Radiation Oncology Training Research Articles

Patient Education Practices and Preferences of Interprofessional Radiation Oncology Providers

Patient understanding of radiotherapy (RT) processes and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. Our objective was to evaluate PE practices and preferences of interprofessional RO providers to inform recommendations for delivering inclusive, accessible, and patient-centered education. An anonymous 17-item online survey, approved by an ethics review board, was administered to all members of the Radiation Oncology Education Collaborative Study Group (ROECSG) between 10/5/22 to 11/23/22. Respondent demographics, provider practices/preferences, and institutional practices were collected. Qualitative items explored key strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by provider role and PE timing. Thematic analysis was used for qualitative responses. A total of 123 ROECSG members, including RO attendings (64%), RO trainees (21%), medical physicists (7%), physician assistants/nurses (2%), and radiation therapists (2%), completed the survey (31% response rate). Most practiced in an academic setting (86%) in North America (82%). The most common PE resources used were custom created institution-specific (61%) and electronic health system generated materials (38%). PE was delivered primarily by one-on-one teaching (72%), paper handouts (69%), and organizational websites (21%) (e.g., RTanswers.org). Almost half (41%) reported that PE practices differed based on type of clinical encounter, for example paper handouts for in-person visits and multimedia for virtual visits. The majority (86%) stated that their institution has disease site-specific PE materials, with nearly all having breast cancer materials (91%). Only 58% reported access to non-English PE materials. RO attendings/trainees were more likely than other team members to deliver PE at consultation (98% vs 71%, p = 0.03). PE practices amongst radiation oncologists differed according to the timing along the RT care path (consultation vs simulation vs first fraction, respectively): one-on-one teaching: 89% vs 49% vs 56%, p<0.01 and paper handouts: 69% vs 28% vs 16%, p<0.01. Key PE strategies included incorporating multimedia resources, personalizing delivery, and repetition at multiple timepoints by the interprofessional team. Limited time, inadequate administrative support, and lack of customized resources were identified as challenges in PE delivery. Interprofessional RO providers engage in PE, with most utilizing institution-specific materials. PE practices differ according to the type of clinical encounter and timing in the RT care path. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources based on language, learning styles, and cultural preferences are needed to foster high-quality, patient-centered PE delivery.

Patient Advocate Presence Helps Poster Presenters Understand Clinical Significance of their Research and Increases Empathy

Patient advocates represent the voice of the patient community and bring a unique perspective to research. We hypothesized that including patient advocates in poster sessions allow trainees to communicate their science in lay language, have an increased understanding of the clinical impact of their work, and increase their empathy for patients. A survey was designed to assess the impact invited patient advocates had on poster presenters at our Department of Radiation Oncology Research Symposium. The two advocates, one with primary breast and primary endometrial cancer, and one with metastatic breast cancer, visited each poster to discuss the project goals and outcomes with all 16 researchers (graduate/medical students, postdoctoral fellows including medical and physics residents, laboratory assistants, and faculty). The survey included demographics, and Likert scored questions about their ease in discussing research and use of lay language, the impact of the advocate on increasing the presenter's empathy and understanding the clinical significance of their work, and future role of advocates in complementing their research. Following the poster session, 14 of 16 participants completed the survey. Respondents were 57.1% male, 57.1% younger than 30 years old, and 50% people of color. Poster presenters comprised: 35.7% Graduate/Medical Students, 42.9% Medical/Physics Residents or Postdoctoral Fellows, 14% Faculty, and 7% laboratory assistants. All respondents agreed/strongly agreed they were comfortable talking to advocates. Overall, 42.8% of participants strongly agreed that they could talk to the patient advocate in lay language. 85.7% agreed/strongly agreed that their empathy for patients increased by this interaction. Although 92.9% of poster presenters believed patient advocates were able to help them understand the clinical impact of their research and 71.4% believed advocates helped them think of ideas to complement their research, 57.1% did not believe advocates could help them identify novel research conclusions. Most respondents would like advocates at future poster presentations (92.9%), but were not as sure and they would like advocates participating in study design or data analysis. Women, people of color, and graduate/medical students were most comfortable communicating in lay language, believed advocates increased their empathy and understanding of the clinical significance of their work. Patient advocates in poster sessions help trainees communicate their science, increase their empathy and understanding of the clinical impact of their research. Workshops should be considered to help young scientists communicate their science in lay language. Future radiation oncology training should consider including the patient advocate voice to improve the tangible connection between research and real-world impact.

Current situation in radiation oncology residency—Results of a national survey performed by the working group Young DEGRO of the German Society of Radiation Oncology

BackgroundThe aim of this study was to assess the current status of the radiation oncology (RO) residency programs in Germany. For this, RO residents and RO specialists were surveyed regarding the current situation of the RO residency training and the working conditions in Germany.MethodsThe Continuing Education Section of the Young DEGRO (yDEGRO) Working Group of the German Society of Radiation Oncology (DEGRO) developed a survey to assess (1) the overall satisfaction, learning objectives, and teaching methods used during training; and (2) the perception of the importance of specific disease patterns in RO training. Open-ended questions were also asked to elicit opinions on areas for improvement. From 21 November to 27 December 2022, RO residents registered with DEGRO and/or in the working group yDEGRO were invited to participate anonymously in an online questionnaire.ResultsOverall, 97 participants completed the survey, including 65 RO residents (67%) and 32 RO specialists (33%); 66 (68%) of the respondents reported being employed in the university setting, 23 (23.7%) in the non-university setting, and 8 (8.3%) in private practice. Within the training, heterogeneity was found in the teaching methods used. In terms of knowledge transfer, the greatest importance was accorded to annual continuing education discussions with the head of the residency training (92.8%), participation in tumor boards (85.6%), written training concepts (81.4%), and evaluations at the beginning (76.3%) and end of a rotation (80.4%). The arithmetic mean of satisfaction with specialist training was 6/10 points (SD: 1.99); 88.7% of respondents would like to see a nationally uniform and mandatory curriculum in RO residency training.ConclusionThe study provides suggestions for improving RO medical training in Germany: further development of accompanying education and training programs in cooperation with professional associations, e.g., the DEGRO, structured feedback, and supervision.

