Radiation Oncology Training Research Articles

Women in medical physics: a preliminary analysis of workforce and research participation in Australia and New Zealand.

Although the participation of women within the science, technology, engineering and mathematics workforces has been widely discussed over recent decades, the recording and analysis of data pertaining to the gender balance of medical physicists in Australia and New Zealand remains rare. This study aimed to provide a baseline for evaluating future changes in workforce demographics by quantifying the current level of representation of women in the Australasian medical physics workforce and providing an indication of the relative contribution made by those women to the local research environment. The 2015 Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) member directory and list of chief physicists at ACPSEM-accredited radiation oncology and diagnostic imaging training centres were interrogated to identify the gender balance of medical physicists working in Australia and New Zealand. A specific investigation of the employment levels of all medical physicists in Queensland was undertaken to provide an example of the gender balance at different levels of seniority in one large Australian state. Lists of authors of medical physics presentations at ACPSEM annual conferences and authors of publications in the ACPSEM's official journal, were used to provide an indication of the gender balance in published research within Australia and New Zealand. The results of this study showed that women currently constitute approximately 28% of the medical physics workforce in Australia and New Zealand, distributed disproportionally in junior roles; there is a decrease in female participation in the field with increasing levels of seniority, which is particularly apparent in the stratified data obtained for the Queensland workforce. Comparisons with older data suggest that this situation has changed little since 2008. Examination of ACPSEM conference presentations suggested that there are similar disparities between the gender-balance of proffered and invited or keynote speakers (28 % and 13% from female authors) and the gender balance of certified and chief physicists (28 % and 21 % female). The representation of women in the ACPSEM journal does not differ substantially between authorship of proffered versus invited work (22 % and 19% from female authors). While this work was limited to evaluating the membership, annual conference and official journal of the ACPSEM (rather than evaluating the entire medical physics workforce and the contributions of male and female physicists to international conferences and publications), this study nonetheless led to the following recommendations: that a longitudinal study analysing correlations between age, period of service, seniority and gender should be undertaken and that future ACPSEM workforce surveys should include analyses of gender representation.

What is the viva experience of phase 2 Radiation Oncology examination candidates? Survey and advice for future candidates.

Medical speciality examination is a very stressful event in medical careers. We aimed to determine the subjective experience of Radiation Oncology Royal Australian and New Zealand College of Radiologists (RANZCR) oral examination candidates. It was hoped the results would provide reassurance and advice for future candidates. We distributed an anonymous online survey through the RANZCR membership database to Radiation Oncology Trainees and fellows who may have sat their oral examination within the last 3years. There were 21 responses, yielding a response rate of 21%. Nineteen percent of respondents were moderately or very surprised during their viva and the most frequently noted cause was the demeanour of the examiners. The clinical cases and clinical examination station were rated very fair by over 80% of responders while the planning cases were rated very fair by 57%. During the viva, 33% thought they passed and 71% of these candidates were successful. Forty-three percent felt they were borderline, and all of these respondents passed. Five participants (24%) failed in the first attempt and four described being unable to convey their actual knowledge. Candidates found mock examinations to be the most useful examination preparation activity. The most frequently given advice was to focus on the planning examination. The majority of this select group of candidates indicated that the oral examination cases were very fair. Candidates rated the planning exam as least fair, indicating this may be the area that would benefit most from better preparation.

Engaging Future Clinical Oncology Researchers: An Initiative to Integrate Teaching of Biostatistics and Research Methodology into Specialty Training

AimsTo evaluate the learner's perspectives on a novel workshop programme designed to improve skills in biostatistics, research methodology and critical appraisal in oncology. Materials and methodsTrainees were surveyed anonymously at the completion of each annual workshop from 2012 to 2015. In total, 103 trainees in years 2–4 of training in radiation oncology responded, giving a 94% survey response rate. A 1 day workshop, designed by biostatisticians and radiation oncologist facilitators, is the central component of a programme teaching skills in biostatistics, research methods and critical appraisal. This links short didactic lectures about statistical concepts to interactive trainee discussions around discipline-related publications. ResultsThe workshop was run in conjunction with the major radiation oncology clinical trials group meeting with alternating programmes (A and B). Most of the participants (44–47/47 for A and 48–55/56 for B), reported that their understanding of one or more individual topics improved as a result of teaching. Refinement of the workshop over time led to a more favourable perception of the ‘optimal’ balance between didactic/interactive teaching: nine of 27 (33%) ‘optimal’ responses seen in 2013 compared with 23 of 29 (79%) in 2015 (P < 0.001). Commonly reported themes were: clinician facilitators and access to biostatisticians helped contextualise learning and small group, structured discussions provided an environment conducive to learning. ConclusionsOverall, radiation oncology trainees reported positive perceptions of the educational value of this programme, with feedback identifying areas where this resource might be improved. This model could readily be adapted to suit other medical disciplines and/or other training environments, using specialty-specific research to illuminate key statistical concepts.

