ACGME Proposed Changes

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Can anyone tell me what "principles of patient-centered care" means?
 
Looks like review and comment form is not anonymous. Here are some initial thoughts in case anyone wants to submit any in their non-anonymous response to the committee:

-No increase in EBRT cases from 450 and no distinction between definitive and palliative?
-No increase in SBRT/ SRS cases? Still require more peds cases than SBRT to graduate...
-Only four FTE rad oncs at the main site seems like a very low bar to open a program...
-Programs with <6 residents will be "allowed time to increase their complement" was a painful sentence to read
-Going from 5 to 7 interstitial cases is barely even a change, not sure what that will actually accomplish educationally or otherwise
-They are really taking the rad bio faculty presence seriously I assume in light of the high boards fail rate and I'm happy to see some changes being made but it's funny because the actual problem was just the Angoff method and the decision to fail too many people
 
In order for a small program to survive, they may be looking at significant expense 1-2 residents and potentially 1-2+ faculty. With the match fiasco, I suspect many GME offices will be hesitant to support such expansion.If this gets adopted, those programs will wither.

As an aside, why would any smart medical student apply to an RO program with <6 residents? There will be high risk these programs could close after they match...
 
multitudes said:
In order for a small program to survive, they may be looking at significant expense 1-2 residents and potentially 1-2+ faculty. With the match fiasco, I suspect many GME offices will be hesitant to support such expansion.If this gets adopted, those programs will wither.

As an aside, why would any smart medical student apply to an RO program with <6 residents? There will be high risk these programs could close after they match...
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Pretty sad actually for the people that matched at those programs this year. If they think this will help application numbers, it’s gonna it hurt big time
 
PointA said:
Looks like review and comment form is not anonymous. Here are some initial thoughts in case anyone wants to submit any in their non-anonymous response to the committee:

-No increase in EBRT cases from 450 and no distinction between definitive and palliative?
-No increase in SBRT/ SRS cases? Still require more peds cases than SBRT to graduate...
-Only four FTE rad oncs at the main site seems like a very low bar to open a program...
-Programs with <6 residents will be "allowed time to increase their complement" was a painful sentence to read
-Going from 5 to 7 interstitial cases is barely even a change, not sure what that will actually accomplish educationally or otherwise
-They are really taking the rad bio faculty presence seriously I assume in light of the high boards fail rate and I'm happy to see some changes being made but it's funny because the actual problem was just the Angoff method and the decision to fail too many people
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I don’t think anyone should be afraid of commenting with their name. If your comments are well reasoned and you don’t come off as Sphinx2019 then you have nothing to worry about.
 
6 months of proton experience should be required-even if it means adding a year to residency. Except if you trained 30 years ago and were grandfathered...those guys absorb everything overnight.


Krukenberg said:
I think that in order to appropriately manage these issues when your name is on the line, you need to have managed real patients with these technical issues in a training environment, not an online module or simulated training course. If you're taking a job in an experienced center where all of this is standard, then you would have experienced faculty and physicists who can guide you. But even still...when you're in that learning curve your patients are still at risk and ultimately your name is on the line. If you're taking a job at a new center where you would have a lot of influence over how the place runs, then I think training is very important.

As I said earlier, "time" in fellowship is less important than # of cases across X, Y, Z disease sites. To see all the technical problems you have to solve with proton treatment you really need to manage the patient from contour approval to end of treatment. If you multiply that amount of time by multiple cases and multiple disease sites then that is going to be longer than a couple of months.
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Great.

Sounds like ASTRO/ACGME are really listening to their constituents.
1. Increase to six residents- don't worry, we will give you time to expand your complement
2. It turns out radiation biologists are responsible for the ABR board fiasco

Maybe it was better when the academics had their heads in the sand...
 
How about create an ASTRO clinical and radbio/physics review book. Most residencies and fellowships get great resources from their national organizations. While rad onc residents get what from ASTRO...
 
The fact that 30% failed physics in the span of a year is being chalked up to small programs?

Everyone is bending over backwards for Wallner, Kachnic.


RadOncG said:
Great.

