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The single best, and likely only real way, to effectively close or reduce the number of rad onc slots at bad programs is through the ACGME survey. While we would all like to believe that chairs and program directors across the country will take the recent ASTRO statement to heart and voluntarily reduce residency slots (there are some programs who were/are planning to contract before the statement), the fact remains that opening residencies and expanding programs is the best way to get a smart, cheap labor for departments.
The annual ACGME survey is taken very seriously by all programs, as it should be. It is basically the only way to keep your residency accredited. It is truly anonymous and for those at small programs with one resident/year, the ACGME will aggregate the survey results across years, usually at least 4 years, in order to protect the anonymity of responses. The rest of the surveys and feedback you give your program is fluff. People will listen but if you want real change, you really just need a couple residents to answer the lowest score on every single question for a year for the ACGME and thus the program to take notice.
This is not just to help close down or reduce spots. But residents should have a great physics and rad bio course taught physics and rad bio faculty that care, an academic fund that covers ASTRO and other conferences + any educational material that is needed. If your program doesn't have that, the best way is to have the program be given a warning through the ACGME survey for related or un-related issues and ask for these things on top of improving the educational component of residency. It works beautifully and have seen it be very effective. Not only will rotations be re-structured, attendings start to care, etc but residents can finally get their poster, flight, hotel room reimbursed at ASTRO.
Having residents is a privilege and for attendings, having a resident SHOULD BE MORE WORK if that attending is doing it right. Why? Attendings should be reviewing every single contour, putting aside a few hours/week for didactics and reviewing key literature on top their normal clinical duties. This is not the standard and I've seen too many attendings just mail the teaching component in and use the resident to help start their clinic, cover CBCT/SBRTs, be the shield between the nurse and themselves, write notes, contour OARs, and pump out retrospective chart reviews that require zero attending input.
I am sick of how our field has taken advantage of residents so I want to empower residents to fight back in the only way that matters and protects the resident through anonymity. We need to get the word out to residents to start using the survey as a weapon and use it to put bad programs on notice. As far I understand it, the ACGME will issue a warning, then probation, and then as a final step, de-accredit a program. Time varies between each step but the goal is to put programs in the warning stage in order to force them to make changes to improve resident education.
Edit: To clarify my thoughts:
Goal: improve bad programs, if not, put them on the path to contracting and/or closing
How: through the ACGME survey which is truly anonymous - b/c most residencies are small, it only takes one or two residents to answer the lowest score on all the questions. what if the program is doing ok on some things but not others? the most effective thing i've seen is when all scores are trending down in the survey and a warning is issued to the program to improve. in reality, if a couple residents in most programs with ~10 or less residents did this for a couple years, the ACGME would tell the program to improve (may even issue a warning which is great for the residents in terms of getting actual changes), thus bringing the program to the table and actually listen to resident concerns. otherwise, most of the time, departments have very little incentive to improve or do anything that would cost them more $ (e.g. give residents larger academic funds or hire rad bio faculty and start a real rad bio course for residents)
Does it work?: yes, as medgator pointed out, this is how Cornell was shut down when it didn't improve and those residents still at Cornell landed at much better programs
The annual ACGME survey is taken very seriously by all programs, as it should be. It is basically the only way to keep your residency accredited. It is truly anonymous and for those at small programs with one resident/year, the ACGME will aggregate the survey results across years, usually at least 4 years, in order to protect the anonymity of responses. The rest of the surveys and feedback you give your program is fluff. People will listen but if you want real change, you really just need a couple residents to answer the lowest score on every single question for a year for the ACGME and thus the program to take notice.
This is not just to help close down or reduce spots. But residents should have a great physics and rad bio course taught physics and rad bio faculty that care, an academic fund that covers ASTRO and other conferences + any educational material that is needed. If your program doesn't have that, the best way is to have the program be given a warning through the ACGME survey for related or un-related issues and ask for these things on top of improving the educational component of residency. It works beautifully and have seen it be very effective. Not only will rotations be re-structured, attendings start to care, etc but residents can finally get their poster, flight, hotel room reimbursed at ASTRO.
Having residents is a privilege and for attendings, having a resident SHOULD BE MORE WORK if that attending is doing it right. Why? Attendings should be reviewing every single contour, putting aside a few hours/week for didactics and reviewing key literature on top their normal clinical duties. This is not the standard and I've seen too many attendings just mail the teaching component in and use the resident to help start their clinic, cover CBCT/SBRTs, be the shield between the nurse and themselves, write notes, contour OARs, and pump out retrospective chart reviews that require zero attending input.
I am sick of how our field has taken advantage of residents so I want to empower residents to fight back in the only way that matters and protects the resident through anonymity. We need to get the word out to residents to start using the survey as a weapon and use it to put bad programs on notice. As far I understand it, the ACGME will issue a warning, then probation, and then as a final step, de-accredit a program. Time varies between each step but the goal is to put programs in the warning stage in order to force them to make changes to improve resident education.
Edit: To clarify my thoughts:
Goal: improve bad programs, if not, put them on the path to contracting and/or closing
How: through the ACGME survey which is truly anonymous - b/c most residencies are small, it only takes one or two residents to answer the lowest score on all the questions. what if the program is doing ok on some things but not others? the most effective thing i've seen is when all scores are trending down in the survey and a warning is issued to the program to improve. in reality, if a couple residents in most programs with ~10 or less residents did this for a couple years, the ACGME would tell the program to improve (may even issue a warning which is great for the residents in terms of getting actual changes), thus bringing the program to the table and actually listen to resident concerns. otherwise, most of the time, departments have very little incentive to improve or do anything that would cost them more $ (e.g. give residents larger academic funds or hire rad bio faculty and start a real rad bio course for residents)
Does it work?: yes, as medgator pointed out, this is how Cornell was shut down when it didn't improve and those residents still at Cornell landed at much better programs
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