Radiation Oncology Residents Research Articles

A Growing Specialty: A 15-year Profile of US Radiation Oncology Residency Growth and Implications for Workforce Imbalances

The radiation oncology (RO) community is concerned about geographic maldistribution and a future oversupply of physicians, driven in part by a sustained growth in residency programs and positions. This growth has previously only been reported in absolute numbers of positions over time. Therefore, the aim of this project is characterize RO residency growth, in both number of programs and number of positions, as it relates to geographic region, major urban centers, and program size. A database of all RO programs & positions from 2003 to 2018 was created using publicly available data from the National Resident Matching Program (NRMP). Programs were categorized by geography (US Census Bureau region designations: Northeast [NE], South [SO], Midwest [MW], and West [WT]), location in a 2018 top metropolitan region (top 10 Combined Statistical Area [CSA] by population vs. all others), and program size (large [>6 trainees] vs. small [≤6 trainees]. Program size definition (large vs. small) was dynamic by year and thus defined as the cumulative number of positions over the prior four years. Linear regression with interaction terms was used to determine the effect of region, metro size, and program size on RO program & positions growth over time. An increase in the number of RO programs (54 to 91, 69%) & annual positions (106 to 193, 82%) was observed during the studied time frame. In decreasing regional order, 2018 programs & positions, respectively, are located in the SO (31.9% & 29.9%), NE (25.3% & 28.5%), MW (23.1% & 25.0%) and WT (19.8% & 16.7%). There is a statistically significant difference in regional RO program & position annual growth rate. Specifically, programs & positions in the NE (0.44 programs/year & 1.48 positions/year), SO (0.70 & 2.28), and WT (0.62 & 1.44) are increasing at faster annual rates relative to the MW (0.16 & 0.84) (all p<0.05). 41.7% of all programs and 48.0% of all positions are in a top metropolitan location. Annual growth rates in RO programs (0.86 vs. 1.04) & positions (2.73 vs. 3.31) were not statistically different between top metropolitan areas vs. all others (p >0.18). Larger programs (change in annual growth rate: 0.23 positions/year) are growing faster than smaller programs (change in annual growth rate: -1.89), p=0.01. In this study of US RO residency growth, we found steady and unequal growth rates among residency programs & positions over the past 15 years. This growth may worsen already existing imbalances in the workforce, including (1) Geographic: MW growing at rates slower than other more saturated regions, 2) Urban: the top urban areas are growing at equal rates as elsewhere, and 3) Size: larger, established programs are growing more rapidly than smaller programs. Further discussion regarding the implications of these imbalances is warranted.

A Novel Radiation Oncology Residency Training Leadership Curriculum: Baseline Attitudes of Past and Current Residents

A Novel Radiation Oncology Residency Training Leadership Curriculum: Baseline Attitudes of Past and Current Residents

Board-certified specialty training program in radiation oncology in a war-torn country: Challenges, solutions and outcomes

BackgroundResidency programs leading to board certification are important for safe and competent Radiation Oncology (RO) practice. In some developing nations, there is a gap in this field. This work addresses the experience that was accomplished to establish such a program in Iraq despite all the challenges that faces a country under war. MethodsDescriptive report of challenges faced in a developing country that is still reeling from war, the steps taken to overcome these challenges and outcomes after graduation of two classes. ResultsAfter over 18 months of prerequisite technical and logistical preparations, a group of local and external faculty members were invited to establish the required syllabus of a structured RO residency program in Iraq. It is comprised of a total of 100 post-graduate academic credits over a 48-months period after clinical internship. First year evaluations included regular practical assessments; seven in-house papers covering RO, cancer and radiation biology, medical physics, radiological anatomy and diagnostic oncology, tumor pathology, onco-pharmacology, and medical statistics, research methodology, and cancer epidemiology, followed by a comprehensive examination. Subsequent evaluations were on an annual bases with enrollment in the American College of Radiology In-Training examination in RO. Final assessment included logbook and skills' reviews, graduation thesis or peer-review publication, two-papers’ written examination, and an exit practical examination. ConclusionsGiven the political, economic and social difficulties in post-war Iraq, it was a major challenge to establish a residency program in RO. Despite the significant difficulties, the first residency program leading to board certification in RO was successfully started in Iraq. The new specialists will help in addressing the shortage of radiation oncologists in the country.

