Resident Clinical Care Responsibilities

Residents will review the documentation of all patients referred to their rotation; obtain a detailed medical history; perform an appropriate level physical exam; present the case to the faculty; and dictate the history and physical examination findings including the clinical assessment and plan, after full review of the case with the faculty member.  The resident will dictate a letter with the evaluation and recommendations to the referring physician, primary care physician, and other physicians involved in the management of the patient.

Residents will develop patient assessment and treatment plans with the Attendings including: appropriate diagnostic radiology studies and laboratory tests to complete the staging evaluation of the patient; consultations with other physicians and services as appropriate; and simulation appointments for patients in our department. All of the above will be coordinated with the assistance of the hospital staff.

Residents will document simulation procedures (templated notes are available in IMPAC for simulation and treatment planning notes); check the initial patient setup and verification imaging; see the patients under treatment at least weekly to assess toxicity with the faculty; prescribe medications; and assess tumor response if possible.  If they have any concerns they will page the faculty.  In addition, the resident will attend weekly chart rounds with the faculty member to coordinate patient care and tumor boards to coordinate multi-disciplinary care.

Residents will dictate an end-of-treatment note summarizing the patient's care at the completion of therapy.  They will also dictate a summary letter to the referring physician and other physicians involved in the patient's cancer care and the primary care physician. 

Following a brachytherapy procedure, residents will be involved in removal of the implant, and will dictate a brachytherapy procedure.

Residents will see follow-up patients with the faculty to assess locoregional control, metastatic disease development, and acute/late toxicity of treatment.  They will develop assessment and treatment plans, order any necessary follow-up laboratory and radiological tests or physician consults, and review the results of these tests with the attending faculty.  They will dictate a follow-up note.

Residents on clinical rotations are expected to remain in the clinic at all times while patients are being seen and treated.  They should be available to see patients in nursing, check patient set-ups, and approve port films unless they are performing clinical duties outside of the department.  Junior residents will give their pager to a senior resident when they are at Physics and Radiobiology Lectures and should not be disturbed with clinical duties during these lectures.

Dictation templates will be provided for the residents.

Clinical Curriculum Responsibilities (Overview)

Resident Patient Logs

• The residents will be required to be involved in the direct patient management of at least 150, but not more than 250 patients per year, and a minimum total of 450 patients during their entire clinical radiation oncology rotations.
• Residents will perform a minimum of 5 interstitial and 10 intracavitary implants and assist with a minimum of 5 interstitial and 10 intracavitary implants.
• Residents are required to treat a total of 12 pediatric cases (9 solid tumor and 3 hematologic) to complete their residency per ACGME guidelines. Residents may rotate on a one-month outside rotation at a Children's Hospital to meet this requirement.
• Residents will participate in the administration of no fewer than 6 procedures using radioimmunotherapy, other targeted therapeutic radiopharmaceuticals, or unsealed radioactive sources per NRC guidelines:
• To meet the requirements as an authorized user, residents will participate in a minimum of three cases involving oral administration of > 33 mCi of I-131 and three cases involving the parenteral administration of any beta emitter, or a photon-emitting radionuclide with photon energy of < 150 KeV. 
• This training and supervised work experience will include all NRC-required items related to the safe handling, administration and quality control of the radionuclide doses used in clinical radiation oncology and nuclear medicine and will be covered in Radiation Safety Training Course, Radiation Physics Didactics Courses, and in the participation of a 1 month nuclear medicine rotation.  The residents will document this experience on a separate written log sheet.
• The residents are required to keep an electronic patient log on the ACGME website of all the teletherapy, brachytherapy, and therapeutic unsealed source patients that they treat, and to provide this log to the Program Director at the time of their semi-annual review.  The residents will maintain their logs on the ACGME Resident DataBase as per ACGME guidelines.  The ACGME resident manual is appended to these guidelines. Only cases for which the resident has primary responsibility may be counted. The electronic logs will be reviewed and verified by the Program Director at each six month resident review meeting.

Didactic Lectures and Conferences

Residents are required to attend, prepare for, and participate in didactic lectures, Journal Club, Multi-Disciplinary Tumor Boards, New Patient and Simulation Conference, and Morbidity and Mortality Conference.  Attendance of the residents and faculty will be kept. Residents will document all scholarly activity on an electronic calendar and submit this to the program director at the time of their bi-annual evaluation.  In addition, residents will be required to attend appropriate institutional conferences, seminars, and tumor boards as well as regional and national meetings to enhance their training.

Resident Research Project

Residents are required to have completed a clinical or laboratory investigative project by the end of their fourth year.  This should be suitable in quality for presentation at MASRO (Mid-Atlantic Society of Radiation Oncologists) or other regional/national/ or international meeting and/or published in a peer review journal.  More detailed information is provided later.

Resident Conference Organizational and Committee Responsibilities

Third year residents will act as resident representatives on the Departmental Quality Assurance Committee and will organize the Morbidity and Mortality Conference.

Fourth year chief residents will represent the radiation oncology residents on the Departmental Residency Curriculum Committee and will coordinate the Journal Club and Resident Presentations and help develop the resident call schedule. 

Resident Review of the Program and Faculty

• All residents are required to evaluate the Faculty at least once annually.
• The residents will evaluate the Residency Program annually.
• Evaluations will be used by Residency Curriculum Committee to determine how effective the faculty and the program are at providing a platform for progressing in the core competencies.
• Most of these evaluations will be completed on-line via the institutional RAFT program.