Sounds like ASTRO/ACGME are really listening to their constituents.
1. Increase to six residents- don't worry, we will give you time to expand your complement
2. It turns out radiation biologists are responsible for the ABR board fiasco

Maybe it was better when the academics had their heads in the sand...
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The fix was in long ago.

And we were called crazy conspiracy theorists. The 2018 ABR rad bio and physics exam resulting in an outrageously unprecedented approximately 50% of residents failing at least one component was completely intentional to make this happen. Period. No other viable explanation has been put forth to date to explain the, what, 5-6 standard deviation difference? It is happening before our eyes. Nobody has the guts to stand up to this. Instead all we see is a bunch of pandering and sycophantry by the twitter clowns.

2015 Wallner article: https://www.redjournal.org/article/S0360-3016(15)00051-6/fulltext

Physics & Radbio

"most postgraduate training programs have six or fewer trainees and small faculties. In fact, most RO programs possess neither the resources nor the faculty depth and breadth described as part of the authors’ departments. One of us (PEW) served as a faculty advisor for the Association of Residents in Radiation Oncology (ARRO) for six years and became keenly aware of the lack of didactic programming and schooled educators in many of our training programs. Numerous faculty members in these small departments are committed almost full-time to clinical activities, with postgraduate trainee education seen as merely an adjunct to these clinical activities."

This was all based on literally nothing except the prejudice and bias of the coastal and academic elite.
 
Painfully clear now. Exam takers this year were used to push Paul Wallner's agenda. He had to get some data. Sad

Should tag everyone on the physics and radbio thread that called people conspiracy theorists back in August and see what they think now.
 
Hard to see how Wallner/Kachnic could have launch a grand coordinated scheme to specifically fail people at small programs and then have ACGME/RRC recommend programs have >6 residents.

That being said, I welcome the change, it may increase educational quality AND it will address residency overexpansion (some programs will close, some programs will expand to 6, and many new programs will not be able to open...but on the balance it should help). Of course, ACGME/RRC can't say its due to economic concerns, but that is absolutely fine! At least they are doing SOMETHING
 
They didn't specifically fail people at small programs. They failed people at ALL programs then presented non statistically significant exam data that said small programs did worse. Harvard/MD Anderson did terrible on the exam as well.

The sequence of events was
1. Paul Wallner writes article that small programs <6 residents are bad after his exam was criticized for applicability to clinical practice
2. He gets criticized for having no data backing up his position (unless you count Wikipedia as data)
3. He approves an exam and post exam scoring that has 5-6 standard deviation difference from prior years
4. Lisa Kachnic produces manipulated data about how small programs did worse but not statistically worse and with very small sample size
5. ACGME proposes changes to increase the number of residents to 6

Nobody has any problems with addressing oversupply concerns but don't do it on the back of residents.
 
Residents can now do up to 350 simulations a year (up from 250 simulations a year).

Describe the Review Committee’s rationale for this revision: The number of treatments per simulation continues to drop as short fraction regimens become more common. As the proposed Program Requirements increase the number of brachytherapy cases, the Review Committee is proposing this change to ensure that residents are able to meet all procedural requirements within the clinical radiation oncology training period.

So part the rationale for raising the number of annual sims is that the brachy requirements went from 5 to 7 interstitial, and 10 to 15 intracavitary and so residents should now be allowed to do an additional 100 cases a year to allow room for their 7 additional brachy cases spread out over 4 years (i.e. <2 cases per year)? Furthermore, while hypofractionation means patients are being treated for shorter periods of time, the educational aspect of these treatments is pretty frontloaded (i.e. consult, treatment planning, plan evaluation) so using this as a justification for residents to do more treatments per year seems anti-education and pro-scut. If the ACGME is concerned about training quality and overexpansion, they need to raise the MINIMUM amount of work residents need to do, not the MAXIMUM amount that they can do. If a resident did 250 simulations a year over a 4 year period they would already have over double our minimum competency requirement of ~450 cases. All this does is allows high volume centers to push more work onto residents, it in no way raises the minimum requirements for competency.

