The role of residents in residency training.

The goals of residents in radiation oncology can be easily summed up: To become excellent radiation oncologists, to pass board examinations and to find a good job after training. Apart from the requisite individual study of radiotherapy material, residents can take an active part in their training. They can form an organization providing services to the resident community, and they can provide feedback to training program directors on important aspects of their training. In 1982, residents in the United States founded the Association of Residents in Radiation Oncology (ARRO), with guidance and support from the American College of Radiology (ACR) and the American Society for Therapeutic Radiology and Oncology (ASTRO). Four main goals were defined: To improve resident education, to represent resident issues, to promote inter-university resident interaction, and to survey residents and so elucidate their concerns. Toward these ends, ARRO provides information on fellowships, sources or research funding, and elective rotations available at other programs. Residents also receive a suggested reference list and directory of trainees and their programs. We are currently negotiating resident discounts on relevant texts and journals. A Practice Entry Seminar offered at the annual ASTRO meeting provides information on the practicalities of job offers and board exams. ARRO representatives participate in the ACR Radiology Summit, 5 of the 7 Committees under the ACR Commission on Radiation Oncology, the Society of Chairmen of Academic Radiation Oncology Programs, the International Symposium on the Education and Training of Radiation Oncology Residents, Radiology CentennialIntersociety of Radiation Oncology, and the Residency Review Committee. ARRO organizes a variety of programs for residents at the annual ASTRO meeting. We also coordinate the Meetthe-Professor Luncheon, and the ARRO Annual Meeting where residents can voice their concerns to the Executive Board. We are currently organizing a board exam review course and, through ASTRO, a program to improve resident preparation for academic careers. Each year, surveys are sent to all residents to assess aspects of resident training and resident concerns. Another survey is sent to radiation oncologists who have completed training in the past 2 to 5 years to address topics ranging from board exams to practice entry choices. Response rates for our surveys range from 50% to 80%. We noted that 90-95% of residents were exposed to journal clubs and didactic courses on physics and radiobiology. However, only 40% of residents have access to instruction on pathology, and despite the need to critically evaluate published literature, less than 20% of residents are given formal training in biostatistics. The median time per week spent in didactic teaching, case conferences and non-radiotherapy conferences is 3 hr, 4 hr, and 2 hr, respectively. While these averages seem adequate, the ranges are 0 to 9, 1 to 10, and 1 to 6 hr per week, respectively. Similarly, exposure to brachytherapy applications, hyperthermia, intra-operative radiotherapy, stereotactic radiosurgery and pediatrics show wide variations from program to program. The need for objective resident self-assessment is addressed by yearly in-service examinations given by the American College of Radiology. While approximately 90% of residents are required to take this exam, nearly all agree that the exam and its method of reporting results, with a breakdown of strengths and weaknesses, is extremely valuable. As intended, these exams are used little in determining a residents annual evaluation. Our next new graduate survey will try to assess the correlation between in-service scores and board scores. While most residents are very satisfied with their training, several aspects have been consistently identified as areas of concern. These include the relative paucity of brachytherapy and pediatric patients, and a desire for more didactic teaching and instruction on the business aspects of radiotherapy. The vast majority of residents