Treatment planning and dosimetry are integral to the practice of radiation oncology, and a strong foundation in these areas enables physicians to safely care for patients. However, given the demands of clinical training and the lack of a standardized formal curriculum, treatment planning and dosimetry education is often informal. This study examines the state of treatment planning and dosimetry education at the resident physician level in the United States. Current radiation oncology residents were identified in Fall 2018 using the Association of Residents in Radiation Oncology (ARRO) directory. A survey was developed with input from multiple stakeholders to evaluate aspects of existing curricula, educational opportunities relevant to clinical rotations, and trainee comfort. Invitations to complete the survey were sent by email, with a single reminder. The survey was administered using REDCap and all responses were deidentified. This study was IRB exempt. The survey response rate was 32% (191/592). Twenty-six percent of residents reported a mandatory treatment planning/dosimetry rotation at their program, typically conducted over 2–4 weeks. Of these rotations, the vast majority (96%) were observerships, with 30% including didactics, 24% including practice modules, and 18% including independent treatment planning. Twenty-four percent of respondents (45/191) were less than moderately comfortable (<3 on scale of 1–5) evaluating treatment plans. This was associated with level of training (85% for postgraduate year (PGY) 2 residents, 22% PGY3, 10% PGY4, and 2% PGY5, p < 0.001). Residents with a mandatory treatment planning and dosimetry rotation were more comfortable evaluating plans (p = 0.045), working with treatment planning systems (p = 0.027), and requesting changes to plans (p = 0.023) compared to residents without mandatory rotations. Residents reported using a median of two treatment planning systems (range 1–6). 83% of residents (159/191) used a standard approach when evaluating treatment plans, which was not significantly different by PGY level (p = 0.61). Forty-three percent of residents (82/191) reported reviewing 50% or fewer contours with an attending. 71% of residents (136/191) reported reviewing 50% or fewer plans with an attending. Overall, 60% (115/191) reported insufficient exposure to treatment planning and dosimetry. Among PGY5 residents, this rate was 52% (25/48). Over 90% of residents expressed interest in supplemental treatment planning and dosimetry resources. The majority of residents, even at the PGY5 level, feel they have insufficient exposure to treatment planning and dosimetry. As only one-quarter of programs have mandatory rotations, which typically take the form of observerships, development of a standardized, practical treatment planning and dosimetry curriculum would offer the opportunity to improve resident education and ultimately quality of care and patient safety on a broad scale.
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Oct 8, 2019
Matthias Bethge + 4
Open Access