2332 - Introducing Grief Education to Radiation Oncology Graduate Medical Education

Purpose/Objective(s): Serious illness can strain physician–patient interactions, as physicians contend with grief, discomfort, and feelings of inadequacy—a phenomenon described as the “second victim” in 1973. Over the past five decades, educational initiatives such as Grieving Rounds (GR) have emerged to address these challenges. Introduced in the early 2000s within critical care training, GR provide protected time for house staff to debrief clinical experiences in the medical intensive care unit (MICU) and the accompanying emotional responses. Prior studies have shown that GR commonly addresses family and medical team conflict, hope for miracles, and physician-physician conflict. Although these issues are highly relevant to radiation oncology (RO), no comparable program exists for RO residents at our institution. This study explores national models for grief education in RO training.

Materials/Methods: A scoping review of qualitative and quantitative studies was conducted using PubMed with the following search terms: (palliative AND radiation oncology AND education), (death rounds AND residents), and (oncology AND grief education). Of 1,167 total resultant studies, 38 addressing grief education in physician trainees were included.

Results: Most resultant education studies (92/107, 86%) focused on oncology nursing and did not include physicians. Among the 15 papers that addressed existing grief education programs, half were implemented in oncology fellowships at large cancer centers and half were in critical care in internal medicine, pediatric, or neurology residencies. Several studies described behavioral, cognitive, physical, and emotional effects of patient deaths on oncologists, with one noting a culture of disengagement toward terminal patients modeled by senior physicians. Multiple studies (18/38, 47%) emphasized the need for improved end-of-life education across oncologic specialties, including evidence that RO program directors and residents value training in end-of-life communication. None described or evaluated a grief education program within RO residency training.

Conclusion: GR and similar programs offer internal medicine residents structured support to address moral injury related to critical illness and patient death. Comparable opportunities remain limited for RO trainees, despite demonstrated need and interest. Implementing grief-focused educational programs in RO may better support trainees and improve end-of-life oncologic care for both physicians and patients.