Radiation oncology as part of medical education-current status and possible digital future prospects

Defining the student perspective on radiation oncology-an analysis of factors influencing medical students' decisions for specialized training

PURPOSE

The new Medical Licensing Regulations 2025 in Germany demand a longitudinal and interdisciplinary oncological curriculum for the future of medical education. Small disciplines like radiation oncology (RO) tend to be underrepresented in the general curriculum, which complicates attracting new residents and doctoral candidates to the field. To bridge this gap, our university successfully implemented a multidisciplinary training for preclinical semesters combining anatomical and RO knowledge. The following study addresses students' perceptions of RO and learning success in the setting of a mandatory preclinical course.

METHODS

A quantitative single-center cross-sectional study with 106 students was conducted via online questionnaire before and after a 1-week semester course in anatomy and RO. The analysis was conceptualized using descriptive statistical methods and the expectancy-value model according to Eccles and Wigfield.

RESULTS

Overall, 106 (73 female, 33 male) students with a mean age of 21.8 years took part in the first survey. Advanced courses during finals and gender had no effect on interest in RO. However, it could be shown that the understanding of RO (p < 0.0001), knowledge about patients who need to be referred to RO (p < 0.0001), and the interest in specialty training in RO (p < 0.0001) significantly increased during the course. The students' perceptions of specialty training in RO remained stable before and after the course.

CONCLUSION

This is the first study on the influence factors for students' decisions to pursue a specialized training in RO. Students' expectations regarding a good specialty training are well represented in RO, and the implementation of preclinical courses significantly increases the knowledge about RO and the level of interest regarding a specialty training in RO.

Digital redesign of the radiotherapy course for medical students with a blended learning approach

PURPOSE

Due to the need for high-quality teaching, we present a new blended learning concept combining digital modules, interactive seminars, and clinical experience. Furthermore, we evaluated its acceptance among students.

METHODS

A new concept for teaching was applied to the radiotherapy module and made available via the Hannover Medical School (MHH) learning management system as part of a blended learning concept with educational films, multimedia learning modules, online seminars, and onsite practical training. The evaluation recorded assessments of the requirement profile, design, and opportunities for skills acquisition; evaluation of the seminar and internship; and questions on the overall assessment.

RESULTS

The new concept was applied to four passes in the fourth academic year. A total of 152 students completed the radio-oncology learning module, which was evaluated by 46 students. Forty students considered the course duration to be appropriate for the material covered, and most students stated that their prior knowledge had been sufficient. The level of difficulty of the content was rated by the students as somewhat too high. The design of the digital course, the opportunity to acquire skills, the seminar course, and the practical course were mostly rated positively.

CONCLUSION

Through digital redesign, a teaching concept can be implemented that combines self-determined learning, professional exchange with doctors, and clinical practice experience. The concept can be transferred to other areas because it combines theoretical knowledge transfer with synchronous teaching and clinical experience. The results of the evaluation show that the students rated the new concept well.

German radiation oncology's next generation: a web-based survey of young biologists, medical physicists, and physicians-from problems to solutions

BACKGROUND

Radiation science is of utmost significance not only due to its growing importance for clinical use, but also in everyday life such as in radiation protection questions. The expected increase in cancer incidence due to an aging population combined with technical advancements further implicates this importance and results in a higher need for sufficient highly educated and motivated personnel. Thus, factors preventing young scientists and medical personnel from entering or remaining in the field need to be identified.

METHODS

A web-based questionnaire with one general and three occupation-specific questionnaires for physicians, biologists, and medical physicists working in radiation oncology and research was developed and circulated for 6 weeks.

RESULTS

While the overall satisfaction of the 218 participants was quite high, there are some points that still need to be addressed in order to ensure a continuing supply of qualified personnel. Among these were economic pressure, work-life balance, work contracts, protected research time, and a demand for an improved curriculum.

CONCLUSION

Mentoring programs, improved education, and strengthening the value of societies in radiation sciences as well as translational approaches and more flexible working arrangements might ensure a high-quality workforce and thus patient care in the future.

A Comprehensive Perspective on Educational and Economic Barriers for Utilization of Palliative Radiation Therapy in Hospice: A Narrative Review

Purpose

Despite the agreed-on efficacy and benefits of palliative radiation therapy (PRT) to alleviate end-of-life complications related to cancer progression, PRT remains an underused treatment in the hospice-care setting.3-4,6-7 Common barriers for hospice patient use of PRT include educational and economic limitations. This paper discussed these barriers and ways to eliminate them based on previously published interventions.

