Knowledge In Radiation Oncology Research Articles

Experience from an Early Exposure Education Program in Radiation Oncology for High School and Undergraduate Students

Exposure to Radiation Oncology (RO), which is a small and highly subspecialized field of oncology, during undergraduate or medical education is often limited. Coupled with reduced elective exposures during the COVID-19 pandemic, unsubstantiated concerns regarding the RO job market have led to a noticeable decline in residency applications and medical students who express an interest in the field. Here we describe a summer education program piloted in our RO department at a Comprehensive Cancer Center to provide pre-medical school students (ranging from high school to post-baccalaureate) early exposure to the specialty through clinical shadowing, research opportunities, journal club, and formal didactic lectures. Pre- and post-program surveys were administered to these students to evaluate the change in knowledge in RO. A total of eight students participated in the program. We found an increase in understanding of the specialty, high levels of interest in considering RO as a career, and positive feedback regarding the program overall. This study supports a role for early exposure and education in stimulating interest in future medical students to pursue RO as a career. Future efforts are needed to further develop and evaluate these education programs, as well as disseminate the program more broadly.

A Qualitative Analysis of Medical Student Reflections Following Participation in a Canadian Radiation Oncology Studentship.

Exposure to radiation oncology in medical school curricula is limited; thus, mentorship and research opportunities like the Dr. Pamela Catton SummerStudentship Program attempt to bridge this gap and stimulate interest in the specialty. In 2021, the studentship was redesigned as virtual research, mentorship, and case-based discussions due to the COVID-19 pandemic. This study explores the impact of COVID-19 on the studentship, on students' perceptions of the program, and on medical training and career choice. Fifteen studentship completion essays during 2021-2022 were obtained and anonymized. Thematic analysis was performed to interpret the essays with NVivo. Two independent reviewers coded the essays. Themes were established by identifying connections between coded excerpts. Consensus was achieved through multiple rounds of discussion and iteratively reviewing each theme. Representative quotes were used to illustrate the themes. The themes confirmed the studentship was feasible during the pandemic. Perceived benefits of the program included mentorship and networking opportunities; gaining practical and fundamental knowledge in radiation oncology; developing clinical and research skills; and creating positive attitudes towards radiation oncology and the humanistic aspect of the field. The studentship supported medical specialty selection by helping define student values, shaping perceptions of the specialty, and promoting self-reflection upon students' personal needs. This study informs future iterations of the studentship to promote radiation oncology in Canadian medical school curricula. It serves as a model for studentships in other specialties that have limited exposure and similar challenges with medical student recruitment.

Exploring Capabilities of Large Language Models such as ChatGPT in Radiation Oncology

PurposeTechnological progress of machine learning and natural language processing has led to the development of large language models (LLMs), capable of producing well-formed text responses and providing natural language access to knowledge. Modern conversational LLMs such as ChatGPT have shown remarkable capabilities across a variety of fields, including medicine. These models may assess even highly specialized medical knowledge within specific disciplines, such as radiation therapy. We conducted an exploratory study to examine the capabilities of ChatGPT to answer questions in radiation therapy. Methods and MaterialsA set of multiple-choice questions about clinical, physics, and biology general knowledge in radiation oncology as well as a set of open-ended questions were created. These were given as prompts to the LLM ChatGPT, and the answers were collected and analyzed. For the multiple-choice questions, it was checked how many of the answers could be clearly assigned to one of the answers, and the proportion of correct answers was determined. For the open-ended questions, independent blinded radiation oncologists evaluated the quality of the answers regarding correctness and usefulness on a 5-point Likert scale. Furthermore, the evaluators were asked to provide suggestions for improving the quality of the answers. ResultsFor 70 multiple-choice questions, ChatGPT gave valid answers in 66 cases (94.3%). In 60.61% of the valid answers, the selected answer was correct (50.0% of clinical questions, 78.6% of physics questions, and 58.3% of biology questions). For 25 open-ended questions, 12 answers of ChatGPT were considered as “acceptable,” “good,” or “very good” regarding both correctness and helpfulness by all 6 participating radiation oncologists. Overall, the answers were considered “very good” in 29.3% and 28%, “good” in 28% and 29.3%, “acceptable” in 19.3% and 19.3%, “bad” in 9.3% and 9.3%, and “very bad” in 14% and 14% regarding correctness/helpfulness. ConclusionsModern conversational LLMs such as ChatGPT can provide satisfying answers to many relevant questions in radiation therapy. As they still fall short of consistently providing correct information, it is problematic to use them for obtaining medical information. As LLMs will further improve in the future, they are expected to have an increasing impact not only on general society, but also on clinical practice, including radiation oncology.

