Hi everyone, I have a question. What’s an optimal number of cases to see during residency? I know some say the more the better but I think after certain numbers, it’s just become burden with low educational yield. We won’t be able to actually think about the patient if you have 10 other consults to see that day.
Residency case numbers
- Thread starter DrProtonX
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10 was hyperbole but i see 6-8 on regular basis. Definitely seen 10 a week few times.
I would say the # does not matter necessarily, but rather how much teaching is involved regarding work-up/staging, contouring, plan evaluation.
I trained at a fairly high volume center and we did not get enough of this ^
Taught myself alot during boards prep
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You guys know there’s data on this. Most recent data would indicate, assuming one research year, that mean resident case experience is about 3-4 new EBRT patients per week
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I genuinely cannot believe that 478 cases is the average. I am not that far out from training and everyone that I overlapped with had >1000. Of course, on paper we all had 99x to avoid ACGME scrutiny.
Much like you trimmed your numbers to avoid ACGME scrutiny, at my residency we routinely stopped logging cases after reaching the required minimums plus a small buffer... That way the program would not be able to make the case to ACGME that there were plenty of cases to support expanding additional residency spots.
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ACR new pts/doc
There's probably a positive correlation between case numbers and expertise using a fax machine, writing notes, and calling pts back.
I wish residency programs spent more time discussing intricacies in contouring and plan evaluation. This is what I would focus on as a resident candidate evaluating programs instead of case number. But unfortunately academics is seen too much as a path to avoid typing notes with a single finger instead of resident education...
I wish residency programs spent more time discussing intricacies in contouring and plan evaluation. This is what I would focus on as a resident candidate evaluating programs instead of case number. But unfortunately academics is seen too much as a path to avoid typing notes with a single finger instead of resident education...
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If the mean number of new patients per MD is somewhere at 203-228 per year as this suggests, a previous guess of 50-95 de novo new patients per year made a good while back is not that far off... as we can estimate ~50% (maybe more?) of "new patients" per year are repeat business, getting palliation >1y after their initial diagnosis or some metastasis-direct RT, or maybe are not even a cancer patient.
Right now, if we are being very generous, a total of 1.2m people in America per year get RT for cancer. If 5000 rad oncs (very conservative), that's 240 EBRT patients/year as the average. The median will be much less.
Did we train at the same place? 🤣
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AI makes this moot. The literature makes clear that "experts" can't agree.
Ultimately, it just all depends. Being busy as a resident gives you the tools to be busy as an attending. I think it's sometimes hard to differentiate scut from training, and I acknowledge that despite not being that far out, it's hard to remember exactly what life was like as a resident. I went to a busy clinical program around 1k cases by the end of training). 10 consults in a day is a lot, but if that's it for the week then there's plenty of time for other stuff.
If you'd like some perspective from the attending side, I run a relatively busy clinic (95th percentile RVUs). Typically see 8-14 consults a week and some re-treat follow ups in the middle there. I see consults 2 days a week and generally don't schedule more than 6 each day. I could definitely see 8-10 if I had to but it wouldn't leave much time for anything else on those days and I wouldn't be able to leave by 330-4.
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Definitely quite busy if solo. More manageable if with a resident.
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10 consults in a day is malignant
10 consults in a week is a reasonable workload for a resident.
Many (I hesitate to say 'most' in 2025) academic attendings are not good at educating residents, be it in clinic or in relation to dosimetry/planning, hence all the stories about self-directed learning.
10 consults in a week is a reasonable workload for a resident.
Many (I hesitate to say 'most' in 2025) academic attendings are not good at educating residents, be it in clinic or in relation to dosimetry/planning, hence all the stories about self-directed learning.
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So ironic as iirc “doctor” is Latin for teacher
In the Enlightenment times, also iirc, the most learned and respected teachers were called “doctus,” a level above doctor
No “doctus” in modern rad onc (sheds tear)
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10 consults in a day is also very bad for patients. I wonder how many people dropping $$ and traveling long distances to get seen at these big centers realize how little of their care is being delivered by the so-called 'thought leaders'
I'm somewhat glad but also sad to know my experience in residency of getting basically zero worthwhile teaching whatsoever was not unique. Academicians who don't teach their residents are breaking the fundamental resident-attending contract: Residents do your dirty work, and in exchange you teach them.
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My program was consistently ranked as a Top 5 program.
The worst moment for me was when I was on a breast service and we were doing interstitial brachytherapy*. I almost never got to place any needles, instead usually just standing there and with great fanfare perhaps was allowed to do one every few cases. We had a breast fellow come down to observe, and my attending not only let her do more or less the whole case, but taught her more during that hour than I received in total in the 3 months I was on his service. It showed that it wasn't that he couldn't teach, it was just that he didn't care to do it for me.
Eighteen years ago. I'm still fired up about it to this day.
(*It was obvious to me even then that interstitial brachy for breast was ridiculous)
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An attending once told me "I'm not incentivized to teach"
D
deleted1217978
The way to peace is realizing it wasn't really education. Just another time wasting hoop to jump through.
It is absurd that you spend 4 years in residency and come out not knowing how to approve plans on your own, literally anything about physics and dosimetry (what the X in 6X energy means -- I have heard someone who completed PGY-5 ask this), or understanding any of the logistics of actually treating patients on the machine. I honestly don't know why anyone hires new grads especially in solo roles as I've learned this is very common and you have to figure it all out on your own.
Instead you learn trial data P-values to 3 decimal points and obscure radiation biology molecular pathways that you forget after the exam and never think about again. But if we want to play this game, we can start talking about the waste of years of medical school and especially undergraduate. No reason someone who is very smart and diligent couldn't be trained to do what we do and practicing independently on their own at age 21-22 with a full-time apprenticeship after high school if all of the fluff were removed. But you aren't allowed to select for IQ because that makes people feel bad so you have to have all these other stupid "educational" hoops to jump through and IQ-test surrogate exams for years to make sure only people with a capacity for higher level reasoning end up doing our jobs.
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There is a lot more to the job then just being "high IQ"
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It's really disappointing to see so many people essentially not be taught by any of their attendings.
Malignancy in a program can be one of a many things....
Malignancy in a program can be one of a many things....
