Oversight and Competency Goals by Year of Clinical Training
As outlined in greater detail in the table below listing competencies by year of clinical training,
residents will be given increasing levels of supervised independence as they proceed through
the residency program. Specifically, they will be supervised by the attending physician, with
feedback given by the attending at the half-way point and at the endpoint of every rotation and
by the Associate Program Directors/Program Director at every 6-month follow-up evaluation.
For residents in the first 2 clinical years, the length of rotations is 3 months. Each rotation will
be devoted to one (or occasionally two) disease sites. Residents in their final clinical year may
elect rotations of 1.5 months in specific disease sites or in the use of advanced technologies at
the discretion of the Residency Program Directors.
 In the first year, residents will primarily be in the role of apprentices and will be involved
in decisions surrounding all aspects of care, including patient evaluation and treatment
plan development.
 In the second year, residents will be expected to demonstrate to the attending physician
competency in several realms, including team communication, radiation treatment plan
evaluation and patient work-up, without the need for attending intervention. However
attending oversight will remain in place.
 The third year is research-based, however residents are expected to attend morning
conferences, perform simulations on services without residents and take overnight call.
All of these activities will be under the continued supervision of the attending physician.
 In the final year of training, residents will be expected to independently evaluate
treatment plans and make modifications prior to finalization; to work up and develop
treatment recommendations for both palliatively and definitively treated patients; and
to function independently within the treatment team, including making decisions
regarding psychosocial, dietary and other appropriate support-service involvement.
 The resident is expected to continue to develop progressive competency in disease sites
covered by rotations done in the first two clinical years. This is accomplished by
attendance and participation in morning case conferences, the summer didactic series
and other teaching sessions and will be assessed by the annual in-service examination
and by competency displayed in discussions during morning conferences.
 One of the strong points of HROP is the multiplicity of experts at the different sites. The
variation of opinions by these experts provides an even greater attention to the
evidence underlying clinical decision-making, which forms a key aspect of life-long
practice-based learning and improvement. The content of the disease-specific rotations
at the different sites does differ and compensation for these differences is accomplished
by attendance and participation in morning case conferences, the summer didactic
series and other teaching sessions and will be assessed by the annual in-service
examinations and by competency displayed in discussions during morning conference.
Competency
Goals
Patient Care
Clinical Year 1
• The resident will become familiar
with his/her role as health care
provider to patients with cancer
and their families.
• The resident will learn the
Clinical Year 2
• The resident will
become competent
in making
appropriate cancer
management
Clinical Year 3
• The resident will
show independence
in making and
implementing
appropriate cancer
Medical
Knowledge
components of a thorough
oncologic history and PE.
• The resident will become familiar
with making appropriate cancer
management recommendations,
including writing appropriate
consultation notes on patients s/he
has evaluated.
• The resident will learn to
recognize signs and symptoms of
an oncologic emergency and
recommend appropriate care.
• The resident will learn the
fundamentals of cancer biology and
of radiation physics with special
emphasis on treatment planning.
• The resident will become familiar
with the rudiments such as staging
and natural history of the common
malignancies.
• The resident will learn the acute
toxicities of radiation treatment
and their management.
• The resident will learn the
“tolerance” doses of the various
organs to radiation treatment.
• The resident will become
knowledgeable regarding
anticipated treatment outcomes so
that these can be discussed with
the patient, family and other
involved physicians.
• The resident will become
competent in the palliative
management of cancer patients
including pain-medication
management and delivery of
palliative radiation therapy for
compression syndromes,
hemorrhage and other urgent
distressing symptoms.
• The resident will learn the
fundamentals of CT-based and MRbased anatomy to define target
volumes and critical normal tissues.
• The resident will learn these
technical skills: lymph node
examination; urinary
recommendations.
• The resident will
become competent
in working with
physicists in devising
treatment plans.
management
recommendations
and planning in the
simulator (under
appropriate
supervision).
• The resident will
become familiar with
alternative forms of
cancer treatment,
including surgery and
systemic therapy, as
well as the benefits
and toxicities of
combined modality
treatment.
• The resident will
develop a solid
foundation in the
physics and biology
of radiation therapy
and the biology of
cancer.
• The resident will
become familiar with
the evaluation of
diagnostic studies
(pathology and
radiology) related to
cancer management.
• The resident will
learn these technical
skills: how to check
set-ups on the
machine and
problem-solve for
difficult set ups; how
to appreciate which
cases are appropriate
for IMRT versus a 3-D
conformal plan or a
2-D plan.
• The resident will
become thoroughly
familiar with the
likelihood of the
long-term potential
toxicities of radiation
related to dose and
volumes.
