Oncology Education Collaborative Study Group Research Articles

Patient Education Practices and Preferences of Radiation Oncologists and Interprofessional Radiation Therapy Care Teams: A Mixed-Methods Study Exploring Strategies for Effective Patient Education Delivery

Purpose/ObjectivesPatients’ understanding of radiotherapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. Materials/MethodsAn anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group (ROECSG) members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. Results113 ROECSG members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices amongst radiation oncologists differed according to RT clinical workflow timing (consultation vs simulation vs first RT, respectively): one-on-one teaching: 88.5% vs 49.4% vs 56.3%, p<0.01 and paper handouts: 69.0% vs 28.7% vs 16.1%, p<0.01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. ConclusionsRadiation oncologists and interprofessional RO team members engage in PE, with most utilizing institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery.

Patient Education Practices and Preferences of Interprofessional Radiation Oncology Providers

Patient understanding of radiotherapy (RT) processes and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. Our objective was to evaluate PE practices and preferences of interprofessional RO providers to inform recommendations for delivering inclusive, accessible, and patient-centered education. An anonymous 17-item online survey, approved by an ethics review board, was administered to all members of the Radiation Oncology Education Collaborative Study Group (ROECSG) between 10/5/22 to 11/23/22. Respondent demographics, provider practices/preferences, and institutional practices were collected. Qualitative items explored key strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by provider role and PE timing. Thematic analysis was used for qualitative responses. A total of 123 ROECSG members, including RO attendings (64%), RO trainees (21%), medical physicists (7%), physician assistants/nurses (2%), and radiation therapists (2%), completed the survey (31% response rate). Most practiced in an academic setting (86%) in North America (82%). The most common PE resources used were custom created institution-specific (61%) and electronic health system generated materials (38%). PE was delivered primarily by one-on-one teaching (72%), paper handouts (69%), and organizational websites (21%) (e.g., RTanswers.org). Almost half (41%) reported that PE practices differed based on type of clinical encounter, for example paper handouts for in-person visits and multimedia for virtual visits. The majority (86%) stated that their institution has disease site-specific PE materials, with nearly all having breast cancer materials (91%). Only 58% reported access to non-English PE materials. RO attendings/trainees were more likely than other team members to deliver PE at consultation (98% vs 71%, p = 0.03). PE practices amongst radiation oncologists differed according to the timing along the RT care path (consultation vs simulation vs first fraction, respectively): one-on-one teaching: 89% vs 49% vs 56%, p<0.01 and paper handouts: 69% vs 28% vs 16%, p<0.01. Key PE strategies included incorporating multimedia resources, personalizing delivery, and repetition at multiple timepoints by the interprofessional team. Limited time, inadequate administrative support, and lack of customized resources were identified as challenges in PE delivery. Interprofessional RO providers engage in PE, with most utilizing institution-specific materials. PE practices differ according to the type of clinical encounter and timing in the RT care path. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources based on language, learning styles, and cultural preferences are needed to foster high-quality, patient-centered PE delivery.

TEAMRO: TEAching Mentorship in Radiation Oncology, a Multicenter Prospective Phase 2 Intervention Study on Teaching Mentorship Skills to Residents Working with Medical Students

While formal curriculum on resident teaching have been associated with improved career growth and sustained positive impact on patient care, mentorship skills are rarely taught in academic medicine. We hypothesized that a formalized resident mentorship curriculum coupled with a near-peer resident-medical student mentoring program would improve resident career growth. A multi-institutional, prospective, phase 2 intervention study, approved by each participating center's institutional review board, was conducted from 4/2022-10/2022 among interested residents in the Radiation Oncology Education Collaborative Study Group Graduate Medical Education. Intervention included: 1) a 4-week mentorship curriculum (utilizing a Six Steps approach) composed of self-guided readings, didactic lecture, and 30-minute faculty check-in, and 2) a formalized 1:1 resident-medical student mentorship program during an existing radiation oncology sub-internship with weekly meetings. Resident participants completed the Mentorship Competency Assessment (MCA), a 26-item validated survey on mentorship skills in medicine scored from 0 (most unprepared) to 7 (most prepared) before and after the intervention. The primary endpoint was average change in MCA skill from pre- to post-intervention survey, with score ranges from -7 (a decrease in 7 points) to +7 (an increase of 7 points). A total of 8 residents participated and all completed pre- and post-intervention surveys. Most residents were PGY-4/5 (75%), from programs with >10 residents (68%), and did not have prior training in teaching (88%) or mentorship (88%). Residents met students on average twice weekly (range 1-3) for an average of 2 hours a week (range 1-5). After the program, most residents felt confident in being a future mentor to students (100%), their overall well-being was positively impacted (63%), and their mentorship relationships were positively impacted (50%). All 26 mentorship skills increased on MCA after intervention (average +1.3/7 per skill). Skills that showed greatest improvement were helping mentees network effectively (+2.6/7), acquire resources (+2.1/7), negotiate a path to professional independence (+2.0/7), set career goals (+1.8/7), and balance work and personal life (+1.7/7). Skills that showed least improvement were establishing a relationship based on trust (+0.4/7), identifying and accommodating different communication styles (+0.6/7), providing constructive feedback (+0.7/7), and aligning mentor-mentee expectations (+0.8/7). The formalized mentorship program improved mentorship skills among residents, translating to increased satisfaction in residents' own mentorship relations and overall well-being. Further studies are needed to assess the sustainability of these skills, as well as impact on career growth and satisfaction.