Methods and Materials

Literature search on PubMed; 30 articles were selected by the authors. All articles included are published after the year 2000 in peer reviewed journals.

Results

Educational barriers for medical practitioners outside radiation oncology can be addressed by creating formal education programs that reduce knowledge gaps previously identified by survey-based research studies. For radiation oncologists, continued education should focus on increasing competence and comfort with end-of-life conversations and indications for use of single-fraction radiation for patients with advanced cancer. More information on radiation oncology options should be provided to patients. As for economic barriers, rapid-access programs that use advanced level practitioners can increase PRT access by the hospice population. Also, these programs can increase use of single-fraction radiation therapy (SFX RT) in patients with a shorter projected prognosis. SFX RT is beneficial in this setting because it decreases hospice expense and is as efficacious at palliating pain in patients with advanced cancer as multiple-fraction radiation.

Conclusions

The barriers of education and economic limitations can be addressed by: expanding the PRT curriculum for all practicing physicians, improving radiation oncologist palliative care knowledge, increasing PRT resources for patients, increasing number of rapid-access radiation therapy programs, and, when indicated, encouraging use of single-fraction radiation treatment for hospice patients.

Successful implementation of online educational lectures of the German Society for Radiation Oncology (DEGRO)

PURPOSE

Modern digital teaching formats have become increasingly important in recent years, in part due to the COVID-19 pandemic. In January 2021, an online-based webinar series was established by the German Society for Radiation Oncology (DEGRO) and the young DEGRO (yDEGRO) working group. In the monthly 120-minute courses, selected lecturers teach curricular content as preparation for the board certification exam for radiation oncology.

METHODS

The evaluation of the 24 courses between 01.2021 and 12.2022 was performed using a standardized questionnaire with 21 items (recording epidemiological characteristics of the participants, didactic quality, content quality). A Likert scale (1-4) was used in combination with binary and open-ended questions.

RESULTS

A combined total of 4200 individuals (1952 in 2021 and 2248 in 2022) registered for the courses, and out of those, 934 participants (455 in 2021 and 479 in 2022) later provided evaluations for the respective courses (36% residents, 35% specialists, 21% medical technicians for radiology [MTR], 8% medical physics experts [MPE]). After 2 years, 74% of the DEGRO Academy curriculum topics were covered by the monthly webinars. The overall rating by participants was positive (mean 2021: 1.33 and 2022: 1.25) and exceeded the curriculum offered at each site for 70% of participants. Case-based learning was identified as a particularly well-rated method.

CONCLUSION

The DEGRO webinar expands the digital teaching opportunities in radiation oncology. The consistently high number of participants confirms the need for high-quality teaching and underlines the advantages of e‑learning methods. Optimization opportunities were identified through reevaluation of feedback from course participants. In its design as a teaching format for a multiprofessional audience, the webinar series could be used as a practice model of online teaching for other disciplines.

Impact of Practical Online Lessons on Chinese Medical Students' Perception of Radiation Oncology

Radiotherapy is an essential component of oncology treatment. It is imperative that clinicians and medical students have a fundamental understanding of radiotherapy. However, radiation oncology education is deficient worldwide. This study introduced an hour-long online Massive Open Online Course (MOOC) as a supplement to the basic curriculum for 8-year medical students at Peking Union Medical College and Tsinghua University in China. The students' personal opinions and comprehension of radiation oncology therapy were assessed through pre- and post-test questionnaires before and after the MOOC study. The results indicated that the percentage of students interested in radiotherapy increased, and their knowledge of radiotherapy significantly improved after the online MOOC study, suggesting that short-term MOOC study may stimulate students' interest in learning and improving their knowledge of radiation therapy. The study suggests that the combination of online and offline teaching may be a feasible way to develop radiation oncology education in the future.

Principles of oncology taught in a one-week course

BACKGROUND

Growing challenges in oncology require evolving educational methods and content. International efforts to reform oncology education are underway. Hands-on, interdisciplinary, and compact course formats have shown great effectiveness in the education of medical students. Our aim was to establish a new interdisciplinary one-week course on the principles of oncology using state-of-the-art teaching methods.

METHODS

In an initial survey, medical students of LMU Munich were questioned about their current level of knowledge on the principles of oncology. In a second two-stage survey, the increase in knowledge resulting from our recently established interdisciplinary one-week course was determined.

