Radiation Treatment Plan Evaluation Education in Residency: A Needs Assessment

Abstract

Advances in radiation oncology have steadily increased the complexity of radiation treatment plan (RTP) development and evaluation. We hypothesized that radiation oncology attendings and residents would hold different attitudes regarding resident knowledge and comfort with RTP review. A web-based survey was distributed to residents (38-item) and attendings (32-item) at 14 ACGME-accredited residency programs. The survey consisted of a combination of multiple-choice questions and free text responses. A total of 169 residents and 71 faculty received the survey. The response rate was 38%. Resident respondents (n = 71) were PGY-2 (21%), -3 (30%), -4 (21%), and -5 (28%), and faculty respondents (n = 20) had 1-4 years (30%), 5-9 (35%), 10-15 (25%), >15 (10%) years in practice. 34% of residents report reviewing ≤2 plans and spending ≤20 minutes on plan review each week. 47% of residents report reviewing less than half of all new treatment plans for their patients. While 20% of residents report "often" or "always" reviewing treatment plans with an attending, 31% report they "rarely" or "never" do. More than half (56%) of residents felt that they have inadequate exposure to RTP review and 47% felt they are receiving inadequate education in this area. 83% cited "difficulty aligning resident and attending schedules" as a reason for inadequate exposure and education. 32% of residents report "rarely" or "never" making suggestions to optimize a plan and 21% report they do so "often" or "always". 54% of residents do not feel confident independently evaluating treatment plans, 31% do not feel confident identifying major planning errors, and 42% do not feel confident optimizing or suggesting minor improvements to plans. In contrast, attendings report that on average, they review 70% of all new treatment plans alongside residents. 40% report they do not have enough time to review RTPs with residents, with 75% citing "difficulty aligning resident and attending schedules" as a main reason. 50% of attendings report that residents "rarely" or "never" suggest optimizations for treatment plans that require them, but 90% of attendings "agree" or "strongly agree" that residents are competent at RTP evaluation by the end of a rotation. Both residents and attendings (90% each) believe that residents would benefit from a dedicated resource on RTP review. Across respondents, 96% were familiar with a systematic RTP review approach and 97% "agree" or "strongly agree" that systematic RTP review improves their ability to evaluate a plan. A large percentage of residents feel they have inadequate RTP education in residency and lack confidence when evaluating RTPs. There is discordance between resident and faculty perceptions of RTP review education and resident competence, but a vast majority agree that systematic RTP review is valuable. Future work should focus on development of learning tools for RTP evaluation using a systematic review process.