Teaching Trainees to be Effective Mentors: A Needs-Based Assessment in Radiation Oncology

Mentorship plays a critical role in the training and career development of medical trainees. Teaching-the-teacher workshops for residents translate to higher long-term job satisfaction and improved patient communication skills. Further, near-peer mentorship has been associated with increased job satisfaction and patient care experience. Resident-as-mentors can add benefit to the mentorship networks of students, particularly in resource-limited environments, while benefiting residents' own mentorship relations and career satisfaction. We hypothesized that residents would desire to be a mentor, but would lack specific skills needed for effective mentoring of students in radiation oncology. A multi-institution, cross-sectional study was conducted among residents in the Radiation Oncology Education Collaborative Study Group (ROECSG) Graduate Medical Education working group from 06/2022-10/2022. Participants completed the Mentorship Competency Assessment (MCA), a validated 26-item questionnaire, scored on a Likert scale from 0-7 (0: most unprepared with mentorship skill, 7: most prepared with mentorship skill). The primary endpoint was the average score in individual mentorship skills among participants. Kruskal-Wallis test assessed associations between total MCA score (range 0-182) and demographics. A total of 36 of 39 participants (92% response rate) responded. A majority were male (58%), from a residency size >10 (75%), and P Gy-2/3 (52%). Most had no formal training in teaching (86%) or mentorship (89%). Many believed they would be a good mentor to students on a rotation (89%), but most felt they would benefit from a formal mentorship program (92%). From the MCA, the mentorship skills residents felt most unprepared for were: coordinating effectively with other mentors (3.4/7), helping mentees acquire resources (3.6/7), negotiating a path to professional independence with mentees (3.6/7), helping mentees network effectively (3.7/7), and working with mentees to set clear expectations of the mentoring relationship (3.9/7). The mentorship skills residents felt most prepared for were: acknowledging mentees' professional contributions (5.6/7), establishing a relationship based on trust (5.6/7), active listening (5.5/7), building mentees' confidence (4.9/7), and working effectively with mentees with personal backgrounds differing from one's own (4.8/7). Higher MCA scores were associated with former training in mentorship (p = 0.0143), and a trend for former training in teaching (p = 0.0525), but was not associated with sex (p = 0.5986), residency size (p = 0.1415), or P Gy-year (p = 0.9747). Residents are interested in mentorship training and report unpreparedness in several important skills. Future work should focus on formal training and assessment of mentoring skills for residents.

Radiation Oncology Providers' Practices and Preferences for Delivering Patient Education on Radiation Therapy: A Mixed Methods Study