RESULTS

The medical students' knowledge of clinically important oncological topics, such as the diagnostic workup and interdisciplinary treatment options, showed a need for improvement. Knowledge of the major oncological entities was also in an expandable state. By attending the one-week course on the principles of oncology, students improved their expertise in all areas of the clinical workup in oncology and had the opportunity to close previous knowledge gaps. In addition, students were able to gain more in-depth clinical knowledge on the most common oncological entities.

CONCLUSION

The interdisciplinary one-week course on the principles of oncology proved to be an effective teaching method to expand the knowledge of the future physicians to an appropriate level. With its innovative and interdisciplinary approach, the one-week course could be used as a showcase project for the ongoing development of medical education in Germany.

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

BACKGROUND

The 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.

METHODS

The 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.

RESULTS

Overall, 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.

CONCLUSION

The 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.

Teaching communication skills in medical education : Best practice example of an interdisciplinary seminar in radiation oncology

BACKGROUND

Communication with patients is challenging, especially in radiation oncology. Therefore, radiation oncology is particularly suited to sensitize medical students for this topic and to train them competently. We report on experiences with an innovative teaching project for fourth- and fifth-year medical students.

MATERIALS AND METHODS

The course, funded as an innovative teaching project by the medical faculty, was offered as an optional course for medical students in 2019 and again in 2022 after a pandemic-related break. The curriculum and evaluation form were developed through a two-stage Delphi process. The course consisted of, first, participation during counselling of patients prior to radiotherapy, mainly on topics with shared decision-making, and, second, a 1-week interdisciplinary block seminar with practical exercises. The topics covered a broad spectrum of the competence areas defined in the National Competence-Based Learning Objectives Catalog for Medicine (NKLM). The number of participants was limited to approximately 15 students because of the practical components.

RESULTS

So far, 30 students (all at least in the seventh semester or higher) have participated in the teaching project. The most frequent reasons for participation were the desire to acquire competence in breaking bad news and confidence in talking to patients. The overall evaluation of the course was very positive, with a grade of 1.08 + 0.28 (on a scale of 1 = totally agree to 5 = totally disagree) plus German grade 1 (very good) to 6 (very bad). Notably, participants' expectations regarding specific competencies (e.g., breaking bad news) were also met.

CONCLUSION

Although the evaluation results cannot be generalized to the entirety of medical students due to the limited number of voluntary participants, the very positive evaluation shows the need for such projects among students and can also be seen as an indication that radiation oncology as a patient-centered discipline is particularly well suited to teach medical communication.

'Hold the course(s)!' - a qualitative interview study of the impact of pandemic-triggered contact restrictions on online instruction in community-based family medicine teaching

The COVID-19 pandemic has been identified as a catalyst for the digitalization of medical education. Less is known about the specific impact of the pandemic on decentralized, community-based education, such as in General Practitioner practices. The aim of this study is to understand the impact of the digital transformation process, triggered by the COVID-19 pandemic. As, family medicine courses involve both university-based and community-based teaching, this study focuses the mode and quality of instruction and instructors in family medicine teaching. A qualitative interview study was conducted. The participants (N = 12) of a multi-perspective Quality Circle in family medicine teaching were interviewed twice: first, in 2019, about digitalization in family medicine teaching in Tübingen, Germany, not yet aware of the global changes and local transformation that would take place shortly thereafter. Second, in a follow-up interview in 2020 about the transition process and digitalization following the impact of contact restrictions during the pandemic. Grounded Theory was used as a qualitative research approach to analyze the complex processes surrounding this transformation. By analyzing the interviews with various stakeholders of community and university-based teaching, a model for the digital transformation process of family medicine teaching at the University of Tübingen in response to an external stimulus (the pandemic) was developed. It involves six chronological steps: "The calm before the storm," "The storm hits," "All hands on deck," "Adrift," "Reset course," and "The silver lining." This model seeks to understand the process of digital transformation and its impact on the teaching institution (medical faculty of the University of Tübingen, Institute for General Practice and Interprofessional Health Care) and instructors from an integrated perspective and thereby critically revisits prior concepts and opinions on the digitalization of medical teaching. Insights gained are presented as key messages.

Teaching in radiation oncology: now and 2025-results of a focus group with medical students

PURPOSE

In Germany, the new Licensing Regulations for Physicians 2025 (Ärztliche Approbationsordnung, ÄApprO) define a binding legal framework on the basis of which medical faculties modernize their curricula. Since 2015, the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog 2.0., NKLM) formulates competencies and learning objectives to be achieved in the course of studies as curriculum orientation for the medical faculties. In addition, about 80% of the areas of a new core curriculum are to be made compulsory. A needs analysis in the target group of students has not yet taken place for the subject of radiation therapy (RT) or radiation oncology (RO). This study therefore surveys the experiences and requirements of students regarding medical education in RT.

