Physics Residents Research Articles

PP03 Presentation Time: 4:18 PM: International Collaboration Reveals Medical Physics Residents Will Perform Brachytherapy in Their First Position and Desire Additional Training Opportunities

PP03 Presentation Time: 4:18 PM: International Collaboration Reveals Medical Physics Residents Will Perform Brachytherapy in Their First Position and Desire Additional Training Opportunities

AAPM BTSC Report 377.B: Physicist brachytherapy training in 2022 - A survey of therapeutic medical physics residents.

A survey of medical physics residency program directors was conducted in Spring 2021 to examine the current state of brachytherapy (BT) training during residency. In this related work, a subsequent survey of therapeutic medical physics residents in 2022 was conducted to assess the confidence and experience of the trainees. Concerns for access to high-quality and diverse training in BT have escalated in importance due to recent declines in BT utilization. A survey consisting of 26 questions was designed by a working unit of the Brachytherapy Subcommittee of the American Association of Physicists in Medicine (AAPM) and approved for distribution by the Executive Committee of the AAPM. The survey was distributed to current trainees and recent graduates of the Commission on Accreditation of Medical Physics Education Programs accredited therapeutic medical physics residency programs by the AAPM. The participant response was anonymously recorded in an online platform and subsequently analyzed using spreadsheet software. The survey was distributed to 796 current medical physics residents or recent graduates over the course of 6weeks in February and March of 2022. The survey received 736 views and a total of 182 responses were collected, with 165 respondents completing the survey in full. Among those responses, 110 had completed their residency training, with program start dates ranging from calendar years 2015 to 2021. Individual responses from the survey takers (including partial survey submissions) were evaluated and analyzed to compile results. Medical physics residents reported the highest levels of confidence and caseload for gynecological BT procedures when compared with other surveyed treatment techniques. This indicates opportunities to improve training and increase access to clinical caseload are needed in order to improve competency and confidence. Time constraints (clinical and rotation-based) were indicated as impediments to BT proficiency. Medical physics residents reported enthusiasm for additional training opportunities in BT, and it is evident that additional structure and programs are required to ensure adequate access to BT training during residency.

Comparison of failure modes and effects analyses and time for brachytherapy ring and tandem applicator digitization between manual and solid applicator source placement methods.

Ring and tandem (R&T) applicator digitization is currently performed at our institution by manually defining the extent of the applicators. Digitization can also be achieved using solid applicators: predefined, 3D models with geometric constraints. This study compares R&T digitization using manual and solid applicator methods through Failure Modes and Effects Analyses (FMEAs) and comparative time studies. We aim to assess the suitability of solid applicator method implementation for R&T cases METHODS: Six qualified medical physicists (QMPs) and two medical physics residents scored potential modes of failure of manual digitization in an FMEA as recommended by TG-100. Occurrence, severity, and detectability (OSD) values were averaged across respondents and then multiplied to form combined Risk Priority Numbers (RPNs) for analysis. Participants were trained to perform treatment planning using a developed solid applicator protocol and asked to score a second FMEA on the distinct process steps from the manual method. For both methods, participant digitization was timed. FMEA and time data were analyzed across methods and participant samples RESULTS: QMPs rated the RPNs of the current, manual method of digitization statistically lower than residents did. When comparing the unique FMEA steps between the two digitization methods, QMP respondents found no significant difference in RPN means. Residents, however, rated the solid applicator method as higher risk. Further, after the solid applicator method was performed twice by participants, the time to digitize plans was not significantly different from manual digitization CONCLUSIONS: This study indicates the non-inferiority of the solid applicator method to manual digitization in terms of risk, according to QMPs, and time, across all participants. Differences were found in FMEA evaluation and solid applicator technique adoption based on years of brachytherapy experience. Further practice with the solid applicator protocol is recommended because familiarity is expected to lower FMEA occurrence ratings and further reduce digitization times.

The Society for Women in Radiation Oncology: Where are We Five Years Later?

The Society for Women in Radiation Oncology (SWRO) was founded in 2017 with a mission to promote representation and gender equity in the field of radiation oncology (RO). SWRO members include faculty and trainee radiation oncologists and medical physicists. We aim to assess the current experiences of SWRO members using a comprehensive survey of gender-related workforce issues we developed. Data was used to establish a 5-year benchmark. From January to February 2023, an anonymous survey was distributed to current SWRO members. Questions included demographics, family planning/fertility issues, perceptions of the field, and membership needs. Descriptive statistics were used to summarize frequencies of the multiple-choice items on the survey. On interim analysis, 115 of 680 (17%) completed the survey from 11 countries, 81% of which reside in the US. 55% were faculty physicians, 26% resident physicians, 10% faculty physicists, and 3% physics residents. The majority were female (97%) and either married or in a domestic partnership (74%). 47% reported having at least one child, and 26% reported that they or their partner became pregnant during residency. Length of leave was impacted by residents' desire to complete residency training on schedule. 53% felt RO was perceived as family-friendly, but much fewer (17%) agreed that it is. After clinical responsibilities (70%), insufficient mentorship was cited as the second most common limitation to professional productivity (35%). 48% reported being somewhat or extremely satisfied with current mentorship availability at their institution, while 56% reported being similarly satisfied with the mentorship available within the field. 69% reported seeking or having sought female mentorship outside of their institution. Unwanted sexual comments, attention, or advances by superiors or colleagues was reported by 38% of respondents. Additionally, 72% either agreed or strongly agreed that SWRO membership and participation were a valuable use of their time, with the top three reasons for joining being networking opportunities, mentorship opportunities, and increasing the visibility of women and gender minorities in RO. Suggested improvements included increasing female physics representation and advocacy, and physics-related events, as well as providing opportunities for members to socialize and interact. This study provides an update on the experiences of women and gender minorities in the field of RO since the creation of SWRO in 2017. The study highlights ongoing targets for improvement such as gender-based obstacles, opportunity for additional education and advocacy, support of family-friendly culture shifts, mentorship, and increased physics inclusion and advocacy. These findings support the need for organizations such as SWRO to continue to promote representation and gender equity in RO.

