In1 J Radiarron Oncology Bml Ph.vs Vol. Pnnted in the U S.A. All nghts reserved.
I& pp. 1245-1248 Copyright
0360-3016190 $3.00 t 00 B 1990 Pergamon Press plc
??Special Feature
TRAINING IN ACADEMIC RADIATION ONCOLOGY IN THE U.S.: A REPORT TO THE INTER SOCIETY COUNCIL FOR RADIATION ONCOLOGY
ROBERT G. PARKER,M.D. B3- 109, Center for Health Sciences, UCLA, Los Angeles, CA 90024 This paper will discuss the need for research oriented training of physician scientists in Radiation Oncology, possible training program structure and curricula, likely need for changes in accreditation of training programs and certification of trainees, potential sources of support for trainees and junior faculty, and a suggested plan of action. Research training; Radiation oncology residents. BACKGROUND
Council for Graduate Medical Education through the Residency Review Committee for Radiology to a maximum of 105 in 1980. This number has decreased to 85 in 1989. The maximum number of positions offered was 546 in 1986; this is currently reduced to 488 in 1989 (Armbruster, J. personal corn. 1989).
INFORMATION
Although certification in Therapeutic Radiology was offered by the American Board of Radiology from its inception in 1934, at the onset of World War II less than 50 physicians limited their professional activities to Radiation Therapy. The first professional organization, the American Club of Therapeutic Radiologists, was officially founded on November 18, 1958 by 54 members (7). Training programs were slow to develop in the U.S. Although separate sections of Diagnostic Roentgenology, Therapeutic Radiology, and Radium Therapy were established at the Mayo Clinic in the early 1920s (8) it was not until 3-4 decades later that the first training programs in Therapeutic Radiology were accredited by the Residency Review Committee (Armbruster, J. personal corn. 1989). In 1960, there were only 25 residents in training in Therapeutic Radiology in the U.S. (7). Funding usually was on an individual, rather than a programmatic basis. The primary sources of financial support were the American Cancer Society and the National Cancer Institute, which offered 1 year fellowships. In February 1952 at the Nineteenth Annual Conference of Teachers of Radiology sponsored by the American College of Radiology, J. A. del Regato documented the need for the establishment of training programs in Therapeutic Radiology in the U.S. (6). This need was recognized by the National Cancer Advisory Board resulting in the establishment of competitively awarded training grants funded by the National Cancer Institute. The initial awards were to the Penrose Cancer Hospital, Colorado Springs, Stanford University and Yale University in 196 1. This action was followed by an increase in the number of training programs accredited by the Accreditation
Accepted
for publication
16 November
The phase out of federal support for training programs has altered the current pattern of financial support of residents and has been a major factor in suppressing a previously continuing increase in the number of training positions available. The perceived shortage of physicians trained in Therapeutic Radiology, expressed in the 1972 document, ‘Crisis in Radiation Therapy Training and Practice (3) has been replaced by a concern that currently there is an oversupply of trainees and practitioners (4). With infrequent exception, training to-date has been clinically oriented with little, if any, requirement for a meaningful research component. Although a great need for clinical care has been met, for the moment, the paucity of research training is ominous, because the essential generation of pertinent new information is greatly restricted and the development of physicians qualified to compete for peer reviewed grant/contract support and succeed in academic medicine is crippled. Currently, the recruitment and retention of faculty in academic Radiation Oncology is inadequate to fill available positions. A major reason is the difficulty of promotion to senior, tenured positions of physicians who are not prepared to develop research programs and to successfully compete for peer reviewed support. RECRUITMENT Currently,
tivated
1989. 1245
there is an excess of intelligent,
candidates
for the 488 residency
highly mopositions in Ra-
1246
1. J. Radiation Oncology 0 Biology 0 Physics
diation Oncology in the U.S. (11). Many of these young physicians have exceptional qualifications, including limited research training. Although such candidates with previous research experience, or those graduates of NIH sponsored Medical Scientist Training Programs, which combine M.D. and Ph.D. degrees, may enter research oriented training programs and remain on medical school faculties, the number is not sufficient to fill the current need in all departments. Therefore, training programs must be designed to develop research oriented scientists from candidates who lack previous research experience. MODELS Difficulties in the recruitment and training of research oriented physicians for medical school faculties is not unique to Radiation Oncology. It has been estimated that over 1,100 new clinical investigators are needed annually for academic medicine faculty positions in the U.S. (1). Model programs have been developed for other medical specialties. One such program is the Internal Medicine Research Residency Track at the Harvard Medical School Department of Medicine at the Brigham and Women’s Hospital, Boston (9). After 12 years of operation, 20 of 23 (78%) of those completing the program remained in full-time faculty or full-time research positions. Sixteen of 18 (89%) of those eligible