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

Abstract Purpose To characterize the resident experience preparing for the 2019 American Board of Radiology initial certification (IC) qualification examinations in radiation oncology. Methods & Materials: The Association of Residents in Radiation Oncology (ARRO) distributed a survey to 360 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) examinations. Results The response rate was 58% (n=210). In the 12 weeks prior to the MP and RCB examinations, first-time examinees studied a median of 160 hours [IQR, 96-270]. Residents reported a "moderate" or "significant" negative impact 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) utilized a protected research or elective block to study while 21% (n=45) utilized 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 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 consolidating the MP, RCB, and CRO examinations into a single written examination would be preferred. Conclusions 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 written qualifying examinations. 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.