Palliative Care Training in Radiation Oncology: A National Survey

Palliative Care Training in Radiation Oncology: A National Survey

Evaluation of a Multi-institutional Radiation Oncology Clerkship Curriculum: A Report From the Radiation Oncology Education Collaborative Study Group

Radiation oncology curriculum development is challenging due to limited numbers of trainees at any single-institution. The specific aim of this project was to implement and evaluate a uniform medical student clerkship curriculum at select academic medical centers (AMCs) following the multi-institutional cooperative group research model. A standardized curriculum was developed consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and an interactive hands-on planning workshop. The planning workshop exposed students to basics of contouring and treatment planning. Students were asked to complete an anonymous evaluation of the curriculum using Likert scales (1 = “not at all” to 5 = “extremely”; reported as median [interquartile range]). Non-parametric statistical tests were used. Two hundred thirteen students at 14 AMCs completed the curriculum during the 2013 and 2014 calendar years; 152/213 students completed evaluations (71% response rate), 142/152 reported intent to pursue radiation oncology as their specialty, and 131/142 reported this was their first time completing the curriculum. Subsequent data is reported for these 131 students. Student ratings of the importance of curricular content were: Overview 4 [4-5]; Radiation Biology/Physics 5 [4-5]; Practical Aspects/Radiation Emergencies 5 [4-5]; Planning Workshop 5 [4-5]. The planning workshop improved student comfort with treatment planning (pre 2 [1-3] vs post 3 [3-4], P<.01), and using a planning workstation (pre 2 [1-3] vs post 3 [3-4], P<.01), and enriched the student’s understanding of an AP/PA spine plan (pre 2 [1-3] vs post 4 [3-4], P<.01). Students also reported the curriculum helped them to understand radiation oncology as a specialty (5 [4-5]), increased specialty decision comfort (4 [3-5]), and would help the transition to radiation oncology residency (4 [4-5]). A standardized curriculum was successfully piloted at 14 AMCs during the 2013 and 2014 calendar years, providing proof-of-principle that radiation oncology curriculum development can follow the multi-institutional cooperative group research model; additionally, subsequent to participation in the curriculum, students felt more comfortable with their specialty decision and better prepared to begin radiation oncology residency. Further curriculum enhancement for radiation oncology trainees, including both medical students and residents, can be pursued using this model.

SP-0101: The importance of palliative care in radiation oncology training programmes

SP-0101: The importance of palliative care in radiation oncology training programmes

Team-based clinical simulation in radiation medicine: value to attitudes and perceptions of interprofessional collaboration