Patient Advocate Presence Helps Poster Presenters Understand Clinical Significance of their Research and Increases Empathy

Patient advocates represent the voice of the patient community and bring a unique perspective to research. We hypothesized that including patient advocates in poster sessions allow trainees to communicate their science in lay language, have an increased understanding of the clinical impact of their work, and increase their empathy for patients. A survey was designed to assess the impact invited patient advocates had on poster presenters at our Department of Radiation Oncology Research Symposium. The two advocates, one with primary breast and primary endometrial cancer, and one with metastatic breast cancer, visited each poster to discuss the project goals and outcomes with all 16 researchers (graduate/medical students, postdoctoral fellows including medical and physics residents, laboratory assistants, and faculty). The survey included demographics, and Likert scored questions about their ease in discussing research and use of lay language, the impact of the advocate on increasing the presenter's empathy and understanding the clinical significance of their work, and future role of advocates in complementing their research. Following the poster session, 14 of 16 participants completed the survey. Respondents were 57.1% male, 57.1% younger than 30 years old, and 50% people of color. Poster presenters comprised: 35.7% Graduate/Medical Students, 42.9% Medical/Physics Residents or Postdoctoral Fellows, 14% Faculty, and 7% laboratory assistants. All respondents agreed/strongly agreed they were comfortable talking to advocates. Overall, 42.8% of participants strongly agreed that they could talk to the patient advocate in lay language. 85.7% agreed/strongly agreed that their empathy for patients increased by this interaction. Although 92.9% of poster presenters believed patient advocates were able to help them understand the clinical impact of their research and 71.4% believed advocates helped them think of ideas to complement their research, 57.1% did not believe advocates could help them identify novel research conclusions. Most respondents would like advocates at future poster presentations (92.9%), but were not as sure and they would like advocates participating in study design or data analysis. Women, people of color, and graduate/medical students were most comfortable communicating in lay language, believed advocates increased their empathy and understanding of the clinical significance of their work. Patient advocates in poster sessions help trainees communicate their science, increase their empathy and understanding of the clinical impact of their research. Workshops should be considered to help young scientists communicate their science in lay language. Future radiation oncology training should consider including the patient advocate voice to improve the tangible connection between research and real-world impact.

Attitudes and Barriers to Planned Family Building among Professionals and Trainees in Radiation Oncology

The timing of residency training often coincides with peak biological fertility. However, family building is frequently deferred and may lead to unanticipated infertility. The attitudes and barriers to family planning are not well described among medical professionals and trainees in radiation oncology (RO). The Society for Women in Radiation Oncology (SWRO) conducted an electronic survey among practicing physicians, physicists, and residents between January and February 2023, using email and social media as recruitment tools. The survey questions queried demographics, family planning, fertility. Frequencies of responses were summarized using descriptive statistics. On interim analysis, 147 responses were collected; 123 (89.8%) were SWRO members. Gender identities reported were female (136, 93.2%), male (7, 4.8%), nonbinary or gender diverse (2, 1.4%), and transgender female (1, 0.7%). 95 (64.6%) respondents were age 35 or younger. The majority were practicing physicians (72, 49.0%) followed by RO residents (45, 30.6%), medical physicists (17, 11.6%), medical students, (5, 3.4%), and medical physics residents (4, 2.7%). Most respondents agreed that their reproductive timeline had been impacted by medical training (106, 76.3%). Of those who deferred parenthood due to training or career, 40 (36.7%) were dissatisfied with their choice and 33 (30.2%) were satisfied. 129 (92.8%) reported not receiving any information about fertility preservation during training. Only 65 (47.4%) felt they had a mentor with whom they could approach to discuss family planning. Overall, 84 (60.4%) expressed concern about their fertility and 34 (24.5%) had previously undergone fertility testing. 16 (11.5%) completed at least one cycle of elective fertility preservation and 12 (8.6%) were planning to do so. 39 (28.1%) had considered elective fertility preservation but not pursued it, while 65 (46.8%) had not considered it. Among those two groups, the common reported barriers to accessing fertility services were financial burden (n = 28, 28.6%), lack of awareness of available options (n = 12, 12.2%), difficulty accessing fertility services (n = 6, 6.1%), and difficulty finding time during training (n = 4, 4.1%). Insurance coverage for elective fertility preservation was fully or partially covered by insurance for 12 (8.8%), not covered for 53 (38.7%), and 72 (52.6%) were uncertain of their coverage. The study highlights the impact of training on family building plans of medical professionals in RO. Despite high levels of concern about fertility, few respondents received education about fertility options in training and a limited number had access to mentors to discuss this issue. Significant barriers exist to accessing fertility services, including knowledge gaps about insurance coverage, highlighting a need for further exploration of these barriers and advocacy for improved family planning support for those in RO who desire it.

81 the Development and Implementation of Simulation-Based Inter-Professional Education for Radiation Oncology and Medical Physics Residents in Radiation Therapy Safety Events

81 the Development and Implementation of Simulation-Based Inter-Professional Education for Radiation Oncology and Medical Physics Residents in Radiation Therapy Safety Events

Radiation Oncology Resident Leadership Course: Does Integrating Communication Skill Development with Real Donors Lead to Effective Presentations?

