Temporal Trends of Resident Experience in External Beam Radiation Therapy Cases: Analysis of ACGME Case Logs from 2007 to 2018

Trends in Program Satisfaction and Perceived Confidence Levels Among United States Radiation Oncology Residents: A 5-Year Aggregate Analysis of the 2020-2024 Association of Residents in Radiation Oncology Graduating Resident Survey

PURPOSE

Transitioning from radiation oncology (RO) training to independent practice is often challenging. Understanding resident attitudes related to program satisfaction and comfort with treatment modalities is essential for improving resident experience.

METHODS AND MATERIALS

Between 2020 and 2024, the Association of Residents in Radiation Oncology conducted web-based surveys of graduating RO residents in the United States. Likert-style scales were used to capture responses and summarized using descriptive statistics. χ2 tests assessed differences in response rates and nominal variables. Kruskal-Wallis H and Kendall's tau-b tests evaluated ordinal variable distributions and correlations, respectively. Ordinal logistic regression estimated the associations between variables.

RESULTS

A total of 820 graduating residents (of 952 invited) completed the surveys, representing a median response rate of 86.5% (range, 77.8%-93.7%). Ninety-one percent of residents were satisfied or very satisfied with their program (range, 89.6%-94.0%). Dissatisfaction with clinical didactics (odds ratio [OR], 5.34; P < .001) and higher numbers of training sites (OR, 5.73; P = .01) were associated with program dissatisfaction. Compared with the 2014-2015 Association of Residents in Radiation Oncology survey, satisfaction improved in treatment planning (85%) and biostatistics (61%) domains but declined in physics (76%) and radiation biology (68%) didactics. Compared with small programs (<6 residents), residents in larger programs reported greater satisfaction with training (eg, clinical didactics, mentorship). More than a third of residents reported excessive (7.9%) or moderate (31.0%) noneducational tasks, which decreased over survey years (adj P = .049). Confidence levels varied between treatment modalities, with high confidence for lung stereotactic body radiation therapy (96.1%) and nonspine bone stereotactic body radiation therapy (87.7%) and low confidence for high-dose-rate (25.7%) and low-dose-rate (22.6%) prostate brachytherapy.

CONCLUSIONS

Graduating RO residents in this analysis were satisfied with their training programs, albeit with low confidence in certain treatment modalities. These data highlight the areas of strength within RO training programs and identify opportunities for improvement to produce graduates ready to enter independent practice with the full scope of RO techniques.

A Prospective Study Measuring Resident and Faculty Contour Concordance: A Potential Tool for Quantitative Assessment of Residents' Performance in Contouring and Target Delineation in Radiation Oncology Residency

PURPOSE/OBJECTIVE(S)

Accurate target delineation (ie, contouring) is essential for radiation treatment planning and radiotherapy efficacy. As a result, improving the quality of target delineation is an important goal in the education of radiation oncology residents. The purpose of this study was to track the concordance of radiation oncology residents' contours with those of faculty physicians over the course of 1 year to assess for patterns.

MATERIALS/METHODS

Residents in postgraduate year (PGY) levels 2 to 4 were asked to contour target volumes that were then compared to the finalized, faculty physician-approved contours. Concordance between resident and faculty physician contours was determined by calculating the Jaccard concordance index (JCI), ranging from 0, meaning no agreement, to 1, meaning complete agreement. Multivariate mixed-effect models were used to assess the association of JCI to the fixed effect of PGY level and its interactions with cancer type and other baseline characteristics. Post hoc means of JCI were compared between PGY levels after accounting for multiple comparisons using Tukey's method.

RESULTS

In total, 958 structures from 314 patients collected during the 2020-2021 academic year were studied. The mean JCI was 0.77, 0.75, and 0.61 for the PGY-4, PGY-3, and PGY-2 levels, respectively. The JCI score for PGY-2 was found to be lower than those for PGY-3 and PGY-4, respectively (all P < .001). No statistically significant difference of JCI score was found between the PGY-3 and PGY-4 levels. The average JCI score was lowest (0.51) for primary head and/or neck cancers, and it was highest (0.80) for gynecologic cancers.

CONCLUSIONS

Tracking and comparing the concordance of resident contours with faculty physician contours is an intriguing method of assessing resident performance in contouring and target delineation and could potentially serve as a quantitative metric, which is lacking currently, in radiation oncology resident evaluation. However, additional study is necessary before this technique can be incorporated into residency assessments.

