Radiation Oncology Training Research Articles

A Paradigm Shift in Radiation Oncology Training

The coronavirus disease 2019 pandemic has been intertwined with the movement for racial justice in the United States and has highlighted and risks aggravating educational and workforce disparities within radiation oncology. We discuss wide-ranging changes within radiation oncology training that are essential to developing and maintaining diversity, including utilization of competency-based educational models that allow for streamlining of training and examinations; responsiveness to the needs of residents and medical students of different gender, racial/ethnic, and socioeconomic groups; and technological integration to increase educational efficiency and decrease barriers.

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.

Qualitative Study of Interprofessional Collaboration in Radiation Oncology Clinics: Is There a Need for Interprofessional Education?

Interprofessional education (IPE) is gaining recognition as a means of improving healthcare delivery and patient outcomes. A primary goal of IPE is improved interprofessional collaboration (IPC). The multidisciplinary team in the radiation oncology clinic requires effective IPC for optimal delivery of radiotherapy. However, there are limited data on IPE and IPC in radiation oncology. This qualitative study aims to characterize IPC and IPE in radiation oncology. Semi-structured phone interviews with radiation oncologists, nurses, dosimetrists, radiation therapists, medical physicists, and medical students across a single academic medical center and affiliated network sites were performed from June to August 2019. Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using constructivist grounded theory methodology. Seventeen interviews were performed with four radiation oncologists, two nurses, two dosimetrists, four radiation therapists, two medical physicists, and three medical students. Grounded theory analysis identified four themes: 1) Management of the radiation oncology clinic, 2) Current climate of interprofessional education in radiation oncology, 3) Potential impact of interprofessional training in radiation oncology, and 4) Creating an interprofessional training program in radiation oncology. Each theme elicited between 2-7 subthemes. From the analytical themes that emerged, it is hypothesized that misunderstanding radiation oncology health professionals’ roles can lead to communication breakdown, which creates less efficient clinic management and disorganized patient care. While other radiation oncology professionals shadow physicians during their training, physicians are not learning about these professions in the same way. Interviewees from each professional category recommend a formal shadowing program for radiation oncology medical trainees at the resident or medical student level. Having structured opportunities for IPE is important given competing demands of learners during residency and medical student rotations. This study suggests an unmet need for exposure of radiation oncology medical trainees to IPE with the ultimate goal of improving IPC in the radiation oncology clinic.

Willingness to Pay for High-Quality Education and Training in Radiation Oncology: Survey Results in Latin America

Willingness to Pay for High-Quality Education and Training in Radiation Oncology: Survey Results in Latin America

High Yield Physics Video Series (Hi-Phy) Pilot for Radiation Oncology Trainees

Mastering the concepts of medical physics necessary for Radiation Oncology (RO) is challenging, especially for medical residents with a variety of backgrounds. Aside from didactic physics courses, preparation for the American Board of Radiology (ABR) radiation physics written exam for radiation oncology medical residents involves a comparatively narrow range of preparation materials or costly review courses. After the substantial failure rate of the 2018 exam, the heterogeneous quality of physics didactics and the adequacy of preparatory methods have been criticized. With the ABR’s commitment to the American Society for Radiation Oncology’s Physics Core Curriculum as the framework for the exam, preparation materials for this exam can be meaningfully expanded. The High Yield Physics Educational (Hi-Phy) initiative postulates that it is possible to develop and disseminate a series of free, high-value, case-based, and engaging videos specifically for RO trainees. The purpose of this study is to develop and test an educational e-learning series to bolster engagement in medical physics training and retention of knowledge. We hypothesize that the Hi-Phy videos will be used by a third of US radiation oncology trainees, whether as a preparatory “bridge” lesson for institutional didactics or a review during board exam preparation. A multi-institutional and multidisciplinary team of 7 medical physicists, a RO resident, a radiation oncologist, pedagogical experts at a center for teaching and learning, and graphic design experts from a broadcasting department has formed. Four videos are planned in the Hi-Phy pilot with expansion to 10-15 videos. The videos will be case-based, with strong graphic design elements, as well as the use of retrieval practice for maximum engagement and concept retention of learners. The hosting website’s data will track views and posted comments. In collaboration with pedagogical experts, validated survey tools will be used to assess indicators of user-acceptance of the e-learning. Likert scale responses on the tool regarding: comprehensibility, format, perceived ease of use, usefulness, and duration will be sought from users. The data collected will be analyzed to assess the depth and scope of material covered. We will solicit self-reported physics board pass rates from initial users longitudinally as they complete their ABR exam. The Hi-Phy initiative is feasible and the pilot will require minimum grant support for the purpose of video production. Hi-Phy is a unique, low cost-to-user initiative that is expected to fill a need of current trainees to learning medical physics at the level required for ABR physics board exams. By presenting physics material in a case-based and interactive format and stimulating ongoing retrieval practice, engagement with high rates of concept retention will be fostered. Using pilot project feedback, Hi-Phy will adapt topic depth, format, and video production.