Radiation oncologists' scope of practice and role in cancer management in Australia, New Zealand, and Singapore: Are we clinicians or technicians?

To evaluate the scope of practice and role in cancer management for radiation oncologists in Australia, New Zealand, and Singapore (ANZ). A 27-question survey was emailed to all practicing radiation oncologists listed on the RANZCR database in mid-2021. There was a 54% response rate. Respondents reported managing symptoms associated with radiation therapy (96%), cancer-related symptoms (86%), writing narcotic and analgesic prescriptions (76%), being involved in palliative care (57%), prescribing non-cytotoxic systemic therapy (45%), and admitting patients (41%). Just over 20% wanted to expand their scope of practice, but for those who were unable to, insufficient time (35%), inter-specialty political difficulties (14%), and lack of support from the organisation (12%) were the major reasons. Over half of respondents (56.4%) thought they provided an opinion on the overall role of cancer management. Just under 20% provided a radiation therapy opinion only and <1% provided radiation therapy at the request of the referring clinician. The remainder reported a combination of these. Over 80% of respondents thought their ideal role was to be involved in overall cancer management and 20% believed they should be providing an opinion on radiation therapy only. The ideal role matched the actual role in over 87% of respondents and most respondents thought radiation oncology training enabled an opinion on overall cancer management. Over 90% of respondents were satisfied with their current role in cancer management. Radiation oncologists felt they were perceived as independent clinicians and the large majority (87%) thought radiation oncologists should be part of a multidisciplinary team rather than leaders in cancer management. This study has revealed a broad but expected scope of practice for ANZ radiation oncologists with the large majority providing an opinion on overall cancer management or radiation therapy and their ideal role matching their actual role.

Attitudes and Perception of the REFLECT Communication Curriculum for Clinical Oncology Graduate Medical Education

Communication and interpersonal skills are essential components of oncology patient care. The REFLECT (Respect, Empathy, Facilitate Effective Communication, Listen, Elicit Information, Compassion, and Teach Others) curriculum is a novel framework to improve and refine physician/patient interactions for oncology graduate medical trainees. We seek to evaluate the attitudes and perceptions of the REFLECT communication curriculum among oncology trainees. Seven-question and 8-question Likert scale surveys (1 = not beneficial and 5 = beneficial) were distributed to resident/fellow participants and faculty mentors, respectively. Questions asked trainees and faculty about their perceptions of improvement in communication, handling of stressful situations, the value of the curriculum, and overall impression of the curriculum. Descriptive statistics determined the survey’s baseline characteristics and response rates. Kruskal–Wallis rank sum tests were used to compare the distribution of continuous variables. Thirteen resident/fellow participants completed the participant survey. Six (43.6%) Radiation Oncology trainees and 7 (58.3%) Hematology/Oncology fellows completed the trainee survey. Eight (88.9%) Radiation Oncologists and 1 (11.1%) Medical Oncologist completed the observer survey. Faculty and trainees generally felt that the curriculum increased communication skills. Faculty responded more favorably to the program’s impact on communication skills (median 5.0 vs. 4.0, p = 0.008). Faculty were more assertive about the curriculum’s capabilities to improve a learner’s ability to handle stressful situations (median 5.0 vs. 4.0, p = 0.003). Additionally, faculty had a more favorable overall impression of the REFLECT curriculum than the residents/fellows (median 5.0 vs. 4.0, p < 0.001). Radiation Oncology residents felt more strongly that the curriculum enhanced their ability to handle stressful topics, compared to Heme/Onc fellows (median 4.5 vs. 3.0, range 1–5, p = 0.379). Radiation Oncology trainees felt more consistently that the workshops improved their communication skills, compared to Heme/Onc fellows (median 4.5 vs. 3.5, range 1–5, p = 0.410). The overall impression between Rad Onc resident and Heme/Onc fellows was similar (median 4.0, p = 0.586). Conclusions: Overall, the REFLECT curriculum enhanced communication skills of trainees. Oncology trainees and faculty physicians feel that the curriculum was beneficial. As interactive skills and communication is critical to build positive interactions, further work is needed to improve the REFLECT curriculum.

A Pilot Study of a Virtual Interactive Radiation Oncology-Specific Residents-As-Teachers Curriculum: Preliminary Results