received extramural grant support, including 11 Research Career Development Awards. The small number of graduates of this unusual program illustrates the problem. Common ingredients of this research oriented training program include: (a) identification of candidates expressing an interest in research while still in medical school: (b) entry of applicants into the program through the standard application process, although recruitment in pairs may be advisable for scheduling purposes; (c) identification of a research preceptor for each candidate; (d) design of a program in which the clinical and research training are in parallel, rather than in series, to avoid long absences from either the laboratory or the clinic; (e) continuing clinical responsibilities, such as participation in one clinic weekly and attendance at conferences during the period of laboratory assignment; (f) establishment of financial support unrelated to clinical activity during assignments to the laboratory. PROGRAM
AND CURRICULA
DEVELOPMENT
Two recent papers, one by the Subcommittee on Research Training in Radiation Oncology of the Intersociety Council for Radiation Oncology (2) and the other by a Committee to Review the Crisis in Academic Radiation Oncology for The American Society for Therapeutic Radiology and Oncology (ASTRO) (lo), have addressed many of the issues in developing programs and curricula for training Radiation Oncologists for careers in academic medicine.
May 1990. Volume 18, Number 5
Common characteristics suggested for such programs include: (a) targeted recruitment of young physicians, who have documented potential for research careers: (b) development of programs in institutions where there are critical masses of scientists, outstanding clinical facilities, an adequate number and diversity of patients, strong cancer programs, including those in basic sciences, Medical Oncology, Surgical Oncology, Pediatric Oncology, Gynecologic Oncology, and Head and Neck Surgery, and documented institutional support and commitment; (c) organization of curricula which will intersperse laboratory research training, under a mentor, with basic clinical training, to include 30 months in Radiation Oncology and 6 months in other disciplines, such as Medical Oncology, after at least 12 months of general clinical training (Post Graduate Year 01). The clinical training in Radiation Oncology should include experience in clinical trials. Clinical responsibilities, such as participation in one patient care clinic weekly and attendance at pertinent conferences, should be continued during the assignments to the laboratory. Laboratory assignments should not be separated by more than 6 months and may be bolstered by a continuity through attendance at research conferences and interactions with laboratory personnel during the assignments to the clinic. ACCREDITATION
AND CERTIFICATION
The special requirements for the accreditation of clinical training programs in Radiation Oncology recently have been revised ( 12) with the approval of U.S. program directors, the Residency Review Committee, and the Accreditation Council for Graduate Medical Education. These requirements include: (a) programs must offer at least 3 years of graduate medical education in Radiation Oncology; (b) a faculty should consist of at least three Radiation Oncologists, one full-time Medical Physicist, and one Radiation Biologist/Basic Scientist, who must be engaged in scholarly activities; (c) the ratio of residents to faculty Radiation Oncologists can not exceed 1.5 to 1: (d) at least 125 patients should be treated annually by each resident; (e) a total of at least 600 patients, with a satisfactory variety of cancers, needs to be irradiated annually in the integrated hospitals. After initial and recurring review, adequate programs are accredited for 3 years of clinically oriented training. If trainees were to be recruited to a research residency track in pairs such that only one of the residents would have full-time clinical assignment at any time, current accreditation requirements would not be violated. Currently, the American Board of Radiology certifies candidates from residency programs accredited for 3 years of training. Starting with those entering programs on or later than July 1, 1987, residents will not be eligible for the written exam until they have completed 4 years of approved training including 3 years of Radiation Oncology, or the oral exam until nearly 4 years of training/
Training in Academic Radiation Oncology 0 R. G.
experience in Radiation Oncology have been completed. Practically, this means that if the times of the examinations are not changed, residents will have a minimum of 3$ years of training in Radiation Oncology prior to the written exam and 3% years of training/experience in Radiation Oncology prior to the oral exam. Research oriented residency programs must provide participants with clinical skills and backgrounds equivalent to their colleagues in the regular residency track. Although a third full year of traditional clinically oriented training may contribute only a small increment to the clinical skills of residents in some specialties (5), the recent addition of a fourth year to many training programs in Radiation Oncology implies a need for skills not easily acquired in 3 years of training. Twelve months of research training would seem the maximum available during this expanded 4%month training period. A longer program to accommodate more than 1 full year of research training in addition to the required 36 months of clinical training might seriously impair recruitment of candidates to the recently expanded programs.
