The radiation oncology in-training examination: an appeal for better testing.

Published on Nov 1, 2013in International Journal of Radiation Oncology Biology Physics7.038
· DOI :10.1016/J.IJROBP.2013.07.001
Ann Morris3
Estimated H-index: 3
(UIHC: University of Iowa Hospitals and Clinics)
Throughout medicine, many residency programs offer annual intraining examinations to gauge the progress of their trainees. As of 1992, 20 of 24 medical specialties offered such an examination (1), including internal medicine, surgery, radiology, and pediatrics. In 1984 the American College of Radiology (ACR) developed a similar examination for radiation oncology, the TXIT. Consisting of approximately 450 questions, this examination addressed the topics of radiation biology, radiation physics, and clinical oncology. Per the authors, the initial goal was to design an examination that “test[ed] the cognitive bases required of radiation oncologists.” At that time, Wilson and Diamond (2) stated that the items “were not chosen to discriminate among training levels but rather to reflect basic core knowledge in radiation oncology.” Unfortunately, it was not articulated at that time how training programs were intended to use the examination, nor were trainees instructed in how to interpret their results. Of note, no indication was given that the examination was intended as a predictive or punitive benchmark. This issue was clarified to some degree in 1992 when a later analysis of the examination stated that the American College of Radiology advised residency program directors not to base their resident evaluations on the examination (1). A 2004 report issued by the Association of Residents in Radiation Oncology further advocated that the examination be used only as a self-assessment measure. They believed that the examination should not be used as a “means of comparing residents within or between programs” (3). Nonetheless, a national survey of radiation oncology residents in 1990 found that 28% of residents felt that the TXIT had a moderate or strong impact on their annual evaluation (1). A similar survey, in 2004, showed that 33% of residents still felt that the TXIT had a moderate to significant impact on their annual review (3). Given this perception, it is important to assess what, if any, evidence exists to support the use of the ACR in-training examination as a formative assessment of radiation oncology residents.
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