Background Patient understanding of the radiation treatment process, including anticipated logistics, side effects, and outcomes of treatment, is often limited. We lack data on optimal radiation oncology provider approaches to patient education. Our objective was to assess patient education practices and preferences of interdisciplinary radiation oncology providers to inform recommendations for providers and institutions. Methods An anonymous, web-based survey was developed in collaboration with the Radiation Oncology Education Collaborative Study Group (ROECSG) Patient Education Working Group and distributed to all members of the ROECSG listserv via Qualtrics in October 2022. The survey contained 17 items: 13 multiple choice and 4 open-ended. Descriptive statistics summarized survey responses. Thematic analysis was used to analyze qualitative responses. Results 123 ROECSG members completed the survey (31% response rate). Most respondents were radiation oncology attendings (64%), worked in an academic/university affiliated setting (86%), and were in North America (82%). Aside from verbal communication, the most common educational approaches used were institution-specific materials (61%) and electronic health system-generated materials (38%). 41% of respondents highlighted that their patient education practices differed according to whether assessments were in-person or virtual; printed handouts versus Internet images/videos were used most often for in-person versus virtual visits, respectively. A majority (86%) stated that their institution utilized disease site-specific patient education materials. Over half (58%) reported that their institution had non-English materials available. Review of patient education materials by staff (53%) was the most common assessment method, though 19% reported no assessment of materials at their institution. Among institutions with an assessment process, respondents were largely "unsure" (56%) of the assessment frequency. On qualitative analysis, a central theme surrounding challenges for providing patient education was lack of time for providers to deliver and patients to review materials provided. Respondents also identified administrative roadblocks such as inadequate leadership support, training, and funding for developing education materials. Key strategies for successful patient education included using visual/multimedia materials, personalizing content for patients/caregivers (e.g., based on their learning styles, preferences, and language), reiterating information at multiple timepoints by multiple team members, and utilizing active education (e.g., teach-back method, encouraging notetaking, involving caregivers). Discussion Many radiation oncology providers use institution-specific and disease site-specific materials to provide patient education, with personalization of content for patients differing for in-person versus virtual environments. Increased adoption of visual/multimedia materials and partnerships with organizational leadership may facilitate access to and contribute towards the development of high-quality, tailored patient education resources. Patient understanding of the radiation treatment process, including anticipated logistics, side effects, and outcomes of treatment, is often limited. We lack data on optimal radiation oncology provider approaches to patient education. Our objective was to assess patient education practices and preferences of interdisciplinary radiation oncology providers to inform recommendations for providers and institutions. An anonymous, web-based survey was developed in collaboration with the Radiation Oncology Education Collaborative Study Group (ROECSG) Patient Education Working Group and distributed to all members of the ROECSG listserv via Qualtrics in October 2022. The survey contained 17 items: 13 multiple choice and 4 open-ended. Descriptive statistics summarized survey responses. Thematic analysis was used to analyze qualitative responses. 123 ROECSG members completed the survey (31% response rate). Most respondents were radiation oncology attendings (64%), worked in an academic/university affiliated setting (86%), and were in North America (82%). Aside from verbal communication, the most common educational approaches used were institution-specific materials (61%) and electronic health system-generated materials (38%). 41% of respondents highlighted that their patient education practices differed according to whether assessments were in-person or virtual; printed handouts versus Internet images/videos were used most often for in-person versus virtual visits, respectively. A majority (86%) stated that their institution utilized disease site-specific patient education materials. Over half (58%) reported that their institution had non-English materials available. Review of patient education materials by staff (53%) was the most common assessment method, though 19% reported no assessment of materials at their institution. Among institutions with an assessment process, respondents were largely "unsure" (56%) of the assessment frequency. On qualitative analysis, a central theme surrounding challenges for providing patient education was lack of time for providers to deliver and patients to review materials provided. Respondents also identified administrative roadblocks such as inadequate leadership support, training, and funding for developing education materials. Key strategies for successful patient education included using visual/multimedia materials, personalizing content for patients/caregivers (e.g., based on their learning styles, preferences, and language), reiterating information at multiple timepoints by multiple team members, and utilizing active education (e.g., teach-back method, encouraging notetaking, involving caregivers). Many radiation oncology providers use institution-specific and disease site-specific materials to provide patient education, with personalization of content for patients differing for in-person versus virtual environments. Increased adoption of visual/multimedia materials and partnerships with organizational leadership may facilitate access to and contribute towards the development of high-quality, tailored patient education resources.