Evolution and Evaluation of a Structured Applied Physics Course for Radiation Oncology and Radiation Physics Trainees

We sought to supplement medical physics textbook knowledge and clinical learning with case-based discussions. To our knowledge, this is the first report on a structured combined applied physics curriculum for radiation oncology (RO) and medical physics (MP) trainees. We reviewed our yearly applied physics course given from the years 2016-2021 inclusive. The number of applied physics trainees ranged from 7 to 14 per year (2-9 RO and 3-6 MP residents per year). Each session was taught by a pair of (RO and MP) faculty members. Twenty-nine case-based sessions were given yearly (2016 to 2019). Because of the COVID-19 pandemic restrictions, the course was shortened to 8 case-based sessions in 2020 and 2021. For the years 2016-2021, the mean and median teaching evaluation scores were 4.65 and 5, respectively (range 2-5), where 1 represents worse teaching quality and 5, the best teaching quality. For the year 2021, 2 questions relating to the video virtual format (implemented due to the covid-19 pandemic), revealed consistent high scores with the mean and median responses of 4.14 and 5, respectively (range 1-5). The results from the teaching evaluation scores indicate that the trainees highly valued the teaching sessions and teachers. Our experience indicates that a case-based applied physics course was delivered successfully with continued high teaching evaluation scores. A video virtual platform for an applied physics course could be useful, especially for small programs without a structured applied physics curriculum.

Leveling Up the Access to Radiation Therapy in Latin America: Economic Analysis of Investment, Equity, and Inclusion Opportunities Up to 2030

PURPOSE

Latin America faces a shortage in radiation therapy (RT) units and qualified personnel for timely and high-quality treatment of patients with cancer. Investing in equitable and inclusive access to RT over the next decade would prevent thousands of deaths. Measuring the investment gap and payoff is necessary for stakeholder discussions and capacity planning efforts.

METHODS AND MATERIALS

Data were collected from the International Atomic Energy Agency's Directory of Radiotherapy Centers, industry stakeholders, and individual surveys sent to national scientific societies. Nationwide data on available devices and personnel were compiled. The 10 most common cancers in 2020 with RT indication and their respective incidence rates were considered for gap calculations. The gross 2-year financial return on investment was calculated based on an average monthly salary across Latin America. A 10-year cost projection was calculated according to the estimated population dynamics for the period until 2030.

RESULTS

Eleven countries were included in the study, accounting for 557,213,447 people in 2020 and 561 RT facilities. Approximately 1,065,684 new cancer cases were diagnosed, and a mean density of 768,469 (standard deviation ±392,778) people per available unit was found. By projecting the currently available treatment fractions to determine those required in 2030, it was found that 62.3% and 130.8% increases in external beam RT and brachytherapy units are needed from the baseline, respectively. An overall regional investment of approximately United States (US) $349,650,480 in 2020 would have covered the existing demand. An investment of US $872,889,949 will be necessary by 2030, with the expectation of a 2-year posttreatment gross return on investment of more than US $2.1 billion from patients treated in 2030 only.

CONCLUSIONS

Investment in RT services is lagging in Latin America in terms of the population's needs. An accelerated outlay could save additional lives during the next decade, create a self-sustaining system, and reduce region-wide inequities in cancer care access. Cash flow analyses are warranted to tailor precise national-level intervention strategies.

Evaluation of Radiation Oncologist And Trainee Opinions on Residency Expansion, Possible Actions, and Training Program Accreditation Changes in the United States

PURPOSE

To sample U.S. radiation oncologist and trainee opinions regarding residency expansion, what action(s) should be taken to limit residency supply, if any, and the proposed Accreditation Council for Graduate Medical Education (ACGME) changes.

MATERIALS AND METHODS

An online survey was distributed to 1048 attending radiation oncologists by email and ∼800 residents through their program coordinators. The survey asked respondents to rank how strongly they agreed with certain statements regarding residency supply, possible solutions to address any perceived oversupply, and the proposed ACGME changes on a 1-10 disagreement-to-agreement scale. The 16% response rate yielded 294 responses for analysis.

RESULTS

Of the respondents, 90 (30%) were residents, and 204 (70%) were attendings, of whom 117 (57%) were academic, and 87 (43%) were non-academic. 86% agreed that there is a residency oversupply issue, and 91% agreed that actions should be taken to limit residency expansion. On chi-square test, residents and attendings were similarly likely to agree that there is a residency oversupply issue (93% and 89%, p=0.27), although residents were more likely to agree that this oversupply should be acted upon compared to attendings (100% and 88%, p<0.01). Regarding possible solutions, respondents were most likely to agree that further expansion should be limited (90%), program requirements should be made more stringent (76%), and the use of the Supplemental Offer and Acceptance Program should be limited (SOAP) (69%). Proposed ACGME changes that respondents were most likely to agree with included requiring that programs have modern image guidance, stereotactic radiotherapy, and brachytherapy techniques (98%) and have 4+ faculty members and maintain a faculty-to-resident ratio of >1.5:1 (86%). Case log minimums most supported to be increased were 4 uterus (65%) and 11 postmastectomy breast (61%) simulations.

CONCLUSIONS

The majority of respondents agree that there is a residency oversupply issue and that actions should be taken to limit residency expansion and make program requirements more stringent.

United States Radiation Oncology Fellowship Growth From 2010 to 2020

PURPOSE

To provide a comprehensive analysis of radiation oncology (RO) fellowship growth from 2010 to 2020.

METHODS AND MATERIALS

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.

RESULTS

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.

CONCLUSIONS

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.