METHODS

Qualitative single-center study using a semistructured in-depth focus group with 11 medical students (20-26 years; 6 female, 5 male) was conducted. Brainstorming sessions were conducted in small groups and individually; oral contributions were recorded, transcribed, and analyzed using qualitative content analysis according to Mayring. Results were compared with the content of the future curriculum and reviewed for congruence with current expert recommendations of the German Society of Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO).

RESULTS

The plans to develop a longitudinal and practice-oriented curriculum was positively received by students. Specifically, students wanted to introduce the basics of RT as an early link to practice in preclinical teaching units. The necessary acquisition of communicative skills should also be taught by lecturers in RO. Methodologically, regular digital survey tools for self-monitoring, discussion rooms, and problem-based learning were named. In the perception of students, the subject appears underrepresented in relation to its relevance in the multimodal therapy of oncological diseases.

CONCLUSION

Results of the needs analysis for the subject of RT are consistent with ÄApprO, NKLM, and DEGRO. Moreover, they complement them and should be considered in the curriculum development of Masterplan Medical Education 2020 (Masterplan Medizinstudium 2020). The results contribute to high-quality and target-group-oriented medical training in the subject of RT, increased visibility, and thus early bonding of future physicians to RO in Germany.

Mobile applications in radiation oncology-current choices and future potentials

PURPOSE

To review existing scientific literature on mobile applications (apps) in the field of radiation oncology and to evaluate characteristics of commercially available apps across different platforms.

METHODS

A systematic review of the literature for publications presenting apps in the field of radiation oncology was carried out using the PubMed database, Cochrane library, Google Scholar, and annual meetings of major radiation oncology societies. Additionally, the two major marketplaces for apps, App Store and Play Store, were searched for available radiation oncology apps for patients and health care professionals (HCP).

RESULTS

A total of 38 original publications which met the inclusion criteria were identified. Within those publications, 32 apps were developed for patients and 6 for HCP. The vast majority of patient apps focused on documenting electronic patient-reported outcomes (ePROs). In the two major marketplaces, 26 apps were found, mainly supporting HCP with dose calculations.

CONCLUSION

Apps used in (and for) scientific research in radiation oncology are rarely available for patients and HCP in common marketplaces.

Development, implementation, and results of a simulation-based hands-on brachytherapy workshop for medical students

PURPOSE

The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) require the development of competence-oriented teaching formats. In addition, there is a great need for high-quality teaching in the field of radiation oncology, which manifests itself already during medical school. For this reason, we developed a simulation-based, hands-on medical education format to teach competency in performing accelerated partial breast irradiation (APBI) with interstitial multicatheter brachytherapy for early breast cancer. In addition, we designed realistic breast models suitable for teaching both palpation of the female breast and implantation of brachytherapy catheters.

METHODS

From June 2021 to July 2022, 70 medical students took part in the hands-on brachytherapy workshop. After a propaedeutic introduction, the participants simulated the implantation of single-lead catheters under supervision using the silicone-based breast models. Correct catheter placement was subsequently assessed by CT scans. Participants rated their skills before and after the workshop on a six-point Likert scale in a standardized questionnaire.

RESULTS

Participants significantly improved their knowledge-based and practical skills on APBI in all items as assessed by a standardized questionnaire (mean sum score 42.4 before and 16.0 after the course, p < 0.001). The majority of respondents fully agreed that the workshop increased their interest in brachytherapy (mean 1.15, standard deviation [SD] 0.40 on the six-point Likert scale). The silicone-based breast model was found to be suitable for achieving the previously defined learning objectives (1.19, SD 0.47). The learning atmosphere and didactic quality were rated particularly well (mean 1.07, SD 0.26 and 1.13, SD 0.3 on the six-point Likert scale).

CONCLUSION

The simulation-based medical education course for multicatheter brachytherapy can improve self-assessed technical competence. Residency programs should provide resources for this essential component of radiation oncology. This course is exemplary for the development of innovative practical and competence-based teaching formats to meet the current reforms in medical education.

Digital transfer in radiation oncology education for medical students-single-center data and systemic review of the literature

PURPOSE

Modern medical education demands innovative, competence-orientated concepts. The forced digital transfer of teaching due to the coronavirus pandemic also affected radiation oncology (RO). The following analysis investigates whether the attractivity of RO teaching at our faculty could be maintained during the pandemic and which possibilities exist to involve students (in active learning). The latter aspect is further elaborated on a broader scale by a systemic review of the literature on competence-orientated digital education.

