Radiation Oncology Training Research Articles

Are They Ready? The Current Status of Canadian and US Radiation Oncology and Radiation Therapy Training Programs in Preparing Trainees for On-Call Emergencies and Interdisciplinary Teamwork

The aim of this study is to evaluate the current practices regarding radiation oncology emergencies training for radiation oncology residents and radiation therapy students and the presence of interdisciplinary curricula across Canadian and US training programs prior to putting trainees on-call. We also aim to evaluate the most significant needs in radiation oncology residency programs and radiation therapy training programs in regard to radiation oncology emergencies training in order to guide curriculum development.

Needs Assessment for an Introductory Radiation Oncology Curriculum for Advanced Practice Providers

Advanced practice providers (APPs) are increasingly integral in clinical care models1. Limited didactic or clinical experience exists for APPs in radiation oncology (RO). 1 Bruinooge SS Pickard TA Vogel W et al. Understanding the Role of Advanced Practice Providers in Oncology in the United States. J Oncol Pract. 2018; 14: e518-e532 Crossref PubMed Scopus (19) Google Scholar ,2 Martin KL Krechmer B Boyajian RN Reynolds MC Cagney DN Martin N. Advanced Practice Providers in Radiation Oncology. Pract Radiat Oncol. 2019; Google Scholar Despite 80% of their role dedicated to patient care, 1 Bruinooge SS Pickard TA Vogel W et al. Understanding the Role of Advanced Practice Providers in Oncology in the United States. J Oncol Pract. 2018; 14: e518-e532 Crossref PubMed Scopus (19) Google Scholar ,2 Martin KL Krechmer B Boyajian RN Reynolds MC Cagney DN Martin N. Advanced Practice Providers in Radiation Oncology. Pract Radiat Oncol. 2019; Google Scholar there is currently no dedicated curriculum for RO APPs. Training has followed an "on the job" model that relies on the established team (physicians, APPs, and nurses) to educate new APPs, resulting in increased times for APPs to achieve clinical independence. 3 WH V Advanced Practitioners in Oncology: Meeting the Challenges. Journal of the Advanced Practitioner in Oncology. 2010; 1: 13-18 Google Scholar ,4 Nevidjon B Rieger P Miller Murphy C Rosenzweig MQ McCorkle MR Baileys K Filling the gap: development of the oncology nurse practitioner workforce. J Oncol Pract. 2010; 6: 2-6 Crossref PubMed Scopus (33) Google Scholar Training also varies in content and quality and may inadequately cover foundational RO topics. Without a dedicated focus on core RO principles, APPs may lack a deep understanding of treatments and be unable to communicate clearly and effectively with colleagues and patients. We sought to address these concerns by performing a needs assessment to guide APP curricular development. This study aimed to measure current post-graduate RO training provided to practicing APPs across the United States via an anonymous survey.

Remote Contouring and Virtual Review during the COVID-19 Pandemic (RECOVR-COVID19): Results of a Quality Improvement Initiative for Virtual Resident Training in Radiation Oncology.

The need to minimize in-person interactions during the COVID-19 pandemic has led to fewer clinical learning opportunities for trainees. With ongoing utilization of virtual platforms for resident education, efforts to maximize their value are essential. Herein we describe a resident-led quality improvement initiative to optimize remote contouring and virtual contour review. From April to June 2020, radiation oncology (RO) residents at our institution were assigned modified duties. We implemented a program to source and assign cases to residents for remote contouring and to promote and optimize virtual contour review. Resident-perceived educational value was prospectively collected and analyzed. All nine RO residents at our institution (PGY1–5) participated, and 97 cases were contoured during the evaluation period. Introduction of the Remote Contouring and Virtual Review (RECOVR) program coincided with a significant increase in mean cases contoured per week, from 5.5 to 17.3 (p = 0.015), and an increased proportion of cases receiving virtual review, from 14.8% to 58.6% (p < 0.001). Residents reported that the value of immediate feedback during virtual review was similar to that of in-person review (4.6 ± 0.1 vs. 4.5 ± 0.2, p = 0.803) and significantly higher than feedback received post hoc (e.g., email; 3.6 ± 0.2, p < 0.001). The implementation of a remote process for contour review led to significant increases in contouring, and virtual contour review was rated as highly as in-person interactions. Our findings provide a data-driven rationale and framework for integrating remote contouring and virtual review into competency-based medical education.

