Canadian Radiation Oncology Residents Research Articles

The Impact on Peer Mentorship After Implementation of a Competency-Based Residency Curriculum in Canadian Radiation Oncology Training Programs

Peer mentorship provides professional and personal support between physicians with similar experiences and levels of training. While peer mentorship has shown to benefit academic success and professional growth, little data has examined contextual factors, such as curricular change, that may affect the quality of these relationships. This study aims to explore the impact of a new, nationwide radiation oncology (RO) residency curriculum, known as competence by design (CBD), on peer mentorship experiences between Canadian RO residents. A qualitative study, with a social constructivist approach, was conducted with 2 groups of Canadian RO residents. The first were those in the academic year before CBD implementation (non-CBD cohort), and the second were those in the inaugural year of CBD (CBD cohort). Semistructured 1-on-1 interviews were conducted to explore experiences of peer mentorship as it related to curriculum change. Interviews were transcribed and analyzed with deductive and inductive methods until data saturation. Between April and December 2021, 14 participants (6 non-CBD and 8 CBD residents) from 8 out of 10 eligible English-speaking RO training programs across Canada participated. Three major themes were identified: (1) the CBD cohort identified fewer opportunities for peer mentorship, with specific concerns regarding new evaluation processes and uncertainty about the later stages of training; (2) there was minimal impact on specialty-specific learning; and (3) peer mentorship thrived when occurring as spontaneous in-person interactions. Inaugural residents of a CBD curriculum perceived fewer opportunities for peer mentorship. There were specific concerns about new evaluative processes, though this did not affect specialty-specific learning. Peer mentorship was most impactful as informal and in-person interactions. Our findings suggest that unintended consequences of curriculum change may be mitigated by improving communication about new training objectives and increasing opportunities for informal interactions between residents.

The Effects of a Curriculum Change on Peer Mentorship among Radiation Oncology Residents

<h3>Purpose/Objective(s)</h3> Peer mentorship is the educational, professional, and personal support provided amongst trainees within a similar level of training. While peer mentorship has shown to benefit academic success and professional growth, little data has examined contextual factors, such as curricular change, that may affect the accessibility, content, and quality of these relationships. This study aims to explore peer mentorship among Radiation Oncology (RO) resident physicians following the implementation of a new nationwide, competence-based RO residency curriculum, known as Competency by Design (CBD). <h3>Materials/Methods</h3> Two cohorts of Canadian RO residents in English programs were invited to participate - one being the final academic year before CBD implementation (non-CBD cohort entering residency in July 2018), and the other being the inaugural CBD academic year (CBD cohort entering residency in July 2019). Residents participated via convenience sampling and engaged in semi-structured interviews to elicit their thoughts and perceptions on the impact of curriculum change on peer mentorship. Interviews were conducted until data saturation, meaning that no new ideas or themes were emerging from the data. Interviews were audio-taped, de-identified and transcribed. Iterative data collection was conducted in parallel with thematic analysis methods, using both deductive and inductive analysis, to generate themes to describe findings. <h3>Results</h3> Between April and December 2021, 14 interviews were conducted with 6 non-CBD (32% response rate) and 8 CBD (53% response rate) residents, at which point thematic saturation was achieved. Participants represented 8 out of 10 eligible English RO training programs across Canada. Three major themes were identified: (i) the CBD-cohort described fewer opportunities for peer mentorship in navigating formal evaluation processes, and in discussing uncertainties about the later stages of residency training; (ii) peer mentorship tended to thrive when able to occur as spontaneous in-person interactions; and (iii) there was minimal impact on specialty-specific learning. <h3>Conclusion</h3> Findings from this study identified that inaugural RO residents of a new curriculum experienced uncertainty around new training objectives, and that peer mentorship was most impactful as informal and in-person interactions. Our findings suggest that the unintended consequences of curriculum change on resident peer mentorship may be mitigated from improved orientation and communication about stage-specific training objectives, and to provide increased opportunities for informal activities amongst residents.

Research Productivity of Canadian Radiation Oncology Residents: A Time-Trend Analysis.

