Radiation Oncology Reforms

The Radiation Oncology Steering Committee reviewed the existing components of the Radiation Oncology Curriculum and identified seven core ‘domains’ of knowledge and skills for assessment purposes. These seven domains form the basis of the new training program.

The Radiation Oncology training program represents a large body of work achieved as a cooperative effort by a large number of people both within and outside the College. The training program will continue to be reviewed and updated in order for it to retain relevance and to meet the goals for which it was designed.

Curriculum Framework

The Radiation Oncology curriculum is made up of five main sections.

  1. Oncology Sciences
  2. Care of the oncology patient
  3. Treatment Modalities
  4. Symptom Control and Palliative care
  5. Care of the oncology patient applied to specific tumor sites

To view the full version of the learning outcomes, please click here.

Work Based Assessments

The Steering Committee, with input from working groups, reviewed all the current assessments and examinations to ensure they are fit for purpose, and allow measurement of trainee’s performance and progression.

New assessment tools are developed adopting the ‘Entrustable Professional Activity’ model of assessment, in which supervisors make judgements of competency based on the level of supervision required by trainees when performing a task.  

The Entrustability Scale was incorporated into some work-based-assessment tools. The scale ranges from one (major supervision required in all aspects of practice) to four (competent) and reflects how ready the clinical supervisor feels the trainee is for independent clinical practice. The concept of Entrustability is at the forefront of modern medical education theory and offers ongoing formative feedback and tracking of competency milestones based on real-world supervisory judgements.  

How does the Entrustability Scale work?

It is expected for example, that in the early phases of training, a trainee will require more direction from their supervisor and will be operating at Level 1 or 2. However, towards the final years of training and particularly before sitting the Phase 2 exam, it is expected that a trainee would require little to no guidance and be assessed as meeting Level 3 or Level 4.

The four levels of the Entrustability Scale are outlined below:

Entrustability Scale

Description

Level 1

Direct Input required

Level 2

Substantial Guidance Required

Level 3

Some Guidance Required

Level 4

Competent

Since frequent feedback contributes significantly to trainee learning, the assessment tools are designed to be used numerous times to obtain feedback to assist trainees in progressing towards competence. It is expected that trainees who have lower ratings earlier in training will demonstrate improvement as they learn and gain more experience. 

Trainees hold the responsibility for initiating work-based assessments, though clinical supervisors may suggest that a trainee observe or discuss a particular case if they believe they might benefit from it. 

The PEAT focuses on providing feedback to trainees on their ability to obtain medical history, conduct a physical examination, interpret patient’s investigations or order additional investigations as required, and then synthesise this information into a management plan.

The trainee may present the case to the assessor, or alternatively they may be observed while consulting with the patient. In the latter scenario, the trainee will also be assessed on their ability to use patient-centred interviewing skills, explain the management plan in a way the patient can understand, and their overall professionalism. The observation allows an assessor to evaluate how the trainee integrates their medical expertise with the intrinsic roles.

Patient Encounter Assessment Tool

Patient Encounter Assessment Tool Instructions

The CPET focusses on the trainee’s level of competence in the tasks required of a radiation oncologist when preparing a radiation therapy plan. Feedback will be provided on their choice of simulation modality, the selection of appropriate imaging and verification of fusion, their ability to discuss decision making in relation to contouring – both target volumes and organs at risk. In addition, Trainees will be required to demonstrate the appropriate choice of radiation modality and accompanying aspects and ability to evaluate a plan.

Contouring and Plan Evaluation Tool

Contouring Plan Evaluation Tool Instructions

The case report discussion tool is a two-step formative assessment. Firstly, the trainee completes the case report which requires the trainee to comprehensively document all aspects of a case they worked fairly independently on within the past month or two. The Case report is the tool to help drive trainee’s self-learning, so they can build the in-depth knowledge about the case. It needs to be prepared prior to presenting to an assessor for a Case Report Discussion.

 

Case Report Discussion Tool

 

Case Report Template 

 

Case Report and Case Report Discussion Tool Instructions

The CST is focused on providing feedback to trainees primarily on their communication skills in a range of different contexts. Feedback will be providing on questioning techniques used to elicit information, how the trainee shares information with a patient and obtain valid consent, demonstrating empathy and her ability to close a consultation and provide reassurance and next steps to the patient. Trainees will be required to complete a CST during:

  • An initial consultation
  • A follow up consultation and treatment review
  • When explaining a management plan to a patient and obtaining informed consent
  • When breaking bad news
  • Recruitment of a patient to a clinical trail

Communication Skills Tool

Want to have your say?

