Radiation Oncology Residency Training Research Articles

Radiation Oncology Residency Training in Saudi Arabia: Direction in Attaining Competencies.

Introduction Radiotherapy is a cornerstone in cancer treatment as a part of multidisciplinary team management. The field has evolved significantly over the past two decades due to technological advancement. To meet the increased need for manpower in the field, the radiation oncology residency program was first established in Saudi Arabia back in 2019. Purpose We sought to survey the trainees' current experience across the country to establish a baseline for the different training aspects and to tackle any challenges that might go unnoticed. Materials and methods This is a cross-sectional survey-based study that targeted all residents enrolled in the Saudi radiation oncology training program, except the first-year residents. The trainees received an anonymous online questionnaire aiming to assess their involvement in every aspect of the daily workflow. Results A total of 13 eligible radiation oncology residents in Saudi Arabia were included. Eleven residents completed the survey with a national response rate of 85%. Nine (82%) of the trainees reported that they review the contours and the treatment plans with their attendings in person and this method of review is the preferred one over the hybrid method as it provides better teaching quality, interactivity, and prompt feedback. Most respondents do not review offline (7, 64%) or online (6, 55%) cone beam computed tomography (CBCT) scans with their attendings, citing the limited involvement in the approval process. Conclusion This study uncovered a need for better resident integration into day-to-day clinical workflow, particularly in CBCT review and approval. Addressing the current concerns will enhance the educational experience and future practice. Acknowledging the limitations of our study, we observed that certaindeficiencies in core competencies reported in long-established North American programs align with our findings. This underscores the need for addressing these gaps through continuous and unbiased evaluations of radiation oncology residency training programs to enhance the educational experience and ensure high-quality preparation for independent practice.

Problem-based learning on the WeChat public platform in radiation oncology residency training programs

PurposeThis study explored the effectiveness of a Problem-based Learning (PBL) teaching model on the WeChat public platform for radiation oncology residency training programs.Materials and methodsThe WeChat PBL program was initiated in 2019. The study recruited student participants, on a voluntary basis, who were in their first and second years of standardized training in radiation oncology. We selected classic and trending issues in radiation oncology as the two main teaching topics. Students in the PBL group searched for relevant literature, summarizing PowerPoint presentations or academic speeches on specific issues published on the professional WeChat public platform after an in-depth review by teachers. The final national standardized training examination scores for resident physicians were used to evaluate teaching effectiveness. The graduation scores of the PBL and non-PBL groups were compared, and a stratified analysis was conducted based on the year of participation to assess the teaching effectiveness of this model. Moreover, questionnaires were administered to evaluate students’ experiences.ResultsAmong the 36 students who joined the study in 2019, 16 (44.0%) voluntarily joined the PBL teaching group. Nine students started teaching PBL in their first year of residency, accounting for 47.4% of that year, and seven started in their second year, accounting for 41.2%. The average graduation scores of the PBL group were superior to those of the non-PBL-focused group for the same grade. The rate of high scores among students in the PBL group (56.3%) was higher than that of students in the non-PBL group (25%). Specifically, first-year residents who joined the PBL group had an average score of 92.3 ± 2.2, significantly higher than their non-PBL counterparts, who scored an average of 88.6 ± 4.6, showing a statistically significant advantage (p = 0.042). All students were satisfied with the PBL WeChat teaching and would recommend the PBL WeChat course to others.ConclusionThe PBL residency teaching model on the WeChat platform improved residency scores and garnered student satisfaction.

180 Implementation of a PGY-1 Multidisciplinary Surgical Block in Radiation Oncology Residency Training

180 Implementation of a PGY-1 Multidisciplinary Surgical Block in Radiation Oncology Residency Training

Radiation Oncology Training in the Philippines: Bridging Gaps for Improved Cancer Care in Low- and Middle-Income Countries.