Development of a United States Radiation Oncology Curricular Framework: A Stakeholder Delphi Consensus

A United States (US) radiation oncology curriculum, developed using best practices for curriculum inquiry, is needed to guide residency education and qualifying examinations. Competency-based training, including entrustable professional activities (EPAs), provides an outcomes-based approach to modern graduate medical education. This study aimed to define US radiation oncology EPAs and curricular content domains using a deliberative process with input from multiple stakeholder groups. The Radiation Oncology Education Collaborative Study Group Core Curriculum Project Leadership Committee developed initial content domains and EPAs. Following recruitment of stakeholders, a Delphi process was used to achieve consensus. In the first round, content domains and EPAs were reviewed for inclusion and exclusion, clarity, time allocation (content domains), and level of training (EPAs). Participants submitted additional content domains and EPAs for consideration. Any content domains or EPAs 1 standard deviation below the median for inclusion and exclusion underwent Leadership Committee review. All participants completing the first Delphi round were invited to the second round. Percent curriculum time allocated for content domains and a single subdomain were finalized. New EPAs or EPAs undergoing major revisions were reviewed. A total of 186 participants representing diverse stakeholder groups participated. One hundred fourteen completed the first Delphi round (61.3%). Of 114 invited, 77 participants completed the second round of the Delphi process (67.5%). Overall, 6 of 9 content domains met consensus, 1 content domain was removed, and 2 content domains were combined. Four subdomains of a single content domain were reviewed and met consensus. Consensus on percent time allocated per content domain and subdomain was reached. Of 55 initial EPAs, 52 final EPAs met consensus. Deliberative curriculum inquiry was successfully used to develop a consensus on US radiation oncology content domains and EPAs. These data can guide the allocation of educational time in training programs, help inform weighting for qualifying examinations, and help guide clinical training and resident assessment.

Cancer Careers a ROECSGXLearnOncology podcast: Increasing Accessibility to Information about Oncology Careers

Purpose In recent years, medical student (MS) applications to U.S. and Canadian radiation oncology (RO) residency programs have declined. The Radiation Oncology Education Collaborative Study Group (ROECSG) recently formed an Undergraduate Medical Education (UGME) committee consisting of attending physicians, residents, and MSs across the globe to further UGME educational efforts. This group identified a need for outreach activities to increase exposure to and interest in RO. Methods In collaboration with LearnOncology, an online, interactive tool to teach oncology skills to learners at all levels, the UGME subcommittee created a structure for a podcast series to highlight oncology careers. This podcast series will be hosted on LearnOncology. Together, these groups identified key topics, informally surveyed MSs, wrote a standardized script, trained interviewers on recording and editing audio content, and set goals for the future scope of the podcast. Results MS and resident interviewers recently completed training and have scheduled initial faculty interviews. Edited podcast episodes will be ≤20 minutes, conducted informally to spotlight both the career and personality of the interviewee. Prominent oncology specialists (e.g. radiation, surgery, medicine, interventional radiology, and physics) will be featured. Listeners will be prompted to complete a brief survey. Interviewers and interviewees will partake in a separate survey to examine the impact of project participation. Podcast analytics and survey data will guide subsequent iterations of podcast episodes. Discussion Podcasts for UGME are a cost-effective teaching method, which gained popularity during the COVID-19 pandemic. We hypothesize that this podcast will be a unique way to positively impact undecided MSs facing the challenge of choosing a career path and increase awareness about oncology specialties. Additionally, this may positively impact mentorship through linking MS and resident interviewers to specialist interviewees. The LearnOncologyXROECSG podcast platform, Cancer Careers, was created to address student questions, anxieties, and excitement related to choosing an oncology career. We expect that this project will increase exposure to oncology and MS interest in oncology careers, including RO. In recent years, medical student (MS) applications to U.S. and Canadian radiation oncology (RO) residency programs have declined. The Radiation Oncology Education Collaborative Study Group (ROECSG) recently formed an Undergraduate Medical Education (UGME) committee consisting of attending physicians, residents, and MSs across the globe to further UGME educational efforts. This group identified a need for outreach activities to increase exposure to and interest in RO. In collaboration with LearnOncology, an online, interactive tool to teach oncology skills to learners at all levels, the UGME subcommittee created a structure for a podcast series to highlight oncology careers. This podcast series will be hosted on LearnOncology. Together, these groups identified key topics, informally surveyed MSs, wrote a standardized script, trained interviewers on recording and editing audio content, and set goals for the future scope of the podcast. MS and resident interviewers recently completed training and have scheduled initial faculty interviews. Edited podcast episodes will be ≤20 minutes, conducted informally to spotlight both the career and personality of the interviewee. Prominent oncology specialists (e.g. radiation, surgery, medicine, interventional radiology, and physics) will be featured. Listeners will be prompted to complete a brief survey. Interviewers and interviewees will partake in a separate survey to examine the impact of project participation. Podcast analytics and survey data will guide subsequent iterations of podcast episodes. Podcasts for UGME are a cost-effective teaching method, which gained popularity during the COVID-19 pandemic. We hypothesize that this podcast will be a unique way to positively impact undecided MSs facing the challenge of choosing a career path and increase awareness about oncology specialties. Additionally, this may positively impact mentorship through linking MS and resident interviewers to specialist interviewees. The LearnOncologyXROECSG podcast platform, Cancer Careers, was created to address student questions, anxieties, and excitement related to choosing an oncology career. We expect that this project will increase exposure to oncology and MS interest in oncology careers, including RO.

