Radiation Oncology Residents Research Articles

Serious Illness Communication Training Among Radiation Oncology Residents

Education and specific training on serious illness communication skills for radiation oncology residents is lacking. The Accreditation Council for Graduate Medical Education requires radiation oncology residents to demonstrate interpersonal and communication skills; however, implementing specific training to address this poses an ongoing challenge. This study assesses the feasibility and effectiveness of a radiation oncology specific serious illness communication curriculum at a single radiation oncology residency program. The primary objectives were to assess observable communication skills among radiation oncology residents and their perceived level of preparedness and comfort with patient encounters surrounding serious illness. Each resident participated in a baseline simulated patient encounter. Two virtual half-day experience-based learning sessions led by faculty experts trained in teaching serious illness communication were held. The training consisted of brief didactic teaching, with the emphasis on small group guided practice with simulated patients in scenarios specific to radiation oncology. Each resident participated in a postcourse simulated patient encounter. Three blinded faculty trained in serious illness communication completed objective assessments of observable communication skills to compare pre- and postcourse performance. A t test based on validated assessments reviewed by blinded faculty demonstrated significant improvement in overall observable communication skills among radiation oncology residents in the postcourse encounter compared with the precourse encounter (P=.0067). Overall, 8 of 9 (89%) residents felt more comfortable and prepared with radiation oncology-specific serious illness communication after the course compared with prior. The simulated patients rated the overall average resident performance higher on the postcourse assessment (Likert 4.89/5) compared with the precourse assessment (Likert 4.09/5), which trended toward a significant improvement (P=.0515). Radiation oncology residents had a significant improvement in observable communication skills after participating in an experience-based training curriculum. This course can serve as an adaptable model that may be implemented by other radiation oncology residency programs.

Predictors of an Academic Career in Radiation Oncology 5 to 10 Years After Residency.

To report the percentage of resident graduates in the modern era who establish careers in academic radiation oncology 5 to 10 years after residency. The study population included 1147 radiation oncologists who completed residency between 2011 and 2017 and were practicing radiation oncologists in 2021. The percentage of 2011-2017 graduates with an academic career in 2021 (5 to 10y after residency): Holman Pathway resident: Yes, 74% versus No, 43% ( P <0.05); PhD degree before residency: Yes, 67% versus No, 38% ( P <0.05), Doximity top-10 ranked residency program: Yes, 66% versus No, 37% ( P <0.05).Logistic regression multivariate analysis confirmed PhD and Doximity top-10 as strong independent predictors for all endpoints.Regarding gender, no significant differences were observed for all 4 endpoints in the percentage of women versus men establishing academic careers at the 5-year to 10-year post-residency time point. Since 2011, at least one-third (~35%) of radiation oncology residents have gone into academic medicine and are academically productive 5 to 10 years after residency. Holman Pathway, PhD degree, or Doximity top-10 residency program approximately doubles the probability of an academic career. Moreover, radiation oncology is on track to achieve gender equity in academic medicine.

Challenges in the transition to independent radiation oncology practice and targeted interventions for improvement.

Numerous radiation oncology residents and junior attendings have identified common weaknesses in residency training that hinder the transition from training to independent practice. Recurrent themes include not only general autonomy but also proficiency in technical skills, such as treatment plan review and image verification, and nontechnical skills, such as leadership, mentorship, and education. While multiple strategies to address these deficiencies have been investigated, many are not widely available or may be difficult to implement. We aim to summarize the frequently cited challenges in the transition to independent radiation oncology practice as well as the pertinent interventions that have been explored.

Gender Differences in the Research Productivity of Radiation Oncology Resident Graduates in the United States: 2015 to 2019

PurposeIt is well-documented that gender disparities exist in academic radiation oncology departments. The purpose of this study was to analyze gender differences in research productivity during residency among recent graduates of radiation oncology training programs in the United States (US). Methods and MaterialsWe used several publicly available sources to create a database of US radiation oncology residents who graduated between 2015 and 2019. We systematically collected gender information from the National Plan and Provider Enumeration System National Provider Identifier Registry and Medicare claims registry. Postresidency employment information was collected using several publicly available sources. PubMed was queried to identify first-author publications of residents. A secondary analysis of metadata including impact factor, number of citations, modified Hirsch index (h index), and type of publication was performed. A multivariable linear regression was performed to evaluate the effect of gender on research productivity during residency. ResultsThere were 910 total graduates identified during this period and who were entered into this database, of whom all had available gender information. Female trainees comprised 29.0% (n = 264) of RO residents and had fewer first-author publications and citations, had lower mean modified h index, and were published in journals with lower impact factors. On multivariable linear regression analysis, female gender was independently associated with decreased total number of publications (P = .005), mean number of citations (P < .001), and modified h index (P = .001) when controlling for residency size and advanced (PhD or master's) degrees. ConclusionsIn the US, female RO trainees had lower research productivity, which was not explained by advanced degrees or residency size. A significant gender gap in trainee research productivity persists, which has known implications in terms of academic achievement, promotions, and career trajectory. Future interventions to improve resident research productivity and mentorship are warranted.