Edit: FYI, 350 simulations is equivalent to about 30 patients on treat. Most academic attendings probably have 15-20 on treat so the only way for a resident to practically reach this number is if they are double covering two busy attendings. Is this likely to happen? Probably not. However, I don't understand why the ACGME would even allow this to be a possibility. I think that 250 sims a year is already a busy load for a resident.
 
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This whole thing is a joke and should raise the biggest of red flags for any medical students considering this field. If anyone at an academic institution tells you not to worry about this stuff they are clearly not being honest or have no idea whats going on. Does this type of non sense happen in any other specialties? From a training a competent and safe physician stand point what does a deep understanding of Rad Bio have to do with anything and why is this being used as the cudgel to make needed changes to academic training programs?

The proposed ACGME changes sounds like it will accomplish nothing overall except to close a few smaller programs while still allowing overall resident numbers to continue increase at the remaining programs. I will guess the number and quality of US medical graduates applying to rad onc will continue to decline next year and this a direct reflection of the quality of the leadership of the field.

This is beyond frustrating to see this happen.
 
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I’m torn. I think something needs to be done about the oversupply, but is this it? Or will the final version be watered down and ultimately lead to even more residency positions? I have a hard time believing this will do anything for quality teaching.

GME funding may be hard to come by at smaller programs, but I have a very hard time believing the potentially affected small programs aren’t already looking for ways to scrape together the money to pick up 1 or 2 more residents. If someone put in the time and effort to make a program, they probably aren’t just going to shut it down without a fight. Why not hire 2 residents when it’s basically 1.3 FTEs worth of NPs?

I’d bet about $1000 fake internet dollars that this ends up as a total wash in terms of # of positions offered nationwide in any given year, while creating a significantly higher barrier to entry for a new programs who are trying to open. That’s not ideal for the job market, but it’s better than nothing. Meanwhile, the quality of residency education will remain essentially unchanged.
 
This is all a cover-up for the ABR. They have a narrative that needs to be pursued. This is how they're doing it.

multitudes said:
I’m torn. I think something needs to be done about the oversupply, but is this it? Or will the final version be watered down and ultimately lead to even more residency positions? I have a hard time believing this will do anything for quality teaching.

GME funding may be hard to come by at smaller programs, but I have a very hard time believing the potentially affected small programs aren’t already looking for ways to scrape together the money to pick up 1 or 2 more residents. If someone put in the time and effort to make a program, they probably aren’t just going to shut it down without a fight. Why not hire 2 residents when it’s basically 1.3 FTEs worth of NPs?

I’d bet about $1000 fake internet dollars that this ends up as a total wash in terms of # of positions offered nationwide in any given year, while creating a significantly higher barrier to entry for a new programs who are trying to open. That’s not ideal for the job market, but it’s better than nothing. Meanwhile, the quality of residency education will remain essentially unchanged.
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The whole thing is basically

1. We won't make anything better
2. We will try to keep it from getting worse

This forum has me seriously reconsidering applying to rad onc.
 
The Review Committee is concerned that programs with fewer than six residents are too small to engender a productive learning environment.
Why? What does resident number have to do with “learning environment?” In education science, aren’t fewer learners per educator better correlated with improved learning environments?​

Programs with six or more residents are more likely to provide the critical mass of learners needed to facilitate the educational environment needed to transform residents from medical student to independent practitioner.
“Critical mass” is weasel wording. Again, there are no data trends (and no historical concerns) to back up this idea re: resident number.​

The proposed revision will improve resident education and patient safety by the cultivation of a richer educational environment… There are currently 19 programs with fewer than six approved resident positions, approximately 20% of radiation oncology residency programs. Adding an additional one or two resident positions could necessitate additional institutional resources. The Review Committee will allow time for these affected programs to increase their complement.
"Richer" (weasel word again) educational environments are achieved by adding one resident to a 5-resident program? That one act by itself makes environments "richer?" If increasing resident number leads to a “richer educational environment,” and a richer educational environment will improve “patient safety,” but the Review Committee proposes to “allow time” for programs to increase the resident number, isn’t this tantamount to saying that ~20% of residency programs are now in a state of potentially harming patient safety? Yet time will be allowed for these programs to continue harming patient safety until they are able to improve their patient safety measures? It would seem that zero time should be allowed to improve patient safety; it should be improved now. If it can not patient care should cease immediately within the system providing unsafe care.​

