Rad Onc Twitter

[thecarbonionangle]

What happened to the cornell program?What was KO referring to? Sorry I’m out of the loop

many more bottomless hell pits out there to learn about as well

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[RickyScott]

many more bottomless hell pits out there to learn about as well

Such as ....

 

[thecarbonionangle]

Such as ....

you know the thing.

there is already an entire thread thread dedicated to this issue. Over the next yr you may very well find out about new residency programs. Stay tuned!

 

[heavyluva]

Wow. There are so many programs that are actually worse though. I wonder if this trend will continue and how acgme will make these evaluations.

Cornell got permanently closed down by the acgme for some reason that hasn’t been publicly stated at this point but rumors on this forum seems to indicate that it had to do with poor resident training experience.

 

[medgator]

Such as ....

A big chunk of the programs in the NYC metro outside of msk and nyu. Probably any program created in the last 5 years

 

[deleted941485]

A big chunk of the programs in the NYC metro outside of msk and nyu. Probably any program created in the last 5 years

If it really came down to it...MSK is probably sufficient in terms of RO for the NYC city limits. NYU could probs do with less residents .

 

[Doctorer]

Yup. In the past med students have overlooked trash training programs because they were in NYC, with the rationalization of "How bad could it be?" and "Hey, New York is better than Ohio!" When finding a job gets harder, the pressure on bad programs is turned up.

 

[evilbooyaa]

If it really came down to it...MSK is probably sufficient in terms of RO for the NYC city limits. NYU could probs do with less residents .

Eh, why don't we start with lowest hanging fruit. NYU probably better than Downstate or Montefiore.... I don't personally knwo about Columbia or NY Methodist or Mt Sinai...

 

[RickyScott]

Amppp

Eh, why don't we start with lowest hanging fruit. NYU probably better than Downstate or Montefiore.... I don't personally knwo about Columbia or NY Methodist or Mt Sinai...

and LIJ and stony brook- does Long Island need 2 programs?

 

[medgator]

Amppp

and LIJ and stony brook- does Long Island need 2 programs?

Weren't both of those programs created within the last 5-10 years? Probably don't need either anymore than we need cedars in LA

 

[deleted941485]

Eh, why don't we start with lowest hanging fruit. NYU probably better than Downstate or Montefiore.... I don't personally knwo about Columbia or NY Methodist or Mt Sinai...

NYM probably the lowest one to go then maybe Columbia.

The others. Probably Monte or downstate kind of a toss up. Been to both. Downstate was a hell hole the only reason they need the program it is for the bodies. What happens to those bodies when the leave well...

 

[elementaryschooleconomics]

Wow. There are so many programs that are actually worse though. I wonder if this trend will continue and how acgme will make these evaluations.

I also find this interesting. My understanding/interpretation of how things went down at Cornell:

1) Historically known to be "bad" or "malignant" (I only heard about this as rumors from the Gossip Train whispered through the wind, I never personally witnessed anything or had any concrete evidence)

2) I think they were put on probation in the past 1-3 years, probably through poor ACGME surveys, poor board pass rates, or a combination thereof (or other reasons). I don't think you can go back in time on the ACGME website and look...though I haven't tried yet

3) The ACGME revisited during the probationary period and problem issues were not addressed/fixed (or perhaps board pass rates did not improve, etc)

4) The ACGME shut them down, letting them finish the 2020-2021 academic year

5) This probably doesn't close the door forever - I imagine they'll be eligible to open back up after a period of time, and I imagine they will do exactly that the second they can

So why Cornell when there are probably several other programs just as "bad", if not "worse"?

Yup. In the past med students have overlooked trash training programs because they were in NYC, with the rationalization of "How bad could it be?" and "Hey, New York is better than Ohio!" When finding a job gets harder, the pressure on bad programs is turned up.

I think this had something to do with it. The NYC location probably 1) attracted a certain kind of resident and 2) there are a bunch of programs in NYC now.

So, say you're at a questionable program in the Midwest. There might not be another RadOnc program for hundreds of miles, and unless you're active on SDN or have a network of buddies in Radiation Oncology, how do you know you're at a bad program? You can suspect, but you might think all programs are like yours. In New York, you have a ton of different residents in different programs who can talk to each other. You can easily discover if what you're experiencing is "normal" or not. And you might not be so shy speaking up about it.