Design and implementation of a radiation oncology standardized letter of evaluation (RO-SLOE) for the evaluation of medical students and radiation oncology residency applicants

<h3>Background</h3> Prior research has shown that clerkship grades and letters of recommendation for radiation oncology residency applicants are susceptible to grade inflation and bias, both of which diminish the utility of these criteria when evaluating prospective candidates. This is especially pertinent in light of the shift of USMLE Step 1 to Pass/Fail and recent initiatives in our field to better promote diversity, equity, and inclusion. Other fields such as emergency medicine have implemented a standardized letter of evaluation (SLOE) to address these and other concerns. This project will seek to design and adopt a new radiation oncology SLOE (RO-SLOE). <h3>Methods</h3> Members of the Radiation Oncology Education Collaborative Study Group (ROECSG) Undergraduate Medical Education (UGME) working group designed a survey to assess attitudes regarding the efficacy and design of a RO-SLOE. This is conditionally approved under an educational IRB waiver and pending full IRB approval. The survey population will be members of the Association of Directors of Radiation Oncology Programs (ADROP), current residency program directors, and medical school clerkship directors. <h3>Results</h3> Our data will provide a contemporary snapshot of residency admissions practices, willingness of residency programs to consider the RO-SLOE in the admissions process and provide a framework to design novel questions for inclusion on a final RO-SLOE. We anticipate that a RO-SLOE would transparently reflect applicant's level of preparedness for residency compared to their peers, reflect institutional and evaluator grading practices, and allow for narrative feedback to qualify these objective metrics. <h3>Discussion</h3> We expect that the RO-SLOE will offer a novel, easily adaptable means to provide both actionable feedback to medical students and a standardized admissions criterion to residency programs to better discriminate between applicants. A RO-SLOE may promote greater diversity in the residency admissions process by minimizing sources of bias in clerkship evaluations and encouraging a shift to more holistic candidate review. By working with stakeholders, we hope to facilitate the RO-SLOE's incorporation into medical school clerkship evaluations and the residency application process.

Development of a United States Radiation Oncology Curricular Framework: A Stakeholder Delphi Consensus

<h3>Purpose/Objective(s)</h3> A United States (US) radiation oncology (RO) curriculum, developed by key stakeholders using best practices for curriculum inquiry, is needed to guide residency education and qualifying examinations. Competency-based training, including entrustable professional activities (EPAs), provides an outcomes-based approach to modern graduate medical education. This study developed the first list of US RO EPAs and curricular content domains (CDs) to guide resident training and assessment in the modern era. <h3>Materials/Methods</h3> The Radiation Oncology Education Collaborative Study Group (ROECSG) Core Curriculum Project Leadership Committee (LC) developed initial EPAs and CDs. Following recruitment of stakeholders, a Delphi process was used for consensus. In the first Delphi, EPAs and CDs were reviewed for inclusion/exclusion, clarity, level of training (EPAs only), and time allocation (CDs only). Participants submitted additional EPAs/CDs for consideration. Any EPA or CD one standard deviation below the median underwent LC review. All participants completing the first Delphi were invited to the second. New EPAs or EPAs undergoing major revisions were re-reviewed. Percent allocated curriculum time was finalized for CDs and for a single subdomain (SD). <h3>Results</h3> 186 participants representing diverse RO stakeholder groups volunteered to participate. 114 completed the first Delphi (61.3%): 6/9 CDs met consensus, 1 CD was removed, 2 CDs were combined (Table 1). Of 114 invited, 77 participants completed the second Delphi (67.5%). Of 55 initial EPAs, 52 final EPAs met consensus. 4 SDs of a single CD (Applied Sciences) were reviewed and met consensus. Consensus on percent time allocated per CD and SD was reached (Table 1). <h3>Conclusion</h3> Deliberative curriculum inquiry was successfully used to develop a consensus on US RO CDs/SDs and EPAs. These data can guide educational time in training programs and help inform weighting for qualifying examinations. CDs are not exclusive; educators must ensure all CDs are considered when delivering curriculum content, regardless of the primary CD. RO-specific EPAs can guide clinical training and resident assessment. The Delphi should be used to reach consensus recommendations for SD content breakdown. Given the evolving nature of RO and the need for curriculum renewal, the Delphi process will be repeated on an interval basis.