Adult Hospitalists' Knowledge of Radiation Oncology in an Independent Nonacademic Healthcare System in Albuquerque, New Mexico.

Radiation oncology (RO) plays a crucial role in cancer care; cancer patients often undergo their initial diagnostic study by general physicians. However, studies have shown that most physicians are uncomfortable referring cancer patients to radiation therapy (RT). To assess the knowledge of RO among non-oncology physicians, we sent invitations to complete an online survey that required the responders to self-rate their understanding of RT and objective assessment. The survey was targeted at hospitalists and primary care physicians. Forty physicians responded to the survey, and 89.7% practiced primarily as hospitalists, with 67% being Internal Medicine graduates. Fifty percent of physicians have referred patients to RO before, although more than 90% have not done additional CME (continuing medical education) in Oncology. More than 50% of recent graduates (one to five years post-residency) self-rated themselves as "not knowledgeable" when it comes referral process to RO as well as general knowledge regarding RT. Factors, such as "type of cancer," "patients' wishes," and "life expectancy," are most cited as factors influencing the decision for a referral.

An interactive smartphone application for trainees in Radiation Oncology: "The Rad Onc Handbook"

1The app is well structured and easy to use. 2The app content is relevant to radiation oncology. 3The audio lessons enhanced my learning. 4The quizzes and cases enhanced my learning. 5My overall knowledge in radiation oncology has increased. 6I would recommend this application to a colleague. 25 participants completed the survey on the advanced learning module. 70% of all survey participants ""agree"" or ""strongly agree"" to the five statements listed below: 1The module was well structured. 2The module is relevant to radiation oncology. 3The module was an appropriate level of complexity. 4My overall knowledge about breast cancers has increased. 5I would recommend this module to a colleague. Overall, the application and advanced learning modules were well received and the trainees express a desire for other advanced learning modules in the free text responses. This free smartphone application provides an easily accessible resource for self-directed learning in radiation oncology. Initial feedback was very favourable and recommended use of this innovative learning resource among a wider group of trainees. In response to trainee feedback, future work will focus on the development of additional modules, incorporating interactive virtual patient cases, in other tumour sites. As web-based learning continues to become increasingly popular, this application can be a useful educational resource for medical trainees." Background Radiation oncology (RO) textbooks and primary references are often complex, technically advanced, and inaccessible to medical trainees. To address this, we designed a free, interactive smartphone application, to introduce trainees to the basics of RO. Methods We created and implemented an Apple iOS smartphone application with RO content, targeted for medical trainees. The beta version is free for download via the TestFlight application (https://testflight.apple.com/join/4A6qXjq2). The application incorporates both introductory topics relevant to radiation oncology and advanced, site-specific modules, that focus on the different tumour sites and their management. Content includes written text, audio lectures, interactive quizzes, and clinical cases. Two questionnaires were implemented to elicit feedback; one for application design and the other a knowledge-quiz for an advanced learning module on breast cancers. Both contain quantitative 5-point Likert-scale questions and one qualitative freeform text question seeking suggestions for improvement. Results There have been over 70 unique downloads of the application. 40 participants completed the survey on application design. Over 80% have selected ""agree"" or ""strongly agree"" to the six statements listed below: Radiation oncology (RO) textbooks and primary references are often complex, technically advanced, and inaccessible to medical trainees. To address this, we designed a free, interactive smartphone application, to introduce trainees to the basics of RO. We created and implemented an Apple iOS smartphone application with RO content, targeted for medical trainees. The beta version is free for download via the TestFlight application (https://testflight.apple.com/join/4A6qXjq2). The application incorporates both introductory topics relevant to radiation oncology and advanced, site-specific modules, that focus on the different tumour sites and their management. Content includes written text, audio lectures, interactive quizzes, and clinical cases. Two questionnaires were implemented to elicit feedback; one for application design and the other a knowledge-quiz for an advanced learning module on breast cancers. Both contain quantitative 5-point Likert-scale questions and one qualitative freeform text question seeking suggestions for improvement. There have been over 70 unique downloads of the application. 40 participants completed the survey on application design. Over 80% have selected ""agree"" or ""strongly agree"" to the six statements listed below:

Improving medical student education in radiation oncology: Integrating and evaluating an experiential interdisciplinary workshop into the medical student curriculum.