Background Radiation oncology resident physicians have expressed the desire for formal training in teaching for settings and audiences that are specific to their specialty. We describe preliminary results from a funded pilot study for a virtual, interactive Residents-As-Teachers (RaTe) curriculum. Methods All radiation oncology trainees at a single institution were invited to voluntarily participate in this study (N=13). The first module of this longitudinal curriculum, "Teaching Medical Students in the Outpatient Radiation Oncology Clinic," was implemented in November 2022. The module included an asynchronous 30-minute interactive video didactic, a self-assessment tool for participants to use while teaching in clinic, and a list of additional relevant resources. Trainees who consented to participate in the study completed self-assessment questionnaires prior to the intervention and completed anonymous questionnaires immediately afterward evaluating their experience with the module. Results Of the 13 trainees who qualified for participation, 8 (62%) consented to participate in the study. There was participation across training levels: 2 (25%) PGY-2, 1 (13%) PGY-3, 2 (25%) PGY-4, 2 (25%) PGY-5, and 1 (13%) fellow. Six (75%) had no prior training in teaching before residency, while 4 (50%) had no training in teaching during residency. Median self-assessment score of overall teaching performance on an 11-point scale (0-10) was 6.5 (range, 3 to 8). Seven out of 8 (88%) study participants completed the post-intervention survey for this module. When asked how likely they were to change their teaching practices as a result of the intervention, all respondents chose "Very Likely" (6 responses, 86%) or "Somewhat Likely" (1 response, 14%). Out of an 11-point scale (0-10), respondents rated their likelihood to recommend this module to other radiation oncology trainees at a median of 10 (range, 8-10). Discussion These preliminary results indicate the feasibility of implementing the first asynchronous virtual module within a radiation oncology-specific residents-as-teachers series at a single institution. The module was well-received, and participants were highly likely to recommend the module to other trainees. Future directions include determining how this curriculum impacts participant teaching confidence and quality. Additionally, we plan to expand the curriculum to include other teaching topics specific to radiation oncology, as well as include participants from other institutions. Radiation oncology resident physicians have expressed the desire for formal training in teaching for settings and audiences that are specific to their specialty. We describe preliminary results from a funded pilot study for a virtual, interactive Residents-As-Teachers (RaTe) curriculum. All radiation oncology trainees at a single institution were invited to voluntarily participate in this study (N=13). The first module of this longitudinal curriculum, "Teaching Medical Students in the Outpatient Radiation Oncology Clinic," was implemented in November 2022. The module included an asynchronous 30-minute interactive video didactic, a self-assessment tool for participants to use while teaching in clinic, and a list of additional relevant resources. Trainees who consented to participate in the study completed self-assessment questionnaires prior to the intervention and completed anonymous questionnaires immediately afterward evaluating their experience with the module. Of the 13 trainees who qualified for participation, 8 (62%) consented to participate in the study. There was participation across training levels: 2 (25%) PGY-2, 1 (13%) PGY-3, 2 (25%) PGY-4, 2 (25%) PGY-5, and 1 (13%) fellow. Six (75%) had no prior training in teaching before residency, while 4 (50%) had no training in teaching during residency. Median self-assessment score of overall teaching performance on an 11-point scale (0-10) was 6.5 (range, 3 to 8). Seven out of 8 (88%) study participants completed the post-intervention survey for this module. When asked how likely they were to change their teaching practices as a result of the intervention, all respondents chose "Very Likely" (6 responses, 86%) or "Somewhat Likely" (1 response, 14%). Out of an 11-point scale (0-10), respondents rated their likelihood to recommend this module to other radiation oncology trainees at a median of 10 (range, 8-10). These preliminary results indicate the feasibility of implementing the first asynchronous virtual module within a radiation oncology-specific residents-as-teachers series at a single institution. The module was well-received, and participants were highly likely to recommend the module to other trainees. Future directions include determining how this curriculum impacts participant teaching confidence and quality. Additionally, we plan to expand the curriculum to include other teaching topics specific to radiation oncology, as well as include participants from other institutions.

Contouring Workshops - The Beneficial Impact on Radiation Oncology Specialist Training in Ireland

Background One of the key components of training in Radiation Oncology is gaining knowledge in contouring tumour volumes and organs at risk for radiotherapy planning. Trainees rotate through different tumour sites during their training and are expected to acquire competencies in contouring skills in tumour sites appropriate to their year of training. These skills are mostly acquired in an unstructured manner during supervised clinical work. We report on our institutional experience of introducing structured contouring workshops and on the feedback obtained from trainees. Methods Eight contouring workshops in different tumour sites - Head & Neck (n=3), Prostate (n=1), SABR Lung (n=2), Breast (n=1) and Oesophagus (n=1) were conducted between April 2019 and March 2022.Six were in-person workshops pre-COVID. Two were run virtually during the pandemic. The workshops were of 2-hour duration, limited to around 12 trainees each with varying degrees of experience in that particular tumour site. All workshops were similar in format with a tutorial on the tumour site followed by a contouring demonstration on an anonymised index case on the Eclipse planning platform referencing published contouring atlases. The trainees had access to a copy of the same case throughout the workshop. Their contours were reviewed individually and collectively. Feedback on the contouring experience was collected through a questionnaire after the workshop from each trainee. This feedback was incorporated into subsequent workshops where relevant. Results An average of 12 trainees (range 10 -14) attended the workshops. All trainees, irrespective of year of training, rated the content, format of the workshops highly and felt that they were relevant to their daily practice. Their reported subjective level of confidence in contouring improved significantly from an average score of 5.6 out of 10 (range 4-7) before the workshop to a score of 8.7 (range 8-9) after, over the 8 workshops. There was no cost associated with conducting these workshops as these were done on our existing planning software. Discussion Based on the feedback obtained from the trainees, the workshops were of definite educational benefit. They favoured the inclusion of this approach to the teaching of contouring skills in their curriculum. In keeping with this feedback and the recent implementation of the new radiation oncology training curriculum in Ireland efforts are currently underway in incorporating these contouring workshops into the training programme on a structured basis. This will ensure that trainees develop progressive expertise in contouring skills in keeping with highest international standards. One of the key components of training in Radiation Oncology is gaining knowledge in contouring tumour volumes and organs at risk for radiotherapy planning. Trainees rotate through different tumour sites during their training and are expected to acquire competencies in contouring skills in tumour sites appropriate to their year of training. These skills are mostly acquired in an unstructured manner during supervised clinical work. We report on our institutional experience of introducing structured contouring workshops and on the feedback obtained from trainees. Eight contouring workshops in different tumour sites - Head & Neck (n=3), Prostate (n=1), SABR Lung (n=2), Breast (n=1) and Oesophagus (n=1) were conducted between April 2019 and March 2022.Six were in-person workshops pre-COVID. Two were run virtually during the pandemic. The workshops were of 2-hour duration, limited to around 12 trainees each with varying degrees of experience in that particular tumour site. All workshops were similar in format with a tutorial on the tumour site followed by a contouring demonstration on an anonymised index case on the Eclipse planning platform referencing published contouring atlases. The trainees had access to a copy of the same case throughout the workshop. Their contours were reviewed individually and collectively. Feedback on the contouring experience was collected through a questionnaire after the workshop from each trainee. This feedback was incorporated into subsequent workshops where relevant. An average of 12 trainees (range 10 -14) attended the workshops. All trainees, irrespective of year of training, rated the content, format of the workshops highly and felt that they were relevant to their daily practice. Their reported subjective level of confidence in contouring improved significantly from an average score of 5.6 out of 10 (range 4-7) before the workshop to a score of 8.7 (range 8-9) after, over the 8 workshops. There was no cost associated with conducting these workshops as these were done on our existing planning software. Based on the feedback obtained from the trainees, the workshops were of definite educational benefit. They favoured the inclusion of this approach to the teaching of contouring skills in their curriculum. In keeping with this feedback and the recent implementation of the new radiation oncology training curriculum in Ireland efforts are currently underway in incorporating these contouring workshops into the training programme on a structured basis. This will ensure that trainees develop progressive expertise in contouring skills in keeping with highest international standards.

