ARRO Graduating Resident Survey 2020 Update: Bad (?)

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I know we keep complaining for them to change the board cert process but I really hope they keep it just how it is. They'll get what's coming....

I'm on the fence about that, because yeah, on the one hand the ABR needs to realize the trivia hazing contest they call Board Certification is over the top and dozens of departments need to realize that it's called residency "training" and the contract is "service for education", not "service for more service and the opportunity to memorize textbooks on nights and weekends"...

...but on the other hand those realizations will come on the backs of future residents, YEARS into their training, who may have been misled by senior members of the field.

I have zero sympathy for those medical students who think they're special, who have heard our warnings and decided they're better than average and can beat the odds. I sympathize with the medical students who have been swayed by elder, delusional members of this field who don't grasp fundamental market forces and think "it worked out for me, it will work out for you".

Members don't see this ad.
 
  • Like
Reactions: 1 users
As much as Graypeace might disagree with me, what has climate change and global warming been correlated with? Some temperature rises. Maybe some fires here and there. True. But... climate change has also been correlated with an incredible improvement in the QOL, wealth, and health of the world's population. As the world has gotten warmer, people have gotten better off. Causative or correlated? Some think easy access to the low-cost energy of fossil fuels helps take some third world residents from poverty to middle-class e.g.

And what has the incredible influx of MD/PhDs, 260+ board score, 10-plus-publication med students been correlated with in rad onc over the last decade? It's been correlated with no real precision medicine approaches in rad onc. Even though everybody and his brother has a "lab" in rad onc nowadays I'm not using anything AFAIK in clinic that went bench-to-bedside. All that talent has been correlated with shrinking fractions, shrinking utilization, etc. There's more social justice in rad onc (sort of), but not much more of anything else (besides residents and rad oncs... there are more of those). Despite the surfeit of med student talent, rad onc as a field has become more straitened. Causative or merely correlative?

Maybe a bunch of slackadaisical ne'er-do-wells might be correlated with something different in rad onc. I just watched "Oliver Sacks: His Own Life." It might shock some what a TOTAL screwup he was in residency. Very lazy, very underperforming. Oh, and he did A LOT of drugs. But, still, somehow, he became Oliver Sacks. And he caused a renaissance in neurology whereby around 2010 nearly 50% of all neurology residents said they had gone into neurology because they were inspired by Oliver Sacks.

So at this point, why don't we just say "what the f***." Let the chips, and med students, fall where they may. It may not be perfect, but it may be positively disruptive. In literature, sometimes only the anti-heroes are the ones able to move the story along. It's not like what's been happening in rad onc when "things were good" has been actually correlated with anything, well, you know, good.
 
Last edited:
  • Like
Reactions: 7 users
Members don't see this ad :)
As much as Graypeace might disagree with me, what has climate change and global warming been correlated with? Some temperature rises. Maybe some fires here and there. True. But... climate change has also been correlated with an incredible improvement in the QOL, wealth, and health of the world's population. As the world has gotten warmer, people have gotten better off. Causative or correlated? Some think easy access to the low-cost energy of fossil fuels helps take some third world residents from poverty to middle-class e.g.

And what has the incredible influx of MD/PhDs, 260+ board score, 10-plus-publication med students been correlated with in rad onc over the last decade? It's been correlated with no real precision medicine approaches in rad onc. Even though everybody and his brother has a "lab" in rad onc nowadays I'm not using anything AFAIK in clinic that went bench-to-bedside. All that talent has been correlated with shrinking fractions, shrinking utilization, etc. There's more social justice in rad onc (sort of), but not much more of anything else (besides residents and rad oncs... there are more of those). Despite the surfeit of med student talent, rad onc as field has become more straitened. Causative or merely correlative?

Maybe a bunch of slackadaisical ne'er-do-wells might be correlated with something different in rad onc. I just watched "Oliver Sacks: His Own Life." It might shock some what a TOTAL screwup he was in residency. Very lazy, very underperforming. Oh, and he did A LOT of drugs. But, still, somehow, he became Oliver Sacks. And he caused a renaissance in neurology whereby around 2010 nearly 50% of all neurology residents said they had gone into neurology because they were inspired by Oliver Sacks.

