title: Challenges faced by pediatric oncology fellows when patients die during their training.
abstract: OBJECTIVE
  Given the paucity of research on the experience of pediatric oncology fellows regarding patient death, the purpose of this study was to explore the specific challenges that pediatric oncology fellows face when patients die during their training.
  
  
  METHODS
  Six pediatric oncology fellows at two academic cancer centers in Ontario, Canada, were interviewed about their experiences with patient death during their fellowship training. The grounded theory method of data collection and data analysis was used. Line-by-line coding was used to establish themes, and constant comparison was used to establish relationships among emerging codes and themes.
  
  
  RESULTS
  Fellows reported structural challenges that included ward duty and lack of follow-up opportunities with bereaved families. Personal challenges included feelings of vulnerability as a result of being a trainee, inexperience with patient death, and feeling alone with one's reactions to patient death. Relational challenges included duration of relationships with families and with supervising staff and perceived lack of modeling on how to cope with patient deaths.
  
  
  CONCLUSIONS
  Structural changes to the fellowship model can be made in order to enhance support with patient death, including informing fellows of all patient deaths and incorporating fellows into follow-up practices with bereaved families. Moreover, integrating fellows' debriefing (facilitated by grief counselors) after a patient death into fellow training, as well as greater involvement with palliative care physicians, can lessen feelings of isolation and help fellows learn effective strategies for dealing with patient deaths from experienced palliative care physicians.
authors.affiliation: Ben-Gurion University of the Negev, Beer Sheva, Israel; SickKids Hospital, University of Toronto; Dalla Lana School of Public Health, University of Toronto, Toronto; McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada; and Children's Hospital Cantonal Hospital, Lucerne, Switzerland Leeatg@gmail.com.
authors.forename: Leeat
authors.initials: L
authors.lastname: Granek
authors.affiliation: Ben-Gurion University of the Negev, Beer Sheva, Israel; SickKids Hospital, University of Toronto; Dalla Lana School of Public Health, University of Toronto, Toronto; McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada; and Children's Hospital Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Ute
authors.initials: U
authors.lastname: Bartels
authors.affiliation: Ben-Gurion University of the Negev, Beer Sheva, Israel; SickKids Hospital, University of Toronto; Dalla Lana School of Public Health, University of Toronto, Toronto; McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada; and Children's Hospital Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Maru
authors.initials: M
authors.lastname: Barrera
authors.affiliation: Ben-Gurion University of the Negev, Beer Sheva, Israel; SickKids Hospital, University of Toronto; Dalla Lana School of Public Health, University of Toronto, Toronto; McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada; and Children's Hospital Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Katrin
authors.initials: K
authors.lastname: Scheinemann
mesh_terms: D000328:Adult; D001293:Attitude to Death; D002173:Cancer Care Facilities; D005257:Fellowships and Scholarships; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000193:education*; D009864:Ontario; D010372:Pediatrics / Q000193:education*; D010820:Physicians / Q000523:psychology