1. science
2. medicine
3. oncology

RESIDENCY MANUAL
DEPARTMENT OF RADIATION ONCOLOGY
2014-2015
LOYOLA UNIVERSITY MEDICAL CENTER
MAYWOOD, IL
AND
EDWARD J. HINES JR.
VETERANS ADMINISTRATION HOSPITAL
HINES, IL
Department Website – http://luhs.org/radiationoncology
Being revised as of 9-12-13
RESIDENCY MANUAL - DEPARTMENT OF RADIATION ONCOLOGY
TABLE OF CONTENTS
General Information
1.1
1.2
1.3
1.4
1.5
2.0
2.1
2.1.1
2.1.2
2.2
2.3
2.3.1
2.3.2
2.3.3
2.3.4
2.4
2.5
2.5.1
2.5.2
2.5.3
2.5.4
2.5.5
2.5.6
2.5.7
2.5.8
2.5.9
2.5.10
2.5.11
2.5.12
2.5.13
2.5.14
2.5.15
2.5.16
2.5.17
2.5.18
2.6
2.6.1
2.6.2
2.6.3
2.6.4
2.7
2.7.1
2.7.2
2.7.3
2.7.4
2.7.5
2.7.6
2.7.7
Welcome ...................................................................................................................................................4
Background .............................................................................................................................................4
Faculty - Department of Radiation Oncology .......................................................................................... 4
Other Staff Members ................................................................................................................................ 6
Equipment ...............................................................................................................................................6
Program Description ................................................................................................................................ 7
Goals and Objectives of Residency Program ........................................................................................... 8
Overall Goals ............................................................................................................................................8
Objectives For Each PGY Level of Training ............................................................................................ 9
Core Curriculum..................................................................................................................................... 19
Clinical Curriculum ................................................................................................................................ 19
Clinical Rotations ................................................................................................................................... 18
External Rotations .................................................................................................................................. 18
Dosimetry/Medical Physics Elective ...................................................................................................... 19
Research Elective ................................................................................................................................... 21
Didactic Curriculum ............................................................................................................................... 21
Conferences and Tumor Boards ............................................................................................................. 22
Morning Case Presentation Conferences ................................................................................................ 22
Chart Rounds .......................................................................................................................................... 24
Mortality and Morbidity Conference (M & M) ...................................................................................... 24
Multidisciplinary Tumor Board .............................................................................................................. 24
Thoracic Oncology Tumor Board ........................................................................................................... 25
Gynecologic Oncology Conference ........................................................................................................ 25
ENT Tumor Board .................................................................................................................................. 25
Breast Oncology Tumor Board ............................................................................................................... 25
Lymphoma Tumor Board ....................................................................................................................... 25
Urology Tumor Board ............................................................................................................................ 25
Gastrointestinal Oncology Tumor Board ................................................................................................ 25
Hines VA Tumor Board ......................................................................................................................... 25
Neuro Oncology Tumor Board ............................................................................................................... 25
Pediatric Tumor Board ........................................................................................................................... 25
Radiation Oncology Journal Club .......................................................................................................... 26
Cancer Center Journal Club ................................................................................................................... 26
Other Intramural Conferences ................................................................................................................ 26
Conferences (Off Campus) –Not Mandatory ......................................................................................... 26
Lectures And Courses ............................................................................................................................ 26
Clinical Didactic Lecture (Radiation Oncology Grand Rounds) ............................................................ 26
Physics Course........................................................................................................................................ 26
Radiation Biology Course ...................................................................................................................... 27
Biostatistics............................................................................................................................................. 27
Evaluation Tools .................................................................................................................................... 27
Evaluations ............................................................................................................................................. 27
Faculty Evaluation Of Resident .............................................................................................................. 27
Resident Evaluation of Faculty ............................................................................................................... 27
Resident Evaluation Of Rotation ............................................................................................................ 27
Resident And Faculty Evaluation Of The Program ................................................................................ 28
360o Evaluation ...................................................................................................................................... 28
Peer Evaluation of Morning Conferences ............................................................................................... 28
2
2.7.8
2.7.9
2.7.10
2.7.11
3.0
3.1
3.1.1
3.1.2
3.1.3
3.1.4
3.1.5
3.1.6
3.1.7
3.1.8
3.1.9
3.1.10
3.1.11
3.1.12
3.1.13
3.1.14
3.2
3.2.1
3.2.2
3.2.3
3.2.4
3.2.5
3.3
3.4
3.5
3.6
4.0
4.1
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
4.13
4.14
4.15
4.16
4.17
4.18
4.19
4.20
4.21
4.22
4.23
4.24
4.25
4.26
4.27
Direct Observations ................................................................................................................................ 29
Self Evaluation ....................................................................................................................................... 29
Resident Semi-annual Evaluation ........................................................................................................... 29
Summative Evaluation ............................................................................................................................ 29
Standard Departmental Policy and Operating Procedures...................................................................... 29
General Patient Care in the Clinic .......................................................................................................... 29
Consultations .......................................................................................................................................... 29
Follow ups .............................................................................................................................................. 30
On Treatment Visits ............................................................................................................................... 30
Physical Examination ............................................................................................................................. 30
Informed Consent ................................................................................................................................... 30
Simulations............................................................................................................................................. 31
Treatment Planning ................................................................................................................................ 31
Radiation Therapy Chart ........................................................................................................................ 31
End of Treatment Summary ................................................................................................................... 31
Port Films ............................................................................................................................................... 32
Follow-Up On Ordered Tests ................................................................................................................. 32
Requests for Medication Refills ............................................................................................................. 32
Additional Documentation ..................................................................................................................... 32
Patient Care Correspondence ................................................................................................................. 32
Brachytherapy Procedures...................................................................................................................... 33
GYN Implants-LDR ............................................................................................................................... 33
High Dose Rate (HDR) Implant Procedures For Gyn, Breast, Head And Neck Sarcoma .................... 33
I-125 Implants ........................................................................................................................................ 34
Resident Participation in Bracytherapy Procedures ............................................................................... 34
Radionuclide Procedures ........................................................................................................................ 34
Dress Code ............................................................................................................................................. 34
On Call Duty .......................................................................................................................................... 34
Resident Supervision .............................................................................................................................. 37
Other Resident Responsibilities ............................................................................................................. 35
Administrative Matters ........................................................................................................................... 37
Eligibility and Selection ......................................................................................................................... 37
Annual Review of Faculty Performance ................................................................................................ 37
Promotion ............................................................................................................................................... 38
Academic Probation ............................................................................................................................... 38
Dismissal ................................................................................................................................................ 38
Duty Hours ............................................................................................................................................. 38
Moonlighting .......................................................................................................................................... 39
National Examinations ........................................................................................................................... 39
Basic/Advanced Cardiac Life Support Certification .............................................................................. 39
Log Books .............................................................................................................................................. 39
Pager ...................................................................................................................................................... 40
Allocations ............................................................................................................................................. 40
Chief Resident ........................................................................................................................................ 40
Responsibilities (in addition to those applicable to all residents)........................................................... 41
Qualifications ......................................................................................................................................... 41
Mailboxes ............................................................................................................................................... 41
Resident Room ....................................................................................................................................... 41
Libraries ................................................................................................................................................. 42
Leave Policies ........................................................................................................................................ 42
General Leave Guidelines ...................................................................................................................... 42
Paid time off ........................................................................................................................................... 43
Education ............................................................................................................................................... 44
Illness ..................................................................................................................................................... 44
Maternity/Paternity Leave ...................................................................................................................... 44
Family Medical Leave Act (FMLA) / General Leave ............................................................................ 44
Time Off for Job Interviews ................................................................................................................... 44
3
4.28
4.29
4.30
5.0
Funeral Leave ......................................................................................................................................... 44
Jury Duty ................................................................................................................................................ 44
Attending Vacations ............................................................................................................................... 44
Other ...................................................................................................................................................... 44
Appendix
1.1
Welcome
The Loyola University/Hines VA Department of Radiation Oncology (hereafter
referred to as Department) welcomes you as a resident physician in the
Department. We are committed to provide you with the basic elements that you
will need and use during your future professional career as a radiation oncologist.
A residency is not, and should not, be considered as a continuation of the
traditional form of University instruction. It does, however, reflect a continuum of
an education process begun in early life and which must continue throughout
one's service both to our patients and professional colleagues
1.2
Background
The Department was established in July 1985 by Loyola University Chicago to
provide radiotherapy services for the Loyola University Medical Center (LUMC)
and the Hines VA Hospital (HVAH). This creation of a new, combined program
was necessary to form a department large enough to support a residency-training
program and to develop the Department to its fullest potential. LUMC is a major
tertiary care center for the Chicago metropolitan area as well as its near western
suburbs. This campus was established in 1969 when Loyola University Chicago
officials purchased land adjacent to the HVAH and relocated the Stritch School of
Medicine and its School of Dentistry. This campus now houses the Loyola Stritch
School of Medicine (SSOM), Loyola University Medical Center (LUMC), including
Loyola University Hospital Tower, Loyola Outpatient Center (LOC), the Cardinal
Bernardin Cancer Center (CBCC), and The Loyola University Chicago Center for
Translational Research and Education. For the purpose of the residency-training
program, Loyola University Medical Center is considered the primary institution
and Hines VAH is considered an integrated institution.
1.3
Faculty - Department of Radiation Oncology
Each Faculty member of the department has the responsibility of supervising and
teaching residents at various points during their residency training.
Clinical Faculty
William Small, Jr., M.D.
Professor and Chairman
Department of Radiation Oncology
Medical Director Loyola and Hines VA
Bahman Emami, M.D.
Professor
Department of Radiation Oncology & Professor of
Otolaryngology
Edward Melian, M.D.
Associate Professor
Department of Radiation Oncology & Neurological Surgery
Matthew Harkenrider, M.D. Assistant Professor
4
Residency Program Director
Department of Radiation Oncology
Tarita Thomas, M.D., PhD
Assistant Professor
Director of Medical Student Clerkship
Department of Radiation Oncology
Mehee Choi, M.D.
Assistant Professor
Director of Continuing Medical Education
Department of Radiation Oncology
Abhishek Solanki, M.D.
Instructor
Department of Radiation Oncology
Radiobiology Faculty
Eun-Kyoung Breuer, PhD
Assistant Professor
Department of Radiation Oncology &
Pharmacology & Molecular Therapeutics
Gayle Woloschak, PhD
(lecturer only)
Professor
Department of Radiation Oncology and
Department of Cell and Molecular Biology
Off-campus location:
Robert H. Lurie Cancer Center
Northwestern University, Feinberg School of Medicine
303 E. Chicago Ave., Ward-13-002
Chicago, IL 60611
phone 312-503-4322
fax 312-577-0751
[email protected]
Academic Medical Physics Staff
John Roeske, Ph.D.
Professor and Vice Chairman
Chief of Medical Physics Section
Department of Radiation Oncology
Anil Sethi, Ph.D.
Associate Professor
Department of Radiation Oncology
Murat Surucu, Ph.D.
Assistant Professor
Department of Radiation Oncology
Advanced Practice Nurse
Colleen Schaidle, BSN, APNAdvanced Practice Nurse
Administrative Personnel
5
Margaret Sowinski
Clinical Practice Manager
Kathy Majeski
Administrative Assistant to the Chairman
Joseph Plovich
Administrative Assistant
1.4
Other Staff Members
Program Coordinator
The program coordinator provides the program director with administrative
support as it relates to the residency program, as well as providing organizational
support for the residency program. The program coordinator will maintain and
update residents’ files to include conference attendance, procedure logs,
evaluations, in-training exam results, other administrative issues and schedule
yearly in-service exams in conjunction with the program director. The program
coordinator is assigned by the Graduate Medical Education office.
Director of Administration
The Director of Administration is responsible for management of clinical and
research operations, faculty and staff recruitment, space and facilities
management. The administrator for the department academic office, under the
direction of the Stritch School of Medicine, oversees the administrative support
staff.
Administrative Support
The administrative support staff provides academic and clerical support for the
staff physicians. They are responsible for scheduling and maintaining calendars,
appointments and meetings for administrator/staff, and keeping accurate record
of department activities. They also coordinate and organize conferences, inservices, meetings, and travel arrangements for faculty, residents, and guest
speakers. The residents also have departmental administrative support including
registering for academic meetings and reimbursements of approved expenses.
Nursing
The Department is staffed by LUMC nurses, some of whom are oncologycertified nurses. They educate patients and their families regarding radiation and
the management of side effects during their treatment. Additionally, they assist
physicians and provide direct patient care during patients visits and special
procedures e.g., radiosurgery, brachytherapy, hyperthermia.
Technical
The radiation oncology technical staff consists of radiation therapists,
dosimetrists, and medical physicists. Collectively, they are responsible for
the planning and delivery of prescribed treatments, performing quality
assurance testing, and providing resources necessary to treat patients with
external beam radiation therapy, brachytherapy, stereotactic radiosurgery,
simulations, and emergency treatments.
6
Service Representatives
The service representatives are responsible for greeting all patients and visitors
to the department. It is the responsibility of the service representatives to capture
the correct patient demographic information, as well as verification of the patient's
insurance. The service representatives also schedule patient follow up
appointments and other tests that the physician may request.
1.5
Equipment
The Department is equipped with five dual energy linear accelerators, a single
energy stereotactic radiation therapy-dedicated linear accelerator, 3 CT
simulators, an HDR remote afterloader, hyperthermia unit, an Intrabeam
intraoperative electronic brachytherapy unit, a template-based prostate
brachytherapy ultrasound unit, and a number of radiation therapy planning (RTP)
workstations. Additionally there are a number of HDR and LDR-based
afterloading applicators for intracavitary and interstitial placement radioactive
sources. A summary of equipment and locations are given below
TYPE
Linear Accelerator
Simulator
Isodose computation
Remote Afterloading
Manual Afterloading
Implantation Device for
I-125 Seeds
Beta-emitting sources
LOYOLA
1 Varian Truebeam
1 Varian Clinac 2100 IX (IGRT)
1 Novalis
1 Varian Clinac 2100EX
Phillips Brilliance Big Bore CT (4D)
Picker AcQ-Sim
Varian Eclipse and XIO (CMS)
Phillips Brilliance Big Bore
CT (4D)
Varian Eclipse and XIO
(CMS)
High Dose-Rate (HDR) Gamma Med ---------------------------------Ir-192 Interstitial Seeds
---------------------------------Pre-loaded needles
---------------------------------Strontium-90
Alpha-emiting sources
Radium-223
Stereotactic Workstations Novalis iPlan
2.0
HINES
1 Varian Clinac IX (IGRT)
1 Varian Clinac 2100EX
(IGRT)
Strontium-90
---------------------------------
Program Description
The Department maintains an Accreditation Council for Graduate Medical
Education (ACGME) accredited four-year residency program in radiation
oncology. Residents start radiation oncology training after completion of a