So at this point, why don't we just say "what the f***." Let the chips, and med students, fall where they may. It may not be perfect, but it may be positively disruptive. In literature, sometimes only the anti-heroes are the ones able to move the story along. It's not like what's been happening in rad onc when "things were good" has been actually correlated with anything, well, you know, good.
He must have also lifted a lot in residency. Set California record for squats...
 
  • Like
Reactions: 1 user
He must have also lifted a lot in residency. Set California record for squats...
 
As much as Graypeace might disagree with me, what has climate change and global warming been correlated with? Some temperature rises. Maybe some fires here and there. True. But... climate change has also been correlated with an incredible improvement in the QOL, wealth, and health of the world's population. As the world has gotten warmer, people have gotten better off. Causative or correlated? Some think easy access to the low-cost energy of fossil fuels helps take some third world residents from poverty to middle-class e.g.

And what has the incredible influx of MD/PhDs, 260+ board score, 10-plus-publication med students been correlated with in rad onc over the last decade? It's been correlated with no real precision medicine approaches in rad onc. Even though everybody and his brother has a "lab" in rad onc nowadays I'm not using anything AFAIK in clinic that went bench-to-bedside. All that talent has been correlated with shrinking fractions, shrinking utilization, etc. There's more social justice in rad onc (sort of), but not much more of anything else (besides residents and rad oncs... there are more of those). Despite the surfeit of med student talent, rad onc as a field has become more straitened. Causative or merely correlative?

Maybe a bunch of slackadaisical ne'er-do-wells might be correlated with something different in rad onc. I just watched "Oliver Sacks: His Own Life." It might shock some what a TOTAL screwup he was in residency. Very lazy, very underperforming. Oh, and he did A LOT of drugs. But, still, somehow, he became Oliver Sacks. And he caused a renaissance in neurology whereby around 2010 nearly 50% of all neurology residents said they had gone into neurology because they were inspired by Oliver Sacks.

So at this point, why don't we just say "what the f***." Let the chips, and med students, fall where they may. It may not be perfect, but it may be positively disruptive. In literature, sometimes only the anti-heroes are the ones able to move the story along. It's not like what's been happening in rad onc when "things were good" has been actually correlated with anything, well, you know, good.
Many people that have done great things have this in common: not always rule followers, think outside box, are not prudes (drugs, sex and alcohol), take chances, not afraid of failure. Likewise, many “criminals” often fit this profile as well so the future superstar must thread the line like a wide receiver sprinting near side line.
 
Last edited:
  • Haha
Reactions: 1 user
Many people that have done great things have this in common: not always rule followers, think outside box, are not prudes (drugs, sex and alcohol), take chances, not afraid of failure. Likewise, many “criminals” often fit this profile as well so the future superstar must thread the line a wide receiver sprinting near side line.
Maybe the criminal that got ranked was guilty of caring too much.
 
  • Haha
  • Like
Reactions: 2 users
Should be enough bread left for those who pass criminal background checks
Maybe one day one of these kids who make it into rad onc can get a patient named Annie and ask her if she's OK. Then, when he cures her cancer, he can say "you've been hit by a smooth criminal."
 
  • Like
  • Haha
Reactions: 3 users
Charges sure ok I get that, just don’t want see convictions.
 
  • Haha
Reactions: 1 user
ABR will lower the bar, 5 years from now

ESPECIALLY after sitting for the basic science boards this week...I have grave concerns about the people who struggled with the USMLE and their ability to get through the RadOnc gauntlet.

For the Step exams, you have literally an entire medical education industry around it, and legions of medical students making incredible free resources on top of that. Additionally, you have two years of dedicated study to prepare you specifically for Step 1.

In RadOnc...there is, in general, not much like that. There are a few programs with great in-house instruction in EITHER RadBio OR Physics (I can't think of a program which has both on staff), and there are other programs who will pay to either send their residents to the Maryland course or pay to bring someone in.