Background Interpersonal and communication skill development in graduate medical education is necessary for providing residents with training to facilitate interactions with oncology patients, such as breaking bad news and showing empathy. Yet, to succeed in professional careers, trainees need to be able to connect with audiences beyond that of colleagues and doctor/patient. Providing actionable feedback from specific audiences is important for trainees to develop communication skills in various situations. We sought to explore how residents could present research ideas to donors to determine effective delivery and approach. Methods At our center, radiation oncology medical and physical residents take part in a longitudinal leadership training course. In 2021, we partnered with our affiliated university communications academic department to discuss how to optimize communication strategies to donors with respect to message, tone of voice, pitch, and overall effectiveness. In 2022, we partnered with actual donors from a local colorectal cancer organization to hear resident pitches and provide real time feedback. Two medical residents and two physics residents were selected for the pitch session to present their research ideas without slides. Three board members from the donor organization and our institution's foundation liaison for the GI program participated virtually. All the resident participants were on-site. Results The residents were rated as highly effective by the donors in their pitches. Importantly, the donors emphasized that the residents appropriately communicated complex ideas at a lay person level. All donors reported that they understood the stated research objectives. The donors felt each resident successfully communicated the research idea and the need for additional funding. Feedback from the donors for the four residents in the pitch session centered around effective messaging, audience engagement, and confidence. Thematic analysis of the feedback revealed a universal need among participants to be more direct regarding the amount of funding necessary for each project. Discussion Leadership training should include focus on "leading self" which involves the development of effective communication skills. The opportunity for residents to speak with real donors and communicate their research ideas for possible future funding was well received by both the donors and the residents. One future improvement is to highlight to the residents the need to clarify what they are asking for with respect to funding amount. Additional studies are needed to assess the effectiveness of such a course with respect to future philanthropic success. Interpersonal and communication skill development in graduate medical education is necessary for providing residents with training to facilitate interactions with oncology patients, such as breaking bad news and showing empathy. Yet, to succeed in professional careers, trainees need to be able to connect with audiences beyond that of colleagues and doctor/patient. Providing actionable feedback from specific audiences is important for trainees to develop communication skills in various situations. We sought to explore how residents could present research ideas to donors to determine effective delivery and approach. At our center, radiation oncology medical and physical residents take part in a longitudinal leadership training course. In 2021, we partnered with our affiliated university communications academic department to discuss how to optimize communication strategies to donors with respect to message, tone of voice, pitch, and overall effectiveness. In 2022, we partnered with actual donors from a local colorectal cancer organization to hear resident pitches and provide real time feedback. Two medical residents and two physics residents were selected for the pitch session to present their research ideas without slides. Three board members from the donor organization and our institution's foundation liaison for the GI program participated virtually. All the resident participants were on-site. The residents were rated as highly effective by the donors in their pitches. Importantly, the donors emphasized that the residents appropriately communicated complex ideas at a lay person level. All donors reported that they understood the stated research objectives. The donors felt each resident successfully communicated the research idea and the need for additional funding. Feedback from the donors for the four residents in the pitch session centered around effective messaging, audience engagement, and confidence. Thematic analysis of the feedback revealed a universal need among participants to be more direct regarding the amount of funding necessary for each project. Leadership training should include focus on "leading self" which involves the development of effective communication skills. The opportunity for residents to speak with real donors and communicate their research ideas for possible future funding was well received by both the donors and the residents. One future improvement is to highlight to the residents the need to clarify what they are asking for with respect to funding amount. Additional studies are needed to assess the effectiveness of such a course with respect to future philanthropic success.

Financial Leadership Skills Training: Can a Hybrid Didactic/Interactive Exercise Model Fill a Gap in Graduate Medical Education?

Background With recent healthcare changes, competition for financial resources is increasing. Graduate medical education (GME) programs do not routinely prepare residents to understand the complexity of financial decisions that affect their practice. At our institution, we designed new sessions to explore personal and departmental financial education in our yearly Radiation Oncology (RO) leadership course. Methods Over the past five years, we have been piloting a longitudinal leadership course for our RO medical and physics residents, integrating a hybrid didactic/interactive exercise approach. The core RO faculty consists of the course director, the residency directors, and department leadership. The course structure includes an introduction to understanding how resource allocation is determined at the institutional level as well as a personal finance component. We recruited the RO Vice Chair, RO Department Administrator, and the MD, MBA Chair of the Vacancy Review Committee at our institution to teach these concepts over three sessions. The first was a didactic introduction to departmental finance by our Vice Chair to prepare attendees for the second interactive session, in which residents worked through a pro forma to determine the feasibility of hiring a new departmental faculty member. The final session was led by our MD, MBA colleague who taught residents how hiring decisions are made and explained what happens to the pro forma at the institutional level. The third session integrated an interactive exercise focusing on personal finance skills. Results At the end of the series, the ten resident attendees were informally surveyed regarding how effective and worthwhile the three finance sessions were. The verbal feedback regarding the curriculum was uniformly positive. All ten residents, including the physics resident, indicated that these classes were helpful and filled a gap in the current GME curriculum. Further feedback analysis noted that additional interactive exercises should be prioritized to reinforce understanding of these financial concepts. Discussion Financial education is lacking in most GME training programs. Targeted instruction for both personal and departmental financial decisions was well received in this novel course at our institution. Further studies are needed to determine effectiveness and optimal integration of financial leadership skill development in the GME setting. Future directions could be to determine the best balance of didactic instruction and interactive exercises to enhance resident understanding of these financial topics. With recent healthcare changes, competition for financial resources is increasing. Graduate medical education (GME) programs do not routinely prepare residents to understand the complexity of financial decisions that affect their practice. At our institution, we designed new sessions to explore personal and departmental financial education in our yearly Radiation Oncology (RO) leadership course. Over the past five years, we have been piloting a longitudinal leadership course for our RO medical and physics residents, integrating a hybrid didactic/interactive exercise approach. The core RO faculty consists of the course director, the residency directors, and department leadership. The course structure includes an introduction to understanding how resource allocation is determined at the institutional level as well as a personal finance component. We recruited the RO Vice Chair, RO Department Administrator, and the MD, MBA Chair of the Vacancy Review Committee at our institution to teach these concepts over three sessions. The first was a didactic introduction to departmental finance by our Vice Chair to prepare attendees for the second interactive session, in which residents worked through a pro forma to determine the feasibility of hiring a new departmental faculty member. The final session was led by our MD, MBA colleague who taught residents how hiring decisions are made and explained what happens to the pro forma at the institutional level. The third session integrated an interactive exercise focusing on personal finance skills. At the end of the series, the ten resident attendees were informally surveyed regarding how effective and worthwhile the three finance sessions were. The verbal feedback regarding the curriculum was uniformly positive. All ten residents, including the physics resident, indicated that these classes were helpful and filled a gap in the current GME curriculum. Further feedback analysis noted that additional interactive exercises should be prioritized to reinforce understanding of these financial concepts. Financial education is lacking in most GME training programs. Targeted instruction for both personal and departmental financial decisions was well received in this novel course at our institution. Further studies are needed to determine effectiveness and optimal integration of financial leadership skill development in the GME setting. Future directions could be to determine the best balance of didactic instruction and interactive exercises to enhance resident understanding of these financial topics.

