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1 Specific Standards of Accreditation for Residency Programs in Radiation Oncology 2015 VERSION 3.0 INTRODUCTION The purpose of this document is to provide program directors and surveyors with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in Radiation Oncology. This document should be read in conjunction with the General Standards of Accreditation and the Objectives of Training and the Specialty Training Requirements in Radiation Oncology. STANDARD B1: ADMINISTRATIVE STRUCTURE There must be an appropriate administrative structure for each residency program. Please refer to Standard B1 in the General Standards of Accreditation for the interpretation of this standard. The program director must have Royal College certification in Radiation Oncology. STANDARD B2: GOALS AND OBJECTIVES There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The general goals and objectives for Radiation Oncology are outlined in the Objectives of Training and the Specialty Training Requirements in Radiation Oncology. Based upon these general objectives, each program must develop rotation specific objectives suitable for that particular program, as noted in Standard B2 of the General Standards of Accreditation. STANDARD B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfil the educational requirements and achieve competence in the specialty. The structure and organization of each accredited program in Radiation Oncology must be consistent with the specialty training requirements as outlined in the Objectives of Training and the Specialty Training Requirements in Radiation Oncology. In addition to offering the components noted in the specialty training requirements, all This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright 2015 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Specialty Education, attn: Associate Director, Specialties. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: For questions regarding the use of this document, please contact: Page 1 of 7

2 accredited programs in Radiation Oncology must offer opportunities for learning outside of the academic learning centre. This experience offers the resident the opportunity to see patients with common tumour types in a different setting. The program must ensure that residents learn appropriate safety techniques specific to Radiation Oncology, including the safe use of radioactive material and relevant regulations for the use of ionizing radiation. The program must be organized such that the residents are given graded responsibility under appropriate supervision. At some point in the program, each resident must undertake senior administrative tasks, such as the role of Chief Resident. STANDARD B4: RESOURCES There must be sufficient resources, including teaching faculty, the number and variety of patients, physical and technical resources, and supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the Royal College specialty training requirements in Radiation Oncology. In those cases where a university has sufficient resources to provide training in adult Radiation Oncology, but lacks pediatric Radiation Oncology, the program may still be accredited, provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate proscribed training. Notwithstanding the status of pediatric Radiation Oncology, if the program lacks no more than one of the following essential elements: i. brachytherapy (gynecologic and prostate) ii. intensity modulated radiation therapy (IMRT) iii. stereotactic radiation treatment The program may still be accredited, provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate proscribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity, appropriate to Radiation Oncology. 1. Teaching Faculty There must be a sufficient number of qualified clinical and basic science teaching staff to provide appropriate teaching of residents. To ensure adequate individualized instruction, there must be at least one full-time equivalent clinical Radiation Oncologist for each resident enrolled in the PGY 2 to 5 years of the program. A majority of the clinical teaching staff must hold Royal College certification in Radiation Oncology. There must be adequate staffing to support residents in the areas of medical physics and dosimetry for all aspects of planning of radiotherapy treatments. Page 2 of 7

3 2. Number and Variety of Patients The number and variety of patients available to the program on a consistent basis must be sufficient to ensure opportunities for training and acquisition of clinical competence and technical proficiency over the full range of malignant disease in adults and in children. 3. Clinical Services Specific to Radiation Oncology Clinical services must be organized to ensure sufficient opportunity to attain competence in the investigation, treatment and follow-up of patients with neoplastic disease in both inpatient and ambulatory settings. Emphasis on a coordinated, multidisciplinary approach to patient care is essential. a. Clinical Services It is desirable that clinical services be organized into tumour-site-specific teams and provide for continuity of care during patient investigation, assessment and management. Appropriate interdisciplinary interaction must be ensured through a variety of activities such as combined new patient evaluation or interdisciplinary patient management conferences. Residents must participate in all phases of management, including consultations, radiotherapy treatment, and follow-up. Residents must learn about the evolution of tissue changes after radical radiotherapy to different anatomical sites. A component of this learning should be through participation in long-term follow-up of patients having undergone representative radical treatments. b. Radiotherapy Treatment Planning The program must provide ample opportunity for acquisition of skills in contemporary radiotherapy treatment planning over the whole range of clinical situations in which radiotherapy is useful, including inverse planned IMRT, intracranial stereotactic radiation treatment, and gynecologic and prostatic brachytherapy. Teaching must include the principles of stereotactic body radiotherapy for other sites including but not limited to lung and liver, and of brachytherapy to other sites including but not limited to breast, head and neck. Equipment must be available for treatment planning, including a treatment planning simulator, a computed tomography (CT) scanner for treatment planning, and treatment planning computers, as well as facilities for fabrication of immobilization devices. There must be facilitated access to treatment planning staff including dosimetrists and physicists to enable residents to obtain experience with treatment planning. c. Physical and Technical Clinical Resources The program must provide experience with all major modalities of radiotherapy planning and delivery. These include external beam radiation of appropriate energy ranges, intracavitary and interstitial sources of radioactive material, and therapeutic use of systemic radioisotopes. Page 3 of 7

