Entering residents may expect 4 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 2 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 American College of Radiology 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 American Board of Radiology’s written and oral examinations. The resident is teamed with an attending physician for a 2 to 3-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 2 rotations over the 4 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 3-month rotation at one of the world’s premier proton radiotherapy centers.
First 2 years (PGY-2 and PGY-3)
Both formal didactic instruction and experiential, case-based learning are structured over the resident’s first 2 years to provide a solid foundation within the sciences and over the full variety of clinical disease sites.
The first 2 weeks of the PGY-2 year are dedicated to resident orientation without patient care responsibilities, which 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.
Across both the first and second years, weekly didactic conferences 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 is provided through scheduled classes as well as more informal weekly brown-bag lunch seminars led by individual radiobiology, bioengineering, and clinical faculty, along with mentored reading of radiobiology and physics texts.
Residents 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 present).
Residents are encouraged to attend weekly Norris Cotton Cancer Care Pavilion Lebanon Grand Rounds (and will present at least once at Grand Rounds during their residency experience). They also are encouraged to attend Medicine Grand Rounds and Medicine M&Ms on pertinent topics, schedules permitting.
During the first year, the resident rotates through 4 core clinical areas, working closely with individual attendings specializing in malignancies of the GU, CNS, sarcoma, breast, lymphoma, gastrointestinal, thoracic, and gynecologic organ systems. As part of this work the resident gains experience with SRS, SBRT, HDR, and LDR technologies, as well as the use of unsealed radioisotopes.
During the second year, this experience is expanded. The resident rotates with attendings specializing in several additional disease areas, including thoracic, gastrointestinal, CNS, skin, endocrine, and head & neck sites. Furthermore, the resident spends 3 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. PGY-3 year concludes with a 3-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 are directly involved in specialty-specific patient management, interacting one-on-one with their attendings. Attendings 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 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 is responsible for supervision of his/her junior colleagues in their schedules, daily work hours, and mastery of professional skills. The Chief is 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 serves as a role model for his or her colleagues in all facets of professional work, service, and experience.
While exercising these duties as Chief, the PGY-5 resident’s clinical responsibilities rotate through the various services in 2-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 serve to integrate the knowledge base and skills that the fifth-year resident has accumulated throughout all the prior years of residency.