There's this whole perception in RadOnc residency programs (probably all residency programs) that if you speak up on the ACGME survey your program immediately gets shut down and you're unemployed. That's simply not true, unless like, your PD is stabbing residents with old scalpels as a hobby - that might get you shut down in a hurry.

I feel like RadOnc residency programs have gotten lazy over the last 10-15 years and expect residents to train themselves, and this is what's going to come back to haunt them as the hangover from the Golden Era and expansion sets in. My experience with "learning" during my internal medicine intern year was certainly vastly different than my current "learning" in Radiation Oncology. There are definitely programs which try to give their residents more of a structured learning experience (from what I can garner from Twitter etc, I think places like Cleveland Clinic, Chicago (though billed as "malignant learning"), VCU, Mayo, UNC, Northwestern, etc), but most of us seem to be in a "lol teach urself" sort of environment.

It's not ideal.

 

[evilbooyaa]

For clinical education, resident-driven lectures as a mainstay of how residents learn in an academic radiation oncology program is a huge red flag to me, precisely for the above reason reason. You can hate on the CCF or UChicagos of the world for being 'mean' with the Socratic method and putting people on the spot but damn it if the clinical training there and of the residents who graduate from those programs does not seem to be excellent. Does Ralph ask some off the ball questions and make people feel bad, sure. Could he do it in a less mean way, also sure. Does Tendulkar run an amazing Socratic session, sure. Is John Suh super intimidating and terrifying when doing the Socratic method, also sure.

Active, interacting learning that was not purely a powerpoint or lecture that was lead by an attending was far and away the most useful 'didactic' time that I ever had during residency.

Unfortunately that seems to be a minority of 'education' in Radiation Oncology residency programs. No impetus for a program to change over the past 10 years as there was a giant supply of willing, smart residents that a program could be proud of. We'll see if people are willing to change course now.

 

[OTN]

For clinical education, resident-driven lectures as a mainstay of how residents learn in an academic radiation oncology program is a huge red flag to me, precisely for the above reason reason. You can hate on the CCF or UChicagos of the world for being 'mean' with the Socratic method and putting people on the spot but damn it if the clinical training there and of the residents who graduate from those programs does not seem to be excellent. Does Ralph ask some off the ball questions and make people feel bad, sure. Could he do it in a less mean way, also sure. Does Tendulkar run an amazing Socratic session, sure. Is John Suh super intimidating and terrifying when doing the Socratic method, also sure.

Active, interacting learning that was not purely a powerpoint or lecture that was lead by an attending was far and away the most useful 'didactic' time that I ever had during residency.

Unfortunately that seems to be a minority of 'education' in Radiation Oncology residency programs. No impetus for a program to change over the past 10 years as there was a giant supply of willing, smart residents that a program could be proud of. We'll see if people are willing to change course now.

I strongly agree re: Socratic method. I was trained at an institution where it was a daily occurrence. It was really the only teaching that was done by the attendings, it was malignant, it could be brutal, and not all the attendings participated, but I learned a ton. I do not have the confidence that all cohorts of residents would be able to succeed in this environment.

 

[elementaryschooleconomics]

For clinical education, resident-driven lectures as a mainstay of how residents learn in an academic radiation oncology program is a huge red flag to me, precisely for the above reason reason. You can hate on the CCF or UChicagos of the world for being 'mean' with the Socratic method and putting people on the spot but damn it if the clinical training there and of the residents who graduate from those programs does not seem to be excellent. Does Ralph ask some off the ball questions and make people feel bad, sure. Could he do it in a less mean way, also sure. Does Tendulkar run an amazing Socratic session, sure. Is John Suh super intimidating and terrifying when doing the Socratic method, also sure.

Active, interacting learning that was not purely a powerpoint or lecture that was lead by an attending was far and away the most useful 'didactic' time that I ever had during residency.

Unfortunately that seems to be a minority of 'education' in Radiation Oncology residency programs. No impetus for a program to change over the past 10 years as there was a giant supply of willing, smart residents that a program could be proud of. We'll see if people are willing to change course now.

I could not agree with this more!!

Unfortunately, I feel like there is somewhat of a mismatch between perceived "rankings"/"prestige" of programs and quality of education. I think, right now in 2020, there are places medical students can match and would get an inferior training experience but due to names and connections have a better shot at jobs, and vice versa.

In an ideal world, the two would align - perhaps we'll get there, someday. But...it's not what you know, it's who you know.