transitional PGY-1 year or internship in internal medicine, pediatrics, surgery or
surgical specialties, obstetrics & gynecology, or family medicine. This PGY-1
year must include at least nine months of direct patient care in medical and/or
surgical specialties other than radiation oncology. The residency program follows
the ACGME program requirements for radiation oncology
http://www.acgme.org/acgmeweb/tabid/149/ProgramandInstitutionalAccreditation/HospitalBasedSpecialties/RadiationOncology.aspx
7
The department chairman and residency program director are responsible and
accountable for the operation of the program
2.1
Goals and Objectives of Residency Program
2.1.1
Overall Goals
The goal of the residency program is to educate and train caring and
compassionate physicians to be skilled in the practice of clinical oncology and
radiation oncology. The residents should be competent with respect to patient
care, medical knowledge, practice-based learning and improvement,
interpersonal and communication skills, professionalism and systems based
practice. Education will focus on the natural history, treatment, and prevention of
malignant neoplasms as well as the management of associated toxicities. This
education will be performed in a multidisciplinary setting and emphasis will be
placed on the knowledge of multidisciplinary management of patients. The
program will instill a broad clinical and scientific radiation oncology knowledge
base into the residents. These goals will be met by the core curriculum.
The resident will obtain competency to the level expected of a new practitioner in
the six ACGME competencies outlined below. A competency based curriculum
table is provided and divides the-curriculum specific activities by competency and
the practice performance tools used to measure the residents’ level of
performance.
Patient Care
The resident is able to provide compassionate, appropriate and effective patient
care for the treatment of health problems and promotion of health with an
emphasis on clinical oncology. The resident should understand how to prioritize
patient issues and develop an appropriate diagnostic plan, prescribe medications,
and manage the treatment of the patient's illness. The resident obtains consent
and is able to perform technical procedures appropriate for his/her level of
training.
Medical Knowledge
The resident demonstrates knowledge of established and evolving biomedical,
clinical, epidemiological, and social/behavioral sciences as well as the application
of this knowledge to patient care. The resident is able to assess diagnostic
information critically and constructively, and recognizes the psychosocial aspects
of illness. The resident is able to critically evaluate the medical literature and
apply new knowledge to the delivery of safe and effective patient care. The
resident is able to evaluate and treat patients in a multidisciplinary setting.
Practice-Based Learning and Improvement
The resident is able to critically evaluate the care of the patients, assimilate and
appraise scientific evidence, and continuously improve patient care delivered on
the basis of ongoing self-evaluation and learning. The resident uses knowledge
to educate patients, families, medical students, allied health personnel, peers,
and other health professionals as appropriate. The resident is capable of selfidentifying strengths, deficiencies, and the limits of his/her knowledge and
expertise. The resident is receptive to constructive criticism with a formative
evaluation process regarding the care of patients and physician performance.
8
The resident is able to set learning and improvement goals, identify and perform
activities to meeting those goals.
Interpersonal and Communication Skills
The resident demonstrates interpersonal and communication skills that result in
effective information exchange and collaboration with patients, families and other
health professionals. These skills include the ability to communicate across a
broad range of socio-economic and cultural backgrounds and the ability to
communicate with physicians, health professionals, and health related agencies
effectively. The resident is able to maintain comprehensive and timely medical
records. The resident can work effectively as a member or leader of a healthcare
team and serve appropriately as a consultant to other physicians and health
professionals.
Professionalism
The resident is committed to carrying out professional responsibilities and
adhering to ethical principles. The resident demonstrates respect for patient
privacy and autonomy and is accountable to patients, society and the medical
profession for his/her actions. The resident demonstrates compassion, integrity
and respect for others as well as responsiveness to patient needs that supersede
self-interest. The resident demonstrates sensitivity and responsiveness to a
broad range of patient population including diversity in gender, age, culture, race,
religion, disability, and sexual orientation. The resident demonstrates the ability to
manage personal stress effectively and will seek assistance if necessary. The
resident understands how to maintain appropriate professional boundaries and
demonstrates integrity, honesty and compassion. The resident must complete
work in a timely fashion.
Systems-Based Practice
The resident understands and is capable of effectively managing different
systems of care. The resident acknowledges the need for referrals and multidisciplinary management of patients. The resident demonstrates the ability to
provide high-quality care in a cost-effective manner. The resident incorporates
consideration of cost-awareness and risk-benefit analysis in patient care
decisions. The resident advocates for high quality care for all patients.
2.1.2
I.
Objectives For Each PGY Level of Training
Below are the general objectives of the program categorized by level of training.
The objectives pertaining to the more advanced year include those of the
previous year(s), with increasing expectations. By the end of the PGY-5 year, the
resident should have met all objectives for all years.
Patient Care
a. PGY-2
i. Perform and document a complete history and physical
examination as it relates to the oncology patient
ii. Review pertinent pathology, laboratory and diagnostic studies
including imaging
iii. Stage a patient with cancer with reference to a staging manual
iv. Summarize and present the patient’s case to attending physician
or in multi-disciplinary conferences
9
v. Begin to formulate a management plan with the guidance of the
attending physician
vi. Begin to understand the roles of surgery and chemotherapy in the
treatment of cancer
vii. Begin to discuss with patients and their families various treatment
options, radiotherapy rationale, and possible side effects and
complications
viii. Learn to obtain informed consent for radiation therapy
ix. Learn the simulation process including patient positioning and
treatment aids (wires, markers, contrast, etc.)
x. Delineate normal organs as well as gross tumor (GTV) on crosssectional imaging
xi. Have a basic understanding of dose, fractionation, overall
treatment time
xii. Learn to write a radiation prescription.
xiii. Learn to review portal images in comparison with simulation
images i.e. DRRs and kV based planar image-guided radiation
therapy (IGRT images).
xiv. Evaluate patient weekly while under treatment and manage acute
toxicities
xv. Follow patients after treatment is completed and assess for long
term toxicities
xvi. Understand the role of palliative radiation therapy and begin to
manage patients with brain metastasis, bone metastasis, spinal
cord compression and other oncological emergencies
xvii. Begin to manage patients undergoing brachytherapy
xviii. Observe and participate in administration of unsealed sources
xix. Begin to accept responsibility for the care and treatment of
patients assigned to a particular clinical service
b. PGY-3
i. Perform and document a complete history and physical
examination as it relates to the oncology patient
ii. Begin to interpret pathology, laboratory, and diagnostic studies
including imaging and recommend further diagnostic testing for
completing work up of the patient
iii. Further refine staging skills with reference to a staging manual
iv. Be able to more succinctly summarize and present the patient’s
case to the attending physician or in multi-disciplinary
conferences.
v. Begin to independently formulate a management plan for the
patient
vi. Continue to improve understanding of the role of surgery and
chemotherapy in the treatment of cancer
vii. Learn to counsel patients and families with straightforward
problems independently including treatment options, radiotherapy
rationale, goal, risks, benefits and side effects and be able to more
independently obtain informed consent
viii. Be able to simulate straightforward cases independently including
the use of treatment aids (markers, contrast) and know external
anatomical landmarks.
10
ix. Be able to properly use image co-registration i.e. fusion in
treatment planning and delineation of target volumes
x. Understand and delineate treatment margins including CTV, ITV
and PTV
xi. Begin to understand the benefits of image-guided radiation
therapy (IGRT) and in which cases such technology may be
helpful.
xii. Select field arrangement, dose, fractionation, overall treatment
time for 2-dimensional treatments including palliative cases
xiii. Be able to calculate monitor units for straightforward cases
xiv. Have a full understanding of the radiation prescription and the
radiation therapy chart and be able to discuss in chart rounds
xv. Review simple computerized treatment plans independently with
dosimetry and begin to understand dose-volume limitations for
organs at risk
xvi. Independently manage straightforward patients undergoing
treatment at weekly treatment visits including acute toxicities
xvii. Begin to independently assess follow-up patients for long term
treatment-related toxicities and tumor recurrence
xviii. Further refine brachytherapy skills including gynecologic, prostate,
head and neck, and sarcoma patients
xix. Accept increasing responsibilities for the care and treatment of
patients assigned to a service.
c. PGY-4
i. Nearly independently perform and document a complete history
and physical examination as it relates to the oncology patient
ii. Be able to nearly independently interpret pathology, laboratory and
diagnostic studies including imaging and recommend further workup and testing appropriately
iii. Be able to nearly independently stage a patient without reference
to staging manual
iv. Summarize and present a patient’s case with little additional input
from the attending physician
v. Be able to nearly independently formulate a comprehensive,
multidisciplinary treatment plan for the patient
vi. Understand the roles of surgery and chemotherapy in the
treatment of cancer including treatment related side effects and
complications
vii. Be able to counsel patients and families with complex problems
nearly independently including treatment options, radiotherapy
rationale, goal, risks, benefits and side effects
viii. Be able to simulate all cases, including 4-D nearly, independently
including use of treatment aids
ix. Be able to delineate all target volumes nearly independently (GTV,
CTV, ITV, PTV)
x. Be able to select beam arrangement, beam energy and modifiers,
total dose, fractionation, overall treatment time for most cases
including 2-D, 3-D, and IMRT cases
xi. Be able to distinguish which cases may benefit from image-guided
radiation therapy (IGRT).
11
xii. Be able to review conformal computerized treatment plans nearly
independently and understand and implement dose-volume
limitations for organs at risk. Be able to modify treatment plan to
achieve goals.
xiii. Begin to review volumetric imaging obtained during IGRT (cone
beam CT).
xiv. Be able to independently discuss and defend treatment plan for
patient at chart rounds
xv. Nearly independently manage more complex patients (including
those undergoing chemoradiation) at weekly treatment visits and
decide when patients require a treatment break or adjustment in
treatment
xvi. Nearly independently assess follow-up patients for long-term
treatment-related toxicities and tumor recurrence. Begin to
recommend appropriate testing for follow-up patients
xvii. Perform brachytherapy procedures nearly independently including
gynecologic, prostate, head and neck and sarcoma patients
xviii. Be able to nearly independently manage the clinical service
d. PGY-5
i. Independently perform and document a complete history and
physical examination as it relates to the oncology patient
ii. Be able to independently interpret pathology, laboratory and
diagnostic studies including imaging and recommend further workup and testing appropriately
iii. Be able to independently stage a patient without reference to
staging manual
iv. Independently summarize and present a patient’s case to an
attending physician or in multi-disciplinary conferences
v. Be able to formulate a comprehensive, multidisciplinary treatment
plan for the patient
vi. Understand the roles of surgery and chemotherapy in the
treatment of cancer including treatment related side effects and
complications
vii. Be able to counsel patients and families with complex problems
independently including treatment options, radiotherapy rationale,
goal, risks, benefits and side effects
viii. Be able to simulate all cases independently including use of
treatment aids
ix. Be able to delineate all target volumes independently (GTV, CTV,
ITV, PTV)
x. Be able to select beam arrangement, beam energy and modifiers,
total dose, fractionation, overall treatment time for all cases
including 2-D, 3-D, and IMRT cases
xi. Be able to review conformal computerized treatment plans
independently and understand and implement dose-volume
limitations for organs at risk. Be able to modify treatment plan to
achieve goals.
xii. Have a full understanding of IGRT as it relates to patient selection,
daily treatment including table shifts, and interpretation of imaging
12
xiii.
xiv.
xv.
xvi.
xvii.
II.
data obtained. Independently review imaging data at the
treatment machine with attending supervision.
Be able to independently discuss and defend treatment plan for
patient at chart rounds
Independently manage more complex patients (including those
undergoing chemoradiation) at weekly treatment visits and decide
when patients require a treatment break or adjustment in
treatment
Independently assess follow-up patients for long-term treatmentrelated toxicities and tumor recurrence including ordering
appropriate testing for follow-up patients
Perform brachytherapy procedures independently including
gynecologic, prostate, head and neck and sarcoma patients
Be able to independently manage the clinical service with indirect
supervision from the attending physician
Medical Knowledge
The residents will be exposed to the major disease sites listed below via the
clinical and didactic curriculum. Residents will be responsible for medical
knowledge pertaining to these sites with respect to year of training. For
further elaboration of the disease sites, the reader is referred to the rotationspecific goals and objectives.
Pediatrics
Pediatrics CNS tumors
Gastrointestinal (GI) tract
Gynecology
Genitourinary (GU) tract
Lymphomas and Leukemias
Head, Neck, Skin
Lung/Mediastinum
Breast
Bone and Soft Tissue
Central Nervous System
Palliative Care
a. PGY-2
i. Understand the anatomy, epidemiology/etiologic agents, natural
history, pathology, routes of spread and initial clinical evaluation of
the major disease sites
ii. Begin to understand basic principles of treatment for common
cancers
iii. Begin to understand the principles of radiation physics and
radiation biology
iv. Begin to understand acute and chronic effects of radiation therapy
v. Begin to understand normal tissue tolerance i.e. TD 5/5 or
QUANTEC
vi. Begin to understand basic principles of dose specification, dose
prescription, field design, and field geometry
vii. Begin to understand SSD and SAD, single field, AP/PA field and
basics of stereotactic radiation therapy and brachytherapy
13
b. PGY-3
i. Refine understanding of the anatomy, epidemiology/etiologic
agents, natural history, pathology, routes of spread and initial
clinical evaluation of the major disease sites
ii. Understand rationale behind selection of a treatment modality
iii. Begin to understand clinical evidence to support treatment
modality including results from landmark clinical trials
iv. Further refine understanding of principles of treatment for all
cancers of major disease sites
v. Refine understanding of principles of radiation physics and
radiation biology
vi. Further refine understanding of acute and chronic effects of and
normal tissue tolerance to radiation therapy
vii. Understand follow-up evaluation of cancer patients
viii. Further refine knowledge of principles of dose specification, dose
prescription, field design, and field geometry including dose
homogeneity
ix. Further refine knowledge of radiation therapy techniques including
3 field, 4 field, oblique field, 3-D conformal radiation therapy,
intensity modulated radiation therapy (IMRT), stereotactic body
radiation therapy (SBRT), stereotactic radiosurgery (SRS), and
brachytherapy
c. PGY-4
i. Begin to master the anatomy, epidemiology/etiologic agents,
natural history, pathology, routes of spread and initial clinical
evaluation of the major disease sites
ii. Understand treatment results and outcomes of therapy (radiation
therapy, surgery, or chemotherapy) with respect to the major
disease sites, including evidence from clinical trials
iii. Understand patterns of failure with respect to the major disease
sites and implications for patient follow-up
iv. Begin to master acute and chronic effects of radiation therapy
v. Understand more advanced radiation therapy techniques such as
multi-field breast, craniospinal irradiation, other junctioned fields,
optimal beam arrangement, stereotactic radiosurgery and
stereotactic body radiation therapy, intensity modulated radiation
therapy (IMRT), image-guided radiation therapy (IGRT) and
brachytherapy
vi. Master the principles of radiation physics and radiation biology in
preparation for the ABR physics and radiobiology exam
d. PGY-5
i. Master the anatomy, epidemiology/etiologic agents, natural
history, pathology, routes of spread and initial clinical evaluation of
the major disease sites
ii. Understand treatment results and outcomes of therapy (radiation
therapy, surgery, or chemotherapy) with respect to the major
disease sites and be able to describe results of clinical trials
iii. Understand patterns of failure with respect to the major disease
14
sites and implications for follow up
iv. Master acute and chronic effects of radiation therapy
v. Master the advanced radiation therapy techniques such as
multiple field breast, craniospinal irradiation, other junctioned
fields, optimal beam arrangement, stereotactic radiosurgery and
stereotactic body radiation therapy, intensity modulated radiation
therapy (IMRT), image-guided radiation therapy (IGRT) and
brachytherapy
vi. Master the principles of clinical oncology with respect to the major
disease sites in preparation for the ABR clinical radiation oncology
exam
III.
Practice-Based Learning and Improvement
a. PGY-2
i. Begin to identify sources for information including textbooks,
journals, on-line resources
ii. Using above sources, begin to locate, appraise and assimilate
evidence from scientific studies to improve patient care
iii. Learn to effectively present patient cases in morning conference
along with supporting evidence in treatment
iv. Critically read and analyze relevant literature during participation in
morning conferences and journal clubs
v. Incorporate formative evaluation feedback (including direct
observations) into daily practice
vi. Learn basic principles of statistics and evidence-based medicine
vii. Start and maintain ACGME web-based patient log
viii. Initiate planning for an investigative project suitable for publication
under faculty supervision as a means of developing practice
improvements
b. PGY-3
i. Critically evaluate clinical studies with regards to methods, design,
statistics and validity of conclusion and use to improve patient care
ii. Continue to read and analyze relevant literature during
participation in morning conferences and journal clubs
iii. Continue to learn principles of statistics including its limitations
iv. Develop an IRB approved investigative project suitable for
publication under faculty supervision as a means of developing
practice improvements and collect data accordingly
c. PGY-4
i. Understand the relevant literature and begin to master the salient
points which can be used in daily radiation oncology practice.
ii. Prepare the investigative project for presentation and publication
in a peer reviewed journal with the guidance of the faculty mentor
d. PGY-5
i. Understand the relevant literature and master the salient points
which can be used in daily radiation oncology practice.
ii. Participate in the education of co-residents, medical students,
nurses, therapists or other staff
15
iii. Execute the presentation and publication of the investigative
project and complete any additional research activities that were
started outside of the primary research endeavor.
IV.
Interpersonal and Communications Skills
a. PGY-2
i. Write a radiation therapy prescription to effectively communicate
the details of treatment delivery to the therapy staff
ii. Use the EMR (Electronic Medical Record) to effectively
communicate details of the patient visit, patient assessment and
treatment plan
iii. Comply with medical documentation requirements including
consultation notes, follow-up notes, end-of-treatment summaries
iv. Understand the importance of informed consent and be able to
obtain informed consent from patient
v. Use personal and electronic communication (via EMR) to
communicate with other staff i.e. nurses, therapists, dosimetrists,
and physicists with regards to patient care
vi. Understand that a radiation oncologist works as an integral part of
a team to effectively care for patients alongside physician
colleagues, co-residents, nurses, therapists, dosimetrists,
physicists, administrative and secretarial staff, social workers,
dieticians, etc and that effective communication is necessary for
effective patient care
vii. Involve the patient and patient’s family in decisions regarding care
using clear communication and empathetic behavior with respect
to emotional needs, intellectual capacity, and ethnic/racial
backgrounds
viii. Develop a relationship with the patient as a health care provider
that begins at consultation and continues through simulation,
treatment and follow-up
b. PGY-3
i. Demonstrate the ability to communicate and coordinate care
between disciplines i.e. medical oncology, surgery, radiology,
pathology, primary care, etc.
ii. Understand the importance of a neat and complete radiation
oncology chart and be able to defend in chart rounds
c. PGY-4
i. Learn to communicate directly and personally with referring
physicians/disciplines
d. PGY-5
i. Communicate with all radiation therapy staff and other pertinent
medical disciplines independently with indirect attending physician
supervision
V.
Professionalism
Professionalism objectives remain the same throughout the PGY2-5
16
years although the expectations of proficiency increase over the 4
years.
a. PGY-2-5
i. Demonstrate compassion, integrity, and respect for patients,
families, medical colleagues, and staff
ii. Demonstrate sensitivity and responsiveness to a diverse patient
population, including but not limited to diversity in gender, age,
culture, race, religion, national origin, disabilities, and sexual
orientation
iii. Respect patient confidentiality and autonomy
iv. Demonstrate the ability to comply with medical records and
charting requirements specific to rotations.
v. Demonstrate a commitment to learning the fields of clinical
oncology and radiation oncology by attending lectures and clinic
on time and demonstrating a commitment to independent learning
vi. Demonstrate accountability to patients, society and the profession
VI.
Systems-based Practice
Systems-based Practice objectives remain the same throughout the
PGY2-5 years although the expectations of proficiency increase over
the 4 years.
a. PGY-2-5
i. Practice cost-effective health care that does not compromise the
quality of care
ii. Advocate for quality patient care and assist patients in dealing with
system complexities
iii. Understand that the practice of radiation oncology is an
interdependent part of the health care system and society at large
iv. Consider how practice of radiation oncology affect other
healthcare professionals and the hospital system
v. Know what resources are available for patient care, within or
outside the institution and make referrals as appropriate
Competency Based Curriculum
Competency
PATIENT CARE
Curriculum Specific Activities