Impact of the COVID-19 Pandemic on Postgraduate Training in Radiation Oncology

Impact of the COVID-19 Pandemic on Postgraduate Training in Radiation Oncology

Remote Contouring and Virtual Review During the COVID-19 Pandemic (RECOVR-COVID19): Results of a Quality Improvement Initiative for Virtual Resident Training in Radiation Oncology

The urgent need to minimize in-person interactions during the ongoing COVID-19 pandemic has limited trainee access to clinical learning opportunities. With ongoing utilization of virtual platforms for resident education, efforts to maximize their value are essential. Herein we describe a resident-led quality improvement initiative to optimise remote contouring and virtual contour review.

Utility of Multi-institutional Pediatric Chart Rounds in the Age of Telemedicine.

Pediatric radiation oncology remains a highly subspecialized field owing to a relatively lower incidence rate of pediatric malignancies, which account for less than 5% of total cancer cases annually in the United States.1,2 Another challenge of treating pediatric malignancies is the diverse profile of tumors, ranging from hematologic malignancies to a heterogenous set of soft tissue and bone sarcomas. These inherent issues result in consistently low case numbers for the average resident,3-5 with almost one-third of senior residents recently reporting insufficient training in pediatric radiation oncology.

Integrating Radiation Oncology Into Undergraduate Medical Education

Cancer is one of the most important public health problems. However, medical education has not advanced at the same rate when it comes to cancer education. Currently, the United States Medical Licensing Examination subject examinations do not cover radiation oncology, prevention, and survivorship planning in its assessment model. Incorporating medical oncology and radiation oncology training into the undergraduate medical education curriculum can have a significant benefit in training future physicians. In this paper, we review current literature and propose some ideas that can help incorporate oncology, and specifically radiation oncology, into undergraduate medical education.

Radiation therapy-associated toxicity: Etiology, management, and prevention.

Radiation therapy (RT) is a curative treatment for many malignancies and provides effective palliation in patients with tumor-related symptoms. However, the biophysical effects of RT are not specific to tumor cells and may produce toxicity due to exposure of surrounding organs and tissues. In this article, the authors review the clinical context, pathophysiology, risk factors, presentation, and management of RT side effects in each human organ system. Ionizing radiation works by producing DNA damage leading to tumor death, but effects on normal tissue may result in acute and/or late toxicity. The manifestation of toxicity depends on both cellular characteristics and affected organs' anatomy and physiology. There is usually a direct relationship between the radiation dose and volume to normal tissues and the risk of toxicity, which has led to guidelines and recommended dose limits for most tissues. Side effects are multifactorial, with contributions from baseline patient characteristics and other oncologic treatments. Technological advances in recent decades have decreased RT toxicity by dramatically improving the ability to deliver RT that maximizes tumor dose and minimizes organ dose. Thus the study of RT-associated toxicity is a complex, core component of radiation oncology training that continues to evolve alongside advances in cancer management. Because RT is used in up to one-half of all patients with cancer, an understanding of its acute and late effects in different organ systems is clinically pertinent to both oncologists and nononcologists.

Radiation oncology training in Singapore - A non-Australasian RANZCR training site.

The Radiation Oncology Department at The National Cancer Institute, Singapore (NCIS) and the Royal Australian and New Zealand College of Radiology (RANZCR) has had a well-established relationship that began as a partnership to grow a pool of local radiation oncologists to meet a nation's demand for radiotherapy services. This journey has surpassed its initial aims and now has produced a generation of radiation oncologists leading a national cancer institute. We recount the history and progress of this partnership here, as well as the unique success of its product; the only RANZCR-accredited radiation oncology training site outside of Australia and New Zealand since 2002. We outline the mutual benefits through many years of collaboration and deliberate efforts to grow the partnership. We also outline the distinctive specialist training path that our trainees take to meet both the local accreditation body as well as the RANZCR requirements.

Radiation oncology training in Australia and New Zealand during and beyond the COVID-19 pandemic - lessons learnt and opportunities for improvement.

Radiation oncology training in Australia and New Zealand during and beyond the COVID-19 pandemic - lessons learnt and opportunities for improvement.

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

e23003 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 non-parametric (Wilcoxon Signed rank tests) 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.

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

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

Gender and racial/ethnic disparities in academic oncology leadership.

