US Radiation Oncology Residents Research Articles

MSOR09 Presentation Time: 8:40 AM: Individuals Who Graduate from a US Radiation Oncology Residency Program and Subsequently Complete a Brachytherapy Fellowship: Who Are They?

MSOR09 Presentation Time: 8:40 AM: Individuals Who Graduate from a US Radiation Oncology Residency Program and Subsequently Complete a Brachytherapy Fellowship: Who Are They?

Understanding Burnout Among US Radiation Oncology Residents

Burnout is a significant concern among medical residents in the United States, including those in radiation oncology. This study aims to understand the extent of burnout among radiation oncology residents and identify modifiable factors within program structure and benefits that may help improve overall wellness and reduce burnout. A Qualtrics-based survey was administered to US radiation oncology program directors and coordinators, utilizing contact information gathered in FREIDA, with a request to forward to all residents. The survey included questions on benefits and program structure as well as the Maslach Burnout Inventory. Data was analyzed using descriptive statistics. To date, 82 of 736 residents (11.1%) completed the survey with representation from all PGY-levels. Median participant age was 31, and 53% identified as male. 20% of surveyed residents feel emotionally drained from work a few times a week and 6% feel emotionally drained daily. 59% feel burned out from work at least a few times a month, with 6% feeling burned out daily. Despite this, 85% feel they are positively influencing other people's lives through their work at least weekly and 77% feel they have accomplished many worthwhile things in this job at least weekly. 65% have salaries between $60,000-$74,999, and 35% have the opportunity to moonlight for supplemental income. 49% have 3 weeks of vacation and 48% have 4 weeks. 27% reported their department had funded wellness events. 61% reported dual coverage rotations, with 40% requiring coverage of multiple attendings in one day. 65% reported protected academic time on all rotations, and 7% have no protected academic time. 48% of respondents have 12 months of research time. 85% and 36% of those with research and protected academic time, respectively, can complete this off-site. Respondent concerns include the job market (62%), declining personal fertility in residency (46%), and cost of living (40%). The most reported ways to decrease stress and anxiety were exercise (35%), a strong support system (34%), and spirituality (10%). Increased salary was identified as the top benefit that could improve wellness by 41 residents, while retirement matching (32), paid gym memberships (23), a personal wellness stipend (30), and free/subsidized childcare (16) were also ranked among the top 5 benefit changes that could improve wellness. Increased mid-level support (16), more protected academic time during the week (15), and flexibility with work location during academic/research time (13) were the top aspects of program structure that were reported as opportunities to improve wellness. Burnout is prevalent among US radiation oncology residents, and changes to residency programs and expanded institutional benefits are strongly perceived as the key components to improved resident wellness. This study highlights the need for further investigation into the root causes of burnout and the development of evidence-based strategies.

Integrating a Grassroots Well-Being Curriculum into a Radiation Oncology Residency Program

PurposeThe burnout rate among US radiation oncology residents was 33% in 2016. To our knowledge there are no published interventions addressing burnout among radiation oncology residents. We describe the implementation of a well-being curriculum, cocreated by a psychologist, a medical humanities professional, and radiation oncology attending and resident physicians. Methods and MaterialsRadiation oncology residents at our institution were surveyed to determine themes that induced burnout. A curriculum was developed, with monthly small group sessions focused on 1 identified topic. Sessions alternated between psychological tool-focused approaches and humanities exercises. These were led by a psychologist or medical humanities professional. Residents were given protected time to attend sessions during business hours. Participation was optional. Participants were assigned a random identifier, and the Stanford Professional Fulfillment Index (PFI) was assessed at baseline and 3-month intervals. PFI trends were analyzed after 1 year. At the end of the year, a focus group was held to evaluate work satisfaction and self-reported interactions with patients and coworkers. This information was used to improve the curriculum. ResultsAll 12 residents in the radiation oncology program participated in the curriculum. There was an equal number of residents of postgraduate years 2 through 5. Six of the participants were female. Of the participants, 11 completed the PFI. At baseline, 80% of residents met criteria for burnout. This decreased to 67%, 50%, and 33% at 3, 6, and 9 months, respectively. The proportion of residents meeting criteria for very good professional fulfillment was 30%, 56%, 38%, and 22% at baseline and 3, 6, and 9 months, respectively. On average, 9 of 12 residents attended each session. ConclusionsOur experience demonstrates the feasibility of collaborating with residents in the development of a well-being curriculum to cater programming to their needs, which we believe led to excellent engagement and attendance at each session.

