Impact of Changing ACGME Case Requirements on Radiation Oncology Resident Rotation Structure

Abstract

The ACGME has updated case requirements for radiation oncology residents beginning with the graduating class of 2026, specifically introducing minimum cases across a wider range of disease sites. We aimed to assess the impact the ACGME update will have on residency rotation scheduling in our training program by retrospectively applying the case minimums to recent graduating classes and determining how rotations should be modified to meet the new standards. Our program utilizes the apprentice model where residents are assigned 1:1 or 1:2 to faculty supervisors. We abstracted case log information from residents graduating between 2020 and 2022, and cases were categorized based on the new ACGME requirements. We also abstracted total department treatment courses from our treatment tracking software which records disease site and resident participation. Hypothetical schedules were created to determine how resident rotations can be structured to ensure adequate exposure to meet all case minimums. The mean number of cases for graduating residents was 666 (range: 563-755). Six (67%) graduating residents would have not met at least one new ACGME site-specific requirement. The most common delinquencies were esophagus, anorectal, non-prostate genitourinary (GU), and lymphoma for which at least 3 residents each did not meet. Review of the treatment tracking software confirmed adequate case volume for these disease sites but that they were often not performed by a resident. We observed that these disease sites were less likely to be performed by a resident than other disease sites at our institution. Specifically, in 2022, 25% of all simulations went uncovered by residents but at-risk disease sites such as GI and GU each averaged 35% of simulations uncovered. We observed that when we retrospectively applied new ACGME minimums to recent graduating classes most residents would have been considered non-compliant despite adequate case volume at our institution. Case exposure, particularly for less common disease presentations, was highly dependent on rotation assignment. In the setting of increasing faculty-to-resident ratio requirements, conventional 1:1 assignments may not be adequate to meet new ACGME site minimums. We are currently comparing different resident coverage models that can be coupled with our traditional apprentice model to increase breadth of case exposure without compromising educational yield. Two models have arisen: a hybrid model where residents traditionally cover one attending and then cover the consults/simulations only of a second attending and a consult service model where residents are paired with 2 or more attendings but only see consults/simulations with these attendings. Coupling these models alongside the traditional apprentice model projects not only increased coverage of all simulations but improves coverage of traditionally "missed" simulations to at least 83% and upwards of 90% on most simulated schedules.