Training in
Radiation Oncology
The Royal Australian and New Zealand College of Radiologists®
About the College
The Royal Australian and New Zealand College of Radiologists (RANZCR) is the
leading professional organisation for the promotion of the science and practice of the
medical specialties of Radiology and Medical Imaging (Diagnostic and Interventional)
and Radiation Oncology in Australia and New Zealand. The College has members in
Australia and New Zealand and throughout the world.
Mission
To promote, encourage and provide for the advancement of the study and the practice
of the sciences known as Diagnostic Radiology and Diagnostic Medical Imaging,
Therapeutic Radiology and Oncology and allied sciences for the carrying out of research
and experimental work in connection with these sciences.
The Faculty of Radiation Oncology
The Faculty of Radiation Oncology, RANZCR, is the peak bi-national body advancing
patient care and the specialty of Radiation Oncology through setting of quality standards,
producing excellent Radiation Oncology specialists, and driving research, innovation and
collaboration in the treatment of cancer.
Vision
To have an innovative, world class Radiation Oncology Specialty for Australia and
New Zealand focused on patient needs and quality.
Our promise to trainees
We ensure the highest standard of training in radiation oncology by combining a
world-class curriculum with passionate and supportive supervisors. The voice of
trainees is valued in Radiation Oncology.
An Introduction to
Radiation Oncology
from the Chief Censor
With the discovery of x-rays in the late 19th century and the pioneering study of radioactivity
by Marie Curie and colleagues in the early 1900s, came a new era in medicine. In particular,
the realisation that some types of radiation (x-rays, electrons and gamma rays from radioactive
materials) destroy malignant cells, infinitely expanded our capacity to treat cancer. Over the last
100 years, the full potential of radiation in curing many cancer patients, and relieving distressing
symptoms (palliation) for others, has unfolded. This stream of medicine has grown into the modern
specialty of Radiation Oncology.
Radiotherapy (or radiation therapy) is now one of the best-established, most effective and welltolerated therapies for treating cancers of nearly all types and presentations, extending the lives
and/or reducing the suffering for patients and those around them. The constantly accumulating
evidence from clinical trials (many conducted by RANZCR Fellows) shows that radiotherapy offers
clear benefits to patients with a wide variety of malignant conditions, in terms of cancer cure, organ
preservation, effective palliation of symptoms and overall quality of life. About one in every three
people will develop cancer in their lifetime and over half of these patients will likely benefit from
radiotherapy, as part of their overall management.
Clinicians who specialise in Radiation Oncology play an integral role in the complex
multidisciplinary team management of cancer patients, applying multifaceted expertise – always
central to this being the care of patients. Their practice is strongly underpinned by a detailed
knowledge of the biological effects and physics of radiation, the application of sophisticated
imaging and treatment technologies, and their extensive understanding of the diverse clinical
behaviours, pathology and management of cancer. This knowledge includes a high-level
appreciation of the integration of radiotherapy with other treatment modalities – especially surgery
and chemotherapy - and the complexities of clinical decision-making. Their approach to patient
care encompasses a holistic view of the individuals’ needs.
Radiation Oncology is a specialty dealing with rapidly changing technological advances directed
largely at improving the accuracy and effectiveness of radiotherapy outcomes, including better
control and cure of tumours, as well as reduction of side effects. It is a stimulating and progressive
field of medicine that seems set to continue on its current trajectory of exciting change. Increasing
use of high quality imaging to direct radiotherapy, and newer types of radiation (such as protons)
and evolving delivery techniques, such as intensity modulated radiotherapy (IMRT), are quickly
becoming standard treatment methods.
RANZCR Radiation Oncologists are highly regarded by other health professionals and bodies,
both in Australia and New Zealand, and internationally. They are sought-after for overseas training
fellowship positions, which usually involve a significant component of clinical or laboratory research.
Radiation Oncology is an intellectually challenging and exciting career with a range of opportunities
in the public, and increasingly, private sectors as well as in the academic sphere. It incorporates
the best aspects of direct clinical management of patients of all ages, with a highly effective, and
technologically-interesting, treatment modality. It is a specialty that will appeal to clinicians with an
interest in having direct contact and meaningful relationships with patients and their families, and
in being a key player in their overall care.
Dr Sandra Turner
Chief Censor in Radiation Oncology
The Royal Australian and New Zealand College of Radiologists (RANZCR)
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What is a
Radiation Oncologist?