The Rise of Open Access Journals in Radiation Oncology: Are We Paying for Impact?

<h3>Purpose/Objective(s)</h3> We aimed to examine how the rise of open access (OA) journals in biomedicine has impacted resident research in radiation oncology. <h3>Materials/Methods</h3> We built a comprehensive database of first-author, PubMed-searchable articles published by US radiation oncology residents who graduated between 2015 and 2019. We then classified each journal in which these manuscripts appeared as either OA or non-OA, and obtained the current article processing charge (APC) for every publication that appeared in an OA journal. Lastly, we performed a secondary analysis to identify the factors associated with publishing an article in an OA journal. <h3>Results</h3> The US radiation oncology residents in this study published 2,637 first-author, PubMed-searchable manuscripts, 555 (21.0%) of which appeared in 138 OA journals. The number of publications in OA journals increased from 0.47 per resident for the class of 2015 to 0.79 per resident for the class of 2019. Likewise, the number of publications in OA journals with a 2019 impact factor of zero increased from 0.14 per resident for the class of 2015 to 0.43 per resident for the class of 2019. Publications in OA journals garnered fewer citations than those in non-OA journals (8.9 versus 14.9, <i>P</i> < 0.01). 90.6% of OA journals levy an APC for original research reports (median $1,896), which is positively correlated with their 2019 impact factor (r = 0.63, <i>P</i> < 0.01). Aggregate APCs totaled $900,319.21 for all US radiation oncology residency programs and appeared to increase over the study period. <h3>Conclusion</h3> The number of first-author, PubMed-searchable manuscripts published by graduating US radiation oncology residents in OA journals rose significantly over the study period. US radiation oncology residency programs appear to be investing increasing and significant sums of money to publish the work of their residents in these journals. A more substantive discussion about the proper role of OA journals in resident research is needed.

United States Radiation Oncology Fellowship Growth From 2010 to 2020

To provide a comprehensiveanalysis of radiation oncology (RO) fellowship growth from 2010 to 2020. A collated database of RO fellowship programs and matriculants was created using (1) RO residency program (n=92) and graduate (n=2082) web searches, (2) prospective American Society for Radiation Oncology (ASTRO) Career Center postings database, (3) Association of Residents in Radiation Oncology Fellowship Directory, (4) RO fellowship survey data, (5) ASTRO Membership Directory, and (6) direct e-mail contact with fellowship program directors. Linear regression was used to assess the statistical significance of RO fellowship program, position, and matriculant growth over time. From 2010 to 2020, the number of RO fellowship programs and annual positions significantly increased from 20 to 37 (1.60 increase per year; 95% confidence interval, 1.32-1.89; P < .001) and 20 to 39 (1.81 increase per year; 95% confidence interval, 1.52-2.10; P < .001), respectively. The most commonly offered fellowship disciplines were proton therapy (n=10), brachytherapy (n=7), stereotactic radiosurgery/stereotactic body radiation therapy (n=6), general RO (n=5), and customizable to trainees' interests (n=3). Only 10 (27%) fellowships had a formal curriculum. All fellowships were unaccredited. Four (10.8%) programs were offered at institutions without an Accreditation Council for Graduate Medical Education-accredited RO residency training program, all established within the past 2 years. In addition, 54.8% (171 of 312) of available fellowship positions were filled between 2010 to 2020. Of these, 94 (55.0%) were graduates of US RO residency programs. The mean number of total fellows and US-residency trained fellows per year was 15 (range, 5-23) and 8 (range, 2-20), respectively. There was no significant increase in the number of annual matriculated fellows over time (P=.077). Among US-residency trained fellows, 27 (28.7%), 37 (39.4%), and 29 (30.9%) were from small (≤6), medium (7-12), and large (>12) residency programs, respectively. Twenty-eight (29.8%), 13 (13.8%), 25 (26.6%), and 27 (28.7%) trained in the Northeast, Midwest, South, and West, respectively. There has been significant growth in unaccredited RO fellowship programs and annual positions during the past decade, although the number of matriculants has remained stable. We report for the first time the recent establishment of fellowships at institutions without an Accreditation Council for Graduate Medical Education-accredited RO residency program. The impact of fellowship programs on the training of RO residents should be studied.

The Impact of COVID-19 on US Radiation Oncology Residents.