The Rise of Open Access Journals in Radiation Oncology: Influence on Resident Research, 2015 to 2019

PurposeWhile a rising share of scientific research articles are being published in open access (OA) journals, their impact on resident research in radiation oncology is unknown. Thus, we sought to determine the number, content, and costs of first-author, PubMed-searchable articles radiation oncology residents in the United States (US) published in OA journals in recent years. Methods and MaterialsWe built a database of first-author, PubMed-searchable articles published by US radiation oncology residents who graduated between 2015 and 2019. We then classified each journal in which these articles appeared as either OA or non-OA and obtained the current article-processing charge (APC) for each publication that appeared in an OA journal. ResultsThe residents in this study published 2637 first-author, PubMed-searchable articles, 555 of which (21.0%) appeared in 138 OA journals. The number of publications in OA journals per resident increased from 0.47 for the class of 2015 to 0.79 for the class of 2019. Publications in OA journals garnered fewer citations than those in non-OA journals (8.9 vs 14.9, P < .01). Furthermore, 90.6% of OA journals levy an APC for original research reports (median, $1896), which is positively correlated with their 2019 impact factor (r = 0.63, P < .01). Aggregate APCs totaled $900,319.21 and appeared to increase over the study period. ConclusionsThe number of first-author, PubMed-searchable articles published by graduating US radiation oncology residents in OA journals rose significantly between 2015 and 2019. To maximize the benefits of OA publishing in the future, US radiation oncology residents will need to ensure that they use vetted OA journals to publish their research findings and avoid predatory journals.

GSOR17 Presentation Time: 11:50 AM: Comparison of Virtual Reality Platforms to Enhance Medical Education for Gynecologic Brachytherapy

<h3>Purpose</h3> Historically, medical education relied on apprentice-based experiences requiring direct observation in patient cases. Simulation-based education has been shown to improve resident confidence but can be time intensive and difficult to coordinate. The COVID-19 pandemic demonstrated the need to develop distributed educational tools. Virtual reality (VR) platform has been shown to improve resident confidence and proficiencies. This pilot study compared educational and cost effectiveness of low-cost cardboard viewer VR (CVVR) and commercially available integrated headset VR (IHVR). <h3>Materials and Methods</h3> We created a VR video of an intracavitary brachytherapy case for treatment of cervical cancer. Radiation oncology residents from a single ACGME-accredited training program were recruited and randomized to IHVR or CVVR. Both groups were given unlimited access to their randomized technology. Each resident performed a timed intracavitary procedure on a simulator while 5 implant quality metrics were recorded. A pre- and post-simulation questionnaire assessed self-confidence, procedural knowledge, and perceived usefulness of VR technology. <h3>Results</h3> There were 13 residents, including four post-graduate year (PGY)-2, three PGY-3, two PGY-4, and four PGY-5, in the study. Seven (53.8%) of residents had previously performed an intracavitary brachytherapy procedure, while six (46.2%) had no prior experience. There were six residents randomized to IHVR and seven residents randomized to CVVR. Both VR technologies improved self-perceived overall confidence, assembly skill, and comfort performing the procedure independently. There were also non-statistically significant improvements in the ability to correctly order the steps of the brachytherapy procedure on post-simulation survey compared to pre-simulation survey in both VR viewer groups. Average time required for implant (mean: CVVR - 200 seconds vs. IHVR - 235 seconds, p=0.38) and median objective proficiencies of implant quality (5/5 in both group, p=0.56) were similar. There was no difference between CVVR and IHVR as useful, enjoyable and engaging educational tool. Both groups would recommend the technology to another trainee. There were differences in the time between last usage of the VR technology with 50% of the residents in the IHVR group completing the last VR SBE more than 2 weeks before the procedure, while the majority of residents in the CVVR group (57%) completed the last VR SBE within 1 hour before the procedure. IHVR-based program would cost ∼33x more than CVVR-based program based on an assessment of US-based programs. <h3>Conclusions</h3> CVVR is a cost-effective alternative to a IHVR as a virtual education tool.

MSPP02 Presentation Time: 4:10 PM: A Six Minute Brachytherapy Waste Audit: A Feasible, Efficient Method for Identifying Opportunities to Enhance the Environmental Sustainability of a Radiation Oncology Department Practices

<h3>Purpose</h3> Operating rooms (OR) have been identified as a major source of greenhouse gas emissions in part due to their waste generation - producing an estimated 30% of hospital waste. Today, unused surgical supplies that end up in the waste system can account for 15% of total surgical supply costs. Nearly all forms of brachytherapy require use of an OR, or designated procedural suite, thus significant opportunities exist to engage staff in analyzing current practices and finding ways to reduce waste. We established a waste audit protocol to increase employee engagement and measure a single department's OR waste. <h3>Materials and Methods</h3> A three-month brachytherapy OR waste audit was conducted. The waste audit team consisted of a brachytherapy attending, two brachytherapy radiation therapists, radiation oncology residents, and a research coordinator. Standardized documents created for the audit included: a one-page waste-audit template, a one-page supply audit, and an email template sent to the brachytherapist whose cases were audited. Equipment used included a patient scale and phone camera used to document standard setup, supplies used, and waste generated. The audit was performed by an independent auditor (a resident and/or research coordinator) upon conclusion of the OR case. Procedural waste was weighed and photographed, and later analyzed collaboratively at waste audit team meetings. <h3>Results</h3> A total of 21 randomly selected HDR brachytherapy OR cases were audited between December 2021 - February 2022. The average length of time required to complete the waste audit was 6 minutes. Results were presented to all brachytherapy staff at an already established monthly meeting, and to the greater department during a five-minute time slot at the monthly departmental Quality Improvement conference. An educational poster was created depicting proper waste sorting of common OR and brachytherapy supplies into biohazard versus non-biohazard waste. All templates and education material were packaged into an public online waste audit "toolkit" which may be adapted by other departments. Further implementation of waste mitigation efforts remain underway. <h3>Conclusions</h3> The OR waste audit protocol described here serves as an efficient, feasible model that seamlessly integrates into brachytherapy practices. The standardized templates and "toolkit" may be used widely by other procedural suites, outpatient clinics, radiation oncology departments, and specialties beyond radiotherapy to evaluate current waste practices, improve care, and possibly reduce costs. Importantly, this waste audit tool serves as an easy entry point, and a call-to-action, for healthcare professionals and radiation oncologists to begin to transition to environmentally sustainable care.

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

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

Brachytherapy training survey among radiation oncology residents in Europe

We aim to investigate the current state of brachytherapy (BT) training among the radiation oncology trainees in Europe. Material and methodsA 22-question online survey based on the one by the American Association of Radiation Oncology Residents (2017) with added queries pertinent to training in Europe was sent to 1450 residents in two iterations. These included site-specific training, volume of experience, barriers to training, institutional support, and preferences for further education. Responses to individual statements were given on a 1 to 5 Likert-type scale. The answers were reported by junior (≤3 years of training) and senior years of training (year of training 4/5/6 and junior staff).Descriptive statistics were used to describe frequencies. ResultsResidents from 21 European countries participated, 445 (31%) responded. 205 (47%) were senior residents. 60% residents consider that performing BT independently at the end of residency is very or somewhat important. Confidence in joining a brachytherapy practice at the end of residency was high or somewhat high in 34% of senior residents. They reported as barriers to achieving independence in BT to be lack of appropriate didactic/procedural training from supervisors (47%) and decreased case load (31%). 68% reported their program lacks a formal BT curriculum and standardized training assessment. ConclusionsResidents in Europe, feel independent BT practice is very or somewhat important, but do not feel confident they will achieve this goal. To address this gap, efforts are needed to develop and implement a formal and comprehensive BT curriculum with easy access to trained instructors.

Characteristics of the Association of Residents in Radiation Oncology Educator of the Year Award Recipients

The Association of Residents in Radiation Oncology (ARRO) presents the Educator of the Year Award to outstanding faculty members at each participating institution every year. The aim of this study was to characterize the recipients of this award. The recipients of the annual ARRO Educator of the Year Award were identified from the years 2008 to 2019. Publicly available website domains were accessed to obtain data regarding clinical treatment site, number of sites treated, whether they were at the same institution where they trained, academic rank, sex, American Society for Radiation Oncology fellow status, repeat awardee status during the period, and number of years since board certification. H- and m-indices were obtained from Scopus and calculated based on the time of the award. General workforce data were obtained from American Society for Radiation Oncology and recently published articles. The authors performed correlative analyses stratified by sex and logistic regression to determine predictors of repeat awardee status. There were a total of 607 ARRO educator awards from the years 2008 to 2019. The majority of recipients were male (77.6%) and assistant professors (39.0%). The median number of years from board certification was 7 (interquartile range, 3-17) and the median h- and m-indices were 14 and 1, respectively. When stratified by sex, publication metrics were significantly higher for men (P < .05), and men were more likely to be repeat awardees (P < .001) and have higher academic rank (P=.007). On multivariate analysis, those of higher rank were more likely to be repeat awardees (associate odds ratio [OR], 3.55; P < .001; full professor OR, 2.04; P=.046) and less likely to be women (OR, 0.41; P=.002), and h- and m-indices were not associated with repeat awardee status. Recipients of the ARRO educator award appear to be diverse in rank and experience; however, associate professor rank and sex were associated with continued recognition of educational excellence.

Geographic Employment Outcomes for Graduating Residents in Radiation Oncology: 2021

PurposeIn light of the persistent disparity in the prevalence of radiation oncologists between rural and urban areas in the United States, we sought to characterize the geographic employment outcomes of the radiation oncology (RO) residency class of 2021. Methods and MaterialsWe identified the employment positions accepted by 2021 RO residency graduates using publicly available information. Then, we classified each position as academic or nonacademic and determined the rural–urban continuum code and core-based statistical area (CBSA) of each position, residency program, and medical school associated with the 2021 graduates. Last, we compared the geographic employment outcomes of the 2021 class with those of the 2019 class. ResultsMost 2021 graduates accepted employment positions outside of the counties, CBSAs, and states in which they attended medical school or residency. A total of 116 graduates accepted nonacademic positions, and 65 graduates accepted academic positions. Nine graduates accepted fellowships and were excluded from this analysis. As with the class of 2019, most 2021 graduates (n = 104; 57.5%) accepted positions in the largest metropolitan areas, and few (n = 11; 6.1%) accepted positions in nonmetropolitan areas. Female residents were more likely to accept academic (48.9% vs 31.3%; P = .03) and academic main site (36.2% vs 21.6%; P = .05) positions than male residents. The distribution of jobs in both the 5 and 10 largest CBSAs was not significantly different from what would have been expected if jobs were equally distributed across the country on the basis of population (P = .81 and P = .87, respectively). However, the distribution was significantly different from what would have been expected if the distribution of such positions reflected the number of residents who graduated from residency programs in those CBSAs (P < .01 and P < .01, respectively). ConclusionsAs with the class of 2019, the majority of graduates in the class of 2021 accepted employment positions in large metropolitan areas. Relatively few graduates accepted positions in nonmetropolitan areas. How key RO stakeholders respond to the challenge of maintaining a stable supply of rural radiation oncologists while also ensuring that jobs available to graduating RO residents reflect their preferences will have a significant effect on the field going forward.

Perceptions of Parental Leave and Parenthood among Program Directors and Residents in Radiation Oncology

<h3>Purpose/Objective(s)</h3> Radiation oncology residents (ROR) face a narrow fertility window while completing a demanding training program. Family planning decisions are often impacted by concerns over perceptions of faculty, co-trainees, and future employers. There is limited data objectively defining these perceptions in medical training and none within radiation oncology (RO). We aim to describe the perspectives of RO program directors (PD) and ROR on parental leave and parenthood in training. <h3>Materials/Methods</h3> Contact information was obtained from FRIEDA. Surveys were distributed to all eligible PDs with a request to forward a parallel survey to trainees. Social media links for both surveys were shared on a social media platform. Descriptive statistics were gathered using survey data. <h3>Results</h3> Surveys were completed for 16 PDs including 5 women and 14 parents and 61 ROR including 35 women and 25 parents. As a PD, 14 PDs had pregnant residents in their program. Only 1 PD was unsure if there was a maternity leave policy at their institution, 3 were unsure about paternity leave, and 13 were unsure about fertility services. In comparison, 15 ROR were unsure if there was a maternity leave policy, 20 were unsure about paternity leave, and 34 were unsure about fertility services. 98% of residents and 100% of PDs felt it would be valuable to have formal policies in place. 47% of ROR felt their program was more or much more supportive than others at their institution with 38% feeling as supported and 15% feeling less supported. In contrast, 93% of PDs felt they were more or much more supportive. 22 ROR felt pressured to delay starting a family, most commonly pressure put on themselves followed by faculty and co-residents. 40% of non-parent residents (NPR) would have children if not in medicine with 89% of women ROR expressing concern about declining fertility. Among PDs, 20% felt that parenthood had a negative impact on the overall education of women and man residents. In terms of academic productivity, 40% of PDs felt parenthood had a negative impact on women residents compared to 27% for man residents. Among NPR, 89% felt that parenthood had a negative impact on the overall education of women residents compared to 66% for man residents. Similarly, 100% of NPR felt that parenthood negatively impacted women residents' academic productivity as compared to 71% of man residents. <h3>Conclusion</h3> Within RO, most PDs are aware of parental leave policies at their institution but are less so for fertility services. Residents are less familiar with these policies. Most ROR feel supported by their PDs, however there is a discordance between the level of support noted by ROR and PDs. The perceived negative impact of parenthood is greater for women ROR than men. Additional initiatives should focus on increasing transparency of parental leave policies and supporting parent trainees to ensure they are academically and clinically successful while balancing the important role of parents.

Leading Change: Perceptions of Current Radiation Oncology Residents and Attending Physicians about the State of the Didactic Curriculum

<h3>Purpose/Objective(s)</h3> Leading successful change efforts first requires assessment of the "before change" environment and culture. At our institution, the Radiation Oncology (RO) residents follow a longitudinal didactic learning program consisting of weekly one-hour lectures, case conferences, and journal clubs organized by disease site specialty. The resident didactic education series format has not changed since its inception over ten years ago. We evaluated the perceptions of current residents and faculty about the effectiveness of the curriculum in its present form. <h3>Materials/Methods</h3> Two parallel surveys were designed using a survey platform, one each for residents and attendings, to assess current attitudes regarding the effectiveness and need for change in the RO residency curriculum, specifically the traditional didactic lectures, the journal club sessions, and the case conferences. Online surveys were individually distributed in person or via video conference and took 5-10 minutes to complete. Attending faculty who practiced at the main campus or regional site and participated in the teaching program were eligible, with the senior author on this project excused. No identifiers were used to preserve anonymity of the respondents given the nature of this single institution cohort. Following completion of the survey, respondents were informally interviewed by the first author about the curriculum's strengths and weaknesses. <h3>Results</h3> Online surveys were individually distributed to 100% of residents (N=10) and 100% of eligible attendings (N=24). Compared to 46% of attendings, 80% of RO residents believe the current curriculum should be changed. Twenty percent of residents believe the traditional didactic lectures are effective in preparing them to manage patients in the clinic, compared to 74% of attendings. Similarly, 10% of residents feel that the journal club sessions are effective vs. 42% of attendings. Finally, 40% of residents believe the case conferences are effective vs. 67% of attendings. Overall, residents were less satisfied and more oriented towards change than faculty members. <h3>Conclusion</h3> Our results suggest that the perceptions of RO residents about the current didactic curriculum do not align with those of attending physicians. Main changes would be to increase the interactive nature of the course material, incorporate more ways to increase faculty engagement, and consider self-assessment questions to promote retention. The discrepancies between residents and faculty highlight the need of a dedicated change management effort to mitigate this gap. Pending approval from the residency program leadership, we will follow Kotter's "Eight steps to transforming your organization" to ensure the highest potential for faculty to transition to a new curriculum.

LGBTQ+ Training in United States Radiation Oncology Residency Programs

<h3>Purpose/Objective(s)</h3> The LGBTQ community is an understudied and medically underserved population who experience increased cancer risk and worse cancer outcomes. Negative provider interactions, including discrimination and lack of knowledge regarding LGBTQ-specific health issues are cited by patients as barriers to care, including in radiation oncology (RO). Notably, little is known regarding LGBTQ knowledge and attitudes among RO residents (ROR) or LGBTQ-specific training in RO residency training programs. Thus, we sought to assess the extent of current LGBTQ-specific training in U.S. RO residency programs. <h3>Materials/Methods</h3> Two published surveys of LGBTQ-education in residency were adapted to RO. The first assessed LGBTQ education from the perspective of program directors (PD) and associate PDs (APD), while the second survey was to RORs. The surveys were sent to all ACGME-accredited U.S. RO residency PD, APD, and program coordinators (PC), with the ROR survey being disseminated by the respective PCs. Each survey consisted of subsections of attitudes and knowledge in the care of LGBTQ patients, RO program characteristics, program inclusion of LGBTQ-specific education, and individual demographics. <h3>Results</h3> There were 69 responses (29 PD, APD and 40 ROR). The majority of respondents (PD, APD/ROR) identified as white (79%/58%), non-Hispanic (76%/72%), male (55%/55%), and heterosexual (86%/78%). The majority of PD, APDs did not receive LGBTQ education in medical school (60%) or residency training (96%), while the majority of residents (68%) did receive LGBTQ training in medical school; yet, both groups felt this training was insufficient to care for LGBTQ patients during residency (76%/68%). Overall, respondents felt comfortable treating LGB (90%/85%) and T (79%/62.5%) patients. However, the majority did not feel confident in their knowledge for LGB (52%/62.5%) or T (79%/85%) health needs. The majority of respondents' programs have never had a didactic session on LGBTQ health (78%/80%) resulting in 61%/61% of respondents feeling their program inadequately prepares residents to work confidently with LGBTQ patients. However, the majority felt their program is receptive to incorporating LGBTQ health content into their curriculum (75%/75%) and expressed a personal interest in such education (97%/80%). Additional data will be available by time of conference. <h3>Conclusion</h3> We found an increase of LGTBQ education in medical schools between PD, APD and ROR, suggestive of a recent improvement in LGBTQ content; yet most residency programs still lacked any LGBTQ-specific education. While the majority felt comfortable treating LGBTQ patients, they simultaneously lacked confidence in knowledge regarding LGBTQ health needs; yet, possessed desire for additional education and belief that such trainings should require. Conclusion is that residencies need to do a better job incorporating LGBTQ health content into their curricula, which is supported by interest from ROR and program leadership.

Patient-Centered Communication Training among Radiation Oncology Residents

<h3>Purpose/Objective(s)</h3> Radiation oncologists frequently speak with patients who are terminally ill and may be near the end of their life. In fact, up to 63% of patients who died of cancer receive palliative radiation in their last year of life. Despite this, education and specific training on palliative care including patient-centered communication skills for radiation oncology residents is lacking. The primary objective of this study was to assess radiation oncology resident-identified needs and preparedness in patient-centered serious illness communication to guide the objectives and development of a practice-based skills course. <h3>Materials/Methods</h3> A needs-based assessment was performed among radiation oncology residents at a single academic medical center. A cross-sectional survey and semi-structured interviews were performed. Data from these metrics were reviewed independently by the authors who then collectively indexed, charted, and analyzed the data. The course was then developed by a multidisciplinary team of specialists in radiation oncology, palliative medicine, and patient communication. The virtual course consisted of didactic teaching, two half-day interactive practice sessions with standardized patient encounters and feedback, and pre- and post-course assessments of measurable communication skills. <h3>Results</h3> 14/14 (100%) responses were available for evaluation. Using a five-point Likert scale, most residents felt only "somewhat prepared" (Likert 3/5) to discuss important topics such as prognosis (93%), reconciling the seriousness of one's illness (71%), and discontinuing life-sustaining treatments (64%). PGY-5 residents generally felt more prepared (Likert 4/5) compared to less experienced residents (Likert 3/5). The interview data supported and expanded on the quantitative data, highlighting both the varied and paucity of communication training prior to residency and the need for radiation oncology specific instruction. When asked how they might improve these skills some residents remarked, "practicing conversations," "observing others," and "learning best practices for these situations." The course development was curated by these results. <h3>Conclusion</h3> Consistent with a national survey of radiation oncology residency program directors, the institution-specific needs assessment study established a convincing need at the residency program level for a practice-based patient-centered communication skills training program for radiation oncology residents. This pre-survey data provided information that was used to guide its objectives, development, and assessment. We hope this future course can serve as an adaptable model that can be instituted among radiation oncology residency programs.