Radiation oncology resident education in palliative care.

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

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

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

Transition to practice in radiation oncology: Mind the gap

IntroductionPhysicians entering independent practice often express apprehension in managing the non-clinical aspects of practice. This study examined the perceived preparedness of radiation oncology (RO) residents for independent practice, identified education gaps, and discussed how these deficiencies could be addressed. Materials and methodsFocus groups with senior RO residents, fellows, new-to-practice radiation oncologists (ROs), and residency program directors were conducted. Data were coded using the Canadian Medical Education Directives for Specialists (CanMEDS) competencies using thematic analysis. ResultsCommonly reported gaps in the transition to practice (TtP) for ROs were lack of experience with: practice management, understanding the structure and function of the health care system and how it varies by jurisdiction, financial planning, effective communication and collaboration with other health care team members, creation of accurate and timely documentation, and radiotherapy problem-solving related to treatment planning and evaluation. Suggestions to address these challenges included use of mentorship, educational resources, courses, simulation-based medical education, improved graded responsibility, resident longitudinal clinics, and formal curricula in radiation therapy planning and evaluation. ConclusionThere are gaps in TtP education for RO trainees with opportunities for enrichment through the forthcoming implementation of a competency-based medical education framework in 2019. The gap in perceived competency in physician-related radiotherapy tasks may be caused by the complex interaction of clinical workflow processes, people and technology that has led to ineffective integration of trainees. The data are informative to medical education leaders for the development of comprehensive TtP curricula.

Temporal Trends of Resident Experience in External Beam Radiation Therapy Cases: Analysis of ACGME Case Logs from 2007 to 2018

We sought to characterize temporal trends of radiation oncology resident-reported external beam radiation therapy (EBRT) case experience with respect to various disease sites, including trends in stereotactic radiosurgery and stereotactic body radiation therapy cases. Summarized, deidentified case logs for graduating radiation oncology residents between 2007 and 2018 were obtained from the Accreditation Council for Graduate Medical Education national summary data report. Mean number of cumulative cases and standard deviations per graduating resident by year were evaluated. Cases were subdivided into 12 disease-site categories using the Accreditation Council for Graduate Medical Education classification. Analysis of variance was used to determine significant differences, and strength of association was evaluated using Pearson correlation. The number of graduating residents per year increased by 66% from 114 in 2007 to 189 in 2018 (P < .001, r = 0.88). The overall mean number of EBRT cases per graduating resident decreased by 13.2% from 521.9 in 2007 to 478.5 in 2018, with a decrease in the ratio of nonmetastatic to metastatic cases per graduating resident. There was significant variation among the disease categories analyzed; however, the largest proportionate decreases were seen in hematologic, lung, and genitourinary malignancies. Stereotactic radiosurgery volume per graduating resident increased from an average of 27.9 cases in 2007 to 50.3 in 2018 (P < .001, r = 0.96). Stereotactic body radiation therapy volume per graduating resident increased as well, from a mean of 6 cases in 2007 to 55.6 cases in 2018 (P < .001, r = 0.99). We report a longitudinal summary of resident-reported experience in EBRT cases. These findings have implications for future efforts to optimize residency training programs and requirements.

Successful Development of a Competency-Based Residency Training Program in Radiation Oncology: Our 15-Year Experience from Within a Developing Country.

