Unveiling the Key Priorities of Future Diverse Palliative Care Workforces

Recent research has found that career growth, organizational culture and impactful work are significant priorities among the next generation of palliative care clinicians, particularly those from underserved populations.

Medical students indicated that these three key areas are “crucial” to their well-being and mental health in a recent study published in the Journal of the American Medical Association (JAMA) Network. Researchers from the American Association of Colleges of Osteopathic Medicine (AACOM) and Motivate Lab examined medical students’ perceptions about their most significant priorities in a learning environment.

A large aim was to learn more about what future clinicians will need to grow in their medical professions, particularly those from historically marginalized communities, according to Mark Speicher, senior vice president of research, learning and innovation at AACOM.

“What we were hoping to find in this project is whether relationships between mindset and well-being were true for all [medical] students,” Speicher told Palliative Care News. “We found that it was particularly true for historically underrepresented students in medical school.”

Understanding clinicians’ driving forces

The study found that three leaning mindsets are important to medical students’ well-being and mental health:

• Growth mindset: Having effective strategies to grow their careers, including collaboration with peers or a mentoring and precepting onboarding program. 
• Purpose and relevance: Finding value and meaningful purpose in their work.
• Sense of belonging: Feeling connected, supported and respected in their work.

Having a better understanding of medical students’ learning mindsets could help future employers better understand the sustainable strategies to implement in their recruitment and retention efforts, according to Yoi Tibbets, assistant professor at the University of Virginia and research director of Motivate Lab.

“Focusing on ‘GPS,’ or growth mindset, relevance and a sense of belonging, helps students create a work environment that supports their well-being,” Tibbets told Palliative Care News. “That’s really important [for] a new palliative care physician finding themselves in a new workplace and learning environment. There’s a lot of ways that a workplace can support that GPS and have a strong relationship between mindset and well-being. Fewer maladaptive psychological symptoms are associated with lower levels of burnout.”

The benefits of this three-pronged approach were most notable in medical students who identified as American Indian or Alaska Native, Black, Latino and Native Hawaiian, the research found. Compared to others, medical students of color more frequently reported that a sense of belonging, purpose and growth were important pieces of feeling supported in their work and curbing burnout.

Data like these can help palliative care providers develop more effective and equitable hiring practices, according to Tibbets. Medical students reported a stronger sense of resiliency and connection to their work, representing two sticking points in retention, Tibbets indicated.

“These mindsets seem particularly beneficial for students from historically underserved backgrounds as we think about how we diversify the position pipeline and create better outcomes for these students,” Tibbets said. “This [research] gives us a lever to think about in the future of how we can support these students going forward in their careers. When we support students in these ways, it manifests with greater downstream outcomes.”

Feelings of exacerbation, frustration and anxiety can mount early on in a medical student’s educational experience and impact their career outlook, according to Dr. Maxwell Vergo, director of hospice and palliative medicine education at Dartmouth Hitchcock Medical Center and Clinics. Vergo is also an associate dean at Dartmouth’s Geisel School of Medicine.

Students can find learning environments to be competitive and stressful, often seeking a workplace that isn’t, Vergo told Palliative Care News.

Organizational culture and peer-supported training are significant retention pieces for new palliative care clinicians entering the workforce, he said. Intentionally building relationships with others in their profession helps with clinical satisfaction and long-term support. This is especially important when considering the interdisciplinary approach in palliative delivery alongside goal concordant care, he added.

“Perspective-taking is a really important skill set in hospice and palliative medicine in the sustainability and sense of well-being,” Vergo said. “Palliative is about trying to take on someone’s perspective and put aside your own to honor someone’s truth. We have fellows do a lot of narrative medicine sessions to look at all the pieces of a facilitated discussion. It’s trying to understand why someone might say something and how to respond in a compassionate way. Having perspective-taking helps build better mental health capacity.”

Supportive pathways for diversifying palliative workforces

A key to training a more inclusive palliative care workforce is having greater diversity among both medical students and educators, according to Vergo.

Underserved communities often face several barriers in terms of equitable access to medical education opportunities, he indicated.

“It’s having opportunities and pipelines to medical schools despite maybe not having the same advantages based on race or ethnicity,” Vergo said. “There’s a lot of social dynamics that get in the way of having diversity and inclusion in our clinical palliative care workforce. While medical school is full of diverse students, hospice and palliative care is not tremendously diverse, and that can make it very hard to recruit different types of people.”

Sustaining clinical teams takes an in-depth understanding of what drew them to the palliative care space and the resources they need to support their own well-being while caring for seriously ill patients, according to Tiffany Hughes, COO and nurse practitioner at Texas-based PalliCare Inc.

Palliative clinicians care for patients and their families through some of the most difficult and challenging situations along their illness trajectories, Hughes stated. It’s important that employers recognize the daily stressors clinicians undergo, particularly those from diverse backgrounds who may experience higher levels of discrimination and adversity, she said.

“Nurse practitioners in palliative care come from very different backgrounds and different mindsets,” Hughes told Palliative Care News. “You see burnout when clinicians don’t have that connection with the patients or that sense of purpose and value that you are actually contributing and moving the needle on patient care. You don’t want them to feel micromanaged, you want them to feel supported. That’s good for the culture and a sense of purpose and career direction to spread their wings.”

Having a clinical workforce from diverse backgrounds and different professional experiences and interests is a large part of shaping an inclusive and encouraging organizational culture, PalliCare CEO Jonathan Fluhart said. Clinical teams work best when they engage with other interdisciplinary professionals with varying perspectives as they navigate patient care, Fluhart stated.

Employers who pour resources into understanding their clinicians’ priorities will reap the benefits in terms of retention, he indicated. Organizations that promote collaboration and peer-support have a firmer grasp on the challenges among clinical staff and strategies to address them. Building this rapport and reputation with clinicians goes a long way in recruiting a more diverse base of new hires, Fluhart said.

“One of the biggest reasons we’ve been successful in the team we’ve built is having this concept of community services in an unbiased program where we work with everyone,” he said. “It’s the whole team that gets the most out of that model and sees personal fulfillment. There’s no blueprint for this. Something that’s important is understanding they have a passion for this, it’s not just a position. It’s measuring ourselves by how well we help and listen to our people giving us input.”