Radiation oncology in the Philippines, a large lower- and middle-income country in Southeast Asia, is facing a critical shortage in manpower, with only 113 radiation oncologists (ROs) over 55 radiotherapy (RT) centers serving 100 million population. Paramount to workforce expansion is ensuring that training programs can produce adequately trained specialists. In this study, we describe the current state of radiation oncology training programs in the Philippines. This is a cross-sectional observational analysis of the nine radiation oncology residency training programs in the Philippines. Data were collected from a survey of the program directors, the Philippine Radiation Oncology Society database, and a PubMed literature search. Eight of the nine programs are in the National Capital Region. Since program standardization in 2005, there have been 82 four-year residency graduates, with up to 18 new graduates annually. Faculty-to-trainee ratio ranges from 0.5 to 2.67. In terms of technology, all programs have intensity-modulated RT and high-dose-rate brachytherapy, but only six are equipped with computed tomography-based image guidance and stereotactic capabilities. Clinical education schemes vary per institution regarding curriculum implementation, resident activities, and methods of evaluation. Required resident case logs are not met for lung, GI, genitourinary, bone and soft tissue, and hematologic malignancies. In total, there are only 22 resident-led publications from 10 unique individuals in two training programs. Program expansions are warranted to meet the projected demand for ROs in the Philippines, but training programs must first improve key aspects of staffing, technology, clinical education, and research. Addressing training challenges related to resource limitations necessitates local and international collaborations with higher-capacity centers to bridge gaps for continued quality improvement with the aim of ultimately delivering better overall cancer care.

The Inpatient Consultation Experience in Radiation Oncology: A Contemporary Evaluation of a Single Academic Institution

Participating in an inpatient consultation service is an essential aspect of radiation oncology residency training. However, there are no reports in the literature describing the inpatient on-call experience. To better describe the clinical burden and define the learning opportunities associated with inpatient consultation service participation, inpatient on-call data were tracked and assessed. From July 1, 2022, through Dec. 31, 2022, radiation oncology residents covering the on-call pager for the inpatient consultation service spanning two hospitals at a single academic institution prospectively self-reported the total number of pages, new consultations, inpatient treatment starts, and treatment indications. Patient billing records and paging logs were reviewed to confirm self-reported cases and track the number of business days between simulation and the first fraction of treatment. A new inpatient consultation was defined as a novel encounter requiring independent evaluation; as such, patients admitted during an ongoing course of radiotherapy who continued the planned course while inpatient were not included. During the initial six months of tracking, on-call residents received a total of 607 pages with an average of 23.1 pages per week (range: 14-38). Of these pages, 212 were for new inpatient consultations with an average of 8.1 consultations per week (range: 2-15). Out of these 212 new consultations, 75 patients (35%) were treated on an inpatient basis. Nine patients (12%) received their first fraction of treatment on the same day as simulation, 13 (17%) on the next day, 11 (15%) two days after, 22 (29%) three days after, and 20 (27%) four or more days after simulation. The most common indications for urgent treatment were malignant spinal cord compression (27%), brain metastases (24%), tumor-related bleeding (8%), malignant obstruction of the airway or vasculature (8%), painful bone metastases (7%), and heterotopic ossification prophylaxis (7%). The most common primary sites of disease were leukemia/lymphoma (16%), gastrointestinal (13%), breast (11%), lung (9%), gynecologic (9%), sarcoma (9%), and benign (9%). Each individual resident's caseload differed greatly in quantity, indication, treatment site, and primary site over this six-month time period. In this longitudinal analysis at a single academic institution, the radiation oncology inpatient consultation service experience was highly variable and diverse in clinical volume and treatment indication on a week-to-week and resident-to-resident basis. Exposure to radiation oncology emergencies is a vital component of residency training. However, the unpredictable nature of inpatient on-call scenarios can lead to variable educational experiences. Tracking inpatient on-call cases during residency may help identify areas needing improvement to enhance both patient care and residency training.