(1) Background: Research productivity is a mandatory component of Canadian radiation oncology (RO) resident training. To our knowledge, Canadian RO resident research publication productivity has not previously been analysed. (2) Methods: We compiled a 12-year database of RO residents in Canadian training programs who completed residency between June 2005 and June 2016. Resident names and dates of training were abstracted from provincial databases and department websites and were used to abstract data from PubMed, including training program, publication year, journal, type of research, topic and authorship position. Residents were divided into four time periods and the linear trend test evaluated publication rates over time. Univariable and multivariable logistic regression analyses were performed to identify authorship predictors. (3) Results: 227 RO residents representing 363 publications were identified. The majority were first-author publications (56%) and original research (77%). Overall, 82% of first-author, and 80% of any-author articles were published in resident year 4 or higher. Mean number of publications for first-author and any-author positions increased significantly over time (p = 0.016 and p = 0.039, respectively). After adjusting for gender and time period, large institutions (> 3 residents per year) trended toward associations with more first-author publications (odds ratio (OR): 2.44; p = 0.066) and more any-author publications (OR: 2.49; p = 0.052). No significant differences were observed by gender. (4) Conclusions: Canadian RO resident publication productivity nearly doubled over a 12-year period. The majority of publications are released in the last 2 years of residency, and larger residency programs may be associated with more publications. These findings serve as a baseline as programs transition to Competency Based Medical Education (CBME).

42: Factors That Promote Medical Student Interest in Radiation Oncology: A Survey of Canadian Radiation Oncology Residents

42: Factors That Promote Medical Student Interest in Radiation Oncology: A Survey of Canadian Radiation Oncology Residents

Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada.

Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.

Motivations, Well-Being, and Career Aspirations of Radiation Oncology Resident Physicians in Canada.

Prior Pan-Canadian surveys of Radiation Oncology (RO) residents reveal a decrease in Canadian RO employment opportunities. Canadian RO resident levels increased from 130 in 2003, peaked at 209 in 2009, then decreased to 130 in 2017. Recognizing that RO has entered another period of transition, we re-examined resident motivations and perspectives on the job market and explored well-being and career aspirations among a contemporary cohort of Canadian RO residents. An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 75 open-ended, Likert-scale, matrix-style, and multiple-choice questions. Student's t test compared subgroups, with statistical significance at p ≤ 0.05. Out of 128 eligible residents, 84 completed the survey (66% response rate) with representative sampling from each training year. Demographics reveal 53% male, and 85% Canadian registry-funded. Top training-related stressors were exam performance, job prospects, and physical/psychological demands of residency. Most intend to pursue fellowship post-residency (80%) and practice in Canada (88%). Few believe they can obtain staff positions treating preferred tumor sites (38%) or at preferred geographic locations (28%). Residents view job market being less competitive than 5years ago (40%) and predict it will be less competitive in 5years (60%). Canadian RO residents feel adequately trained, and most pursue post-residency fellowships. Current perceptions of the Canadian job market remain guarded, but appear more optimistic about the future. This update provides insights into current RO training and identifies areas that could be addressed by incoming competency-based medical education models for RO.

109 Attitudes Towards Research During Radiation Oncology Residency Training: A Survey of Canadian Radiation Oncology Residents and Program Directors

109 Attitudes Towards Research During Radiation Oncology Residency Training: A Survey of Canadian Radiation Oncology Residents and Program Directors

Attitudes Towards Research During Residency Training: a Survey of Canadian Radiation Oncology Residents and Program Directors.

Radiation oncologists require clinical appraisal and research methodology skills, yet it is unclear how to develop these competencies during residency. We sought to attain a deeper understanding of the barriers that limit, as well as the factors that promote, engaging in research/scholarly activity during radiation oncology residency training in Canada. Following ethics approval, online surveys were circulated to all Canadian Radiation Oncology program directors and residents. Unidentifiable demographics, prior research experience, and descriptions of current research environment and barriers to engaging in research and scholarly activities were collected. Thirty-three percent (35/105) of residents and 71% (10/14) of program directors responded. Ninety-seven percent of residents, and 90% of program directors, agreed or strongly agreed that research/scholarly activity was an important part of residency training. While 66% of residents felt that there was a lack of protected time for research/scholarly activity, only 20% of program directors agreed this was a barrier (p = 0.011). While 94% of residents thought mentorship was important to completing high-quality research/scholarly activity, only 48% of respondents had a mentor. The highest barriers to completing research/scholarly activity projects were lack of protected time (for both residents and faculty), high resident clinical workload, and lack of experience in research skills. Canadian Radiation Oncology residents expressed strong enthusiasm to participate in research/scholarly activity, yet lack of protected time and competing demands were identified as major barriers. We suggest programs offer more protected time for research/scholarly activity, provide optional research methodology training, and support meaningful mentorship relationships.

