Radiation Oncology Program Directors Research Articles

Applicant and Program Director Perceptions of Second Look Events During the 2023 Radiation Oncology Residency Match

Introduction/PurposeVirtual radiation oncology (RO) residency interviews may impair applicant and program evaluation. Second look events (SLEs) exist; however, the frequency, nature, and implications are unknown. We surveyed applicants and program directors (PDs) to characterize the 2023 RO Match SLEs and assess perspectives. Method and MaterialsAn online, anonymous survey was distributed to 2023 RO Match applicants and ACGME-accredited RO PDs post-Match. Number and percentage are reported as response per question. Likert-type scores (1, strongly agree; 5, strongly disagree) are reported as median, interquartile range (IQR). ResultsResponses were received from 51 of 246 applicants (21%) and 52 of 88 PDs (59%). Forty applicants (87%) were offered in-person and virtual SLEs; 20 (51%) and 17 (44%) applicants were invited to 1-3 and 4-6 events, respectively. Most invited applicants attended none (21, 54%). Applicants reported that all (21, 54%) or some (16, 41%) programs communicated intentions to finalize rank order lists (ROLs) prior to SLEs. Most applicants (29, 74%) agreed that SLEs were optional without ROL consequences (median 2, IQR 1-3). Applicants declined in-person SLEs due to city/facility indifference (10, 43%); finances (10, 43%); logistics (9, 39%). Most (12, 86%) in-person SLE attendees agreed that SLEs influenced their ROL (median 2, IQR 1-2).Nineteen PDs (40%) reported offering SLEs, with 18 of 19 being in-person. PDs who did not offer SLEs cited ethical concerns (13, 45%) and institutional policies (11, 38%). All PDs reported that SLEs were optional, and 18 of 19 explained that the SLE would be without ROL consequences. SLEs mostly occurred in February before (11, 58%) and after (15, 79%) ROL submission. ConclusionsIn-person SLEs occurred during Match 2023. All PDs considered SLEs optional which was trusted by most applicants. Attendance at in-person SLEs influenced applicants’ ROLs, however, finances and logistics impaired applicant attendance. Further work is needed to appreciate SLE implications and ensure equitable residency recruitment.

Understanding Burnout Among US Radiation Oncology Residents

Burnout is a significant concern among medical residents in the United States, including those in radiation oncology. This study aims to understand the extent of burnout among radiation oncology residents and identify modifiable factors within program structure and benefits that may help improve overall wellness and reduce burnout. A Qualtrics-based survey was administered to US radiation oncology program directors and coordinators, utilizing contact information gathered in FREIDA, with a request to forward to all residents. The survey included questions on benefits and program structure as well as the Maslach Burnout Inventory. Data was analyzed using descriptive statistics. To date, 82 of 736 residents (11.1%) completed the survey with representation from all PGY-levels. Median participant age was 31, and 53% identified as male. 20% of surveyed residents feel emotionally drained from work a few times a week and 6% feel emotionally drained daily. 59% feel burned out from work at least a few times a month, with 6% feeling burned out daily. Despite this, 85% feel they are positively influencing other people's lives through their work at least weekly and 77% feel they have accomplished many worthwhile things in this job at least weekly. 65% have salaries between $60,000-$74,999, and 35% have the opportunity to moonlight for supplemental income. 49% have 3 weeks of vacation and 48% have 4 weeks. 27% reported their department had funded wellness events. 61% reported dual coverage rotations, with 40% requiring coverage of multiple attendings in one day. 65% reported protected academic time on all rotations, and 7% have no protected academic time. 48% of respondents have 12 months of research time. 85% and 36% of those with research and protected academic time, respectively, can complete this off-site. Respondent concerns include the job market (62%), declining personal fertility in residency (46%), and cost of living (40%). The most reported ways to decrease stress and anxiety were exercise (35%), a strong support system (34%), and spirituality (10%). Increased salary was identified as the top benefit that could improve wellness by 41 residents, while retirement matching (32), paid gym memberships (23), a personal wellness stipend (30), and free/subsidized childcare (16) were also ranked among the top 5 benefit changes that could improve wellness. Increased mid-level support (16), more protected academic time during the week (15), and flexibility with work location during academic/research time (13) were the top aspects of program structure that were reported as opportunities to improve wellness. Burnout is prevalent among US radiation oncology residents, and changes to residency programs and expanded institutional benefits are strongly perceived as the key components to improved resident wellness. This study highlights the need for further investigation into the root causes of burnout and the development of evidence-based strategies.