Results of a Multi-Disciplinary and Multi-Institutional Pilot Creating High-Yield Physics Educational Content (Hi-Phy)

The quality of medical physics education is heterogenous across training programs, despite its importance in radiation oncology (RO) residency training. We present the results of a pilot series of free high-yield physics educational videos covering 4 topics chosen from the American Society for Radiation Oncology core curriculum. Scripting and storyboarding of videos were iterative processes performed by 2 ROs and 6 medical physicists, with animations created by a university broadcasting specialist. Current RO residents and those who had graduated after 2018 were recruited through social media and e-mail with an aim of 60 participants. Two validated surveys were adapted for use and were completed after each video as well as a final overall assessment. Content was released sequentially after completion of the survey instruments for each prior video. All videos were created and released within 1 year of project initiation with a duration of 9 to 11 minutes. There were 169 enrollees for the pilot from across the world, 211% of the targeted cohort size. Of these, 154 met eligibility criteria and received the first video. One hundred eight enrollees initiated the series and 85 completed the pilot, resulting in a 78% completion rate. Participants reported improved understanding and confidence applying the knowledge learned in the videos (median score 4 out of 5). All participants reported that the use of graphic animation improved understanding across all videos. Ninety-three percent agreed with a need for additional resources geared specifically toward RO residents and 100% would recommend these videos to other residents. Use metrics revealed the average watch time was 7 minutes (range, 6:17-7:15). The high-yield educational physics video pilot series was successful in developing videos that were effective in teaching RO physics concepts.

Radiation Oncology Residency Training Program Integration of Diversity, Equity, and Inclusion: An Association of Residents in Radiation Oncology Equity and Inclusion Subcommittee Inaugural Program Director Survey

The aim of this study was to investigate United States (US) radiation oncology (RO) program directors' (PDs) attitudes and practices regarding racial/ethnic diversity, equity, and inclusion (DEI) to better understand potential effects on underrepresented in medicine (UIM) residents in RO. A 28-item survey was developed using the validated Ethnic Harassment Experiences Scale and the Daily Life Experiences subscale, as well as input from DEI leaders in RO. The survey was institutional review board-approved and administered to RO PDs. PDs were provided with the American Association of Medical Colleges definition of UIM, that is, "Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population." Descriptive statistics were used in analysis. The response rate was 71% (64/90). Institutional Culture and Beliefs: 42% responded that they had a department DEI director. A minority (17%, n = 11) agreed "I believe that people from UIM backgrounds have equal access to quality tertiary education in the US." The majority (97%, n = 62) agreed "My program values residents from UIM backgrounds." Support and Resources: The majority (78%, n = 50) agreed "My program has resources in place to assist/provide support for resident physicians from UIM backgrounds." Interview and Recruitment: Most PDs (53%) had not taken part in activities aimed at recruiting UIM residents and 17% had interviewed no UIM applicants in the past 5 years for residency. Resident Experiences of Racism: 17% (n = 11) agreed "UIM residents in my program have reported incidents of racism to me," and 28% (n = 18) agreed "I believe that UIM residents in my program have been treated differently because of their race/ethnicity by faculty, staff, coresidents or patients." Most PDs reported that they did not believe that UIM residents were treated differently in their department because of their race/ethnicity, and only a minority had received reports of racial discrimination experienced by residents. These data contrast resident experiences and suggest a disconnect between DEI perceptions and resident experiences among US RO PDs that should be addressed through increased programmatic action and evaluation.

Ten-year trends in Canadian female medical student interest in radiation oncology: an analysis of data from the Canadian Resident Matching Service (2012-2021)

