Toward a national consensus: teaching radiobiology to radiation oncology residents

Radiation and Cancer Biology Educators of Radiation Oncology Residents and the Courses They Teach1

The purpose of this study was to characterize today's radiation and cancer biology educators of radiation oncology residents, and the biology courses they teach. An e-mail list of 133 presumptive resident biology educators was compiled, and they were invited to participate in a 46-item survey. Survey questions were designed to collect information about the educational and academic backgrounds of the educators, how they self-identify, characteristics of the courses they teach, the value that they assign to their teaching activities, their level of satisfaction with their courses and how they see these courses being taught in the future. Findings of this survey were compared and contrasted with prior surveys of biology educators (conducted 12 and 20 years ago, respectively), and with more recent surveys of radiation oncology residents and radiation oncology residency program directors conducted in 2018 and 2019. A total of 67 survey responses were received. Biology educators range in age, academic rank and years of teaching experience from junior (18%) to quite senior (45%). Only about 40% self-identify as radiation biologists, biophysicists or chemists, compared to 56% in 2001. The majority of the others consist of cancer biologists (15%), radiation oncologists (15%) and radiation oncology physician-scientists (16%). Educators prioritize their resident teaching as important or very important. Biology courses are widely variable in contact hours between programs and have not changed significantly over the past 20 years. About 75% of the courses are team-taught, including 15% involving multiple training programs. An average biology course consists of about 42% foundational ("classical") radiobiology, 28% clinical radiobiology and 28% cancer biology. While biology educators and radiation oncology program directors are highly satisfied with their biology courses, approximately a third of residents report being not very, or not at all, satisfied. That fewer biology educators are radiobiologists by training and their courses have remained quite variable in length and content over long periods point to the need for a consensus core curriculum for resident education in radiation and cancer biology. Both current educators and program directors also support making online teaching resources available, diversifying course instructors and consolidating biology teaching across multiple training programs.

Education and training of clinical oncologists-experience from a low-resource setting in Zimbabwe

As the burden of cancer increases worldwide, more so in low- and middle-income countries, one of the greatest challenges is human resource capacity development. Addressing this is critical in reducing the burden of cancer in the African continent. Other challenges include socio-economic demographics and disparities in the overall cancer care. Lack of sufficient numbers of qualified staff has been one of the obstacles in developing adequate and modern cancer treatment centres in Africa. Training in clinical oncology in Zimbabwe was established in 1990 through the collaboration between the Government of Zimbabwe and the WHO as a regional project. The training is offered by the University of Zimbabwe through the established Master of Medicine in Radiotherapy and Oncology (MMed Rad & Onco) postgraduate programme. Regional and local fellows have been trained, yielding more than 20 clinical oncologists over the years, who have initiated cancer treatment facilities in Africa and beyond. They have continued to train others, fulfilling the original WHO programme target of transfer of skills in sub-Saharan Africa. Collaborations with external partners have complemented efforts by the local faculty in addressing deficiencies in training, in areas where experts in the subject are lacking and in supporting nationals working abroad to come and teach newer technologies and techniques. The curriculum continues to evolve from knowledge-based training to competency-based training. However, there is a need to expand the current infrastructure to keep up with changing technology.

Clinical oncology training in Zimbabwe continues and remains a regional resource. Emphasis on subspecialising seems to be the next natural step in progression. Strengthening of other disciplines, including surgical oncology and medical physics, would be complementary to the training. The programme is an example of a sustainable initiative born out of collaborative partnership and is sustained by local resources. The greater majority of qualified oncologists have remained in Africa.

