Academic Program

Conferences and teaching rounds attended by residents, radiation oncologists and other staff provide for and encourage progressive resident participation. The clinical and basic sciences are taught through regularly scheduled lectures, case presentations, conferences, and discussion relevant to the practice of radiation oncology. A curriculum in medical physics includes didactic lectures and laboratory demonstration of radiation safety procedures, calibration of radiation therapy machines, computer treatment planning, construction of treatment aids, and the safe handling of sealed and unsealed radionuclides. Radiation biology lectures include didactic lectures on all aspects of radiation effects on normal and neoplastic tissues. Organized lectures or conferences familiarize the resident with medical statistics, and oncologic pathology with special emphasis on neoplasia and radiation effects.

Residents learn in a continuous flow through intradepartmental clinical oncology conferences: new patient conferences, weekly chart review, problem case conferences, morbidity and mortality, physics, dosimetry, radiation biology and journal review.

Through attendance at multidisciplinary and departmental conferences there is didactic instruction in the potential value and limitations of other oncologic disciplines, such as medical oncology, surgical oncology, gynecologic oncology, hematologic oncology, pediatric oncology and the various surgical subspecialties that play a role in the management of the patient.

Residents are required to do an investigative project under faculty supervision with results suitable for publication or presentation.

Requirements:

• A first year (PGY1) of postgraduate clinical training must be spent in medicine, surgery, obstetrics/gynecology, family practice, pediatrics or a transition year program.   The PGY-1 year must include at least nine months of direct patient care in medical and/or surgical specialties other than radiation oncology.   Arrangements for the transition year must be made by the program applicant.
• Resident must have passed USMLE Step 2.

Rotations 

• Year 1
  PGY 2
  The resident completes three-month rotations in radiation oncology teaching and clinical settings, assigned to a clinical faculty member who represents for the resident, the “hub” in an interactive learning process. It is one-to-one, ongoing throughout each day, through simulation, dosimetry, treatment planning, disease pathology, scans, discussions with family members, medical oncologist regarding chemotherapy and radiation. This teaching method continues through the 4-year program with the resident increasingly acquiring knowledge, proficiency, confidence, and professionalism.

Residents learn standard radiation techniques as well as use of treatment aids and treatment planning, radiation safety, the principles of normal tissue tolerance to radiation and tumor dose-response, record keeping, dictating patient reports, department procedures.

Clinical and basic sciences are taught regularly throughout the 4 years of training by way of scheduled Q&A conferences, lectures, case presentations, multi-disciplinary site-specific conferences, and discussions relevant to the practice of radiation oncology.

Ongoing throughout the program residents receive instruction, and gain proficiency, in the physics, biology and clinical applicability of radiosurgery, intraoperative radiation therapy, conformal therapy, three-dimensional treatment planning, radioimmunotherapy, total body irradiation, total skin irradiation, high-dose-rate brachytherapy, hyperthermia, plaque therapy, particle therapy, intensity modulated radiation therapy. There is instruction in use of combined modality therapy and altered fractionation schemes, as well as prostate seed implant, gynecologic oncology, and eye tumor plaque.

Residents must pass USMLE Step 3 before they can enter PGY 3.

• Year 2
  PGY 3
  Three-month one-to-one rotations with clinical faculty members continue coordinated with a rotation in radiation physics curriculum includes lectures and laboratory demonstrations of radiation safety procedures, calibration of radiation therapy machines, use of the computer for treatment planning, construction of treatment aids, and the safe handling of sealed and unsealed radionuclides.

The radiation biology rotation and curriculum includes lectures on all aspects of radiation effects on normal and neoplastic tissues; familiarizes resident with medical statistics, and onoclogic pathology, with special emphasis on neoplasia and radiation effects.

Residents are required to engage in an investigative project under faculty supervision such as laboratory research, clinical research, or the retrospective analysis of data from treated patients, and results should be suitable for publication or presentation at scientific meetings.