The purpose of our study is to assess the impact of COVID-19 on the clinical responsibilities, training, and wellness of US radiation oncology residents. An anonymous cross-sectional survey was sent to all 91 radiation oncology residency programs in the USA. The survey included questions related to demographics, changes in clinical duties and training, job prospects, and wellness indicators. Univariate and multivariate logistic regression analyses were used to evaluate factors associated with residents endorsing high satisfaction with their departments’ response to COVID-19. A total of 96 residents completed the survey from 67 US radiation oncology programs. In the multivariate logistic regression model, remote contouring (OR: 3.91 (95% CI: 1.11, 13.80), p = 0.03) and belief that one will be adequately trained to independently practice after completing residency (OR: 4.68 (1.12, 19.47), p = 0.03) were significantly associated with high resident satisfaction with their department’s response to COVID-19. Most residents indicated that hypofractionation was encouraged to a greater extent (n = 79, 82.3%), patients were triaged by disease risk (n = 67, 69.8%), and most agreed/strongly agreed that they have been provided with adequate personal protective equipment (PPE) (n = 85, 88.5%). The COVID-19 pandemic has affected the training and wellness of radiation oncology residents. Our analysis suggests that radiation oncology programs might increase resident satisfaction with their department’s response to COVID-19 by enabling remote contouring and working with residents to identity and remedy possible concerns regarding their ability to independently practice post residency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-01993-5.

Radiation Oncology Resident Research Productivity in the United States: 2015 to 2019

Multiple efforts have been made in recent years to establish national benchmarks for research productivity among US radiation oncology residents. Morgan etal found a mean of 1.01 first-author, PubMed-searchable articles published by US radiation oncology residents over 4 years of residency between 2002 and 2007, whereas Verma etal found a mean of 1.97 first-author, PubMed-searchable articles published by members of the graduating US radiation oncology residency classes of 2014 and 2015. In this study, we sought to establish new national benchmarks for US radiation oncology resident research productivity and characterize the scholarly work produced by graduating US radiation oncology residents. We built a database of US radiation oncology residents who graduated between 2015 and 2019 using multiple sources of publicly available data. We subsequently searched the PubMed database to identify all first-author publications for every resident in our database from the start of residency until 3 months after the completion of residency. Publications were categorized by type (original research, review, case report, or commentary) and content. We performed a secondary analysis to identify factors associated with an increased probability of publishing during residency. We identified 909 US radiation oncology residency graduates from 89 residency programs between 2015 and 2019. Collectively, these graduates published 2637 first-author, PubMed-searchable articles (mean: 2.90; median: 2.0; range, 0-58; interquartile range, 1-4) in 392 distinct peer-reviewed journals during their residency, and 69.7% of the first-author publications comprised original research. On multivariable analysis, only residency size was predictive of publishing a first-author manuscript during residency. Among residents with at least 1 first-author manuscript, male sex, lack of a doctorate degree, and residency size were all significant predictors of the number of first-author manuscripts published during residency. US radiation oncology resident research productivity, as measured by the number of first-author, PubMed-searchable publications, has increased compared with historical data. However, substantial variability exists in resident research productivity nationwide.

First Author Publications of US Radiation Oncology Residents Graduating Between 2015 and 2019

Scholarly work is seen as an increasingly important component of radiation oncology (RO) residency. In fact, most programs now provide residents with dedicated research time and support to augment clinical training. In this study, we sought to describe scholarly work among graduating RO residents nationwide in the modern era. Using publicly available information from the ARRO directory, residency program and hospital websites, we identified RO residents who graduated from ACGME-accredited residency programs in the United States between 2015 and 2019. We then queried PubMed to identify first-author peer-reviewed publications completed by each resident during residency. To account for publication lag after completing residency, articles published between January 1st of PGY-2 and December 31st of the year of graduation were included. Publications were downloaded and manually checked. We extracted meta-data, including journal name, impact factor, and articles citing the publication. Publications were classified into original articles, reviews, or commentary; original articles were further classified by type. Results were aggregated by individual and by residency program. This project was determined to be exempt human research by our IRB (19-02888). We identified 882 RO residents from 87 programs who produced 2683 first author publications (median 2; range 0-59; interquartile range (IQR) 1-4). 78% of residents authored ≥1 publication. The articles were published in 394 distinct peer-reviewed journals. The median 2018 impact factor was 3.13 (range 0-70.7, IQR 2.3-6.1), with the two most common journals being IJROBP (14%) and PRO (7%). 76% of publications were original scientific articles, 13.5% - reviews, and 10.5% - commentaries. Grant support was identified in 25% of original research publications. Within original research, 70% of studies were retrospective, of which 27% of data originated from a national database (e.g. NCDB/SEER). Additionally, 8% of publications were classified as case reports, 6% as physics/dosimetry, 4% as clinical trials, 4% as basic/translational science, 3% as surveys, 2% as economic analyses, and 1% as meta-analyses. We then grouped residency programs into quartiles of productivity. Residents from programs in the top quartile published a median of 3 publications per resident, while those from programs in the lowest quartile published a median of 1 publication per resident. The most productive program had a median of 7.5 publications per resident, while 13% of programs had a median of 0 publications per resident. Programs with higher average residency productivity tended to publish in journals with a higher impact factor (r = 0.41, p<0.001). Substantial variability exists in resident research productivity nationwide, both in terms of publication numbers and study design. These data serve as an important benchmark for first-author publications in RO residency.