Being generous, I think less than 50% of programs have good resources for RadBio/Physics (including mythical recalls). The rest are banking on the fact that their residents can find the time and motivation to memorize textbooks. That's it. That's the entire educational plan.

So, if you struggled with Step 1 - let alone failed it - you better hope you Match into a program that actually gives you an education while also gives you a good shot at a job. Unfortunately, there are a lot of smoke and mirrors surrounding board exams on interview day, so the applicants can't actually know the truth until it's too late.
 
  • Like
Reactions: 1 users
ABR will lower the bar, 5 years from now
It'll be fun. On the radiation biology writtens, 5 years from now:

In radiation biology, a parameter that references Greek letters is often used to quantitate the cell-killing effects, and clinical effects, of radiotherapy. What is that parameter?

a. The alpha/beta ratio
b. The Lambda Lambda Lambda ratio
c. alpha and omega
d. Yorba Linda
 
  • Like
  • Haha
  • Sad
Reactions: 6 users
Members don't see this ad :)
ABR will lower the bar, 5 years from now

Probably back to where it was 10 years ago. Not a single attending who took radbio/physics pre-2012 was able to answer a single question from this year's exams.

Believe me, the sample size for my unofficial survey was large.
 
  • Like
Reactions: 1 user
ESPECIALLY after sitting for the basic science boards this week...I have grave concerns about the people who struggled with the USMLE and their ability to get through the RadOnc gauntlet.

For the Step exams, you have literally an entire medical education industry around it, and legions of medical students making incredible free resources on top of that. Additionally, you have two years of dedicated study to prepare you specifically for Step 1.

In RadOnc...there is, in general, not much like that. There are a few programs with great in-house instruction in EITHER RadBio OR Physics (I can't think of a program which has both on staff), and there are other programs who will pay to either send their residents to the Maryland course or pay to bring someone in.

Being generous, I think less than 50% of programs have good resources for RadBio/Physics (including mythical recalls). The rest are banking on the fact that their residents can find the time and motivation to memorize textbooks. That's it. That's the entire educational plan.

So, if you struggled with Step 1 - let alone failed it - you better hope you Match into a program that actually gives you an education while also gives you a good shot at a job. Unfortunately, there are a lot of smoke and mirrors surrounding board exams on interview day, so the applicants can't actually know the truth until it's too late.

I strongly disagree with the implied premise of evaluating residency programs based on the quality of rad bio / physics preparation. I don't think that should enter into any applicant's calculus of ranking/considering programs at all. The difference between "good instruction" and "bad instruction" from the program is marginal and self-study is required no matter what. Additionally, the consequences for failing on your initial try are pretty much nothing, it's mildly annoying but the long term impact is completely different from something like failing a step.

Quality of education / training is important. Quality of rad bio / physics education isn't. Of course that again calls into question why we have this obsolete board certification process that includes these comically useless exams but that's a whole other topic.
 
  • Like
  • Haha
Reactions: 2 users
I strongly disagree with the implied premise of evaluating residency programs based on the quality of rad bio / physics preparation. I don't think that should enter into any applicant's calculus of ranking/considering programs at all. The difference between "good instruction" and "bad instruction" from the program is marginal and self-study is required no matter what. Additionally, the consequences for failing on your initial try are pretty much nothing, it's mildly annoying but the long term impact is completely different from something like failing a step.

Quality of education / training is important. Quality of rad bio / physics education isn't. Of course that again calls into question why we have this obsolete board certification process that includes these comically useless exams but that's a whole other topic.

Sorry, to be clear - I was just using radbio/physics as a concrete example, my wider point being that I feel like many programs have come to trust that their residents will teach themselves whatever they need to know.

As has been talked about elsewhere on this forum, for me (and others), there was a distinct change (decline) in the effort and quality of teaching residents that I experienced going from my Internal Medicine intern year to my Radiation Oncology residency. The expectation that I perform at a high level was immediately present, but it was just assumed that it would...happen.