Clinical Rotations

Morning Conferences

Grand Rounds

Chart Rounds

Multidisciplinary
Conferences and
Clinics
Practice Performance Tools/Evaluation

Rotation Evaluation(s)

Review of case log

Peer Evaluation of Morning Conference

ACR In-service Exam

360 Evaluation

Semi-Annual Evaluation
17
MEDICAL KNOWLEDGE






PRACTICE-BASED
LEARNING &
IMPROVEMENT
















INTERPERSONAL &
COMMUNICATION SKILLS





PROFESSIONALISM







SYSTEMS-BASED
PRACTICE









Clinical Rotations
Morning Conference
Chart Rounds
Grand Rounds
Multidisciplinary
Conferences and
Clinics
Medical Physics and
Dosimetry Rotation
Research Rotation
Journal Club
Radiobiology Course
Physics Course
Statistics Course
Clinical Rotations
Morning Conference
Grand Rounds
Chart Rounds
M & M Conference
Medical Physics and
Dosimetry Rotation
Journal Club
Research Rotation
Annual OVID/Medline
Library Class
Maintenance of case
log
ASTRO Annual
Conference
Clinical Rotations
Morning Conference
Chart Rounds
Multidisciplinary
Conferences and
Clinics
Intra/Interdepartmental
Communication
Clinical Rotations
Morning Conference
External Rotations
Intra/Interdepartmental
Communication
Chief resident
Fatigue awareness
Radiation Safety
Lecture
Billing/Coding Lecture
Clinical Rotations
Morning Conference
Multidisciplinary
Conferences and
Clinics
M & M Conference
Billing and Coding
Lectures
Annual Radiation Safety
Lecture
HIPAA and Patient
Safety Training
Medical Physics and