multitudes said:
Or will the final version be watered down and ultimately lead to even more residency positions?
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Bingo. Reading between the lines... "allowing time" for programs to increase resident number, requiring more attending rad oncs on staff, having a cancer or radiation biologist in a firmly education role (vs research role)... this all equates to nationwide rad onc residency growth. Perhaps I missed something?
 
I think it's a step in the right direction by making a minimum resident requirement (not a perfect solution), but I am concerned that existing programs will continue to expand. Any ideas about how to make it more difficult for current programs to expand?
 
metview said:
Any ideas about how to make it more difficult for current programs to expand?
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They need to raise the minimum case requirements. Raising the maximum EBRT cases is meaningless IMO because there are lots of programs where residents are routinely going the over the maximums but are explicitly warned not to log excess cases.
 
PointA said:
Looks like review and comment form is not anonymous. Here are some initial thoughts in case anyone wants to submit any in their non-anonymous response to the committee:

-No increase in EBRT cases from 450 and no distinction between definitive and palliative?
-No increase in SBRT/ SRS cases? Still require more peds cases than SBRT to graduate...
-Only four FTE rad oncs at the main site seems like a very low bar to open a program...
-Programs with <6 residents will be "allowed time to increase their complement" was a painful sentence to read
-Going from 5 to 7 interstitial cases is barely even a change, not sure what that will actually accomplish educationally or otherwise
-They are really taking the rad bio faculty presence seriously I assume in light of the high boards fail rate and I'm happy to see some changes being made but it's funny because the actual problem was just the Angoff method and the decision to fail too many people
Click to expand...


EBRT: Why are they removing the distinction? It ensures that you get a good exposure to definitive cases and aren't just treated a bunch of bone and brain mets. Also, there is a considerably different calculus and thought process when you go from treating someone definitively vs palliation which should be recognized and appreciated. Also, 450 needs to be upped to 600. If they refuse to do that then increase the amount of documentation for each case in the log. Disease site? What dose? Dose per Fraction? Dose constraints used? Did you meet them and what were they? Concurrent immuno or chemo? All too often I see residents just logging cases after laying eyes on them in sim and never doing anything else beyond that which is totally wrong.

SBRT/SRS: This should have been a no brainer for any RO who has a has had a pulse for the last 4 years. SRS and SBRT are the freaking future. This should have been front and center this time around. 25 cases a piece is pathetic and should be at least 75-100. With the same sort of detail documented in the case log.

FTE ROs - How will they even check if a person is a FTE? A Pic on the website? A pay stub? It would not surprise me if institutions lie about this. Pull out old attending's that are retired or dead and list them as part of the faculty. incorporate non-teaching attending satellite cogs and make them "teaching" even though they never see a resident.

The <6 resident thing will end up backfiring in a big way. It may drive programs to merge/share resources or to spuriously expand without the resources just to stay ahead of the game. Might be throwing fuel on the fire with that one tbh.

Rad bio faculty are getting harder and harder to secure simply because most have little to no grant money or research going on. Many might even just be straight up cancer biologists just convieniantly relabeled "rad biologists" who do little to nothing with RT.
 
metview said:
Any ideas about how to make it more difficult for current programs to expand?
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Do what Dr. Zeitman suggested and let the future job market weed out applicants. Eventually, it will get so bad that even the desperate and poorly qualified will steer clear. This will be the ultimate wake up call for the ivory tower, not what they are trying to do at present. Only an existential crisis will result in the change our specialty needs.
 
This is going to create some awkward politics. Ultimately the RRC approves residency expansions, and must use objective criteria in making that decision. A program requesting an increase from 5 to 6 will either go from 5 to 0 or 5 to 6 at the hands of a small group in a relatively small specialty.
 
Who exactly are making these proposals? Are there any non-academic representatives - it doesn't seem so.