Parent Penalty: Parental Leave Experiences of Trainees and Early-Career Faculty in Oncology Subspecialties.

Prime childbearing years occur during medical training and early career, leaving physicians with tough choices between family planning and career growth. Restrictive workplace parental leave (PL) policies may negatively affect physician well-being. We evaluate existing PL and lactation policies, as well as return-to-work experiences, among oncology trainees and early-career faculty. An anonymous 43-question cross-sectional survey was distributed via e-mail and social media channels between May and June 2021 to oncology trainees and physicians within 5 years of terminal training in the United States. The survey was administered through SurveyMonkey. Descriptive statistics were used to analyze data. Two hundred seventy-five participants were recruited via social media and outreach to program directors and coordinators in adult hematology/oncology and radiation oncology program directors. The average duration of PL was <6 weeks for most participants. Among those who used PL, 50% felt pressured to work while on PL, 60% felt guilty asking coworkers for help, and 79% were overwhelmed with demands of work and home, whereas only 27% had resources available at workplace to assist with transition back to work. Among those who breastfed at return to work, 31% did not have access to a lactation room, 56% did not have adequate pumping breaks, and 66% did not have pumping breaks mandated in contract. Our findings underline the immense magnitude of problems surrounding inadequate PL and support for lactating mothers among trainees and early-career physicians in oncology subspecialities. Policies and practices around PL and lactation should be restructured to meet the needs of the evolving oncology workforce.

Radiation and Cancer Biology Educators of Radiation Oncology Residents and the Courses They Teach1.

The purpose of this study was to characterize today's radiation and cancer biology educators of radiation oncology residents, and the biology courses they teach. An e-mail list of 133 presumptive resident biology educators was compiled, and they were invited to participate in a 46-item survey. Survey questions were designed to collect information about the educational and academic backgrounds of the educators, how they self-identify, characteristics of the courses they teach, the value that they assign to their teaching activities, their level of satisfaction with their courses and how they see these courses being taught in the future. Findings of this survey were compared and contrasted with prior surveys of biology educators (conducted 12 and 20 years ago, respectively), and with more recent surveys of radiation oncology residents and radiation oncology residency program directors conducted in 2018 and 2019. A total of 67 survey responses were received. Biology educators range in age, academic rank and years of teaching experience from junior (18%) to quite senior (45%). Only about 40% self-identify as radiation biologists, biophysicists or chemists, compared to 56% in 2001. The majority of the others consist of cancer biologists (15%), radiation oncologists (15%) and radiation oncology physician-scientists (16%). Educators prioritize their resident teaching as important or very important. Biology courses are widely variable in contact hours between programs and have not changed significantly over the past 20 years. About 75% of the courses are team-taught, including 15% involving multiple training programs. An average biology course consists of about 42% foundational ("classical") radiobiology, 28% clinical radiobiology and 28% cancer biology. While biology educators and radiation oncology program directors are highly satisfied with their biology courses, approximately a third of residents report being not very, or not at all, satisfied. That fewer biology educators are radiobiologists by training and their courses have remained quite variable in length and content over long periods point to the need for a consensus core curriculum for resident education in radiation and cancer biology. Both current educators and program directors also support making online teaching resources available, diversifying course instructors and consolidating biology teaching across multiple training programs.

Diversity, Equity, and Inclusion Perspectives Among Radiation Oncology Program Directors: A Knowledge, Attitudes, and Practices Survey

Diversity, Equity, and Inclusion Perspectives Among Radiation Oncology Program Directors: A Knowledge, Attitudes, and Practices Survey

A Call for Reform: Variability and Insufficiency in Radiation Oncology Resident Didactics-a Brief Report and National Survey of Program Directors.

