Less Direct Patient Care Delivered by Medical Trainees by the End of a Hematology-Oncology Ward Rotation: association with empathy and related factors.

OBJECTIVE: The education of trainee physicians in hematology-oncology is challenged by inherent stressors of hematology-oncology. Clinical work load, death and dying, and the known phenomenon of empathy decline during clinical education affect trainees. Time spent with patients or Direct Patient Care Time (DPCT) is influenced by many factors, which ultimately affect medical education. Therefore, DPCT may decrease by the end training on a busy hematology-oncology ward rotation.

METHODS: Internal medicine interns and residents (n=64) rotating on a hematology-oncology ward rotation were consecutively selected to participate. Questionnaires containing Likert scale questions assessing time spent with patients before and after the rotation, empathy/resilience/distress measurements (Interpersonal Reactivity Index [IRI], Connors-Davidson Resilience Scale [CD-RISC], and Impact of Events Scale-Revised [IES-R], respectively), and demographic and situational information were collected at the beginning and end of the rotation RESULTS: DPCT decreased from over 10-15 minutes per patient to slightly over 1-5 minutes with over half of the trainees spending less than one minute per patient per day (p<.001, cohen's d=1.05). Empathy scores decreased 2.01 points from 58.9 to 56.8 (p=.018, cohen's d=0.33) during the rotation. DPCT decrease was associated mistreatment (p<.001) and lack of support (p=.001) while endorsing external issues (p=.002) and longer rotation time predicted for greater DPCT accounting for 67% of DPCT variance on multivariate analysis.

CONCLUSION: Medical trainees in oncology who feel a lack of social/familial support and feel mistreated by mentors/superiors spend significantly less time with patients. Educational initiatives should replicate and utilize these associations to enhance patient-centric care in oncology.