 

[metallica81788]

I feel like RadOnc residency programs have gotten lazy over the last 10-15 years and expect residents to train themselves, and this is what's going to come back to haunt them as the hangover from the Golden Era and expansion sets in. My experience with "learning" during my internal medicine intern year was certainly vastly different than my current "learning" in Radiation Oncology. There are definitely programs which try to give their residents more of a structured learning experience (from what I can garner from Twitter etc, I think places like Cleveland Clinic, Chicago (though billed as "malignant learning"), VCU, Mayo, UNC, Northwestern, etc), but most of us seem to be in a "lol teach urself" sort of environment.

Bingo 100% cannot agree enough.

I didn't know I was in a "bad" program until halfway through residency. Ignorance is bliss. The "teaching" was a huge dropoff from my not-even-mid-tier internal medicine prelim year. I didn't have any other outside friends in radiation oncology and only had a few other interviews and aways to compare in order to match in "a spot." Eventually meeting other people from different programs and even talking to past residents from my program I realized how deficient it was both in general and compared to even 5 years prior.

Would imagine many others feel the same way.

 

[scarbrtj]

I guess at least we see someone of import acknowledging “I see an iceberg.” Now the discussions are moving into “As we approach and hit this iceberg, here’s what I see playing out...”

Reading The Atlantic ("Can History Predict the Future? The Next Decade Could Be Even Worse") on an article completely unrelated to rad onc. Completely, totally unrelated. And yet... in reading, my mind substitutes some words. In brackets. Didn't take too many brackets.

• The fundamental problems, he says, are a dark triad of social maladies: a bloated elite class, with too few elite jobs to go around; declining living standards among the [new grads and fellows]; and a [proton center] that can’t cover its financial positions.
• Of the three factors driving social violence, Turchin stresses most heavily “elite overproduction”—the tendency of a society’s ruling classes to grow faster than the number of positions for their members to fill.
• ...[SDN]* is a counter-elite movement.
• Elite overproduction creates counter-elites [SDN'ers], and counter-elites look for allies among the commoners. If commoners’ living standards slip—not relative to the elites, but relative to what they had before—they accept the overtures of the counter-elites and start oiling the axles of their tumbrels. Commoners’ lives grow worse, and the few who try to pull themselves onto the elite lifeboat are pushed back into the water by those already aboard. The final trigger of impending collapse, Turchin says, tends to be [breadlines]. At some point rising insecurity becomes expensive. The elites have to pacify unhappy citizens with handouts and [instructorships]—and when these run out, they have to police dissent and oppress people. Eventually the state exhausts all short-term solutions, and what was heretofore a coherent civilization disintegrates.
• Turchin proposed, for example, that populations of organisms grow or decline exponentially, not linearly... This law is simple enough to be understood by a high-school math student, and it describes the fortunes of everything from ticks to starlings to camels.
• He opposes [just pumping out new grads], for example, which he says is a way of mass-producing elites without also mass-producing elite jobs for them to occupy.
• Eventually, Turchin hopes, our understanding of historical dynamics will mature to the point that no government [ABR or ACGME etc] will make policy without reflecting on whether it is hurtling toward a mathematically preordained disaster.
• Turchin likens [rad onc] to a huge ship headed directly for an iceberg: “If you have a discussion among the crew about which way to turn, you will not turn in time, and you hit the iceberg directly.” The past 10 years or so have been discussion. That sickening crunch you now hear—steel twisting, rivets popping—is the sound of the ship hitting the iceberg.

* Trumpism [substituted]

 

[medgator]

Bingo 100% cannot agree enough.

I didn't know I was in a "bad" program until halfway through residency. Ignorance is bliss. The "teaching" was a huge dropoff from my not-even-mid-tier internal medicine prelim year. I didn't have any other outside friends in radiation oncology and only had a few other interviews and aways to compare in order to match in "a spot." Eventually meeting other people from different programs and even talking to past residents from my program I realized how deficient it was both in general and compared to even 5 years prior.

Would imagine many others feel the same way.

I knew i was in a very low mid tier program but during peak rad Onc, me and my 250+ step 1 AOA brethren were happy to have matched knowing there was a good destination on the other side. It was the bargain we agreed to....