A radiation oncologist is a medical specialist who has specific postgraduate training in the
management of patients with cancer, in particular, involving the use of radiation therapy (also
called radiotherapy) as one aspect of their cancer treatment. They also have expertise in the
treatment of non-malignant conditions with radiation therapy. Radiation oncologists work closely
with other medical specialists, especially surgeons, medical oncologists and palliative care
physicians, as part of a multi-disciplinary team caring for patients with cancer.
What does a Radiation
Oncologist do?
Most patients have a diagnosis of cancer prior to referral to a radiation oncologist. The radiation
oncologist is responsible for assessing the patient by clinical evaluation, and organising imaging
and other tests, in order to establish a management plan for an individual. Often, this is done in
conjunction with other members of the team (both medical and non-medical). Radiation oncologists
are an integral part of the initial and ongoing management process, and have an important role in
communicating with patients, their family members and other carers in relation to all aspects of the
management of the patient’s disease and overall care. In particular, they are the experts managing
the detail of the radiation therapy component of treatment. They work closely with medical physicists
and radiation therapists to plan and deliver effective radiation treatment.
Radiation oncologists have overall responsibly for determining and prescribing the most suitable dose of
radiation (from high energy X-rays, electron beams or gamma rays) to deliver in a particular case, and
the method and technique by which this will be achieved. They have skills and knowledge that enable the
many relevant clinical, biological and pathological factors to be merged into an individual recommendation
regarding a course of radiation treatment. The application of their clinical and technical expertise aims
at optimising the benefit of radiation therapy for their patients, whether the goal be cure of cancer or
alleviation of symptoms e.g. pain. Consideration of the patient’s social situation, their beliefs and wishes,
and the impact of any treatments on quality of life of a person is a critical part of decision making.
Many radiation oncologists work in hospital cancer departments or in larger cancer treatment centres.
Many also do clinical research, asking their patients if they wish to enter clinical trials and some also do
laboratory research. Most radiation oncologists are also involved with teaching – both medical students
and especially trainees training on-the-job in the specialty.
Why become a
Radiation Oncologist?
Radiation oncology is an exciting career that incorporates the
best aspects of direct clinical management of patients of all ages,
with a highly effective and technologically interesting treatment
modality. Radiation therapy is a well established treatment which,
based on constantly accumulating evidence from many clinical
trials, offers clear benefits to patients in terms of cancer cure,
organ preservation, effective palliation of symptoms and overall
quality of life for many malignant conditions.
Radiation oncology is a fast evolving and intellectually
challenging discipline. It would appeal to clinicians with an
interest in having direct contact with patients and their families,
and in being a key player in their overall cancer care.
The collaboration with other health professionals in the
management of cancer treatment is stimulating. It is also
rewarding for those who enjoy the prospect of participating and
collaborating with colleagues for the purpose of clinical (and/or
laboratory) research, and for those interested in teaching.
There are few oncologic-related emergencies that require urgent
radiation treatment or attendance ‘out of hours’. As a result, most
Radiation oncologists work fairly predictable hours. This allows
time for them to pursue other interests or spend time with their
family, as well as enabling them to follow any ’special’ interests
related to research, teaching, or other professional activities.
Becoming a
Radiation Oncologist
In Australia, New Zealand and Singapore, newly qualified doctors are required to complete
at least two years of general medical intern/resident terms in the hospital setting before
they can apply to enter the specialist training program for radiation oncology. Entry into the
training program, as for most specialist training programs, is highly competitive and it may
take further experience (usually within the hospital system) before entry is gained into the
five (5) year training program. All training sites require accreditation by The Royal Australian
and New Zealand College of Radiologists (RANZCR).
The training program is structured in two major phases. The two-phase structure is
designed to provide a framework for learning, feedback and acquisition of required skills and
knowledge throughout the course. Phase 1 extends from the trainee’s commencement in
training through to approximately 18 to 24 months into the program. Phase 2 extends over the
remainder of the program, from the satisfactory completion of Phase 1 through to a minimum
of five (5) years from program entry. The exact length of each phase is determined by the
individual trainee’s progress and achievement of certain milestones. Within Phase 1, there is
a foundation period (approximately the first six (6) months after entry) during which essential
background knowledge in the related clinical sciences is acquired. All training is done in
the context of the clinical registrar service position occupied at the time and the learning
opportunities that arise as part of this.