METHODS

Evaluation results and participation rates of clinical lectures in radiation oncology (RO) were analyzed between the winter semester 2018/2019 and the summer semester 2021. A systemic review of the literature on digital education in RO for medical students was conducted.

RESULTS

Concerning evaluation results, a significant improvement for the 7th and 9th semesters was observed in comparison between the pre-pandemic and pandemic semesters (p = 0.046 and p = 0.05, respectively). Overall participation rates did not differ. However, the number of students attending > 75% of classes in the respective semester increased significantly between the pre-pandemic and pandemic period (median values: 38 vs. 79%, p = 0.046; 44 vs. 73%, p = 0.05; 45 vs. 64%, p = 0.05; 41 vs. 77%, p = 0.05; 41 vs. 71%, p = 0.05, for the 6th to 10th semester, respectively).

CONCLUSION

The analysis demonstrates the possibility of efficient digital transfer of a core curriculum in RO to the digital era, with a more continuous participation of students. This transfer may enable amelioration of teaching quality and the introduction of innovative and interactive concepts in accordance with the literature.

Education in Radiation Oncology-Current Challenges and Difficulties

The evolution and development of radiotherapy in the last two decades has meant that postgraduate medical training has not kept up with this rapid progress both in terms of multidisciplinary clinical approaches and especially in terms of technological advances. Education in radiation oncology is a major priority in the context of the rapid development of radiotherapy, including advanced knowledge of radiobiology, radiation physics and clinical oncology, anatomy, tumor biology and advanced medical imaging. In this context, the lack of training in radiation oncology in the curricula of medical faculties may have detrimental consequences for the training of residents in radiotherapy but also in their choice of specialty after completing their university studies. There is a clear gap between resident physicians’ actual and required knowledge of radiotherapy, and this requires urgent remediation. In the context of technical advances in imaging-guided radiotherapy (IGRT) and new radiobiology data, a balanced approach divided equally between general oncology, clinical radiation oncology, radiation oncology technology, medical physics and radiobiology, anatomy and multimodal imaging, including mentorship could bring educational and career choice benefits for students of radiation oncology.

Flipped classrooms in higher education during the COVID-19 pandemic: findings and future research recommendations

Flipped classroom (FC) approaches have gotten substantial attention in the last decade because they have a potential to stimulate student engagement as well as active and collaborative learning. The FC is generally defined as a strategy that flips the traditional education setting, i.e., the information transmission component of a traditional face-to-face lecture is moved out of class time. The FC relies on technology and is therefore suitable for online or blended learning, which were predominant forms of learning during the COVID-19 pandemic (March 2020-July 2021). In this paper we present a systematic literature review (SLR) of studies that covered online FC approaches in higher education during the pandemic. We analyzed 205 publications in total and 18 in detail. Our research questions were related to the main findings about the success of implementation of online FC and recommendations for future research. The findings indicated that those who had used FC approaches in face-to-face or blended learning environments more successfully continued to use them in online environments than those who had not used it before. The SLR opened possible questions for future research, such as the effectiveness of the FC for different courses and contexts, the cognitive and emotional aspects of student engagement, and students' data protection. It pointed to the need to examine different aspects of online delivery of the FC more comprehensively, and with more research rigor.

Integration of radiation oncology teaching in medical studies by German medical faculties due to the new licensing regulations : An overview and recommendations of the consortium academic radiation oncology of the German Society for Radiation Oncology (DEGRO)

The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) will soon be passed by the Federal Council (Bundesrat) and will be implemented step by step by the individual faculties in the coming months. The further development of medical studies essentially involves an orientation from fact-based to competence-based learning and focuses on practical, longitudinal and interdisciplinary training. Radiation oncology and radiation therapy are important components of therapeutic oncology and are of great importance for public health, both clinically and epidemiologically, and therefore should be given appropriate attention in medical education. This report is based on a recent survey on the current state of radiation therapy teaching at university hospitals in Germany as well as the contents of the National Competence Based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog Medizin 2.0, NKLM) and the closely related Subject Catalogue (Gegenstandskatalog, GK) of the Institute for Medical and Pharmaceutical Examination Questions (Institut für Medizinische und Pharmazeutische Prüfungsfragen, IMPP). The current recommendations of the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) regarding topics, scope and rationale for the establishment of radiation oncology teaching at the respective faculties are also included.