I don't want to imply that I think this is the case at all programs, there are definitely programs that make an effort - do I think it's more than 50% of programs? I do not.

As an example - several weeks ago I was called by an attending and asked to address an issue with one of our new residents, who had forgotten (read: didn't know was necessary) to do something in the workflow of getting a patient on-beam. This attending told me they didn't feel like it was their job to teach this resident this particular thing, that this attending just assumed we knew how to do everything, and could I "please take care of it" so this attending didn't have to deal with it.

I would like to think I'm alone in these experiences...but I doubt it.
 
Last edited:
  • Like
  • Love
Reactions: 3 users
I strongly disagree with the implied premise of evaluating residency programs based on the quality of rad bio / physics preparation. I don't think that should enter into any applicant's calculus of ranking/considering programs at all. The difference between "good instruction" and "bad instruction" from the program is marginal and self-study is required no matter what. Additionally, the consequences for failing on your initial try are pretty much nothing, it's mildly annoying but the long term impact is completely different from something like failing a step.

Quality of education / training is important. Quality of rad bio / physics education isn't. Of course that again calls into question why we have this obsolete board certification process that includes these comically useless exams but that's a whole other topic.
Good Will Hunting could be a rad onc without even doing a rad onc residency.
Probably back to where it was 10 years ago. Not a single attending who took radbio/physics pre-2012 was able to answer a single question from this year's exams.

Believe me, the sample size for my unofficial survey was large.
HMU
 
  • Like
  • Haha
Reactions: 1 users
Sorry, to be clear - I was just using radbio/physics as a concrete example, my wider point being that I feel like many programs have come to trust that their residents will teach themselves whatever they need to know.

As has been talked about elsewhere on this forum, for me (and others), there was a distinct change (decline) in the effort and quality of teaching residents that I experienced going from my Internal Medicine intern year to my Radiation Oncology residency. The expectation that I perform at a high level was immediately present, but it was just assumed that it would...happen.

I don't want to imply that I think this is the case at all programs, there are definitely programs that make an effort - do I think it's more than 50% of programs? I do not.

As an example - several weeks ago I was called by an attending and asked to address an issue with one of our new residents, who had forgotten (read: didn't know was necessary) to do something in the workflow of getting a patient on-beam. This attending told me they didn't feel like it was their job to teach this resident this particular thing, that this attending just assumed we knew how to do everything, and could I "please take care of it" so this attending didn't have to deal with it.

I would like to think I'm alone in these experiences...but I doubt it.
Oh yeah we are totally on the same page regarding that issue. People should definitely be on the lookout for that kind of thing. However I don't think the quality of radbio/physics education specifically at a program has much correlation with the larger quality of training/education/culture, future applicants will probably get misled if they try to use that as a gauge. Honestly if I think back to the places I interviewed at it was probably a negative correlation at several places.
 
Last edited:
Oh yeah we are totally on the same page regarding that issue. People should definitely be on the lookout for that kind of thing. However I don't think the quality of radbio/physics education specifically at a program has much correlation with the larger quality of training/education/culture, future applicants will probably get misled if they try to use that as a gauge.

Eh, there is some correlation. I think a program which makes an effort to hire someone to come teach annually (i.e. bring in Caggiano), or send their residents to Maryland, or keep someone like Zeman or Woloschak on staff - that speaks to the wider culture of the institution.

Yes, it shouldn't be the only metric, but I don't know if they would be "misled". It's like that adage that you can tell a lot about a person by how they treat animals.

The animals, of course, being RadOnc residents.
 
  • Like
Reactions: 2 users
The competitiveness of the specialty, the rapid expansion of residents without concordant expansion of infrastructure for teaching, the complete disregard for the rationale and substance and objectives of examination/certification all played a role in how bad the majority of radiation oncology education is in this country.