Rotation Evaluation(s)
Direct Observation of CT Simulation
and Radiation Therapy Planning
Peer Evaluation of Morning Conference
Evaluation of Grand Rounds
Direct Observation during Dosimetry
and Medical Physics Rotation
ACR In-Service Exam
RAPHEX Exam
RABEX Exam
Semi-Annual Evaluation


Rotation Evaluation(s)
Mid Rotation Evaluation
Peer Evaluation of Morning Conference
Evaluation of Grand Rounds
Direct Observation of CT Simulation
and Radiation Therapy Planning
Direct Observation of Brachytherapy
Procedures
Direct Observation of Informed Consent
Direct Observation during Dosimetry
and Medical Physics Rotation
Improvement Initiative on Evaluations
Semi Annual Evaluations





Rotation Evaluation(s)
Direct Observation of Informed Consent
Peer Evaluation of Morning Conference
360 Evaluation
Semi-Annual Evaluations





Rotation Evaluation(s)
Peer Evaluation of Morning Conference
360 Evaluation
Direct Observation of Informed Consent
Semi-Annual Evaluations



Rotation Evaluation(s)
Peer Evaluation of Morning Conference
Direct Observation during Medical
Physics and Dosimetry Rotation
Semi-Annual Evaluations




18
Dosimetry Rotation
(QA)
2.2
Core Curriculum
The core curriculum is comprised of the clinical curriculum as well as the didactic
curriculum. It is competency based. The clinical curriculum is comprised of
approximately 42 months of clinical rotations. The didactic curriculum is
comprised of mandatory conferences, lectures, and tumor boards. The majority of
the curriculum will be dedicated to treatment of cancer patients with external
beam radiation therapy and brachytherapy, but will also include topics such as
intraoperative radiation therapy, radioimmunotherapy, unsealed sources,
hyperthermia, kilovoltage irradiation, plaque therapy, particle therapy, benign
disease and others topics that may be developed. Multiple evaluation tools will
be used to assess competency.
2.3
Clinical Curriculum
The clinical curriculum includes clinical experience with lymphomas and
leukemias, gastrointestinal, gynecologic, genitourinary, breast, soft tissue and
bone, skin, head and neck, lung, pediatric, central nervous system tumors, and
treatment of benign diseases for which radiation is utilized. The residents will
learn indications for irradiation and special therapeutic considerations unique to
each site and stage of disease including the use of combined modality therapy,
altered fractionation, stereotactic radiotherapy, brachytherapy, pain management
and palliative care.
Clinical rotations are 2-3 months in duration and will be scheduled in such a way
to provide educational experience in different disease sites and radiation therapy
techniques. The resident will maintain a one-to-one teaching relationship with
his/her attending on that service. There is a four week Dosimetry/Medical
Physics Rotation which will be split into two 2-week rotations during the PGY2 &
3 years. There is one optional external rotation to fulfill the pediatric case number
if needed. The ACGME required electives including medical oncology, oncologic
pathology, and diagnostic imaging are fulfilled by documented participation in
multidisciplinary conferences where medical oncology management, radiographic
imaging, and pathology are shown and discussed though electives in these
disciplines can be performed at the discretion of the resident and residency
program director. Signing in to each conference is required to document
attendance.
Throughout the course of these rotations and in accordance with ACGME
requirements residents are expected to participate in the case of approximately
150-200 patients per year (determined by the number of patients simulated) with
a minimum of 450 over the four years of residency.
The faculty will ensure that the resident participates in performing technical
19
procedures, including treatment setups as well as intracavitary and interstitial
brachytherapy according to level of training.
Follow-up of the irradiated patients by the resident, including pediatric patients,
on an inpatient or outpatient basis is a required part of resident training to ensure
that residents have the opportunity to learn about the problems of recurrent and
disseminated tumors and of later after-effects and complications of radiation
therapy.
2.3.1
Clinical Rotations
There are multiple clinical services within the primary and integrated institutions,
Loyola University Medical Center and Hines VA Hospital. Rotation on all services
is mandatory and is generally in 2-3-month blocks.
The total typical numbers of months per service are noted below. In general, the
residents rotate through the clinical services 2-3 times through their residency (at
least once during PGY 2-3 and once during PGY 4-5). The clinical rotation
schedule will be generated by the program director, and will be done so at the
discretion of the program director to best fit the needs/goals of the resident and
the department.
Rotation Description
Total Duration
Required:
1. Clinical Rotations
40 months
2. External Pediatric Rotation (i.e. St. Jude Children’s) 1 month
3. Dosimetry/Physics
1 month
Electives
4. Research or Clinical
6 months
TOTAL
2.3.2
48 months
External Rotations
To complement the resident experience, one external rotation has been
established in pediatric oncology. This is optional and usually takes place during
the PGY-4 or -5 year. This institution has the status of an affiliated institution for
the purpose of residency training. External electives can be established and
coordinated by the resident in lieu of an elective month.
Pediatrics: A one-month pediatric oncology rotation at St. Jude Children’s
Research Hospital is optional for residents. The resident must be at least a PGY3. Residents are expected to follow standard policies and procedures already in
existence in that institution.
2.3.3
Dosimetry/Medical Physics Rotation
During the PGY-2 or PGY-3 year, the resident will spend four weeks on the
clinical dosimetry and medical physics service. The resident will be supervised by
the Chief of Physics. The intent of this rotation will be for the resident to become
intimately familiar with standard planning techniques: 2-D, 3-D, IMRT, IGRT,
brachytherapy, stereotactic radiation therapy. The resident will be introduced to
dosimetry and the RTP workstations and will be required to participate in the
planning of a variety of “standard” cases. Additionally the resident will also
participate in the QA of radiation therapy equipment as it applies to clinical
20
practice. This will also serve as an opportunity for the resident to identify a
potential research project and mentor. The goals and objectives of this elective
can be found in Appendix A.
2.3.4
Research Elective
The ACGME requires that an investigative project be completed under faculty
supervision. To facilitate this, residents will have an opportunity to participate in
up to 6-months of elective time dedicated to research. This will generally be
scheduled in the PGY-4 & 5 year and completion of the statistics course is a
prerequisite. Participation in this elective rotation is not mandatory and at the
discretion of the resident and residency program director. It can be withheld if
there is failure to be promoted to the next year of training, multiple unsatisfactory
evaluations, or other academic or disciplinary actions that have occurred. The
project(s) must be formalized and a one-page proposal must be presented to the
program director at least 1 month in advance of the rotation. This proposal should
identify the faculty mentor, the objective of the project, proposed methods i.e.
retrospective review versus prospective data collection, and statistical methods,
which will be used to analyze data. If patient data are to be reviewed, the project
must be reviewed and approved by the IRB. Once the project is approved and
begun, the mentor and resident should meet regularly to review progress. The
mentor will be responsible for formally evaluating the resident at completion of
the research elective. Should there be no or minimal progress, the resident may
be required to defer the remainder of the research elective. Ideally the resident
will present his/her research at a regional/national meeting and will write a
corresponding manuscript. The resident must remain on campus during daytime
hours unless prior arrangements are made with the program director or
supervising faculty. Failure to do so will result in usage of vacation time or
cancellation of elective.
2.4
Didactic Curriculum
There are a number of conferences, multi-disciplinary tumor boards, lectures and
courses scheduled on a regular basis, which together comprise an integral
component of the residency program. Attendance at these conferences is
mandatory and MUST be documented by a sign-in sheet. The chief resident is
responsible for the accuracy of the sign in sheet. Topics will also be recorded as
applicable. Attendance to these conferences supersedes clinical responsibilities
except in certain circumstances i.e. evaluation of an emergency patient or
participation in a procedure. The schedule for these conferences is made in
advance and recorded on the resident education calendar. All multidisciplinary
tumor boards present radiology and pathology and thus fulfill ACGME
requirements for medical oncology, pathology, and radiology. A typical monthly
calendar is shown below:
21
Radiation Oncology Didactic Curriculum Schedule –Typical Monthly Schedule
Monday
Tuesday
Wednesday
WEEK 1
Didactic ConferenceRadiation Oncology 7:00
am
GU Tumor Board- 7:00 am
Chart Rounds 7:00 am
Lymphoma-Hematologic
Malignancy Tumor Board
8:00 am
Statistics 4:30pm (AprilMay)
WEEK 2
Chart Rounds 7:00 am
Lymphoma-Hematologic
Malignancy Tumor Board
8:00 am
Statistics 4:30pm (AprilMay)
WEEK 3
Chart Rounds 7:00 am
Lymphoma-Hematologic
Malignancy Tumor Board
8:00 am
Statistics 4:30pm (AprilMay)
WEEK 4
Lung Tumor Board
8:30 am
Grand RoundsRadiation Oncology
7:00 am
Head/Neck-Tumor Board
7:30 am
Gyn/Onc Tumor Board
12:00 pm
Friday
Didactic ConferenceRadiation Oncology
12:00 pm
Breast Tumor Board
1:30 pm
Radiobiology Lecture 3:006:00 pm (March-May)
Neuro Oncology Tumor
Board 4:00 pm
GI Tumor Board 2:30 pm
Hines VA Tumor BoardLung
Physics Course 4:00-6:00 pm
4:00 pm
Didactic ConferenceRadiation Oncology
7:00 am
Lung Tumor Board
8:30 am
Chart Rounds-7:00 am
Head/Neck-Tumor Board
7:30 am
Gyn/Onc Tumor Board
12:00 pm
Radiobiology Lecture 3:006:00 pm (March-May)
Neuro Oncology Tumor
Board 4:00 pm
Hines VA Tumor Board-GI
4:00 pm
Physics Course
4:00-6:00 pm
Didactic ConferenceGU Tumor Board- 7:00 am
Radiation Oncology 7:00
am
Head/Neck-Tumor Board
7:30 am
Lung/Chest Tumor Board
8:30 am
Gyn/Onc Tumor Board
12:00 pm
Radiobiology Lecture 3:006:00 pm (March-May)
Neuro Oncology Tumor
Board 4:00 pm
Hines VA Tumor BoardLung-4:00 pm
Physics Course 4:00-6:00 pm
Chart Rounds- 7:00 am
Didactic ConferenceRadiation Oncology
7:00 am
Lymphoma-Hematologic
Malignancy 8:00 am
Lung/Chest Tumor Board
8:30 am
Statistics 4:30pm (AprilMay)
Thursday
Breast Tumor Board
1:30 pm
Didactic ConferenceRadiation Oncology 12:00 pm
GI Tumor Board 2:30 pm
Grand RoundsRadiation Oncology
7:00 am
Didactic ConferenceRadiation Oncology
12:00 pm
Breast Tumor Board
1:30 pm
GI Tumor Board 2:30 pm
Pediatric Tumor Board 4:00
pm
Head/Neck-Tumor Board
7:30 am
Breast Tumor Board
1:30 pm
Cancer Center Tumor Board Didactic Conference7:30 am
Radiation Oncology
12:00 pm
Gyn/Onc Tumor Board
Radiobiology Lecture 3:00- 12:00 pm
GI Tumor Board 2:30 pm
6:00 pm (March-May)
Neuro Oncology Tumor
Hines VA Tumor Board-GI Board 4:00 pm
4:00 pm
Physics Course 4:00-6:00 pm
*Other Didactic Conferences (lectures) Morbidity & Mortality (M & M) every three months
Radiation Oncology Journal Club every other
2.5
Conferences and Tumor Boards
2.5.1
Education Conference
Education conference takes place two times per week and are mandatory for
residents. One faculty will serve as the mentor each conference. Topics will be
22
chosen according the residency curriculum. There are 3 primary types of morning
conferences:
1) Case-based presentation
The presenting resident leads this conference. To maximize faculty involvement
and ability to teach, the resident should provide the presentation to the mentor 2
or more days prior to the presentation. The faculty mentor should be prepared to
complement the discussion presented by the resident. The components of
conference include a case based patient presentation and workup, general
management, radiation therapy plan discussion, and a presentation of a pertinent
article that supports the clinical management of the patient. Patient information
including diagnostic studies is presented.
2) Planning conference
Planning conferences will be assigned to the residents by the Chief Resident.
Topics that best correspond with the residents’ rotations and level of training will
also be assigned by the Chief Resident. Topics (below) should be discussed
once per calendar year. A patient case will be selected to aid in discussion of an
assigned planning conference topic i.e. a H&N case could be presented for
discussion of IMRT, or a breast case presented for discussion of wedges. One
resident, attending, and physicist will be assigned to each planning conference.
One dosimetrist will also be assigned to most conferences, depending on the
topic. The format of the conference will be as follows: Resident presents a brief
summary of patient presentation, work-up, diagnosis, treatment recommendation,
contours, prescription dose, DVH and plan review (10-15 min). The physicist and