Large-Scale Remote Training for Medical Physicists to improve Intensity-Modulated Radiation Therapy/Volumetric Modulated Arc Therapy in Low and Middle-Income Countries

Background High-quality intensity-modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT) is necessary to drive positive patient outcomes, yet gaps in staff training hinder its implementation in low-to-middle-income countries (LMICs). We aimed to evaluate a large-scale remote training curriculum for medical physicists and clinicians with existing IMRT capabilities in LMICs. Methods We conducted a virtual course on "Mastering IMRT/VMAT for Medical Physicists." The program comprised 15 weekly 1-hour live video conferencing sessions with interactive didactics and case-based learning taught by expert volunteer medical physicists. Enrollment was free and open to LMICs globally for 1 month on a first-come basis with a limit of 500, plus few exceptions. We distributed an electronic survey before and after the course to assess participants' confidence (on a 1-5 Likert scale) in 7 domains of IMRT/VMAT and knowledge through 11 multiple choice questions. We tracked attendance hours for course credit. We also gave participants the option to develop an IMRT or VMAT plan for identical, standardized bilateral Head & Neck cancer cases before and after the course, earning additional credit hours upon submission. After the program, 8 medical physics volunteers independently graded treatment plans using a rubric for qualitative domains. Furthermore, we gave plans a quantitative score using an automated scorecard with dose-volume histogram metrics. We utilized the ProKnow DS platform for file-sharing and grading. Two-tailed paired t-test analyses compared pre- vs. post-course survey and treatment planning scores for medical physicists, medical physics residents, and dosimetrists. Results A total of 514 participants from 63 countries and 342 unique centers enrolled, including 448 (87.1%) medical physicists, 49 (9.5%) medical physics residents, 5 (1%) dosimetrists, and 12 (2.4%) other clinicians. Of these, 240 medical physicists, medical physics residents, and dosimetrists responded to both the pre- and post-course surveys. Mean confidence scores increased from 3.00/5 (SD: 1.04) to 3.80/5 (0.87) (p < 0.001). Knowledge scores improved from 4.16/11 (SD: 1.77) to 5.98/11 (SD: 2.11) (p < 0.001). Additionally, 33 participants completed both the pre-course and post-course treatment planning assignments. Automated scorecard performance significantly improved from 12.64/25 (SD: 7.50) to 17.74/25 (SD: 6.74) (p = 0.0068). Grading rubric scores did not significantly change, from 9.15/14 (SD: 3.33) to 9.76/14 (SD: 2.65) (p = 0.4). Discussion A virtual curriculum on IMRT/VMAT improved participant's treatment planning performance, knowledge, and confidence. A distributed team of volunteers enabled this to be a low-cost, scalable intervention to help clinics in LMICs. High-quality intensity-modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT) is necessary to drive positive patient outcomes, yet gaps in staff training hinder its implementation in low-to-middle-income countries (LMICs). We aimed to evaluate a large-scale remote training curriculum for medical physicists and clinicians with existing IMRT capabilities in LMICs. We conducted a virtual course on "Mastering IMRT/VMAT for Medical Physicists." The program comprised 15 weekly 1-hour live video conferencing sessions with interactive didactics and case-based learning taught by expert volunteer medical physicists. Enrollment was free and open to LMICs globally for 1 month on a first-come basis with a limit of 500, plus few exceptions. We distributed an electronic survey before and after the course to assess participants' confidence (on a 1-5 Likert scale) in 7 domains of IMRT/VMAT and knowledge through 11 multiple choice questions. We tracked attendance hours for course credit. We also gave participants the option to develop an IMRT or VMAT plan for identical, standardized bilateral Head & Neck cancer cases before and after the course, earning additional credit hours upon submission. After the program, 8 medical physics volunteers independently graded treatment plans using a rubric for qualitative domains. Furthermore, we gave plans a quantitative score using an automated scorecard with dose-volume histogram metrics. We utilized the ProKnow DS platform for file-sharing and grading. Two-tailed paired t-test analyses compared pre- vs. post-course survey and treatment planning scores for medical physicists, medical physics residents, and dosimetrists. A total of 514 participants from 63 countries and 342 unique centers enrolled, including 448 (87.1%) medical physicists, 49 (9.5%) medical physics residents, 5 (1%) dosimetrists, and 12 (2.4%) other clinicians. Of these, 240 medical physicists, medical physics residents, and dosimetrists responded to both the pre- and post-course surveys. Mean confidence scores increased from 3.00/5 (SD: 1.04) to 3.80/5 (0.87) (p < 0.001). Knowledge scores improved from 4.16/11 (SD: 1.77) to 5.98/11 (SD: 2.11) (p < 0.001). Additionally, 33 participants completed both the pre-course and post-course treatment planning assignments. Automated scorecard performance significantly improved from 12.64/25 (SD: 7.50) to 17.74/25 (SD: 6.74) (p = 0.0068). Grading rubric scores did not significantly change, from 9.15/14 (SD: 3.33) to 9.76/14 (SD: 2.65) (p = 0.4). A virtual curriculum on IMRT/VMAT improved participant's treatment planning performance, knowledge, and confidence. A distributed team of volunteers enabled this to be a low-cost, scalable intervention to help clinics in LMICs.

AAPM BTSC Report 377: Physicist Brachytherapy Training in 2021-A survey of therapeutic medical physics residency program directors.

Brachytherapy (BT) was the first radiotherapeutic technique used to treat human disease and remains an essential modality in radiation oncology. A decline in the utilization of BT as a treatment modality has been observed and reported, which may impact training opportunities for medical physics residents. A survey of therapeutic medical physics residency program directors was performed as part of an assessment of the current state of BT training during residency. In March 2021, a survey consisting of 23 questions was designed by a working unit of the Brachytherapy Subcommittee of the American Association of Physicists in Medicine (AAPM) and approved for distribution by the Executive Committee of the AAPM. The survey was distributed to the directors of the Commission on Accreditation of Medical Physics Education Programs (CAMPEP)-accredited therapeutic medical physics residency programs by the AAPM. The participant response was recorded anonymously in an online platform and then analyzed using MATLAB and Microsoft Excel software. The survey was distributed to the program directors of 110 residency programs. Over the course of 6 weeks, 72 directors accessed the survey online, and 55 fully completed the survey. Individual responses from the directors (including partial submissions) were evaluated and analyzed. Nearly all participating programs (98%) utilize high dose rate BT treatments with 74% using low dose rate BT techniques. All programs treated gynecological sites using BT, and the next most common treatment sites were prostate (80%) and breast (53%). Overall, the residency program directors had a positive outlook toward BT as a radiotherapeutic treatment modality. Caseload and time limitations were identified as primary barriers to BT training by some programs. Based on the responses of the program directors, it was identified that the residency programs might benefit from additional resources such as virtual BT training, interinstitutional collaborations as well as resident fellowships. Programs might also benefit from additional guidance related to BT-specific training requirements to help program directors attest Authorized Medical Physicist eligibility for graduating residents.