An informal needs assessment and lack of a national standardized curriculum suggest that there is tremendous variability in the formal teaching of radiation oncology resident throughout the USA. The goal of this study was to characterize formal radiation oncology resident education, in order to identify knowledge gaps and areas for improvement. We developed a 14-item survey consisting of the following domains: program characteristics, teaching faculty, formal teaching time, instructional approaches for formal teaching, curricular topics, and satisfaction with didactics. All 91 accredited US-based radiation oncology program directors received an invitation to complete the survey anonymously by email. Twenty-four (26% response rate) program directors responded. Programs used a variety of instructional methods; all programs reported using lecture-based teaching and only a minority using simulation (38%) or flipped classroom techniques (17%). Other than PowerPoint, the most common electronic resource utilized was quizzing/polling (67%), webinar (33%), and econtour.org (13%). The lack of a national, standardized, radiation oncology residency didactic curriculum promotes variability and insufficiency in resident training. Themes for improvement were diversity in didactic topics, incorporation of evidence-based teaching practices, increased faculty involvement, and sharing of resources across programs. Development of a national curriculum and increased electronic resource sharing may help address some of these areas of improvement.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-02080-5.

Radiation Oncology Program Directors' Attitudes Toward Twenty-Seven Discrete Palliative Care Skills.

Background: We evaluated radiation oncology residency program directors' attitudes toward discrete palliative care skills in effort to determine which skills should be prioritized in radiation oncology resident training. Design: We identified 93 U.S. radiation oncology residency program directors and sent them a survey through e-mail. The survey assessed views of 27 discrete palliative care skills in eight domains and was adapted from the American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement defining high-quality primary palliative care in medical oncology. Using a nine-point scale, respondents rated each skill on three constructs: (1) importance to high-quality cancer care, (2) relevance of the skill to radiation oncology practice, and (3) importance to radiation oncology residency education. Skills were categorized as "Include" (median score ≥7 for all constructs), "Exclude" (median score ≤3 for all constructs), or "Uncertain" (all other skills) using a composite score of all constructs. Results: Twenty-nine program directors (response rate 31%) completed the survey. Of the 27 skills, 100% were rated as highly important to high-quality cancer care, 70% were rated as highly relevant to radiation oncology practice, and 81% were rated as highly important to resident education (median score ≥7). Using the composite score, 70% of skills were categorized as "Include." The domains of Caregiver Support (100%), End-of-Life Care (66%), and Spiritual/Cultural Assessment and Management (33%) had the highest proportions of skills rated as "Uncertain." Conclusions: The surveyed radiation oncology residency program directors generally value palliative care skills within radiation oncology.

Radiation Oncology Resident Didactic Variability: A National Program Director Survey

An informal needs assessment and lack of a national standardized curriculum has suggested that there is tremendous variability in radiation oncology resident didactics throughout the United States. The goal of this study was to evaluate the current educational landscape for radiation oncology resident didactics throughout the United States, in order to identify knowledge gaps and areas for improvement. All 91 radiation oncology program directors in the U.S. were sent an IRB approved, anonymous, 14 question survey by email in May of 2019, regarding the current implementation of resident didactics. Prior to dissemination, this survey underwent content validation by seven medical education experts, and was piloted with nine radiation oncology physician volunteer participants with subsequent cognitive interviews. 24/91 (26%) of program directors responded. The average number of residents per program was 10, faculty was 16, and hours per week spent on didactics was 6. The most common teachers during resident didactics were residents and faculty, and no fellows participated in teaching in any program. The average time a faculty member was present during didactics was 79%, with some programs having a faculty member present only 20% of the time. All but one program director (96%) stated that resident didactic time is protected from clinical responsibilities; however, 8/24 (33%) stated that residents are sometimes or often interrupted during didactic time by clinical responsibilities. Programs use a variety of teaching styles; all programs reported using lecture-based teaching, with a majority also using quizzing (67%), and only a minority using simulation (38%) and flipped classroom (17%) techniques. Other than PowerPoint, the most common electronic resource utilized was quizzing/polling (used in 16 programs), webinar (used in 8 programs), and econtour.org (used in 3 programs). There was wide variability in didactic topics, with no two programs providing an identical curriculum. Free response areas for improvement included: desire for increased faculty involvement, sharing of resources nationally across programs, and inclusion of novel topics such as: ethics, finance, practice participation, quality, contouring, simulations, grant writing, interviewing, and research/educational scholarship. The lack of a national, standardized, radiation oncology residency didactic curriculum leads to variability in its implementation and opportunities for improvement such as resource sharing, content updating, incorporation of novel evidence-based-teaching techniques, encouragement of faculty participation, and protected time for residents.