attending physician will lead the discussion and ask questions focusing on the
plan and assigned topic (30-40 min).
Topics are as follows:
-Electron planning
-IMRT/IGRT
-Image registration/fusion
-SRS
-SBRT & Respiratory Gating
-H&N/sarcoma brachytherapy
-Prostate brachytherapy
-Vaginal brachytherapy
-Cervical brachytherapy
-Re-irradiation
-Total Body Irradiation
-Total Skin Electron Irradiation
-Hyperthermia
3) ASTRO Video Lecture Symposium
The symposium consists of video presentation of one of the ASTRO or ASTRO
spring refresher courses with incorporated discussion by a faculty and residents.
The chief resident is responsible for assigning topic, reviewing the presentation
ahead of time to ensure its quality, and managing the discussion of the
presentation.
23
2.5.2
Chart Rounds
Departmental Chart Rounds are held every week to review new patients who
have recently started radiation therapy. Residents are required to present new
cases and participate in discussion of the treatment. Residents are responsible
to know all aspects of the patient’s case, rationale for all aspects of treatment,
and pertinent data relevant to the case. The chief therapist will have a list of
patients to be presented.
2.5.3
Mortality and Morbidity Conference (M & M)
This conference is held every 3 months. Once a year, each resident will present a
conference covering a treatment complication from radiation therapy on a
particular patient. The resident will be informed in advance with an annual
calendar of dates for M & M. The resident initiates choice of case with assistance
from the attending. The resident is responsible for the preparation and
presentation of the conference. The attending radiation oncologist will advise
and should be prepared to complement the discussion presented by the resident.
The attending and the resident should have at least one meeting to review all of
the materials to be presented and the important points to be emphasized.
The presentation for M&M will include the following:
1.
2.
3.
4.
5.
6.
7.
8.
2.5.4
Summary of clinical history
Detailed description of radiation therapy, including portal descriptions,
dose, and dosimetric analysis; localization films and isodose curves
must be available for detailed analysis at the conference; the physics
staff should be consulted for the dosimetry and technical review
Detailed description of time of appearance, nature, and severity of the
complication
Correlation analysis of techniques of irradiation or other factors that may
have contributed to the complication; the resident and staff must identify
specific points that they wish to emphasize about the possible
explanation for the complication and whether a review of the treatment
technique is in order
Suggestions to avoid this morbidity or mortality in the future
Detailed pathological description of the radiation effects (gross and
microscopic)
Short review of the literature on the subject, particularly with regard to
incidence of complication and specific dose levels, fractionation
schedules, volume, and treatment
List of selected references. A copy of the presentation should be
submitted to the program coordinator for placement in a file available to
anyone wishing to study the complication.
Multidisciplinary Tumor Board
Held once a month (usually the last Wednesday of the month) at 7:30 AM in the
Cardinal Bernardin Cancer Center Auditorium, per schedule prepared in advance
by the Cancer Center. Attendance is encouraged.
24
2.5.5
Thoracic Oncology Tumor Board
Part of the Multidisciplinary Thoracic Oncology clinic held every Tuesday at 8:30
AM in the Cardinal Bernardin Cancer Center Auditorium. Attendance is
mandatory for the resident on Lung service.
2.5.6
Gynecologic Oncology Conference
Held Every Wednesday at 12 PM in the pathology department, 2nd floor, EMS
building. Attendance is mandatory for resident on Gynecologic service.
2.5.7
ENT Tumor Board
Held every Wednesday 7:30 AM in the McGuire building, 1st floor. Attendance is
mandatory for resident on Head and Neck/Lymphoma service.
2.5.8
Breast Oncology Tumor Board
Breast Tumor Board is part of the multidisciplinary breast clinic every Friday at
1:30 pm in the Cardinal Bernardin Cancer Center Auditorium. Attendance is
mandatory for the resident on the Breast/Gynecologic service.
2.5.9
Lymphoma Tumor Board
Lymphoma Tumor Board held Mondays at 8 AM at the Cardinal Bernardin
Cancer Center Auditorium. Attendance is encouraged for residents on the Head
and Neck/Lymphoma service though mandatory if the faculty is attending.
2.5.10 Urology Tumor Board
Urology Tumor Board is held the 1st and 3rd Wednesdays of the month at 7 AM on
the 2nd floor EMS building, Department of Pathology conference room.
Attendance is mandatory for residents on Genitourinary service.
2.5.11 Gastrointestinal Oncology Tumor Board
Multidisciplinary GI Oncology clinic is held every Thursday PM in the auditorium
of the Cardinal Bernardin Cancer Center. Attendance is mandatory for resident
on Gastrointestinal service.
2.5.12 Hines VA Tumor Board
Tumor board case conferences are held weekly on Tuesday in the Hines VA
Media Library conference room from 4-5 PM. Topics alternate weekly between
Lung and Gastrointestinal cancers. The resident assigned to the Lung service
must attend the Lung tumor board and resident assigned to the Gastrointestinal
service must attend the GI tumor board.
2.5.13 Neuro Oncology Tumor Board
Tumor board is held every Wednesday at 4 PM in the Neurosurgery conference
room. Attendance is mandatory for resident on CNS service.
2.5.14 Pediatric Tumor Board
Pediatric Tumor Board is held the 3rd Thursday of every month from 4:00-5:00pm
in the Pediatric conference room (3rd floor Maguire).
25
2.5.15 Radiation Oncology Journal Club
Radiation Oncology Journal Club is held regularly and may occur at a location off
campus. Both residents and faculty will present current journal articles of
significance. Residents will be assigned a faculty mentor and should choose
article in conjunction with that faculty member.
2.5.16 Cancer Center Journal Club
Held every other Thursday at 12:00 Noon in the Cancer Center Auditorium.
2.5.17 Other Intramural Conferences
There are a variety of other oncology-related conferences predominantly held in
the Cardinal Bernardin Cancer Center Auditorium. The attendance at these
conferences is optional, depending on schedule and interest.
2.5.18 Conferences (Off Campus) –Not Mandatory
Chicago Radiological Society (CRS) – holds meetings once a month
(Thursday evening). A one-hour lecture is presented and attendance is
encouraged.
2.6
Lectures And Courses
2.6.1
Radiation Oncology Grand Rounds
These didactic lectures are held usually twice per month on Fridays at 7 AM and
cover a wide variety of topics related to radiation oncology. This lecture series
ideally follows the residency curriculum. The chief resident is responsible for
scheduling speakers based on need. Each resident is required to present once
per year. They are to be advised by a faculty member and are required to discuss
the presentation in detail with the advisor several days prior to the presentation to
ensure an enriching educational experience. Speakers from other specialties are
invited periodically.
2.6.2
Physics Course
The medical physics course consists of a sequence of lectures/laboratories given
the Medical Physics Faculty. The course is held from September through May,
and is divided into two semesters. Lectures are generally held from 4:00-6:00 pm
on Wednesdays in the Radiation Oncology training room. The practicum labs are
integrated to the didactic curriculum in order to provide a more hands-on physics
experience to the residents. During the labs, residents participate in various
physics tasks such as calibration and quality assurance of radiation devices, use
of various dosimeters, and IMRT/RapidArc planning optimization. The program
addresses all of the topics in ASTRO’s 2007 Core Physics Curriculum for
Radiation Oncology Residents (Int J Radiat Oncol Biol Phys 68(5): 1276-88).
Problem sets are distributed and discussed at each lecture. Homework is
assigned and graded. Each semester of the course culminates with a written
exam. The resident is required to get passing grades on the homework and
examinations before the Program director recommends the resident to take the
American Board of Radiology examination. After completing the course and
passing the exam a certificate of completion will be given to the resident.
26
2.6.3
Radiation Biology Course
The radiation biology didactic course is yearly course held from March – May.
Lectures are generally held from 3:00-6:00pm on Tuesday/Thursdays during
these months. Topics are based on the ABR radiobiology study guide
(http://www.theabr.org/ic/ic_ro/ic_ro_study_bio.html). The course is currently
being directed by an external radiobiologist. The resident will receive a certificate
at the completion of the course.
2.6.4
Biostatistics
This course is a prerequisite for the research elective. It is part of a Universitywide biostatistics course and directed by faculty from the Department of
Epidemiology and Preventive Medicine in the School of Medicine. The resident
will receive a certificate at the completion of the course.
2.7
Evaluation Tools
2.7.1
Evaluations
In order to continually assess, maintain, and improve the residency program,
evaluations will be conducted regularly and are required. Evaluations are
generally entered on-line using New Innovations.
2.7.2
Faculty Evaluation Of Resident
Each resident will be evaluated during and at the end of each rotation by the
attending radiation oncologist. Evaluations will follow criteria outlined by the
ACGME and will consist of objective assessments of competence in patient care,
medical knowledge, practice-based learning and improvement, interpersonal and
communication skills, professionalism, and systems-based practices. Goals and
objectives will be distributed electronically prior to the start of each rotation.
In order to facilitate this process in a timely manner, a session called “Rotation
Relay” will be held quarterly approximately 1 day prior to the upcoming rotation. It
will be held at noon (lunch hour) in Maguire faculty offices. The purpose of this
session will be for the attending to formally evaluate the resident with whom they
have just worked with i.e. at the end of the rotation. Additionally, the attending
physicians will review the goals and objectives (based on level of training) of the
upcoming rotation with the resident who will be starting the rotation. The first half
of the hour will be the evaluation session and the second half will be goals and
objectives session.
2.7.3
Resident Evaluation of Faculty
Residents will have the opportunity to anonymously evaluate all clinical faculty
annually. The aggregate of these evaluations will be distributed anonymously to
the faculty member, chairman, and program director annually and discussed with
the chairman during the faculty member’s annual review. Continual monitoring
and evaluation of the faculty review process is performed to ensure anonymity of
the evaluating resident. The chairman will document such discussion in the
Faculty Information System.
2.7.4
Resident Evaluation Of Rotation
After each rotation the resident will have the opportunity to anonymously evaluate
the rotation, which they just completed. Aggregate results of these evaluations
27
will be distributed to the faculty annually and will be discussed at the educational
committee meetings at least annually.
2.7.5
Resident And Faculty Evaluation Of The Program
Residents and faculty will have an opportunity to evaluate the residency program
annually. This evaluation will be to continuously improve the quality of the
program. Results of these evaluations will be discussed at the educational
committee meetings. Plans for improvement of the program will form a
component of the annual review of the program.
2.7.6
360o Evaluation
This evaluation is meant to assess the resident competency in professionalism
and communication. Residents will be evaluated anonymously semiannually by
therapists, dosimetrists, nurses, and support staff. Evaluations will be discussed
during the semi-annual evaluations.
2.7.7
Peer Evaluation of Morning Conferences
Peer evaluations will be completed by residents quarterly. The evaluations will be
anonymous. Evaluations will be discussed during the semi-annual evaluations.
2.7.8
Direct Observations
Direct observations will be used as an evaluation methodology. Direct
observation tools are meant to supplement the rotation evaluations and offer an
opportunity to evaluate a particular task. They are meant to foster discussion
between the resident and evaluators to identify potential areas for improvement.
They are not meant to serve as a graded test/exam. Residents are responsible
for having evaluations completed and submitted to the program coordinator in a
timely manner. The frequency of evaluation and description of each tool are as
follows:
2.7.9

Direct Observation Of CT Simulation And Treatment
Process/Preparation:
To be completed twice during each clinical rotation (once during the first
6-weeks and once during the second 6-weeks). Residents are
encouraged to choose the case prior to simulation and inform the faculty
of the evaluation. PGY 2 and 3 should choose more straightforward
cases i.e. palliative, brain, prostate, breast, 3/4 field pelvis, and advanced
lung cancer. PGY 4 and 5 should choose more advanced cases i.e. IMRT
Head and Neck, SBRT, 3 field breast and abdomen. A variety of cases
should be chosen over the duration of the rotation(s).

