Radiation Oncology Reforms

The enhanced Radiation Oncology Training Program is designed as a five-year (5) program over two (2) phases: 
  • Trainees must complete all Phase 1 requirements by 30 months accredited training time, and cannot progress to Phase 2 before 18 months accredited training time 
  • Trainees need to complete twenty-four (24) months of Phase 2 training (1.0 FTE) before they can have their portfolio reviewed (and then subsequently apply for examinations) by the Network Governance Committee.
  • Trainees must present for their portfolio review by the Network Governance Committee within thirty-six (36) months (1.0 FTE) from entry into Phase 2 (and then subsequently apply for the Phase 2 Examinations). 

The Radiation Oncology Steering Committee reviewed the existing components of the Radiation Oncology Curriculum and identified seven (7) 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.

Learning Outcomes

The Radiation Oncology Learning Outcomes are made up of five (5) 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

Work-Based Assessments

The Steering Committee, with input from Radiation Oncology Working Groups, reviewed all the current assessments and examinations to ensure they are fit for purpose and allow measurement of trainee performance and progression.

The Entrustability Scale was incorporated into the work-based assessments (WBAs) to allow supervisors to make judgements of competency based on the level of supervision a trainee requires when they are performing a task. The scale ranges from one (1) (direct guidance required in all aspects of practice) to four (4) (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 clinical supervisor and will be operating at an Entrustability Level 1 or 2. However, towards the final years of training and particularly before sitting the Phase 2 Examinations, it is expected that a trainee would require little to no guidance and be assessed as meeting Entrustability Level 3 or Level 4.

The four (4) 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 WBAs, though clinical supervisors may suggest that a trainee observe or discuss a particular case if they believe they might benefit from it. 

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.

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

The trainee may present the case to the clinical supervisor, 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 a clinical supervisor 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 the trainee's choice of simulation modality, the selection of appropriate imaging and verification of fusion, and their ability to discuss decision making in relation to contouring – both target volumes and organs at risk (OAR). 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 CRDT is a two-step formative assessment. Firstly, the trainee completes the case report which requires them 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.

After the report is completed, the trainee should approach the clinical supervisor to organise a time to meet for the case report discussion. The trainee must provide the case report prior to the meeting, including copies of treatment summaries and letters to the GP.

The discussion is guided by the items on the form and includes the trainee’s approach to the case and the rationale behind the decision making. The supervisor may discuss treatment alternatives or theoretical variations on case scenarios

Case Report Discussion Tool

 

Case Report Tool 

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 provided on questioning techniques used to elicit information, how the trainee shares information with a patient and obtain valid consent, demonstrating empathy and their 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 trial

Communication Skills Tool

Examinations

Radiation Oncology Phase 1 Examinations

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 SAQs (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 no changes to the Phase 2 Examinations. 

Structured Learning Experiences

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

Running a Meeting Feedback Tool

The purpose of this assessment is to assess a 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 a Multi-Disciplinary Team (MDT) Meeting 

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

Phase 1 Oncology Sciences Learning Workshops

Three (3) Oncology Sciences Learning Workshops were developed and intended to be run at the 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 1 Examinations. 
  2. Topic material that demonstrates the level of knowledge expected of trainees approaching the Phase 1 Examinations. They also may help trainees identify if there are certain 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 Experiences (POEs) 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

The remaining 4 'half-day' sessions can focus on any treatment modality (i.e. could be an additional session in one of the above categories or something different).

A ‘half-day’ session is  minimum of three (3) hours. Sessions can be completed as one ‘block’ or distributed.

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.

Clinician Scientist Pathway

The model of the ‘Clinician Scientist’ has become more attractive as a means of combining specialist training with a formal graduate research higher degree (RHD). There are a growing number of radiation oncologists engaging with this model. As such, the College has adopted a position on how this might be accommodated alongside the training requirements of the Radiation Oncology Training Program.

Monitoring, Review and Feedback Tools

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.

The trainee also fills out a MSF self-assessment form which allows them to rate themselves against a range of intrinsic roles.

The MSF helps 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 (CPD) purposes.

Multi-Source Feedback Form

Multi-Source Feedback Self-Assessment Form

Trainee Assessment of Training Site (TATS)

The Trainee Assessment of Training Site (TATS) is a simple rating assessment where a trainee is asked to rate a training site on a range of dimensions, including any particular strengths or weaknesses of the training site.

Each trainee is required to complete a minimum of one (1) TATS every six (6) months of training including trainees undertaking training in a part time capacity. In addition, a TATS must also be completed for each training site at which a trainee has spent a total of four (4) weeks or more during the year.

The TATS provides the College with valuable information on training sites that may be taken into account during accreditation of a training site. This methodology has been found to be a predictor of difficulties at training sites.

 

Clinical Supervisor Appraisal

The clinical supervisor is critical in preparing trainees for practice as radiation oncologists through work-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 the 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

{slider=Frequently Asked Questions}

What changes were made to the Radiation Oncology Training 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 Tool (CPET) 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 Examinations (Anatomy, Radiation Oncology Physics and Radiation and Cancer Biology). The examinations will be delivered electronically and MCQs will be introduced to the new examination format.

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

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 Examination papers (Anatomy, Radiation Oncology Physics, Radiation and Cancer Biology) separately and pass of any paper can be carried over to the next series of examinations. There will be two examination sittings each year.

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

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

{/slide