Cross-Sectional Gender Analysis of US Radiation Oncology Residency Programs in 2019: More Than a Pipeline Issue?

PurposeThe purpose of this study is to assess the current status of gender disparities in academic radiation oncology departments in the United States and the associated factors. Methods and MaterialsThe data were collected from publicly available resources, including websites of individual radiation oncology programs, the Fellowship and Residency Electronic Interactive Database, the Accreditation Council for Graduate Medical Education, and the Association of American Medical Colleges. We collected data on the gender information of residents in each year (postgraduate years 2-5) and of the faculty (attendings, program director, and chair) during the academic year 2018 to 2019. Spearman’s rho test, Pearson’s chi-squared test, and Fisher exact tests were used for evaluating the correlation among variables using SPSS version 24. ResultsWomen constituted 30.8% of radiation oncology residents in the United States in 2019. Eight programs (12.5%) did not have any female residents in their programs, whereas 6 programs (9%) had women constituting more than half of their resident class. The fraction of female medical students applying to radiation oncology over the last 7 years varied between 27% and 33%. Female attending physicians accounted for 30.5% of all the attending physicians in the academic programs. In the leadership positions of the department, the gender gap was wider where only 19 (20%) and 11 (12%) of programs had female program director or chair, respectively. There was a positive correlation between the number of attending physicians and the number of female residents in programs (P = .01). ConclusionsA significant gender disparity continues to exist among the residents and physicians in the academic radiation oncology departments in the US. This disparity is pronounced in the leadership positions. The results of this study could be used as a benchmark to evaluate the progress that has been made by the efforts to improve gender disparities in radiation oncology.

Perceptions and Patterns in Academic Publishing: A Survey of United States Residents in Radiation Oncology

PurposeWe aimed to assess perceptions of, and training regarding, the publishing process among US radiation oncology (RO) residents, focusing on awareness and understanding of criteria for selecting appropriate and legitimate peer-reviewed journals for academic publishing. The growing challenge of predatory publication in the broader scientific realm and its relevancy to resident training is also briefly discussed. Methods and MaterialsA survey was opened to residents of all Accreditation Council for Graduate Medical Education–accredited RO programs in the United States, focusing on 3 categories: (1) demographics; (2) submission, peer review, and publication of academic research; and (3) subjective ranking of factors for choosing an appropriate publisher/journal. Results were stratified by level of training and number of publications. ResultsOverall, 150 of 690 residents (19.8%) responded, with a 98% (147 of 150) completion rate. Twenty of 150 residents (13.3%) reported formal training in manuscript preparation and choosing academic journals. Only 3.4% of residents reported departmental guidelines regarding publication in “predatory” journals; 57.7% were unsure. The 3 most important factors influencing publisher and journal choice were impact factor (ranked first for 59.0%), whether a journal is found in a major index (ranked first for 18.0%), and association with a reputable organization (ranked first for 17.0%). Importance of impact factor increased with number of publications (50% with 0 publications, 48.3% with 1-5, 63.9% with 5-10, 76.2% with 10-15, and 70.6% with >15). Cost considerations influenced journal choice at least once for 79 (52.7%) residents. ConclusionsImpact factor was the most important consideration for residents when choosing an appropriate publisher, with increased emphasis with increasing number of publications. A minority had formal training in choosing appropriate academic journals and knowing how to identify so-called predatory journals or were aware if their department has proscriptions regarding publication in such journals. Additional emphasis on formal training for RO residents in manuscript preparation and choosing academic journals is warranted.

