Competency by Design (CBD) has been fully launched in Radiation Oncology training programs across Canada in 2019-2020 academic year. The program will continue to be a 5 year program, divided into four stages of the Competence Curriculum:

• Transition to Discipline (i.e. orientation) – 2 months
• Foundations of Discipline (i.e. medical, surgical and related training that is the foundation of radiation oncology) – 9-12 months
• Core of discipline (i.e. radiation oncology rotations) — 36 — 44 months
• Transition to Practice (after the Royal College Specialty examination) — 5 -9 months

The clinical training occurs at Princess Margaret Cancer Centre, Odette Cancer Centre (OCC), and affiliated teaching hospitals in Toronto.

Each resident is encouraged to complete one or more research projects during the program and produce a manuscript for publication. Opportunities to present completed work are available annually and residents are supported to present their work at national and international conferences.

Throughout the entire training program, clinical conferences, seminars/tutorials and formal courses emphasize and reinforce the academic aspects of the specialty.

This five-year programis structured to train the academic leaders of tomorrow and is research-intensive. The program’s strength is due to its large, multi-professional faculty’s extensive academic expertise, and advanced radiation medicine technology resources.

Competency by Design (CBD) has been fully launched in Radiation Oncology training programs across Canada in 2019-2020 academic year. The program will continue to be a 5 year program, divided into four stages of the Competence Curriculum:

• Transition to Discipline (i.e. orientation) – 2 months
• Foundations of Discipline (i.e. medical, surgical and related training that is the foundation of radiation oncology) – 9-12 months
• Core of discipline (i.e. radiation oncology rotations) — 36 — 44 months
• Transition to Practice (after the Royal College Specialty examination) — 5 -9 months

More frequent assessments of clinical competencies and documentation of mastery of entrustable professional activities (EPAs) occur on rotations both within radiation oncology and other specialties where our trainees are rotating, and will continue for all residents – those formally in the CBD programs and those residents who are ahead of them, and in the traditionally structured program.

More information about CBD can be found at the Royal College website.

— The sections below describes the curriculum and schedules for the residents —

PGY-1 Year – Transition to Discipline and Foundations of Discipline

This first postgraduate year stresses a broad based education with a 2 block (8 week) rotation that starts in Radiation Oncology, with a combination of lectures, orientations, and clinical experience in clinics and on inpatient wards, both at Princess Margaret (PM) and Odette Cancer Center (OCC). These two blocks in July and August offer teaching in basic oncology, clinical skills, communication skills, research methods, ethics, in addition to introduction and orientation to systems, technology, clinics, wards and expectations during residency, and constitute the “Transition to Discipline” (TTD).

The expectation is that residents will be able to demonstrate competencies in the following two entrustable professional activities (EPAs): EPA TTD-1-RadOnc: History and Physical Exam, and EPA TTD-2-RadOnc: Patient Handover.

Following these two initial blocks the residents will rotate in a variety of medical and surgical specialties, including some or all of the following: internal medicine, surgical oncology, medical oncology, ENT, radiology, palliative care. These rotations take place at one of several University of Toronto teaching hospitals (University Health Network i.e. Toronto General, Toronto Western and Princess Margaret Hospital, Sunnybrook hospital which includes Odette Cancer center, Mt Sinai Hospital, St Michael’s hospital).

These rotations form the “Foundations of Discipline” (FOD). In addition to goals and objectives specific to each rotation, residents will be expected to work towards the following EPAs during this phase.

• EPA FOD-RadOnc-1 Assessing and managing patients with common medical and surgical problems in various settings
• EPA FOD-RadOnc-2 Identifying learning needs from clinical encounters and addressing one’s own gaps in knowledge and skills with guidance
• EPA FOD-RadOnc-3 Managing a medical error/adverse event
• EPA FOD-RadOnc-4 Assessing and managing patients with a cancer diagnosis in various settings

In addition to teachings and learnings during rotations, the Physics curriculum begins in the PGY1 year and will carry on into the PGY2 year, and the Academic Half day for all Radiation Oncology residents (PGY1-5) takes place every Friday AM, 9-12, either through a virtual platform, or once in person lectures resume, at PM or Odette.