Design and Prospective Assessment of a Free Online Course on Radiological Anatomy for Target Volume Delineation

Radiological anatomy is extremely relevant to target delineation in modern radiation oncology, but is not integrated with the curriculum in most countries. We created a free online course on radiological anatomy for radiation oncology trainees and prospectively tested the effect of the learning on understanding of anatomy and target delineation skills. The teaching material for radiological anatomy was divided into 5 courses, with a total of 107 teaching modules including text, images and 3-dimensional visualizations. Twelve delineated real-life cases with more than 300 anatomical structures and anatomy-based target volumes were made available for viewing as reference contours through a third-party online portal. Three modes of assessment were used. A pre-planned pilot evaluation amongst 28 trainees in India, Nepal and the US was carried out. Students completed pre- and post-course target delineation exercises on 27 structures over different parts of the body on an online platform. The delineation accuracy was measured using area domain accuracy tests (DICE similarity), Jaccard Index and line domain accuracy tests. Compulsory student feedback was collected, and quality assessment was made using the QOCI rubric based on feedback from three expert faculty members. Twenty-one students completed all assessments. Mean scores of the pre-course quiz showed a baseline score of 21.1/35 (60.2%) which increased to 54.5 /69 (78.9%) in the combined post-course evaluations (p < 0.001, paired T test). Of the 27 structures, the DICE similarity coefficient improved by more than 5% in 21 structures and more than 10% in 17 structures. The Jaccard Index improved by more than 10% in 18 structures. The line domain errors reduced in all but one structure. The course content was rated highly (excellent or good) by more than 85% participants. The course images and media were rated highly by more than 80% participants. The course met expectations on most criteria on the QOCI rubric except for group-work and combined audio-video teaching. The course was released in late 2018 with free unrestricted access. This free online course resulted in an improvement in understanding of anatomy relevant to radiation oncology and target delineation skills. The online medium can be explored further for teaching of complex skills relevant to this field to enable greater access across the world.

A guide to curriculum inquiry for brachytherapy simulation-based medical education

PurposeBrachytherapy is a required clinical competency within radiation oncology training but decreased utilization and volume have limited trainee exposure. Simulation-based medical education is an established educational tool that allows learners to engage in higher-order learning in a safe space and has unique application in brachytherapy instruction. Methods and MaterialsWe reviewed best practices in curriculum development for simulation-based medical education in brachytherapy, current works in brachytherapy simulation, and identify areas for future development. ResultsThe systematic curriculum inquiry method as it relates to brachytherapy was described using the “six-step approach” of problem identification and general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation and feedback. Best practices in simulation identified several features of effective learning, including feedback, repetitive practice, and curriculum integration. A review of current simulation-based medical education brachytherapy publications revealed five manuscripts to date with a focus on feasibility across a variety of disease sites, including the prostate, cervical, breast, and head and neck. Potential areas of future development include curricular quality improvement, long-term outcomes, objectives that scale to the learner’s competencies, and expansion beyond psychomotor skills. ConclusionsBrachytherapy is an essential modality in radiation oncology. Simulation-based medical education provides a powerful opportunity to improve brachytherapy training effectively.