Assessment of the Medical Schools Radiation Oncology Residents Come fom Suggests A Reasonable Approach for Diversifying the Workforce

The US radiation oncology (RO) workforce has significant underrepresentation of women, African Americans, and Latinos compared to the US population and medical school (MS) graduates. Our hypothesis is that this reflects inadequate RO exposure and mentoring for these students. Our objective was to better understand how MS and RO department demographics correlate with MS-specific residency match rates in RO. The ASTRO directory was used to search all RO physicians that self-identified as a “resident” and listed their MS. This included 507 residents, of which 36 who attended osteopathic or international schools were excluded. Demographic information for all 147 allopathic US medical schools and any on-site affiliated RO department and residency program was also collected from other freely accessible web resources. Spearman’s rank-order and Wilcoxon signed-rank tests were used for correlative analyses. A total of 100 schools (68%) had an affiliated RO department and 81 (55%) had a RO residency program. There was a median of 9 faculty members (interquartile range (IQR) 5 - 15) per RO department, with a median of 2 female faculty (IQR 1 - 5) and 0 African American or Latino faculty per department (IQR 0 - 1). In total, 26.5% of all US RO academic faculty were women and 4.4% African American or Latino. The median percentage of students per MS that matched in a RO residency was 0.4% (IQR 0.2 - 0.7%), and the median percentage of all US RO residents that came from each MS was 0.6% (IQR 0.2 - 1.1%). Both of these percentages were significantly higher when there was an affiliated RO department (p < 0.01) or RO residency program (p < 0.01), and for RO departments with more faculty members (rs = 0.45 and 0.43, p < 0.01), but there was no significant association with any MS factors assessed (percentages of women or underrepresented minority students, or average matriculating student MCAT scores or GPA). RO residents’ ethnicity could not be determined for analysis, however, the number of female RO faculty in a department predicted for significantly more female RO residents graduating from that MS (rs = 0.35, p<0.01), and the top quartile of RO departments with the most female faculty were affiliated with schools that graduated 49% of all female RO residents. Only 57 US RO residents (12%) graduated from the 47 schools without an affiliated RO department, whereas the 25 schools that graduated the highest percentage of US RO residents accounted for 46% of all RO residents. The proportion of students at a given MS that match into RO is strongly associated with affiliation to a larger RO department and residency program. As such, the majority of RO residents come from a select number of schools. Targeted education and mentoring outreach initiatives for schools with fewer affiliated RO faculty should be considered in order to help diversify the workforce.

Non-Clinical Time in Radiation Oncology Residency Programs: A National Survey of Program Structure and Resident Perspectives

Data regarding the amount and use of non-clinical time (NCT) in radiation oncology residency programs are scarce. We surveyed every US Radiation Oncology residency program to obtain benchmark data to inform decisions about optimal program structure. An anonymous, internet-based survey was distributed to all PGY5 residents at ACGME-accredited radiation oncology training programs. The survey consisted of 33 yes/no, Likert-scale, and free-response questions. Up to 2 reminder emails were sent to any resident who did not complete the survey. Program data were analyzed for all programs; those considered “top 10” per Doximity and those not considered “top 10.” Likert-scale responses were dichotomized as “not as satisfied” (1, 2, 3) or “very satisfied” (4, 5). 123 residents completed the survey (response rate 68%). Program specific data were obtained for 100% of programs (n=82). The vast majority of training programs (98%) provide residents with protected NCT. The median NCT was 10 months, 12 months, and 9 months in all 82 programs, “top 10” programs, and not “top 10” programs, respectively (p=0.03). Most (68%) of programs reported having more than 6 months of NCT. The median number of publications resulting from NCT did not differ significantly between residents who had 9 or fewer months compared to 10 or more months of NCT (p=0.07). The proportion of residents who reported wanting more NCT increased as the amount of time decreased (100%, 73%, 52%, and 19% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.01). The proportion of residents who reported being very satisfied with NCT flexibility increased with more NCT (50%, 58%, 79%, and 94% for 1-3 , 4-6 , 7-9 , and 10-12 months, respectively; p=0.04) as did proportion of residents very satisfied with accomplishment during NCT (0%, 35%, 53%, and 73% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=.03). When asked whether residents would theoretically want to give up their NCT to shorten their residencies, the proportion of residents willing to shorten their residencies decreased as amount of NCT increased (100%, 57%, 47%, and 33% for 1-3, 4-6, 7-9, and 10-12 months respectively; p=0.02) Residents with more NCT reported placing more importance on amount of NCT while making rank lists (0%, 37%, 51%, and 73% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.04) and less frequently desired to change the importance of this factor in their rank list decision retrospectively (100%, 50%, 41%, and 25% for 1-3, 4-6, 7-9, and 10-12 months, respectively; p=0.03). Most residency programs dedicate > 6 months of non-clinical time to residents. In addition, > 50% of residents value the experience from their non-clinical time such that they would not trade it to shorten their residency if given the option. Programs should maintain an emphasis on such time and implement measures to ensure meaningful resident experiences.

