellness Chair for the GME Division of Physician Wellness, and a medical oncologist specializing in cutaneous oncology.

FARAH NASRATY: Hi, Everyone. I'm Farah Nasraty. I'm a third year hematology oncology fellow at Scripps Clinic MD Anderson in San Diego, California.

ANNIE IM: Thank you. So let's get right into it. First, let me ask how are training programs adjusted at your institution during the COVID-19 pandemic? What was the impact on learning? What adjustments did your institution make? And what has worked well that you can share with the treating program community? Let's start with Dr. Bhadkamkar.

NISHIN BHADKAMKAR: When the pandemic hit us, we obviously had to rapidly make changes to our clinical and educational programs. I think the first change that came about was transitioning to telemedicine for many of our outpatient visits. And obviously this had an impact on outpatient rotations for our trainees. At the same time, we also changed all of our didactic programming to the virtual format. And this also had to be done fairly quickly to meet institutional requirements.

And what we found in making these changes was first and foremost on the clinical side that trainees on outpatient rotation definitely had a perception that their learning would be adversely impacted by having less in-person interactions. And so we really relied on our rotation coordinators to make sure that fellows were involved in the telemedicine platforms to talk about decision making, and to interact with the patients. Obviously, there's no way to completely recreate the interaction. But we wanted there to be the element of fellow talking to patient, than fellow talking to the attending, and then all three again coming together to talk about the treatment plan.

With regard to education, we certainly found that there was a social element that is important to learning that it was more difficult to recreate on a virtual platform. However, there were certainly advantages to the virtual setting in the sense that it allowed people to connect from different campuses. It allowed some people to participate who perhaps in a live setting would be less likely to speak up. And so using chat features and other elements, we found that there was a segment of our trainees who actually were participating more than they would have in our normal format. So clearly there were advantages and disadvantages. But I think overall it was a necessary change, and one that I think trainees in the end embraced and were able to make the most of.

NINA BALANCHIVA...

Air Date: 5/26/2021

TRANSCRIPT

[MUSIC PLAYING]

NINA BALANCHIVADZE: Hello my name is Nina Balanchivadze. I'm a second year fellow at Henry Ford Hospital in Detroit, Michigan.

JONATHAN BERRY: Hi, my name is Jonathan Berry. I'm a first year fellow at Beth Israel Deaconess in Boston, Massachusetts.

FARAH NASRATY: Hi, Everyone. I'm Farah Nasraty. I'm a third year hematology oncology fellow at Scripps Clinic MD Anderson in San Diego, California.

NINA BALANCHIVA...

Previous Episode

Cancer Topics - Can You Hear Me Now? Challenges and Benefits of Telemedicine

Can you hear me now? In this episode of the ASCO Education Podcast, host Rami Manochakian (Medical Oncologist, Mayo Clinic Florida) discusses Telemedicine with medical oncologists Ana Maria Lopez (Sidney Kimmel Cancer Center), Estelamari Rodriguez (University of Miami) and Douglas Flora (Executive Medical Director or Oncology at Saint Elizabeth Healthcare).

Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us

Air Date: 5/20/2021

TRANSCRIPT

[MUSIC PLAYING]

ANNOUNCER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

[MUSIC PLAYING]

RAMI MANOCHAKIAN: Hello, and welcome to the ASCO Education Podcast. Today, we will be discussing the challenges and benefits of telemedicine in oncology, something that has become especially important over the last year in the wake of COVID-19 pandemic. My name is Dr. Rami Manochakian. I'm a thoracic medical oncologist and a vice chair for education at the heme/onc division at the Mayo Clinic, Florida. As the host of today's podcast, I am very excited to be joined by our three distinguished guest speakers. And I'll let them introduce themselves.

ANA MARIA LOPEZ: Hi, my name is Dr. Ana Maria Lopez, and I'm a medical oncologist and an integrative oncologist. And I am professor and vice chair of medical oncology and chief of the New Jersey Division of Cancer Services at the Sydney Kimmel Cancer Center in Philadelphia, Pennsylvania.

RAMI MANOCHAKIAN: Welcome.

ESTELAMARI RODRIGUEZ: Hi, I'm Dr. Estelamari Rodriguez. I am an associate director of community outreach and co-lead of the Thoracic Sciences Group at the Sylvester Comprehensive Cancer Center at the University of Miami.

DOUG FLORA: Hi. I'm Doug Flora. I'm a treating medical oncologist. I'm also the executive medical director for oncology here at Saint Elizabeth Health Care just out of Cincinnati, Ohio.

RAMI MANOCHAKIAN: Great to have you all here. Without further ado, we'll go ahead and start with our first questions. We all agree, this has been a very, very hot topic lately. And it's probably, for quite some time, it's going to continue to be. When we talk about telemedicine, specifically in oncology, what are some of the main advantages of telemedicine and oncology for patients and for providers, respectively?