AbstractIntroductionSimulation has been effective for changing attitudes towards team-based competencies in many areas, but its role in teaching interprofessional collaboration (IPC) in radiation medicine (RM) is unknown. This study reports on feasibility and IPC outcomes of a team-based simulation event; ‘Radiation Medicine Simulation in Learning Interprofessional Collaborative Experience’ (RM SLICE).MethodsRadiation therapy (RTT), medical physics (MP) and radiation oncology (RO) trainees in a single academic department were eligible. Scheduled closure of a modern RM clinic allowed rotation of five high-fidelity cases in three 105-minute timeslots. A pre/post-survey design evaluated learner satisfaction and interprofessional perceptions. Scales included the Readiness for Interprofessional Learning Scale (RIPLS), UWE Entry Level Interprofessional Questionnaire (UWEIQ), Trainee Test of Team Dynamics and Collaborative Behaviours Scale (CBS).ResultsTwenty-one trainees participated; six ROs (28·57%), six MPs (28·57%) and nine RTTs (42·86%). All cases were conducted, resolved and debriefed within the allotted time. Twenty-one complete sets (100%) of evaluations were returned. Participants reported limited interaction with other professional groups before RM SLICE. Perceptions of team functioning and value of team interaction in ‘establishing or improving the care plan’ were high for all cases, averaging 8·1/10 and 8·9/10. Average CBS scores were 70·4, 71·9 and 69·5, for the three cases, scores increasing between the first and second case for 13/21 (61·9%) participants. RIPLS and UWEIQ scores reflected positive perceptions both pre- and post-event, averaging 83·5 and 85·2 (RIPLS) and 60·6 and 55·7 (UWEIQ), respectively. For all professions for both scales, the average change in score reflected improved IP perceptions, with agreement between scales for 15/20 (75·0%) participants. Overall, perception of IPC averaged 9·14/10, as did the importance of holding such an event annually.ConclusionsTeam-based simulation is feasible in RM and appears to facilitate interprofessional competency-building in high-acuity clinical situations, reflecting positive perceptions of IPC.

Evaluation of high-fidelity simulation training in radiation oncology using an outcomes logic model.

PurposeTo evaluate the feasibility and educational value of high-fidelity, interprofessional team-based simulation in radiation oncology.MethodsThe simulation event was conducted in a radiation oncology department during a non-clinical day. It involved 5 simulation scenarios that were run over three 105 minute timeslots in a single day. High-acuity, low-frequency clinical situations were selected and included HDR brachytherapy emergency, 4D CT artifact management, pediatric emergency clinical mark-up, electron scalp trial set-up and a cone beam CT misregistration incident. A purposive sample of a minimum of 20 trainees was required to assess recruitment feasibility. A faculty radiation oncologist (RO), medical physicist (MP) or radiation therapist (RTT), facilitated each case. Participants completed a pre event survey of demographic data and motivation for participation. A post event survey collected perceptions of familiarity with the clinical content, comfort with interprofessional practice, and event satisfaction, scored on a 1–10 scale in terms of clinical knowledge, clinical decision making, clinical skills, exposure to other trainees and interprofessional communication. Means and standard deviations were calculated.ResultsTwenty-one trainees participated including 6 ROs (29%), 6 MPs (29%), and 9 RTTs (43%). All 12 cases (100%) were completed within the allocated 105 minutes. Nine faculty facilitators, (3MP, 2 RO, 4 RTTs) were required for 405 minutes each. Additional costs associated with this event were 154 hours to build the high fidelity scenarios, 2 standardized patients (SPs) for a total of 15.5 hours, and consumables.The mean (±SD) educational value score reported by participants with respect to clinical knowledge was 8.9 (1.1), clinical decision making 8.9 (1.3), clinical skills 8.9 (1.1), exposure to other trainees 9.1 (2.3) and interprofessional communication 9.1 (1.0). Fifteen (71%) participants reported the cases were of an appropriate complexity. The importance of further simulation events was rated highly at 9.1/10.ConclusionsHigh-fidelity simulation training is feasible and effective in a radiation oncology context. However, such educational activities require significant resources, including personnel and equipment.

Evaluating the impact of an integrated multidisciplinary head & neck competency-based anatomy & radiology teaching approach in radiation oncology: a prospective cohort study.

BackgroundModern radiation oncology demands a thorough understanding of gross and cross-sectional anatomy for diagnostic and therapeutic applications. Complex anatomic sites present challenges for learners and are not well-addressed in traditional postgraduate curricula. A multidisciplinary team (MDT) based head-and-neck gross and radiologic anatomy program for radiation oncology trainees was developed, piloted, and empirically assessed for efficacy and learning outcomes.MethodsFour site-specific MDT head-and-neck seminars were implemented, each involving a MDT delivering didactic and case-based instruction, supplemented by cadaveric presentations. There was no dedicated contouring instruction. Pre- and post-testing were performed to assess knowledge, and ability to apply knowledge to the clinical setting as defined by accuracy of contouring. Paired analyses of knowledge pretests and posttests were performed by Wilcoxon matched-pair signed-rank test.ResultsFifteen post-graduate trainees participated. A statistically significant (p < 0.001) mean absolute improvement of 4.6 points (17.03%) was observed between knowledge pretest and posttest scores. Contouring accuracy was analyzed quantitatively by comparing spatial overlap of participants’ pretest and posttest contours with a gold standard through the dice similarity coefficient. A statistically significant improvement in contouring accuracy was observed for 3 out of 20 anatomical structures. Qualitative and quantitative feedback revealed that participants were more confident at contouring and were enthusiastic towards the seminars.ConclusionsMDT seminars were associated with improved knowledge scores and resident satisfaction; however, increased gross and cross-sectional anatomic knowledge did not translate into improvements in contouring accuracy. Further research should evaluate the impact of hands-on contouring sessions in addition to dedicated instructional sessions to develop competencies.