One of the main challenges of delivering high quality of care to cancer patients in developing countries is the lack of well-trained radiation oncologists. This is a direct cause for the lack of residency programs coupled with lack of resources. This article describes and details establishments of a successful and sustainable radiation-oncology residency program in our country. The program has been in operation for 14years and has trained and graduated radiation oncologists who are now working in various countries. The curriculum of the 4-year residency program, fashioned according to American College of Radiologists (ACR) recommendations, includes site-specific clinical rotations and didactic lectures in clinical oncology, radiobiology, medical physics, statistics, and epidemiology. It also includes a component of advanced clinical experience in the form of 3-month externship at one of collaborating centers outside the country. Evaluation of the residents is conducted annually via written exams and 360° feedback. Residents also sit for the formal certification exam in radiation oncology from the national Medical Council. The exam consists of 2 written exams and one oral. As a form of benchmarking residents' knowledge, they are required to sit for the ACR examinations held annually and conducted in Amman in tandem. The program has successfully trained and graduated 28 residents, who now work as consultant radiation oncologists locally and abroad. Each resident has gone through a structured training that includes exposure to a Western-style patient-management culture, enhancing the breadth and width of their clinical experience. The residency program, initiated in a developing country, underwent many challenges, yet it overcome all obstacles and resulted in a successful training of competent radiation oncologists serving the region.

Gender-based analysis of pre-residency research productivity among a current United States radiation oncology resident class.

10504 Background: The increasing proportion of women in medicine has not been adequately reflected in the gender distribution of residents, particularly in highly competitive subspecialties such as neurosurgery and radiation oncology. The presence of at least one pre-residency peer-reviewed publication (PRP) was found to be associated with future resident choice of academic over private practice career in a recent radiation oncology resident graduating class, with no significant gender difference in the likelihood of having a PRP (McClelland et al., Practical Radiation Oncology 2017). We sought to pursue a gender-based analysis of PRP productivity in a current junior resident class. Methods: A list of radiation oncology residents from the graduating class of 2022 (PGY-2 academic year of 2018-2019) was obtained through internet investigation. In addition to gender, demographics included dual degree status and presence/absence of a PhD. Research productivity was calculated using PRP number, defined as the number of a resident’s publications listed in PubMed (pubmed.gov) through the calendar year of residency application (2016 for the class of 2022), as previously described. Fisher’s exact test was used for statistical analysis. Results: Of 179 residents examined from the 2022 class, 55 (31%) were women, representing a nine percent increase from the resident class of 2016. Four-fifths had at least one PRP, 33% had dual degrees, and 18% had a PhD. These percentages were comparable to their male counterparts, 73% of whom had at least one PRP, 28% who had dual degrees, and 15% who had a PhD. Specific analyses revealed no statistically significant differences by gender in any of these benchmarks (p&gt;0.05). Conclusions: While slower than the overall trend of increased female representation in medicine, the proportion of women in radiation oncology residency has increased by approximately 1.4% per year over a recent six year span. There remain no significant differences in PRP productivity between male and female residents, and there are no significant gender differences in the likelihood of dual degree status or PhD status. Further study will be needed to determine how these findings manifest in career choice following graduation.

A Survey Study of Female Radiation Oncology Residents’ Experiences to Inform Change

Women remain underrepresented at all levels within the field of radiation oncology. We sought to study current female residents' experiences and concerns to inform interventions to promote gender equity. Furthermore, we evaluated interest in a professional society specifically for women radiation oncologists. An anonymous 76-item survey was designed and distributed to current women residents in radiation oncology in 2017-2018. Analyses describe personal, program, and family characteristics and experiences before and after joining the field. Of 170 female residents surveyed, 125 responded (74% response rate). Over one-quarter were in programs with ≤2 female residents (29%) and ≤2 female attendings (29%). One-third (34%) reported having children. Over half (51%) reported that lack of mentorship affected career ambitions. Over half (52%) agreed that gender-specific bias existed in their programs, and over a quarter (27%) reported they had experienced unwanted sexual comments, attention, or advances by a superior or colleague. Only 5% reported no symptoms of burnout. Almost all (95%) agreed that radiation oncology is perceived as family friendly; however, only 52% agreed that it actually is. An overwhelming majority (90%) expressed interest in joining a professional group for women in radiation oncology. In the first study to our knowledge to focus specifically on the experiences of women residents in radiation oncology, a number of areas for potential improvement were highlighted, including isolation and underrepresentation, mentorship needs, bias and harassment, and gender-based obstacles such as need for support during pregnancy and motherhood. These findings support the organization of groups such as the Society for Women in Radiation Oncology, which seeks to target these needs to promote gender equity.