Attitudes and Perceptions of the REFLECT Communication Curriculum for Clinical Oncology Graduate Medical Education

Background Communication and interpersonal skills are important medical components of oncology patient care. The REFLECT (Respect, Empathy, Facilitate Effective Communication, Listen, Elicit Information, Compassion, and Teach Others) curriculum is a novel communication to improve and refine physician/patient interactions for oncology graduate medical trainees. Each year, this comprehensive course consisted of quarterly (four-hour) workshops comprised of assigned reading, knowledge assessments, didactic lectures, expert guest lecturers, standardized patient (SP) simulations, role-playing, patient/expert panels, coaching, reflective writing, and debriefing/feedback sessions. We sought to evaluate the attitudes and perceptions of the communication curriculum in oncology trainees. Methods Surveys were developed to obtain perceptions of the REFLECT curriculum from trainee (Radiation Oncology and Medical Oncology) participants and faculty mentors. A 9-question and 11-question Likert scale surveys (1 = not beneficial, 5 = beneficial) was distributed to resident/fellow participants and faculty mentors, respectively. Questions asked trainee and faculty opinions about perception of improvement in communication, handling of stressful situations, value of curriculum, and overall impression of the curriculum. Surveys were distributed through Qualtrics, and were anonymous, voluntary, and non-incentivized. Results Twelve resident/fellow participants completed the participant survey. Five (41.6%) Radiation Oncology trainees and 7 (58.3%) Hematology/Oncology fellows completed the survey. Nine faculty members, 8 radiation oncologists and 1 medical oncologist, completed the faculty survey. In general, trainees felt that the curriculum improved their communication skills (mean = 3.5, range 1-5). Additionally, most also felt the workshop was beneficial in being able to handle certain topics (69.2%). Seven participants (54%) felt that the curriculum enhanced their communication. However, only 28.4% of trainees felt it was beneficial to their training. The overall impression was positive, with 77% of participants rating the curriculum as beneficial. Meanwhile, faculty members felt the curriculum was beneficial with average responses ranging from 4.5-5. There was a significantly more positive perception of the REFLECT curriculum among faculty members compared to trainees (p <0.05). Discussion While the REFLECT curriculum was perceived to enhance communication skills, trainees did not find the curriculum beneficial. On the other hand, faculty physicians and staff felt the curriculum was beneficial. As interactive skills and communication is critical to build positive interaction with patients, further work is needed to improve trainee's perception of the REFLECT curriculum. Communication and interpersonal skills are important medical components of oncology patient care. The REFLECT (Respect, Empathy, Facilitate Effective Communication, Listen, Elicit Information, Compassion, and Teach Others) curriculum is a novel communication to improve and refine physician/patient interactions for oncology graduate medical trainees. Each year, this comprehensive course consisted of quarterly (four-hour) workshops comprised of assigned reading, knowledge assessments, didactic lectures, expert guest lecturers, standardized patient (SP) simulations, role-playing, patient/expert panels, coaching, reflective writing, and debriefing/feedback sessions. We sought to evaluate the attitudes and perceptions of the communication curriculum in oncology trainees. Surveys were developed to obtain perceptions of the REFLECT curriculum from trainee (Radiation Oncology and Medical Oncology) participants and faculty mentors. A 9-question and 11-question Likert scale surveys (1 = not beneficial, 5 = beneficial) was distributed to resident/fellow participants and faculty mentors, respectively. Questions asked trainee and faculty opinions about perception of improvement in communication, handling of stressful situations, value of curriculum, and overall impression of the curriculum. Surveys were distributed through Qualtrics, and were anonymous, voluntary, and non-incentivized. Twelve resident/fellow participants completed the participant survey. Five (41.6%) Radiation Oncology trainees and 7 (58.3%) Hematology/Oncology fellows completed the survey. Nine faculty members, 8 radiation oncologists and 1 medical oncologist, completed the faculty survey. In general, trainees felt that the curriculum improved their communication skills (mean = 3.5, range 1-5). Additionally, most also felt the workshop was beneficial in being able to handle certain topics (69.2%). Seven participants (54%) felt that the curriculum enhanced their communication. However, only 28.4% of trainees felt it was beneficial to their training. The overall impression was positive, with 77% of participants rating the curriculum as beneficial. Meanwhile, faculty members felt the curriculum was beneficial with average responses ranging from 4.5-5. There was a significantly more positive perception of the REFLECT curriculum among faculty members compared to trainees (p <0.05). While the REFLECT curriculum was perceived to enhance communication skills, trainees did not find the curriculum beneficial. On the other hand, faculty physicians and staff felt the curriculum was beneficial. As interactive skills and communication is critical to build positive interaction with patients, further work is needed to improve trainee's perception of the REFLECT curriculum.