Determining an Imaging Literacy Curriculum for Radiation Oncologists: An International Delphi Study

Rapid evolution of imaging technologies and their integration into radiation therapy practice demands that radiation oncology (RO) training curricula be updated. The purpose of this study was to develop an entry-to-practice image literacy competency profile. A list of 263 potential imaging competency items were assembled from international objectives of training. Expert panel eliminated redundant or irrelevant items to create a list of 97 unique potential competency items. An international 2-round Delphi process was conducted with experts in RO. In round 1, all experts scored, on a 9-point Likert scale, the degree to which they agreed an item should be included in the competency profile. Items with a mean score ≥ 7 were included, those 4 to 6 were reviewed in round 2, and items scored <4 were excluded. In round 2, items were discussed and subsequently ranked for inclusion or exclusion in the competency profile. Items with >75% voting for inclusion were included in the final competency profile. Forty-nine radiation oncologists were invited to participate in round 1, and 32 (65%) did so. Participants represented 24 centers in 6 countries. Of the 97 items ranked in round 1, 80 had a mean score ≥ 7, 1 item had a score <4, and 16 items with a mean score of 4 to 6 were reviewed and rescored in round 2. In round 2, 4 items had >75% of participants voting for inclusion and were included; the remaining 12 were excluded. The final list of 84 items formed the final competency profile. The 84 enabling competency items were aggregated into the following 4 thematic groups of key competencies: (1) imaging fundamentals (42 items); (2) clinical application (27 items); (3) clinical management (5 items); and (4) professional practice (10 items). We present an imaging literacy competency profile which could constitute the minimum training standards in radiation oncology residency programs.

Radiation Oncology Residency Selection: A Targeted Assessment of Factor Importance Among Fourth-Year Medical Students

Fourth-year medical students (MS4s) have limited meaningful exposure to radiation oncology training programs and thus base their decision largely on a limited number of factors. The assessment of variables utilized by MS4s during the selection process has never formally been investigated. We sought to better understand the importance of factors assessed by MS4s during the process of residency selection to gain perspective, which might be useful to training programs and future applicants.

Current State of Brachytherapy Teaching in Canada: A National Survey of Radiation Oncologists, Residents and Fellows