Results from the 2017 Survey of Radiation Oncology Residents in Canada

Previous Pan-Canadian surveys of Radiation Oncology (RO) residents performed in 2003 and 2009 identified job availability as a major concern, and characterized a perceived decline in employment opportunities for radiation oncologists in Canada. The Canadian post-MD education registry indicates that Canadian RO trainee levels rose from 130 in 2003 to reach a peak of 209 in 2009 before declining to approximately 130 in 2017. Recognizing that RO has entered another period of transition, we investigated resident perspectives among a more contemporary cohort of RO trainees in Canada. Surveys were distributed electronically to residents at each RO training program in Canada. Surveys consisted of 116 multiple choice and open-ended questions assessing center demographics, motivations for choosing RO, clinical experiences, didactic learning, research experiences, professional relationships, resident satisfaction, and career aspirations. Questions were constructed based on the 2003 and 2009 Canadian survey, and on previous Association of Residents in Radiation Oncology reports from the United States. Anonymized, aggregate responses from completed surveys were abstracted, and descriptive statistics were calculated. Out of 128 eligible residents, 84 completed the survey (65.6% response rate) with representative sampling from each training year (17.1% - 22.4% each year). Demographics reveal 52.6% were male, 68.4% were Canadian medical school graduates (CMGs), 22.4% held either a master’s degree or doctorate, and 2.6% held additional medical certification. Nearly all respondents (97.9%) were satisfied with their specialty and training program. The most frequently perceived weakness in training was feeling unprepared to be competitive in the job market (42.6%), and 78.7% plan to pursue a post-residency fellowship. Most CMGs (86.1%) plan to practice in Canada, but only 12.8% of respondents believe there is strong demand for RO in Canada. Few respondents believe they can obtain staff positions treating their preferred tumor sites (38.3%), and at their preferred geographic location (27.7%). The job market was perceived by 40.4% to be less competitive than it was 5 years ago, and 59.6% predict it will be less competitive 5 years from now. Canadian RO residents feel adequately trained as competent physicians, and a majority of trainees pursue post-residency fellowships, similar to prior surveys. Although current perceptions of the Canadian job market remain guarded, RO residents are highly satisfied with their choice of specialty and training program, and are more optimistic about their future job prospects. Our survey update provides continued insights into RO residency training in Canada, and identifies opportunities for improvement that could be addressed by the incoming competency-based medical education model for RO.

National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology.

Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents' geriatric oncology learning needs. The purpose of this study is to determine the geriatric oncology educational needs of the Canadian RO residents and to inform Canadian RO residency training. A cross-sectional survey, with Likert, multiple choice, and open-ended questions, was pretested and distributed electronically by program directors to Canadian RO residents over 6weeks. Responses were analyzed with descriptive statistics and common themes. One-hundred and thirty-five Canadian RO residents were contacted and 63 responded (47%). Half (49%) lacked confidence managing the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairment, and challenging social circumstances;73% agreed additional training would be helpful. Forty-four percent lacked confidence regarding psychogeriatric referrals, fall prevention, palliative and hospice care, and community resources preventing re-hospitalization; 63% agreed additional training would be helpful. Seventy-six percent believed discussion groups, continuing education, geriatric oncology electives, and journal clubs would provide learning opportunities. Seventy-one percent agreed integrating geriatric assessment into RO curricula would improve care. Seventy-nine percent believed geriatric oncology principles have not been adequately integrated into radiation oncology curricula. There are significant gaps specific to geriatric assessment and management of older cancer patients in the current Canadian RO curricula. Most residents agreed that it is important to integrate geriatric oncology training to improve and personalize the care of older cancer patients.

2009 Canadian Radiation Oncology Resident Survey

Statistics from the Canadian post-MD education registry show that numbers of Canadian radiation oncology (RO) trainees have risen from 62 in 1999 to approximately 150 per year between 2003 and 2009, contributing to the current perceived downturn in employment opportunities for radiation oncologists in Canada. When last surveyed in 2003, Canadian RO residents identified job availability as their main concern. Our objective was to survey current Canadian RO residents on their training and career plans. Trainees from the 13 Canadian residency programs using the national matching service were sought. Potential respondents were identified through individual program directors or chief resident and were e-mailed a secure link to an online survey. Descriptive statistics were used to report responses. The eligible response rate was 53% (83/156). Similar to the 2003 survey, respondents generally expressed high satisfaction with their programs and specialty. The most frequently expressed perceived weakness in their training differed from 2003, with 46.5% of current respondents feeling unprepared to enter the job market. 72% plan on pursuing a postresidency fellowship. Most respondents intend to practice in Canada. Fewer than 20% of respondents believe that there is a strong demand for radiation oncologists in Canada. Respondents to the current survey expressed significant satisfaction with their career choice and training program. However, differences exist compared with the 2003 survey, including the current perceived lack of demand for radiation oncologists in Canada.

THE DEVELOPMENT OF A MULTIMEDIA WEB SITE FOR INSTRUCTION OF PEDIATRIC ONCOLOGY.