Radiation oncology resident education in palliative care.

Palliative and supportive care education for radiation oncologists in training is essential to deliver comprehensive care to patients. Surveys on palliative care education among radiation oncology program directors and residents demonstrate a disparity in formal teaching and didactics. Integration of formal didactics, communications skills programs, and teaching modules are being piloted at academic centers. A dedicated palliative radiation oncology service has been implemented and the experience evaluated. Future directions to improve resident education in palliative care include improving access and time dedicated to formal didactics, online and interactive modules, rotation in a palliative care service, emphasis on board examinations, and consideration of an advanced palliative care fellowship for radiation oncologists. This is the first review of the available literature reviewing formal palliative education in radiation oncology training programs in the United States.

Attitudes Towards Research During Residency Training: a Survey of Canadian Radiation Oncology Residents and Program Directors.

Radiation oncologists require clinical appraisal and research methodology skills, yet it is unclear how to develop these competencies during residency. We sought to attain a deeper understanding of the barriers that limit, as well as the factors that promote, engaging in research/scholarly activity during radiation oncology residency training in Canada. Following ethics approval, online surveys were circulated to all Canadian Radiation Oncology program directors and residents. Unidentifiable demographics, prior research experience, and descriptions of current research environment and barriers to engaging in research and scholarly activities were collected. Thirty-three percent (35/105) of residents and 71% (10/14) of program directors responded. Ninety-seven percent of residents, and 90% of program directors, agreed or strongly agreed that research/scholarly activity was an important part of residency training. While 66% of residents felt that there was a lack of protected time for research/scholarly activity, only 20% of program directors agreed this was a barrier (p = 0.011). While 94% of residents thought mentorship was important to completing high-quality research/scholarly activity, only 48% of respondents had a mentor. The highest barriers to completing research/scholarly activity projects were lack of protected time (for both residents and faculty), high resident clinical workload, and lack of experience in research skills. Canadian Radiation Oncology residents expressed strong enthusiasm to participate in research/scholarly activity, yet lack of protected time and competing demands were identified as major barriers. We suggest programs offer more protected time for research/scholarly activity, provide optional research methodology training, and support meaningful mentorship relationships.

Radiation oncology resident training in patient safety and quality improvement: a national survey of residency program directors

BackgroundPhysicians and physicists are expected to contribute to patient safety and quality improvement (QI) in Radiation Oncology (RO), but prior studies suggest that training for this may be inadequate. RO and medical physics (MP) program directors (PDs) were surveyed to better understand the current patient safety/QI training in their residency programs.MethodsPDs were surveyed via email in January 2017. Survey questions inquired about current training, curriculum elements, and barriers to development and/or improvement of safety and QI training.ResultsEighty-nine RO PDs and 84 MP PDs were surveyed, and 21 RO PDs (28%) and 31 MP PDs (37%) responded. Both RO and MP PDs had favorable opinions of current safety and QI training, and used a range of resources for program development, especially safety and QI publications. Various curriculum elements were reported. Curriculum elements used by RO and MP PDs were similar, except RO were more likely than MP PDs to implement morbidity and mortality (M&M) conference (72% vs. 45%, p < 0.05). RO and MP PDs similarly cited various barriers, but RO PDs were more likely to cite lack of experience than MP PDs (40% vs. 16%, p < 0.05). PDs responded similarly independent of whether they reported using a departmental incident learning system (ILS) or not.ConclusionsPDs view patient safety/QI as an important part of resident education. Most PDs agreed that residents are adequately exposed to patient safety/QI and prepared to meet the patient safety/QI expectations of clinical practice. This conflicts with other independent studies that indicate a majority of residents feel their patient safety/QI training is inadequate and lacks formal exposure to QI tools.

