Radiation Oncology Initial Certification Qualification Examinations: The Resident Experience in 2019

To characterize the resident experience preparing for the 2019 American Board of Radiology initial certification (IC) qualifying examinations in radiation oncology.

The Association of Residents in Radiation Oncology distributed a survey to 360 radiation oncology residents from the 2019 and 2020 graduating classes covering topics pertinent to preparation for the medical physics (MP), radiation and cancer biology (RCB), and clinical radiation oncology (CRO) qualifying examinations.

The response rate was 58% (n = 210). In the 12 weeks before the MP and RCB examinations, first-time examinees studied a median of 160 hours (interquartile range, 96 to 270). Residents reported a "moderate" or "significant" negative effect on research productivity (3 [2-4]), mental health (3 [2-4]), clinical development (3 [2-4]), and family life (3 [2-4]). Half of surveyed residents (52%, n = 110) used a protected research or elective block to study while an additional 21% (n = 45) used a median of 5 (3-20) vacation days. Residents overall "agreed" (4 [2-4]) that their program's physics course was "important" for their preparation but were "neutral" (3 [2-4]) regarding the value of their program's radiobiology course. Question-based educational resources were most frequently rated as "important" study resources. Respondents "strongly" endorsed the development of a consensus radiation oncology curriculum (5 [4-5]) and "agreed" (4 [3-4]) that consolidation of the MP, RCB, and CRO qualifying examinations into a single written examination would be preferred.

Radiation oncology residents dedicate substantial time preparing for the IC examinations at the expense of training- and health-related outcomes. Residents report a wide range in quality of internal program didactic courses in physics and radiobiology, endorse development of a consensus radiation oncology curriculum, and prefer consolidation of the three qualifying examinations into a single written IC examination. We caution the high pass rates seen on the 2019 examinations do not obviate the need for ongoing improvement in radiation oncology graduate medical education and the board certification process.