11009 Background: Gender &amp; racial/ethnic leadership disparities have been independently identified in academic hematology/oncology (HO) and radiation oncology (RO). Here, we evaluate gender and racial/ethnic intersectionality from the trainee to the leadership level. Methods: All ACGME accredited HO and RO training program websites were queried to identify constituent trainees, academic faculty, program directors (PD) and department chairs (DC), with a leadership position defined as PD or DC. Individual gender &amp; race/ethnicity was determined using externally validated software tools (Gender-API, NamSor, &amp; Onolytics), publicly available descriptors, and image review. We grouped individuals into 6 categories: White Male (WM), White Female (WF), Asian Male (AM), Asian Female (AF), Underrepresented Groups in Medicine (as defined by AAMC) Male (URMM) and Female (URMF). The chi-squared goodness-of-fit test was applied to examine if deviations exist between the observed vs. expected proportions of gender/race dyads in trainees, PD, and DC compared to academic faculty. Results: We identified 7,722 individuals from 2019-2020: 1,759 trainees (HO=1525; RO=234), 5,726 faculty (HO=4834; RO=892), 242 PD (HO=149; RO=93) and 237 DC (HO=144; RO=93). Leadership positions were most often comprised by WM (52.6%), and least often comprised by URMF (2.9%). Combined HO/RO analysis revealed significant differences in the observed representation of trainees &amp; DC vs expected levels based on total faculty, respectively: WM (33.7% &amp; 60.3% vs. 42.3%), WF (19.2% &amp; 13.9% vs. 22.3%), AM (20.75% &amp; 16.9% vs. 16.4%), AF (17.9% &amp; 2.5% vs. 12.7%), URMM (4.09% &amp; 5.5% vs. 3.5%) and URMF (4.3% &amp; 0.8% vs. 2.8%), p&lt;0.01. No differences were seen between PD vs total faculty. On subset analysis, there were significant differences observed in HO programs at the trainee, PD and DC levels compared to total faculty, whereas significant differences in RO programs were seen only at the DC level [Table]. Conclusions: Gender &amp; racial/ethnic disparity is present in academic oncology. Specifically, women of all races/ethnicities are proportionally underrepresented in DC positions in HO and RO programs. These data can serve as a benchmark to raise awareness and monitor progress towards a more balanced workforce in oncology.[Table: see text]

Using advanced information and communication technologies to advance oncology education in Africa.

BackgroundRecent work has highlighted the tremendous potential of information and communication technologies (ICTs) in advancing global oncology education, research and care. The COVID-19 pandemic has made the development of effective approaches for online education even more crucial. Here we assessed the readiness, interest and potential models for effective implementation of ICT-powered oncology education in Africa.MethodsBuilding on previous work by the African Organisation for Research and Training in Cancer (AORTIC), a survey was conducted to assess the electronic learning (e-Learning) readiness of oncology health professionals using an online self-assessment tool. Components of e-Learning readiness assessed include access to computers, Internet, appropriate bandwidth and interest. As a practical test model, an ICT resource-intensive radiation oncology training programme was implemented via the Global Oncology University (GO-U) collaborative education platform. An analysis of results, challenges and opportunities resulting from these is discussed for advancing online oncology education in Africa.ResultsThe survey showed over 92% of health professionals have access to computers, laptops or other technology that can allow them to participate in online education. Over 45% of oncology health professionals have already participated in some form of online education. Interest in online education was over 93%. Models for effective online learning in oncology include synchronous and asynchronous short-term courses for continuous education and long-term degree and residency programmes. There was a significant increase in skills level following the collaborative radiation oncology training model used by the GO-U platform.ConclusionAfrica has the capacity to implement successful e-Learning in oncology, which is consistent with findings in previous work such as the AORTIC. Greater investment by institutions and governments is needed in terms of resources and policy changes to facilitate the implementation of effective online oncology training. Purposeful engagement of diaspora oncology health professionals with relevant cultural backgrounds as with some current collaborative efforts is highly recommended in helping turn brain drain into brain circulation.

Clinical research mentorship programme (CRMP) for radiation oncology residents in Africa-building capacity through mentoring.