4 d. Resources for Community Learning Experiences The program must offer opportunities to experience radiation oncology practice outside a centre that is the primary host site of a residency training program. e. Other Clinical Resources The program must be organized to provide adequate exposure to other therapeutic modalities and supportive care services used in the care of patients with malignancies, including surgery, chemotherapy, hormonal therapy, and biological agents. There must also be access to a physician practicing in palliative medicine, and social, spiritual, and psychological resources. 4. Supporting Facilities and Services - Clinical, Diagnostic, Technical Liaison with Other Specialties and Subspecialties There must be appropriate liaison with teaching services in diagnostic radiology, general surgery and relevant surgical subspecialties, gynecologic oncology, internal medicine, medical oncology, nuclear medicine, palliative care, anatomical pathology, and pediatric hematology/oncology. There must be access to community health care resources such as palliative care units, hospices, home care, and community physicians, to provide experience in working with other health professionals and to ensure a familiarity with and understanding of the role of appropriate community resources in the continuing care of patients with cancer. The following facilities and services must be available to the program and closely coordinated with the activities of the program: a. Facilities organized for teaching in medical imaging, with particular emphasis on diagnostic imaging and nuclear medicine investigations pertinent to the evaluation of, and treatment planning for, patients with malignant disease; b. Laboratory services adequate for the evaluation of patients with malignant disease; c. A teaching service in pathology, with provision for the study of relevant pathologic material, and adequate instruction in clinico-pathological correlation; d. Access to operating room facilities to enable the Radiation Oncologists to perform staging procedures as well as intracavitary and interstitial radiation treatments. Page 4 of 7

5 STANDARD B5: CLINICAL, ACADEMIC AND SCHOLARLY CONTENT OF THE PROGRAM The clinical, academic and scholarly content of the program must be appropriate for university postgraduate education and adequately prepare residents to fulfil all of the CanMEDS Roles. The quality of scholarship in the program will, in part, be demonstrated by a spirit of enquiry during clinical discussions, at the bedside in clinics, or in the community, and in seminars, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice. Please refer to Standard B5 in the General Standards of Accreditation, the Objectives of Training, the Specialty Training Requirements in Radiation Oncology, and the CanMEDS Framework for the interpretation of this standard. Each program is expected to develop a curriculum for each of the CanMEDS Roles, which reflects the uniqueness of the program and its particular environment. Specific additional requirements are listed below. 1. Medical Expert - A coordinated educational program must be provided in oncology and related fields of diagnostic imaging, medicine and surgery. - The academic program must include organized teaching in physics, radiation biology, tumour and molecular biology and pathology relevant to the practice of Radiation Oncology. - The academic program must include organized quality assurance (QA) education and activities, including radiation treatment machine QA, radiation treatment plan peer review and radiation safety. - The academic program must include opportunities for patients to be offered participation in clinical trials. 2. Communicator The General Standards of Accreditation apply to this section. 3. Collaborator The General Standards of Accreditation apply to this section. 4. Manager - The program must be organized to provide radiation treatment quality assurance activities, one of which must be peer review of treatment plans. Other activities, such as mortality and morbidity review rounds, and incident reporting are strongly recommended. Page 5 of 7

6 - The program must provide opportunities for residents to learn the process required for a facility s accreditation to use ionizing radiation, including the role of the Canadian Nuclear Safety Commission in ensuring patient and public safety during the therapeutic use of ionizing radiation. 5. Health Advocate - The program must provide opportunities for residents to learn advocacy for issues such as radiation safety, quality assurance and access to radiotherapy services. 6. Scholar - The radiation oncology service must be engaged in research and scholarly activities and participate in clinical trials on a local, national and/or international basis. There must be staff resources to instruct on the design and implementation of research studies, interpretation of data and critical assessment of medical literature and of new technologies. - The program must provide residents with appropriate resources, time and supervision to conduct at least one research or scholarly project. 7. Professional The General Standards of Accreditation apply to this section. STANDARD B6: ASSESSMENT OF RESIDENT PERFORMANCE There must be mechanisms in place to ensure the systematic collection and interpretation of assessment data on each resident enrolled in the program. Please refer to Standard B6 in the General Standards of Accreditation for the interpretation of this standard. There must be a mechanism for the on-going assessment of the competence and progress of each resident. Records of such assessments must be maintained with appropriate counselling of each resident. The resident must be evaluated through the use of direct observation with a STACER-like assessment tool (Structured Assessment of Clinical Encounter Report). Page 6 of 7

7 There must be a formal process and procedures for the identification and remediation of residents with borderline or poor performance. APPROVED Royal College Council April 1997 REVISED Education Committee November 2004 REVISED Specialty Standards Review Committee December 2008 REVISED Specialty Standards Review Committee May 2012 REVISED Specialty Standards Review Committee December 2014 Page 7 of 7

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