Development of a United States Radiation Oncology Curricular Framework: A Stakeholder Delphi Consensus

Abstract

<h3>Purpose/Objective(s)</h3> A United States (US) radiation oncology (RO) curriculum, developed by key stakeholders using best practices for curriculum inquiry, is needed to guide residency education and qualifying examinations. Competency-based training, including entrustable professional activities (EPAs), provides an outcomes-based approach to modern graduate medical education. This study developed the first list of US RO EPAs and curricular content domains (CDs) to guide resident training and assessment in the modern era. <h3>Materials/Methods</h3> The Radiation Oncology Education Collaborative Study Group (ROECSG) Core Curriculum Project Leadership Committee (LC) developed initial EPAs and CDs. Following recruitment of stakeholders, a Delphi process was used for consensus. In the first Delphi, EPAs and CDs were reviewed for inclusion/exclusion, clarity, level of training (EPAs only), and time allocation (CDs only). Participants submitted additional EPAs/CDs for consideration. Any EPA or CD one standard deviation below the median underwent LC review. All participants completing the first Delphi were invited to the second. New EPAs or EPAs undergoing major revisions were re-reviewed. Percent allocated curriculum time was finalized for CDs and for a single subdomain (SD). <h3>Results</h3> 186 participants representing diverse RO stakeholder groups volunteered to participate. 114 completed the first Delphi (61.3%): 6/9 CDs met consensus, 1 CD was removed, 2 CDs were combined (Table 1). Of 114 invited, 77 participants completed the second Delphi (67.5%). Of 55 initial EPAs, 52 final EPAs met consensus. 4 SDs of a single CD (Applied Sciences) were reviewed and met consensus. Consensus on percent time allocated per CD and SD was reached (Table 1). <h3>Conclusion</h3> Deliberative curriculum inquiry was successfully used to develop a consensus on US RO CDs/SDs and EPAs. These data can guide educational time in training programs and help inform weighting for qualifying examinations. CDs are not exclusive; educators must ensure all CDs are considered when delivering curriculum content, regardless of the primary CD. RO-specific EPAs can guide clinical training and resident assessment. The Delphi should be used to reach consensus recommendations for SD content breakdown. Given the evolving nature of RO and the need for curriculum renewal, the Delphi process will be repeated on an interval basis.