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The Impact of a Physician Awareness Group and the First Year of Training on Hematology-Oncology Fellows

Mikkael A. Sekeres, Miriam Chernoff, Thomas J. Lynch, Jr, Eydie I. Kasendorf, Daniel H. Lasser, Donna B. Greenberg

From the Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH; the Harvard Program in Refugee Trauma, Massachusetts General Hospital; the Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; Clark University; and the Department of Family Medicine, University of Massachusetts, Worcester, MA.

Address reprint requests to Mikkael A. Sekeres, MD, MS, Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Desk R35, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: sekerem{at}ccf.org.

Purpose: To assess the impact of a Balint-like physician awareness group on hematology-oncology fellows’ attitudes and measure changes in attitudes during the first fellowship year.

Patients and Methods: We used a modified crossover design in which one half of a fellowship class at a time was exposed to the group intervention over a 2-year period (2000 to 2002). Two 14-fellow classes were followed for 1 year each and were given three "attitudes" questionnaires, at the beginning, middle, and end of the academic year.

Results: Forty Balint group sessions were held during the 2-year study period; 82 questionnaires of the 84 administered (98%) were recovered. Instrument content and criterion validity were demonstrated, as was topic domain reliability. Overall, mean attitude scores increased following the group intervention, from 3.6 (95% CI, 3.5 to 3.7) to 3.7 (95% CI, 3.6 to 3.8; P = .09). Within domains, scores increased in a "fellow’s views of him/herself as a physician," from 3.8 (95% CI, 3.6 to 3.9) to 4.1 (95% CI, 3.9 to 4.2; P = .008) and "comfort dealing with emotional patient/clinical situations," from 3.5 (95% CI, 3.3 to 3.7) to 3.7 (95% CI, 3.6 to 3.9; P = .11). Changes in responses to individual questions included: an increase in fellows’ comfort with the technical aspects of being an oncologist (P < .03); an increase in fellows’ comfort with discussing the stress of home at work (P < .023); and an increase among fellows in feeling pressed for time to discuss psychosocial issues with patients (P = .035).

Conclusion: A physician awareness group was feasible and enhanced fellows’ development as physicians. Further research is needed to determine how to incorporate such groups into oncology fellowships.

This work was supported in part by a grant from the Kenneth B. Schwartz Foundation.

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