 

[thecarbonionangle]

The amount of programs where residents mostly teach eachother is alarmingly large. This can create the illusion that this is “normal” and cannot be improved, “look at all the other places that are just as bad or even worst”. How effing depressing is that? “meh it could be worst”. There is definitely a crisis of hope and like creativity if you think this cannot be improved or is impossible. Many internal medicine programs have a very legit education system and it is faculty led and interactive. Faculty are expected to be heavily involved. How did we turn our field into one with the lowest expectations possible, one where asking for faculty to lecture and be involved in many places is so sort of huge giant unreasonable unrealistic ask? We have a huge crisis of positivity, innovation and leadership. It should be no surprise our leaders take such a passive approach because the plurality/attitude/culture of the specialty toward pressing issues is often “meh”. The other worrisome consequence of this is that you breed more useless goons who turn around and do the exact same once the older guys leave.

 

[OTN]

The amount of programs where residents mostly teach eachother is alarmingly large. This can create the illusion that this is “normal” and cannot be improved, “look at all the other places that are just as bad or even worst”. How effing depressing is that?”meh it could be worst”. There is definitely a crisis of hope and like creativity if you think this cannot be improved or is impossible. Many internal medicine programs have a very legit education system and it is faculty led and interactive. Faculty are expected to be heavily involved. How did we turn our field into one with the lowest expectations possible, one where asking for faculty to lecture and be involved in may places is so sort of huge giant ask? We have a huge crisis of positivity, innovation and leadership.

When radonc was at its peak competitiveness, it didn't matter at all how the teaching was - med students were just happy to get a spot. There was zero incentive for these academicians to put forth any effort into teaching, so many didn't. IM departments have a ton of history behind them, and usually plenty of attendings who like to teach. Most radonc departments don't have that history, and when they were getting amazing applicants without lifting a finger, why lift that finger? Additionally, radonc was a bottom-of-the-barrel specialty in the 90s, when most of our current "leaders" matched. Poor quality in, poor quality out. I distinctly remember being very upset at several of my attendings in training who simply couldn't be bothered to teach me a damn thing, no matter the work I did for them. They violated the unspoken contract (I do the grunt work, you teach), but there were no repercussions, so who cares? I knew, though, that a great job was likely waiting for me after training, and I could teach myself, so I was willing to put my head down and do it.

We are seeing more interest in resident education on Twitter at least, so that's a start. They're going to need to do it, too, as the incoming crop of (AMAZINGLY DEDICATED, SUPER INTO THEIR PATIENTS, MORE SO THAN WE EVER COULD BE) residents are going to need that help.

 

[w00tz]

I knew i was in a very low mid tier program but during peak rad Onc, me and my 250+ step 1 AOA brethren were happy to have matched knowing there was a good destination on the other side. It was the bargain we agreed to....

I ranked places I would have hated to live in, but my thinking was 'it's just 4-years, then I go the promise land.' So misguided.

 

[thecarbonionangle]

I ranked places I would have hated to live in, but my thinking was 'it's just 4-years, then I go the promise land.' So misguided.

i know someone who interviewed in a bunch of top places but used same strategy, ended up in desirable city, hated their time there, had trouble getting A job, zero faculty help, and really regrets choice as well.

 

[RickyScott]

i know someone who interviewed in a bunch of top places but used same strategy, ended up in desirable city, hated their time there, had trouble getting A job, zero faculty help, and really regrets choice as well.

very reasonable strategy in past. Historically, across almost all specialties, us med school grads have had no issues finding gainful employment.

 

[fiji128]

My experience was that all didactics were done by the residents and consisted of twice weekly resident delivered lectures. This was a crazy big burden on the residents. The clinical faculty would give maybe one lecture a year themselves, if they couldn't find a excuse to get out of it. The program ran into some trouble with the ACGME while I was there through low residents survey scores but this only resulted in a slap on the wrist with no real corrective measures being done. The 100% resident driven didactics is a huge red flag and something the acgme should prohibit, but they don't. This is a dead give away of a terrible program. As is more residents then clinical faculty (ie not counting a chair who sees 15 patient a year).

 

[Lamount]

My experience was that all didactics were done by the residents and consisted of twice weekly resident delivered lectures. This was a crazy big burden on the residents. The clinical faculty would give maybe one lecture a year themselves, if they couldn't find a excuse to get out of it. The program ran into some trouble with the ACGME while I was there through low residents survey scores but this only resulted in a slap on the wrist with no real corrective measures being done. The 100% resident driven didactics is a huge red flag and something the acgme should prohibit, but they don't. This is a dead give away of a terrible program. As is more residents then clinical faculty (ie not counting a chair who sees 15 patient a year).