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

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

Brachytherapy Training Survey of Radiation Oncology Residents

As brachytherapy utilization rates decline, we sought to evaluate the state of brachytherapy training during radiation oncology residency. US radiation oncology residents in the Association of Residents in Radiation Oncology database were sent an online questionnaire regarding brachytherapy training. Survey questions addressed a wide array of topics, and responses were often given on a 1 to 5 Likert-type scale that reflected strength of opinion. Postgraduate year (PGY) 4/5 respondents' answers were analyzed. Descriptive statistics were generated, and rank correlation analyses (Kendall's τ coefficient and Wilcoxon signed-rank test) were used for comparisons. The survey was completed by 145 of 567 residents (62% being PGY4/5). Of PGY4/5 respondents, 96% (86 of 90) believed learning brachytherapy during residency was important, and 72% (65 of 90) felt their program valued brachytherapy training. Resident brachytherapy comfort varied by site, decreasing as follows: gynecologic, prostate, breast, skin. The current intracavitary 15-case minimum was believed adequate by most, but only a minority believed the 5-case interstitial minimum was adequate. Most respondents (59%) believed that caseload was the greatest barrier to achieving independence in brachytherapy. Significant support exists for American Brachytherapy Society training courses and on-the-job education to enhance training, but enthusiasm about pursuing brachytherapy fellowship training was low. Most respondents expressed confidence in developing a brachytherapy practice (54%); however, this was significantly lower than the rate of those confident in developing a stereotactic body radiation therapy/stereotactic radiosurgery program (97%) (P<.001). Furthermore, there was an association between aggregate number of brachytherapy cases performed and resident confidence in starting a brachytherapy practice (τ=0.37; P<.001). Brachytherapy is an important component of residency training that is valued by residents and programs. Because caseload was the greatest perceived barrier in brachytherapy training, with confidence correlated with case volume, attempts should be made to expand opportunities for training experiences that are feasible to complete during residency.

Importance of First and Second Authorship in Assessing Citation-Based Scholarly Activity of US Radiation Oncology Residents and Subsequent Choice of Academic Versus Private Practice Career

PurposeThe Hirsch index (h-index) has been shown to correlate with radiation oncology residents’ having a first job in academics versus private practice, but it is limited by its inability to distinguish between the differing significance of coauthor roles in articles. MethodsA list of 2016 radiation oncology resident graduates and their postresidency career choices was compiled. The Scopus bibliometric citation database was then searched to collect h-index data for articles limited to first author only (hf) and first or second-author only (hs) for each resident. ResultsMean hf was 2.06 for all resident graduates, and mean hs was 2.77. Residents with PhDs had significantly higher hf (3.11 versus 1.76, P < .01) and hs (4.50 versus 2.28, P < .01). There was no statistically significant difference between male and female residents for hf (2.19 versus 1.61, P = .11) or hs (2.91 versus 2.25, P = .15). Residents choosing academia had higher hf (2.72 versus 1.44, P < .01) and hs (3.57 versus 2.01, P < 0.01) than those in private practice. Fewer than 20% of graduates with hf = 0 and only 10% of graduates with hs = 0 secured academic jobs. ConclusionThe average radiation oncology resident graduate has published a minimum of two first- and/or second-author articles cited at least twice. Graduates with PhDs and/or choosing academic careers were more likely to have higher hf and hs scores; there was no significant score difference by gender. Only 10% of graduates without any first- and/or second-author articles cited at least once secured academic jobs. These findings indicate that stratifying publications by first or second authorship when developing benchmarks for evaluating resident productivity and postresidency career type may be useful.