Definitely need to give feedback.
 
Give feedback! I did. That’s the point of it
 
Also maybe they should look st faculty turnover rates in these programs. I mean if a Dept is churning through faculty every 3-5 years and just hiring new grads who then leave I do not think that’s particularly good for resident education quality. This is become more commonplace at programs last 5 years or so.
 
I think it is reasonable to require that programs have at least 6 residents, independent of the discussion on residency expansion/job market. Having other residents around adds value to training. I trained at a program with ~3 residents/year. I can confidently say that much of the practical knowledge I acquired during training came from my co-residents; and having a couple of other residents in my year who I could share gripes with certainly helped make things less stressful.

Clearly there are many excellent doctors who trained in small programs, and my opinion is biased by my experience. Nonetheless, I am curious to hear if anyone from a small program thinks that having limited numbers was an asset... or if they think that they were successful in spite of having few peers to chat with.
 
Lamount said:
I think it is reasonable to require that programs have at least 6 residents, independent of the discussion on residency expansion/job market. Having other residents around adds value to training. I trained at a program with ~3 residents/year. I can confidently say that much of the practical knowledge I acquired during training came from my co-residents; and having a couple of other residents in my year who I could share gripes with certainly helped make things less stressful.

Clearly there are many excellent doctors who trained in small programs, and my opinion is biased by my experience. Nonetheless, I am curious to hear if anyone from a small program thinks that having limited numbers was an asset... or if they think that they were successful in spite of having few peers to chat with.
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Agree a million percent
 
xrthopeful said:
Agree a million percent
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Most new programs start out with 4 and ramp up. ABR conspiracy theories aside, this seems like a way to eliminate any of the recently created small programs. In order to be fair though, the RRC really needs to give the once over to any of the big programs requesting expansion.

Honestly a few years moratorium on expansion is in order.
 
A lot of the programs will just expand. Take for example the totally unnecessary Cedar Sinai new LA program a few years back. Is Sandler going to shut it down or just expand? You know the answer
 
What if every program committed to reduce resident complement by 1. Wouldn’t all have to happen in same year..
 
thecarbonionangle said:
A lot of the programs will just expand. Take for example the totally unnecessary Cedar Sinai new LA program a few years back. Is Sandler going to shut it down or just expand? You know the answer
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I mean that's probably the only new program to come up in recent years that has the money, resources, patient volume, faculty with academic/mentorship interest etc to justify existence/expansion.

If the rule went into effect, what I would hope/expect is that - it would be very HARD for new programs to open, some programs would close/stop taking new residents, and a small few would be able to expand. Perhaps Cedars (if they already haven't expanded past 4, which I am sure they have) would be one to expand. That's still overall a net positive as a whole in my book, since they would expand past 4 anyways.
 
RadsWFA1900 said:
Also maybe they should look st faculty turnover rates in these programs. I mean if a Dept is churning through faculty every 3-5 years and just hiring new grads who then leave I do not think that’s particularly good for resident education quality. This is become more commonplace at programs last 5 years or so.
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They're already working on this.

If you flood the market with rad oncs and there are no other jobs, than your faculty won't turnover.

09-roll-safe.w700.h700.2x.jpg
 
"...and became keenly aware of the lack of didactic programming and schooled educators in many of our training programs".
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I fail to understand why it is SO difficult for the ACGME and ASTRO to grasp that soon there will be NO MORE RADIOBIOLOGISTS, only cancer biologists and rad onc physician-scientists. And NONE of us – who are still around, that is – have any "schooling" whatsoever in education, nor do, or will, any of the younger faculty gradually replacing us.

Cancer biologists as a rule don't know much about radiobiology, let alone radiation oncology, so how are they supposed to develop and teach a radiation/cancer biology course? Plus, they all do research first and everything else second, so even if they wanted to learn a new field, they wouldn't have time.

As for the rad onc physician-scientists, they'll likely be the ones carrying the torch for the field of radiobiology (to the extent that their own rad bio education was adequate), but they also have much more important things to do than organize and teach a course, especially during their first decade of independence. A lecture here or there, sure, but responsibility for an entire course?