To evaluate a novel interactive educational workshop designed to improve medical student knowledge and awareness of radiation oncology (RO). A 2.5-h pilot workshop in RO was introduced in 2018 for one teaching hospital cohort of postgraduate medical students. Students participated in a voluntary interactive programme of learning 'stations' situated in the RO department, introducing students to practical aspects of RO planning, delivery and patient care. Students were surveyed before and immediately after the workshop to assess their perceptions of its educational value and the impact on RO knowledge and awareness. Forty-four of 51 students participated in the RO workshop with 44 students (100%) completing the preworkshop survey and 38 students completing postworkshop survey (86%). Twenty-three of 44 students had prior RO teaching, and 11/23 students (48%) had received between 30 and 60 min of teaching with only 4/44 (9%) confident in their knowledge of RO. Following the workshop, 22/38 (58%) felt their knowledge now met expectations for their level of training. Preworkshop, objective RO knowledge was low, regarding optimal use of RT (25%) and bone pain response (41%) and improved to 100% and 86% respectively. Overall, feedback around workshop value was highly positive with regard to enjoyment (97%) and students commented on the enthusiasm and multidisciplinarity of teachers. There remain large gaps in medical student knowledge and confidence in RO, and intervention is necessary to address these discrepancies. A novel interactive RO workshop for medical students has demonstrated improved awareness and knowledge with high levels of self-reported learner satisfaction.

Educating the Colleagues: Radiation Basics for Obstetrics and Gynecology Residents

Exposure to radiation oncology (RO) is limited among medical students, excluding those who wish to pursue a radiation oncology career. Consequently, RO knowledge in gynecological malignancies may differ among obstetricians and gynecologists (OB&G), depending on their experience and training level. Establishing a program to educate OB&G residents about basic radiation oncology principles may improve patients' coordination and treatment with gynecological malignancies. At our institution, radiation oncology residents conducted a 2-part training session for OB&G colleagues, which included a lecture and hands-on training. Educational sessions targeting OB&G residents are needed to enhance knowledge about radiation treatments and improve patient care.

Multi-Institutional Virtual Medical Student Clerkship in Radiation Oncology

<h3>Purpose/Objective(s)</h3> Medical student education in radiation oncology traditionally takes place in-person during 3^rd or 4^th year of medical school. Due to the COVID-19 pandemic, onsite clerkships were placed on hold, leading to virtual medical student clerkships in radiation oncology which incorporated didactics and hands-on learning. We sought to implement this virtual medical student clerkship in radiation oncology at multiple institutions and analyze the impact and utility of this platform. <h3>Materials/Methods</h3> An IRB-approved virtual clerkship was created and implemented at 7 institutions. Students enrolled in home or away rotations. Clerkships offered general and disease subsite-specific oncology topics through recorded didactics geared towards medical students on www.radoncvirtual.com, as well as clinical vignettes, telehealth visits, chart rounds, contouring, and capstone presentations. Surveys were given pre- and post-clerkship to assess baseline comfort and knowledge. At the end of each clerkship, a course exam was given consisting of 48 questions. Clerkship directors were given a survey to assess comfort and ease of implementing the virtual clerkship. Surveys and course exams were analyzed using Wilcoxon Signed rank test and t-test, 2-sided. <h3>Results</h3> Seventy-two (72) students enrolled at 7 institutions between 4/2020 and 2/2021. Survey response rates were 100% pre- and post-clerkship as well as from course directors. The majority of students were MS4 (57%) and MS3 (33%) with equal distribution in gender. Each institution's median number of total medical students doing an away rotation was 4 (range 3-9) and home rotation number of students 2 (range 0-36). The median length of each virtual rotation was 2.5 weeks (range: 1-4 week). 71% (n = 51) of medical students had never previously enrolled in a radiation oncology elective. Improvements in the overall knowledge of radiation oncology, as well as specific knowledge in the scope of radiation oncology, roles of radiation physicist, dosimetrist and therapist, contouring, treatment planning, and training path to the field (all <i>P</i> < 0.001). There was no significant difference in course final exam scores between students who had attended a radiation oncology elective before enrollment and those who had not (<i>P</i> = 0.27). Course directors reported spending an additional 5-10 hours per week with students. The survey revealed 100% were satisfied with content and delivery of this virtual elective, and 83% (n = 6) indicated they would utilize the material for future rotations. <h3>Conclusion</h3> Implementation of a multi-institutional virtual radiation oncology elective was successful at improving knowledge for medical students at all levels, even those that had exposure previously. This virtual elective platform can be utilized to improve access to multiple institutions, resources, mentors, and networking opportunities. Resources in the virtual rotation platform can also be integrated into traditional educational paradigms to increase exposure in the field.

