The April 2022 #RadOnc #JC focuses on recent changes to the ACGME Program Requirements for Graduate Medical Education (GME) in Radiation Oncology.
The discussion will begin Saturday, April 23rd at 8 AM CST and go through Sunday, April 24th, culminating in the live hour from 1-2 pm CST, Sunday April 24th.
A key role of health professional education is to meet societal needs. Accreditation is an important enabler that provides a process of formal evaluation of an educational program, institution, or system against defined standards by an external body for quality assurance and enhancement.1 With rapidly increasing demands of health systems and their physicians, both have been undergoing increased scrutiny and evolution worldwide.
For Radiation Oncology, the primary goal of GME (‘residency’) is to assure each resident develops the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine2. However, with rapid advancements in radiation oncology, our education systems have had difficulty keeping pace.
In 2020 the Accreditation Council for Graduate Medical Education (ACGME) released their new Common Program Requirements (CPR)2, set to take effect in July 2022 and guide the revision of Program Requirements (PR)4. These continued to emphasize that GME programs are designed to provide professional education; are based on the best available evidence; and support the philosophy of competence-building and provision of an adequate learning environment with specific changes to personnel recommendations (Section II).2
A few months ago the final revised ACGME Program Requirements (PR) for Radiation Oncology were released, included CPR changes, and greatly expanded on them with additional focused revisions to sections on oversight (I), personnel (II), and the educational program (IV).4 For example, prior versions of the program requirements specified that the minimum number of external beam radiation therapy (EBRT) cases per resident was 450. However, the requirements did not specify a minimum case requirement per disease site. Recent technological advances and evolution in indications for radiation have led to the expansion of SBRT and SRS and additionally with the continued expansion of residency programs and positions, there has been a large increase in the total number of radiation oncology residents over recent years. The expansion in residency programs has led to some concern in educational rigor, especially with potentially related issues including an increase in unmatched positions, decrease in US senior medical students applying to radiation oncology, and concerns about future employment opportunities5, 6. These challenges provide an opportunity for the field of radiation oncology to consider ways to improve.
A review of case logs for graduating radiation oncology residents between 2007 and 2018 demonstrated that the overall mean number of EBRT cases per graduating resident decreased by 13.2% over the study period (from 521.9 in 2007 to 478.5 in 2018), and there was also a decrease in the ratio of nonmetastatic to metastatic cases per graduating resident. The largest decreases in cases were seen for hematologic, lung, and genitourinary malignancies. Overall, SRS and SBRT case volume increased over the study period6. Another review of radiation oncology programs reported on marked variations among radiation oncology residency programs, including variation in availability of specialized EBRT machines (52% of programs), gamma knife (22% of programs), proton therapy (20% of programs), and MRI linear accelerator (8% of programs).6, 7
The new ACGME Program Requirements for Radiation Oncology are set to take effect on July 1, 2022.
These new requirements have set a bold direction towards high-quality care of patients with a committed and well-prepared workforce, increased scrutiny for radiation oncology education in the USA, and potential implications for medical education and oncologists worldwide.
In this month’s #RadOnc #JC, we will focus on the recent changes to the ACGME radiation oncology residency program requirements that are effective on 7/1/22.
ACGME. Radiation Oncology – Program Requirements and FAQs –
Future Effective Date 7/1/2022, (Accessed April 16 2022). https://bit.ly/RadOncJC_ACGME_Webpage
Our guiding topics this month are as follows:
T1. Background: What is radiation oncology education and how is accreditation important in the USA and worldwide?
T2. Methods: How were the ACGME Program Requirements for Radiation Oncology developed?
T3. Results & Discussion: What were the changes in requirements and how do they compare with other countries?
a. General: Do you think tightening program requirements is a good approach for the health of the field of radiation oncology?
b. Personnel: What are the new personnel requirements (number of core faculty, faculty-to-resident ratio)?
c. Rotations: What are the changes to rotation requirements (percent of educational experiences that must take place at the primary site+/- additional site)?
d. Cases: What are the requirements for case numbers (including subsites)?
T4. #PatientsIncluded: What do patients feel is important for radiation oncology education?
T5. Next steps: Do these changes go far enough and what else can be done to improve radiation oncology education in the USA and worldwide?
*1. Frank JR, Taber S, van Zanten M, et al. The role of accreditation in 21st century health professions education: report of an International Consensus Group. BMC Medical Education 2020; 20: 305. DOI: 10.1186/s12909-020-02121-5.
*2. ACGME. Common Program Requirements, https://www.acgme.org/what-we-do/accreditation/common-program-requirements/ (2022, accessed April 16 2022).
3. Golden DW. United States Radiation Oncology Curriculum Development: The Tail is Wagging the Dog. International Journal of Radiation Oncology, Biology, Physics 2020; 106: e1-e4. DOI: 10.1016/j.ijrobp.2019.11.399.
*4. ACGME. Radiation Oncology – Program Requirements and FAQs https://www.acgme.org/specialties/radiation-oncology/program-requirements-and-faqs-and-applications/ (2022, accessed April 16 2022).
*5. Wu TC, McCloskey SA, Wallner PE, et al. The Declining Residency Applicant Pool: A Multi-Institutional Medical Student Survey to Identify Precipitating Factors. Adv Radiat Oncol 2021; 6: 100597. 2020/10/27. DOI: 10.1016/j.adro.2020.10.010. https://www.sciencedirect.com/science/article/pii/S2452109420302992
6. Brower JV, Blitzer GC, Vapiwala N, et al. Declining Medical Student Interest in Radiation Oncology: Wake-Up Call With a Silver Lining? Int J Radiat Oncol Biol Phys 2021; 110: 274-277. 2021/03/16. DOI: 10.1016/j.ijrobp.2021.02.035.
*7. Vengaloor Thomas T, Perekattu Kuruvilla T, Kahn J, et al. Variations in Resources Among Radiation Oncology Residency Programs in the United States. Advances in Radiation Oncology 2021; 6. DOI: 10.1016/j.adro.2020.08.001. https://www.sciencedirect.com/science/article/pii/S2452109420302128
*free to access