Research skills are mandatory for all oncology residency training programmes. Creating the environment to foster skills and passion can be a challenge in all settings, and a unique challenge in low and middle income countries (LMICs). Tremendous clinical workload places exceptional demand on clinician teachers, research infrastructure and access to research collaborators with diverse methodological skill sets can be limited. International collaborations, and in particular relationship partnerships (Whitehead et al ((2018) Acad Med 93 1760–1763)) can be a useful approach to bridge resource gaps and enrich the support available to trainees (Research EoH ((2014) TDR/ESSENCE/2.14)). The Clinical Research Mentorship Programme (CRMP) is a collaborative initiative created by the University of Toronto Department of Radiation Oncology, Princess Margaret Cancer Centre, delivered in collaboration with LMIC radiation oncology residency programmes with the primary goal of enriching the research experience of LMIC oncology trainees. It was inspired by observing a need, an enthusiasm to collaborate and some seed funding that supported the idea. At the heart of the programme is a formalised relationship, a triad, between a LMIC oncology trainee, their local supervisor and a mentor from Toronto. Within the collaborative environment created between the LMIC and high income country (HIC) institutions, enabled by remote learning technologies, a 12-week research methods seminar kick starts a year-long mentorship for the trainee on their research question. The goal is to enrich the quality of the research experience for the trainee, resulting in dissemination of research findings in international conferences and publications. A standard evaluation package is used (Vuple et al ((2021) 6 919–928)). In this paper, through a description of our collaboration, we will highlight how a distant mentorship programme was used to enhance clinical research mentorship skills for radiation oncology trainees in Africa. We hope the format we have chosen will continue to demonstrate effectiveness for our trainees, sustainability for our faculty and institutions and will serve as one mechanism to build radiation capacity for LMIC through collaboration, mentorship and research.

Training in Radiation Oncology: Missing Leadership and Advocacy Development

Training in Radiation Oncology: Missing Leadership and Advocacy Development

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

Interprofessional education (IPE) is gaining recognition as a means of improving health care 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 radiation therapy. However, there are limited data on IPE and IPC in radiation oncology. This qualitative study aims to characterize IPC in radiation oncology. Semistructured phone interviews were performed from June to August 2019 with radiation oncologists, nurses, dosimetrists, radiation therapists, medical physicists, and medical students across a single academic medical center and affiliated network sites. Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using thematic analysis. Seventeen interviews were performed with 4 radiation oncologists, 2 nurses, 2 dosimetrists, 4 radiation therapists, 2 medical physicists, and 3 medical students. Thematic analysis identified 4 themes: (1) management of the radiation oncology clinic, (2) potential impact of interprofessional training in radiation oncology, (3) current climate of interprofessional education in radiation oncology, and (4) creating an interprofessional training program in radiation oncology. Each theme elicited between 2 and 7 subthemes. From the analytical themes that emerged, it is hypothesized that misunderstanding professionals' roles can lead to communication breakdown, which creates less efficient clinic management and disorganized patient care. Although other medical professionals shadow physicians during their training, physicians are not learning about other professions in the same way. Interviewees from each professional category recommend a formal shadowing program for radiation oncology trainees at the medical student or resident level. Having structured opportunities for IPE is important given competing demands of learners during medical student rotations and residency. 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.

Fostering Radiation Oncology Physician Scientist Trainees Within a Diverse Workforce: The Radiation Oncology Research Scholar Track

There is a need to foster future generations of radiation oncology physician scientists, but the number of radiation oncologists with sufficient education, training, and funding to make transformative discoveries is relatively small. A large number of MD/PhD graduates have entered he field of radiation oncology over the past 2 decades, but this has not led to a significant cohort of externally funded physician scientists. Because radiation oncologists leading independent research labs have the potential to make transformative discoveries that advance our field and positively affect patients with cancer, we created the Duke Radiation Oncology Research Scholar (RORS) Program. In crafting this program, we sought to eliminate barriers preventing radiation oncology trainees from becoming independent physician scientists. The RORS program integrates the existing American Board of Radiology Holman Pathway with a 2-year post-graduate medical education instructor position with 80% research effort at the same institution. We use a separate match for RORS and traditional residency pathways, which we hope will increase the diversity of our residency program. Since the inception of the RORS program, we have matched 2 trainees into our program. We encourage other radiation oncology residency programs at peer institutions to consider this training pathway as a means to foster the development of independent physician scientists and a diverse workforce in radiation oncology.

Current Social Media Use Among Radiation Oncology Trainees

PurposeResident 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 MaterialsAn 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. ResultsOf 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 <25% of overall SM time on professional/academic purposes, and 21% reported using SM >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 < .001) were more likely to spend >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%). ConclusionsMost 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.

PO-1281: Heterogeneity in radiation oncology training, a problem that calls for attention in Latin America

PO-1281: Heterogeneity in radiation oncology training, a problem that calls for attention in Latin America