Rapid Adaptation of Cancer Education in Response to the COVID-19 Pandemic: Evaluation of a Live Virtual Statistics and Research Skills Workshop for Oncology Trainees

Due to COVID-19, an annual interactive statistics and research methodology workshop for radiation oncology trainees was adapted at short notice into a live virtual format. This study aimed to evaluate trainee opinions around the educational value of the workshop, logistical aspects and impact on interactivity. A post-course on-line survey was completed by 26/42 trainee attendees (response rate 62%). For five pre-specified learning outcomes (LO), 58 to 69% of trainees agreed that the LO was completely or largely met (Likert scores 6 and 7 on a scale 1 = not met at all; 7 = completely met). All trainees felt that logistical aspects of the workshop including organisation, accessibility to the platform and sound/image quality were good or excellent. With regard to opportunities for interaction and suitability for small-group ‘break-out’ sessions, the majority felt that interaction could be adequately maintained whilst just under a quarter felt the delivery method was not fit for the purpose. Networking/social engagement with peers and teachers was the factor most impaired using the live virtual delivery format. Over three-quarters of trainees replied they would favour the current event or other educational sessions being offered (at least as an option) in a virtual format in the future. Cost and convenience were given as the major non-COVID-19–related benefits of virtual on-line learning. These preliminary findings provide valuable feedback to help adapt or develop further on-line educational and training initiatives that will be necessary in the COVID-19 pandemic period and beyond.Electronic supplementary materialThe online version of this article (10.1007/s13187-020-01898-9) contains supplementary material, which is available to authorized users.

Fostering interspeciality learning in cancer survivorship care: Learning suite results.

59 Background: As survivorship provision declines within cancer centres, primary care providers are increasingly entrusted in the follow-up care of cancer survivors. Empowering specialists and primary care providers about survivorship through educational interventions is essential. Interspecialty education is poorly integrated into residency training, which may impede collaboration between different providers in practice. Interspecialty partnership can positively impact patient and resource- use outcomes. The aim of this study was to assess if a cancer survivorship learning suite (LS) impacts attitudes of family medicine, radiation oncology and medical oncology trainees towards interspecialty collaboration in Montreal, Canada. Methods: A survivorship (LS) developed by a Manitoba-based team under the sponsorship of a Canadian Partnership Against Cancer grant held by Cancer Care Ontario was delivered to 49 McGill University family medicine, radiation oncology, and medical oncology trainees. The LS comprised in-person delivery of a 3-hour case-based workshop, presented by a radiation oncologist and a family physician, both experienced in the field of survivorship. An adapted version of the Readiness for Interprofessional Learning Scale (RIPLS) was completed by participants before and after workshop delivery. Statistical analyses included Wilcoxon Signed-rank test comparisons. Results: Response rate was 63.2%, and included family medicine (65%), radiation oncology (26%), and medical oncology (10%) trainees, respectively. Following the workshop, participants were significantly more likely to agree that interspecialty learning in residency “would help physicians become better team workers”, (Z = 2.7, p &lt; 0.008, n = 31), and “improves relationships between physicians of different specialties in independent practice afterwards”, (Z = 2.6, p &lt; 0.009, n = 31). Participants were also significantly more likely to agree that “shared interspecialty learning &lt; would &gt; increase &lt; their &gt; ability to understand clinical problems”, (Z = 2.8, p &lt; 0.005, n = 31). Conclusions: While much literature has focused on interprofessional collaboration at different levels of education and practice, few studies have assessed interspecialty collaboration of physicians of different specialties. This survivorship LS demonstrated favorable changes in attitudes towards interspecialty learning.

Current challenges facing pediatric radiation oncology viewed through an economics lens.