We encourage trainees and supervisors to pilot the work-based assessments below and provide feedback to This email address is being protected from spambots. You need JavaScript enabled to view it. on their experience.

Examinations

Radiation Oncology Phase 1 Examination

The new Phase 1 exams will be rolled out in March 2022, and will apply to all trainees, including new trainees commencing in 2021, and current trainees who will be required to sit the Series 1 2022 examinations for various reasons.

Current

Future

Two written papers of two and a half hours each, to assess

  • Anatomy
  • Radiation Oncology Physics
  • Radiation and Cancer Biology

There are two written papers of 2.5 hours each. Candidates sit both papers on the same day.

Each paper has 6 questions (with sub parts).

Each paper has six Short Answer Questions (with sub parts).

Candidates sit both papers on the same day.

One exam sitting every year in September.

Three separate papers to comprise of

  • Two-hour Anatomy Exam with Diagram Labelling, MCQs and SAQs
  • Two-hour Radiation Oncology Physics Exam with MCQs and SAQs
  • Two-hour Radiation and Cancer Biology Exam with MCQs and SAQs

Trainees can sit for the three papers separately and pass of any paper can be carried over to next Series.

Two exam sittings every year, in early March and early September.

Radiation Oncology Phase 2 Examinations

For the time being there will be minimal changes to the Phase 2 exams. The College will provide updates via email and e-newsletters when the Phase 2 exams are finalised.

Structured Learning Experiences

A number of structured learning activities were developed to assist with trainee’s learning, while being manageable in terms of workload for both trainees and trainers. 

Phase 1 Oncology Sciences Learning Workshop

Three Oncology Sciences learning workshops were developed and intended to be run at training network level.

These workshops are a learning activity, not an assessment.

The workshops aim to provide:

  1. A style of learning that is thought to be helpful in establishing a good core of knowledge on which to build and will assist in preparation for the Phase I Examination. 
  2. Topic material that demonstrates the level of knowledge expected of trainees approaching the Phase 1 examination. They also may help trainees identify if there are certain sciences or topics that they need to focus more time on during their personal study. The workshop questions will primarily cover material related to: Radiation Oncology Physics and Radiation and Cancer Biology 
  3. An interactive environment that encourages trainees and facilitators to discuss important issues raised by the questions.  This may include linking in some clinical application of the subject topics being discussed, and also establishing some cross-linkages between the science subjects.

Practical Oncology Experiences

The Practical Oncology Experience (POE) are designed as quarantined time in which the trainee undertakes a particular practical activity. The POEs are mainly observational and are designed to give the trainee an opportunity to gain practical understanding of the technical aspects of radiation oncology, palliative care and other treatment modalities.

Phase 1 POE

Trainees are required to complete the following:

  • Two ‘half-day’ sessions in an anatomical pathology laboratory
  • Four ‘half-day’ sessions involved in radiation therapy planning
  • Four ‘half-day’ sessions involved in radiation therapy delivery
Phase 2 POE

Trainees are required to complete 10 ‘half-day’ sessions, with at least two sessions for each of the following:

  • With patients being managed by a specialist palliative care team
  • With patients undergoing surgery
  • With patients receiving systemic therapy,
  • Focuses on any treatment modality (i.e. could be an addition session in one of the above categories or something different)
SMART Workshop

The College conducts this annual workshop on statistics, research methodology and critical appraisal for radiation oncology trainees and it is run in conjunction with the Annual Scientific Meeting of the TransTasman Radiation Oncology Group (TROG), thereby also providing trainees with the opportunity to observe trials related discussions and to learn the processes involved in clinical trial development.’

The workshop aims to offer an interactive learning experience for participants using example clinical trials (hypothetical and actual) to form the basis for illustrating and stimulating discussion around key concepts.

The topic for the workshop alternates every second year, and trainees are required to attend at least one of the workshops.

Other Monitoring and Review Tools

Want to have your say?

We encourage trainees and supervisors to pilot the draft Monitoring and Review Tools below and provide feedback to This email address is being protected from spambots. You need JavaScript enabled to view it. on their experience.

Multi-Source Feedback (MSF)

The MSF aims to aid trainee learning by providing an opportunity for trainees to receive feedback on intrinsic role competencies from a range of co-workers who have direct experience with the trainee. Radiation oncologists work as part of multidisciplinary teams, and how other team members perceive their skills in delivering patient care can provide valuable input.

