Entering residents may expect four years of solid training in radiobiology and radiation physics and in the clinical practice of radiation oncology, preparing them for Board certification and their chosen careers within academia or the community. Both formal didactic instruction and experiential, case-based learning are structured across the resident’s first two years to provide a solid foundation within the sciences and across the clinical disease sites. The third year of residency allows time for in-depth study or investigation, offering residents an opportunity to integrate translational science, clinical research, further academic study, or advanced clinical elective work into their curriculae. The fourth and final year provides integration of the chief resident’s acquired knowledge into a facile skill set for future clinical practice and team leadership.
A variety of periodic internal evaluations as well as nationally administered annual ACR In-Training Exams are used to monitor residents’ progress. These evaluations serve to test, validate, and improve continually our pedagogical efforts, as well as to allow direct comparison of our residents’ progress against all residents in the country.
Clinical rotations on the main Lebanon campus encompass all disease sites covered on the ABR’s Written and Oral Examinations. The resident is teamed with an attending physician for a two- to three-month block, during which time the resident focuses on competencies applied to that attending’s clinical specialties.
Rotations at our St. Johnsbury, Vermont, facility provide residents clinical experience in a community-based setting, with a series of three rotations over the four years allowing gradations in greater independence and responsibility in patient management over the course of training.
Through our partnership with Harvard’s radiation oncology pediatrics program at the Massachusetts General Hospital in Boston, residents’ education in pediatric radiation oncology is supplemented through a three-month rotation at one of the world’s premier proton radiotherapy centers.
First two years (PGY-2 and PGY-3)
Both formal didactic instruction and experiential, case-based learning are structured over the resident’s first two years to provide a solid foundation within the sciences and over the full variety of clinical disease sites.
The first two weeks of the PGY-2 year will be dedicated to resident orientation without patient care responsibilities, which will include classes and seminars on hospital procedures, electronic charting in the hospital (Epic) and Section (Varian’s Aria) systems, introductory material in radiation physics and radiobiology, and hands-on time with dosimetry, physics, therapy machines, and the nursing clinic – all of which will be assigned with blocks of time set aside for the resident and a supervising faculty or staff member.
Across both the first and second years, weekly didactic conferences will enable mastery of the scientific knowledge base required for the ABR’s Written Examinations, both in radiation biology and in radiation physics. Formal didactic instruction in the PGY-2 and PGY-3 years will be pursued primarily through weekly brown-bag lunch seminars led by individual radiobiology, bioengineering, and clinical faculty with mentored reading of radiobiology and physics texts.
Residents will be expected to attend weekly academic teaching conferences, weekly section-wide chart rounds of new cases, site-specific weekly Tumor Boards, monthly radiation oncology M&M Rounds, twice monthly “advanced technology meetings,” monthly radiation oncology QA/QI meetings, and quarterly radiation oncology journal clubs (at which residents will present).
Residents will be actively encouraged to attend weekly NCCC Grand Rounds (and will present at least once at NCCC Grand Rounds during their residency experience). They also will be encouraged to attend Medicine Grand Rounds and Medicine M&Ms on pertinent topics, schedules permitting.
During the first year, the resident will rotate through three core clinical areas, working closely with individual attendings specializing in malignancies of the GU, CNS, sarcoma, breast, lymphoma, gastrointestinal, endocrine, and gynecologic organ systems. As part of this work the resident will gain experience with SRS, SBRT, HDR, and LDR technologies, as well as the use of unsealed radioisotopes. Furthermore, in the spring of the first year the resident will spend two months at our satellite facility in St. Johnsbury, Vermont, a busy community-based practice providing a wide panoply of cancer care treatments across all disease sites.
During the second year, this experience will be expanded. The resident will rotate with attendings specializing in several additional disease areas, including thoracic, gastrointestinal, CNS, skin, and head & neck sites. A further three months in St. Johnsbury will allow integration of these specialty skills. The PGY-3 year will conclude with a three-month rotation at MGH in Boston studying pediatric radiation oncology under outstanding faculty within the context of a busy, world-class proton radiotherapy center.
On-service, residents will be directly involved in specialty-specific patient management, interacting one-on-one with their attendings. Attendings will provide a “mock oral board” exam for their residents at the conclusion of each rotation, an exercise important for preparation towards the ABR Oral Examination.
Third year (PGY-4)
The third year of residency allows time for in-depth investigation, offering residents an opportunity to integrate translational science, clinical research, further academic study, and/or advanced clinical elective work into their curricula.
It is a major goal of the D-H Radiation Oncology Residency Program to provide our residents a year in which to explore intellectual, academic, and professional areas that otherwise might not be available to them, though which pertain to the academic maturation of their professional skills within the specialty. We believe that the broadening of academic, intellectual, professional, and personal vistas invariably leads to growth that is healthy and productive, yet in ways that are profound and unpredictable, often for years or even full lifetimes into the future.
Fourth year (PGY-5), Chief Resident
The fourth and final year provides integration of the resident’s acquired knowledge into a facile skill set intended for future clinical practice and team leadership.
As Chief Resident, the resident will be responsible for supervision of his/her junior colleagues in their schedules, daily work hours, and mastery of professional skills. The Chief will be included in management decisions and duties of the residency, working hand-in-hand with the Program Director to assure the Program is serving the needs of its residents in an exemplary fashion.
The Chief Resident in all matters will serve as a role model for his colleagues in all facets of professional work, service, and experience.
While exercising these duties as Chief, the PGY-5 resident’s clinical responsibilities will rotate through the various services in two-month blocks: HN/Skin/Lung, GI/Gyn/GU, GU/CNS/Sarcoma, Lung/GI/CNS, Breast/Lymphoma, and St. Johnsbury’s consolidative practice. These repetitive experiences will serve to integrate the knowledge base and skills that the 5th-year resident has accumulated throughout all the prior years of residency