PGY-2 Year — starting Core of Discipline

In the second postgraduate year, residents will begin their radiation oncology rotations, starting with rotations that focus on one clinical site at a time (e.g. breast cancer, or GU cancers), working with several staff oncologists, and gradually progressing to more complex clinical sites. Focus is on acquiring knowledge about workup and management of those cancers, and developing skills in radiation planning (outlining targets for radiation, organs at risk, evaluating plans etc). Residents at both PMH and Odette have on-call duties, looking after inpatients and taking urgent calls from outpatients. The on-call at PM is in house (and includes carrying the “code pager”), and at Odette is from home, but the resident may need to come in, eg to see consults in ER. Residents are always supported by staff while on call. Call frequency is well within PARO guidelines, and residents have a day off post-call for in-house call.

Clinical oncology teaching sessions are scheduled for all residents in a weekly academic half-day (Friday AM) and include case-based drills regarding patient management and treatment planning. All residents are expected to attend AHD and are freed from clinical duties to do so.

The six EPAs that are the focus of the Core of Discipline (COD) are:

• EPA COD-RadOnc-1 Performing and presenting initial assessment
• EPA COD-RadOnc-2 Developing and communicating a management plan
• EPA COD-RadOnc-3 Developing, evaluating and implementing radiation treatment plans
• EPA COD-RadOnc-4 Managing patients with cancer through their treatment
• EPA COD-RadOnc-5 Developing plans for follow-up, surveillance, and survivorship, for patients with cancer
• EPA COD-RadOnc-6 Delivering scholarly teaching to a wide variety of audiences

PGY-3 and 4 Years – Core of Discipline

These years primarily consist of radiation oncology rotations at PM & OCC. All the clinical sites will be covered (gyne, lung, CNS, GI, sarcoma, lymphoma, pediatric, palliative, ENT etc), working typically with one or more staff RO at a time, for two to three months at a time. Focus is on developing competencies in all aspects of radiation oncology decision making and planning, including seeing patients in clinic (new patient consults, follow-ups, reviews), contouring and plan evaluation, monitoring of patients, assessment of response, dealing with toxicities and ongoing surveillance, as well as interacting with the radiation therapy team and the multidisciplinary team in providing care for the patients.

The formal curriculum includes: weekly academic half-day consisting of treatment planning drills and lectures covering all aspects of the radiation oncology curriculum, as well as career planning and resident wellness and other topics to cover all CANMEDS roles.

Written or planning exams are held annually so that residents can be assessed and prepared for the Royal College exams.

The UTDRO program places a large emphasis on research and scholarly work. Each resident is expected to complete several research projects during the program and submit manuscripts for publication.

Opportunities to present completed work are available annually and residents are supported to present their work at national and international conferences. Research time can be taken if the project requires dedicated time, and if the resident is progressing well in their clinical training.

Throughout the entire training program, clinical conferences, seminars/tutorials and formal courses emphasize and reinforce the academic aspects of the specialty.

PGY-5 – Completion of Core of Discipline, Transition to Practice

It is anticipated that all Core EPAs will be completed by this time, and that residents will be proceeding to the Royal College specialty exams (written are currently anticipated to occur in spring of the PGY4 year and oral in the fall of the PGY5 year. Successful residents will then enter a Transition to Practice (TTP) phase of their training in which they will consolidate their clinical knowledge further, gain more independence and pursue other activities that fit with their career goals. The following EPAs will need to be completed during this phase:

• EPA TTP-RadOnc-1 Providing radiation oncology consultation and management for patients with cancer or other indications for radiation therapy
• EPA TTP-RadOnc-2 Contributing to administrative and professional aspects of a radiation oncology practice
• EPA TTP-RadOnc-3 Executing a scholarly project relevant to Radiation Oncology

It is only upon completion of all aspects of their training, and successful completion of the Royal College Specialty Exams, that residents will have completed their Radiation Oncology Specialty training and be granted FRCPC status.

Research

Each resident is encouraged to complete one or more research projects during the program and produce a manuscript for publication. Opportunities to present completed work are available annually and residents are supported to present their work at national and international conferences.