• The resident will
demonstrate a strong
working knowledge
of all the options, as
well as their risks and
benefits, in the
management of
common
malignancies, with
emphasis on the use
of radiation therapy.
• The resident will
become conversant
with the major
clinical studies
regarding common
malignancies.
• The resident will
have a thorough
knowledge of
medical physics and
cancer biology,
particularly as they
relate to radiation
therapy.
• The resident will
learn the specific
technical skills for
Practice-based
Learning and
Improvement
Interpersonal and
Communication
Skills
catheterization and insertion of
rectal tubes and vaginal markers;
AP-PA set-up using SSD and
isocentric technique; calculation of
radiation doses using equivalent
square, phi and psy tables; wholebrain set-ups; 3- and 4-field setups; opposed oblique set-ups;
interpretation of dose-volume
histograms; radiation safety
procedures and reviewing port
films.
• The resident will learn the
specific technical skills for his/her
rotations in the first year.
• Morning case conference occurs
2-3 times a week during the nonsummer months. The resident will
learn to competently present cases
at these conferences, identifying
both the critical issues of the case
and the pertinent literature
bearing on these issues. The
resident will present cases over
his/her 3 clinical years and this
approach to cases will form a key
aspect of life-long practice-based
learning and improvement.
• The resident will also learn how
to competently present at Journal
Club, Mortality and Morbidity
Conference, chart rounds, diseasespecific courses, resident seminars
and other opportunities for critical
literature review.
• The resident will become familiar
with his/her role as consultant,
including the preparation of
concise and specific consultation
notes.
• The resident will become familiar
with the ‘team’ aspect of radiation
oncology, in which the physician
works effectively with physicists,
dosimetrists, nurses, therapists,
other health-care providers and
administrative and secretarial staff.
• The resident will develop
• The resident will
learn the specific
technical skills for
his/her rotations in
the second year
his/her rotations in
the third year
• The resident will be
able to critically
evaluate clinical
studies in regard to
their design, use of
statistics and the
validity of their
conclusions.
• The resident will
complete an original
research project.
• The resident will
function effectively
with the ‘team’
aspect of radiation
oncology, in which
the physician works
effectively with
physicists,
dosimetrists, nurses,
therapists, other
health-care providers
and administrative
and secretarial staff.
• The resident will
function effectively in
dealing with difficult
situations common in
oncology, such as the
dying patient, the
newly relapsed
patient and the
hostile patient.
• The resident will
function effectively
with the ‘team’
aspect of radiation
awareness and respect for different
cultural backgrounds and
ethnicities in order to provide
sensitive and effective care.
• The resident will learn to provide
clear and concise off-service notes
to facilitate patient care.
Professionalism
Systems-based
Practice
• The resident will have the
conviction to be a Radiation
Oncologist.
• The resident will record duty
hours in a timely fashion.
• The resident must consistently
protect patient confidentiality.
• The resident will enter notes into
the electronic medical record
within 24 hours of seeing a patient
and promptly sign off on these
notes.
• The resident will treat
patients/families with utmost
respect and maintain patient
confidentiality at all times.
• The resident will maintain
collegial relations with all staff and
providers across disciplines.
• The resident will demonstrate a
commitment to providing patients
with the best possible care through
continuous learning and self
improvement.
• The resident will be open to
receiving feedback and willing to
provide it when appropriate.
• The resident will become familiar
with multidisciplinary cancer care,
including effectively
communicating with medical and
surgical oncologists to develop a
unified and complete treatment
plan.
• The resident will learn to use the
• The resident will be
able to acknowledge
areas that require
further work and set
up a plan to address
them.
The resident will be
able to discern when
consultation with
social work or
psychiatry services,
dieticians or other
services are needed.
oncology, in which
the physician works
successfully with
physicists,
dosimetrists, nurses,
therapists, other
health-care providers
and administrative
and secretarial staff.
 The resident will
effectively
communicate with
referring physicians.
• The resident will
develop clear and
thoughtfully
considered career
goals.
• The resident will
develop a deep
understanding of the
ethics of curative
therapy and end-oflife care.
The resident will be
able to follow
through on
recommendations
from support
services listed in the
column for year 2
and make
electronic medical record to obtain
medical information.
• The resident will become
proficient in the use of electronic
radiation oncology prescription
writing and documentation for
compliance.
appropriate
recommendations
with the oncology
team.
• The resident will
become familiar with
the use of databases
for research projects.
• The resident will
develop an
understanding of the
economics of
practice, and in
particular, with the
appropriate use of
cutting-edge
technology and
fractionation.