Medical student education through flipped learning and virtual rotations in radiation oncology during the COVID-19 pandemic: a cross sectional research

BackgroundThe COVID-19 pandemic has stripped many medical students worldwide of their right to quality education. In response, we developed hybrid courses involving aspects of both online and in-person teaching for radiation oncology medical student clerkship.MethodsWe entitled students to customize their own rotation schedule using Google Forms and developed a flipped learning online class, which consisted of at least one video clip on basic knowledge of radiation oncology per day (yonsei-radonc.com). Students were instructed to watch online videos before the next day’s discussion session. Required components of the medical education program (e.g., target drawing, site visits to treatment facilities) were also prepared and conducted in accordance with the appropriate level of social distancing measures. Finally, we conducted questionnaire surveys after the completion of the week-long course and clerkship.ResultsFrom March to June 2020, 110 fourth-year medical students undertook a clinical module in our 1-week radiation oncology program course. Each day, students completed the flipped learning prior to meeting with the educator and then participated in the online discussion session and conference. All activities were well performed as scheduled. Students’ motivation was high, as was their overall satisfaction with the course. The students were satisfied with the online contents, flipped learning strategy, and instructors.ConclusionsWe successfully integrated open and virtual educational platforms to improve access to and satisfaction with student clerkship. In the future “new normal,” minimized face-to-face learning interactions, such as flipped learning, should be actively utilized for medical and other students’ education.

Radiation Oncology Virtual Education Rotation (ROVER) for Medical Students.

We describe the implementation of a novel virtual educational program for medical students, Radiation Oncology Virtual Education Rotation (ROVER), and its effect on student interest and knowledge in radiation oncology. ROVER comprised a series of virtual educational panels with case-based discussions across disease sites tailored to medical students. The panels were moderated by radiation oncology residents and included faculty panelists from academic radiation oncology programs across the country. Student pre- and postsession surveys were collected. Paired t tests were used to compare the pre- and postsession assessment results. Six ROVER sessions were held from June 4, 2020, to August 20, 2020, with a total of 427 medical students registering for at least 1 session. Of these, 231 students attended at least 1 session, with 140 completing at least 1 postsession survey (60.6% response rate). Fourth-year medical students were the largest group represented among attendees (32.0%). Most attendees had exposure to radiation oncology (78.8%) before the sessions. The majority of students signed up for these sessions for education (90.6%). Some students signed up for the sessions to help with specialty selection (30.9%) and to network (30.4%). Medical students' understanding of the role of radiation oncology in each disease site (breast, sarcoma, central nervous system, pediatrics, gastrointestinal, genitourinary, gynecologic, lymphoma, lung, and head and neck) was improved by attending each session (pre- vs postsession; P < .0001 for all disease sites). Over three-quarters of respondents stated they were considering applying or were likely to apply to radiation oncology both before and after the sessions. ROVER improved medical student perceived knowledge of radiation oncology across all disease sites covered. ROVER fulfills a need for a national medical student education platform for radiation oncology. Future work is warranted to augment virtual and open educational platforms to improve access to radiation oncology education.

