Abstract
BackgroundModern radiation oncology demands a thorough understanding of gross and cross-sectional anatomy for diagnostic and therapeutic applications. Complex anatomic sites present challenges for learners and are not well-addressed in traditional postgraduate curricula. A multidisciplinary team (MDT) based head-and-neck gross and radiologic anatomy program for radiation oncology trainees was developed, piloted, and empirically assessed for efficacy and learning outcomes.MethodsFour site-specific MDT head-and-neck seminars were implemented, each involving a MDT delivering didactic and case-based instruction, supplemented by cadaveric presentations. There was no dedicated contouring instruction. Pre- and post-testing were performed to assess knowledge, and ability to apply knowledge to the clinical setting as defined by accuracy of contouring. Paired analyses of knowledge pretests and posttests were performed by Wilcoxon matched-pair signed-rank test.ResultsFifteen post-graduate trainees participated. A statistically significant (p < 0.001) mean absolute improvement of 4.6 points (17.03%) was observed between knowledge pretest and posttest scores. Contouring accuracy was analyzed quantitatively by comparing spatial overlap of participants’ pretest and posttest contours with a gold standard through the dice similarity coefficient. A statistically significant improvement in contouring accuracy was observed for 3 out of 20 anatomical structures. Qualitative and quantitative feedback revealed that participants were more confident at contouring and were enthusiastic towards the seminars.ConclusionsMDT seminars were associated with improved knowledge scores and resident satisfaction; however, increased gross and cross-sectional anatomic knowledge did not translate into improvements in contouring accuracy. Further research should evaluate the impact of hands-on contouring sessions in addition to dedicated instructional sessions to develop competencies.
Highlights
Modern radiation oncology demands a thorough understanding of gross and cross-sectional anatomy for diagnostic and therapeutic applications
In the field of radiation oncology, while a competencybased paradigm continues to be gradually integrated into post-graduate curricula, the technology of radiation therapy is evolving at a rapid rate; primarily as a result of the evolution of computer applications and the integration of diagnostic imaging and dose delivery technology [3]
Radiotherapy has progressed from three dimensional conformational radiotherapy (3D-CRT), in which the design and delivery of radiotherapy treatment plans are based on 3-D image data (CT-based) with treatment fields individually shaped to treat only the target tissue, to even more advanced techniques such as Intensity-Modulated Radiotherapy (IMRT, Figure 1B-D) [4,5]
Summary
Study design This study is modeled after a prospective cohort research design. The institutional review board, Western University’s Research Ethics Board (REB), approved this pilot study (REB 102624) under the Delegated Health Sciences Review – Level 2 Category prior to study initiation. The educational intervention involved introducing a formalized integrated, kinesthetic, and MDT-based anatomy and radiology (head-and-neck) curriculum into the postgraduate radiation oncology training at Western University, through the implementation of four seminars addressing head-and-neck anatomic sub-sites that are pertinent to radiation oncologists. During a 4-week period, all participants simultaneously attended three 3-hr seminars on head-and-neck sub-sites: base of skull, oropharynx, and larynx; followed by one 3-hr seminar dedicated solely to the principles of head-andneck radiation oncology (Table 1). Investigators provided participants with the opportunity to observe 3-D anatomic relationships through the direct visualization of human cadavers, so as to better integrate anatomical concepts and assist postgraduate trainees to translate anatomic principles to 2-D diagnostic images with clinical context to radiation oncology priorities and concerns [6]. The baseline evaluation was conducted prior to the content dissemination during the teaching intervention, Primary outcome measures To assess the effectiveness of this educational intervention, the following aims and assessment tools were defined: To assess the educational impact of the teaching intervention on participants’ anatomic and radiographic knowledge,
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