Learning outcomes are closely linked to various in-training (formative) and summative
assessments throughout the training program. There is a Phase 1 examination and a Phase 2
(exit) examination. Trainees who are progressing well through Phase 1 are able to undertake
some of the activities that are predominantly linked to Phase 2 of the program but at all points,
the curriculum facilitates linkage of the concepts to be learned, with the day to day clinical
activities associated with caring for patients.
Progression through the program occurs by the completion of regular satisfactory
assessments as determined by Clinical Supervisors (all radiation oncologists who work directly
with trainees) and Directors of Training at each centre.
Goals and Objectives of
Radiation Oncology Training
The principal objective of the Radiation Oncology Training Program is to ensure that registrars in training develop the
knowledge, skills and attributes to practise as competent radiation oncologists. The College’s Radiation Oncology Training
Program and curriculum have been based on the CanMEDS roles.
The Royal College of Physicians and Surgeons of Canada described the seven roles of a specialist doctor as: Medical
Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. These were named the Canadian
Medical Education Directions for Specialists (CanMEDS).
The role of Medical Expert is seen as central to the work of a radiation oncologist. The other six roles are also important, and
together the seven roles are intended to encompass all aspects of our professional knowledge and conduct. There is deliberately
a significant overlap between the roles. However, this model does allow for some individual focus on the various important aspects
of professional life as a radiation oncologist and allows for these to be consciously promoted and practised as part of training.
The Radiation Oncology Curriculum provides a clear statement of the requirements, learning outcomes and opportunities within
training and has also been organised around the CanMEDS framework as they relate to a radiation oncologist.
Role 1: Medical Expert
Role 3: Collaborator
Central to the role of the radiation oncologist is the interaction
with the person with cancer. The radiation oncologist:
• Synthesises oncological knowledge with clinical information
to formulate and convey a plan of management
• Applies technical expertise in carrying out planning and
delivery of management programs, in particular those
involving radiation therapy
• Devises and conducts an effective program of patient
assessment throughout and beyond initial treatment
• Coordinates psychosocial and physical care during the
follow up period, including delivery of further courses
of radiation therapy and management of other cancer and
treatment-related problems
The radiation oncologist:
• Establishes and maintains interpersonal co-operative
relationships with patients
• Establishes and maintains interpersonal co-operative
relationships with other healthcare providers
• Facilitates optimal patient care both in the out-patient
and inpatient setting
• Participates in research and educational activities.
The Medical Expert role draws on the competencies included
in the roles of communicator, collaborator, manager, health
advocate, scholar and professional.
Role 2: Communicator
The radiation oncologist:
• Establishes a professional relationship with the patient and
their family, and is sensitive to their illness, social situation
and cultural background
• Is expert in eliciting and synthesising relevant history
and patient preferences by directed questioning and
effective listening
•Discusses information with patients, their families
and their health care team, using appropriate language
• Maintains ethical and effective verbal and written
communication with other practitioners, in all roles.
Role 4: Manager
The radiation oncologist:
•Optimises decisions regarding individual patient
care in the context of finite health care resources
• Provides leadership in healthcare organisations
•Ensures effective work practices through staffing
and the development of policies and procedures
based on appropriate use of information systems.
Role 5: Health Advocate
Role 7: Professional
The radiation oncologist:
• Applies expertise and influence, whether individually or
as part of a group, to improve cancer services on behalf
of individual patients, groups of people with cancer and the
community at large.
The radiation oncologist:
• Delivers the highest level of patient care with integrity,
honesty and compassion
• Exhibits exemplary personal and interpersonal behaviour,
and practises ethically
• Practises with diligence and active concern for the progress
of the profession, while continuing to improve mastery of
the discipline.
Role 6: Scholar
The radiation oncologist:
• Engages in life-long learning with the goal of continuously
improving his or her mastery of the discipline
• Contributes to the collection, analysis and interpretation of
data that relate to health care quality and outcomes
• Critically evaluates scientific literature and research
• Integrates emerging evidence into clinical practice
• Participates in the education of peers, trainees, other health
care providers, and community bodies
• Actively participates in advancing knowledge in the clinical
and laboratory settings.
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Practical Training
and Assessments
Radiation oncology training is for the most part an on-the-job self-directed learning process based on modern
adult-learning methodology. In keeping with this, supervision by and regular feedback from senior colleagues
and co-workers is an important feature of the program. The skills, experience and knowledge developed by
the trainee through active learning, self-reflection, study and continual practice is supplemented and guided
by Clinical Supervisors and Directors of Training by means of both didactic and experiential teaching.