<h3>Background</h3> Canadian medical student (MS) interest in Radiation Oncology (RO) residency training has varied over the last decade. Concerns related to post-training job availability, employment location flexibility, and extended fellowship training may have affected MS perceptions of RO, potentially deterring past applicants. With recent job market improvements, there has been increased MS interest in the specialty. However, despite recent years showing no gender differences in successfully matching to first-choice overall nonsurgical disciplines, the number of women entering RO residency remains low. This study examines 10 years of resident match data to assess trends in gender-specific interest and match characteristics in RO. <h3>Methods</h3> Publicly available Canadian Resident Matching Service (CaRMS) data from 2012 to 2021 were compiled. Gender-based analysis focused on Canadian medical graduates (CMGs) ranking RO as their first-choice discipline in the match's first iteration. No applicant gender data were available for the 1 to 8 first-year residency positions carried over to the second iteration that occurred in 7 out of 10 matches over the study period. Pearson's chi-square test was used to evaluate whether the number of female applicants differed significantly from what could be expected if RO applicant gender breakdown reflected Canadian CaRMS participant demographics. <h3>Results</h3> Numbers of applicants ranking RO as their first-choice discipline have recently increased. 2018-2021 saw 23-28 RO-preferring applicants, while 2012-2017 saw 9-18. Total applicants ranged from 24-51 per year over the study period. Numbers of female RO-preferring applicants have remained largely unchanged, with a 10-year average of 7 women per year, ranging from 2/15 (13%) in 2016 to 12/27 (44%) RO-preferring applicants in 2018. Overall, 190 CMG applicants ranked RO as their first choice over the last 10 years, comprising 73 females (38%) and 117 males (62%). During this period, 56% (17696/31618) of CMG applicants who participated in the CaRMS match were female. ​​Rates of female applicants to RO were significantly lower compared to rates of female applicants to all specialties combined (p < 0.01). <h3>Discussion</h3> While recent years have had more RO-preferring applicants overall, numbers of RO-preferring female applicants have remained low, and disproportionately less than rates of female CaRMS participants. Findings highlight the need for greater understanding of the factors influencing female medical students' career selection and CaRMS ranking decisions to develop strategies to improve female representation in RO.

Radiation Oncology Residency Training in Latin America: A Call to Attention

PurposeDespite the call to increase the number of radiation oncologists in Latin America, the quality, similarity, and number of residency training programs are unknown. We seek to describe the current state of residency programs in radiation oncology in Latin America. Methods and MaterialsLatin American Residents in Radiation Oncology performed a cross-sectional analysis of universities and training centers for radiation oncologists in Latin America. Latin American Residents in Radiation Oncology members identified and contacted current residents and specialists at each center to obtain information and documents that described their training curricula. ResultsAs of 2020, 13 of 23 (56.5%) Latin American countries have radiation oncology training. Seventy-three training centers were identified (59 active and 14 inactive), associated with 28 universities. On average, each active center trains 2.6 new residents per year, and in total, 156 residents are trained annually. The average length of training programs is 3.6 years. Brazil and Mexico comprise 31 (52.5%) and 7 (11.9%) of active programs, respectively, and 64 (41.8%) and 50 (32.7%) residents, respectively. Training is available in 38 cities in 13 countries, and outside Brazil and Mexico, only 13 cities in 11 countries (9 capitals and 4 noncapital cities). Individualized curriculum documents were provided by 20 (83.3%) of 24 non-Brazilian programs, while 1 standardized guideline was provided for Brazilian training programs. These demonstrated variation between subjects taught, their devoted time, outside specialty rotations, and experiences in modern techniques. Seventy-five percent include volumetric modulated arc therapy, 70% stereotactic radiosurgery, and 55% stereotactic body radiation therapy training. One-hundred percent include gynecologic brachytherapy education and <50% brachytherapy education in other disease sites. ConclusionsTraining is highly centralized in capital cities. The number of trainees is insufficient to close the current human resource divide but is limited by available job openings. Over 50% of training programs now include technological training in stereotactic radiosurgery, stereotactic body radiation therapy, or volumetric modulated arc therapy; however, substantial variation still exists. The development of radiation oncology specialists must be improved and modernized to address the escalating demand for cancer care.

Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: an Institutional Implementation Pilot Study.