Direct Observation Of Informed Consent:
To be completed twice during each clinical rotation (once during the first
6-weeks and once during the second 6-weeks. A variety of cases should
be chosen over the duration of the rotation(s).
Self Evaluation
Residents will complete competency based self-evaluations semi-annually prior
to meeting with the program director for the semi-annual evaluations. In advance
of the self-evaluation, residents will be provided a summary of evaluations, direct
observations, and attendance to conferences/tumor boards.
28
2.7.10 Resident Semi-annual Evaluation
The program director will meet semiannually with each resident to discuss and
document the resident’s performance and progress and to review the residententered electronic patient log. Prior to this a self-evaluation will be completed by
each resident. Evaluations, direct observations, attendance, in-service exam
scores, case logs, and research activities, will be reviewed. Areas for
improvement will be identified and a plan of action documented. Other concerns
that residents may have can also be discussed during this time.
2.7.11 Summative Evaluation
Each resident will also receive a final evaluation at the end of his/her training.
The Program director will meet with the resident to review their final period of
education and verify that the resident has demonstrated sufficient professional
ability to practice competently and independently. The graduating resident must
have completed the ACGME based case log and sign the document at the final
meeting. The evaluation and case log will be kept in the resident’s permanent
academic file. The signed final case log will be forwarded to the ACGME Data
Analysis Department.
3.0
Standard Departmental Policy and Operating Procedures
This section of the manual details department -specific patient care
responsibilities with respect to the residency program. The ACGME and Loyola
University specific requirements are incorporated where appropriate. This is also
referred to the “Loyola University Medical Center Resident Handbook, Policies
and Procedures for Residents”, hereafter referred to as “Resident Handbook” for
institutional requirements and regulations.
3.1
General Patient Care in the Clinic
The attending physician’s generally have half-day clinics where they see new
patients, consultations, follow-up visits, or on-treatment visits. The attending
physician may review the clinic list and its patient’s prior to each clinic and assign
an appropriate number (see below) and types of patients for the resident to
primarily see. Potential educational value of the patient visit should be
considered. Residents will be assigned to a single attending physician during
clinical rotation. It is expected that they will participate in all aspects of patient
care including consultation, simulation and treatment planning, managing patients
under treatment and follow-up visits.
3.1.1
Consultations
Residents will see inpatient and outpatient consults assigned to that attending.
The resident should review all pertinent notes, reports and diagnostic data prior
to the consultation. The resident will obtain the patient’s history and present the
patient’s history, physical and work-up thus far to the attending. Residents will be
asked to recommend a treatment plan based on level of training. The resident will
then assume appropriate responsibility for the patient’s management after
consultation according to expectations according to PGY level as detailed in the
rotation goals and objectives. Consultation notes should be entered into
appropriate EMR on the day of the consultation. The resident should work with
the attending physician to determine desired content and format.
29
It is important that they include:
1.
Encounter date
2.
Referring Physician(s)
3.
Reason for consultation
4.
Pathology
5.
Radiology
6.
Details of multi-disciplinary management
Inpatient consultation recommendations should be directly communicated with
service requesting the consultation. Attending physicians will be responsible for
reviewing the note to be sure that it is accurate and for documenting their own
note/co-signing in accordance with departmental policy.
3.1.2
Follow ups
Residents will see follow-up patients with appropriate attending physician
supervision and will responsible for entering documentation into the EMR on the
patients who they primarily saw and examined the same day of the encounter. If
the attending physician primarily saw and examined the patient, then the
attending physician and resident should discuss who is responsible for the
documentation. Attending physicians will be responsible for reviewing the
resident note to be sure that it is accurate and for documenting their own note/cosigning in accordance with departmental policy.
3.1.3
On-Treatment Visits
Residents will see on-treatment patients with appropriate attending physician
supervision and will be responsible for entering the note into the EMR on the
patients who the primarily saw and examined. Acute side effects should be
graded according to CTCAE (Common Terminology Criteria for Adverse Events).
Attending physicians will be responsible for reviewing the note to be sure that it is
accurate and for documenting their own note/co-signing in accordance with
departmental policy. Occasionally, depending on patients’ circumstances,
residents will need to see their patients more than once in a week or patients
assigned to other attending physicians. These visits should be staffed with either
their respective attending physician or the staff attending assigned to the clinic
that day if their attending is not available.
3.1.4
Physical Examination
When performing a sensitive exam on a patient, i.e., a rectal, gynecological, or
breast, a female nurse chaperone (for female patients and male physicians) must
be present.
3.1.5
Informed Consent
Informed consent for treatment with external beam radiation therapy or
brachytherapy should be obtained by the resident if appropriate and if the
resident has seen the patient. This should detail the acute and chronic side
effects and possible complications. The attending physician is responsible for
reviewing the consent form with the patient. All patients MUST have the
appropriate informed consent forms signed BEFORE the initiation of and up to 30
days prior to therapy. A new consent is required for each treatment course. Inhouse or multi-institutional protocols require additional consent forms. The
30
research coordinator should be present and provide the appropriate consent form
for all protocol patients.
3.1.6
Simulations
Simulations should be scheduled directly with the simulator therapist.
Communication with the therapist is necessary to ensure proper simulation and
efficient use of time. The simulation order must be placed into the appropriate
EMR. All parameters including chemotherapy, IV contrast, positioning aids should
be conveyed. Therapy staff will review the patient chart prior to the simulation
date to make sure that informed consent and current lab results (IV contrast) are
in the chart. Should it be found that these are missing, the respective
resident/attending physician will be informed and arrangements will have to be
made for consent to be taken at the time of the simulation (this should be
avoided, if at all possible to reduce delays). If this cannot be scheduled, then the
resident/attending physician will call the patient and inform him/her that the
simulation appointment must be rescheduled. Simulation techniques, setup, and
treatment planning devices should be discussed with the attending physician
prior to simulation. The resident will be responsible for aspects of the simulation
according to PGY level. The resident should be available for the simulation,
particularly to do special procedures, such as catheterization, rectal marker
placement/administration.
3.1.7
Treatment Planning
The resident is responsible for the initial steps associated with treatment planning
including importing diagnostic image sets to be used for image fusion as well as
initial contouring of target volumes and organs at risk. These should be
accomplished prior to the next working day unless specifically discussed with the
Attending. . The diagnosis (including R/L side if paired organ), care plan, and
tentative prescription are entered into the EMR. The prescription must be detailed
and include dose, fractionation, treatment technique, anatomical description of
the planning target volume, and use of portal imaging or image guidance. If non
IMRT is utilized the resident, in collberation with dosimetry/physics, should design
the initial radiation fields. The resident should be available for review of the final
treatment plan with dosimetry. Changes to the plan should not be made without
attending physician approval.
3.1.8
Radiation Therapy Chart
The resident must strive for clarity and completeness in radiation therapy chart
documentation. The radiation therapy prescription must include total dose, total
number of fractions, total number of weeks of treatment, special technique i.e.
SBRT, IMRT and explicit description of volume(s) to be irradiated. The sole use
of terms such as PTV is not sufficient.
3.1.9
End of Treatment Summary
Residents are to enter an end of treatment summary on each patient after
physics final review. Residents are only responsible for summaries on patients
who completed treatment while the resident was on service. The completion
notes should be succinct and should include, 1) diagnosis and stage of the
cancer, 2) treatment recommendation including specific chemotherapy agents,
where applicable, 3) radiotherapy treatment delivered including start and end
dates, 4) CTCAE based acute toxicity, 5) disposition. If the resident was out (but
on the service and familiar with the patients) while the patient completed
31
treatment, he/she is responsible for the completion of treatment note. This
documentation should then be forwarded to their respective attending.
3.1.10 Port Films
Port films should be reviewed daily and signed by resident and attending at the
end of each day. Any adjustments should be clearly indicated on the film by
placing a “X” where the isocenter should be placed and directing the therapist on
what to do next, i.e. re-film or move, etc. IGRT-based kV flims must be reviewed
daily. Major changes are to be directly communicated with the therapists on the
machine where the patient is being treated. If the respective attending physician
is out of town, the resident must review port films of patients on-service with the
covering physician.
3.1.11 Follow-Up On Ordered Tests
Residents must follow up on any tests that are ordered on patients that are under
their care. The resident must check all reports and correspondence in the EMR
daily and respond appropriately. If any immediate action is required, the resident
should consult with the attending or the radiation oncologist staffing the clinic.
This may also include communication with the referring physician or service.
3.1.12 Requests for Medication Refills
Occasionally, the residents are called by patients or pharmacies requesting
medication refills. The following procedure should be observed for all
telephone prescriptions:
Verify that the patient is indeed a radiation oncology patient and that the
medication has been prescribed by a radiation oncologist. The chart should be
reviewed to verify the following:
 Review the indications and contraindications for the medication.
 Obtain the name of the pharmacy and telephone number.
 Document this encounter, recording the medication, dose, and schedule,
including the name, address, and telephone number of the pharmacy.
When a controlled drug is prescribed, the following information is required:
 patient's full name and date of birth;
 actual date prescription is written;
 drug name, strength, and quantity;
 instructions for use of the drug;
 signature;
 Resident DEA/NPI number.
3.1.13 Additional Documentation
Residents must always document in the EMR any additional interaction they have
with or concerning the patient, such as examinations, discussions, telephone
conversations, or new, renewal, or refill of prescriptions. If medication is ordered
over a weekend, it is important to make a chart note by Monday AM.
3.1.14 Patient Care Correspondence
Patient care correspondence includes messages from other physicians,
secretaries, nurses, or therapists, pertinent to a patient. Such messages come
32
through the EMR and residents are expected to check the EMR daily and
respond appropriately with the supervision of the attending physician.
Should the resident receive a message for a patient from a prior rotation, the
resident should triage the message and forward them to the appropriate
resident who is now on service or the attending physician.
3.2
Brachytherapy Procedures
Brachytherapy procedures include LDR and HDR intracavitary, interstitial, or
permanent seed implants. During the PGY 2-3 years, it is expected that the
resident will assist in the procedure. During the PGY 4-5 years it is expected that
the attending physician will allow the residents to become more independent in
performing procedures as experience permits.
3.2.1
GYN Implants-LDR
It is expected that all residents will be familiar with the following areas regarding
manual afterloading implants:
a.
b.
c.
Patient surveys
Manual afterloading procedures
Completion of treatment documentation and forms
The radiation oncology resident is responsible for assisting with and/or
performing the implant under the supervision of the staff. For LDR inpatient
implants the resident is also responsible for writing the postoperative note and
the postoperative orders in conjunction with gynecology oncology resident note.
The postoperative orders must include the time for implant removal, along with
the appropriate pager numbers and phone numbers for the resident and staff
involved. The resident must round on the patient twice a day, in the morning and
in the evening and write a note in the chart daily. After the implant films have
been taken and the staff has approved the final loadings, the resident should
dictate a loading note for the radiation therapy chart. The resident is then
responsible for loading the patient and for removing the implant at the appropriate
time.
3.2.2
High Dose Rate (HDR) Implant Procedures
HDR Implants are typically done for gynecologic, breast, head and neck,
sarcomas, and a variety of other malignancies. The radiation oncology resident is
responsible for assisting with, or performing the implant under the supervision of
the attending radiation oncologist. The radiation oncology resident is also
responsible for writing the procedure note into the EMR. The implant note should
include the procedure, operative findings, and applicators used. After the
brachytherapy catheters are placed and confirmed under fluoroscopy in the
operating room, the orthogonal implant films or CT scans are taken. The
prescription should be determined in collaboration with the attending radiation
oncologist. The resident should be fully acquainted with the mechanical aspects
of the HDR machine, the dosimetry involved in the treatment calculation, and the
treatment checks required before initiating treatment. The resident should also be
familiar with the emergency procedures regarding HDR treatment. The resident
should be present, along with the attending staff physician, dosimetrist, and
technologist, at the time of the high dose rate treatment delivery.
33
3.2.3
Prostate Brachytherapy
Low Dose Rate I-125 seed implants are generally used in the treatment of
prostate cancer patients and are implanted permanently. The radiation oncology
resident is responsible for assisting with, or performing the volume study and the
implant under the supervision of the attending radiation oncologist. The surgery
resident will generally write the postoperative orders and postoperative note.
However, the radiation oncology resident should write the procedure note into the
EMR. All implants require that radiation safety instructions be given to the patient
and a copy put in the patient’s chart.
3.2.4
Resident Participation in Brachytherapy Procedures
If an attending physician is not assigned a resident to his or her clinical service,
the program director and/or chief resident will make all efforts to have a resident
participate in the brachytherapy procedure with the respective attending. This is
in an effort to maximize case log and resident experience with brachytherapy
procedures.
3.2.5
Radionuclide Procedures
The residents will be responsible for participating in radionuclide procedures and
administration in accordance with ABR guidelines – 6 administrations including 3
therapeutic I-131 administrations.
3.3
Dress Code
Dress and personal grooming should be neat and consistent with a professional
atmosphere. Residents should wear dress pants, dress shirts, skirts, blouses,
etc. Male residents should always wear a tie. Blue jeans and tennis shoes are
not allowed. Residents are always to wear white coats when they are in patient
areas. This dress code applies to all working days of the week, including “nonclinic days”.
3.4
On Call Duty
The chief resident is responsible for the call schedule, and with the assistance of
the program coordinator/departmental secretary will ensure that all appropriate
parties receive this schedule. The resident on-call must carry the on-call pager
and be available to provide emergency care from 4:30 PM until 7 AM the next
day, and 24 hrs during the weekend. It is the individual resident’s responsibility to
arrange back-up coverage if he/she is unable to fulfill call duties. A request for
emergency evaluation should be handled promptly. The patient should be seen
within 90 minutes from the time the consult is received or sooner should the
situation dictate. Call is taken from home; the continuous presence of the resident
in-house is not required. Consequently, the hospital does not provide on-call
rooms or free meals for radiation oncology residents. Home call does not count
toward duty hours. Coming into the hospital for patient-related activities does
count however.
When a resident is asked to see a patient while on-call, the resident is to evaluate
the patient in the same manner as during normal clinical hours. The resident
must notify the on-call attending radiation oncologist and discuss the case once
all information is available. At the discretion of the supervising attending
physician, he/she will also come in to see the patient. If the patient requires
radiotherapy treatment while on-call, the attending physician must come in. If
34
there is uncertainty as to whether a patient needs to be seen on an emergent
basis, versus seeing patient on an non-emergent basis the next day, the resident
should discuss the case with the attending physician on-call and the attending
physician should make the final decision as to when the patient should be seen.
A resident cannot refuse to see a patient. During the hours of 7 AM until 4:30 PM
the on-call resident is to triage all calls as specified in the “On Call Pager” Call
Triage Flowsheet. The patient may be transferred to a different service based on
attending-to-attending discussion. Proper information including name, MR
number, and description of clinical situation and treatment up to the point of
transfer shall be provided to the accepting service.
3.5
Resident Supervision
During rotations, a resident will be given responsibilities that are commensurate
with the level of training and his/her proficiency in radiation oncology skills. The
rotation-attending physician will primarily be responsible for supervision of the
resident on their rotation, however if not available, the attending in the clinic that
day will be the supervising attending. The following details reflect levels of
supervision required by PGY level. (please see below)
3.6
Other Resident Responsibilities
If a resident is approached by any member of the medical team and asked to
perform a duty for which he/she is unfamiliar or feels it is not their responsibility,
the following should be done:
- Ask the supervising attending for guidance in addressing the duty immediately.
- Inform the chief resident and residency program director so that
appropriateness of the requested duty and the need for special education can be
addressed.
The residents are required to maintain harmonious relationships with members of
other departments, nurses, therapists, dosimetrists, physicists, clerical staff and
other healthcare providers caring for the patients. The resident must treat
patients with compassion, courtesy and respect. The resident should be sensitive
to cultural and religious issues. Patient confidentially is to be respected at all
times. The resident should strive to resolve conflicts in a constructive manner and
display courteous behavior towards colleagues and staff. The residents should
direct any concerns to the program director. Resident behavior that interferes
with patient care or departmental functioning may be grounds for corrective
disciplinary action.
35
RESIDENT SUPERVISION IN RADIATION ONCOLOGY
D= Indicates residents at this level of training may perform service only under DIRECT supervision of faculty
O= Indicates residents at this level of training may perform service only if faculty is ON-SITE and immediately available
I= Indicates resident at this level of training may perform service under INDIRECT supervision of faculty who may
be contacted readily at all times
SERVICE/PROCEDURE
PGY2 PGY3 PGY4 PGY5
Basic CPR (BLS) until code team arrives (or ACLS if certified)
I
I
I
I
Initial evaluation of patient illnesses, adverse reactions, or falls/injuries
I
I
I
I
Write prescriptions for medications related to radiotherapy management
I
I
I
I
Performing history and physical examination
I
I
I
I
Perform pelvic exam (chaperone required)
I
I
I
I
Perform breast exam (chaperone required)
I
I
I
I
Perform rectal exam (chaperone required)
I
I
I
I
Contouring treatment planning volumes
I
I
I
I
Approving treatment planning volumes
D
D
D
D
Participating in isodose optimization for approved volumes
I
I
I
I
Approval of radiotherapy treatment plan
D
D
D
D
After-hours and/or emergency simulation and treatment initiation
D
D
D
D
Supervising after-hours or weekend treatments of established sites/fields
I
I
I
I
Review of port films
I
I
I
I
Review of image-guided radiation therapy films (planar, CBCT)
O
O
O
O
Injection of iodine contrast for radiographic studies
I
I
I
I
Injection of amifostine or other radioprotector
I
I
I
I
Insertion of IV catheters
I
I
I
I
Insertion of rectal markers, catheters or contrast
I
I
I
I
Insertion of vaginal markers (with chaperone)
I
I
I
I
Placement of urinary catheters (with chaperone)
I
I
I
I
Performance of retrograde urethrogram
I
I
I
I
Performing flexible fiber-optic nasopharyngolaryngoscopy
D
O
I
I
Placement of brachytherapy applicator in operating room
D
D
D
D
Placement of permanent seed implant
D
D
D
D
Examination under anesthesia
D
D
D
D
Evaluation for intraoperative brachytherapy catheter placement
D
D
D
D
Removal of interstitial needle brachytherapy device
D
O
I
I
Delivering HDR treatment
D
D
D
D
Removal of LDR radioactive sources
Removal of tandem and ovoid/ring applicator
D
D
O
O
I
I
I
I
36
Removal of Mammosite applicator
Intraoperative Electronic Brachytherapy
Hyperthermia
D
D
D
D
D
O
O
D
O
O
D
O
4.0
Administrative Matters
The basic conditions of employment of residents are clearly set forth in the
agreements between the resident and Loyola University Medical Center. As
employees of the Medical Center, the residents should recognize that these
conditions cannot be modified by the individual departments. Specific policies
which apply to residents in the Department of Radiation Oncology are explained
below. The resident is also referred to the “Loyola University Medical Center
Resident Handbook, Policies and Procedures for Residents”, hereafter referred to
as “Resident Handbook” for institutional requirements and regulations.
4.1
Eligibility and Selection
The Department follows eligibility criteria set forth by the institution as stated in
the Resident Handbook and the RRC requirements set by ACGME.
Residents are required to complete one year of postgraduate clinical training in
internal medicine, pediatrics, surgery or surgical specialties,
obstetrics/gynecology, family practice or transitional-year program prior to the
start of the training in radiation oncology. The PGY-1 year should include at least
9 months of direct patient care in medical and/or surgical specialties.
The residency program participates in ERAS (Electronic Residency Application
System) and the NRMP (National Residency Match Program). Candidates
are selected for an interview based on their ERAS application criteria such as
previous academic performance; standardized test scores and letters of
recommendation are also considered. Race, gender, religion, national origin,
age, disability, veteran status, and sexual orientation are not considered.
Applicants are interviewed by at least four full time faculty members and graded
by each. Applicants are ranked on the NRMP match-list based on average
grades given by interviewers and faculty member discussion. The participating
faculty members participate in creation of the final rank-list to be submitted to
NRMP. One to two applicants are selected for admission to the program each
year.
4.2
Clinical Competency Committee (CCC)
The purpose of CCC is to review, on a semi-annual basis, the progress of the
residents. This includes reviewing overall and individual resident performance
and program outcomes data (and improvement initiatives if necessary). The
committee will be made up of the program director, the departmental chairman,
and selected faculty/staff. The program director will report results from the semiannual reviews to the CCC for review of resident performance.
4.3
Annual Review of Faculty Performance
Faculty performance will be reviewed annually by the program director and the
chairman. This review will be incorporated into the University faculty evaluation
on the Faculty Information System.
37
4.4
Promotion
Resident will be promoted to the next level of training based on the
recommendation by the program director and CCC . This will be based on
satisfactory performance on clinical rotations/evaluations and semi-annual
progress reports.
4.5
Academic Probation
A resident who demonstrates educational and clinical deficiencies a clinical
rotation will meet with the program director to discuss the resident's performance
in the deficient rotation and methods for improvement. In the event of continued
deficiency evaluation, the progress of this resident will be brought before the
department’s educational committee for discussion and consideration. The
resident may then be placed on academic probation as outlined and specified in
the Resident Handbook. At the end of the probation period, depending on the
resident’s performance, he or she may be removed from probation, given an
additional period of probation or terminated from the program. At the discretion of
the Program director and per terms of academic probation, residents may be
required to repeat part or all of (a) rotation(s) in which their performance was
considered less than acceptable. The resident has the right to file a grievance
regarding an academic probation action.
4.6
Disciplinary Action/Termination
The program director may recommend corrective disciplinary action/termination
from the training program for the reasons including, but not limited to:







Unsatisfactory evaluation from 3 rotations or more
Failure to comply or demonstrate improvement with a remediation program
Gross personal misconduct
Repeated violations of standard operating procedures as outlined in section 3.0.
Engaging in extradepartmental professional activities not approved by the
program director and/or department chairperson
Taking time off without prior approval
Other events as outlined in the Resident Handbook.
The dismissed resident has a right to file a grievance with Loyola Graduate
Medical Education (GME) office as outlined in the Resident Handbook.
4.7
Duty Hours
The residency program will follow duty hour requirements as specified by the
ACGME program requirements. In general, resident working hours in the
department are from 7:00 AM to 5:00 PM daily, Monday through Friday.
Residents should always be able to be reached by pager during these hours.
Patient care duties may exceed these hours.



Duty hours are defined as all clinical and academic activities related to
residency program. Duty hours do not include reading and preparation
time spent for presentations or conducting research.
Duty hours do include moonlighting* (see below).
Duty hours shall be limited to 80 hour per week averaged over 4 weeks,
inclusive of all in-house calls and moonlighting.
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


Resident shall receive at least one full day off in 7 workdays, free of
patient care including pager call and educational responsibilities,
averaged over 4 weeks.
A total time spent on duty continuously shall not exceed 24 hours, with up
to 6 hour allowed for educational activities. No new patients can be
accepted after 24 hours of continuous duty.
Residents shall have at least 10 hours rest between duty periods.
If a resident reaches any of the limits set forth above, he or she is responsible for
informing the chief resident and the program director. The resident shall be
relieved of duty and the service attending physician will provide patient coverage.
4.8
Moonlighting
Moonlighting is defined as any additional professional activity outside the training
program. Because residency is a full-time endeavor, moonlighting may interfere
with the ability of the residents to achieve the goals and objectives of the training
program. Residents wishing to engage in moonlighting must have prior written
permission by the program director and department chair. This permission will be
granted only to those residents with exemplary performance in training. Resident
must obtain a State of Illinois permanent license, outside professional liability
insurance and a personal federal DEA number for use in activities not related to
training program. Loyola University Medical Center malpractice insurance
does not include any moonlighting activity at other institutions. Residents
engaging in moonlighting must maintain their caseload and academic
performance. The time spent in moonlighting counts towards “on-duty” hours.
Moonlighting hours must not result in the resident exceeding the duty hours
restrictions. The permission to moonlight or participate in extracurricular activity
may be withdrawn at any time at the discretion of the program director or the
chairman. Non-adherence to those rules may be grounds for disciplinary action.
4.9
National Examinations
There are two mandatory in-service exams that must be taken yearly by all
residents unless they have passed the appropriate ABR Exam. These include the
American College of Radiology In-service Examination (March), which covers
clinical oncology, physics and radiobiology and RAPHEX which covers physics
taken in June. Other exams may be required as a part of the didactic curriculum
i.e. physics, radiobiology, statistics.
4.10
Basic/Advanced Cardiac Life Support Certification
Residents must have current Basic Life Support (BLS) and are encouraged to
maintain Advanced Cardiac Life Support (ACLS) certification. A copy of the
certificate will be kept on file by the Program Coordinator.
4.11
Log Books
Each resident is to keep a detailed and accurate log book of the cases where
he/she functioned as the primary resident responsible for simulation treatment
and planning. Logged cases are entered online on the ACGME website
(acgme.org). Log books will be reviewed twice per year by the program director
during the semi-annual evaluation.
Log books must finalized within 2 weeks from the completion of training.
39
4.12
Pager
All residents are assigned a pager at the beginning the their residency. Pagers
are to be carried at all times. Replacement batteries are available in the clinic.
The first incident of a lost pager will be at the expense of the department. Any
other incidents will be at the expense of the resident and replacement is
mandatory.
4.13
Allocations
The Department will assist the residents in covering certain expenses if they are
incurred for the purpose of education and are not paid for by the training
institution. This support is not intended to supplement the salary. Examples
include conference registration fees, membership dues for professional
organizations including American Board of Radiology dues, book purchases,
journal subscriptions, etc. Electronics such as computers, tablets, handheld
devices, smartphones etc. cannot be purchased with these educational funds.
Any item in question requires approval by the program director and/or chariman.
Residents will be provided with the following textbooks at the time of joining the
department. These expenses will not be deducted from the annual allocation:
1.
2.
3.
4.
Perez & Brady’s: Principles and Practice of Radiation Oncology
Small: Radiation Toxicity: A Practical Medical Guide
Khan: Physics of Radiation Therapy
Hall: Radiobiology for Radiologists
Annual resident allocation is as follows:

PGY2- $250 plus above required texts

PGY3- $750

PGY4- $750

PGY5- $750 plus up to $1,500 for ASTRO

Total - $4,000 over 4 years
Travel Expense Policy
The LUMC FCO (Faculty Clinical Operations) expense policy guidelines must be
followed.