This commentary addresses two problems facing pediatric radiation oncology: workforce education and the cost of technology. The tools of economics can help us understand these problems. Because cancer in children is relatively infrequent and the role of pediatric radiotherapy (RT) is limited, there are a small number of cases of children requiring RT in the US compared to the number of radiation oncology trainees. This creates a paucity of necessary clinical training material. Proton RT, rather than photon RT, is being recommended in many situations when RT is indicated in children. Cost, however, is a significant concern. The arguments for and against proton RT continue and a consensus on this matter has not emerged.

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.

Survey of clinician opinions on the role of proton beam therapy in Australia and New Zealand.

We surveyed the Australian and New Zealand (ANZ) radiation oncology community to assess their perceptions, understanding and experience of the current role of proton beam therapy (PBT) and the existing referral process to access PBT overseas, ahead of the development of the first PBT centre in Australia. The survey was conducted between September and October 2019 using a 17-question instrument, which was distributed by email to all 632 radiation oncology fellows and trainees listed in the Royal Australian and New Zealand College of Radiologists database. One hundred and one respondents completed the survey, with an overall response rate of 16%. Most respondents were based in Australia (93%), with the majority working in public centres only (59%); 51% were >10years post fellowship and 17% were trainees. Most respondents (76%) reported moderate or high levels of confidence in the role of PBT. Only 28% had previously referred a patient for PBT overseas, with the most common referral indication being chordoma. Of those who had not previously referred a patient, 48% were not convinced about the rationale of PBT over current therapies available locally, 33% were not aware of the referral process, and 24% had concerns about the timeliness of a decision for government-funded PBT abroad. This survey has demonstrated that, although there is reasonable confidence in the role of PBT among ANZ radiation oncologists, there are a number of important aspects of PBT awareness, education and access that need to be developed prior to commencement of PBT in Australia.

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.

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.

Training and education of pediatric radiation oncologists: A survey from the 2019 Pediatric Radiation Oncology Society meeting.

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), a survey consisting of 20 questions was distributed asking for demographic and educational background, clinical practice, and preferences regarding pediatric radiation oncology CME. Of 188 participants, 130 (69.2%) returned the questionnaire. More than 80% reported access to CT simulation, three-dimensional radiotherapy, and general anesthesia while <30% had access to intraoperative radiotherapy, proton, and heavy particle therapy. After residency, 12.1% did further training in pediatric radiation oncology. When asked about further training in pediatrics after residency, 88.8% answered that there should be a formal training program beyond residency in order to treat children. More than 75% acquired knowledge in pediatric radiation oncology through journals, books, live meetings, and tumor boards. The results of this survey may help Pediatric Radiation Oncology Society (PROS) in creating guidelines and recommendations for improvement in pediatric radiation oncology training and practice support as well as the development of CME activities most likely to benefit practitioners.

Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada.

Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.

Integration of Gross Anatomy Laboratory sessions into Medical Physics Curriculum using Segmentation and Augmented‐Reality

Anatomy teaching to Medical Physics (MP) trainees is recognized by the Commission on Accreditation of Medical Physics Education Programs, and yet anatomy laboratory sessions have not been integrated in MP training curricula. This study outlines the development of anatomy laboratory sessions for MP trainees and serves as the initial step to developing an anatomical curriculum guideline for MP. The two objectives of this qualitative study are: (a) to explore the educational potential of integrated anatomy laboratory sessions in the MP curriculum and (b) to evaluate the benefits of interprofessional education activities between MP trainees and Radiation Oncology residents.Participants included 17 MP graduate students, 2 MP residents and 8 Radiation Oncology residents, over two years. Two 2‐hour anatomy laboratory sessions per year were organized following the respective in‐class lectures on the pelvis, head and neck and thorax. After the two laboratory sessions, participants were asked to fill out a survey reflecting on their experience in the laboratory.Both MP students and radiation oncology residents voiced an appreciation for the anatomy laboratory sessions for the consolidation and application of knowledge. Most mentioned that these sessions helped to “visualize” and “have a better understanding” of the anatomy taught in class and made them more “confident”. In terms of interprofessionalism, both the MP and the radiation oncology trainees expressed a better understanding of one another’s level of knowledge in anatomy. Both groups suggested to have more interprofessional sessions. They also suggested to build a stronger link between cadaveric anatomy and imaging anatomy through augmented reality technology.The integration of anatomy laboratory sessions into the anatomy curriculum for MP enhances trainees’ understanding of human anatomy and its pivotal role in radiation therapy treatment. Furthermore, interprofessional activities prior to clinical placement of MP students reinforce technical and professional communication.Support or Funding InformationThe authors would like to thank the support provided by the Centre for Medical Education Innovation and Research Seed Fund (to GPJCN).