Where I trained, the didactics were mostly led by residents (though this was changing toward the end of my training). Attendings would frequently show up and pimp everyone. Preparing hour-long talks and having to justify every bullet point in a hardcore pimping session was very cumbersome, but I did end up learning quite a bit, and every talk I have given since felt easy by comparison.

 

[evilbooyaa]

Where I trained, the didactics were mostly led by residents (though this was changing toward the end of my training). Attendings would frequently show up and pimp everyone. Preparing hour-long talks and having to justify every bullet point in a hardcore pimping session was very cumbersome, but I did end up learning quite a bit, and every talk I have given since felt easy by comparison.

Pimpin' ain't easy but it is necessary

 

[scarbrtj]

“Resident led didactics” ... also known as recalls?

 

[RickyScott]

“Resident led didactics” ... also known as recalls?

presentations mostly help the presenter learn. Otherwise past astro lectures more than suffice and typically better for learning than a resident presentation unless resident has put in a lot of effort.

 

[kimplera]

we had resident led lectures for most of residency as well - 3/week while on call (q4). BUT - almost all attendings came to the sessions and much of the time was spent discussing the merits of the data. When faculty led the lectures (last year) the attending attendance was not as robust

 

[RadOncMegatron]

presentations mostly help the presenter learn. Otherwise past astro lectures more than suffice and typically better for learning than a resident presentation unless resident has put in a lot of effort.

I think a lecture series that is led mostly by attendings with 1 or 2 lectures a year given by each resident is best. I did learn a lot from the lectures I gave, but the depth and insight an experienced attending can give are precious. All resident led didactics is really unacceptable.

 

[elementaryschooleconomics]

Ralph with another drive-by douchebag Tweet...RadICaL cAnDOr

 

[thecarbonionangle]

View attachment 323039
View attachment 323042

Ralph with another drive-by douchebag Tweet...RadICaL cAnDOr

“Sir, this is a Wendys?!”

 

[fiji128]

In our program there were 6 or fewer residents. Doing an hour long lecture every 2 to 3 weeks was brutal while the faculty sat back and took pop shots. Just asking often irrelevant questions and saying hey its the socratic method is hardly teaching and no one would send their own children to such a place for an education.

If you think about it the way rad onc is often taught is completely wack. In my opinion, this has to do with the crazy focus on studies and the history of prior studies even before residents know how to actually clinically treat cases. Just look at any rad onc text book and read any chapter and you may not get any practical/useful information on the nuts and bolts of how to actually clinically treat something but you will get a great history of prior studies. I think a sane education model would be learn anatomy/imaging/staging first, then indications and treatment strategies and finally plan evaluation. After that, then worry about the whole history of prior studies thing.

 

[metallica81788]

If you think about it the way rad onc is often taught is completely wack. In my opinion, this has to do with the crazy focus on studies and the history of prior studies even before residents know how to actually clinically treat cases. Just look at any rad onc text book and read any chapter and you may not get any practical/useful information on the nuts and bolts of how to actually clinically treat something but you will get a great history of prior studies. I think a sane education model would be learn anatomy/imaging/staging first, then indications and treatment strategies and finally plan evaluation. After that, then worry about the whole history of prior studies thing.

Don't you dare tell these people we can do things without clinical trial data!!! We are radiation oncology with four board exams!!!

Completely agree. Most attendings will pimp first year residents about path CR rates from the German rectal trial without actually showing them anything about how to treat rectal cancer. But you learned something did you not? The way most of this field "educates" is completely screwed up and a lot of it goes back to how we can't even put our pants on without a randomized clinical trial showing it's non-inferior to go one leg at a time.

 

[Grubbe-a-dub-dub]

“Sir, this is a Wendys?!”

LOL. I think gramps should stay off twitter. He's clearly out of his league.

 

[evilbooyaa]

In our program there were 6 or fewer residents. Doing an hour long lecture every 2 to 3 weeks was brutal while the faculty sat back and took pop shots. Just asking often irrelevant questions and saying hey its the socratic method is hardly teaching and no one would send their own children to such a place for an education.