And like any training program is going to spend money to hire a full-time biology faculty member only for teaching purposes, and not for a revenue-generating research program as well? HA! The fact is that I'm pretty sure I'm the only radiobiologist in the country whose main job responsibility is teaching, and trust me when I say that I'm <ahem> "under-employed".

Meanwhile, one possible solution, namely to allow programs that lack a critical mass of biologists to join courses based at larger programs via teleconference or web meeting, is being threatened by the other proposed programatic change mandating "...an on-site didactic educational program core curriculum..."

Frankly, this entire thing is ridiculous.
 
Lamount said:
I think it is reasonable to require that programs have at least 6 residents, independent of the discussion on residency expansion/job market. Having other residents around adds value to training. I trained at a program with ~3 residents/year. I can confidently say that much of the practical knowledge I acquired during training came from my co-residents; and having a couple of other residents in my year who I could share gripes with certainly helped make things less stressful.

Clearly there are many excellent doctors who trained in small programs, and my opinion is biased by my experience. Nonetheless, I am curious to hear if anyone from a small program thinks that having limited numbers was an asset... or if they think that they were successful in spite of having few peers to chat with.
Click to expand...

From folks I've discussed with regarding what they liked the most about being at a small program (8 or less total residents): Lack of comparison with your peers. More collegiality and less hierarchy. More relaxed nature with attendings. Lack of competition for prime research projects.
 
SBRT and SRS are the future of our field and increasingly shown to be beneficial for patient and society. How can one review residency requirements without adjustment of the aforementioned and even pretend these changes are geared toward producing better physicians or helping society? Radiation biology on site faculty is more important than familiarity with SBRT? Nonsense
 
MadamCurie said:
I fail to understand why it is SO difficult for the ACGME and ASTRO to grasp that soon there will be NO MORE RADIOBIOLOGISTS, only cancer biologists and rad onc physician-scientists. And NONE of us – who are still around, that is – have any "schooling" whatsoever in education, nor do, or will, any of the younger faculty gradually replacing us.

Cancer biologists as a rule don't know much about radiobiology, let alone radiation oncology, so how are they supposed to develop and teach a radiation/cancer biology course? Plus, they all do research first and everything else second, so even if they wanted to learn a new field, they wouldn't have time.

As for the rad onc physician-scientists, they'll likely be the ones carrying the torch for the field of radiobiology (to the extent that their own rad bio education was adequate), but they also have much more important things to do than organize and teach a course, especially during their first decade of independence. A lecture here or there, sure, but responsibility for an entire course?

And like any training program is going to spend money to hire a full-time biology faculty member only for teaching purposes, and not for a revenue-generating research program as well? HA! The fact is that I'm pretty sure I'm the only radiobiologist in the country whose main job responsibility is teaching, and trust me when I say that I'm <ahem> "under-employed".

Meanwhile, one possible solution, namely to allow programs that lack a critical mass of biologists to join courses based at larger programs via teleconference or web meeting, is being threatened by the other proposed programatic change mandating "...an on-site didactic educational program core curriculum..."

Frankly, this entire thing is ridiculous.
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Sharp-eyed readers will note that the ACGME has completely removed the requirement that the "teacher of radiobiology" be someone devoting the majority of his/her time to research, much less even be a soi disant radiobiologist.

So in essence the radiation oncology radiobiology exam is becoming more and more esoteric (and more difficult to pass!), but the teachers of radiobiology to radiation oncologists are having less and less of a station within radiobiological basic science.

It's like in 'Guardians of the Galaxy' when Rocket yells "We didn't have time to work out the MINUTIAE of the plan!"

uQxom4n.png
 
The suggestions below are rooted in the FACT that our time in residency is limited and scant, and we need to master the basics before we delve into the areas that are not directly impacting day-to-day practice.

