Training in. Radiation Oncology. The Royal Australian and New Zealand College of Radiologists

Transcription

1 Training in Radiation Oncology The Royal Australian and New Zealand College of Radiologists

2 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.

3 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)

4 therapy 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.

5 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.

6 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 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 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 3: Collaborator 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. 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.

7 Role 5: Health Advocate 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. 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. Role 7: Professional 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. learning

8 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.

9 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.

10 Entering the Training Program training Training Positions 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. 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. Selection of Trainees The criteria for candidates applying to train in radiation oncology are listed below. They must show that they: 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. 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.

11 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 The Canberra Hospital 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) Queensland Royal Brisbane and Women s Hospital South Australia Royal Adelaide Hospital Victoria Peter MacCallum Cancer Centre (Moorabbin, Bendigo and Box Hill) William Buckland Radiotherapy Centre (The Alfred Hospital) New Zealand Auckland Hospital Christchurch Hospital Waikato Hospital Wellington Hospital (Blood and Cancer Site) Post Fellowship 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. 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. Medical students interested in observing clinics, planning or assistance with projects may contact: Dr Sandra Turner Chief Censor sandra.turner@swahs.health.nsw.gov.au Associate Professor Martin Berry Radiation Oncologist Sydney martin.berry@cancer.com.au Dr Mark Lee Radiation Oncologist Victoria mark.lee@petermac.org Associate Professor Graham Stevens Radiation Oncology Chief Accreditation Officer New Zealand gstevens@adhb.govt.nz 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.

12 The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street, SYDNEY NSW 2000 AUSTRALIA Tel +61 (0) Fax +61 (0) For more information visit the College website: March 2011