The Radiation Oncology Mentorship Initiative: Analysis of a Formal Mentoring Initiative for Medical Students Interested in Radiation Oncology.

The importance of mentorship in medicine and its impact on academic and professional development has been widely studied. However, mentorship for medical students in the field of radiation oncology is limited. Our radiation oncology department developed a formal medical student mentorship program in 2004. This program included both clinical and research mentoring pathways. Our study aims to gain feedback and perspective from former medical student participants who subsequently entered into a radiation oncology residency program. An anonymous survey was sent to 22 former students in the mentorship program from 2005 to 2016 who entered a radiation oncology residency program. The survey included Likert scales (1-5), multiple choice, strength category rankings, and free responses. Data was compiled and analyzed with Qualtrics data software. The survey response rate was 100%. Seventeen (77.3%) participants reported that the mentorship program strongly affected their career choice and a majority reported that their research experience strongly (45.5%) or moderately affected (31.8%) their career choice. Fourteen (63.6%) respondents reported that the mentorship program was very effective and 8 (36.4%) reported it as being effective. Eighteen (81.8%) respondents reported that mentorship was extremely important to their career. Students participating in the research pathway also reported improvement in valuable skills such as presentations, abstract writing, manuscript writing, statistical analysis, and coordination with colleagues. A total of 66.7% of attending radiation oncologists who previously participated in this program now practice in an academic setting. Our institution successfully developed a formalized mentorship program for medical students interested in radiation oncology. Participants in this program reported high levels of satisfaction and emphasized the importance of mentorship in the development of valuable research competencies and on their overall career path. This program can serve as a model for future mentorship initiative in medical school.

Results of a Gynecologic Brachytherapy Simulation Course Designed to Improve Radiation Oncology Trainees Skills and Confidence

The utilization of high-dose-rate (HDR) gynecologic brachytherapy in the management of non-operable locally advanced cervical cancer is directly linked to improved survival. Unfortunately we continue to see a decline in its utilization in the treatment of cervical cancer in the United States. A recent survey of U.S. radiation oncology residents demonstrated caseload as the greatest barrier to achieving independence in brachytherapy practice. In an effort to improve resident brachytherapy skills and confidence in performing brachytherapy independently a gynecologic brachytherapy simulation course was developed.

Use of the g-index for assessment of citation-based scholarly activity of United States radiation oncology residents and subsequent choice of academic versus private practice career.

The Hirsch index (h-index) evaluates citation-based scholarly activity, but has limited ability to acknowledge those publishing a smaller number of manuscripts with exceedingly high citations. The g-index addresses this limitation by assessing the largest number of manuscripts (g) by an author cited at least (g×g) times, but has yet to be applied to radiation oncology resident productivity. A list of recent radiation oncology resident graduates (comprising 86% of the 2016 graduating class) and their post-residency career choice was compiled. The Scopus bibliometric citation database was searched to collect and calculate g-index data for each resident. The mean g-index score for all resident graduates was 7.16. Residents with a PhD had significantly higher g-index scores (11.97 versus 5.80; p<0.01), while there was no statistically significant difference in g-index scores between male and female residents. Residents choosing academic careers had higher g-index scores than those choosing private practice (9.47 versus 4.99; p<0.01). Programs graduating at least three residents produced significantly higher g-index scores/resident than those graduating two residents, and while comprising only 25% of programs and 45% of residents, produced 60% of academic careers (p<0.02). Radiation oncology resident graduates published on average a minimum of seven manuscripts cited at least 49 times. PhD-degree graduates had significantly higher g-index scores, as did residents choosing academic over private practice careers. There was no significant gender-related difference in g-index score regardless of career choice. The majority of academic careers are produced from programs graduating at least three residents.

Delivering Challenging News: An Illness-Trajectory Communication Curriculum for Multispecialty Oncology Residents and Fellows.