Targeting Education as a Barrier to Implement Hypofractionation: Results of a Country-Wide Training Program

Access to radiation therapy in low- and middle-income countries (LMICs) could be improved with modern hypofractionated radiation therapy schedules, although their adoption remains limited. We aimed to evaluate perceptions regarding hypofractionation and the effect of a dedicated curriculum in an LMIC. We developed a pilot e-learning hypofractionation curriculum focused on breast, prostate, rectal cancer, and high-grade glioma in Colombia. International educators taught 13 weekly, 90-minute sessions. Participants completed pre- and postcurriculum questionnaires regarding hypofractionation attitudes, 1 to 5 Likert-scale self-confidence, and practices for 12 clinical scenarios. Physicians' responses were categorically scored "1" (for hypofractionation or ultrahypofractionation) or "0" (for conventional fractionation). We used the paired t test to measure pre- versus postcurriculum differences in self-confidence and the McNemar test to detect differences in hypofractionation selection. Across 19 cities in Colombia, 147 clinicians enrolled: 61 radiation oncologists, 6 radiation oncology residents, 59 medical physicists, 18 physics residents, and 3 other staff. Among physicians, education was the greatest barrier to select hypofractionation, common in ultrahypofractionation for prostate (77.6%) and breast cancer (74.6%) and less common for moderate hypofractionation of prostate (61.2%) and breast cancer (52.2%). Additional perceived barriers included unfamiliarity with clinic protocols (7%-22%), clinical experience (5%-15%), personal preference (3%-16%), and lack of technology (3%-20%), with variation across different clinical settings. After the curriculum, paired (n=38) physicians' selection of hypofractionation increased across all disease sites (mean aggregate score 6.2/12 vs 8.2/12, P <.001). Self-confidence among paired clinicians (n=87) increased for prostate ultrahypofractionation (+0.45), rectal ultrahypofractionation (+0.43), breast hypofractionation (+0.38), and prostate hypofractionation (+0.23) (P ≤ .03). In an LMIC with a bundled payment system, lack of education and training was a perceived barrier for implementation of hypofractionation and ultrahypofractionation. A targeted e-learning hypofractionation curriculum increased participant confidence and selection of hypofractionated schedules.

PHSOR06 Presentation Time: 12:55 PM: Medical Physics Residents Have Spoken: They Want More Brachytherapy Training Opportunities

<h3>Purpose</h3> To evaluate the current status of brachytherapy (BT) training received by medical physics residents (MPR) in North America by surveying residents currently enrolled in, and recently graduated from CAMPEP-accredited residency programs. The documented decline in the use of BT may result in reduced training opportunities. This survey aims to identify the current strengths and areas for improvement in MPR BT training. <h3>Materials and Methods</h3> A survey consisting of 26 questions was developed to collect data in five areas: (1) training program demographics; (2) didactic and practical training methods; (3) caseload and confidence levels of residents for various treatment modalities (including HDR, LDR, IORT, TARE, and Radiopharm), disease sites, and clinical tasks (including treatment planning, plan checks, and treatment delivery); (4) level of interest in performing BT post-residency; and (5) level of interest in receiving additional BT training opportunities. The survey was reviewed by several AAPM committees and was approved by the Executive Committee. The survey was distributed to residents currently enrolled in, and graduates within 5 years of residency training. <h3>Results</h3> The response rate was 23% (186 responses / 796 recipients). 60% of respondents had completed their training and 40% were currently enrolled in a program. Only 53% of currently enrolled residents had completed the BT training required by their program's curriculum. Therefore, to accurately depict the BT training experience of MPR, data is presented only from those having completed training. The majority of residents (94%) received three months or more of dedicated BT training and 96% believed it was important to learn BT during residency. Further, MPR (88%) believed their program director valued their BT education. A very notable finding was that only 49% of residents felt confident enough to perform BT for all sites treated at their training institution upon completion of their training program. HDR gynecological procedures were the only modality and disease site combination out of 14 modality and site combinations with more than 50% of individuals reporting feeling "very confident" at the completion of their training. MPR indicated an increase in caseload (29%) would most improve their confidence level followed closely by increased case involvement (25%). Few (11%) believed additional didactic training would improve their confidence level. The majority (73%) of MPR enjoyed their BT rotation more than other rotations. Most wanted to (72%) and would be (67%) performing BT at their first position post-residency. Additional training opportunities were desired by the majority (64%) of MPR and 10% were unsure. This subset of individuals reported interest in selecting BT as an elective rotation (66%), performing a BT rotation at another institution with a higher caseload (76%), and completing a BT fellowship post-residency (63%, Figure 1). The interest level of MPR in pursuing a fellowship was greater than the 2% reported by Marcrom et al. (IJROBP, 2018) for radiation oncology residents. <h3>Conclusions</h3> MPR believe BT training during residency is important and the majority of MPR did not achieve their desired level of confidence in performing BT procedures at the completion of their residency training. Caseload was identified as the primary factor contributing to low confidence levels. The majority indicated they wanted to (and would be) performing BT post-residency, and desired additional training opportunities. Strong interest was expressed in pursuing (1) an additional rotation, (2) rotations through outside training facilities, and (3) optional fellowships. These opportunities are available to radiation oncology residents through the ABS-sponsored 300-in-10 program. There is a demonstrated need and interest for an equivalent program for medical physicists.

Gender-Based Discrimination and Sexual Harassment in Medical Physics

Gender-based discrimination and sexual harassment have been well-studied in the fields of science, technology, engineering, math, and medicine. However, less is known about these topics and their effect within the profession of medical physics. We aimed to better understand and clarify the views and experiences of practicing medical physicists and medical physics residents regarding gender-based discrimination and sexual harassment. We conducted in-depth, semistructured, and confidential interviews with 32 practicing medical physicists and medical physics residents across the United States. The interviews were broad and covered the topics of discrimination, mentorship, and work/life integration. All participants were associated with a department with a residency program accredited by the Commission on Accreditation of Medical Physics Education Programs and had appointments with a clinical component. Participants shared views about gender-based discrimination and sexual harassment that were polarized. Some perceived that discrimination and harassment were a current concern within medical physics, while some either perceived that they were not a concern or that discrimination positively affected women and minoritized populations. Many participants shared personal experiences of discrimination and harassment, including those related to unequal compensation, discrimination against mothers, discrimination during the hiring process, gender-biased assumptions about behaviors or goals, communication biases, and overt and persistent sexual harassment. There is an urgent need to acknowledge, better understand, and address gender-based discrimination and sexual harassment in the field of medical physics.