The Radiation Oncology Curriculum introduces the Learning Portfolio. A trainee’s personal Learning Portfolio
is built across the whole program as a compilation of the evidence of the trainee’s learning and activities.
These portfolios provide trainees with an opportunity to show how well they have met the requirements of the
curriculum and that specified skills and knowledge have been aquired. Minimum and mandatory requirements
form part of the program. The Learning Portfolio also provides trainees with an opportunity to individualise
their learning within areas of particular interest and to accumulate other documentation illustrating the
individual’s pathway through the program.
Documentation of completed assessments forms part of the portfolio. The instruments used have been chosen
to both aid progression and to ensure completion of required skills and attributes, as well and promote feedback
and discussion with supervisors. These include: mini-clinical evaluation exercises (mini-CEX) which provide
feedback to trainees on patient interactions and multi-source feedback (MSF) surveys assessing trainee’s
communication skills and ability to work as a team member. Additional assessments include Clinical Supervisor
Assessments (CSA) of each term, Trainee Assessment of Training Terms (TATTs) where the trainee can report
on the usefulness of a term for their training, and a six-monthly review by the Director of Training (DoT).
Phase 1 clinical assignments, which guide and test learning around the oncology sciences subject material as
they relate to clinical situations, are included in the Learning Portfolio in Phase 1.
In Phase 2, trainees are required to meet the statistics and research requirements and case reports. The latter
are used to document actual cases with which the trainee has been involved, both in relation to radiation planning
and delivery, as well and non-radiation related cancer management situations and other learning opportunities.
These deal with and give evidence for experience across the full spectrum of tumour sites and types of treatment.
There are also case report requirements in relation to special radiation therapy procedures and practical
oncology experience such as participating in brachytherapy treatment, management of paediatric patients,
total body irradiation, stereotactic radiation therapy and observation of surgical oncology procedures and
chemotherapy delivery.
Trainees will require a satisfactory portfolio assessment in order to progress from Phase 1 to Phase 2 and then
again in order to be eligible to sit the Phase 2 examination.
Prerequisites
for Studying
Radiation
Oncology
To be accepted into the College’s training program, a candidate must:
a)Have appropriate basic medical qualifications:
•be a graduate of a medical school recognised by a medical
board in Australia and the Council of the RANZCR (or
have successfully completed both Part I and Part II AMC
examinations for overseas medical graduates in Australia)
or
•be a graduate of a medical school recognised by the Medical
Council of New Zealand and the Council of the RANZCR (or
have successfully completed the NZREX for overseas medical
graduates in New Zealand)
or
•be a graduate of a medical school recognised by the registering
authority of the country in which the RANZCR training program
is conducted and the Council of the RANZCR
and
b)Be fully registered as a medical practitioner by the registering
authority recognised by the Council of the RANZCR, in the state
or country in which the RANZCR training program is conducted
and
c)Have completed at least two full years in an approved hospital as
an intern/resident.
As a general rule, the College encourages experience in a broad
spectrum of clinical disciplines prior to undertaking radiation
oncology training.
Radiation Oncology
Education Governance
Radiation oncology training, education and examination
conduct and structures of the College are the responsibility of
the Radiation Oncology Education Board. The Board consists
of the Chief Censor in Radiation Oncology, Chief Accreditation
Officer, the Dean of the Faculty of Radiation Oncology, and
radiation oncology representatives from Australia, New Zealand
and a radiation oncology trainee representative.
An Accredited
Radiation Oncology
Training Program
The Royal Australian and New Zealand College of Radiologists
is recognised by the Australian Medical Council (AMC), the
New Zealand Medical Council and the various medical boards
in Australia as the academic body responsible for setting the
standards of the training and assessment required to allow
recognition and registration as a specialist in radiation oncology.
The aim of the radiation oncology training program is to provide
broadly based experience in all current radiation therapy
treatments. The standards are set to ensure that, at the end of the
five year training program, the trainee is capable of performing
as a consultant radiation oncologist and can be recommended to
the various medical boards and specialist recognition committees
in Australia and New Zealand for registration as a Specialist in
Radiation Oncology.
The College’s examinations and other assessments ensure that
these standards have been achieved. Upon successful completion
of the College’s training program trainees are eligible to apply for
Fellowship of The Royal Australian and New Zealand College of
Radiologists, entitling them to use the post-nominal’s FRANZCR.