Purpose Deficiencies in pediatric oncology (PO) training for residents have been identified internationally. One of the main reasons for this is lack of exposure to pediatric patients during residency training. The goal of this project is to develop a series of Web-based learning modules to supplement current teaching in this area. Methods A Web-based survey was sent to Canadian radiation oncology (RO) program directors and Canadian RO residents. The survey was designed to identify the limitations of current training curriculum and supplemental materials to enhance it. Survey results guided Web site development. The curriculum was developed using teaching modules to focus on specific pediatric tumor sites. Modules followed a common format, reviewing the epidemiology, pathology, radiology, and treatment planning for each tumor. A self-assessment tool was included at the end of the modules, allowing learners to evaluate their grasp of topics. Results Survey results indicated a need for novel teaching methods in pediatric RO. One hundred percent (10/10) of Canadian RO program directors and 66% (69 of 106) of Canadian RO residents responded to the survey. More than 55% (38 of 69) of residents felt that teaching in pediatric RO was inadequate in comparison with other areas of RO. Fifty-five percent (15 of 27) of senior residents felt unprepared for questions in pediatric RO on qualifying board examinations. Over 90% (63 of 69) of respondents felt that a Web-based teaching tool would be a useful supplement to traditional teaching methods. Four modules have been written to date. Theses include brain tumors, sarcomas, Wilms9 tumor, and pediatric specialty tumors. Web development for the project is continuing. Efforts are being made to increase the use of problem-based learning and clinical skills in the Web site. Preliminary results indicate that users find this Web site useful to supplement their learning in PO. Conclusions This is a unique project utilizing Web-based learning modules to teach pediatric RO. This educational program will allow self-directed study in the area of pediatric RO, providing more effective learning of this challenging yet essential area of study.

Online pediatric oncology education: A novel teaching tool for oncology residents

9048 Background: Deficiencies in pediatric oncology training for residents have been identified internationally. A lack of training in pediatric oncology during residency is correlated with impaired outcomes for pediatric patients. There is a clear need for novel teaching tools to supplement training in pediatric oncology. Purpose: The goal of this project was to develop a series of multimedia web-based learning modules for the interactive instruction and review of pediatric oncology. A needs-based assessment of pediatric oncology training in Canadian radiation oncology residency programs was used to guide web-site development. Methods: A needs-based analysis was conducted via a web-based survey sent to all Canadian radiation oncology program directors and residents. The survey was designed to identify the limitations of current training curriculum in pediatric oncology. A multidisciplinary team, including pathologists, radiologists, medical physicists, radiation and medical oncologists, developed the web site curriculum. The site was designed using teaching modules to focus on pediatric tumour sites. Modules were developed using a common format, divided into chapters detailing specific tumour types. Each chapter reviewed relevant epidemiology, anatomy, pathology, radiology, and treatment for the tumor type. A self-assessment tool was included at the end of the modules. User satisfaction surveys were used for feedback. Results: 100% (10/10) of Canadian radiation oncology program directors and 66% (69/106) of Canadian residents responded to the survey. 56% (59/106) of resident respondents felt that teaching in pediatric radiation oncology was inadequate and 56% (20/36) of senior residents felt unprepared for questions in pediatric oncology on qualifying board exams. 90% (105/116) of respondents felt that a web-based teaching tool would be useful. The first module, pediatric neuro-oncology, has been completed. Results indicate users find this module useful for supplementing traditional training. Conclusions: There are no other interactive teaching tools in pediatric oncology. This unique web-based educational program will allow self-directed study in the area of pediatric oncology, providing more effective learning of this challenging yet essential area of study. No significant financial relationships to disclose.

2003 survey of Canadian radiation oncology residents

Radiation oncology's popularity as a career in Canada has surged in the past 5 years. Consequently, resident numbers in Canadian radiation oncology residencies are at all-time highs. This study aimed to survey Canadian radiation oncology residents about their opinions of their specialty and training experiences. Residents of Canadian radiation oncology residencies that enroll trainees through the Canadian Resident Matching Service were identified from a national database. Residents were mailed an anonymous survey. Eight of 101 (7.9%) potential respondents were foreign funded. Fifty-two of 101 (51.5%) residents responded. A strong record of graduating its residents was the most important factor residents considered when choosing programs. Satisfaction with their program was expressed by 92.3% of respondents, and 94.3% expressed satisfaction with their specialty. Respondents planning to practice in Canada totaled 80.8%, and 76.9% plan to have academic careers. Respondents identified job availability and receiving adequate teaching from preceptors during residency as their most important concerns. Though most respondents are satisfied with their programs and specialty, job availability and adequate teaching are concerns. In the future, limited time and resources and the continued popularity of radiation oncology as a career will magnify the challenge of training competent radiation oncologists in Canada.

64 2003 survey of Canadian radiation oncology residents

64 2003 survey of Canadian radiation oncology residents