DOUG FLORA: So obviously, this year, we dealt with a lot being handed at us. And I'm glad that we're coming from three different sections of the country because I think our perspectives will be unique. I'm coming from a community aspect here. We have about four or five hospitals in our system. And I practice in a place that's partially Cincinnati-based, and partially some patients from deep and rural Appalachia. And so obviously, there's some access issues that I think we'll talk about a little bit later.

I will say, in our system, it was interesting. We've been trying desperately to get our doctors to embrace telehealth before coronavirus landed on our shores. And it was a struggle as you guys know, and I think we'll talk about. There were some reimbursement issues, and the way that we approached this as a system was not finding traction with the providers.

So we went from about 250 patients on virtual visits or telehealth visits the year prior to COVID, to almost 250,000 in our large physician group the year after. And so I wondered if you guys had a similar experience where you were sort of pushed off that burning platform and all of a sudden, had to adapt to technologies that were maybe used in regular world but not yet in medical world yet. So how are things in Miami, Dr. Rodriguez?

ESTELAMARI RODRIGUEZ: So at the beginning of the pandemic, as a system, we turned all our visits from in-person to, overnight, telemedicine. And we had a system where you could connect in our electronic medical record via Zoom. But our patients didn't have that system. So there was a large kind of growing pain in terms of getting the patients adapted to the technology. And still, a year later, patients have a tough time with the technology.

But I think one of the great advantages of telemedicine, and we have learned,...

Next Episode

Cancer Topics - Burned Out? Here's What You Can Do About It (Part 1)

In this episode of the ASCO Education Podcast, moderator Todd Pickard, MMSc, PA-C (MD Anderson Cancer Center) speaks with Drs. Daniel McFarland (Northwell Cancer Institute), Sayeh Lavasani (City of Hope), and Fay Hlubocky (University of Chicago) about individual and institutional interventions to prevent and address burnout among oncology professionals. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us

Air Date: 6/16/2021

SPEAKER 1: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

SPEAKER 2: This is the first of a two-part episode on burnout in oncology. Stay tuned for part two of this conversation launching June 30, 2021.

TODD PICKARD: Hello, and welcome to ASCO's podcast episode focused on burnout in oncology. The prevalence of burnout among oncologists and other health care providers that care for oncology patients has been increasing in recent years, bringing along serious implications for personal well-being and professional satisfaction. My name is Todd Pickard. I'm an oncology PA at the University of Texas MD Anderson Cancer Center.

I'm pleased to introduce our three guest speakers today. Dr. Fay Hlubocky is a clinical health psychologist and research ethicist at the University of Chicago Medicine. She's also co-chair of the ASCO Oncology Clinician Well-Being Task Force and has extensive research experience in burnout.

We're also joined by Dr. Daniel MacFarland, a medical oncologist and consult liaison psychiatrist specializing in head and neck thoracic malignancies and psycho-oncology at Northwell Health Lenox Hill Hospital. He has conducted research on empathy, resilience, and distress in trainees, and edited an upcoming Springer book publication entitled Depression, Burnout, and Suicide in Physicians.

And finally, we are also joined by Dr. Sayeh Lavasani, a medical oncologist specializing in breast cancer and an assistant clinical professor in the department of medical oncology and therapeutic research at City of Hope. Many oncologists around the world are struggling with burnout, but the topic is rarely openly discussed. We are excited to launch a discussion of causes and signs of burnout, as well as proven tools for the prevention of burnout that our listeners may apply in their own daily lives.

Welcome, all. I look forward to this interesting conversation today. Dr. Lavasani, can you tell us about your personal experience with burnout during your training and professional life? And then, how has the pandemic affected your experience of burnout?

SAYEH LAVASANI: Sure. First, I want to thank you for having me on this podcast. I noticed the symptoms of burnout when I was an internal medicine resident and had to do 30-hour shifts covering the ER, admissions, the internal medicine service, code blues in hospital, et cetera. It was a challenging time. I had a young child and [INAUDIBLE].

I would try to relax and meditate. And the peer support at that time was critical. All residents were very close to each other, which, I believe, can be the best strategy to overcome burnout during training. When I was going through my fellowship, things were definitely better and my calls were all home calls. And then I started to work as an attending.

Initially, I was under the impression that things would be easier, but I realized that my job is still very stressful but in different ways. I'm fully responsible for my patients and treatment decisions I make for them. Patients and their families are under tremendous amount of stress. We need to provide them with support and give them the strength to help them to go through treatment.

I felt multiple times that this is overwhelming for my health and well-being. I experienced burnout as a [INAUDIBLE] oncologist when I was in the process of moving to my current position, which required moving from East Coast to West Coast, moving and settling in there. Very stressful.

And then, this month actually marked the one-year anniversary of the start of the COVID-19 pandemic and the subsequent restrictions and lockdowns. It was an exhaustin...