The Fellowship (FRANZCR) is recognised throughout Australia,
New Zealand and Singapore as evidence of attainment of
specialist knowledge and training in radiation oncology.
train
Entering the
Training Program
ing
Training Positions
Selection of Trainees
Selection of trainees depends on undergraduate medical
course results, previous interest as demonstrated by electives,
publications or presentations, performance as an intern based
on references and an interview. In most instances training
will be obtained by rotating between several departments to
provide the required variety of experience and exposure to
radiation oncology.
The criteria for candidates applying to train in radiation
oncology are listed below. They must show that they:
Each training centre must apply for accreditation by the
College. Accreditation is based on many factors including
medical school affiliation, number and case mix of patients,
number of consultants (Faculty members), spectrum of clinical
departments, teaching program, and access to all treatment
modalities. In particular, each trainee must be guaranteed
training in each tumour modality, and training must be obtained
under the direct supervision of Specialists in Radiation
Oncology recognised by the College.
The College has accepted that certain overseas departments
and private hospitals may be accredited for training provided
that the guidelines laid down by the Education Board are met.
At the present time, one training centre in Singapore has been
accredited for FRANZCR training.
Enrolment with the College
Following commencement of training, a candidate must agree to abide
by all the regulations and rules governing training and assessment
for the RANZCR. In addition, all trainees must apply for Student
Membership of the College.
• meet the prerequisites for entry into the training program
in terms of past medical training and experience
• had met high standards in previous academic
performance
• are dedicated to pursuing a career in radiation oncology
•have excellent interpersonal and professional
communication skills
• are committed to continuing professional education
and development
• have satisfactory professional referee reports
• have satisfactory reports from previous and
current employers
•have an interest in, and commitment to research
as well as teaching junior colleagues and others.
Current Training Sites
The number of positions available for vocational training is
determined by the funding provided for such training by the
various health departments, the New Zealand Health Authority
and the National University Hospital, Singapore. For the number
of positions available please contact the relevant training sites,
Head of Department or Directors of Training. Universities in
Australia and New Zealand are publicly funded institutions and the
majority of accredited training positions are in departments with
some affiliation with medical schools of those universities. As such
there is strong competition for training places.
Accredited Training Sites
Australian Capital Territory
Queensland
New Zealand
The Canberra Hospital
Royal Brisbane and
Women’s Hospital
Auckland Hospital
Christchurch Hospital
Waikato Hospital
Wellington Hospital
(Blood and Cancer Site)
New South Wales
Calvary Mater Newcastle Hospital
Liverpool and Campbelltown Hospitals
South West Cancer Centre
Prince of Wales Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital
Westmead/Nepean Hospital
Wollongong Hospital (Illawarra Cancer
Care Centre)
South Australia
Royal Adelaide Hospital
Victoria
Peter MacCallum Cancer Centre
(Moorabbin, Bendigo and Box Hill)
William Buckland Radiotherapy Centre
(The Alfred Hospital)
Post Fellowship
Medical students interested in observing clinics,
planning or assistance with projects may contact:
Most radiation oncologists continue their clinical (patient centred)
career for many years but many choose to combine this with
teaching, research, further study in the form of a subspecialty
Fellowship or post graduate research qualification such as MD, or
PhD. Administration of radiation oncology departments in public
hospitals is also performed by radiation oncologists.
Dr Sandra Turner
Chief Censor
Email: [email protected]
At the scientific and educational level, the College holds an Annual
Scientific Meeting, which presents on the range of radiation
therapy currently being practised or researched.
The College administers a number of Fellowships, awards, grants
and prizes. Chief among these are the Carestream Professorship
and the Thomas Baker Fellowship.
The College publishes its own bi-monthly journal, the Journal of
Medical Imaging and Radiation Oncology and quarterly newsletter,
Inside News.
Associate Professor Martin Berry
Radiation Oncologist
Sydney
Email: [email protected]
Dr Mark Lee
Radiation Oncologist
Victoria
Email: [email protected]
Associate Professor Graham Stevens
Radiation Oncology Chief Accreditation Officer
New Zealand
Email: [email protected]
An information DVD on Radiation Oncology can be obtained by contacting the College.
Thank you to the Radiation Oncology Department at the Royal Prince Alfred Hospital,
Sydney who assisted with images.
The Royal Australian and New Zealand College of Radiologists ®
Level 9, 51 Druitt Street, SYDNEY NSW 2000 AUSTRALIA
Tel +61 (0)2 9268 9777
Fax +61 (0)2 9268 9799
Email: [email protected]
For more information visit the College website: www.ranzcr.edu.au
March 2011