PurposeThe objective of the current study was to determine perceptions and barriers concerning brachytherapy teaching in Canada to guide the development of a brachytherapy credentialing process.Materials and MethodsIn May 2013, an electronic survey was sent all radiation oncologists, program directors, residents and fellows in Canada. Questions were asked regarding demographics, practice patterns, teaching methods and assessment, curriculum content, perceptions on resident education and barriers to resident teaching.ResultsOne hundred twenty-one staff radiation oncologists and 32 residents responded to the survey. Only 54% of respondents stated that their center had defined specific written objectives with respect to knowledge, skills & attitudes required for a resident to be competent in BT. The main barriers to brachytherapy teaching were stated as being the lack of Royal College guidance (55%), clinical workload (49%), lack of time (37%) and the fact that too much emphasis is placed on passing exams (32%). Ninety-seven percent of respondents felt it was important or very important that some elements of brachytherapy be included in the mainstream Radiation Oncology curriculum. Table 1 shows results of which brachytherapy modalities respondents agreed or strongly agreed should be included as components of the mainstream radiation oncology curriculum. 70% of residents were either extremely motivated or very motivated to learn about brachytherapy. 80% of respondents were in agreement with the development of a credentialing process by the Royal College of Physicians and Surgeons of Canada. 64% of respondents a separate fellowship outside of basic Radiation Oncology training should be required for certification in brachytherapy.Conclusions PurposeThe objective of the current study was to determine perceptions and barriers concerning brachytherapy teaching in Canada to guide the development of a brachytherapy credentialing process. The objective of the current study was to determine perceptions and barriers concerning brachytherapy teaching in Canada to guide the development of a brachytherapy credentialing process. Materials and MethodsIn May 2013, an electronic survey was sent all radiation oncologists, program directors, residents and fellows in Canada. Questions were asked regarding demographics, practice patterns, teaching methods and assessment, curriculum content, perceptions on resident education and barriers to resident teaching. In May 2013, an electronic survey was sent all radiation oncologists, program directors, residents and fellows in Canada. Questions were asked regarding demographics, practice patterns, teaching methods and assessment, curriculum content, perceptions on resident education and barriers to resident teaching. ResultsOne hundred twenty-one staff radiation oncologists and 32 residents responded to the survey. Only 54% of respondents stated that their center had defined specific written objectives with respect to knowledge, skills & attitudes required for a resident to be competent in BT. The main barriers to brachytherapy teaching were stated as being the lack of Royal College guidance (55%), clinical workload (49%), lack of time (37%) and the fact that too much emphasis is placed on passing exams (32%). Ninety-seven percent of respondents felt it was important or very important that some elements of brachytherapy be included in the mainstream Radiation Oncology curriculum. Table 1 shows results of which brachytherapy modalities respondents agreed or strongly agreed should be included as components of the mainstream radiation oncology curriculum. 70% of residents were either extremely motivated or very motivated to learn about brachytherapy. 80% of respondents were in agreement with the development of a credentialing process by the Royal College of Physicians and Surgeons of Canada. 64% of respondents a separate fellowship outside of basic Radiation Oncology training should be required for certification in brachytherapy. One hundred twenty-one staff radiation oncologists and 32 residents responded to the survey. Only 54% of respondents stated that their center had defined specific written objectives with respect to knowledge, skills & attitudes required for a resident to be competent in BT. The main barriers to brachytherapy teaching were stated as being the lack of Royal College guidance (55%), clinical workload (49%), lack of time (37%) and the fact that too much emphasis is placed on passing exams (32%). Ninety-seven percent of respondents felt it was important or very important that some elements of brachytherapy be included in the mainstream Radiation Oncology curriculum. Table 1 shows results of which brachytherapy modalities respondents agreed or strongly agreed should be included as components of the mainstream radiation oncology curriculum. 70% of residents were either extremely motivated or very motivated to learn about brachytherapy. 80% of respondents were in agreement with the development of a credentialing process by the Royal College of Physicians and Surgeons of Canada. 64% of respondents a separate fellowship outside of basic Radiation Oncology training should be required for certification in brachytherapy. Conclusions

Promoting a Research Culture among Junior Radiation Oncologists: Outcomes from the Introduction of the Australian and New Zealand Research Requirement in Training

AimSince 2005, radiation oncology trainees in Australia and New Zealand have had to undertake a piece of original research during training, and submit a manuscript, as first author, for senior peer-review. Satisfactory completion of this requirement is one component of eligibility to sit the Royal Australian and New Zealand College of Radiologists Fellowship examinations. The purpose of this study was to examine the value of this curriculum requirement, including the publication rates and potential barriers to trainee research. Materials and methodsAn online survey was sent to 116 radiation oncologists/trainees who trained since the mandatory research requirement was introduced (2005–2011). Questions concerned research topics, publications, subsequent research activity, perceptions on barriers to research and aids to conducting research during training. A web-based search of PubMed by author name was carried out to complete and verify publication statistics. ResultsIn total, 108 (93.1%) of the 116 trainees across 20 centres who submitted their research papers to the Radiation Oncology Faculty Research Committee were successful in meeting the required standard first time. Half of these trainees ultimately published their paper in a peer-reviewed journal. Of trainees responding to the survey, 62% presented their research at a scientific meeting. Most of the studies were either retrospective (62.3%) or dosimetry/physics projects (10.1%). The main problems encountered in conducting projects were competing clinical commitments and lack of dedicated research time. Notably, long ethics approval processes, lack of supervision and statistical support for projects were not considered barriers. ConclusionThis mandatory research requirement ensures trainees initiate and complete at least one project during their training. Since the introduction of this curriculum component, half of the research projects have resulted in publication in a peer-reviewed journal. Increased ‘protected time’ and training in scientific writing and methods may improve publication rates and quality. This first review of the Australian and New Zealand radiation oncology trainee research requirement highlights areas that need to be addressed to further support and foster a research culture among junior radiation oncologists.