Introductory Radiation Oncology Curriculum: Report of a National Needs Assessment and Multi-institutional Pilot Implementation

To assess the optimal structure of an introductory curriculum (IC) for radiation oncology residents, including the perceived utility of a 2-day off-site "boot camp," and evaluate the success of a pilot introductory radiation oncology curriculum (IROC) based on these initial data. In the first phase, anonymous, web-based surveys were sent to US radiation oncology program directors and residents. Likert-type scores (1, not at all; 5, extremely) are reported as the median and interquartile range. Using the phase 1 results, IROC was developed, piloted, and evaluated. Of the 89 program directors and 697 residents, 47 (53%) and 165 (24%) responded, respectively. Of the 89 program directors, 37 (79%) reported offering a formal IC. However, only 83 residents (50%) reported having a formal IC. Program directors reported resident preparation for clinical training as "moderate" (median 3, interquartile range 2-3) on entering residency and "moderate" (median 3, interquartile range 3-4) after IC completion (P=.03). However, residents only believed they were "slightly" prepared (median 2, interquartile range 1-2) on entering residency and "moderately" (median 3, interquartile range 2-3) prepared after IC completion (P<.01). Program directors believed an off-site boot camp would be of "moderate" utility (median 3, interquartile range 3-4) with participation limited by funding (57%). Residents without an IC reported that having an IC would be "quite" beneficial (median 4, interquartile range 3-5). Residents preferred instruction before the clinical training (49%) and over 1week (40%). Both program directors and residents rated lectures on radiation emergencies and simulation highly. Using these data, IROC was developed and piloted with incoming residents at 4 institutions. After IROC, residents reported improvement in overall preparedness for clinical training (before: median 1, interquartile range 1-2; vs after: median 3, interquartile range 2-3; P<.01) and among specific practice domains. Beginning radiation oncology residents frequently lack structured introductory curricula but desire instruction before the clinical training with a focus on practical aspects (emergency management, contouring). Program directors recognize the value of both off-site and on-site boot camps. An on-site IC could mitigate funding barriers. A standardized IC, IROC, piloted at 4 programs, showed promising outcomes.

(P101) Burnout Evaluation of Radiation Residents Nationwide (BERRN): Results of a Survey of United States Residents

Burnout is an increasing problem among U.S. physicians. Up to half experience professional burnout which is associated with many negative consequences, including decreased job satisfaction, increased medical errors, divorce, and even self-harm. Burnout varies widely among residents in different specialties and has been associated with a drop in medical knowledge equivalent to one full year of training. However, burnout has never been formally assessed among U.S. radiation oncology residents. A nationwide survey was sent to all U.S. radiation oncology program directors and coordinators as published by the Association of Residents in Radiation Oncology. The survey included the Maslach Burnout Index (MBI)-Human Services Survey, a validated and widely accepted burnout assessment questionnaire, as well as demographic and program-specific questions tailored to radiation oncology residents. Primary endpoints included rates of emotional exhaustion, depersonalization, and personal achievement as measured on MBI subscale scores. Overall, 205 residents responded, representing 28.0% of the 733 radiation oncology residents nationwide. Of the respondents, 31.2% were women. Response by post-graduate year (PGY) was 26.3% PGY-2, 26.8% PGY-3, 21.5% PGY-4, and 25.4% PGY-5. High levels of emotional exhaustion and depersonalization were reported in 28.3% and 17.1%, respectively; 33.1% experienced a high burnout level on at least one of these MBI subscales. Furthermore, 12% had low rates of perceived personal achievement. Twelve residents (5.9%) reported feeling “at the end of my rope” on a weekly basis or more. Approximately one third of radiation oncology residents have high levels of burnout symptoms. Particularly concerning was that more than one in twenty felt at the end of their rope on a weekly basis or more. Steps should be taken to identify program or resident-specific factors associated with burnout, followed by targeted interventions aimed at addressing modifiable factors to prevent the negative consequences of burnout.