If you think about it the way rad onc is often taught is completely wack. In my opinion, this has to do with the crazy focus on studies and the history of prior studies even before residents know how to actually clinically treat cases. Just look at any rad onc text book and read any chapter and you may not get any practical/useful information on the nuts and bolts of how to actually clinically treat something but you will get a great history of prior studies. I think a sane education model would be learn anatomy/imaging/staging first, then indications and treatment strategies and finally plan evaluation. After that, then worry about the whole history of prior studies thing.

Agree that asking a PGY-2 about trials when they don't even know the appropriate treatment paradigm is dumb AF. Socratic method, when done properly, builds from lowest tier of information (what stage is this patient) to higher (what is appropriate treatment) to highest (why is X the appropriate treatment) to the, eventually, esoteric (what was the % benefit of X,Y,Z in X trial). Many an attending (usually older) only focuses on the esoteric. When a junior resident gets a question wrong, go up the ladder.

Everyone involved in resident education should read art of pimping: The Art of Pimping

My main take aways from this:

" Clinical teaching sessions often involve direct questioning of individual students in the presence of their peers. This differs from most examinations in which the student's knowledge base is not on public display. In some cases, participants volunteer answers. More often, the faculty member selects 1 or more of the participants to respond. If the first student cannot correctly answer, another student is chosen, and so on until someone answers the question correctly. If no one answers the question correctly, the attending does (assuming he or she knows the answer). If not, a student is usually assigned to investigate the question and report back the next day. Some students thrive on displaying their knowledge (or lack thereof) in public, others do not.

"Respect educational order. Never ask a medical student to respond to a question after a resident has answered incorrectly. One way to avoid this faux pas: always start at the bottom of the educational chain and move serially up a level if no one at the first level has a correct answer (ie, third-year students before fourth-year students, before interns, before residents). There is an important corollary for the junior residents and medical students: do not break ranks by showing up the senior resident on the team (or the junior resident or student's next admission may be a very difficult patient). "

 

[scarbrtj]

View attachment 323039
View attachment 323042

Ralph with another drive-by douchebag Tweet...RadICaL cAnDOr

"I know you're a resident; you shouldn't be doing this case until you've been able to do many more cases." And with the last keystroke of that Twitter reply what few neurons Ralph possessed between the sea of neurofibrillary tangles entered into a phenomenal, and fatal, storm of electrical activity due to an unresolvable feedback loop.

 

[elementaryschooleconomics]

Don't you dare tell these people we can do things without clinical trial data!!! We are radiation oncology with four board exams!!!

Completely agree. Most attendings will pimp first year residents about path CR rates from the German rectal trial without actually showing them anything about how to treat rectal cancer. But you learned something did you not? The way most of this field "educates" is completely screwed up and a lot of it goes back to how we can't even put our pants on without a randomized clinical trial showing it's non-inferior to go one leg at a time.

No exaggeration - my first day in my first clinic as a PGY2. It was probably my first or second case I was presenting to the attending:

"Ok - and what do we know about dose escalating the esophagus, from the Minsky trial?"

Me: "What's a Minsky"

 

[RadOncMegatron]

In our program there were 6 or fewer residents. Doing an hour long lecture every 2 to 3 weeks was brutal while the faculty sat back and took pop shots. Just asking often irrelevant questions and saying hey its the socratic method is hardly teaching and no one would send their own children to such a place for an education.

If you think about it the way rad onc is often taught is completely wack. In my opinion, this has to do with the crazy focus on studies and the history of prior studies even before residents know how to actually clinically treat cases. Just look at any rad onc text book and read any chapter and you may not get any practical/useful information on the nuts and bolts of how to actually clinically treat something but you will get a great history of prior studies. I think a sane education model would be learn anatomy/imaging/staging first, then indications and treatment strategies and finally plan evaluation. After that, then worry about the whole history of prior studies thing.

The textbooks are a hot pile of garbage. It seems they are writing for other academics and not intended to teach. The fact that we need to have other textbooks that go over countouring is just pitiful. PITIFUL. Shouldn't our textbooks be about contouring? Yes, put in the studies blah blah but we need practical information.

The best rad onc education (not including clinical experience) IMHO is from a combo of ASTRO lectures + Recalls + Trial Protocols + NCCN + Contouring Guidelines (pubs and Nancy Lee's books).

I also highly recommend listening to lectures from non-rad oncs.