Development of an Educational Workshop on the Practical Application of Respiratory Motion Management Techniques for Radiation Oncology Trainees

<h3>Background</h3> Respiratory motion management (RMM) is an important tool that is increasingly utilized in the era of image-guided radiation therapy. There are several different techniques available to limit tumor motion during respiration with the goal of allowing for effective dose escalation to the target, while limiting toxicity to nearby organs at risk. Selection of the appropriate RMM tool depends on the clinical scenario and requires input from the treating physician and/or residents and medical physics staff, however, there is a paucity in trainee education on the various RMM methods. The purpose of this initiative was to develop a formal didactic and hands on experience for our trainees that described the RMM tools available and the appropriate clinical scenarios in which to best implement these specific techniques. <h3>Methods</h3> Trainees (medical and physics residents as well as medical students) participated in a two-phase educational workshop: a 45 minute didactic session followed by a hands-on demonstration of RMM modalities and pertinent software for motion evaluation. Each participant completed pre- and post-workshop surveys assessing their confidence on RMM (based on a 5-point Likert scale) and knowledge based quizzes to assess their understanding of the various RMM techniques. Participant scores were paired for statistical analysis using Wilcoxon-Rank Sum and student T-tests. <h3>Results</h3> This educational workshop was held annually in 2021 and 2022. There were 7 participants (5 medical and 2 physics residents) in 2021 and 9 (2 medical students, 6 medical, and 1 physics resident) that participated in 2022. For all participants, there was a significant increase in self-reported post-workshop confidence in RMM techniques (median 3.625 pre- vs 4.634 post-workshop, p=0.018 in 2021 and median 1.125 vs 3.750, p=0.008 in 2022). There was also a significant increase in the participants' scores in the post-workshop knowledge based quizzes (mean 85.71% vs 92.86%, p=0.03 in 2021 and mean 48.60% vs 87.50%, p=0.008 in 2022). <h3>Discussion</h3> In order to optimize patient care, it is essential that RO trainees understand and are able to implement RMM techniques appropriately when treating intrathoracic and abdominal cavity tumors. This initiative showed that a dedicated educational workshop on RMM techniques significantly improved RO trainee's knowledge and confidence on the use of these important tools. Future aims of this project include continuing to offers this workshop annually to trainees to assess information retention and creation of a shared resource for trainees at other institutions.

Sustainability and expansion of an interprofessional education for medical assistants in radiation oncology after 4 years of experience

Background Medical assistants (MAs) are allied health professionals who support a diverse range of functions in the clinical setting. Few certification requirements or continuing education opportunities exist for MAs; training specific for work in radiation oncology is particularly lacking. A interprofessional education program for MAs in radiation oncology was established in 2017. Here we report on the sustainability of the program and the aim of expansion. Methods In previous work, we describe the development of a novel education program based on needs assessment of a single institution cohort of MAs in radiation oncology. The resulting 20-month curriculum was implemented primarily through resident-led didactics (2017-2020, Cycle 1). Program evaluation was performed through pre- and post-assessments. Following completion, the curriculum was updated to foster greater interprofessional education and was led by a mixture of medical residents, physics residents, nursing, nurse practitioners, therapists and additional radiation oncology staff (2020 - current, Cycle 2). Educators were nominated based on topic area expertise and interest. Results As previously reported, sessions in Cycle 1 were found to be consistently comprehensive (median Likert score, MLS 4-5) and informative (MLS 5) and the program showed increases in sense of empowerment (MLS change from 3.5 to 5) among the cohort (n=2-5 responses per session). Over the length of Cycle 1, there was sustained improvement in clinical knowledge within the scope of the MA role (MLS 5) and empathy for patients (MLS 5) and stably high rating of job satisfaction (Likert Scale range 4-5). Cycle 2 is currently in progress with results forthcoming. Notably, the program was stably expanded from n=5-7 to n=7-8 MAs in Cycles 1 and 2 respectively. Program participation was challenged by COVID-19 staffing shortages however demonstrated sustained interest and participation (range 2-6 participants per topic). Cycle 1 included 4 (20%) interprofessional educators whereas Cycle 2 included 11 (55%). Discussion Here we report on a 20-month interprofessional education program for MAs in radiation oncology which demonstrated improvement in empowerment, clinical knowledge, and high job satisfaction. The program is found to be implemented longitudinally with expansion in both educators and participants. Incorporation of interprofessional educators has improved leadership and educational opportunities and increased program sustainability. Future directions of the program include expansion to a multi-institutional setting for Cycle 3, to begin July 2022. Increased cohort size may allow for further understanding of the impact of MA education on clinical workflow, interprofessional collaboration, and patient care. Medical assistants (MAs) are allied health professionals who support a diverse range of functions in the clinical setting. Few certification requirements or continuing education opportunities exist for MAs; training specific for work in radiation oncology is particularly lacking. A interprofessional education program for MAs in radiation oncology was established in 2017. Here we report on the sustainability of the program and the aim of expansion. In previous work, we describe the development of a novel education program based on needs assessment of a single institution cohort of MAs in radiation oncology. The resulting 20-month curriculum was implemented primarily through resident-led didactics (2017-2020, Cycle 1). Program evaluation was performed through pre- and post-assessments. Following completion, the curriculum was updated to foster greater interprofessional education and was led by a mixture of medical residents, physics residents, nursing, nurse practitioners, therapists and additional radiation oncology staff (2020 - current, Cycle 2). Educators were nominated based on topic area expertise and interest. As previously reported, sessions in Cycle 1 were found to be consistently comprehensive (median Likert score, MLS 4-5) and informative (MLS 5) and the program showed increases in sense of empowerment (MLS change from 3.5 to 5) among the cohort (n=2-5 responses per session). Over the length of Cycle 1, there was sustained improvement in clinical knowledge within the scope of the MA role (MLS 5) and empathy for patients (MLS 5) and stably high rating of job satisfaction (Likert Scale range 4-5). Cycle 2 is currently in progress with results forthcoming. Notably, the program was stably expanded from n=5-7 to n=7-8 MAs in Cycles 1 and 2 respectively. Program participation was challenged by COVID-19 staffing shortages however demonstrated sustained interest and participation (range 2-6 participants per topic). Cycle 1 included 4 (20%) interprofessional educators whereas Cycle 2 included 11 (55%). Here we report on a 20-month interprofessional education program for MAs in radiation oncology which demonstrated improvement in empowerment, clinical knowledge, and high job satisfaction. The program is found to be implemented longitudinally with expansion in both educators and participants. Incorporation of interprofessional educators has improved leadership and educational opportunities and increased program sustainability. Future directions of the program include expansion to a multi-institutional setting for Cycle 3, to begin July 2022. Increased cohort size may allow for further understanding of the impact of MA education on clinical workflow, interprofessional collaboration, and patient care.