Improving Research in Radiation Oncology through Interdisciplinary Collaboration

The contribution of radiation oncology to the future of cancer treatment depends significantly on our continued clinical progress and future research advancements. Such progress relies on multidisciplinary collaboration among radiation oncologists, medical physicists and radiobiologists. Cultivating collaborative educational and research opportunities among these three disciplines and further investing in the infrastructure used to train both clinicians and researchers will therefore help us improve the future of cancer care. This article evaluates the success of a short-term educational environment to foster multidisciplinary collaboration. The NIH-funded educational course developed at Wayne State University, called "Integration of Biology and Physics into Radiation Oncology" (IBPRO), was designed to facilitate the engagement of radiation oncologists, medical physicists and radiobiologists in activities that enhance collaborative investigation. Having now been delivered to nearly 200 participants over the past four years, the relative success of IBPRO in fostering productive interdisciplinary collaboration and producing tangible research outcomes can be evaluated. The 140 IBPRO participants from the first three years were surveyed to quantify the effectiveness of the course. In total, 62 respondents reported developing 23 institutional protocols, submitting more than 25 research grants (nine of which have been funded thus far), and publishing more than 30 research manuscripts attributable to participation in IBPRO. Nearly one-half (45%) of respondents reported generating at least one of these research metrics attributable to participation in IBPRO and these participants reported an average of over four such quantitative research metrics per respondent. This represents a very substantial contribution to radiation oncology research by a relatively small number of researchers within a relatively short time. Nearly one-half of respondents reported ongoing collaborative working relationships generated by IBPRO. In addition, approximately one-half of respondents stated that specific information presented at IBPRO changed the way they practice, and over 80% of respondents practicing in a clinical setting stated that, since participation in IBPRO, they have approached clinical dilemmas more collaboratively. We believe that educational opportunities such as IBPRO can have a significant impact on interdisciplinary collaborative research. In addition, such interventions have the ability to effect significant clinical change. Both of these should have a positive impact on future advancements in radiation oncology and affect the future contribution of radiation oncology to the treatment of cancer.

The Future of Radiobiology

Innovation and progress in radiation oncology depend on discovery and insights realized through research in radiation biology. Radiobiology research has led to fundamental scientific insights, from the discovery of stem/progenitor cells to the definition of signal transduction pathways activated by ionizing radiation that are now recognized as integral to the DNA damage response (DDR). Radiobiological discoveries are guiding clinical trials that test radiation therapy combined with inhibitors of the DDR kinases DNA-dependent protein kinase (DNA-PK), ataxia telangiectasia mutated (ATM), ataxia telangiectasia related (ATR), and immune or cell cycle checkpoint inhibitors. To maintain scientific and clinical relevance, the field of radiation biology must overcome challenges in research workforce, training, and funding. The National Cancer Institute convened a workshop to discuss the role of radiobiology research and radiation biologists in the future scientific enterprise. Here, we review the discussions of current radiation oncology research approaches and areas of scientific focus considered important for rapid progress in radiation sciences and the continued contribution of radiobiology to radiation oncology and the broader biomedical research community.

IBPRO - A Novel Short-Duration Teaching Course in Advanced Physics and Biology Underlying Cancer Radiotherapy

This article provides a summary and status report of the ongoing advanced education program IBPRO - Integrated course in Biology and Physics of Radiation Oncology. IBPRO is a five-year program funded by NCI. It addresses the recognized deficiency in the number of mentors available who have the required knowledge and skill to provide the teaching and training that is required for future radiation oncologists and researchers in radiation sciences. Each year, IBPRO brings together 50 attendees typically at assistant professor level and upwards, who are already qualified/certified radiation oncologists, medical physicists or biologists. These attendees receive keynote lectures and activities based on active learning strategies, merging together the clinical, biological and physics underpinnings of radiation oncology, at the forefront of the field. This experience is aimed at increasing collaborations, raising the level and amount of basic and applied research undertaken in radiation oncology, and enabling attendees to confidently become involved in the future teaching and training of researchers and radiation oncologists.

American Society for Radiation Oncology (ASTRO) survey of radiation biology educators in U.S. and Canadian radiation oncology residency programs

PURPOSE

To obtain, in a survey-based study, detailed information on the faculty currently responsible for teaching radiation biology courses to radiation oncology residents in the United States and Canada.

METHODS AND MATERIALS

In March-December 2007 a survey questionnaire was sent to faculty having primary responsibility for teaching radiation biology to residents in 93 radiation oncology residency programs in the United States and Canada.

RESULTS

The responses to this survey document the aging of the faculty who have primary responsibility for teaching radiation biology to radiation oncology residents. The survey found a dramatic decline with time in the percentage of educators whose graduate training was in radiation biology. A significant number of the educators responsible for teaching radiation biology were not fully acquainted with the radiation sciences, either through training or practical application. In addition, many were unfamiliar with some of the organizations setting policies and requirements for resident education. Freely available tools, such as the American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Practice Examination and Study Guides, were widely used by residents and educators. Consolidation of resident courses or use of a national radiation biology review course was viewed as unlikely by most programs.