Published curricula to teach communication skills for postgraduate fellows in oncology are few in number despite the fact that oncologists conduct many difficult discussions with their patients and their families. Such discussions may include disclosing initial diagnosis or relapse of a patient's cancer or relaying a poor prognosis or change to palliative care. An eight-module course on communication in oncology practice was delivered over 2 months for palliative and oncology fellows and radiation oncology residents. Learners were given a precourse survey in which they were asked to rate their proficiency in various communication tasks. Each learner then participated in a videotaped precourse objective structured clinical exam (OSCE) on breaking bad news with standardized patients (SPs). The course took place over 8 weeks with weekly didactics and role-play. At the end of the course, a second OSCE took place. After the course was completed, the fellows again filled out a proficiency survey. Twenty-two learners participated over 2 years of this course. Participants reported a significant increase in perceived competence in all areas on the postcourse survey. SP feedback on OSCEs pre- and postcourse indicated improvement in skills for learners. Pre- and postcourse OSCE video assessment revealed a significant improvement in global communication skills. Initial data show that this course successfully improved communication skills and increased fellows' comfort level across several domains of communication. Future directions include validating our assessment tool, expanding the topic base, and investigating the impact on practice after course completion.

The Influence of Online Forums on Radiation Oncology Residency Program Selection

The Influence of Online Forums on Radiation Oncology Residency Program Selection

Regional Influence of Radiation Oncology Residency Training on Job Securement over Two Time Periods.

PurposeRecent reports have noted conflicting predictions regarding the future of the radiation oncology job market. Residents and practicing radiation oncologists (ROs) report perceptions of an increasingly saturated market. An important factor contributing to the job landscape is the potential geographic maldistribution of ROs in the United States. Given the importance of the evolving job market and appropriate supply and demand for future ROs, this study investigated whether residency training region influences employment region and whether “portability” of residency training has changed over time from 2003-2015.MethodsRadiation oncology residency graduates were identified from Association of Residents in Radiation Oncology (ARRO) directories from 2003-2012. This information was cross-referenced with the American Society of Radiation Oncology directory to determine current employment location. The region of residency training and employment were categorized into four regions per the US Census Bureau: Northeast (NE), South (S), Midwest (MW), and West (W). The change in “portability” of residency training over time was determined from the results of an anonymous internet-based survey which provided information on year of graduation and location of first job. “Portability” was defined as the rate at which a trainee in one region could find employment in another region. From the survey, two cohorts were identified: early (graduated from 2003-2006) and late (graduated from 2012-2015).ResultsCurrent employment location was available for 817/1168 (70%) residents identified in the ARRO directories from 2003-2012. The percentages of residents who trained in the NE, S, MW, and W were 29%, 28%, 27%, and 15%, respectively. The percentages of residents with current employment in the NE, S, MW, and W were 20%, 34%, 22%, and 24%, respectively. Residents were more likely to remain employed in the region in which they trained (p < 0.05), with 58% having current employment in the region of their training. Residency graduation year and location of first job (in the United States) were available for 139/198 (70%) survey respondents. Portability of residency training did not significantly change from 2003-2012 with 49% of the early cohort securing their first job in the region in which they trained compared to 57% of the late cohort (p = 0.39).ConclusionsThis study suggests that recent residents are not moving to different geographic regions at an increased rate than previous and that residents are more likely to find employment in the region in which they trained.

Analysis of pre-residency research productivity, dual degree status, and gender distribution of underrepresented minorities among a current United States radiation oncology junior resident class.