 

[OTN]

No exaggeration - my first day in my first clinic as a PGY2. It was probably my first or second case I was presenting to the attending:

"Ok - and what do we know about dose escalating the esophagus, from the Minsky trial?"

Me: "What's a Minsky"

Ha! I once saw an attending pimp a 3rd-year medical student about the rates of nodal recurrence in the classic lobectomy vs wedge trial.

Always drove me crazy as well how much emphasis was put on studying trial after trial...but when it came to learning how my attending pre-planned his brachy seed insertion, I got a 20-second speed talk, with a smirk as he knew he was doing it so quickly there was no way for me to learn.

 

[dieABRdie]

In our program there were 6 or fewer residents. Doing an hour long lecture every 2 to 3 weeks was brutal while the faculty sat back and took pop shots. Just asking often irrelevant questions and saying hey its the socratic method is hardly teaching and no one would send their own children to such a place for an education.

If you think about it the way rad onc is often taught is completely wack. In my opinion, this has to do with the crazy focus on studies and the history of prior studies even before residents know how to actually clinically treat cases. Just look at any rad onc text book and read any chapter and you may not get any practical/useful information on the nuts and bolts of how to actually clinically treat something but you will get a great history of prior studies. I think a sane education model would be learn anatomy/imaging/staging first, then indications and treatment strategies and finally plan evaluation. After that, then worry about the whole history of prior studies thing.

I didn't know what an iso was for 6 months. Everyone kept saying it so I knew it was common knowledge and I didn't want to look stupid by asking.

 

[elementaryschooleconomics]

I didn't know what an iso was for 6 months. Everyone kept saying it so I knew it was common knowledge and I didn't want to look stupid by asking.

Oh my God, I think I have about 4,000 stories like this.

For lurking medical students and residents, if these posts resonate with you, I HIGHLY recommend this book:

I have searched high and low for something that answers fundamental questions that everyone seems to know but you're too afraid to ask, and I think this is one of the best that's out there right now.

 

[RickyScott]

Me: "What's a Minsky"

I would be suspended if I told you.

 

[Mandelin Rain]

I didn't know what an iso was for 6 months. Everyone kept saying it so I knew it was common knowledge and I didn't want to look stupid by asking.

I think we've all been there.

 

[thecarbonionangle]

Isnt it crazy how bad education is in our field that you can go 6 months not knowing what an iso is, what d max is, what V20, D100 refers to, but you know path CR rate is 25 pct in this rectal cancer study plus you know that one useless study from
The 80s that you “must know for boards”? Great stuff folks!

 

[Grubbe-a-dub-dub]

My program director told us stories of a resident who didn't once see a linac throughout his residency... Deep down I know this is very possible at some programs.

Certainly need to change the paradigm of memorizing every study under the sun, but can't handle some radiation dermatitis or set up a patient on a linac.

 

[scarbrtj]

My program director told us stories of a resident who didn't once see a linac throughout his residency... Deep down I know this is very possible at some programs.
Certainly need to change the paradigm of memorizing every study under the sun, but can't handle some radiation dermatitis or set up a patient on a linac.

In the "old days" you had to know how to hand calc to get some MUs, put a patient on the table, take a 1 MU port film, and mode the machine up for your 3 Gy or 500 rad PA spine fraction (no one did 8 Gy!) or whatever. So that in theory you (resident MD) could do all that yourself if need be. Ideally would be one of the first things to teach a resident IMHO. Very simple RT: What are we doing? How do we do it? Why do we do it?

 

[elementaryschooleconomics]

My program director told us stories of a resident who didn't once see a linac throughout his residency... Deep down I know this is very possible at some programs.

Certainly need to change the paradigm of memorizing every study under the sun, but can't handle some radiation dermatitis or set up a patient on a linac.

Yup, I was told about a person who showed up to oral boards and didn't know what a VacLock was.

When I first heard that, I just couldn't believe it, how is that possible? How can you complete residency and be eligible for oral boards with that gap in knowledge?

Subsequently, I have observed enough about this field to think...yeah...yeah that's definitely something that could happen.

 

[Mandelin Rain]

Vac-Lok is a trademarked brand name from Civco. Though it is used rather ubiquitously in the field like "Kleenex". I suppose it's possible that they use another brand or even a foam based system like AlphaCradle and had just never heard the term.

 

[RadOncDoc21]

I bet we all knew how to dictate notes though. That’s the one constant in all residency programs!