Radiation Oncology Education Research Articles

The status of radiation oncology teaching in Australian and New Zealand medical schools.

Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession. An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval. Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5years; however, most have no intention of changing radiation oncology teaching. Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.

Utilization of a Web-Based Conferencing Platform to Improve Global Radiation Oncology Education and Quality—Proof of Principle Through Implementation in India

Chartrounds (www.chartrounds.com) was established in the United States in 2010 as a web-based platform for radiation oncologists to review cases with leading disease-site experts. However, the need for access to experts for peer review and education is not unique to the United States, and the Chartrounds platform was therefore adapted for improved global reach. Chartrounds was first expanded to India, and herein we report our initial experience with this initiative. The US Chartrounds platform was adapted to create Chartrounds India (ind.chartrounds.com). Through collaboration with the Association of Radiation Oncologists of India, India-based specialists were recruited, and the association's membership list was used to announce sessions to potential participants. Between June 2017 and January 2018, 27 Chartrounds India sessions were completed, led by 21 different specialists (representing 10 centers in India) and covering 11 different disease sites/topics. A total of 240 members from 126 centers (private: 56%; teaching: 36%; public: 8%) across 24 states/territories participated in ≥1 session. Of the 240 members who participated in ≥1 session, 159 (66%) participated in ≥2 sessions and 60 (25%) participated in ≥5 sessions. The average number of participants per session was 34 (range, 13-72). On average, 80% of respondents rated the sessions as high or very high quality; 87% and 95% agreed or strongly agreed that the time was used effectively and that the sessions were relevant to daily practice, respectively. Seventy-six percent agreed or strongly agreed that the sessions will result in a change in their practice. The average feedback survey response rate was 32% (range, 17%-49%). Chartrounds has proven to be an effective resource for US-based radiation oncologists, and our initial experience with Chartrounds India suggests that an online platform for radiation oncology case review and education can be successfully implemented globally with use of local disease site experts.

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.

SP-0108: The ESTRO School - Radiation oncology education of the highest standard for all

SP-0108: The ESTRO School - Radiation oncology education of the highest standard for all

Patient education in radiation oncology: Evolution and innovation

Patient education in radiation oncology: Evolution and innovation

Augmented and virtual reality: Exploring a future role in radiation oncology education and training

Augmented and virtual reality: Exploring a future role in radiation oncology education and training

Simulation As More Than a Treatment Planning Tool: A Systematic Review of the Radiation Oncology Simulation-Based Medical Education Literature

Simulation-based medical education (SBME) is gaining prominence with the increased focus on ACGME-mandated competency-based assessment. SBME exists in radiation oncology, although studies to date are infrequently framed in the context of SBME. The goal of this study is to complete the first systematic literature review of radiation oncology SBME. The review focused on radiation oncology-specific SBME literature. Inclusion criteria were according to the PICOS (Population, Intervention, Comparison, Outcome and Setting) framework. The population included undergraduate, graduate, and continuing medical education learners. Simulation was defined as screen-based, virtual reality, part-task trainers, simulated patients or environments, and hybrid. Studies could be single arm or comparative and outcomes could be quantitative or qualitative. Any medical education environment was included. Additionally, studies were limited to English, published after 1/1/1990, and in peer-review manuscript form. PubMed, MedEdPORTAL and in-press articles at prominent radiation oncology and cancer education journals were searched. The PubMed search was conducted using pre-defined search terms. Studies were selected based on independent review by two reviewers (FZ and DWG). References and similar articles of the selected article were also examined. MeSH terms in selected articles were reviewed to ensure that all MeSH terms were included. The two independent sets of studies were reviewed by the entire study team to ensure that they meet the inclusion criteria. Results: 54 SBME publications met the inclusion criteria representing 45 unique SBME interventions. Only 5 studies identified themselves as SBME. The vast majority of SBME was designed to include physicians (40/45), followed by therapists (8/45), physicists (7/45), patients (3/45), others (3/45), dosimetrists (3/45), and nurses (1/45). The SBME classification was mostly screen-based (30/45) with 22/30 providing simulated contouring. Additional SBME types included simulated environments (7/45), virtual reality (5/45) including one haptic, part-task trainers (3/45), and simulated patients (2/45). Overall, this systematic review of the literature provides historical context for further SBME development. More importantly, it provides structure and guidance to future SBME researchers in radiation oncology. Few papers describe their educational methods as SBME. Appropriately framing SBME in radiation oncology as such will allow improved development, implementation, and evaluation of novel SBME interventions. It would also be beneficial to centralize teaching resources resulting from these experiences.