Canadian radiation oncology (RO) residency programs transitioned to a competency-based medical education (CBME) training model named Competence by Design (CBD) in July 2019. Prior to this, CBD was piloted in a single RO training program to characterize assessment completion and challenges of implementation. Six residents and seven staff participated in a mixed-methods study and were oriented to CBD. Four Entrustable Professional Activities were assessed over a 4-week-long block and documented using online assessment forms. Anonymized assessments were analyzed to characterize completion. Post-pilot surveys were completed by 4/6 residents and 5/7 staff. Semi-structured post-pilot focus groups were conducted with all residents. Assessments were requested and documented on a weekly basis. Narrative comments were found in 68.1% of assessments, of which 26.7% described specific examples of observed competence or recommendations for improvement. Three of five staff believed that assessments have a negative impact on clinical workflow. Three themes were identified: (1) direct observation is the most challenging aspect of CBD to implement; (2) feedback content can be improved; and (3) staff attitude, clinical workflow, and inaccessibility of assessment forms are the primary barriers to completing assessments. This study demonstrates that CBD assessments can be completed regularly in an outpatient radiation oncology setting and that implementation challenges include improving feedback quality, promoting direct observation, and continuing faculty development to improve perceptions of this assessment model. Further study is required to identify best practices and expectations for the discipline in the era of CBME.

A Roadmap for Implementing Radiation Oncology Residency Training in Low and Middle Income Countries (LMICs)

LMICs need more qualified radiation oncology professionals to confront the cancer pandemic. However, institutionalized training programs are needed for this. Despite the accessibility of reports, from IAEA, ASTRO and ESTRO and the related recommendations, practical 'how-to' guidance for establishing and managing competency-based training programs is non-existent in many LMICs. This is especially true for countries where no programs exist, and there is no frame of reference on how to initiate one. To approach this problem, we sought to transfer the mostly-rigid recommendations available into an easy-to-implement roadmap.Three main axes of work were targeted for improvement with specific gaps to address. 1) Didactic lectures and practical training: Many reports discuss the "what" to teach. Absent is an illustration of how involved the topics (e.g., physics) are in the daily clinical practice of a radiation oncologist beyond the didactic lectures. 2) Managing workflow: Most LMIC centers treat patients with minimal quality management. Absent are peer review, disease site-specific clinics and guidelines, and how to promote a learning environment when many patients are lost to follow up. 3) Assessment and evaluation: Many LMICs rely on paper-based exams for assessing trainees. Absent are ways to assess the competencies of a radiation oncology trainee more comprehensively. Using the perspectives of LMIC-origin professionals, a "roadmap" document was drafted to address these axes with practical examples based on real-world experience in LMICs.A 157-page roadmap document was developed. The document details the amount of lecturing, material content, and the timeline for completing each training topics. It includes tables for site-specific rotations and a daily-work schedule to cover all aspects of clinical work such as new patient clinics, simulation, planning, on-treatment and follow-up clinics. Forms for documentation and assessment are proposed with an explanation of each assessment level. This roadmap document was developed built over the years and was piloted successfully, eight years ago, at a cancer center north of Iraq, which graduated its first batch of residents in 2017. It has since been going through various improvements and reevaluation.LMIC-origin professionals can help identify practical gaps and build roadmap documents to support radiation oncology training programs. This roadmap document was peer-reviewed at the University of Qatar Press in Doha, Qatar and was published as an open-access book in Feb 2021. As of this writing the document has been accessed 1702 times; the table below shows the top country views. Future work remains to assess the benefit of this roadmap document and its ease of implementation.

Diversity and Inclusion in Radiation Oncology: A Survey of Residency Program Directors