9-Year Analysis of Trends in the Radiation Oncology Residency Match

<h3>Purpose/Objective(s)</h3> To assess the trends in Radiation Oncology residency applicants, programs, and positions from 2013 to 2021. <h3>Materials/Methods</h3> United States Radiation Oncology residency program and applicant data were obtained from the National Resident Matching Program, Main Residency Match, Charting Outcomes, and Electronic Residency Application Service (ERAS) reports from 2013 to 2021. <h3>Results</h3> The total number of U.S. MD senior Radiation Oncology applicants decreased from 339 in 2017 to 193 in 2021. This corresponded to a decrease in the mean applications received per program from 167.0 to 100.2 applications. In contrast, the number of applicants who were not U.S. MD Seniors (DO & IMG) increased from 38 (11.2%) in 2017 to 106 (54.9%) in 2021. The total number of positions offered (PGY-1 & PGY-2) increased steadily from 183 in 2013 to 207 in 2019, after which there was a sharp decline to 189 and 188 in 2020 and 2021, respectively. The mean number of Radiation Oncology-specific applications per applicant decreased from 39.1 in 2017 to 20.7 in 2021. The number of positions per U.S. senior remained steady from 2014 to 2018 at 1.0. However, this ratio has increased each year since 2018 and reached 1.9 positions per U.S. MD senior applicant in 2021. The mean number of unfilled programs (PGY-1 & PGY-2) prior to Supplemental Offer and Acceptance Program (SOAP) from 2013 to 2018 was 4.8 programs (5.4% of all programs) compared to a now-increased mean of 25.0 unfilled programs (27.7% of all programs) from 2019 to 2021. From 2014 to 2020, the match rate for Radiation Oncology residency applicants increased from 89% to 99%. <h3>Conclusion</h3> Despite an increase in interest among DO and IMG applicants and recent efforts to decrease the number of available Radiation Oncology residency positions, a continued rise in the number of positions offered relative to U.S. applicants has led to a growing number of unfilled programs. As a result, measures should be taken to increase exposure to Radiation Oncology during medical school and to make our field more appealing to medical students who may be considering Radiation Oncology as their ultimate career choice.

Current Educational Practices within Resident Rotations across Radiation Oncology Residency Programs

<h3>Purpose/Objective(s)</h3> Limited information is available about the structure and components of radiation oncology residency rotations. We hypothesize that there is variation in rotations between and within residency programs. We evaluated various educational elements of radiation oncology rotations among United States residents. <h3>Materials/Methods</h3> We developed and distributed an anonymous online survey to current radiation oncology residents (PGY2 – PGY5) in ACGME-accredited residency programs in 2021 - 2022. Questions address rotation design, educational sessions, and attending feedback. <h3>Results</h3> A total of 117 residents completed the survey (overall response rate, 15%). Respondents consisted of more junior than senior residents (60% PGY2 or PGY3 vs. 40% PGY4 or PGY5) and a higher proportion of men than women (68% vs. 32%). Seventy-seven percent of responding residents (90/117) stated that half of their rotations or fewer featured regular educational sessions outside of didactics, and 62% (72/117) of all respondents stated they wanted more routine educational sessions. Over a quarter (27%, 32/117) said that no attending had ever evaluated one of their patient encounters, either directly or remotely, during real or simulated encounters. While all respondents said that at least some attendings provide feedback on contours (in-person or remotely), only 52% (61/117) replied that this occurs during every rotation. <h3>Conclusion</h3> A striking number of residents receive insufficient evaluation and feedback in patient encounters and contouring, two significant components of radiation oncology practice. More than half of respondents are seeking more dedicated education from teaching faculty members. Although the impact of these practices on resident development is unclear, we have identified potential deficiencies in radiation oncology residency education.

Implementing a Flipped Classroom Curriculum for Radiation Oncology Residency Didactics

<h3>Purpose/Objective(s)</h3> In the past decade, medical schools across the country have widely adopted a flipped classroom educational model that emphasizes an active learning approach to promote greater engagement and critical thinking and shifts away from lectures and other forms of passive learning. This model has yet to be implemented in residency programs. We sought to evaluate the efficacy of the traditional lecture-based didactic format in a Radiation Oncology residency program and design a pilot flipped classroom curriculum. <h3>Materials/Methods</h3> Radiation Oncology residents completed a pre-implementation survey to assess impressions of traditional lecture-based didactics. The survey evaluated engagement with faculty, learning and consolidation, and quality of the content presented using a 5-level ordinal scale with 5 being the most favorable rating (Table 1). <h3>Results</h3> The pre-implementation survey was completed by 10 of 17 residents (59%). All questions assessing traditional lecture-based didactics scored an average rating of <4 (range: 2.7-3.9). Subsequently, a pilot flipped classroom curriculum was created and implemented for each disease site over 1 year. This curriculum includes pre-recorded video lectures and seminal journal articles reviewed by residents independently prior to live didactic sessions. Live sessions are structured as journal club and case review discussions led by faculty and are designed to facilitate engagement and discourse between faculty and residents of all training levels. This pilot curriculum is currently ongoing. <h3>Conclusion</h3> Survey data of Radiation Oncology residents at a single institution suggest that traditional lecture didactics can be improved to better facilitate learning and consolidation. A flipped classroom approach to residency didactics may yield improved educational outcomes. We have implemented a flipped classroom curriculum across all disease site didactic blocks with a planned 1–2-year pilot program. Next steps include post-implementation surveys for comparison and formal assessment of this curriculum.