Radiation Treatment Plan Evaluation: An Educational Tool for Radiation Oncology Trainees

Background Resident education in radiation treatment plan evaluation is variable, but it is a critical component of resident education as treatment plans are patient-tailored and customized. Prior studies have reported that over 90% of residents are interested in additional resources, but most report insufficient training. We developed a case-based educational curriculum to increase confidence and competence in plan evaluation by incorporating physics and dosimetry faculty input. We used this pilot study to evaluate feasibility of implementing dedicated treatment plan evaluation teaching sessions at an academic institution. Methods A single institution pilot study with 14 volunteer residents involving pre- and post-plan evaluation teaching session. Three de-identified central nervous system (CNS) cases, including high-grade and low-grade gliomas, were selected that corresponded to the topics of the residents' clinical lectures during the time they were administered. Physics faculty and dosimetrists developed treatment plans that incorporated common problems identified during plan evaluation including inaccurate contours, excessive doses to organs at risk (OARs), suboptimal beam arrangements, and inadequate target volume coverage. An interactive, dosimetry-led teaching session reviewed the cases and tips for requesting plan changes. Residents completed anonymous follow-up surveys regarding the cases and didactic session. Results Seven of 14 (50%) eligible residents completed the three initial case surveys which took on average 11 minutes and 55 seconds to complete (range 8 minutes 39 seconds -13 minutes 50 seconds). Of the participants, most correctly identified the major issues with each case: correctly indicating which plans they would approve and the differences between plans. However, a minority of residents were able to accurately discuss more nuanced details, with only 57% and 42% correctly rejecting inaccurate contours and OAR constraints, respectively; 29% accurately listed the pros and cons of specific beam arrangements; and 14% identified techniques dosimetry could use to improve target coverage. On the follow-up survey, 100% of residents reported that both the cases and the review session improved their confidence and understanding of treatment planning and plan evaluation and stated that they would like to see similar educational material incorporated in residency training in the future. Discussion We describe an effective, multidisciplinary tool to supplement resident education in plan evaluation. This curriculum simulates frequent problems that providers face and provides tools to collaborate with dosimetry and physics to improve treatment plans. Additional follow-up on evaluating and improving confidence and preparedness with plan evaluation in independent practice is warranted. Resident education in radiation treatment plan evaluation is variable, but it is a critical component of resident education as treatment plans are patient-tailored and customized. Prior studies have reported that over 90% of residents are interested in additional resources, but most report insufficient training. We developed a case-based educational curriculum to increase confidence and competence in plan evaluation by incorporating physics and dosimetry faculty input. We used this pilot study to evaluate feasibility of implementing dedicated treatment plan evaluation teaching sessions at an academic institution. A single institution pilot study with 14 volunteer residents involving pre- and post-plan evaluation teaching session. Three de-identified central nervous system (CNS) cases, including high-grade and low-grade gliomas, were selected that corresponded to the topics of the residents' clinical lectures during the time they were administered. Physics faculty and dosimetrists developed treatment plans that incorporated common problems identified during plan evaluation including inaccurate contours, excessive doses to organs at risk (OARs), suboptimal beam arrangements, and inadequate target volume coverage. An interactive, dosimetry-led teaching session reviewed the cases and tips for requesting plan changes. Residents completed anonymous follow-up surveys regarding the cases and didactic session. Seven of 14 (50%) eligible residents completed the three initial case surveys which took on average 11 minutes and 55 seconds to complete (range 8 minutes 39 seconds -13 minutes 50 seconds). Of the participants, most correctly identified the major issues with each case: correctly indicating which plans they would approve and the differences between plans. However, a minority of residents were able to accurately discuss more nuanced details, with only 57% and 42% correctly rejecting inaccurate contours and OAR constraints, respectively; 29% accurately listed the pros and cons of specific beam arrangements; and 14% identified techniques dosimetry could use to improve target coverage. On the follow-up survey, 100% of residents reported that both the cases and the review session improved their confidence and understanding of treatment planning and plan evaluation and stated that they would like to see similar educational material incorporated in residency training in the future. We describe an effective, multidisciplinary tool to supplement resident education in plan evaluation. This curriculum simulates frequent problems that providers face and provides tools to collaborate with dosimetry and physics to improve treatment plans. Additional follow-up on evaluating and improving confidence and preparedness with plan evaluation in independent practice is warranted.

Assessment of Research Mentorship During Medical School for Future Radiation Oncology Trainees

Assessment of Research Mentorship During Medical School for Future Radiation Oncology Trainees

Postgraduate teaching-learning pattern for radiation oncology students in India - A survey-based analysis.

Teaching and training in Radiation Oncology is only at postgraduate level with 8-10 hours of theory sessions during undergraduate course. Uniform training during the post-graduation course across the country is a major challenge as many new concepts are introduced. This study is an effort to look into various aspects of training in terms of teaching-learning and assessment. In addition, we aim to look into innovative methods that can be implemented across the country. This is a survey-based analysis. Postgraduate teaching institutes in Radiation Oncology were obtained from the National Medical Council and National Board of Examination websites. A questionnaire was created with Google form and sent to the heads of departments across the country. The data were entered on a spreadsheet and the responses were analyzed using Microsoft Excel sheet. Thirty-five out of 87 institutes responded out of which 40% were government institutes. Twenty-six (74%) offered MD seats with 14 (40%) having less than five teachers and 13 (37.14%) with 5-10 teachers. With uniform teaching learning method across the country, there was wide variation in formative assessment patterns. There was consensus regarding inadequate exposure in research methodology and statistics. There is uniformity in teaching learning methods with differing patterns of formative assessment. Innovative methods focusing on affective and skill domains with competency-based medical education will help in bringing out a competent radiation oncologist.