Women and traditionally underrepresented minorities in medicine (URM) including Black Americans, Hispanic/Latino Americans, and Indigenous Americans remain underrepresented in the radiation oncology workforce. It has been argued by some in the field that addressing racial and gender disparities in the radiation oncology workforce or in radiation oncology residency training represents an ethical imperative in light of both the tangible benefits diversity generates as well as the fact that these disparities are often byproducts of unethical societal practices. In light of this, however, the question remains: how can we increase diversity and inclusion of URM and women physicians in radiation oncology? Moreover, what methods are currently in use or preferred by residency program directors to address any disparities in representation that exist? Although similar studies have been performed in other medical specialties such as otolaryngology, they have not been conducted for the specialty of radiation oncology.A questionnaire was developed and distributed to Program Directors of radiation oncology residency programs throughout the United States. The purpose of this questionnaire is to measure the relative representation of women and underrepresented racial/ethnic minorities in radiation oncology departments as well as to identify the methods that are most preferred by program directors to increase diversity in residency programs. The survey was disseminated electronically to residency program directors of radiation oncology programs in the United States. Analyses will be performed using statistical software.At the time of abstract submission, final results of this study were pending. The strategies to increase diversity that are preferred by residency program directors and those that are currently being implemented will be reported and then compared using chi-squared analysis. Residency program characteristics will additionally be analyzed as predictor variables for strategies to increase diversity and inclusion in radiation oncology residency.Of the 91 radiation oncology residency programs that are currently accredited by the ACGME, responses from 7 were received at the time of abstract submission. This survey may inform program directors about the current representation of women and URM in radiation oncology residencies. Furthermore, program directors may benefit from being aware of which strategies to increase diversity are preferred by their contemporaries. Finally, identification of strategies used to promote diversity in radiation oncology residency is critical to increasing representation of women and URM within the field.

Competency-Based Medical Education in Canadian Radiation Oncology Residency Training: An Institutional Implementation Pilot Study

Competence by Design (CBD) is the Royal College of Physicians and Surgeons of Canada's (RCPSC) adaptation of competency-based medical education (CBME) for medical residency training.1 Canadian radiation oncology (RO) residency programs transitioned to CBD in July 2019. Prior to this, CBD was piloted in a single RO residency program to characterize assessment completion and challenges of implementation.

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.

Representation trends in radiation oncology training programs in the United States.

11043 Background: The ASCO and American Society of Radiation Oncologists (ASTRO) have recently committed to initiatives on increasing URM representation in the radiation oncology workforce. This study aims to assess representation trends in radiation oncology training programs across five academic years in order to understand representation trends and better guide initiatives moving forward. Methods: Data on racial and ethnic representation from the ACGME Data Resource Books over a span of five academic years (2015-2020) was included. URM was defined as those who identified as Hispanic, Black, or Native American/Alaskan in concordance with AAMC definition. Chi square testing was used to compare the proportion of residency positions occupied by URM residents by self-identified race and ethnicity in radiation oncology to that of hematology and medical oncology, complex general surgical oncology, and all other specialties. Results: A total of 3,315 radiation oncology positions were identified over the study period, 2015 and 2020. 1,938 (58.5%) of radiation oncology residency positions were filled by residents who identified as White, 967 (29.2%) as Asian/ Pacific Islander, 126 (3.8%) as Hispanic, 120 (3.6%) as Black, 7 (0.2%) as Native American/ Alaskan, and 157 (4.7%) as Other. URM representation was 7.6% in total and was relatively stagnant, remaining between 7.3% and 8.0% across study years. Results of chi square comparative analysis demonstrated lower rates of representation in radiation oncology in comparison to hematology and medical oncology as well as all other specialties (Table). Conclusions: There is lack of racial and ethnic diversity in radiation-oncology residency training positions in the United States. Over the five-year study period, only 7.6% of trainees identified as URM. URMs have significantly lower rates of representation in radiation-oncology compared to hematology and medical oncology, and other specialties. Efforts to mitigate disparities require a multifaceted approach.[Table: see text]

Transitioning Roles from Residency to Attending Physician in Radiation Oncology.

Moving from the role of resident into that of a young attending is one of the most anticipated transitions in a medical trainee's career path. Radiation oncology residency training is typically apprentice-style focused in the outpatient setting, which carries additional unique challenges. Twenty-seven junior attendings at academic institutions within their first 5 years of practice were sent an online open-ended questionnaire in 2018 regarding aspects of their practice using a snowball sampling method. Responses were collected, and a thematic analysis was conducted in which two independent reviewers coded the responses. Nineteen junior attendings (70%) from 18 institutions completed the questionnaire. General themes included the importance of cultivating relationships for peer support and to be professional and polite as confidence was gained to enable them to be seen as an attending. All respondents felt that bringing an open mind, balance, and adaptability was crucial in their transition. Respondents stayed up to date on literature and practices by subscribing to journals, courses, and participation in resident education. Forty-two percent of young attendings were matched with a mentor at their new institution through a formal mentor-mentee relationship. Respondents wished that they had more autonomy during residency to prepare for independent practice. Transitioning from residency to a junior attending provides unique stressors and challenges. Allowing for residents to have more autonomy during their training, such as a senior resident clinic, may help improve this transition by providing an opportunity for independent decision-making with guidance as appropriate.

Research Productivity of Canadian Radiation Oncology Residents: A Time-Trend Analysis.

(1) Background: Research productivity is a mandatory component of Canadian radiation oncology (RO) resident training. To our knowledge, Canadian RO resident research publication productivity has not previously been analysed. (2) Methods: We compiled a 12-year database of RO residents in Canadian training programs who completed residency between June 2005 and June 2016. Resident names and dates of training were abstracted from provincial databases and department websites and were used to abstract data from PubMed, including training program, publication year, journal, type of research, topic and authorship position. Residents were divided into four time periods and the linear trend test evaluated publication rates over time. Univariable and multivariable logistic regression analyses were performed to identify authorship predictors. (3) Results: 227 RO residents representing 363 publications were identified. The majority were first-author publications (56%) and original research (77%). Overall, 82% of first-author, and 80% of any-author articles were published in resident year 4 or higher. Mean number of publications for first-author and any-author positions increased significantly over time (p = 0.016 and p = 0.039, respectively). After adjusting for gender and time period, large institutions (> 3 residents per year) trended toward associations with more first-author publications (odds ratio (OR): 2.44; p = 0.066) and more any-author publications (OR: 2.49; p = 0.052). No significant differences were observed by gender. (4) Conclusions: Canadian RO resident publication productivity nearly doubled over a 12-year period. The majority of publications are released in the last 2 years of residency, and larger residency programs may be associated with more publications. These findings serve as a baseline as programs transition to Competency Based Medical Education (CBME).

Multimaterial three-dimensional printing in brachytherapy: Prototyping teaching tools for interstitial and intracavitary procedures in cervical cancers

PurposeAs the utilization of brachytherapy procedures continues to decline in clinics, a need for accessible training tools is required to help bridge the gap between resident comfort in brachytherapy training and clinical practice. To improve the quality of intracavitary and interstitial high-dose-rate brachytherapy education, a multimaterial, modular, three-dimensionally printed pelvic phantom prototype simulating normal and cervical pathological conditions has been developed. Methods and MaterialsPatient anatomy was derived from pelvic CT and MRI scans from 50 representative patients diagnosed with localized cervical cancer. Dimensions measured from patients’ uterine body and uterine canal sizes were used to construct a variety of uteri based off of the averages and standard deviations of the subjects in our study. Soft-tissue anatomy was three-dimensionally printed using Agilus blends (shore 30 and 70) and modular components using Vero (shore 85). ResultsThe kit consists of four uteri, a standard bladder, a standard rectum, two embedded gross tumor volumes, and four clip-on gross tumor volume attachments. The three anteverted uteri in the kit are based on the smallest, the average, and the largest dimensions from our patient set, whereas the retroverted uterus assumes average dimensions. ConclusionsThis educational high-dose-rate gynecological pelvic phantom is an accessible and cost-effective way to improve radiation oncology resident training in intracavitary/interstitial brachytherapy cases. Implementation of this phantom in resident education will allow for more thorough and comprehensive physician training through its ability to transform the patient scenario. It is expected that this tool will help improve confidence and efficiency when performing brachytherapy procedures in patients.

202 Characterizing the Initiation, Completion, and Integration of Entrustable Professional Activity Assessments in Radiation Oncology Residency Training and Clinical Workflow: An Institutional Pilot of Competence by Design

202 Characterizing the Initiation, Completion, and Integration of Entrustable Professional Activity Assessments in Radiation Oncology Residency Training and Clinical Workflow: An Institutional Pilot of Competence by Design

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

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