Impact of an Interactive Contouring Module on Knowledge and Interest in Radiation Oncology Among Pre-Clinical Medical Students: A Randomized Trial

Approximately 2 out of 3 patients with cancer are treated with radiation, and it is estimated that by 2030 there will be over 4 million survivors living at least 5 years after radiation treatment. Previous studies have reported significant gaps in knowledge of radiation therapy among medical students and primary care providers. The goal of this study was to evaluate the impact of an interactive contouring module on knowledge and interest in radiation oncology among pre-clinical medical students. Second-year medical students were recruited from the UC San Diego School of Medicine to engage in a 1-hour educational session. Students were randomized to a) watch a traditional didactic lecture or b) complete an interactive contouring module (trial educational materials can now be accessed at http://econtour.org/cervical). Both the lecture and contouring module described radiation in the context of a cervical cancer case, though only students in the contouring module completed a contouring exercise with access to eContour (http://econtour.org/cases/64). Upon completion of the educational session, students completed a short questionnaire regarding engagement, usefulness, and a multiple choice question (MCQ) test evaluating knowledge of patient experience of radiation including side effects and radiographic anatomy. Knowledge was tested again 3 months later for retention. Statistical analysis included Wilcoxon signed-rank test for pre- and post-test comparisons and Wilcoxon rank sum test for comparison between groups. Forty-three medical students completed this trial (21 in the didactic group and 22 in the contouring group). Baseline knowledge was similar in both groups (78% vs. 79%, NS). Students completing the contouring module scored as well as the traditional didactic group on general knowledge (86% vs. 86%, NS) but endorsed greater engagement on a 5-point likert-type scale (3.1 vs. 3.76, p=0.02). At 3 months, overall knowledge was similar (43% vs. 51%, p=0.10), but knowledge of side effects (51% vs. 75%, p=0.003) was improved in the contouring group. Interest in a clinical radiation oncology rotation was greater in the contouring group on a 5-point likert-type scale (2.5 vs. 3.3, p=0.01). Use of an interactive contouring module to teach pre-clinical medical students about radiation oncology was as effective as a traditional didactic lecture. However, higher engagement among students completing the contouring module led to improved retention of knowledge of side effects, and greater interest in radiation oncology. These data suggests that pre-clinical radiation oncology education, which impacts all physicians who will care for patients undergoing radiation and surviving after cancer treatment, may benefit from incorporation of interactive contouring modules.

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

Gaps in Radiation Therapy Awareness: Results From an Educational Multi-institutional Survey of US Internal Medicine Residents

Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings should serve as a call to increase the educational collaboration between internal medicine and radiation oncology departments to ensure optimal cancer care.

Need for Competency-Based Radiation Oncology Education in Developing Countries

Although not a new concept in itself, competency-based education has set the trend for the globally accepted standard norm for education and training of medical professionals including postgraduate education in radiation oncology. Societal needs demand from radiation oncologists that they be not only competent in the knowledge and skills relevant to their specific discipline, but that they also display competencies such as professionalism, scholarship, health advocacy, management/leadership, collaboration and communication. The realities of developing countries, in particular low and middle income countries (LMICs) set different priorities than in high income countries. A large proportion of cancer patients do not have access to adequate radiotherapy services. Resource constraints determine limitations in equipment, accessories, and dosimetry. Lower than standard staffing levels and limited quality education and training also contribute to substandard care and clinical outcomes. In this environment, the addition and assessment of competency-based elements to training programmes can be challenging. On the other hand, it is precisely in these countries, where competencies such as the ones listed above are highly needed in the radiation oncology profession. Implementation of competency-based medical education in the education of radiation oncologists in LMICs is both a need and a challenge. The available frameworks and competencies, despite being very relevant to the realities faced by radiation oncologists in LMICs, will still need to be adapted in order to ensure effective implementation at the national/regional level. Radiation oncologists need to employ effective change-management strategies to ensure that the changes which are introduced can remain sustainable within the context of national healthcare, education and political systems.