Impact of a Single Institution Resident-Led Education Committee in Radiation Oncology

Purpose Resident-led collaborative groups provide a platform to refine ideas and support professional development and scholarship during residency. To actively engage in radiation oncology (RO) education and leadership, residents formed an Education Committee (EC). Here, we discuss the structure and impact of a resident-led EC. Methods With the support of the RO program leadership at a single academic institution, this committee was created with the goals of (1) identifying and addressing gaps in residency education, (2) implementing sustainable educational initiatives across various interprofessional groups, and (3) sharing ongoing projects within medical education to identify resources and invite collaboration. The leadership core consisted of 1-2 resident co-chairs and committee sub-leads. The committee held one-hour monthly meetings, which consisted of journal club to review medical education literature followed by pre-set discussion of topics spanning committee goals. Faculty consultants were invited to attend to provide their expertise. Results The EC included medical and physics residents and grew from 6 to 10 members within the first two years of implementation. It worked with department and institutional leadership to implement initiatives to address gaps identified in medical resident education, medical student outreach, and interprofessional RO education. Additionally, members used this platform to find collaborators and identify resources for education projects, including global health and climate health initiatives. Key outputs of the EC included an updated repository of shared residency resources with high-yield educational material, site-specific reading lists developed with faculty, and a week-long statistics module now integrated into the curriculum. To improve medical student outreach, the EC established collaboration with the affiliated medical school's Oncology Interest Group to launch mentorship programs, including a tumor board seminar series engaging students in multidisciplinary oncology care. To support interprofessional RO education, the EC leads a medical assistant RO curriculum, which now has plans for multi-institutional expansion to other RO programs. Discussion Residencies are in need of pathways to foster resident engagement in medical education and scholarship. Additionally, the apprenticeship nature of RO training often lacks leadership and teaching opportunities, which can be supplied through resident-led collaborative groups. Here, we described our experience establishing a resident-led EC in RO, which has cultivated a community of resident leaders in education at our institution. This committee has been instrumental in implementing and sustaining initiatives across various facets of medical education. Successful initiatives can then be scaled for national implementation. This committee structure can serve as a framework for other RO programs. Resident-led collaborative groups provide a platform to refine ideas and support professional development and scholarship during residency. To actively engage in radiation oncology (RO) education and leadership, residents formed an Education Committee (EC). Here, we discuss the structure and impact of a resident-led EC. With the support of the RO program leadership at a single academic institution, this committee was created with the goals of (1) identifying and addressing gaps in residency education, (2) implementing sustainable educational initiatives across various interprofessional groups, and (3) sharing ongoing projects within medical education to identify resources and invite collaboration. The leadership core consisted of 1-2 resident co-chairs and committee sub-leads. The committee held one-hour monthly meetings, which consisted of journal club to review medical education literature followed by pre-set discussion of topics spanning committee goals. Faculty consultants were invited to attend to provide their expertise. The EC included medical and physics residents and grew from 6 to 10 members within the first two years of implementation. It worked with department and institutional leadership to implement initiatives to address gaps identified in medical resident education, medical student outreach, and interprofessional RO education. Additionally, members used this platform to find collaborators and identify resources for education projects, including global health and climate health initiatives. Key outputs of the EC included an updated repository of shared residency resources with high-yield educational material, site-specific reading lists developed with faculty, and a week-long statistics module now integrated into the curriculum. To improve medical student outreach, the EC established collaboration with the affiliated medical school's Oncology Interest Group to launch mentorship programs, including a tumor board seminar series engaging students in multidisciplinary oncology care. To support interprofessional RO education, the EC leads a medical assistant RO curriculum, which now has plans for multi-institutional expansion to other RO programs. Residencies are in need of pathways to foster resident engagement in medical education and scholarship. Additionally, the apprenticeship nature of RO training often lacks leadership and teaching opportunities, which can be supplied through resident-led collaborative groups. Here, we described our experience establishing a resident-led EC in RO, which has cultivated a community of resident leaders in education at our institution. This committee has been instrumental in implementing and sustaining initiatives across various facets of medical education. Successful initiatives can then be scaled for national implementation. This committee structure can serve as a framework for other RO programs.

Experience from a hypofractionation curriculum pilot: Overcoming education as a barrier to implement hypofractionation

<h3>Background</h3> Hypofractionation has equivalent oncologic outcomes to conventional fractionation, with the advantage of shortening treatment time. This is beneficial for health systems in low-to-middle income countries (LMICs); however, little is known about how to promote its adoption globally. <h3>Methods</h3> The non-profit Rayos Contra Cancer developed a hypofractionation e-learning program to pilot in Colombia, free of charge, and shared through the Colombian Association of Radiation Oncology. Two electronic surveys were distributed, one before and one after the completion of the course. Physicians were asked questions regarding their attitudes to hypofractionation. Different sections focused on clinical scenarios related to breast, prostate, rectal, and CNS gliomas, asking current practices regarding conventional fractionation, hypofractionation (15-20 fractions), and ultra-hypofractionation (5 fractions). To measure the impact of the curriculum, we categorized physicians' use of hypofractionation with a numerical score from 0 to 12 (12 = More conventional, 0=more hypofractionation). <h3>Results</h3> Across 19 cities in Colombia, 149 participants enrolled: 61 radiation oncologists, 59 medical physicists, 7 radiation oncology residents, 18 physics residents, 1 technologist, and 1 dosimetrist. 33 physicians responded both surveys. More respondents chose hypofractionation after the curriculum for all scenarios (mean "pre-curriculum" score=5.9, vs. "post-curriculum" score = 4.15, p=0.03). For breast cancer, hypofractionation use after N0 lumpectomy increased by 24.2% for older patients (51% to 75%, p=0.766) and 18.2% for younger patients (42% to 60%, p=0.00), and for locally advanced postmastectomy increased by 12.1% (76% to 85%, p=0.435). For prostate cancer, use for unfavorable intermediate-risk patients increased by 15% (67% to 82%, p=0.176), for favorable intermediate-risk by 12.1% (76% to 85%, p=0.00), and for high-risk by 12.1% (42% to 54%, p=0.52). For rectal cancer, the increase in hypofractionation for T3N1 and T4N1 mid-rectal patients was 24.2% and 21.2%, respectively. In CNS high-grade gliomas respondents increased the use of hypofractionation in older patients with poor performance status (18.2%). At baseline, education was perceived as a barrier for the use of breast (ultra-hypo/hypo), prostate (ultra-hypo/hypo), rectal, and CNS hypofractionation in 69.7%, 45.5%, 78.8%, 63.6%, respectively. These percentages decreased by 24.2%, 9.1%, 18.2% and 12.1%. When asked if the course had increased their confidence and knowledge towards hypofractionation 100% of respondents said yes. <h3>Discussion</h3> Education is a perceived barrier for the use of ultra-hypofractionation schedules in a LMIC with a bundled payment system. An E-learning approach appears to be feasible and effective at reducing the educational barrier and increasing the use of hypofractionation.

