Facilitating the Transition to Independent Radiation Oncology Practice Through a Resident-Led, Veterans Affairs Teaching Hospital Service

Abstract

Ideal radiation oncology residency clinical rotations will teach essential knowledge, yet also convey clinical and technical skills necessary for independent practice (collectively described as entrustable professional activities). Implementing such experiences, however, is fraught with challenges. 1 Jeans EB Beard TB Boon AL et al. Empowering residents into independent practice: A single-institutional endeavor aimed at developing resident autonomy through implementation of a chief resident service in radiation oncology. Int J Radiat Oncol Biol Phys. 2020; 107: 23-26 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 2 Best LR Sengupta A Murphy RJL et al. Transition to practice in radiation oncology: Mind the gap. Radiother Oncol. 2019; 138: 126-131 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar , 3 Kahn JM, DiazGranados D, Fields EC. Transitioning roles from residency to attending physician in radiation oncology [e-pub ahead of print]. J Cancer Educ. doi: 10.1007/s13187-020-01936-6, accessed September 16, 2021. Google Scholar , 4 Brower JV Chen S Ritter A et al. Comfort level of US radiation oncology graduates: Assessment of transition to independent clinical practice. J Cancer Educ. 2021; 36: 278-283 Crossref PubMed Scopus (2) Google Scholar , 5 Yoo SK Bian SX Lin E et al. Development of a radiation oncology resident continuity clinic to improve clinical competency and patient compliance. Int J Radiat Oncol Biol Phys. 2018; 100: 551-555 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar These include the continued reliance on the apprenticeship-based model, where ultimate responsibility for patient care is assumed by attending physicians. This is reinforced by Medicare billing and supervision rules requiring attendings to personally complete many key radiation oncology tasks. This limits the training experience by diminishing opportunities for residents to make key management decisions, limited review of treatment imaging, and inability to lead interdisciplinary teams. 4 Brower JV Chen S Ritter A et al. Comfort level of US radiation oncology graduates: Assessment of transition to independent clinical practice. J Cancer Educ. 2021; 36: 278-283 Crossref PubMed Scopus (2) Google Scholar The lack of resident autonomy and constructive feedback inherent in apprenticeship is linked to dissatisfaction with residency training 3 Kahn JM, DiazGranados D, Fields EC. Transitioning roles from residency to attending physician in radiation oncology [e-pub ahead of print]. J Cancer Educ. doi: 10.1007/s13187-020-01936-6, accessed September 16, 2021. Google Scholar ,6 Ahmed AA Ramey SJ Dean MK et al. Resident satisfaction with radiation oncology training. Adv Radiat Oncol. 2018; 3: 234-239 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar with 15% to 20% of residents desiring increased independence as postgraduate year (PGY)-5s. 7 Nabavizadeh N Burt LM Mancini BR et al. Results of the 2013 to 2015 Association of Residents in Radiation Oncology survey of chief residents in the United States. Int J Radiat Oncol Biol Phys. 2016; 94: 228-234 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar