Radiation Oncology Residents Research Articles

Improving Patient Communication Among Oncology Trainees: A Systematic Review of Communication Interventions

Navigating difficult patient conversations is a core competency of oncologists, yet structured communication training for residents and fellows is lacking. Trainee-targeted interventions have been reported in the literature; however, no systematic review of communication skills education in oncology trainees has been performed. We analyzed the available evidence to understand the breadth and effectiveness of communication interventions in this population. EMBASE and PubMed were queried to identify English language publications examining targeted interventions for pediatric or adult oncology-trainees aimed at improving communication skills with cancer patients. Exclusion criteria included studies without a clear intervention aimed to improve skills, or without an objective measurement of the intervention. Titles, abstracts, and full texts were screened by two independent reviewers, with a third author serving as an adjudicator of conflicts. Relevant data were abstracted and analyzed. Of 811 studies identified, 14 were included, representing 1024 unique trainees (range, 11-262). Three studies were randomized control trials (RCTs) and 11 were longitudinal cohort studies. Populations were heterogenous, including trainees from medical, radiation, hematologic, surgical and pediatric oncology, spanning all post-graduate levels. Only 1 study (n = 11) examined a population of exclusively radiation oncology residents, and showed no significant improvement in pre- and post-intervention scores as assessed by standardized patients. Radiation oncology residents were minimally represented in other studies. Ten different intervention designs were used and included facilitated role-play, multimedia, and didactic components. Time commitment ranged from 1-hour videos to 40 hours of in-person training over 8 months. Intervention arms in all RCTs showed statistically significant improvement in communication domains, including empathy, support, open-ended questions and active listening scores. Self-assessed confidence or skills improved significantly post-intervention in 10/11 studies. Eight studies included assessments by faculty, with 5 showing improvement and 3 showing no significant change. Four studies utilized assessments from standardized patients showing perceived improvement in all. Only one study had evaluation by real patients, and failed to demonstrate improvement. No studies evaluated competency more than 12 weeks post-intervention. Despite variability in interventions, patient communication training for oncology trainees improved perceived performance based on assessments from participants and standardized patients. Opportunities for further study include examining the benefit of specialty-specific training, expanding the breadth of communication scenarios beyond BBN and developing standardized metrics to evaluate the immediate and sustained effectiveness of these programs

Current Social Media Use Among Radiation Oncology Trainees

Abstract Purpose Resident physicians use social media (SM) for many reasons. We sought to characterize current SM use by radiation oncology (RO) trainees for education and professional development. Methods and Materials An anonymous 40-question survey was sent by e-mail to RO residents in the 2018 to 2019 academic year. SM platform use, time spent on SM, professional use, and opinions regarding SM use were assessed. Descriptive statistics and a univariate logistic regression analysis were performed to identify factors associated with perceptions of SM and spending >25% of SM time for academic or professional purposes. Results Of the 615 residents surveyed, 149 responded (24% response rate). Facebook (73%), theMednet (62%), Instagram (59%), Twitter (57%), and Doximity (50%) were the top SM platforms used. Most respondents (53%) reported 60 minutes per day over the past week. Residents with an RO mentor on SM (n = 35; 24%; odds ratio [OR]: 2.79; 95% confidence interval [CI], 1.29-6.08; P = .010), those participating in RO discussions on SM (n = 71; 48%; OR: 2.85; 95% CI, 1.42-5.72; P = .003), and those interacting with professional societies (n = 69; 46%; OR: 7.11; 95% CI, 3.32-15.24; P 25% of their SM time on professional/academic purposes. The vast majority of respondents agreed that SM exposed them to novel educational content (82%) and was helpful for career development (65%). In addition, 69% agreed that SM can improve clinical skills and knowledge. A substantial minority agreed that SM distracts them from studying (38%) or they felt pressure to have a SM presence (29%). Conclusions Most RO residents reported that SM provides novel educational content and can help with career development. Potential disadvantages of SM for trainees may include distraction and pressure to maintain a SM presence. SM use by RO trainees merits further research to optimize its potential for education and professional development.

Radiation Oncology Medical Student Formal Research Mentorship: Update on the Medical Student Summer Research Program

The Medical Student Summer Research Program (MSSRP) at our institution provides the opportunity for medical students to conduct 7-10 weeks of supported research between their first and second years in medical school. Interested students submit a research proposal in collaboration with a faculty mentor. The program includes sessions on responsible conduct of research, critical thinking, and presentation skills. Herein we report research output based on total publications and presentations from students who have participated in the MSSRP with a radiation oncology faculty mentor, as well as their future career choice. Since 2005, radiation oncology faculty have mentored 16 medical students on a variety of projects in the MSSRP. Data were collected on the total number of unique publications (manuscript or abstract) authored by these 16 students, number of publications with a student as the first author versus co-author, and for the 10 students who have graduated, what their residency choice was. Among the 16 students, 37 unique abstracts and 22 unique manuscripts have been presented or published, which represents a mean of 2.31 abstracts per student and 1.38 manuscripts per student, respectively. Of the 37 abstracts, 18 (48.6%) had a student as the first author, while out of the 22 manuscripts, 7 (31.8%) had a student as the first author. Furthermore, 27 abstracts had one student author, while 10 abstracts had two student authors. Sixteen manuscripts had one student author, while 6 had two student authors. None of the abstracts or manuscripts had three or more student authors. For abstracts, the distribution of co-authorships is as follows: 18 first authors, 9 second, 5 third, 5 fourth, 9 fifth, and 1 sixth. For manuscripts, the distribution of co-authorships is as follows: 7 first authors, 3 second, 10 third, 3 fourth, 2 fifth, 1 sixth, and 2 seventh. A total of 6 abstracts were selected for oral presentation at national conferences. Among the ten students who have graduated, 3 (30%) chose to pursue careers in radiation oncology, and the remaining students include 2 current medical oncology fellows, 2 internal medicine residents, 1 radiology resident, 1 dermatology resident, and 1 attending neurologist. Radiation oncology research mentorship via the MSSRP, a formal, funded summer program, has allowed for successful student research. Participation in the MSSRP is beneficial in promoting research skills that lead to future publications in the form of abstracts, oral presentations, and manuscripts. Radiation oncology faculty mentorship is productive for students entering both radiation oncology and non-radiation oncology residencies.

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.

Linguistic Biases in Letters of Recommendation for Radiation Oncology Residency Applicants

Linguistic Biases in Letters of Recommendation for Radiation Oncology Residency Applicants

A RO-ILS Based Patient Safety and Incident Learning Training Program for Radiation Oncology Residents

A RO-ILS Based Patient Safety and Incident Learning Training Program for Radiation Oncology Residents

I Need A Sign: Modeling a Signaling Mechanism in the Radiation Oncology Residency Interview Application Process

The radiation oncology interview process (ROIP) for the match in the 21st century has been a competitive process, leading candidates to apply broadly. To alleviate application review burden, some programs utilize performance measures to stratify applicants. Additionally, programs may estimate the candidates perceived likelihood of ranking the program or accepting an interview in order to make efficient use of interview slots. Consequently, programs may eliminate interested candidates deemed unlikely to rank, and those with inadequate performance measures but an overall strong application. We hypothesize this may be partially overcome by passing information between match participants without violating no contact rules, in the form of two free virtual “signals of interest” (SOIs) from a candidate to chosen programs. We modeled the effect of implementing SOIs in the ROIP based on the results of implementation of a similar mechanism in the American Economics Association (AEA) PhD job match. Data from the AEA PhD job match, which resembles ROIP in terms of applications per applicant, interviews per position, and interview invitation rates, was used. The AEA implemented a SOI mechanism whereby candidates could use a secure online portal to send SOIs to up to two preferred employers. AEA applicant and employer survey data collected from 2006-2011, and annual employment metrics published by the AEA from 2014-2018, were used to model the effect of implementing a two-signal system in the ROIP. Applicant data was derived from the results of the National Residency Matching Program applicant surveys from 2011-2019. Sensitivity analysis was performed by inputting the historical maximum and minimum values of model parameters, establishing the likely upper and lower extremes of model effect. The median interview invitation rate per application submitted by matched applicants in the ROIP ranged from 25-39% between 2011 and 2019. AEA data demonstrate an accompanying SOI improves the relative rate of an application resulting in an interview invite by 28-34% in the AEA match. Incorporating fluctuations in ROIP application numbers and interview invitation rates, our model led to an estimation that applications submitted in the ROIP accompanied by an SOI would have an absolute 7-13% increased rate of resulting in an interview invite. This corresponds to a 10-15% increased absolute likelihood of an applicant receiving at least one interview to a signaled program that they would not have otherwise received. We would also expect 36-40% of programs to receive at least one SOI, and 25-28% of programs overall to offer an interview in part because of signaling. We modeled the expected effect of a SOI mechanism to improve outcomes in the ROIP for both applicants and programs. This system may increase the likelihood of being granted an interview to a signaled program for candidates, and may also influence interview candidate selection in ∼25% of programs.

The Declining Residency Applicant Pool: A Multi-Institutional Medical Student Survey to Identify Precipitating Factors

PurposeThe purpose of our study was to better understand and identify concerns that may be responsible for the declining radiation oncology (RO) residency applicant pool. Methods and MaterialsAll RO residency programs affiliated with a US medical school were asked to participate in the study survey. An optional and anonymous survey consisting of 12 questions was emailed to all graduating medical students in 2020 at the 12 allopathic medical schools that agreed to survey administration. Survey responses were collected from March to May 2020. ResultsThe study consisted of 265 survey responses out of 1766 distributed to eligible medical students, resulting in a response rate of 15.0%. The majority of students reported no exposure to RO (60.8%) and never considered it as a career option (63.8%). Neutral perceptions of the field were more common (54.3%) than positive (39.6%) and negative (6.0%). The top factors attracting medical students to RO were perceptions of high salary, favorable lifestyle and workload, and technological focus. The top negative factors were the field’s interplay with physics, competitive United States Medical Licensing Examination board scores for matched applicants, and the focus placed on research during medical school. In the subgroup of students who were interested in RO but ultimately applied to another specialty, the job market was the most salient concern. ConclusionsFinding a place for RO in medical school curricula remains a challenge, with most surveyed students reporting no exposure during their education. Concern over the job market was the primary deterrent for medical students interested in pursuing RO. For disinterested students who had not considered RO as a career option, the required physics knowledge was the main deterrent.

Simulation-based learning for enhanced brachytherapy training among radiation oncology residents

Brachytherapy is a critical and irreplaceable component of treatment for gynecologic malignancies, but its curricula in residency is highly variable, particularly procedural experience. In surgical fields, simulation-based learning has been shown to improve learner's clinical and procedural competence. Thus, we performed, for the first time, a hands-on simulation-based gynecologic brachytherapy education intervention using a custom 3D pelvic phantom to evaluate the benefit of simulation-based learning on resident brachytherapy education.

Novel MR-Guided Radiotherapy Elective Rotation for Radiation Oncology Trainees.

MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. However, this is still a relatively nascent technology and only a few institutions and programs have access to this technology for clinical use and trainee education. To increase the diversity of elective offerings and improve the understanding of an MR-guided radiotherapy program, we initiated a unique MR-guided radiotherapy elective rotation for radiation oncology residents. During a representative four-week rotation, 21 simulations were completed by the resident on service. A plurality of simulations were for pancreas stereotactic body radiation therapy (SBRT; 48%) and a majority (71%) of simulations were for adaptive treatments. Additionally, 74 adaptive fractions were completed during this month, of which a significant majority (74%) were for pancreas SBRT. Of the non-adaptive fractions, the majority were for prostate SBRT and intensity-modulated radiation therapy (IMRT). Although many programs may offer training in some aspects of MR-guided radiotherapy as trainees rotate through certain disease sites, we hope this may serve as a blueprint to encourage programs with this technology to fully embrace training in essential competencies related to MR-guided radiotherapy. MR-guided radiotherapy has unique challenges that trainees need to understand to deliver treatment safely: geometric uncertainty, MRI to RT isocenter, and uncertainties with voxel size/tracking.

Development, implementation, and outcomes of a simulation-based medical education (SBME) prostate brachytherapy workshop for radiation oncology residents

PurposeDespite a preponderance of data demonstrating strong clinical outcomes and cost-effectiveness, prostate brachytherapy use and competency continue to decline. Enhanced resident education may help reverse this trend. We therefore developed and implemented a simulation-based medical education course for low-dose-rate prostate brachytherapy (LDR-PB). Materials and MethodsA 1-week LDR-PB course comprised four 1-h lectures on clinical outcomes, physics, radiobiology, and anatomy/contouring, followed by a 4.5-h simulation session on ultrasound-guided prostate phantom implantation, was developed for radiation oncology residents at an academic institution. A 10-statement Likert-scale survey and 20-question multiple-choice test were administered 1 week before and 4 weeks after the course. ResultsPrecourse and postcourse instruments were completed by 24 and 20 residents, respectively. The median number of prior LDR-PB cases after at least one genitourinary rotation was 10.5 (range 5–20). Overall mean test scores were significantly improved (55% before the course vs 68% after the course; p = 0.010). Mean Likert scores significantly increased on nine of 10 survey statements and were significantly increased overall (2.4 before the course vs 3.3 after the course, p < 0.001). When asked about interest in performing brachytherapy after residency, 37.5% of residents “agreed” or “strongly agreed” before the course vs 50% after the course (p = 0.41). Those with higher postresidency brachytherapy interest (scores of 4–5 vs 1–3) had significantly more LDR-PB cases (11.2 vs 5.3 cases; p = 0.005). ConclusionsA 1-week simulation-based medical education course for LDR-PB can improve didactic performance and self-reported technical competence/confidence, and may increase overall enthusiasm for brachytherapy. Future studies at our institution will incorporate evaluation of implant quality and assessment of procedural competence into this framework. Residency programs should dedicate resources to this essential component of radiation oncology.

Abstract PO-033: Professional and psychological impact of COVID-19 pandemic on medical and radiation oncology residents: Results of a national survey

Abstract Background: The COVID-19 pandemic deeply impacted clinical practices in oncology leading to organizational, ethical, and medical issues. It has raised challenges in a context of competing care priorities between COVID-19 and cancer treatment. Residents and fellows were in the front line and had to face difficulties related to increasing care needs and urgent reorganization of the health care system while managing stress and uncertainty. Methods: We conducted a national survey (39 questions) in France among all oncology and radiation therapy residents to describe psychological impact and difficulties encountered by residents (i.e., reassignment, training/research time, supervision, teleworking, management of patients) during the COVID-19 pandemic. Results: Overall, 222 residents (oncologists: 61% and radiation therapists: 39%) participated in our survey (representing around one third of all residents and fellows in France). Reassignment in COVID-19 wards involved 32% of respondents. Training and research activity were decreased for 89% and 41% of respondents, respectively. 70% have been confronted with ethical issues, 35% felt worried about their health, and 23% experienced psychological distress. According to the Hospital Anxiety and Depression Scale, 32% were anxious and 17% depressive. Consumption of tobacco, psychostimulants, and alcohol was increased in 45%, 40%, and 24%, respectively. Conclusion: French oncology residents were highly impacted by the COVID-19 pandemic in terms of training and emotions. This national survey can be used as a basis for improved management, medical reorganization, and training of residents during the COVID-19 pandemic, especially when further waves are not excluded. Citation Format: Marc Hilmi, Alice Boilève, Anabelle Ducousso, Morgan Michalet, Anthony Turpin, Cindy Neuzillet, Natacha Naoun. Professional and psychological impact of COVID-19 pandemic on medical and radiation oncology residents: Results of a national survey [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-033.

Progression of Citation-Based Scholarly Activity from Postgraduate Year One to Postgraduate Year Two in a Current Radiation Oncology Resident Class

Recent work has demonstrated multiple measures of citation-based scholarly activity. Measures including Hirsch index (h-index), h-index limited to first-author manuscripts (hf), h-index limited to first or second-author only manuscripts (hs), and g-index have been associated with radiation oncology resident choice of academic versus private practice career. To date, there has been no evaluation of the progression of citation-based scholarly activity during residency. A list of radiation oncology residents from the graduating class of 2022 (PGY-2 academic year of 2018-2019) was obtained through internet investigation. Citation-based scholarly activity was collected and calculated from searches of the SCOPUS bibliometric citation database for h-index, hf, hs, and g-indices for each resident as previously described. Calculations were derived in June 2018 for the PGY-1 year, and in June 2019 for the PGY-2 year. Fisher’s exact test was used for statistical analysis. Analysis of 195 residents from the 2022 class revealed that the citation-based scholarly activity significantly increased from PGY-1 to PGY-2 for h-index (2.59 to 3.23; p=0.047) and g-index (4.03 to 5.13; p=0.045), but not for hf (1.03 to 1.28; p=0.169) or hs (1.48 to 1.88; p=0.0654). From the PGY-1 to PGY-2 year, the proportion of residents with hf of zero (no cited articles as first author) decreased from 43.6% to 38.5%, as did the proportion of residents with hs of zero (no cited articles as first or second author) from 32.3% to 26.7%. Underrepresented minority race/ethnicity (African-American/Hispanic) did not impact the significance of the h-index and g-index findings. From the PGY-1 to PGY-2 academic year, radiation oncology residents significantly increased in citation-based academic productivity, with an increase in the proportion of residents with a cited first-or-second author manuscript. Further study is necessary to determine how this trend persists in future years.

Educating Our Colleagues: Radiation Basics for Obstetrics and Gynecology Residents

Exposure to Radiation Oncology is minimal among medical students, except for those who intend to pursue a career in Radiation Oncology. Consequently, fundamental knowledge of radiation treatment in gynecologic malignancies may vary among Obstetrics and Gynecology residents depending upon their experiences and level of training. To develop a curriculum to educate Obstetrics and Gynecology residents about basic concepts in Radiation Oncology to improve coordination and management of patients with gynecologic malignancies. Radiation oncology residents met with Obstetrics and Gynecology residents to identify gaps in their knowledge related to radiation oncology topics of interest. A lecture was developed to cover these topics with the help of Radiation Oncology and Gynecologic Oncology attending physicians. The target audience of the lecture were the members of the Department of Gynecology and Obstetrics, including residents, attending physicians, nurse practitioners, and patient care coordinators. The session was divided into an orientation lecture, followed by hands-on training. The orientation lecture covered the following topics: • Common gynecologic malignancies and standard of care treatments • Indications for radiation treatments including emergent radiation treatment • Description of different radiation modalities including external beam radiation and brachytherapy and how they are used • EBRT: CT simulation, radiation planning software, and treatment machines • Brachytherapy: Basic physics background, placement of Smit sleeve for cervical cancer brachytherapy, CT simulation, and treatment planning and delivery • Expected treatment side effects • Radiation safety and protection • Radiation and pregnancy A demonstration/ hands-on-training session was conducted with patient mannequins to familiarize attendees with treatment planning, brachytherapy equipment, and placement of devices. Attendees also toured the department to learn more about the following: • Tandem and ovoids, tandem and ring, cylinders, and interstitial needles/catheters • Treatment planning software • Treatment machines – LINAC, brachytherapy after-loaders. This training session resulted in a better understanding of the rationale and logistics of radiation treatments and improved coordination of patient care for gynecologic oncologic patients. Future research opportunities and avenues for collaboration were identified as well. A Radiation Oncology education program targeted at Obstetrics and Gynecology residents led to greater knowledge about radiation treatments and enhanced patient care and coordination.

Variations among Radiation Oncology Residency Programs in the USA

Variations among Radiation Oncology Residency Programs in the USA

How Serious are we Regarding Resident Education and Wellness in Radiation Oncology Residency Programs?

Residency is the time for education and training during which a medical student transforms into a capable physician to take care of the patients. Resident wellness and prevention of burnout has become an important objective of ACGME in recent years. Despite the efforts from ACGME to make sure the basic standards are met across the training programs, significant variations exist in educational and wellness resources among residency programs. The purpose of this research is to evaluate the educational and wellness resources for residents among Radiation Oncology residency programs across the United States. A list of accredited programs for the academic year 2018-2019 was collected using the ACGME website (www.acgme.org). Individual residency program websites were used as the main source of the data whereas Fellowship Residency Electronic Interactive Data Access System (FREIDA) website (www.freida.ama-assn.org) aided to complement the missing data. Information from all the 94 Radiation Oncology residency programs which are currently ACGME accredited, was up to date as of April 30th, 2019. Excel 2013 was used for analysis. Educational resources Only 53 radiation oncology residency programs reported the duration of protected education time per week on their websites. The median protected education time was 8 hours/week (range: 2 hours to 13 hours) including all the conferences the residents were supposed to attend. Seventy-five (80%) programs have reported the duration of dedicated research time on their websites. At least six months were allowed in 48 (51%) programs, whereas 27 (29%) programs have reported the dedicated research time is negotiable. Outstandingly, 20 (21.28%) programs allow one year of dedicated research time, and the median dedicated research time was nine months. Elective rotations outside the primary department or the primary training institutions help the residents improve their clinical skills and perspectives. From our study, only 13 (14%) residency programs reported to allow residents to rotate in other departments of the same institution. Fifty-nine (63%) of programs allow away rotations at other institutions (external electives). An international rotation was permitted only in 19 (20%) programs. Wellness resources Resident burnout and wellness are areas where ACGME and individual residency programs focus to improve the training for the residents. We evaluated the availability of wellness resources as presented in the radiation oncology program websites and found that there are a lot of variations across the programs. Fatigue management training was available in 50 (53%) programs. Twenty-four (26%) programs routinely organize resident retreat yearly. Thirty-nine (42%) programs reported that they have resident mentoring programs. Financial wellness is an important part of resident wellness and we evaluated the resident salary information across the programs. The salary information was obtainable for 63 institutions, and residents are reasonably well-compensated (range: 51000$ to 78,000 yearly) compared to the median family income in the United States. Moonlighting was allowed only in 28 (30%) of programs. Our study found that significant variations exist among radiation oncology residency programs in the United States with regards to educational and wellness resources for residents. This study reports the current status of these resources and significant improvements can be made from this baseline.

Continuing Medical Education Preferences and Pediatric Radiation Practices of Radiation Oncologists Attending the 2019 Meeting of the Pediatric Radiation Oncology Society

Little is known regarding the credentials and continuing medical education of radiation oncologists who treat children with cancer. To examine the educational background, clinical practice, and preferences regarding continuing medical education (CME) among radiation oncologists who attended the 2019 meeting of the Pediatric Radiation Oncology Society (PROS). During the 2019 meeting of PROS in Bangkok, Thailand, a survey was distributed to all meeting participants asking for the participant’s demographic and educational background, clinical practice, and preferences regarding pediatric radiation oncology CME. The survey consisted of 20 questions with the first question asking if the participant was a radiation oncologist who treated children with cancer. The remaining questions were only answered by pediatric radiation oncologists. Of 188 PROS meeting participants, 130 (69.2%) returned the questionnaire. 104 respondents were pediatric radiation oncologists and answered the remaining questions. 55.3% of the respondents were male. 51.5% and 62.4% of respondents have been practicing radiation oncology and pediatric radiation oncology, respectively, < 10 years from completion of radiation oncology training. The respondents were from: Asia 60%, Europe 20%, North America 13%, Australia/New Zealand 5%, and other 2%. >80% reported access to CT simulation, 3-D radiotherapy, IMRT/VMAT and use of general anesthesia. 40 in 25.3%. A formal radiation oncology residency program was available in the home country of 88.2% of respondent’s; with 72.4% of programs lasting > 4 years. Radiation oncology board certification was available in 91% of respondent’s countries. Only 18% of respondents had a formal pediatric radiation oncology fellowship program in their country, while 12.1% did some pediatric radiation oncology training beyond residency. When asked about further training after residency, 88.8% answered that there should be a formal training program beyond residency in order to treat children with radiation. >75% of respondents acquired knowledge in pediatric radiation oncology through journals, books, live meetings such as ASTRO, SIOP, PROS, and tumor boards. < 40% of respondents answered that they acquire knowledge through web-based meetings. The majority of pediatric radiation oncologists in attendance at the meeting had < 10 years of clinical experience beyond residency. Most practitioners learn pediatric radiation oncology by reading books and journals and attending live meetings and tumor boards. While only 12.1% had actually done further training in pediatrics beyond their initial radiation oncology training, 88.8% believed there should be further training beyond residency to practice pediatric radiation oncology. This may reflect the belief that the complexity of treating children and the technological advances in radiation oncology merit specialized pediatric radiation oncology training.

Students’ Perspectives and Concerns for the 2020 to 2021 Radiation Oncology Interview Season

PurposeRecently, the Coalition for Physician Accountability Work Group on Medical Students in the Class of 2021 recommended limiting visiting medical student rotations, conducting virtual residency interviews, and delaying the standard application timeline owing to the ongoing coronavirus disease 2019 (COVID-19) pandemic. These changes create both challenges and opportunities for medical students and radiation oncology residency programs. We conducted a comprehensive needs assessment to prepare for a virtual recruitment season, including a focus group of senior medical students seeking careers in oncology. Methods and MaterialsA single 1.5-hour focus group was conducted with 10 third- and fourth-year medical students using Zoom videoconferencing software. Participants shared opinions relating to visibility of residency programs, virtual clerkship experiences, expectations for program websites, and remote interviews. The focus group recording was transcribed and analyzed independently by 3 authors. Participants’ statements were abstracted into themes via inductive content analysis. ResultsInductive content analysis of the focus group transcript identified several potential challenges surrounding virtual recruitment, including learning the culture of a program and/or city, obtaining accurate information about training programs, and uncertainty surrounding the best way to present themselves during a virtual interview season. In the present environment, the focus group participants anticipate relying more on departmental websites and telecommunications because in-person interactions will be limited. In addition, students perceived that the educational yield of a virtual clerkship would be low, particularly if an in-person rotation had already been completed at another institution. ConclusionsWith the COVID-19 crisis limiting visiting student rotations and programs transitioning to hosting remote interviews, we recommend programs focus resources toward portraying the culture of their program and city, accurately depicting program information, and offering virtual electives or virtual interaction to increase applicant exposure to residency program culture.