MSF also help to identify specific aspects where the trainee requires improvement, so that appropriate support and remediation can be provided.

It is the College’s intention that a standard MSF form will incorporate items from all the intrinsic roles and be used for Continued Professional Development purposes.

Multi-Source Feedback form

Running a Meeting Feedback Tool

The purpose of this assessment is to assess trainee’s intrinsic skills, e.g., management, leadership, communication, through running/chairing meetings with patients and their family, colleagues, peers, multi-disciplinary team etc. Clinical supervisors are expected to provide feedback at those meetings.

This form can be used as long as the trainees have more involvement in meetings than just presenting at the meeting.

Running a Meeting Feedback Tool

Presenting a patient at an MDT meeting Feedback Tool

This form is designed to assist the development of competencies in the Collaborator, Leader, Health Advocate and Scholar roles as they relate to presenting at an MDT meeting to assist management of an individual patient.

This activity includes preparation for and follow-up of the presentation and should be discussed before and after the actual meeting. The observer may be an active member of the meeting or may be present as an observer only.

MDT Meeting Feedback Tool

Clinical Supervisor Appraisal

The clinical supervisor is critical in preparing trainees for practice as radiation oncologists through workplace-based supervision, feedback and mentorship. 

The purpose of this appraisal is to seek the unique perspective of clinical supervisors on trainee activity and behaviour during their term.  It is designed to provide realistic and useful feedback to the trainee relevant to their level of training, as well as an opportunity to flag issues for discussion at the time of DOT reviews. 

Clinical Supervisor Appraisal Form

Director of Training (DOT) Review 

The purpose of this review is for the DoT and the trainee to jointly evaluate the trainee’s progress through the training program. 

For trainees who are meeting or exceeding expectations, this review provides an opportunity to identify new milestones for achievement and areas for development. For trainees who are falling short of expected milestones, this provides an opportunity to initiate corrective measures, including, if needed, an earlier DoT review and/or commencing a formal trainee in difficulty pathway. 

Director of Training Review Forms

Phase 1 DoT Review form

Phase 2 DoT Review form

 How do I find out more information?

For more information about the Radiation Oncology Training Program please contact us at

This email address is being protected from spambots. You need JavaScript enabled to view it. or call (+61) 02 9268 9777

What changes were made to the Radiation Oncology Program?

The enhanced Radiation Oncology training program has been designed to fill the gaps that had been identified in the existing program.

Trainees identified contouring and plan evaluation as an area in which they would like more exposure. Therefore, we have developed the Contouring and Plan Evaluation Assessment to help improve their learning experience and exposure in this area.

The enhanced Radiation Oncology training program also includes newly structured learning activities like Oncology Sciences Learning Workshops, which provide trainees with great opportunities to engage in an interactive learning experience to increase their knowledge of oncology sciences. The Oncology Sciences Learning Workshops have been piloted in several training networks, have proven beneficial to trainees and are not onerous for organisers and facilitators. 

Is it still a five-year training program?

Each of the phases of the program have minimum time requirements and whilst it is anticipated that the length of training for most trainees will remain the same, it will be possible to complete the training in less than five years in some cases.

What do you mean when you say that examinations are of an ‘optimised format and duration’

For Radiation Oncology, there will be three separate papers of two-hour duration for each of the three Phase 1 Exams (Anatomy, Radiation Oncology Physics and Radiation and Cancer Biology). The exam will be delivered electronically and MCQs will be introduced to the new exam format.

For the time being there will be minimal changes to the Phase 2 exams.

What does it mean when you say there will be ‘more flexibility around examination sittings’?

For Radiation Oncology, trainees can sit for the three Part 1 exam papers (Anatomy, Radiation Oncology Physics, Radiation and Cancer Biology) separately and pass of any paper can be carried over to the next series of exams. There will be two exam sittings each year, one in March and one in September.

Will all exams be changed in 2021?

The changes to the Radiation Oncology Phase 1 exams will commence in 2022. The Phase 2 exam change timeline is yet to be confirmed.

How would we transition IMGs who were previously assessed/ started sitting the Part 2 exams?

We would use work-based assessments and exams to transition IMGs. Each IMG will also have their own individual transition plan.

How would we transition IMGs who were previously assessed/ started sitting the Part 2 exams?

We would use work-based assessments and exams to transition IMGS. Each IMG will also have their own individual transition plan.