Exploring the feasibility and utility of a competency based curriculum in United States radiation oncology training

Summary: There has been increasing focus in medical education on transitioning to a competency based curriculum. Recently, an outcome-based approach in the field of radiation oncology has been proposed, composed of field specific, observable, and measurable units of work called Entrustable Professional Activities (EPAs). To date, no evaluation of the feasibility and utility of the Radiation Oncology Education Collaborative Study Group (ROECSG) EPAs in educational practice has been completed. This report describes preliminary results from an ongoing pilot study assessing the use of EPAs for resident evaluation on clinical rotations. An IRB approved multi-institutional pilot study was initiated in October 2023. The study included attending and resident physician pairs at academic training programs in the United States who were working together on a clinical rotation. All participants agreed to utilize the ROECSG EPAs as the primary tool for assessment and to complete a survey at the beginning and end of the rotation. Surveys were created using Qualtrics and distributed via email. Baseline survey questions assessed current evaluation practices, while end-of-rotation questions assessed perceptions of using EPAs. No information regarding resident self- or faculty-provided assessment was collected as part of this protocol. Seven pairs of attending and resident physicians from six geographically diverse institutions have enrolled. Residents from all post graduate years have been included. The majority of attending participants had ≥5 years of experience teaching residents. ACGME milestones and core competencies were the most frequently utilized baseline assessment methods. Half of surveyed faculty felt that their baseline assessment method sometimes added burden to their teaching obligations. 83% of resident participants felt that they were infrequently provided actionable items to improve their performance prior to utilizing the EPAs. Following use of the ROECSG EPAs, all resident participants responded that they would prefer continued use of the EPAs for both self- and faculty-provided evaluation. No faculty respondents were resistant to utilizing EPAs in the future. All residents and faculty reported that they found the EPAs to be comprehensive, providing task focused and actionable items to improve education. The majority of both residents and faculty report completing the EPAs in < 15 minutes. These results represent the first analysis of the ROECSG EPAs as a method of resident assessment on clinical rotations. The results suggest that the EPAs provided high quality feedback for trainees, were not burdensome to faculty or residents, and were the preferred method of evaluation by resident physicians. This study continues to accrue participants with the goal of providing a robust baseline understanding of the feasibility, utility, and benefits of implementing a competency based training curriculum in radiation oncology. Ryan Brisson, MD (Presenting Author) - University of Florida; Jordan Holmes, MD, MPH (Co-Author) - Indiana University; Kevin Shiue, MD (Co-Author) - Indiana University; Daniel Golden, MD, MHPE (Co-Author) - Rush University; Vincent Cassidy, MD, MBA (Co-Author) - University of Florida; Alexandra De Leo, MD (Co-Author) - University of Florida