(P100) Burnout Among Trainees in Radiation Oncology: Determining the Root of the Problem

More than 30% of U.S. radiation oncology residents experience burnout during residency. For some residents, these sentiments are accompanied by dissatisfaction with the residency program and feelings of hopelessness. Determining demographic factors and aspects of residency associated with burnout allows for implementation of strategies to prevent or alleviate burnout and improve program satisfaction among residents. A nationwide survey, including the Maslach Burnout Index (MBI)-Human Services Survey, was sent to all U.S. radiation oncology program directors and coordinators as published by the Association of Residents in Radiation Oncology. The survey included demographic-, resident-, and program-specific questions. Univariate binomial models examined the relationship between various residency-specific and resident-specific characteristics and two endpoints: 1) high burnout levels (as identified on the MBI Emotional Exhaustion and Depersonalization subscales) and 2) likelihood the resident would choose the same radiation oncology program again. Variables with a p <0.10 were included in multivariable models. There was a statistically significant inverse association with adequate work-life balance (OR 0.37; 95% CI: 0.17-0.83) and burnout. Female gender (OR 3.39; 95% CI: 1.32-9.52), marriage (OR 2.27; 95% CI 1.02-5.20), work-personal life balance (OR 4.24; 95% CI: 1.75-10.7), residents’ opinions about whether the program served patient needs (OR: 2.93; 95% CI: 1.11-7.91), and residents opinions about whether the program was invested in the resident’s educational success (OR: 5.23; 95% CI: 2.12- 13.4) were each associated with the likelihood of choosing the same radiation oncology program again. On univariate and multivariate regressions, factors directly examining time at work were not significantly associated with choosing the same radiation oncology program or burnout. Increasing educational opportunities and maintaining adequate work-life balance may lead to an increase in residency program satisfaction. Ensuring an adequate work-life balance in the residency program may reduce burnout and its associated negative outcomes.

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.

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.

Stress and Burnout Among Residency Program Directors in United States Radiation Oncology Programs

To evaluate stressors among radiation oncology residency program directors (PDs) and determine the prevalence and indicators of burnout. An anonymous, online, cross-sectional survey was offered to PDs of US radiation oncology programs in the fall of 2014. Survey content examined individual and program demographics, perceptions surrounding the role of PD, and commonly encountered stressors. Burnout was assessed using the validated Maslach Burnout Inventory-Human Services Survey. In total, 47 of 88 PDs (53%) responded to the survey. Although 78% of respondents reported feeling "satisfied" or "highly satisfied" with their current role, 85% planned to remain as PD for <5 years. The most commonly cited stressors were satisfying Accreditation Council for Graduate Medical Education/Residency Review Committee requirements (47%), administrative duties (30%) and resident morale (28%). Three-quarters of respondents were satisfied that they became PDs. Overall, 11% of respondents met criteria for low burnout, 83% for moderate burnout, and 6% for high burnout. Not having served as a PD at a prior institution correlated with high depersonalization (OR 6.75, P=.04) and overall burnout (odds ratio [OR], 15.6; P=.04). Having more years on faculty prior to becoming PD correlated with less emotional exhaustion (OR, 0.44, P=.05) and depersonalization (OR, 0.20, P=.04). Finally, having dedicated time for PD duties correlated with less emotional exhaustion (OR, 0.27, P=.04). Moderate levels of burnout are common in U.S. radiation oncology PDs with regulatory stressors being common. Despite this, many PDs are fulfilled with their role. Longitudinal studies assessing dynamic external factors and their influence on PD burnout would be beneficial.