The Radiation Oncology Education Collaborative Study Group 2020 Spring Symposium: Is Virtual the New Reality?

Because of the COVID-19 pandemic, the Radiation Oncology Education Collaborative Study Group (ROECSG) hosted its annual international symposium using a virtual format in May 2020. This report details the experience of hosting a virtual meeting and presents attendee feedback on the platform.

Radiation Oncology Education Collaborative Study Group Annual Spring Symposium: Initial Impact and Feedback.

The Radiation Oncology Education Collaborative Study Group (ROECSG) is an international collaborative network of radiation oncology (RO) professionals with the goal of improving RO education. This report summarizes the first two ROECSG annual symposia including an overview of presentations and analysis of participant feedback. One-day symposia were held in June 2018 and May 2019. Programs included oral and poster presentations, RO education leadership perspectives, and keynote addresses. Post-symposia surveys were collected. Research presentations were recorded and made available online. The 2018 symposium was had 36 attendees from 25 institutions in three countries. The 2019 symposium had 76 individuals from 41 institutions in five countries. Attendees represented diverse backgrounds including attending physicians (46%), residents (13%), medical students (14%), physicists (2%), nurses (1%), and program coordinators (1%). Fifty-five oral presentations were given with 53 released online. Ninety percent of attendees rated the symposium as improving their knowledge of RO educational scholarship, 98% felt the symposium provided the opportunity to receive feedback on RO education scholarship, and 99% felt that the symposium fostered the development of collaborative RO education projects. ROECSG was rated higher than professional organizations in fostering educational scholarship (p<0.001). All attendees felt that the symposium produced new RO education scholarship ideas and provided unique networking opportunities. The first two ROECSG symposia drew a diverse population of attendees and provided unique opportunities for presentation of RO education scholarship. Future ROECSG symposia will be designed to enhance opportunities to present RO education scholarship and to facilitate networking.

The Radiation Oncology Education Collaborative Study Group 2020 Spring Symposium: Is Virtual the New Reality?

Because of the COVID-19 pandemic, the Radiation Oncology Education Collaborative Study Group (ROECSG) hosted its annual international symposium using a virtual format in May 2020. This report details the experience of hosting a virtual meeting and presents attendee feedback on the platform. The ROECSG symposium was hosted virtually on May 15, 2020. A postsymposium survey was distributed electronically to assess attendee demographics, participation, and experience. Attendee preference and experience were queried using 3-point and 5-point Likert-type scales, respectively. Symplur LLC was used to generate analytics for the conference hashtag (#ROECSG). The survey was distributed to all 286 registrants, with a response rate of 67% (191 responses). Seventeen nonattendee responses were omitted from this analysis, for a total of 174 included respondents. Eighty-two attendees (47%) were present for the entire symposium. A preference for a virtual symposium was expressed by 78 respondents (45%), whereas 44 (25%) had no preference and 52 (30%) preferred an in-person meeting. A total of 150 respondents (86%) rated the symposium as "extremely" well organized. Respondents who had not attended a prior in-person ROECSG symposium were more likely to prefer the virtual format (P = .03). Seventy-eight respondents (45%) reported a preference for the virtual platform for reviewing scholarly work, and 103 (59%) reported a preference for an in-person platform for networking. On the day of the symposium, #ROECSG had 408 tweets and 432,504 impressions. The 2020 ROECSG symposium was well received and can serve as a framework for future virtual meetings. Although the virtual setting may facilitate sharing research, networking aspects are more limited. Effort is needed to develop hybrid virtual and in-person meetings that meet the needs of participants in both settings. Social media is a significant avenue for dissemination and discussion of information and may be valuable in the virtual setting.

