Improving Well-Being and Combating Burnout in Radiation Oncology Training

Crises in public health and social unrest have heightened the need to support trainee well-being. External factors coupled with oncology-specific factors, such as regularly facing mortality, balancing palliation with toxicity, the rapid pace of treatment advances, and engaging in emotionally charged conversations with patients, can lead to burnout.¹ Burnout is characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment; it affects physicians and physicians-in-training at greater rates than the general population.² Emotional exhaustion, depersonalization, and burnout affected 28%, 17%, and 33% of radiation oncology residents, respectively, in the United States in 2016.³ Consequences may include inadequate patient care, professional ineffectiveness, and physician harm, including substance abuse, clinical depression, and suicidality.⁴

Building community is important for increasing professional fulfillment, while decreasing burnout. A recent study described the implementation of a well-being curriculum for residents within a radiation oncology department, which allowed residents to openly discuss topics that cause distress in a supportive environment.⁵ This intervention led to a decrease in burnout among residents.

Strong relationships among colleagues are essential to identify residents at risk for burnout or depression. Mayo Clinic has proposed 5 steps to recognize and support learners in distress:⁶

• Be on the lookout: Burnout and depressive symptoms are prevalent among medical students and residents. Keep your eyes open for signs of mental distress in colleagues.
• Recognize the signs: Watch for changes in hygiene and behavior, including mood swings, sadness, irritability, and social isolation.
• Trust your gut: Follow your intuition when concerned about someone. If you think something may be troubling them, do not hesitate to ask.
• Ask questions: Assume you are the only one who will reach out. Be direct with colleagues when red flag behaviors are present. Asking them about their emotional health is the most helpful thing you can do.
• React to the answer: Provide support to your colleague. Do not minimize their problems or feelings. Take on the role of encourager, not a clinical role of assessment, diagnosis, and referral.
• With the changing state of radiation oncology and the challenges of the COVID-19 pandemic, residents are now more vulnerable than ever to burnout and stress. Establishing well-being programming and identifying learners in need are crucial steps to improve overall professional fulfillment and education.

References

1. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30(11):1235-1241. doi:10.1200/JCO.2011.39.7380
2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-13785. doi:10.1001/archinternmed.2012.3199
3. Ramey SJ, Ahmed AA, Takita C, Wilson LD, Thomas CR, Jr., Yechieli R. Burnout evaluation of radiation residents nationwide: results of a survey of United States residents. Int J Radiat Oncol Biol Phys. 2017;99(3):530-538. doi:10.1016/j.ijrobp.2017.06.014
4. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388(10057):2272-2281. doi:10.1016/S0140-6736(16)31279-X
5. Gergelis KR, Anand US, Rian JS, et al. Integrating a grassroots well-being curriculum into a radiation oncology residency program. Adv Radiat Oncol. 2022;7(1):100837. doi:10.1016/j.adro.2021.100837
6. Wolanskyj-Spinner A, Rackley S. Take 5 takeaways: how to support a learner in distress. Identifying and acting on signs of struggle. Mayo Clinic. 2019.