Is comparative effectiveness research emphasized in oncologic residency training programs? Results of a national survey.

e17577 Background: Comparative effectiveness research (CER) is informally defined as an assessment of all available efficacious options for a specific medical condition, with intent to estimate effectiveness and efficiency in specific subpopulations. The American Recovery and Reinvestment Act of 2009 allocated $1.8 B to increase CER and train physicians in its practice. Although program directors (PDs) of medical oncology (MO) and radiation oncology (RO) training programs know that CER is emphasized nationally, it is unknown if CER is emphasized in oncological training programs themselves. We examine the emphasis of CER in MO and RO training programs. Methods: A web-based, anonymous survey was sent to RO PDs (n = 85) and chief residents (CRs; 98); and MO PDs (99), asking them to forward a link to fellows (Fs; 160). Mean weighted Likerts (MWLs ± standard deviations [SDs]) were calculated from scales (1, strongly disagree; 3, neutral; 5, strongly agree). Results: The response rates for RO PDs, RO CRs, MO PDs, and MO Fs were 20%, 21%, 11%, and 10% (combined, 15%, 68/442). Respondents had mixed beliefs in having a clear definition of CER (MWL, 3.1 ± 1.2); their programs encouraging CER (3.2 ± 1.2); including a course on CER (2.3 ± 0.9); or discussing the differences among efficacy, effectiveness, and efficiency (2.9 ± 0.9). Retrospective cohort studies were easy to perform at institutions (4.3 ± 0.8), but less so CER (3.1 ± 1.3). Respondents believed their programs’ research integrated some core values of CER, including comparing treatments to influence clinical decision making (4.6 ± 0.7). Respondents believed CER was important (4.3 ± 0.7); 47% would divert funding from other types of research toward CER; 35% would, only if funding for other research was unaffected. Conclusions: CER is not emphasized in oncologic training programs, and most PDs and trainees cannot clearly define CER. In the era of health care reform and potential future payment reforms, it is anticipated that CER will become an increasingly important component of evidence-based medicine and continuous quality improvement. This study identifies a need for oncology training programs to incorporate education about CER into their curricula.

Continuity Clinics in Oncology Training Programs in Canada

Continuity clinics (ccs) give trainees an opportunity for longitudinal follow-up of a patient cohort. Trainees can function in a semi-autonomous manner and prepare for independent practice. Data about such clinics in Canada are limited. Our objective was to assess the utility of ccs in Canadian oncology training programs. Surveys were developed by the authors for medical and radiation oncology program directors (pds) and trainees, to assess the utility of ccs in Canadian oncology training programs.oncology patients, to assess their attitudes toward ccs. The pds were contacted by e-mail, using the Web site of the Canadian Resident Matching Service; the trainees were contacted by e-mail through the pds and their administrative assistants. Surveys were distributed electronically using SurveyMonkey. Patients were approached by staff oncologists during follow-up visits at The Ottawa Hospital Cancer Centre. Completed surveys were received from 33% of trainees and 63% of pds contacted; patient surveys were completed by 95 patients. Participation in a cc was reported by 47% of responding pds and 37% of responding trainees. Among respondents, 80% rated the ccs as "important" or "very important" to training. The biggest challenge identified by trainees and pds was lack of clinic space. Most pds (57%) and trainees (59%) felt that the staff oncologist should review the patient only if the trainee has concerns, but only 37% of patients shared that view (p = 0.0002). However, many patients expressed the desire to participate in trainee education. Continuity clinics are considered beneficial by pds and trainees. Patients desire more trainee supervision than the trainees themselves and the pds do, a factor that should be considered when implementing a cc.

Results of the Association of Directors of Radiation Oncology Programs (ADROP) Survey of Radiation Oncology Residency Program Directors

To survey the radiation oncology residency program directors on the topics of departmental and institutional support systems, residency program structure, Accreditation Council for Graduate Medical Education (ACGME) requirements, and challenges as program director. A survey was developed and distributed by the leadership of the Association of Directors of Radiation Oncology Programs to all radiation oncology program directors. Summary statistics, medians, and ranges were collated from responses. Radiation oncology program directors had implemented all current required aspects of the ACGME Outcome Project into their training curriculum. Didactic curricula were similar across programs nationally, but research requirements and resources varied widely. Program directors responded that implementation of the ACGME Outcome Project and the external review process were among their greatest challenges. Protected time was the top priority for program directors. The Association of Directors of Radiation Oncology Programs recommends that all radiation oncology program directors have protected time and an administrative stipend to support their important administrative and educational role. Departments and institutions should provide adequate and equitable resources to the program directors and residents to meet increasingly demanding training program requirements.