Radiation Oncology Virtual Elective Rotation for Medical Students and Residents: Implementation of a National Virtual Education Resource

Radiation Oncology Virtual Education Rotation (ROVER) is a virtual education platform developed to support radiation oncology (RO) education for medical students and residents. This national education platform was implemented to improve interest and knowledge in RO.

Junior Doctor Evaluation of Radiation Oncology Education and Training in Medical Schools and Prevocational Training in Australia.

The purpose of this study is to evaluate radiation oncology (RO)-specific education, confidence and knowledge of junior doctors in Australian teaching hospitals. A 38-item web-based survey was emailed to prevocational junior doctors working in Australian hospitals in New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between November 2017 and January 2018. The survey evaluated RO educational and clinical exposure of participants during medical school, and prevocational training and their confidence and knowledge of the specialty. A total of 183 respondents across 17 Australian hospital networks completed the survey. During medical school, 53.4% had RO incorporated into their formal curriculum, 19.5% had no formal lectures and 51.7% had never visited a RO department. As a junior doctor, 73.8% of respondents did not receive any formal RO education. When compared with other oncology specialties, fewer junior doctors were confident in consulting the RO team (21.0%) compared with medical oncology (42.0%), palliative care (75.2%) and haematology (40.1%). Majority of respondents (61.6%) showed limited understanding of radiation safety. On multivariate sub-group analysis, both confidence and knowledge in RO improved when RO was incorporated into the formal medical school curriculum. This survey highlights the current low confidence and poor knowledge standard amongst Australian junior doctors on RO due to inadequate teaching during medical school and prevocational training and suggests improvement through standardisation of formal RO curriculum teaching within medical school and prevocational training.

Assessment of the Impact of an Interprofessional Curriculum on Radiation Therapy Knowledge in Radiation Oncology Nursing Staff

Prior educational initiatives for radiation oncology nursing staff have been shown to improve self-reported confidence in managing common clinical scenarios. We sought to use an objective knowledge assessment to quantify the impact of an interprofessional curriculum on radiation therapy knowledge among radiation oncology nursing staff. We also sought to determine barriers preventing the successful implementation of this curriculum. Nursing staff from a single radiation oncology department participated in this study. A curriculum of nine 30-minute lectures was designed and administered to nurses twice monthly. Lectures were devised by radiation oncology residents and faculty as well as radiation therapists, medical physicists, and an expert in quality improvement methodology. Lecture topics included the management of commonly treated cancers, the basics of radiation planning and delivery, and special cases in radiation therapy. A standardized 18-item multiple choice question knowledge assessment was completed by participants pre- and post-curriculum. The objective knowledge assessment was adapted from a previously validated tool used to assess medical student knowledge of radiation oncology as well as prior nursing licensing exam questions. Pre- and post-curriculum total scores were compared using a paired sample t-test. Nurses received continuing education credits for participation. A total of 10 nursing staff participated. The interval between the pre- and post-curriculum assessments was 5.5 months. Post-test data was not available for a nurse who left the department mid-curriculum, and pre-test data was not available for 2 nurses (1 new hiree, 1 did not complete), leaving 7 nurses to be included in the analysis (response rate 70.0%). The majority of nurses (85.7%) attended at least 4 of 9 lectures. Mean scores on the knowledge assessment were 71.4% ± 11.3% pre-curriculum and 80.2% ± 9.0% post-curriculum (p=0.07). When the participant who attended less than 4 lectures was excluded from analysis, mean scores were 71.3% ± 12.4% pre-curriculum and 82.4% ± 7.4% post-curriculum (p=0.03). When total scores were broken into subdomains, mean scores pre- and post-curriculum were as follows: “Commonly treated cancers” 72.8% vs. 76.2%, “Radiation planning and delivery” 78.5% vs. 83.3%, and “Special cases in radiation therapy” 61.9% vs. 81.0%. This study suggests a formalized interprofessional education curriculum may objectively improve knowledge of radiation therapy among radiation oncology nursing staff. However, difficulties with attendance and typical staff turnover may serve as barriers to successful implementation. Future collaboration with other institutions to confirm the effectiveness of this approach and appreciation of barriers impacting successful uptake of nursing educational initiatives are warranted.

Oncology and Radiation Oncology Awareness in Final Year Medical Students in Australia and New Zealand.