Achieving Exceptional Cochlea Delineation in Radiotherapy Scans: The Impact of Optimal Window Width and Level Settings.

Introduction Radiation therapy (RT) aims to maximize the dose to the target volume while minimizing the dose to organs at risk (OAR), which is crucial for optimal treatment outcomes and minimal side effects. The complex anatomy of the head and neck regions, including the cochlea, presents challenges in radiotherapy. Accurate delineation of the cochlea is essential to prevent toxicities such as sensorineural hearing loss. Educational interventions, including seminars, atlases, and multidisciplinary discussions, can improve accuracy and interobserver agreement in contouring. This study seeks to provide radiation oncology practitioners with the necessary window width and window level settings in computed tomography (CT) scans to accurately and precisely delineate the cochlea, using a pre-and post-learning phase approach to assess the change in accuracy. Methods and materials The study used the ProKnow Contouring Accuracy Program (ProKnow, LLC,Florida, United States), which employs the StructSure method and the Dice coefficient to assess the precision of a user's contour compared to an expert contour. The StructSure method offers superior sensitivity and accuracy, while the Dice coefficient is a more rudimentary and less sensitive approach. Two datasets of CT scans, one for each left and right cochlea, were used. The author delineated the cochlea before and after applying the proposed technique for window width and window level, comparing the results with those of the expert and general population. The study included a step-by-step method for cochlea delineation using window width and window level settings. Data analysis was performed using IBMSPSSStatistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Results The implementation of the proposed step-by-step method for adjusting window width and window level led to significant improvements in contouring accuracy and delineation quality in radiation therapy planning. Comparing pre- and post-intervention scenarios, the author exhibited increased StructSure scores (right cochlea: 88.81 to 99.15; left cochlea: 88.45 to 99.85) and Dice coefficient scores (right cochlea: 0.62 to 0.80; left cochlea: 0.73 to 0.86). The author consistently demonstrated higher contouring accuracy and greater similarity to expert contours compared to the group's mean scores both before and after the intervention. These results suggest that the proposed method enhances the precision of cochlea delineation in radiotherapy planning. Conclusion In conclusion, this study demonstrated that a step-by-step instructional approach for adjusting window width and window level significantly improved cochlea delineation accuracy in radiotherapy contouring. The findings hold potential clinical implications for reducing radiation-related side effects and improving patient outcomes. This study supports the integration of the instructional technique into radiation oncology training and encourages further exploration of advanced imaging processing and artificial intelligence applications in radiotherapy contouring.

Correlation Between Research Productivity During Medical School and Radiation Oncology Residency

This analysis investigates whether research productivity during medical school predicts future research productivity during radiation oncology residency. At our institution, there have been 20 medical students who graduated between 2005 and 2015 and subsequently completed their residency training in radiation oncology. We built a database of all PubMed-indexed publications in which these former students were the first author or coauthor. Mean publication rates with 95% confidence intervals (95% CI) were computed. The paired t test and McNemar-Bowker test of symmetry were used to examine differences in first-author and coauthor publications between the medical school and residency periods. An ordinal logistic regression model was employed to measure the odds ratio of publishing during residency versus during medical school. A Spearman correlation coefficient was calculated for the relationship between the number of publications during medical school and the number during residency. A total of 14 and 60 first-author publications (46 and 117 coauthor publications) were identified for 20 individuals during medical school and residency, respectively. There was an average of 0.7 (95% CI, 0.17-1.23) first-author publications during medical school and 3.08 (95% CI, 1.56-4.44) first-author publications during residency (P=.003). Only 15% (3/20) had ≥2 publications during medical school, and 50% (10/20) had ≥2 publications during residency (P=.012). The Spearman correlation coefficient between research publications before and during residency was .457 (P=.043). The mean number of coauthor publications during medical school and residency was 2.3 (95% CI, 0.92-3.68) and 5.85 (95% CI, 3.50-8.20), respectively (P=.004). Based on this retrospective analysis from our institution, student research productivity during medical school, as defined by the number of first-author publications, does correlate with future research productivity during radiation oncology residency.

SUPPORT: SUrvey of Parental Leave POlicies of RadiaTion Oncology Programs and Residency Applicants

Recruitment to radiation oncology training programs has recently declined, and gender inequities persist in radiation oncology. Policies that promote inclusivity, such as the updated American College of Graduate Medical Education parental leave policy establishing minimum parental leave requirements, may support recruitment to radiation oncology. We surveyed 2021-2022 radiation oncology residency applicants and program directors (PDs) about program-specific parental leave policies, transparency of parental leave information during the residency application and interview process, and perceptions of the effect of parenthood on residency training, career advancement, and well-being. Of 89 radiation oncology PDs, 29 (33%) completed the survey. Of 154 residency applicants (current fourth-year medical students, international applicants, or postdoctoral fellows) surveyed, 62 (40%) completed the survey. Most applicants planned to start a family during residency (53%) and reported perceived flexibility to start a family influenced their decision to pursue radiation oncology over other career specialties (55%). Many applicants viewed time in residency (nonresearch, 22%), in research (33%), and as early career faculty (24%) as the best time to start a family. A small number of applicants used program-specific parental leave policy information in determining their rank list (11%), and many applicants sought information regarding fertility health care benefits (55%). Many applicants obtained parental leave information verbally, despite expressing a preference for objective means (slide deck, 63%; website, 50%; or handout, 42%) of information sharing. PDs were all supportive of a 6-week maternity leave policy (100% agree or strongly agree with the policy) and did not feel parental leave would negatively affect a resident's ability to pursue an academic (100%) or private practice career (100%). Many radiation oncology residency applicants plan to start families during training, seek and value program-specific parental leave information and health benefits, and prefer objective means of information sharing. These findings likely reflect those who have strong views of parental leave policies.

Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

There is a vital need to train radiation therapy professionals in low- and middle-income countries (LMICs) to develop sustainable cancer treatment capacity and infrastructure. LMICs have started to introduce intensity modulated radiation therapy (IMRT), which is the standard of care in high-income countries, because of improved outcomes and reduced toxicities. This work reports the efficacy of a complementary asynchronous plus synchronous virtual-training approach on improving radiation therapy professions' self-confidence levels and evaluating participants' attitudes toward asynchronous and synchronous didactic hands-on learning in 3 LMICs. Training was provided to 37 participants from Uganda, Guatemala, and Mongolia, which included 4 theoretical lectures, 4 hands-on sessions, and 8 self-guided online videos. The 36-day training focused on IMRT contouring, site-specific target/organ definition, planning/optimization, and quality assurance. Participants completed pre- and postsession confidence surveys on a 0 to 10 scale, which was converted to a 5-point Likert rating scale to evaluate the training outcomes. The pros and cons of the 3 different training formats were compared. The participants included 15 (40.5%) radiation oncologists, 11 (29.7%) medical physicists, 6 (16.2%) radiation therapists, and 5 (13.5%) dosimetrists. Approximately 50% had more than 10 years of radiation therapy experience, 70.8% had no formal IMRT training, and only 25% had IMRT at their institutions. The average experience and confidence levels in using IMRT at baseline were 3.2 and 2.9, which increased to 5.2 and 4.9 (P < .001) after the theoretical training. After the hands-on training, the experience and confidence levels further improved to 5.4 and 5.5 (P < .001). After the self-guided training, the confidence levels increased further to 6.9 (P < .01). Among the 3 different training sessions, hands-on trainings (58.3%) were most helpful for the development of participants' IMRT skills, followed by theoretical sessions with 25%. After completing the training sessions, Uganda and Mongolia started IMRT treatments. Remote training provides an excellent and feasible e-learning platform to train radiation therapy professionals in LMICs. The training program improved the IMRT confidence levels and treatment delivery. The hands-on trainings were most preferred.

Training in Radiation and Clinical Oncology in Europe.

The European population is strongly affected by cancer. Radiotherapy is roughly used in 50% of cancer patients in European countries. The increased cancer burden demands a new generation of radiation/clinical oncologist (RO/CO) that, besides a strong evidence-based oncological knowledge, will be ready for leadership in cancer care. The mutual recognition of professional qualifications of Radiation/Clinical Oncology in the EU needs training harmonization. The European Society of Radiotherapy and Oncology (ESTRO) and the European Union for Medical Specialties (UEMS) made important efforts toward a European Common Curriculum for RO/CO leadership in cancer care. If qualifications are mutually recognized, the training supporting these qualifications should be also harmonized. Since 1991, ESTRO produced several editions of the Core Curriculum in Radiation Oncology (1991, 2004, 2012, 2019). These Core Curricula were endorsed as European Training Requirements by the UEMS in 2004, 2013, and 2019. A core curriculum for clinical oncology was also produced to provide this harmonization tool to countries where radiation oncology is practiced inside the broader specialty of clinical oncology. New initiatives are in place to continuously adapt the training programs to the rapidly evolving cancer care organization.

Gender Differences in the Research Productivity of Radiation Oncology Resident Graduates in the United States: 2015 to 2019

PurposeIt is well-documented that gender disparities exist in academic radiation oncology departments. The purpose of this study was to analyze gender differences in research productivity during residency among recent graduates of radiation oncology training programs in the United States (US). Methods and MaterialsWe used several publicly available sources to create a database of US radiation oncology residents who graduated between 2015 and 2019. We systematically collected gender information from the National Plan and Provider Enumeration System National Provider Identifier Registry and Medicare claims registry. Postresidency employment information was collected using several publicly available sources. PubMed was queried to identify first-author publications of residents. A secondary analysis of metadata including impact factor, number of citations, modified Hirsch index (h index), and type of publication was performed. A multivariable linear regression was performed to evaluate the effect of gender on research productivity during residency. ResultsThere were 910 total graduates identified during this period and who were entered into this database, of whom all had available gender information. Female trainees comprised 29.0% (n = 264) of RO residents and had fewer first-author publications and citations, had lower mean modified h index, and were published in journals with lower impact factors. On multivariable linear regression analysis, female gender was independently associated with decreased total number of publications (P = .005), mean number of citations (P < .001), and modified h index (P = .001) when controlling for residency size and advanced (PhD or master's) degrees. ConclusionsIn the US, female RO trainees had lower research productivity, which was not explained by advanced degrees or residency size. A significant gender gap in trainee research productivity persists, which has known implications in terms of academic achievement, promotions, and career trajectory. Future interventions to improve resident research productivity and mentorship are warranted.

