Resident Versus Teaching Faculty Perceptions of Radiation Treatment Plan Education: A National Survey

Purpose: Radiation treatment plan (RTP) evaluation is a critical, but often undertaught component of radiation oncology training. We hypothesized that radiation oncology residents and attendings would hold different attitudes regarding resident knowledge and comfort with RTP review. Methods and Materials: A web-based survey was developed and distributed to residents (35 items) and attendings (28 items) at 14 geographically diverse Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs. The survey consisted of a combination of multiple-choice questions, Likert-style, and free-text responses. Results: One hundred sixty-nine residents and 71 faculty received the survey (response rate: 43% and 28%, respectively). Approximately half (47%) of residents reported reviewing fewer than half of all treatment plans for their patients. While 20% of residents reported "often" or "always" reviewing treatment plans with an attending, 31% reported "rarely" or "never" doing so. More than half (56%) of residents felt they had inadequate exposure to RTP review. More than half (54%) did not feel confident or competent independently evaluating RTPs. In contrast, 85% of attendings reported reviewing at least half of all treatment plans alongside residents and 90% of faculty agreed or strongly agreed that residents were competent at RTP evaluation by the end of a rotation. Both residents and faculty perceived that challenges in schedule alignment and interest of the other party were common barriers to adequate RTP exposure and both agreed that a systematic approach to RTP review and a dedicated educational resource would improve the ability to evaluate a RTP. Conclusions: A majority of residents reported inadequate RTP education and a lack of confidence and competence in evaluating RTPs. There was discordance between resident and faculty perceptions of RTP education and resident competence, but both groups agreed that residents would benefit from a dedicated resource on RTP review. Future work should focus on the development of a systematic guideline and accompanying tools for RTP evaluation.