This study aimed to determine final year students' core oncology and radiation oncology knowledge and attitudes about the quality of teaching in medical programmes delivered in Australia and New Zealand. Does the modern medical programme provide core oncology skills in this leading global cause of mortality and morbidity? An online survey was distributed between April and June 2018 and completed by 316 final year students across all 21 medical schools with final year cohorts in Australia and New Zealand. The survey examined teaching and clinical exposure, attitudes and core knowledge for oncology and radiation oncology. Several questions from a survey done of graduates in 2001 were repeated for comparison. We found that clinical exposure to oncology and its disciplines is low. Students rated oncology and haematology the worst taught medical specialties at medical school. Students reported the most confidence identifying when surgical management of cancer may be indicated and much lower levels of confidence identifying when systemic therapy and radiation therapy may be helpful. The majority of students had no formal course content on radiation therapy and more than one third of final year students erroneously believed that external beam radiation therapy turned patients radioactive. Exposure to oncology practice and the teaching of core oncology knowledge remains low for medical students in Australia and New Zealand. Many areas of oncology teaching and knowledge have worsened for medical students in Australia and New Zealand over the past 20years. Well-established gaps in the core oncology knowledge of medical graduates must be urgently addressed given the increasing incidence of cancer and ongoing underutilisation of radiation therapy in particular.

Objective Evaluation of a Didactic Curriculum for the Radiation Oncology Medical Student Clerkship

A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment. Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6months after receiving the curriculum. One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P<.01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values<.01). Post-scores for students rotating de novo at ROECSG institutions (n=30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n=55) (77.3% vs 68.8%, P=.01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6months after curriculum exposure (70.5% vs 65.6%, P=.11). Objective evaluation of a structured didactic curriculum for the radiationoncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completedclerkships at non-ROECSG institutions. These results support including a structureddidactic curriculum as a standard component of the radiation oncology clerkship.

DNA Methylation in Radiation-Induced Carcinogenesis: Experimental Evidence and Clinical Perspectives.

Ionizing radiation is a valuable tool in many spheres of human life. At the same time, it is a genotoxic agent with a well-established carcinogenic potential. Progress achieved in the last two decades has demonstrated convincingly that ionizing radiation can also target the cellular epigenome. Epigenetics is defined as heritable changes in the expression of genes that are not due to alterations of DNA sequence but consist of specific covalent modifications of chromatin components, such as methylation of DNA, histone modifications, and control performed by non-coding RNAs. Accumulating evidence suggests that DNA methylation, a key epigenetic mechanism involved in the control of expression of genetic information, may serve as one of the driving mechanisms of radiation-induced carcinogenesis. Here, we review the literature on the effects of ionizing radiation on DNA methylation in various biological systems, discuss the role of DNA methylation in radiation carcinogenesis, and provide our opinion on the potential utilization of this knowledge in radiation oncology.

Developing Bayesian networks from a dependency-layered ontology: A proof-of-concept in radiation oncology.

Bayesian networks (BNs) are graphical representations of probabilistic knowledge that offer normative reasoning under uncertainty and are well suited for use in medical domains. Traditional knowledge-based network development of BN topology requires that modeling experts establish relevant dependency links between domain concepts by searching and translating published literature, querying domain experts, or applying machine learning algorithms on data. For initial development these methods are time-intensive and this cost hinders the growth of BN applications in medical decision making. Further, this approach fails to utilize knowledge representation in medical fields to automate network development. Our research alleviates the challenges surrounding BN modeling in radiation oncology by leveraging an ontology based hub and spoke system for BN construction. We implement a hub and spoke system by developing (a) an ontology of knowledge in radiation oncology (the hub) which includes dependency semantics similar to BN relations and (b) a software tool that operates on ontological semantics using deductive reasoning to create BN topologies (the spokes). We demonstrate that network topologies built using the software are terminologically consistent and form networks that are topologically compatible with existing ones. We do this first by merging two different BN models for prostate cancer radiotherapy prediction which contain domain cross terms. We then use the logic to perform discovery of new causal chains between radiation oncology concepts. From the radiation oncology (RO) ontology we successfully reconstructed a previously published prostate cancer radiotherapy Bayes net using up-to-date domain knowledge. Merging this model with another similar prostate cancer model in the RO domain produced a larger, highly interconnected model representing the expanded scope of knowledge available regarding prostate cancer therapy parameters, complications, and outcomes. The causal discovery resulted in an automatically-built causal network model of all ontologized radiotherapy concepts between a 'Mucositis' complication and anatomic tumor location. The proposed model building approach lowers barriers to developing probabilistic models relevant to real-world clinical decision making, and offers a solution to the consistency and compatibility problems. Further, the knowledge representation in this work demonstrates potential for broader radiation oncology applications outside of Bayes nets.