In addition to the above, residents may request travel expenses for specific
academic submissions. These requests must be in writing before the submission
is made. In general, submissions must be to high level academic meetings with
acceptance for oral presentation. For example, an oral presentation at ASTRO is
likely to receive approval, but a poster presentation at ASTRO or an oral
presentation at a lesser meeting is likely not to be approved.

This additional travel grant will be limited to one per year and 1,500 dollars.

The reimbursement for travel will require itemized receipts.
4.14
Chief Resident
The chief resident is a senior resident appointed by the program director to assist
with administrative matters regarding the residency program. The Chief resident
40
acts as a liaison between the residents, the program director, the program
coordinator, and clinical staff.
Responsibilities (in addition to those applicable to all residents)
A. The program coordinator will keep attendance and track of topics covered in
all departmental conferences via the sign in sheet. It is the responsibility of
the chief resident to make sure that the sign in sheets are filled in accurately
each day and turned in to the departmental secretary, who will forward to the
coordinator.
B. The chief resident will schedule all morning conferences to ensure an
adequate number of case-based, planning, M&M, journal club and ASTRO
symposium conferences are scheduled. The chief resident will screen the
online ASTRO symposium lectures in advance and moderate the
presentations to ensure discussion of high yield topics to maximize
educational benefit.
C. The chief resident is in charge of scheduling the Grand Rounds lectures in
accordance with the didactic curriculum. He or she will invite outside
speakers as needed. The chief resident will review the curriculum and the
topics which need to be covered with the program director at least once a
year.
D. The chief resident will ensure that tumor board sign-in sheets are filled out
and returned to the program coordinator on a monthly basis
E. The chief resident may be asked to make the rotation schedule for residents in
conjunction at the request of the program director. The program director must
approve the rotation schedule.
F. The chief resident will make the call schedule for residents. The program
director must approve the call schedule.
G. The chief resident will make the conference schedule and will review with all
residents. The program director must approve the conference schedule.
4.16
Qualifications
a.
Must be a PGY 4 or 5 resident.
b.
Must display responsibility and organization skills
c.
Must have satisfactory clinical performance.
4.17
Mailboxes
Individual mailboxes are provided to the residents and are located in the
departmental mailroom in the Maguire building.
4.18
Resident Room
The residents are provided a room, individual desk and computer within the
departmental administrative office space in the Maguire building. The Resident
room contains a library of books and journals of interest of radiation oncology.
These books and journals are departmental property and are for resident use.
41
The department will periodically update the library with updated books as they
become available. It is residents’ responsibility to keep the room neat.
4.19
Libraries
The residents have access to two medical libraries: one at Loyola in Building 101
on the first floor; and another at Hines in Building 1 - G section on the first floor.
In addition, the residents have access to most electronically published journals of
interest in oncology. The residents will periodically have an opportunity to
participate in classes offered by the library.
4.20
Leave Policies
The residency program will follow leave policies as outlined in the Resident
Handbook including sick days, FMLA (Family Medical Leave Act),
maternity/paternity, leave of absence, personal leave of absence, funeral, jury
duty and paid time off i.e. vacation. Additionally, per the requirements of the
American Board of Radiology (ABR) leaves of absence and vacation are as
follows (http://www.theabr.org/ic/ic_ro/ic_ro_progdir.html):
Leaves of absence and vacation may be granted to residents at the discretion of
the program director in accordance with local rules. Within the required period(s)
of graduate medical education, the total such leave and vacation time may not
exceed:
6 calendar weeks
(30 working days)
for residents in a program for one year
12 calendar weeks
for residents in a program for two years
(60 working days)
18 calendar weeks
for residents in a program for three years
(90 working days)
24 calendar weeks
for residents in a program for four years
(120 working days)
If a longer leave of absence is granted, the required period of graduate medical
education must be extended accordingly.
Please note that the ABR policy has no relationship to maternal/paternal leave
policies, institutional vacation policies, sick leave policies, or any other issues
related to contractual obligations, institutional policies, and/or state or Federal
government legislation or regulation, or employment law. The policy relates only
to the time in training requirements for eligibility to take the ABR certification
examination.
4.21
General Leave Guidelines
All residents must complete the "REQUEST FOR HOUSE OFFICER LEAVE OF
ABSENCE" form available from the residency program website for vacation,
educational, and personal leave. Form should be completed at least 30 days in
advance of leave.
42
1. Complete the LOA form with requested dates and type of leave (i.e. vacation,
educational or personal)
2. Submit and obtain for signature of the attending physician with whom the resident
will be rotating with for approval
3. Return form to program director (via mailbox in Maguire)
4. The program director will either approve or reject the request based on schedule
impacts for clinic coverage, past leave requests, and compliance with University
policy. The departmental secretary will keep a log of leaves of absence for each
resident.
For circumstances when the "REQUEST FOR HOUSE OFFICER LEAVE OF
ABSENCE" form is turned in less than 30 days in advance the resident MAY be
required to find clinic coverage by another resident. Additionally, the program
director or attending reserve the right to not grant permission for leave.
Any absence from the campus or the assigned rotation (except in a case of
sudden illness) without previously submitted and approved LOA form is a
violation of the departmental policy and may result in disciplinary action.
If a resident is unable to return to duty on time, he/she must contact the
administrative secretary at either extension 62587 or 62562 as well as the
attending radiation oncologist by 8:00 am of the day due back. Failure to return
on the appropriate date without approval by program director may result in
disciplinary action.
4.22
Paid time off
All residents are allowed four (4) weeks of paid time off for vacation or education
(20 business days) as per the Resident Handbook.
Up to five (5) days of vacation/education can be carried over to a subsequent
year.
Residents are not permitted to take more than two consecutive weeks of vacation
during a rotation.
Residents may take vacation time during the holidays and work out a schedule
with their respective attending in order to not compromise patient care (i.e. both
the attending and resident taking vacation for an extended period of time). On
days where one of the clinics is closed, while the other remains open, the
resident will follow the schedule of the clinic to which they are scheduled. For
example, if on the Friday after Thanksgiving the Loyola Clinic is closed, but the
Hines VA clinic is open and the resident/attending have a clinic there, the
resident is required to be there unless a vacation day was previously requested.
If that resident is normally scheduled to be at Loyola that day, no vacation
request is needed.
43
4.23
Education
The program allows educational days as per institutional and departmental
guidelines. A total of 20 days are allotted for vacation or educational purposes.
At the discretion of the program director, additional educational days may be
allotted.
4.24
Illness
Per Loyola’s resident handbook, residents receive 12 days of sick leave. It is the
resident’s responsibility to contact and speak to the administrative secretary, at
either extension 62587 or 62562, informing that he/she will not be reporting to
work for that day. E-mail or text messaging are not acceptable. The ill
resident will switch the status of their pager to:
“Out of Hospital/Unavailable”.
The secretary will be responsible for informing the attending physician as well as
the Loyola and Hines staff. An LOA form for the sick day should be filled out
upon return and submitted to the departmental secretary.
If multiple days are required the ill resident is expected to follow the above
procedure for everyday of absence. After 3 days of absence a note from a
physician is required upon returning to work.
4.25
Maternity/Paternity Leave
As per the Resident Handbook.
4.26
Family Medical Leave Act (FMLA) / General Leave
As per the Resident Handbook. Please also refer to the ABR website (theabr.org)
for further details regarding leaves of absence
4.27
Time off for job interviews
Residents in their final year of training will not be allowed to take additional days
off for job interviews. Time off will comply with the allotment of vacation days.
4.28
Funeral
As per the Resident Handbook.
4.29
Jury Duty
As per the Resident Handbook.
4.30
Attending Leave
While the service attending is on vacation, he/she will designate covering attending
physician(s) who will be responsible for the patients. If the service attending has a
resident, that resident will be primarily responsible for the service’s patients with the
covering attending physician(s) being ultimately responsible. The resident will be
responsible for seeing the service patients while under treatment, checking port
films daily, taking care of acute issues and generally taking care of typical day to
day responsibilities i.e. simulations, contouring, and checking EPIC in-basket. The
resident must be present at the location (Loyola or Hines) of the assigned
attending. Again, this will be under the supervision of the covering attending
physician(s).
44
On the mornings/afternoons that the service attending normally has a new
patient/follow-up clinic in the department (LOC/Hines), their resident should be
available even if the clinic is cancelled. This is necessary as the radiation oncology
staff (nursing, dosimetry, therapists, and front desk) expect that a physician from
the team is available during this time. If the attendings’ clinic is cancelled, the
resident must either be (1) present in the clinic or (2) must call nursing, dosimetry,
therapists, front desk to be sure there aren’t any pending patient issues. If there
are no pending patient issues, the resident may be available by pager and is
required to be on campus during that time. The resident can designate that another
resident “cover” for any urgent matters. The primary Hines VA resident must
remain at the Hines Clinic on all days except on days where their attending is
normally not required to be present.
5.0
Other
Any matter that is not covered in this document will be evaluated and determined at
the discretion of the residency program director and/or chairman.
45
Appendix A
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www.luhs.org/radiationoncology
Direct Observation of Radiation Therapy Planning During Dosimetry/Medical Physics
Resident: _________________________________________
Dates of Rotation: ____________________________
During the dosimetry/medical physics rotation, the resident physician will learn basic dosimetric principles
and radiation therapy planning techniques by participating in planning “standard” patient cases. This will be
done under the supervision of a certified medical dosimetrist or medical physicist. The resident will also
participate in departmental quality assurance. Please have supervising staff document participation in the
following by initialing where appropriate.
INITIALS
DATE
PLEASE CHOOSE ANY 6 OF 10 (PGY 2 & 3)
1. Breast (2 field)
2. Breast (3 field)
3. Pelvis (3 DCRT)
4. Whole Brain
5. Prostate (IMRT)
6. Spine
7. Thorax
8. Abdomen
9. H+N (3DCRT i.e. 3 Field)
10. H+N (IMRT)
PLEASE CHOOSE ANY 3 OF 7 (PGY 2 & 3)
1. Brain (3 DCRT)
2. Prostate (brachytherapy)
3. Cervix (brachytherapy)
4. Vaginal (brachytherapy)
5. Stereotactic Body (SBRT)
6. Stereotactic Brain (SRS)
7. Other IMRT Case (i.e. pelvis abdomen)
ALL REQUIRED
Departmental QA meeting
Daily LINAC Warmup/QA (one-time only)
Monthly LINAC QA (with physicist)
Daily CT QA (one-time only)
Monthly CT QA
HDR QA (day of procedure)
Chart Check/ QA (with physicist)-3 charts
Respiratory Gating (CT)
IGRT Delivery
IMRT QA (delivery and analysis)
Comments/Suggestions for improvement:
The resident has PASSED/FAILED dosimetry/medical physics rotation (please circle)
46
□ I discussed the above with the resident
Supervisor: _____________________ Supervisor Signature: _____________________ Date: _________
Print
Resident: _______________________ Resident Signature: _______________________Date:__________
Print
47