Evaluating a structured applied physics case-based course for radiation oncology and radiation physics residents

Background We supplemented applied physics textbook learning and clinic learning with case-based discussions. The purpose of this study was to review this applied physics course, in terms of structure and teaching evaluations. Methods We reviewed the 6 year applied physics teaching experience (2016-2021) in a multi-hospital site university affiliated accredited training program. A unique component of the course is the intentional inter-professional education, due to the inclusion of both radiation oncology and medical physics learners and faculty. This course ran weekly from September to May for a total of 29 weeks. All sessions were 1 hour long and case based except for 5 didactic sessions. Each session was taught by a pair of faculty members (one radiation oncologist and one medical physicist). The cases in the syllabus were reviewed yearly by teaching faculty and adjusted for updated clinical management and technological changes. A final examination was given to each trainee consisting of 3 clinical case scenarios, with written and oral questions on applied physics concepts learned throughout the course. In 2020 and 2021, during the pandemic, the applied physics course syllabus was shortened to 8 weekly video sessions (2 hour class per week) and given from April to May. Results The number of trainees who took the course ranged from 7-14 per year. Ninety-four percent of trainees passed the final exam. Trainees who did not pass the final exam were given a supplemental exam. Feedback was given to each trainee who did not pass the first exam. All trainees who did not pass the final exam, were successful in passing the supplemental exam. For the years 2016-2021, the mean and median teaching evaluation scores were 4.65 and 5 respectively, where 1 represents the worst teaching quality and 5 represents the best. In 2020-2021, due to the covid-19 pandemic, the teaching evaluations administered included 2 questions regarding the virtual format of the course. For these 2 questions relating to the virtual format of the course, the mean and median responses were 4.14 and 5 respectively. Discussion The structured syllabus of cases, case based questions and discussions were ranked highly by the trainees for teaching effectiveness. The success of this course is also dependent on faculty who demonstrate excellent teaching skills. Our experience indicated that the nature of this course was adaptable to a virtual format and could be useful for small programs without a structured applied physics curriculum. We supplemented applied physics textbook learning and clinic learning with case-based discussions. The purpose of this study was to review this applied physics course, in terms of structure and teaching evaluations. We reviewed the 6 year applied physics teaching experience (2016-2021) in a multi-hospital site university affiliated accredited training program. A unique component of the course is the intentional inter-professional education, due to the inclusion of both radiation oncology and medical physics learners and faculty. This course ran weekly from September to May for a total of 29 weeks. All sessions were 1 hour long and case based except for 5 didactic sessions. Each session was taught by a pair of faculty members (one radiation oncologist and one medical physicist). The cases in the syllabus were reviewed yearly by teaching faculty and adjusted for updated clinical management and technological changes. A final examination was given to each trainee consisting of 3 clinical case scenarios, with written and oral questions on applied physics concepts learned throughout the course. In 2020 and 2021, during the pandemic, the applied physics course syllabus was shortened to 8 weekly video sessions (2 hour class per week) and given from April to May. The number of trainees who took the course ranged from 7-14 per year. Ninety-four percent of trainees passed the final exam. Trainees who did not pass the final exam were given a supplemental exam. Feedback was given to each trainee who did not pass the first exam. All trainees who did not pass the final exam, were successful in passing the supplemental exam. For the years 2016-2021, the mean and median teaching evaluation scores were 4.65 and 5 respectively, where 1 represents the worst teaching quality and 5 represents the best. In 2020-2021, due to the covid-19 pandemic, the teaching evaluations administered included 2 questions regarding the virtual format of the course. For these 2 questions relating to the virtual format of the course, the mean and median responses were 4.14 and 5 respectively. The structured syllabus of cases, case based questions and discussions were ranked highly by the trainees for teaching effectiveness. The success of this course is also dependent on faculty who demonstrate excellent teaching skills. Our experience indicated that the nature of this course was adaptable to a virtual format and could be useful for small programs without a structured applied physics curriculum.

Development and validation of a checklist for use with automatically generated radiotherapy plans.

PurposeTo develop a checklist that improves the rate of error detection during the plan review of automatically generated radiotherapy plans.MethodsA custom checklist was developed using guidance from American Association of Physicists in Medicine task groups 275 and 315 and the results of a failure modes and effects analysis of the Radiation Planning Assistant (RPA), an automated contouring and treatment planning tool. The preliminary checklist contained 90 review items for each automatically generated plan. In the first study, eight physicists were recruited from our institution who were familiar with the RPA. Each physicist reviewed 10 artificial intelligence‐generated resident treatment plans from the RPA for safety and plan quality, five of which contained errors. Physicists performed plan checks, recorded errors, and rated each plan's clinical acceptability. Following a 2‐week break, physicists reviewed 10 additional plans with a similar distribution of errors using our customized checklist. Participants then provided feedback on the usability of the checklist and it was modified accordingly. In a second study, this process was repeated with 14 senior medical physics residents who were randomly assigned to checklist or no checklist for their reviews. Each reviewed 10 plans, five of which contained errors, and completed the corresponding survey.ResultsIn the first study, the checklist significantly improved the rate of error detection from 3.4 ± 1.1 to 4.4 ± 0.74 errors per participant without and with the checklist, respectively (p = 0.02). Error detection increased by 20% when the custom checklist was utilized. In the second study, 2.9 ± 0.84 and 3.5 ± 0.84 errors per participant were detected without and with the revised checklist, respectively (p = 0.08). Despite the lack of statistical significance for this cohort, error detection increased by 18% when the checklist was utilized.ConclusionOur results indicate that the use of a customized checklist when reviewing automated treatment plans will result in improved patient safety.