Women’s Representation in Leadership Positions in Academic Medical Oncology, Radiation Oncology, and Surgical Oncology Programs

Women are underrepresented in medical leadership positions; however, representation of women among academic oncology leadership is unknown. To evaluate representation of women overall and in leadership positions in academic medical oncology (MO), radiation oncology (RO), and surgical oncology (SO) programs and to examine the association of women leadership with overall faculty representation of women per program. In this cross-sectional study, MO, RO, and SO training program websites were queried from October 2018 through June 2019. All faculty from 265 of 273 accredited MO, RO, and SO training programs (97.1%) were included. Gender. Observed proportions of women in leadership positions compared with the expected proportion of overall women faculty in MO, RO, and SO were assessed. Rates of representation of women across each MO, RO, and SO program's faculty based on the presence or absence of a woman in a leadership position were compared. Of 6030 total faculty, only 2164 (35.9%) were women. Total representation of women among MO, RO, and SO faculty was 37.1% (1563 of 4215), 30.7% (389 of 1269), and 38.8% (212 of 546), respectively. Women composed only 21.7% (30 of 138), 11.7% (11 of 94), and 3.8% (1 of 26) of MO, RO, and SO chair positions, respectively. The observed proportion of women in chair positions was significantly lower than the expected proportion for MO, RO, and SO. In all, 47.9%, 33%, and 18.5% of MO, RO, and SO programs, respectively, had at least 1 woman in a leadership position (program director or chair). Programs with 1 or more women in a leadership position were associated with a higher mean (SD) percentage of women faculty than those without at least 1 woman leader in MO (40.7% [12.5%] vs 33.1% [11.0%]; P < .001) and RO (36.2% [13.3%] vs 23.4% [12.3%]; P < .001) but not SO (40.2% [15.4%] vs 31.4% [16.9%]; P = .29). Gender disparity exists in academic MO, RO, and SO faculty, which is magnified at the chair level. Programs in MO and RO with a woman physician in a leadership position were associated with a higher percentage of women faculty, but this was not true for SO. These data will serve as a benchmark to monitor progress toward a more balanced workforce.

Motivations, Well-Being, and Career Aspirations of Radiation Oncology Resident Physicians in Canada.

Prior Pan-Canadian surveys of Radiation Oncology (RO) residents reveal a decrease in Canadian RO employment opportunities. Canadian RO resident levels increased from 130 in 2003, peaked at 209 in 2009, then decreased to 130 in 2017. Recognizing that RO has entered another period of transition, we re-examined resident motivations and perspectives on the job market and explored well-being and career aspirations among a contemporary cohort of Canadian RO residents. An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 75 open-ended, Likert-scale, matrix-style, and multiple-choice questions. Student's t test compared subgroups, with statistical significance at p ≤ 0.05. Out of 128 eligible residents, 84 completed the survey (66% response rate) with representative sampling from each training year. Demographics reveal 53% male, and 85% Canadian registry-funded. Top training-related stressors were exam performance, job prospects, and physical/psychological demands of residency. Most intend to pursue fellowship post-residency (80%) and practice in Canada (88%). Few believe they can obtain staff positions treating preferred tumor sites (38%) or at preferred geographic locations (28%). Residents view job market being less competitive than 5years ago (40%) and predict it will be less competitive in 5years (60%). Canadian RO residents feel adequately trained, and most pursue post-residency fellowships. Current perceptions of the Canadian job market remain guarded, but appear more optimistic about the future. This update provides insights into current RO training and identifies areas that could be addressed by incoming competency-based medical education models for RO.