Introductory Radiation Oncology Curriculum: Report of a National Needs Assessment and Multi-institutional Pilot Implementation

To assess the optimal structure of an introductory curriculum (IC) for radiation oncology residents, including the perceived utility of a 2-day off-site "boot camp," and evaluate the success of a pilot introductory radiation oncology curriculum (IROC) based on these initial data. In the first phase, anonymous, web-based surveys were sent to US radiation oncology program directors and residents. Likert-type scores (1, not at all; 5, extremely) are reported as the median and interquartile range. Using the phase 1 results, IROC was developed, piloted, and evaluated. Of the 89 program directors and 697 residents, 47 (53%) and 165 (24%) responded, respectively. Of the 89 program directors, 37 (79%) reported offering a formal IC. However, only 83 residents (50%) reported having a formal IC. Program directors reported resident preparation for clinical training as "moderate" (median 3, interquartile range 2-3) on entering residency and "moderate" (median 3, interquartile range 3-4) after IC completion (P=.03). However, residents only believed they were "slightly" prepared (median 2, interquartile range 1-2) on entering residency and "moderately" (median 3, interquartile range 2-3) prepared after IC completion (P<.01). Program directors believed an off-site boot camp would be of "moderate" utility (median 3, interquartile range 3-4) with participation limited by funding (57%). Residents without an IC reported that having an IC would be "quite" beneficial (median 4, interquartile range 3-5). Residents preferred instruction before the clinical training (49%) and over 1week (40%). Both program directors and residents rated lectures on radiation emergencies and simulation highly. Using these data, IROC was developed and piloted with incoming residents at 4 institutions. After IROC, residents reported improvement in overall preparedness for clinical training (before: median 1, interquartile range 1-2; vs after: median 3, interquartile range 2-3; P<.01) and among specific practice domains. Beginning radiation oncology residents frequently lack structured introductory curricula but desire instruction before the clinical training with a focus on practical aspects (emergency management, contouring). Program directors recognize the value of both off-site and on-site boot camps. An on-site IC could mitigate funding barriers. A standardized IC, IROC, piloted at 4 programs, showed promising outcomes.

Burnout Evaluation of Radiation Residents Nationwide: Results of a Survey of United States Residents

Toassess rates of burnout among US radiation oncology residents and evaluate program/resident factors associated with burnout. A nationwide survey was distributed to residents in all US radiation oncology programs. The survey included the Maslach Burnout Index-Human Services Survey (MBI-HSS) as well as demographic and program-specific questions tailored to radiation oncology residents. Primary endpoints included rates of emotional exhaustion, depersonalization, and personal accomplishment from MBI-HSS subscale scores. Binomial logistic models determined associations between various residency/resident characteristics and high burnout levels. Overall, 232 of 733 residents (31.2%) responded, with 205 of 733 (27.9%) completing the MBI-HSS. High levels of emotional exhaustion and depersonalization were reported in 28.3% and 17.1%, respectively; 33.1% experienced a high burnout level on at least 1 of these 2 MBI-HSS subscales. Low rates of personal accomplishment occurred in 12% of residents. Twelve residents (5.9%) reported feeling "at the end of my rope" on a weekly basis or more. On multivariable analysis there was a statisticallysignificant inverse association between perceived adequacy of work-life balance (odds ratio 0.37; 95% confidence interval 0.17-0.83) and burnout. Approximately one-third of radiation oncology residents have high levels of burnout symptoms, consistent with previous oncology literature, but lower levels than those among physicians and residents of other specialties. Particularly concerning was that more than 1 in 20 felt "at the end of my rope" on a weekly basis or more. Targeted interventions to identify symptoms of burnout among radiation oncology residents may help to prevent the negative downstream consequences of this syndrome.