There is training in the use of external beam modalities, including superficial irradiation; megavoltage irradiation, such as cobalt 60 and low and high-energy ex-rays; electron beam; simulation to localize anatomy, computerized treatment planning. The resident should be able to personally perform technical procedures, including treatment setups as well as intracavitary and interstitial placement of radiation sources.

Evaluations should demonstrate increasing initiative and proficiency in judgment, patient relations, record keeping, ability to evolve a meaningful plan for patient management, radiation therapy, teaching performance and knowledge of radiobiology, radiation therapy, physics and dosimetry.

There should be a good base of knowledge of pathology and radiology evolved through experiences in the routine pathology conferences and radiology reviews, continued throughout the four-year program.

• Year 3
  PGY 4
  Three-month one-to-one rotations with clinical faculty members continue coordinated with a rotation in medical oncology providing another perspective on approach to the cancer patient and the principles of integrated multi-modality approach to cancer. Pediatric radiation oncology training is gained through a rotation at a hospital devoted to pediatric cancers and research. An experience log of numbers of pediatric radiation oncology and brachytherapy cases are kept by resident.

Residents are required to maintain each year an experience log of patients irradiated, procedures performed and observed, and modalities used.

Residents should be engaged in an investigative project under faculty supervision. Results should be suitable for publication or presentation at local, regional, or national scientific meetings.

• Year 4
  PGY 5
  Three-month, one-to-one rotations with clinical faculty members continue. Residents should have experience with gastrointestinal, gynecologic, genitourinary, reticuloendothelial, breast, soft tissue and bone, skin, head and neck, lung, pediatric cancers.

Resident evaluation after each rotation should reflect independent thought, initiative, quality judgement, patient management and patient relations, teaching ability and performance, professionalism.

Requirements for completing the training program a resident must have no fewer than 36 months spent in the clinical core curriculum of radiation oncology.

There must be a rotation or its equivalent in hematology/medical oncology to include adult and pediatric patients; exposure to oncologic pathology with remaining months allowing for electives applicable in radiation oncology such as a research component, clinical or basic laboratory research.

Upon completion of the program the resident must submit an experience log with combined numbers from the 4-year training program of patients irradiated, procedures performed and observed, and modalities.

Conferences

There are intradepartmental clinical oncology conferences, including new patient conferences, weekly chart review, problem case conferences, morbidity and mortality, physics, dosimetry, radiation biology and journal review. There is a visiting professor series.

Residents attend and gain experience from bi-monthly pathology conferences conducted throughout the 4 -year program. They, routinely throughout the 4-year program, attend and gain experience in radiology reviews with radiologists attending.

Accomplished by attendance at multidisciplinary and departmental conferences the resident receives didactic instruction in the potential value and limitations of other oncologic disciplines, such as medical oncology, surgical oncology, gynecologic oncology, hematologic oncology, pediatric oncology and the various surgical subspecialties that pay a role in the management of the patient.

Research

• Monoclonal antibodies in treatment of cancer
• EGFr as an adjuvant to treatment of high grade gliomas of the brain
• Histones – a new treatment for leukemias and lymphomas
• Brain tumor localization techniques
• Stereotactic radiotherapy
• Stereotactic radiosurgery
• 3D Conformal
• Antibodies

Evaluations

An evaluation is given by a faculty clinician member after the resident completes a rotation. The evaluation provides assessment of intellectual ability, attitudes, interpersonal relationships and patient relations, initiative, as well as assessment of clinical competence, decision making and clinical management skill; knowledge of radiobiology, physics and dosimetry and radiation therapy.

There is provision for the resident for appropriate and timely feedback of the content of the evaluations.

Residents are required each year to take the American College of Radiology In-Training exam in order to gauge progress, strengths and weaknesses. Mock oral exams take place in the spring of each year.

Residents are advanced to positions of higher responsibility on the basis of evidence of their satisfactory faculty appraisal; on performance on the in-service training examination; and demonstrated competence in management decisions and derivation of treatment programs, in follow-up assessment, and in radiation oncology technologies.

Residents are required each year to submit their experience logs of patients irradiated, procedures performed and observed, and modalities used.