Medical physics training for radiation oncology residents in Greece

s / Physica Medica 30 (2014) e45ee74 e49 Results: Although all of the 120 sunglasses tested in this study were effective in reducing the intensity of visible light, nearly none of the sunglasses could offer efficient protection against UV radiation. The UVA and UVB transmittance of the sunglasses were in the range of 0.31% (price category of more than 150$) and 72.2% (price category of 30-90$). Conclusion: The majority of sunglasses tested in this study strongly decreased the visible light intensity but couldn’t block all UV radiation. According to the ANSI Z80.3-2001 (U.S. standard) the lens should have a UVB (280 to 315 nm) transmittance of no more than 1%. These findings lead us to this conclusion that these sunglasses can endanger the vision due to dilation of the pupil and overexposure of the lens to UV radiation. MEDICAL PHYSICS TRAINING FOR RADIATION ONCOLOGY RESIDENTS IN GREECE G. Pissakas , S. Nikoletopoulos , P. Georgolopoulou , D. Kardamakis . Hellenic Society of Radiation Oncology, Greece; Hellenic Association of Medical Physicists, Greece; Medical Physics Department, G.Anticancer Athens Hospital “Saint Savvas”, Greece Purpose: Medical physics is an essential part of recommended curricula for residents in radiation oncology (RO). With no official training programs in place, medical physics training is often incidental and incomplete for RO residents in Greece. The aim of this work is to measure the effectiveness of an educational session on medical physics offered to RO trainees of the country. Method: The Hellenic Society of Radiation Oncology (EEAO) hosts quarterly educational meetings for RO residents of all levels. On April 2013 a physics-dedicated meeting was planned for a body of 52 residents. Topics ranged from basic radiation physics, physics of radiotherapy, brachytherapy, 3DCRT, IMRT to physics of specialized treatment modalities. Attendance compared favourably to 30 previous EEAO meetings focusing on clinical issues. Assimilation of material was measured by completion of a test at the end of the meeting focused on main Learning Objectives (LO). Results: Test questions covered all sessions of the meeting with equal weights. Main Bloom’s taxonomy categories were represented. Top 3% of grades achieved corresponded to residents whose home institutes put a substantial effort in training. Students responded better to sessions of an interactive naturewith higher grades on respective LO’s but indicated their enthusiasm over sessions on cutting edge technology. Given the lack of adequately equipped training institutes in the country, this suggests the need for rotation of residents, as recommended by international guidelines on RO training programs (IAEA, ESTRO, ASTRO). Conclusions: Educational meetings for RO residents focused in medical physics are quite effective in bringing together the physics background needed in their clinical practice. The need remains for implementing official training programs throughout the country and for rotation of residents in different institutes during their training. PORTUGUESE PATHWAY TO THE IMPLEMENTATION OF THE NEW EUROPEAN GUIDELINES ON MEDICAL PHYSICS EXPERT Ana Rita Figueira , Esmeralda Poli , Jorge Isidoro , Maria do Carmo Lopes . a Professional Matters and Education and Training Technical Commissions of the Medical Physics Division of the Portuguese Physics Society (DFM-SPF); Centro Hospitalar S~ ao Jo~ ao, EPE e Porto Portugal; Centro Hospitalar Lisboa Norte, EPE e Lisboa Portugal; Centro Hospitalar Universit ario de Coimbra, EPE e Coimbra e Portugal; e Instituto Portugues de Oncologia de Coimbra de Francisco Gentil, EPE e Coimbra e

The integration of cancer survivorship training in the curriculum of hematology/oncology fellows and radiation oncology residents