Radiation oncology resident palliative education

PurposeAlthough palliative care is recognized as integral to oncology care, limited data exist regarding the extent to which palliative care training is incorporated into radiation oncology residency training in the United States. We aim to characterize US radiation oncology residents’ perceived palliative care educational needs and experience to guide future palliative oncology educational interventions. Methods and materialsAn 8-person expert panel developed a survey to assess resident perceptions of generalist palliative care education within radiation oncology residency. Domains of palliative oncology education, derived from national guidelines, included symptom management (pain and non-pain), communication about goals of care, advance care planning, psychosocial issues, cultural considerations, spiritual needs, care coordination, and ethical/legal issues. Residents rated adequacy of their training and their perceived competency in each domain. A total of 433 US radiation oncology residents were identified for participation; 404 completed the survey (response rate, 93%). ResultsResidents characterized themselves as “not at all/minimally/somewhat confident” in their ability to take care of patients with palliative care issues in the following domains: symptom management (36% pain, 44% non-pain), communication about goals of care (31%), advance care planning (48%), psychosocial (55%), cultural (22%), spiritual (44%), care coordination (50%), and ethical/legal (50%). On average, 79% of residents rated their training as “not/minimally/somewhat” adequate across all domains. Most (96%) view palliative care as an important competency within radiation oncology and 81% desire more palliative care education. ConclusionsAlthough the majority of residents view palliative care as an important competency for radiation oncologists, a majority perceived their educational training as inadequate across multiple domains. Most residents desire further palliative oncology care training. These findings suggest efforts should be made to improve palliative care education during radiation oncology training.

Program director and chief resident perspectives on the educational environment of US radiation oncology programs

PurposeOur goals were toexamine the educational approachesused at radiation oncology residency programs nationwide andto evaluate program director(PD) and chief resident (CR) perceptions of their educational environment. Methods and materialsWe distributed a survey regarding curricular structure via email toall identified US radiation oncology residency PDs and CRs. Pearson χ2 test was used toevaluate whether differences existed between answers provided by the 2 study populations. ResultsThe survey was disseminated to 200 individuals in 85 US residency programs: 49/85PDs(58%)and 74/115 (64%)CRs responded. More than one-half of PDs and CRs report that attending physicians discussed management, reviewed contours, and conducted mock oral board examinations with the residents. At nearly 50% of programs, the majority of teaching conferences use a lecture-based approach, whereas only 20% reported predominant utilization of the Socratic method. However, both PDs (63%) and CRs (49%) reported that Socratic teaching is more effective than didactic lectures (16% and 20%, respectively), with the remainder responding that they are equally effective. Teaching sessions were reported to be resident-led ≥75% of the time by 50% of CRs versus 18% of PDs (P = .002). Significantly more CRs than PDs felt that faculty-led teaching conferences were more effective than resident-led conferences (62% vs 26%, respectively; P < .001). There was a difference in perception regarding the protection of educational time, with 85% of PDs versus 59% of CRs reporting this time as being “never” or “infrequently” compromised by clinical duties (P = .005). ConclusionsThere is considerable variability between PDs and CRs in the perceived structure and effectiveness of resident education in US radiation oncology residency programs. These data suggest opportunity for improvement in radiation oncology residency training, such as encouraging more faculty-led, Socratic-based teaching conferences. Increased communication between PDs and CRs can better align perceptions with educational goals.

Results of the 2013-2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States

The purpose of this project was to survey radiation oncology chief residents to define their residency experience and readiness for independent practice. During the academic years 2013 to 2014 and 2014 to 2015, the Association of Residents in Radiation Oncology (ARRO) conducted an electronic survey of post-graduate year-5 radiation oncology residents in the United States during the final 3 months of training. Descriptive statistics are reported. Sixty-six chief residents completed the survey in 2013 to 2014 (53% response rate), and 69 completed the survey in 2014 to 2015 (64% response rate). Forty to 85% percent of residents reported inadequate exposure to high-dose rate and low-dose rate brachytherapy. Nearly all residents in both years (>90%) reported adequate clinical experience for the following disease sites: breast, central nervous system, gastrointestinal, genitourinary, head and neck, and lung. However, as few as 56% reported adequate experience in lymphoma or pediatric malignancies. More than 90% of residents had participated in retrospective research projects, with 20% conducting resident-led prospective clinical trials and 50% conducting basic science or translational projects. Most chief residents reported working 60 or fewer hours per week in the clinical/hospital setting and performing fewer than 15 hours per week tasks that were considered to have little or no educational value. There was more than 80% compliance with Accreditation Council for Graduate Medical Education (ACGME) work hour limits. Fifty-five percent of graduating residents intended to join an established private practice group, compared to 25% who headed for academia. Residents perceive the job market to be more competitive than previous years. This first update of the ARRO chief resident survey since the 2007 to 2008 academic year documents US radiation oncology residents' experiences and conditions over a 2-year period. This analysis may serve as a valuable tool for those seeking to improve training of the next generation of oncology leaders.