It should have been an outrage before the current tragedy unfolding before our eyes. But, during "peak rad onc" we were all so damn scared to say anything as students, and even more scared to say anything during residency lest we lose an opportunity at future employment. I hear so called leaders saying things like "Why don't our own residents say anything if it's so bad?" Do they even hear themselves talk? When a small or medium sized residency has just one good teacher, it's a breath of fresh hair. Most don't even have one. This is the state of the field. We have good people (and I truly mean that) like spratt, goodman, golden, and a few others willing to engage here, but they have nothing to say about the disaster left in the wake of dozens of terrible decisions made by our dear leaders. They think because they don't see it or hear about it, it doesn't exist. "Where is the proof? Where is the data?" Give me a break.

And though the style/writing/rhetorics of the 'climate' piece left a bit to be desired, the points stood on their own. Yet, I am hearing attendings say that the substance of it should be disregarded because it was anonymous and that it would have been stronger if the author made herself known or pursued the peer review process. Listening to these people in real life if you are junior faculty must drive you bonkers. If anonymity comes up amongst faculty, it's up to the junior faculty and residents to push back hard and corner them about the relevance.
 
  • Like
  • Love
Reactions: 5 users
Yet, I am hearing attendings say that the substance of it should be disregarded because it was anonymous and that it would have been stronger if the author made herself known or pursued the peer review process.
If Martin Luther had waited on peer review of his 95 Theses from the Catholic Church "Protest"antism never would've gotten started.

But, sure, you can get an *opinion* piece with "peer review" stamped on it; makes a man feel good. Put that piece under your pillow at night and hope the Peer Review Fairy comes by and leaves you a quarter. But how do you know the fairy isn't a crazy glue sniffer. "Just buildin' model airplanes!" he says. He sneaks in your house once and next thing you know there's money missing off the dresser and your daughter's knocked up. I've seen it a hundred times!
 
  • Like
  • Haha
  • Love
Reactions: 7 users
Sorry, to be clear - I was just using radbio/physics as a concrete example, my wider point being that I feel like many programs have come to trust that their residents will teach themselves whatever they need to know.

As has been talked about elsewhere on this forum, for me (and others), there was a distinct change (decline) in the effort and quality of teaching residents that I experienced going from my Internal Medicine intern year to my Radiation Oncology residency. The expectation that I perform at a high level was immediately present, but it was just assumed that it would...happen.

I don't want to imply that I think this is the case at all programs, there are definitely programs that make an effort - do I think it's more than 50% of programs? I do not.

As an example - several weeks ago I was called by an attending and asked to address an issue with one of our new residents, who had forgotten (read: didn't know was necessary) to do something in the workflow of getting a patient on-beam. This attending told me they didn't feel like it was their job to teach this resident this particular thing, that this attending just assumed we knew how to do everything, and could I "please take care of it" so this attending didn't have to deal with it.

I would like to think I'm alone in these experiences...but I doubt it.
You are not alone. There are many places out there with this and far worst. Im not sure everyone knows how bad some of these places are, the bottomless pits of hell, the warm body farms in our specialty. I know people from these places and believe me they are miserable. Take a look at the multiple threads about bad programs, the interview reviews thread. This is not unknown. Applicants even with a criminal record should look elsewhere. Nobody deserves to go to these places and receive a bad education and zero support.
 
  • Like
Reactions: 1 users
The competitiveness of the specialty, the rapid expansion of residents without concordant expansion of infrastructure for teaching, the complete disregard for the rationale and substance and objectives of examination/certification all played a role in how bad the majority of radiation oncology education is in this country.

It should have been an outrage before the current tragedy unfolding before our eyes. But, during "peak rad onc" we were all so damn scared to say anything as students, and even more scared to say anything during residency lest we lose an opportunity at future employment. I hear so called leaders saying things like "Why don't our own residents say anything if it's so bad?" Do they even hear themselves talk? When a small or medium sized residency has just one good teacher, it's a breath of fresh hair. Most don't even have one. This is the state of the field. We have good people (and I truly mean that) like spratt, goodman, golden, and a few others willing to engage here, but they have nothing to say about the disaster left in the wake of dozens of terrible decisions made by our dear leaders. They think because they don't see it or hear about it, it doesn't exist. "Where is the proof? Where is the data?" Give me a break.