Among the most competitive medical subspecialties, representation of underrepresented minorities (African-American race and/or Hispanic ethnicity) among resident trainees has historically been low compared to their United States Census general population representation. Research productivity and dual degree status may impact residency applicant competitiveness. To date, such an analysis has yet to be performed in Radiation Oncology. A list of radiation oncology residents from the graduating class of 2022 was obtained through internet searches. Demographics included were gender and dual degree status. Research productivity was calculated using the number of pre-residency peer-reviewed publications (PRP). Fisher's exact test was used for statistical analysis. Of the 179 residents evaluated from the 2022 class, eleven (6.1%) were underrepresented minorities. Compared to the remainder of the class, underrepresented minorities had a lower proportion of men (63.6% versus 69.3%), a higher proportion of dual degrees (45.5% versus 28.6%), and a lower proportion of MD-PhD degrees (9.1% versus 17.2%). Underrepresented minorities had a higher proportion of residents with at least two PRP (72.7% versus 57.1%) and a lower proportion of residents with no PRP (18.2% versus 24.4%). None of these differences reached statistical significance (p>0.05). Underrepresented minorities were comparable to the remainder of their Radiation Oncology resident class regarding gender distribution, dual degrees status, and likelihood of having at least two peer-reviewed publications cited in PubMed during the calendar year of residency application. Further studies will be needed to determine how these findings translate into future scholarly activity and post-graduate career choice.

P58 - Use of the G-Index for Assessment of Citation-Based Scholarly Activity of United States Radiation Oncology Residents and Subsequent Choice of Academic versus Private Practice Career

Abstract Introduction The Hirsch index (h-index) evaluates citation-based scholarly activity, but has limited ability to acknowledge those publishing a smaller number of manuscripts with exceedingly high citations. The g-index addresses this limitation by assessing the largest number of manuscripts (g) by an author cited at least (g × g) times, but has yet to be applied to radiation oncology resident productivity. Methods A list of recent radiation oncology resident graduates (comprising 86% of the 2016 graduating class) and their post-residency career choice was compiled. The Scopus bibliometric citation database was searched to collect and calculate g-index data for each resident. Results The mean g-index score for all resident graduates was 7.16. Residents with a PhD had significantly higher g-index scores (11.97 versus 5.80; p Conclusion Radiation oncology resident graduates published on average a minimum of seven manuscripts cited at least 49 times. PhD-degree graduates had significantly higher g-index scores, as did residents choosing academic over private practice careers. There was no significant gender-related difference in g-index score regardless of career choice. The majority of academic careers are produced from programs graduating at least three residents.

P57 - The Relationship Between Pre-Residency Peer-Reviewed Publications and Subsequent Citation-Based Scholarly Activity of United States Radiation Oncology Residents

P57 - The Relationship Between Pre-Residency Peer-Reviewed Publications and Subsequent Citation-Based Scholarly Activity of United States Radiation Oncology Residents

Mind the Gap: An Analysis of “Gap Year” Prevalence, Productivity, and Perspectives Among Radiation Oncology Residency Applicants

Medical students may take a year off during medical school (a "gap year") to strengthen their applications for competitive specialties such as radiation oncology. This can incur significant financial and opportunity costs. We sought to understand the prevalence, nature, and funding of gap years undertaken by radiation oncology applicants. An anonymous survey was emailed to all applicants to a single radiation oncology program from 2015 to 2017. Survey questions assessed gap year utilization, funding, motivations, and perceptions. Separately, all 2017 Electronic Residency Application Service (n=176) applications to this program were reviewed for reference. The 2017 cohort had a response rate of 69% (n=121), with an overall response rate of 39% (n=194) for applicants between 2015 to 2017. Of non-MD/PhD respondents, 33% (n=53) reported taking a gap year. The main reason for a gap year (68%) was to produce more publications, and 50% of all respondents viewed a gap year as "important" or "very important" for matching in radiation oncology. Twenty-eight students (53%) reported using personal loans, savings, or family support to cover gap year expenses. Most who took a gap year (83%) viewed funding as "difficult" or "extremely difficult" to obtain. Fewer publications before gap year and more dedicated research time were significant predictors of undertaking a gap year, whereas sex, marital status, dependent status, and financial aid were not significant. Research productivity is commonly perceived as important for matching in radiation oncology, leading many applicants to take gap years, which are usually supported by personal financial resources. We did not identify statistically significant socioeconomic disparities between applicants that took a gap year and those who did not. However, further study is warranted to determine whether pressure to take a gap year, particularly in the absence of readily available funding sources, deters some potential applicants from pursuing radiation oncology altogether.