Brachytherapy training survey among radiation oncology residents in Europe

We aim to investigate the current state of brachytherapy (BT) training among the radiation oncology trainees in Europe. Material and methodsA 22-question online survey based on the one by the American Association of Radiation Oncology Residents (2017) with added queries pertinent to training in Europe was sent to 1450 residents in two iterations. These included site-specific training, volume of experience, barriers to training, institutional support, and preferences for further education. Responses to individual statements were given on a 1 to 5 Likert-type scale. The answers were reported by junior (≤3 years of training) and senior years of training (year of training 4/5/6 and junior staff).Descriptive statistics were used to describe frequencies. ResultsResidents from 21 European countries participated, 445 (31%) responded. 205 (47%) were senior residents. 60% residents consider that performing BT independently at the end of residency is very or somewhat important. Confidence in joining a brachytherapy practice at the end of residency was high or somewhat high in 34% of senior residents. They reported as barriers to achieving independence in BT to be lack of appropriate didactic/procedural training from supervisors (47%) and decreased case load (31%). 68% reported their program lacks a formal BT curriculum and standardized training assessment. ConclusionsResidents in Europe, feel independent BT practice is very or somewhat important, but do not feel confident they will achieve this goal. To address this gap, efforts are needed to develop and implement a formal and comprehensive BT curriculum with easy access to trained instructors.

Value-Based Cancer Care: How are We Training Future Radiation Oncologists on the Quality/Cost Equation?

<h3>Purpose/Objective(s)</h3> The cost of a cancer diagnosis has increasingly caused financially harm to many Americans. Calls have been made by the American Medical Association and others to educate physicians on value and affordability with the goal to improve patient care and contribute to systemic change. This study sought to evaluate how future physicians are educated on cost and value-based principles during their undergraduate medical education. As a terminal oncology residency, radiation oncologists were the focus. <h3>Materials/Methods</h3> An anonymous 18-question survey was developed by the study team to assess undergraduate medical education experiences on cost, quality, and value. A list of recently graduated (2016-2021) physicians was generated from residency applications; emails and Twitter handles were identified via publicly available data and contacted August 2021- February 2022 to complete the survey. <h3>Results</h3> Of 279 contacted, 62 (22.2% response rate) completed the survey. The graduation year breakdown was: 2016 (27.4%), 2017 (4.8%), 2018 (24.2%), 2019 (19.4%), 2020 (14.5%), and 2021 (9.7%). Respondents trained in the Northeast (32.3%), South (29.0%), Midwest (29.0%), and West (9.7%). Less than half had had a lecture on value in healthcare (46.8%, n=29) or costs (32.3%, n=20); only 16.1% (n=10) had a class on value, and for most of those (60%, n=6) it was elective. 98.4% (n=61) had previously met a patient unable to afford healthcare however only 9.7% (n=6) had a good idea of the charged/billed prices and even less (6.5%, n=4) had a good idea of the out-of-pocket costs for standard tests, procedures, and medications. Two-thirds (64.5%, n=40) indicated that the value or cost of a test, procedure, or medication was rarely or never discussed at the point of care. 48.4% (n=30) hadn't heard of the "Choosing Wisely" guidelines during medical school although 82.3% (n=51) were are least vaguely familiar with the concept of "financial toxicity". Most physicians (90.3%, n=56) felt their education about value, affordability, and cost was marginal or insufficient. The vast majority indicated they thought these topics are important for their patients (96.8%, n=60). <h3>Conclusion</h3> Most recent graduates training in radiation oncology have suboptimal education on cost, affordability, and value during medical school despite widespread interest. Few had had a class on these vital topics and most indicated that costs and value were rarely discussed when ordering tests or medications. These educational gaps likely contribute to their present vague understanding of either billed or out of pocket costs. Given rising health care costs, systemic reform of medical education will be required to educate the next generation of oncologists on the importance of value-based cancer care.

Evaluation of Simulation-Based Virtual Patient Encounters for Learning Oncologic Emergency Management

<h3>Purpose/Objective(s)</h3> Managing oncologic emergencies is a fundamental competency for radiation oncology trainees and is evaluated through an entrustable professional activity (EPA) in the competency-by-design curriculum. Simulation-based learning has been extensively studied in medical education as an effective learning strategy to support achieving specific clinical skill goals. This study aims to evaluate the effectiveness of virtual cases in improving trainee knowledge and readiness to assess oncologic emergencies. <h3>Materials/Methods</h3> Three virtual patient modules simulating common oncologic emergencies encountered throughout residency training in radiation oncology were developed using a simulation-based online learning platform. These modules include spinal cord compression, superior vena cava syndrome, and tumor-induced hemorrhage. Clinical vignettes were designed to mimic the clinical presentation and evolution of a patient exhibiting signs and symptoms of these common oncologic emergencies. Each module consisted of pre- and post-module questions compared to assess immediate knowledge acquisition. Questions focused on physical examination, imaging interpretation, staging, anatomy, epidemiology, differential diagnosis, prognostication, radiation planning, communication skills, and pertinent literature. We recruited radiation oncology residents from across Canada to participate over a 6-month period from June to December 2021. <h3>Results</h3> A total of 13 radiation oncology trainees across Canada (PGY2-6) completed 32 virtual patient scenarios. The modules were completed by junior residents (PGY2-3) 24 times and by senior residents (PGY4-6) 8 times. For all residents, the mean pre-module completion score was 66% (range 60-71%). Mean pre-module completion scores were 65% (range 63-68%) and 69% (range 50-80%) for junior and senior residents, respectively. Mean post-module completion scores were higher, at 92% (range 89-95%) for all residents, 92% (range 90-94%) and 91% (range 88-95%) for junior and senior residents, respectively. Pre-module completion scores were lowest for the tumor-induced hemorrhage scenario, identifying a potential knowledge gap. Resident feedback was unanimously positive, and residents reported that these online modules were useful for their learning. <h3>Conclusion</h3> Online virtual patient modules can be used as complementary learning and assessment tools in the management of different oncologic emergencies. There is a significant improvement in knowledge acquisition after completion of each module, and this improvement is seen across all years of residency. Overall, residents find this learning method useful.