Non-Clinical Time in Radiation Oncology Residency Programs: A National Survey of Program Structure and Resident Perspectives

Abstract

Data regarding the amount and use of non-clinical time (NCT) in radiation oncology residency programs are scarce. We surveyed every US Radiation Oncology residency program to obtain benchmark data to inform decisions about optimal program structure. An anonymous, internet-based survey was distributed to all PGY5 residents at ACGME-accredited radiation oncology training programs. The survey consisted of 33 yes/no, Likert-scale, and free-response questions. Up to 2 reminder emails were sent to any resident who did not complete the survey. Program data were analyzed for all programs; those considered “top 10” per Doximity and those not considered “top 10.” Likert-scale responses were dichotomized as “not as satisfied” (1, 2, 3) or “very satisfied” (4, 5). 123 residents completed the survey (response rate 68%). Program specific data were obtained for 100% of programs (n=82). The vast majority of training programs (98%) provide residents with protected NCT. The median NCT was 10 months, 12 months, and 9 months in all 82 programs, “top 10” programs, and not “top 10” programs, respectively (p=0.03). Most (68%) of programs reported having more than 6 months of NCT. The median number of publications resulting from NCT did not differ significantly between residents who had 9 or fewer months compared to 10 or more months of NCT (p=0.07). The proportion of residents who reported wanting more NCT increased as the amount of time decreased (100%, 73%, 52%, and 19% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.01). The proportion of residents who reported being very satisfied with NCT flexibility increased with more NCT (50%, 58%, 79%, and 94% for 1-3 , 4-6 , 7-9 , and 10-12 months, respectively; p=0.04) as did proportion of residents very satisfied with accomplishment during NCT (0%, 35%, 53%, and 73% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=.03). When asked whether residents would theoretically want to give up their NCT to shorten their residencies, the proportion of residents willing to shorten their residencies decreased as amount of NCT increased (100%, 57%, 47%, and 33% for 1-3, 4-6, 7-9, and 10-12 months respectively; p=0.02) Residents with more NCT reported placing more importance on amount of NCT while making rank lists (0%, 37%, 51%, and 73% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.04) and less frequently desired to change the importance of this factor in their rank list decision retrospectively (100%, 50%, 41%, and 25% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.03). Most residency programs dedicate > 6 months of non-clinical time to residents. In addition, > 50% of residents value the experience from their non-clinical time such that they would not trade it to shorten their residency if given the option. Programs should maintain an emphasis on such time and implement measures to ensure meaningful resident experiences.