Palliative care and palliative radiation therapy education in radiation oncology: A survey of US radiation oncology program directors

PurposeThe purpose of this study was to assess the state of palliative and supportive care (PSC) and palliative radiation therapy (RT) educational curricula in radiation oncology residency programs in the United States. Methods and materialsWe surveyed 87 program directors of radiation oncology residency programs in the United States between September 2015 and November 2015. An electronic survey on PSC and palliative RT education during residency was sent to all program directors. The survey consisted of questions on (1) perceived relevance of PSC and palliative RT to radiation oncology training, (2) formal didactic sessions on domains of PSC and palliative RT, (3) effective teaching formats for PSC and palliative RT education, and (4) perceived barriers for integrating PSC and palliative RT into the residency curriculum. ResultsA total of 57 responses (63%) was received. Most program directors agreed or strongly agreed that PSC (93%) and palliative radiation therapy (99%) are important competencies for radiation oncology residents and fellows; however, only 67% of residency programs had formal educational activities in principles and practice of PSC. Most programs had 1 or more hours of formal didactics on management of pain (67%), management of neuropathic pain (65%), and management of nausea and vomiting (63%); however, only 35%, 33%, and 30% had dedicated lectures on initial management of fatigue, assessing role of spirituality, and discussing advance care directives, respectively. Last, 85% of programs reported having a formal curriculum on palliative RT. Programs were most likely to have education on palliative radiation to brain, bone, and spine, but less likely on visceral, or skin, metastasis. ConclusionsResidency program directors believe that PSC and palliative RT are important competencies for their trainees and support increasing education in these 2 educational domains. Many residency programs have structured curricula on PSC and palliative radiation education, but room for improvement exists in management of fatigue, assessing role of spirituality, and discussion regarding advance care planning.

Perspectives on medical education in radiation oncology and the role of the ESTRO School

Radiation oncology is a medical specialty not just delivering ionizing radiation to cancer patients but also participating as an important partner in the care of the patient from diagnosis to cure, follow up or end of life. The specialty is rapidly evolving in a multi- and interdisciplinary setting as multimodality treatment is becoming frequent. This requires that the medical undergraduate and postgraduate training evolve to these changes. The ESTRO School has for more than 30years offered postgraduate training courses in and outside Europe and strives to develop its services to accommodate the educational needs of a specialty in constant development. Some of these developments are described in the present paper.

Postgraduate Education in Radiation Oncology in Low- and Middle-income Countries

Radiation therapy is one of the most cost-effective ways to treat cancer patients on both a curative and palliative basis in low- and middle-income countries (LMICs). Despite this, the gap in radiation oncology capacity is enormous and is even increasing due to a rapid rise in the incidence of cancer cases in LMICs. The urgent need for radiotherapy resources in terms of bunkers and megavoltage machines is important, but equally important is the tremendous lack of properly educated health care professionals. This includes not just medical doctors, but also medical physicists, radiation therapists and nurses, as well as other supporting health care personnel. This overview discusses different ways to develop the standard setting of postgraduate specialist training and continuous medical education in LMICs.

Palliative care and palliative radiotherapy education in radiation oncology: A survey of US radiation oncology program directors.