Characteristics of the Association of Residents in Radiation Oncology Educator of the Year Award Recipients

<h3>Purpose/Objective(s)</h3> The Association of Residents in Radiation Oncology (ARRO) presents the Educator of the Year Award to outstanding faculty members at each participating institution every year. Given that educational efforts are an important component in the process of academic promotion, the aim of this study was to characterize the recipients of this award. <h3>Materials/Methods</h3> We identified recipients of the annual ARRO Educator of the Year Award from the years 2008-2019. Publicly available website domains were accessed to obtain data regarding clinical treatment site, number of sites treated, whether they were at the same institution where they trained, academic rank, gender, ASTRO fellow status, repeat awardee status during the time period and number of years since board certification. H- and m-indices were determined from Scopus and calculated based on the time of the award. General workforce data was obtained from ASTRO and recently published articles. The authors performed correlative analyses stratified by gender and logistic regression to determine predictors of repeat recognition with multiple awards. <h3>Results</h3> A total of 607 ARRO educator awards were presented from 2008-2019. The majority of recipients were male (77.6%) and assistant professors (39.0%). The median number of years from board certification was 7 (IQR 3-17) and the median h- and m-indices were 14 (IQR 8-25) and 1 (IQR 0.6-1.6), respectively. When stratified by gender, publication metrics were significantly higher for men (p<0.05) and men were more likely to be repeat awardees (p<0.001) and have higher academic rank (p=0.007). On multivariate analysis, those of higher rank were more likely to be repeat awardees (associate OR 3.55, p<0.001; full professor OR 2.04, p=0.046) and less likely to be women (OR 0.41; p=0.002), while h- and m-indices were not significant predictors for being a repeat awardee. <h3>Conclusion</h3> Recipients of the ARRO educator award appear to be diverse in rank and experience, with a similar distribution of awards to men and women comparable to the radiation oncology workforce. However, associate professor rank and gender most impacted continued recognition of educational excellence.

The Effects of a Curriculum Change on Peer Mentorship among Radiation Oncology Residents

<h3>Purpose/Objective(s)</h3> Peer mentorship is the educational, professional, and personal support provided amongst trainees within a similar level of training. While peer mentorship has shown to benefit academic success and professional growth, little data has examined contextual factors, such as curricular change, that may affect the accessibility, content, and quality of these relationships. This study aims to explore peer mentorship among Radiation Oncology (RO) resident physicians following the implementation of a new nationwide, competence-based RO residency curriculum, known as Competency by Design (CBD). <h3>Materials/Methods</h3> Two cohorts of Canadian RO residents in English programs were invited to participate - one being the final academic year before CBD implementation (non-CBD cohort entering residency in July 2018), and the other being the inaugural CBD academic year (CBD cohort entering residency in July 2019). Residents participated via convenience sampling and engaged in semi-structured interviews to elicit their thoughts and perceptions on the impact of curriculum change on peer mentorship. Interviews were conducted until data saturation, meaning that no new ideas or themes were emerging from the data. Interviews were audio-taped, de-identified and transcribed. Iterative data collection was conducted in parallel with thematic analysis methods, using both deductive and inductive analysis, to generate themes to describe findings. <h3>Results</h3> Between April and December 2021, 14 interviews were conducted with 6 non-CBD (32% response rate) and 8 CBD (53% response rate) residents, at which point thematic saturation was achieved. Participants represented 8 out of 10 eligible English RO training programs across Canada. Three major themes were identified: (i) the CBD-cohort described fewer opportunities for peer mentorship in navigating formal evaluation processes, and in discussing uncertainties about the later stages of residency training; (ii) peer mentorship tended to thrive when able to occur as spontaneous in-person interactions; and (iii) there was minimal impact on specialty-specific learning. <h3>Conclusion</h3> Findings from this study identified that inaugural RO residents of a new curriculum experienced uncertainty around new training objectives, and that peer mentorship was most impactful as informal and in-person interactions. Our findings suggest that the unintended consequences of curriculum change on resident peer mentorship may be mitigated from improved orientation and communication about stage-specific training objectives, and to provide increased opportunities for informal activities amongst residents.