Cancer specialists require an understanding of survivors' needs to insure optimal delivery of care. Training programs currently focus on treatment, while survivorship care focuses on time after treatment. Cancer survivorship training represents an education paradigm shift. The Cancer Survivorship Workshop was held at the James P. Wilmot Cancer Center of the University of Rochester in academic year 2011-2012, with six sessions held. Objectives included the following: learning about survivorship from patient, primary care physician, and oncologist perspectives using a curriculum based on survivorship literature; designing treatment summaries (TSs) and survivorship care plans (SCPs) for five malignancies (lung, breast, prostate, colon, and lymphoma); and establishing collaboration between hematology/oncology (HO) and radiation oncology (RO) trainees by working together in teams. Course impact was assessed pre- and post-training using a 13-question survey. Questions were answered using a 10-point scale, with predefined rating for each question. Statistically significant differences in responses to several survey questions were observed comparing pre- and post-course experience. Improvement was noted in comfort discussing survivorship issues with patients (p = 0.001), reported knowledge of survivorship care for five types of cancer (p = 0.002), confidence in ability to explain a SCP (p = 0.001), and comfort discussing late effects of cancer treatment (p = 0.001). Five unique sets of TS and SCPs were completed. This study demonstrates the feasibility of implementing cancer survivorship education into the curriculum of HO and RO training. The project was designed with intension to optimize survivor care through enhanced provider training.

Faculty of Radiation Oncology 2012 trainee survey

This paper reports the key findings of the first Faculty of Radiation Oncology survey of trainees dealing with experiences and perceptions on work practices and choice of specialty. The survey was conducted in mid 2012 using a 37-question instrument. This was distributed by email to 159 current trainees and advertised through the Radiation Oncology Trainees Committee and other channels. There were six email reminders. Respondents were reassured that their responses were anonymous. The overall response rate was 82.8%. Gender was balanced among respondents with 67 (51.5%) being male and 63 (48.5%) being female. The most common age bracket was the 31 to 35 years range. There were similar proportions of trainee responders in each of the five years of training. A substantial number of trainees held other degrees besides medical degrees. The large majority were satisfied with radiation oncology as a career choice and with the Training Network within which they were training. Interest in oncology patients, lifestyle after training and work hours were given as the major reasons for choosing radiation oncology as a career. Nearly half of trainees were interested in undertaking some of their training in a part-time capacity and working part time as a radiation oncologist in the future. Over 70% of trainees stated they were working 36-55 clinical hours per week with additional non-clinical tasks, after-hours work and on-call duties. Nearly half of all trainees reported having one or less hours of protected time per week. Nonetheless, 40% of respondents indicated they had enough time to pursue outside interests. Radiation treatment planning and maintaining currency in general medicine were considered the most difficult aspects of training in radiation oncology. Most respondents were keen on the concept of fostering a research mentor. In terms of views on practice after completion of training, the majority were interested in pursuing a fellowship, and nearly all expressed an interest in maintaining an element of academic practice. The large majority of respondents preferred to work in an urban department as a component of their practice after training and nearly all wanted a component of public sector practice. There were only four per cent who preferred to work only within the private sector. Job availability was a concern for 94% of trainees, which far outweighed any other concerns. Trainees in radiation oncology are generally satisfied with their choice of specialty and their training. Most trainees are interested in fellowship positions, links with academia and largely public sector work in the future. Job availability for the future is their major concern.

The STYRO 2011 project: a survey on perceived quality of training among young Italian radiation oncologists

In order to evaluate the perceived quality of training and education among young Italian radiation oncologists (age <40), AIRO Giovani (Italian Association of Radiation Oncology-Young Members Working Group) carried out a nationwide online survey in 2011, employing a 63-item-based questionnaire, addressed to physician's self-perception of personal training experience (during decade 2001-2011). Issues explored investigated demographics data, duration/organization/content/characteristics of residency programs, the quality of education in clinical oncology, radiation oncology, management and communication attitudes. A total of 382 questionnaires were sent out to physicians and 217 (56.8%) were returned with 197 (51.6%) appropriately filled in and considered for the analysis. The general perception of education and training is positive in most of the explored fields, however some specific contexts and skills still require optimization (combination therapy, peculiar clinical scenarios, particular radiotherapy technical issues, structural organization of residency programs). The present report is expected to be useful for residents, program directors and scientific societies (such as AIRO), to further continue the effort in the improvement of training in radiation oncology.

