Improving Educational Practices During Radiation Oncology Residency Rotations

Background

As rotations in radiation oncology residency are typically designed according to the apprenticeship model, there can be variability in educational value. Overall, the current design and educational content of residency rotations in radiation oncology are not well understood. Furthermore, there are no recommendations for how rotations should be structured, despite ongoing efforts to standardize the radiation oncology residency curriculum. We aim to describe current educational practices within rotations of United States radiation oncology residency programs and suggest best practices.

Methods

First, we created an anonymous online survey to identify current elements and potential deficiencies within residency rotations. Questions addressed rotation duration, setting of expectations, one-on-one educational sessions, review of example cases, attending feedback, and educational simulations. We distributed the survey to current (2021-2022) radiation oncology residents (PGY2 - PGY5) in ACGME-accredited programs by e-mailing program coordinators, directors, and select residents with publicly available e-mail addresses. Next, we developed a guideline for best rotation practices using survey results. This guideline will be used to guide teaching faculty members. We plan to pilot these guidelines in a single institution and monitor feasibility and adherence to recommendations.

Results

Of an estimated total of 773 radiation oncology residents, 118 completed the survey (overall response rate, 15%). Respondents consisted of residents from both small and large residency programs (47% from programs with less than 9 total residents vs. 53% with 9 or more total residents), more junior than senior residents (60% PGY2 or PGY3 vs. 40% PGY4 or PGY5) and a higher proportion of men than women (68% vs. 32%). The most commonly reported rotation length was 2 months (44%), and a majority stated that most rotations have a 1:1 resident-to-faculty ratio (84/118, 71%). Forty seven percent (56/118) of residents reported that none or only some of rotations provided a service-specific guideline that clearly expressed expectations of the rotating resident. Most responding residents (63%, 74/118) said that none or only some rotations include regular educational sessions outside of didactics, and a similar number (62%, 73/118) state they want more routine educational sessions.

Discussion

A substantial number of radiation oncology residents report few routine educational sessions within rotations and are interested in receiving more dedicated teaching from attendings. A considerable number also indicate a limited understanding of expectations at the start of rotations. In response, we have developed a guideline for rotation best practices and plan to pilot these within a single institution and will monitor implementation and response.