Radiation Oncology Education Collaborative Study Group Annual Spring Symposium: Initial Impact and Feedback

The Radiation Oncology Education Collaborative Study Group (ROECSG) is an international collaborative network of radiation oncology (RO) professionals with the goal of improving RO education. This report summarizes the first two ROECSG annual symposia including an overview of presentations and analysis of participant feedback. One-day symposia were held in June 2018 and May 2019. Programs included oral and poster presentations, RO education leadership perspectives, and keynote addresses. Post-symposia surveys were collected. Research presentations were recorded and made available online. The 2018 symposium was had 36 attendees from 25 institutions in three countries. The 2019 symposium had 76 individuals from 41 institutions in five countries. Attendees represented diverse backgrounds including attending physicians (46%), residents (13%), medical students (14%), physicists (2%), nurses (1%), and program coordinators (1%). Fifty-five oral presentations were given with 53 released online. Ninety percent of attendees rated the symposium as improving their knowledge of RO educational scholarship, 98% felt the symposium provided the opportunity to receive feedback on RO education scholarship, and 99% felt that the symposium fostered the development of collaborative RO education projects. ROECSG was rated higher than professional organizations in fostering educational scholarship (p<0.001). All attendees felt that the symposium produced new RO education scholarship ideas and provided unique networking opportunities. The first two ROECSG symposia drew a diverse population of attendees and provided unique opportunities for presentation of RO education scholarship. Future ROECSG symposia will be designed to enhance opportunities to present RO education scholarship and to facilitate networking.

Continuing Medical Student Education During the Coronavirus Disease 2019 (COVID-19) Pandemic: Development of a Virtual Radiation Oncology Clerkship

PurposeOur institution cancelled all in-person clerkships owing to the coronavirus disease 2019 pandemic. In response, we designed a virtual radiation oncology medical student clerkship. Methods and MaterialsWe convened an advisory panel to design a virtual clerkship curriculum. We implemented clerkship activities using a cloud-based learning management system, video web conferencing systems, and a telemedicine portal. Students completed assessments pre- and postclerkship to provide data to improve future versions of the clerkship. ResultsThe virtual clerkship spans 2 weeks and is graded pass or fail. Students attend interactive didactic sessions during the first week and participate in virtual clinic and give talks to the department during the second week. Didactic sessions include lectures, case-based discussions, treatment planning seminars, and material adapted from the Radiation Oncology Education Collaborative Study Group curriculum. Students also attend virtual departmental quality assurance rounds, cancer center seminars, and multidisciplinary tumor boards. The enrollment cap was met during the first virtual clerkship period (April 27 through May 8, 2020), with a total of 12 students enrolling. ConclusionsOur virtual clerkship can increase student exposure and engagement in radiation oncology. Data on clerkship outcomes are forthcoming.

Report on the First Annual Symposium for the Radiation Oncology Education Collaborative Study Group

The Radiation Oncology Education Collaborative Study Group (ROECSG) was founded in 2013 as a collaborative platform to promote and study education initiatives within Radiation Oncology (RO), modelled after clinical cooperative research groups. Given limited opportunities for live presentation and extended discussion of RO specific educational research, the first annual ROECSG symposium was held in Chicago in June 2018. This report summarizes symposium proceedings, analyzes participant feedback regarding challenges and opportunities for RO education scholarship, and evaluates attendee perceptions of the symposium. This one day symposium consisted of research talks, perspectives from the Association of Directors of Radiation Oncology Program (ADROP) leadership, and a keynote speaker on the topic of medical education scholarship. Presentations were recorded and made available online (https://voices.uchicago.edu/roecsg/events/2018symposium/). A 30-item feedback survey instrument was administered at the close of the symposium. There were 40 attendees from 20 institutions including international representation from Canada and Europe. Participants included attending physicians (50%), residents (33%), medical students (11%), nurses (3%), and program coordinators (3%). 86% of participants were involved with either undergraduate or graduate medical education. Twenty-two moderated scholarly presentations were given on topics, including curriculum development, mentorship, and wellness, with focus on technology, simulation based medical education, and innovative learning tools. Participants reported a median of 2 (interquartile range 0-3) poster presentations of their educational research in the past two years but a median of 0 (interquartile range 0-1) oral presentations. 55% of attendees gave an oral presentation at the symposium. 68% felt there was a lack of opportunity to present their RO education scholarship at other meetings. 29% reported a lack of education research-oriented seminars, funding, or mentorship at their respective institutions. 97% of participants felt the symposium provided ample opportunity for feedback and networking on their RO education scholarly activities. All felt that the symposium provided a forum to foster development of collaborative education projects. The first annual ROECSG symposium provided a new venue for educational scholarship presentation, development, networking, and collaboration. Feedback confirmed a unique opportunity for oral presentation and discussion of ROcentric education research. Impact on subsequent scholarship activities will be assessed on follow up surveys. Given the diverse attendee pool, this forum may also allow for development of interprofessional education. Based on the success of this first ROECSG symposium the organizing committee plans to make this an annual event.