178 Background: To assess the state of palliative care education curricula in radiation oncology residency programs in the United States. Methods: We surveyed 90 program directors of radiation oncology residency programs in the United States from September 2015 to November 2015. An electronic survey on palliative care education during residency was sent to all program directors. The survey consisted of questions on perceived relevance of palliative care in radiation oncology residency, formal didactics on domains of palliative care, effective teaching formats for palliative care education, and perceived barriers for integrating palliative care into the residency curriculum. Results: Sixty-three percent (57/90) residency program directors completed the survey. Most (93%) program directors agree or strongly agree that palliative care is an important competency for radiation oncologists. A vast majority (90%) of programs have dedicated palliative care services; however, only 57% of programs offer residents an opportunity to spend elective time on a palliative care service. Of these programs, only 30% reported residents rotating on a palliative care service in the past two years. Furthermore, 67% of residency programs have formal educational activities in principles and practice of palliative care. The palliative care curriculum included faculty-led lectures (73%), resident-led lectures (42%), and seminars (22%). Most programs have one or more hours of formal didactics on management of pain (66%), management of neuropathic pain (64%), and management of nausea and vomiting (64%). 35%, 46%, and 48% programs had one or more hours of management of non-physical symptoms including fatigue, anorexia, and anxiety, respectively. Conclusions: Residency program directors believe that palliative care is an important competency for their trainees. The survey revealed that many programs have structured curricula on PSC and palliative radiation education, but that there are still areas for improvement.

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.

Updated Analysis of a Multi-Institutional Radiation Oncology Clerkship Curriculum: A Report From the Radiation Oncology Education Collaborative Study Group

Updated Analysis of a Multi-Institutional 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

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

Radiation Oncology Teaching Programmes as Part of the Undergraduate Degree in Medicine in Spanish Universities: the Need for an Update of the Contents and Structure.

The relevance of radiation oncology (RO) teaching in the Faculty of Medicine Degree Plan is justified by the high number of cancer patients who will require it at some point in their evolution of radiotherapy (RT). About 40% of the population who will suffer cancer will be cured by RT alone or other related treatment modalities. Therefore, cancer education and RT teaching needs to have an in depth impact in the undergraduate medicine programmes. This education component is highly variable, not only among countries but also within each country, in terms of content (theory and practical training), number of credits and departmental affiliation of the teachers. Our aim is to take a snapshot of the situation of the teaching of RO in undergraduate university education in Spain. We have analysed 40 Spanish universities about specific aspects related to the teaching of RT. Information was obtained by mail or telephone contact throughout 2015. We have analysed the elements involved in teaching performance. In universities with various instructional units, we have taken the average of them. Among the Universities consulted in Spain, during the period of the medical degree, the average time allocated to RT lectures is 12h (range, 0-36), the mean time allocated to seminars is 4h (range, 0-22), and the mean time assigned to practices is 11h (range, 0-38). The subject is mainly taught by a radiation oncologist and 80% of Spanish universities have at least one radiation oncologist on staff. Undergraduate radiation oncology teaching in Spain shows structural heterogeneity. The Spanish Society of Radiation Oncology (SEOR) University Forum has identified new opportunities and elaborated a proposal to improve undergraduate education in oncology.

Radiation Oncology and Online Patient Education Materials: Deviating From NIH and AMA Recommendations

Physicians encourage patients to be informed about their health care options, but much of the online health care-related resources can be beneficial only if patients are capable of comprehending it. This study's aim was to assess the readability level of online patient education resources for radiation oncology to conclude whether they meet the general public's health literacy needs as determined by the guidelines of the United States National Institutes of Health (NIH) and the American Medical Association (AMA). Radiation oncology-related internet-based patient education materials were downloaded from 5 major professional websites (American Society for Radiation Oncology, American Association of Physicists in Medicine, American Brachytherapy Society, RadiologyInfo.org, and Radiation Therapy Oncology Group). Additional patient education documents were downloaded by searching for key radiation oncology phrases using Google. A total of 135 articles were downloaded and assessed for their readability level using 10 quantitative readability scales that are widely accepted in the medical literature. When all 10 assessment tools for readability were taken into account, the 135 online patient education articles were written at an average grade level of 13.7±2.0. One hundred nine of the 135 articles (80.7%) required a high school graduate's comprehension level (12th-grade level or higher). Only 1 of the 135 articles (0.74%) met the AMA and NIH recommendations for patient education resources to be written between the third-grade and seventh-grade levels. Radiation oncology websites have patient education material written at an educational level above the NIH and AMA recommendations; as a result, average American patients may not be able to fully understand them. Rewriting radiation oncology patient education resources would likely contribute to the patients' understanding of their health and treatment options, making each physician-patient interaction more productive and efficient.