And though the style/writing/rhetorics of the 'climate' piece left a bit to be desired, the points stood on their own. Yet, I am hearing attendings say that the substance of it should be disregarded because it was anonymous and that it would have been stronger if the author made herself known or pursued the peer review process. Listening to these people in real life if you are junior faculty must drive you bonkers. If anonymity comes up amongst faculty, it's up to the junior faculty and residents to push back hard and corner them about the relevance.

In the fervor over the effect of expansion on the job market, I think its effect on education is somewhat of an overlooked point.

Internal Medicine is a great counter-example. It's one of - if not the - largest specialties in Medicine. As we have said before regarding number of fractions/PTV size - "errors balance out". In IM, your teams are large and generally, at minimum, consist of a student, intern, resident, and attending. Sometimes there's a fellow, and sometimes there's more than one person at each level. The rotations are short - often 2-4 weeks. What does this mean? You get exposed to a lot of people of varying abilities and knowledge in many different environments. Add on top of this: morning report, other "reports" at various levels, lectures, grand rounds, the expectation that senior residents and fellows have "pocket" 5-15 minute lectures ready to give a "chalk talk" with at a moment's notice - there are lots of educational opportunities. Then, the IM residents have a single board exam which is the culmination of their training and clinical in nature. There are a plethora of strong resources available for personal study for this exam.

The opposite end of the spectrum is Radiation Oncology. The concept of team is gone - it's usually a single resident with a single attending (except for those lovely double-coverage rotations). Rotations last, at minimum, 1 month - though I think that's rare, most rotations are 2-3 months at most places. While programs - as an ACGME requirement - have didactics, attending involvement is variable. I also don't have a sense for how many places do "morning report" - Chicago is obviously "infamous" for it, but how many others? Chart rounds is also widely variable in form and quality.

I would argue the standard experience for a RadOnc resident in America is entirely dependent on a single attending for months at a time. That attending's volume - and quality - of teaching is highly variable. We have a total of 4 board exams, only 2 of which are clinical in nature. The two basic science boards are equivalent to the comprehensive PhD qualifying exams - and I say this with utter confidence, because I have a PhD and was required to complete comprehensive qualifying exams. A department's willingness - and ability - to prepare you for these exams is highly variable, and can be used as a surrogate for their opinion on resident education in general (not a perfect surrogate, I admit). The resources for these exams are of dubious quality - though I feel like things have improved significantly since the formation of RadOncQuestions in 2014.

For at least the past ten years, it seems reasonable to hypothesize that how much Radiation Oncology you "learn" is dependent on your ability to memorize textbooks and is divorced from your training program. There are obviously notable exceptions to this - people and programs which provide their residents with tremendous educational experiences. Unfortunately, educational experience is somewhat divorced from reputation - as I have said before, there are programs which I personally think very highly of which don't have a shiny, pedigree name - and there are programs with stellar reputations that depend exclusively on the amazing talent their residents have to teach themselves.

Now, with appropriately declining medical student interest in this dumpster fire field, I think a lot of things will become unmasked in the next 5-10 years. As I said earlier - if you struggled with the USMLE exams, you better pray to whatever God you hold dear that you Match into the "right" program.
 
Last edited:
  • Like
Reactions: 7 users
If Martin Luther had waited on peer review of his 95 Theses from the Catholic Church "Protest"antism never would've gotten started.

But, sure, you can get an *opinion* piece with "peer review" stamped on it; makes a man feel good. Put that piece under your pillow at night and hope the Peer Review Fairy comes by and leaves you a quarter. But how do you know the fairy isn't a crazy glue sniffer. "Just buildin' model airplanes!" he says. He sneaks in your house once and next thing you know there's money missing off the dresser and your daughter's knocked up. I've seen it a hundred times!

Yes - nothing of value ever came from people writing under pen names
 
  • Like
Reactions: 1 users
Top