Evaluation of a Multi-Modal Radiation Oncology Elective for First-Year Medical Students

Given the paucity of exposure to radiation oncology in the undergraduate medical curriculum, it is important to provide alternative avenues for interested students early in their medical careers. The objective of this project was to evaluate student understanding of the role of radiation oncology in the treatment of cancer, interest in conducting summer research with radiation oncology faculty, and interest in future radiation (as well as medical and surgical) oncology education after completion of an elective course. First-year medical students received lectures derived from the Radiation Oncology Education Collaborative Study Group with additional lectures given by faculty presenting current research endeavors and clinical cases. In addition, medical students had the opportunity to participate in clinic and the treatment planning workflow. Pre and post-course student knowledge was assessed with multiple-choice quizzes. A survey was administered before and after the elective to evaluate both interest and self-perceived understanding of the field. Students also rated each component of the course and each speaker. We used paired t-tests to assess pre- and post-course differences in quiz/survey results. Interest in radiation oncology training was correlated to the rating of each aspect of the course using the Pearson Correlation. 25 students took the course and contributed data. Students scored significantly higher on the quiz after the course; the average score improved 20% (p < 0.05). We noted a significant increase in students' self-perceived understanding of: a) cancer treatment; b) the role of radiation therapy; c) limits and challenges of radiation therapy; and d) ability to discuss research topics in radiation oncology. The majority of students expressed an interest in pursuing the radiation oncology clinical clerkship (84%) and in pursuing additional oncology educational opportunities in medical school (100%), both before and after the elective. The course did slightly alter the distribution of interest in pursuing radiation oncology residency training. The number of students with moderate interest decreased after the course, while the number of students with very high or low interest increased. The course was rated highly with 84% of students recommending the class to others. Anonymous narrative feedback revealed enjoyment in the clinical shadowing experience, as well as a need to tailor course material to the level of a first-year medical student. A single-institution first year medical student elective enhanced understanding of the principles and research opportunities in radiation oncology. At the completion of the elective, most students expressed an interest in radiation oncology residency. It appears that the elective helped students determine whether a career in radiation oncology may be a good fit. We plan to improve this course by tailoring the lecture material to the level of the first-year medical student.

National Radiation Oncology Medical Student Clerkship Trends From 2013 to 2018

The purpose of this study was to assess national trends in fourth-year medical student radiation oncology clerkships over the past 6 academic years. Results demonstrate a national trend toward inclusion of structured didactics in radiation oncology clerkships coinciding with the implementation and expansion of the Radiation Oncology Education Collaborative Study Group (ROECSG) clerkship curriculum. However, over half of clerkship experiences continue to lack a structured didactic curriculum. Over the past 6years, the ROECSG implemented and expanded upon a national standardized curriculum for the fourth-year medical student radiation oncology clerkship. This study hypothesized that this would lead to increased use of structured clerkship educational methods on a national level. From 2013 to 2018, all applicants to a single United States radiation oncology residency program were sent an anonymous clerkship experience survey. The χ2 test was used for statistical analysis. Of 1183 students, 488 completed the survey (41.3% response rate); 1303 total clerkship experiences were described. From 2013 to 2018, there has been a significant increase in clerkships with lectures designed for medical students, from 28.3% of clerkships in 2013 to 43.2% in 2018 (P=.02). Students who received ≥1 formal lecture perceived greater postclerkship confidence in radiation oncology-related knowledge (P<.01) and overall confidence in their ability to function as a postgraduate year-2 resident (P=.02). These results demonstrate a national trend toward inclusion of structured didactics in radiation oncology clerkships coinciding with the expansion of the ROECSG curriculum and support the addition of structured didactics to the clerkship experience to provide medical students with foundational radiation oncology knowledge to function as residents.

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.

Objective Evaluation of a Structured Didactic Radiation Oncology Clerkship Curriculum: A Report from the Radiation Oncology Education Collaborative Study Group

Objective Evaluation of a Structured Didactic Radiation Oncology Clerkship Curriculum: A Report from the Radiation Oncology Education Collaborative Study Group

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.