Radiation Oncology Resident Quality by National Resident Matching Program Metrics From 2007 to 2018

To quantify how the quality of US medical students accepted to radiation oncology (RO) training programs, as defined by National Resident Matching Program (NRMP) metrics, has changed over time. We examined NRMP data of senior US medical students matched into RO training programs from 2007 to 2018. Metrics include United States Medical Licensing Exam (USMLE) Step 1 and 2-Clinical Knowledge scores, research output, percentage with PhD, and percentage in Alpha Omega Alpha (AOA), among others. Linear regression analysis assessed the statistical significance of changes in available metrics of matched RO residents over time. The Student t test and χ2 test compared quality metrics between matched students in RO versus all other specialties. From 2007 to 2018, the mean USMLE Step 1 and 2-Clinical Knowledge for RO residents significantly increased from 235 to 247 (1.0 point/year; 95% confidence interval [CI], 0.70-1.52; P = .002) and from 237 to 253 (1.3 points/year; 95% CI, 1.27-1.62; P <.001), respectively. The mean number of research experiences and abstracts/presentations/publications increased from 3.7 to 6.1 (0.2/year; 95% CI, 0.12-0.29; P = .003) and from 6.3 to 15.6 (0.78/year; 95% CI, 0.60-1.04; P <.001), respectively. The percentage of RO residents inducted into AOA increased from 24.2% to 35.2%, whereas those with a PhD remained stable (∼21%). Matched RO residents had statistically superior metrics versus all other specialties for USMLE Step 1 scores (mean +13.5 points; 95% CI, 7.26-19.67; P <.001), research experience (mean +2.04; 95% CI, 1.11-2.97; P <.001), abstracts/presentations/publications (mean +6.80; 95% CI, 3.38-10.22; P = .001), percentage with a PhD (22.2% vs 4.1%; P <.001), and percentage in AOA (29.5% vs 15.8%; P <.001). RO resident quality, defined by routinely reported NRMP metrics, increased from 2007 to 2018. Furthermore, RO resident quality is significantly higher than in all other specialties combined for most metrics. Whether the recent decline in medical student interest in RO will correlate with reduced NRMP quality metrics is unknown.

Evaluation of a 3-Dimensional-Printed Head Simulation Technique for Teaching Flexible Nasopharyngoscopy to Radiation Oncology Residents

PurposeSimulation-based medical education is an effective tool for medical teaching, but simulation-based medical education deployment in radiation oncology (RO) is limited. Flexible nasopharyngoscopy (FNP), an essential skill for RO residents, requires practice that typically occurs on volunteer patients, introducing the potential for stress and discomfort. We sought to develop a high-fidelity simulator and intervention that provides RO residents the opportunity to develop FNP skills in a low-pressure environment.Methods and MaterialsComputed tomography images were used to create an anatomically accurate 3-dimensional–printed model of the head and neck region. An intervention incorporating didactic instruction, multimedia content, and FNP practice on the model was designed and administered to RO residents attending the Anatomy and Radiology Contouring Bootcamp. Participants completed pre- and postintervention evaluations of the training session and model fidelity, and self-assessments of FNP skill and confidence performing FNP. Participants were video recorded performing FNP pre- and postintervention. Videos were scored by a blinded observer on a predefined rubric. Changes in scores were evaluated using the Wilcoxon signed-rank test.ResultsTwenty-four participants from 17 institutions and 4 countries completed the intervention, 50% were women, and most were senior residents. Postintervention, FNP confidence and FNP performance improved significantly (mean ± standard deviation on a 10-point scale: 1.8 ± 1.8, P < .001; 2.2 ± 2.0, P < .001, respectively). Participants felt the model was helpful (mean ± standard deviation on a 5-point scale: 4.2 ± 0.6), anatomically correct (4.1 ± 0.9), and aided in spatial comprehension (4.3 ± 0.8). Overall satisfaction for the intervention was high (4.3 ± 0.8). Participants strongly agreed the intervention should be integrated into RO training programs (4.3 ± 0.8).ConclusionsA 3-dimensional–printed model and associated intervention were effective at improving FNP performance and the teaching method was rated highly by participants. RO residents may benefit from broader dissemination of this technique to improve trainee performance.