Educational Impact of a Structured Radiation Oncology Clerkship Curriculum: An Interinstitutional Comparison

Abstract Purpose Many medical school clerkships have structured curricula; however, most radiation oncology clerkships do not. The Radiation Oncology Education Collaborative Study Group (ROECSG) implemented a curriculum for fourth-year radiation oncology clerkships at 14 institutions. We hypothesized that students completing clerkships with the curriculum would report greater subjective knowledge and comfort to function as a radiation oncology resident compared with students completing clerkships without the curriculum. Methods The ROECSG curriculum included three 1-hour lectures and a 1-hour hands-on radiation treatment planning workshop. Applicants to a single radiation oncology residency program in the 2014-2015 academic year were sent an anonymous, validated clerkship experience survey. Students indicated if clerkships were completed at a curriculum site. Likert-type data (1 = not at all, 5 = extremely) are reported as median (interquartile range). Results Respondents described 276 clerkship experiences, of which 64 (23.2%) were completed at a curriculum site. Students whose first clerkship was at a curriculum site perceived greater postclerkship confidence in knowledge of radiation biology (3 [3-4] versus 2 [2-3], P P P P P Conclusions These results support the curriculum's ability to increase student knowledge in radiation oncology, especially in the students' first clerkship. Further, these findings suggest that expanded implementation of such curricula may ensure a rewarding educational experience during radiation oncology clerkships.

Educational Impact of a Structured Radiation Oncology Clerkship Curriculum: An Interinstitutional Comparison

PurposeMany medical school clerkships have structured curricula; however, most radiation oncology clerkships do not. The Radiation Oncology Education Collaborative Study Group (ROECSG) implemented a curriculum for fourth-year radiation oncology clerkships at 14 institutions. We hypothesized that students completing clerkships with the curriculum would report greater subjective knowledge and comfort to function as a radiation oncology resident compared with students completing clerkships without the curriculum. MethodsThe ROECSG curriculum included three 1-hour lectures and a 1-hour hands-on radiation treatment planning workshop. Applicants to a single radiation oncology residency program in the 2014-2015 academic year were sent an anonymous, validated clerkship experience survey. Students indicated if clerkships were completed at a curriculum site. Likert-type data (1 = not at all, 5 = extremely) are reported as median (interquartile range). ResultsRespondents described 276 clerkship experiences, of which 64 (23.2%) were completed at a curriculum site. Students whose first clerkship was at a curriculum site perceived greater postclerkship confidence in knowledge of radiation biology (3 [3-4] versus 2 [2-3], P < .01), treatment setup/positioning (3 [2-3] versus 2 [2-3], P < .05), treatment planning (3 [2-3] versus 2 [2-3], P < .01), and ability to integrate evidence-based medicine into treatment (4 [2-4] versus 3 [2-4], P < .05). Students who completed any clerkship with the curriculum had greater postclerkship confidence to function as a radiation oncology resident (3 [3-4] versus 3 [2-3], P < .05). ConclusionsThese results support the curriculum’s ability to increase student knowledge in radiation oncology, especially in the students’ first clerkship. Further, these findings suggest that expanded implementation of such curricula may ensure a rewarding educational experience during radiation oncology clerkships.

A National Assessment of Medical Student Knowledge in Radiation Oncology and Comparison to Primary Care and Radiation Oncology Attending Physicians

To (1) evaluate and compare knowledge of 1st year (MS1) vs 4th year (MS4) medical students about radiation therapy (RT); and (2) compare MS1 and MS4 knowledge of RT to institution-matched primary care physicians (PCPs) and radiation oncology (RO) attending physicians.