Addressing the Growing Cancer Burden in the Wake of the AIDS Epidemic in Botswana: A Collaborative Partnership

The majority of cancer cases and nearly three-quarters of cancer deaths occur in resource-limited settings. With an adult HIV prevalence of 24.8 percent, Botswana has experienced a dramatic increase in HIV-related malignancies over the past decade. The availability of free antiretroviral treatment since 2003 has led to a major reduction in AIDS deaths; however the burden of cancer has continued to increase. The leading cancers in Botswana are cervical, non-Hodgkin lymphoma, head and neck, breast and Kaposi's sarcoma. Limited specialized oncologic services are available in two government and two private facilities, including one linear accelerator and one high dose rate brachytherapy source. With basic oncologic infrastructure in place, we sought to establish a longitudinal collaboration with the Botswana oncology community in order to improve cancer care in this nation. We focused our efforts in the following areas: the creation of a multi-disciplinary tumor board, connecting the Botswana oncology community with Massachusetts General Hospital (MGH)/Harvard-based disease site experts, on site training and capacity building in radiation oncology, and long distance learning and development. Activities have been directed through the active participation of representatives from the Botswana Ministry of Health, Botswana Harvard AIDS Institute, Gaborone Private Hospital, University of Botswana, US Embassy in Botswana, Botswana-University of Pennsylvania partnership and the MGH/Harvard oncology community. We have established the first sustainable multidisciplinary tumor board in Botswana, which has been meeting monthly since February 2012. Utilizing an internet-based platform connecting Botswana and MGH/Harvard oncology providers, case histories and pertinent radiology and pathology images are reviewed from recent challenging cases. Cases are followed by focused review of best practice by MGH/Harvard disease site experts. In addition to providing a venue for education and constructive peer review, the conference provides a regular forum for Botswana oncologists, infectious disease physicians, house officers, surgeons, and pathologists to discuss relevant health systems issues. Furthermore, the collaboration has assisted with the introduction of cervical brachytherapy in Botswana, through on site training in manual skills, treatment planning, and ongoing mentorship. A collaborative relationship in oncology care has been established between MGH/Harvard and Botswana, resulting in the introduction of new approaches to treatment and perceived improvements in patient care. The MGH/Harvard-Botswana collaboration provides a model for partnership between academic oncology centers and high burden countries with limited resources.

Development of a Software for Quantitative Evaluation Radiotherapy Target and Organ-at-Risk Segmentation Comparison

Modern radiotherapy requires accurate region of interest (ROI) inputs for plan optimization and delivery. Target delineation, however, remains operator-dependent and potentially serves as a major source of treatment delivery error. In order to optimize this critical, yet observer-driven process, a flexible web-based platform for individual and cooperative target delineation analysis and instruction was developed in order to meet the following unmet needs: (1) an open-source/open-access platform for automated/semiautomated quantitative interobserver and intraobserver ROI analysis and comparison, (2) a real-time interface for radiation oncology trainee online self-education in ROI definition, and (3) a source for pilot data to develop and validate quality metrics for institutional and cooperative group quality assurance efforts. The resultant software, Target Contour Testing/Instructional Computer Software (TaCTICS), developed using Ruby on Rails, has since been implemented and proven flexible, feasible, and useful in several distinct analytical and research applications.

Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs

To describe resident-reported experience in brachytherapy in Accreditation Council of Graduate Medical Education-accredited radiation oncology training programs over the last 5 years. Archived reports of Accreditation Council of Graduate Medical Education final resident case logs from the last 5 years were reviewed and summarized. Brachytherapy was categorized according to the dose rate (low dose rate vs. high dose rate), technique (interstitial vs. intracavitary), and primary tumor site. Linear regression was used to test for trends. The mean number of total brachytherapy procedures performed per resident in the last 5 years has decreased from 80.8 in 2006-2007 to 71.0 in 2010-2011, but the trend is not statistically significant. The average number of intracavitary procedures has remained steady. The average resident experience with interstitial brachytherapy has decreased in a statistically significant manner. The average number of interstitial procedures has decreased by 25%. The average number of interstitial procedures reported by residents has decreased by 25%. The community charged with training residents in interstitial brachytherapy should consider methods to ensure that residents obtain sufficient experience in the future.