CONCLUSIONS

A high priority should be given to the development of comprehensive teaching tools to assist those individuals who have responsibility for teaching radiation biology courses but who do not have an extensive background in critical areas of radiobiology related to radiation oncology. These findings also suggest a need for new graduate programs in radiobiology.

Recent initiatives for radiation oncology resident education in radiation and cancer biology

Nearly all residents from accredited radiation oncology residency programs in the United States are required to take the American College of Radiology (ACR) In-Training examination each year. The test is comprised of three sections: Clinical Radiation Oncology, Radiological Physics, and Radiation (and Cancer) Biology. Here we provide an update on changes to the biology portion of the ACR exam. We also discuss the availability and use of the ACR and biology practice exams as assessment and teaching tools for both the instructors of radiation and cancer biology and the residents they teach.

Recommendations for the future of translational radiobiology research: a Canadian perspective

The use of molecular medicine is now merging into clinical practice with the advent of molecular targeting agents, molecular pathology and molecular imaging for both diagnosis and treatment response. Radiation oncologists must therefore gain expertise in utilizing this information to drive new treatment protocols. Recognizing the importance of this issue, the Canadian Association of Radiation Oncologists (CARO) charged a Task Force in Translational Radiobiology to: (1) critically assess training programs and research infrastructure in relation to current and future translational radiobiology requirements; and (2) make specific recommendations to accelerate the implementation of translational science into day-to-day practice. Selected Task Force recommendations included the principle that universities and departmental Chairs increase the opportunities for academic promotion, funding, and tenure track positions of radiobiologists and translational radiation oncologists. The dedication of 4 to 5 national centers as translational 'hubs', can serve as an interface between clinicians, clinical specimens and radiobiological sciences within the context of correlative clinical trials. The model of the clinician-scientist was encouraged as an important adjunct to good clinical care to be associated with strong enticement, training and mentoring programs and 75%-protected research time. Finally, an integrated model of radiobiological training programs and mutual continuing education between clinicians and basic scientists can be facilitated through a new national radiobiology meeting sponsored by CARO. These recommendations have been accepted by the national radiation oncology membership. Such a framework may serve useful for national programs wishing to develop rapid conduits from the lab to the clinic as a means of integrating molecular biology and the day-to-day practice of radiation oncology.

Education and training for radiation scientists: radiation research program and American Society of Therapeutic Radiology and Oncology Workshop, Bethesda, Maryland, May 12-14, 2003

Current and potential shortfalls in the number of radiation scientists stand in sharp contrast to the emerging scientific opportunities and the need for new knowledge to address issues of cancer survivorship and radiological and nuclear terrorism. In response to these challenges, workshops organized by the Radiation Research Program (RRP), National Cancer Institute (NCI) (Radiat. Res. 157, 204-223, 2002; Radiat. Res. 159, 812-834, 2003), and National Institute of Allergy and Infectious Diseases (NIAID) (Nature, 421, 787, 2003) have engaged experts from a range of federal agencies, academia and industry. This workshop, Education and Training for Radiation Scientists, addressed the need to establish a sustainable pool of expertise and talent for a wide range of activities and careers related to radiation biology, oncology and epidemiology. Although fundamental radiation chemistry and physics are also critical to radiation sciences, this workshop did not address workforce needs in these areas. The recommendations include: (1) Establish a National Council of Radiation Sciences to develop a strategy for increasing the number of radiation scientists. The strategy includes NIH training grants, interagency cooperation, interinstitutional collaboration among universities, and active involvement of all stakeholders. (2) Create new and expanded training programs with sustained funding. These may take the form of regional Centers of Excellence for Radiation Sciences. (3) Continue and broaden educational efforts of the American Society for Therapeutic Radiology and Oncology (ASTRO), the American Association for Cancer Research (AACR), the Radiological Society of North America (RSNA), and the Radiation Research Society (RRS). (4) Foster education and training in the radiation sciences for the range of career opportunities including radiation oncology, radiation biology, radiation epidemiology, radiation safety, health/government policy, and industrial research. (5) Educate other scientists and the general public on the quantitative, basic, molecular, translational and applied aspects of radiation sciences.