Over the course of three clinical years (PGY-2, PGY-3, and PGY-5), residents rotate through the gamut of disease sites. For each rotation, residents are assigned to a single institution and attending physician or physician group. The curriculum comprises breast, genitourinary, thoracic/lung, gastrointestinal, central nervous system, gynecological, head and neck, pediatric, sarcoma/cutaneous base of skull, lymphoma, and physics rotations. Rotations are typically 10 week assignments, with shorter blocks accommodating individual resident needs and interests, assigned to emphasize the most common and basic elements of radiation treatment for junior residents and the more complex and esoteric elements for senior residents.
Each rotation assumes an individual mentorship structure that emphasizes the practical components of the disease site’s treatment as a fundamental framework for the essential literature that informs the approach. The primary goal of each rotation is for the resident to be able to provide the best possible care for patients from initial consultation to creation of a multidisciplinary care plan, radiation simulation and planning, management during and after therapy, and long-term follow-up. The specifics of education in each rotation commonly include discussions of practice-changing and informing papers, but may also include hands-on experience with the surgical, radiological and medical disciplines, as well as more extensive time with the radiation therapy team.
While the majority of time is occupied by rotations at Massachusetts General Hospital, Brigham and Women’s Hospital and Dana Farber Cancer Institute, resident also rotate at Boston’s Children’s Hospital. The variety of care centers provides a diverse foundation that emphasizes elements of consensus and debate among even, and sometimes specially, leaders within the field. The heterogeneity also fosters the versatility and flexibility required to successfully collaborate with a variety of institutional cultures, protocols, and techniques both inside radiation oncology and in its many neighboring specialties. The large pool of resources also provides access to and training with a great variety of radiation modalities, including robotic radiosurgical devices, prostate and gynecological brachytherapies, intraoperative radiotherapy, and proton therapy at Massachusetts General Hospital, where protons have been in use for clinical treatment since 1961.
Call is distributed among residents in 1-week blocks of come-call divided by institution, with PGY-2 residents taking the most call and decreasing call responsibilities among more senior residents. While on call, resident and their assigned attending assume after-hours care of all radiation oncology needs for patients at their assigned institution: phone calls, in-house consultations, and arranging urgent/emergent radiation. These responsibilities teach and reinforce the essentials and basics of addressing common and important clinical situations in the field: managing the side effects and sequelae of radiation and treating patients with new indications for treatment, especially brain metastases, malignant spinal cord compression, malignant hemorrhage, painful metastases, and airway obstruction.