1. Replace radiobiology with a running course of radiology and basics of medical oncology.
Let's ask ourselves: what kind of knowledge an average, non-academic graduate is more likely to to need in his practice? I'd say definitely NOT this:

1554322353005.png

Given the absence of any guidance (to either the residents or the teachers) from ABR or ASTRO regarding the contents of the course, it has assumed different, sometimes quite bizarre, shapes at different institutions. And in the end, the residents are all forced to rely on recalls (*gasp*). By the way, I don't really understand why recalls are wrong - ultimately, if they want us to memorize the intracellular signaling cascade initiated by RET, what do they care if we learn it from recalls?

2. Physics needs to be practice-related.
Does our average, non-academic (or academic, for that matter) rad onc really need to know that Cs-131 is obtained via ______ from ____ isotope? No!
Does he need to know the difference between kV and MV CBCT? you bet. A little bit about planning? Yes! Yet we learn none of that (unless we are particularly driven and/or curious). Does he need to know the exact numerical value in mm of the recommended kV/MV/laser alignment? No. Should he have participated in person in each particular type of QA that's done in the department. For sure.
 
Look at this mishmash of goofy shiznit on the Vanderbilt "Cancer and Radiation Biology" website.

Some of the citations are nearly 20 years old. And not a single one impact any day-to-day clinical decision by any radiation oncologist in the world.

But. It's important. I guess.

Goo goo g'joob
 
I am a busy full-time radiation oncologist in private practice. I can say with full confidence that radiobiology has zero relevance to clinical practice. (What about comparing different fractionation schemes? That's what the literature is for. I'm rarely going to pull something out of a hat and treat a patient just because I've done some sort of BED calculation that, as we all know, is fundamentally flawed from the get-go, as SBRT BED calcs have proven. MAYBE I've done it once or twice in my last ten years of practice, but that's basically it.) I have no doubt whatsoever that I would fail the radiobiology exam spectacularly. When it came time for my radbio exam back in the day, I used recalls, memorized what I had to memorize, then forgot everything immediately.

I also know that I basically had to teach myself CT, MRI, and PET/CT-based imaging, as my attendings really didn't understand it themselves too well and no formal courses were offered in it. It would have been tremendously valuable to have this included in our education.

It's truly very bizarre to me that radiobiology is not only taught to the extent it is in residency, but that we actually have a board examination about the topic. Do medical oncologists take biology boards? Neuro-oncologists? Gynecologic oncologists? Surgical oncologists? Anyone at all? Why on Earth do we? I have yet to hear an answer to this most basic of questions.
 
There is definitely some value to knowing basic RadBio. Understanding serial vs parallel OARs. Being able to do a quick EQD2 calculation and the concept of a/B for iso-effectiveness and the inherent uncertainties that come with it. Radiation sensitivity syndromes seem important. Understanding how radiation works to kill cancer cells, as patients will ask. Struggling to come up with other examples, but I'm sure they exist.

Knowing that watch dial painters died of leukemia, or when some one would die (and from what) if exposed to a whole body 100Gy, 6Gy, 2Gy in the event of a nuclear war is not something I've incorporated into my practice. Nor is the Taqman assay or RET pathway or any of the other stuff they've just stapled on last year. These are things that may interest radiation biologists but obviously have nothing to do with the minimal competency for a safe clinical radiation oncologist, and should simply be thrown out of any didactic/book/exam we're exposed to.
 
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I certainly agree re: the basics. Serial vs parallel organs is a first-year medical school concept, and obviously BED calcs should be taught. Knowing how what we do works is also important. I could see 2-3 lectures covering it all, maybe 5 ish questions on written boards. Anything more than that really can't be justified.
 
OTN said:
I certainly agree re: the basics. Serial vs parallel organs is a first-year medical school concept, and obviously BED calcs should be taught. Knowing how what we do works is also important. I could see 2-3 lectures covering it all, maybe 5 ish questions on written boards. Anything more than that really can't be justified.
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Yup and the amount of material needed to test on could be folded into the clinical exam
 
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Honest question: when was the last time anyone said Bremsstrahlung to a patient*? Never?

*engineers don't count
 
medgator said:
Yup and the amount of material needed to test on could be folded into the clinical exam
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These things are common sense. I wonder why they remain fringe and not already being done? What is the issue as people see it
 
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