SUPPORT
OF JUNIOR
FACULTY
The most difficult career step for full-time academic faculty in medical schools is promotion to tenured positions, usually at the level of associate professor. This implies a long-term commitment of the school to the faculty member and supports the faculty member’s choice of an academic career. At medical schools where academic reviews of individuals are controlled by committees with members chosen from the entire university faculty, performances are likely to be judged on accomplishments in research, documented by peer reviewed grant support and scientific publications, rather than on accomplishments in teaching or service, including patient care. At most schools, this decision point for tenure is 6-8 years after appointment at the assistant professor level. This short schedule necessitates research training prior to initial academic appointment and during the early years as a junior faculty person to allow adequate time for the establishment and maturation of a research program. It is likely that promising young faculty will need temporary support for research activities from sources such as the department chair, the professional partnership, the dean, or others outside the school, such as the American Cancer Society, the National Cancer Institute, professional societies or philanthropic foundations until their programs can generate continuing support.
FUNDING During the clinical assignments, the research track resident can be supported in the same manner as other residents, usually directly or indirectly from fees generated by patient care.
1247
PARKER
During the research assignments, support needs to be generated from nonpatient-care funds. Although this support may be available from the grants or contracts of the carefully selected research mentors, often such sources are not available and other sources must be identified. The development of a vigorous research residency track depends on the continuing availability of such external funding sources. Reliable financial support for research-oriented residency training can be provided by governmental, medical societal, and philanthropic sources. Although clinical residency training was generously supported for many years by the National Cancer Institute, no broad support targeted for research training programs in Radiation Oncology is currently available or anticipated. National Research Service Awards (NIH) are available to support M.D.s for 2 years of research training. It is highly possible that a program analogous to the Surgical Oncology Research Training Grant (T32) could be developed for the support of research training for Radiation Oncologists. This requires at least 2 years of research training correlated with the clinical training. The American Society for Therapeutic Radiology and Oncology recently instituted a Research Fellowship Program which provides support for I year, and may be renewable for an additional year, to support a resident or recent graduate to engage in a meaningful laboratory/ clinical research project. The Radiological Society of North American supports Fellowship and Scholarship Programs through the RSNA Research and Education Fund. The American Cancer Society has Clinical Oncology Fellowships. Physician’s Research Training Fellowships and Postdoctoral Fellowships. Potential sources of support for residents during the research component of a research oriented residency are listed in Table 1. Support of research oriented junior faculty is likely to be more unstructured with components from many sources. The Federal Government currently offers Physician Scientist Awards (Kl I), Clinical Investigator Awards (K08), and Research Career Development Awards (K4). Table 1. Financial
support
for residents/fellows
Federal Government (NIH. NCI) National Research Service Award Surgical Oncology Research Training Grant (T32) American Society for Therapeutic Radiology and Oncology Fellowships Radiological Society of North American Fellowships Scholarships American Cancer Society Clinical Oncology Fellowship Physician’s Research Training Fellowship Postdoctoral Fellowship
1248
I. J. Radiation Oncology 0 Biology 0 Physics
Table 2. Financial support for junior faculty Federal Government (NIH, NCI) Physician Scientist Award (K 11) Clinical Investigator Award (K08) Research Career Development Award (K4) Radiological Society of North America Fellowship Seed Grant Scholarship American Cancer Society Clinical Oncology Career Development Award Faculty Research Award Scholar in Cancer Research Award Junior Faculty Research Award
The Radiological Society of North America sponsors Fellowships, Seed Grants and Scholarships. The American Cancer Society offers Clinical Oncology Career Development Awards, Faculty Research Awards, Scholar in Cancer Research Awards, and Junior Faculty Research Awards. These potential sources of support for junior faculty are listed in Table 2.
PLAN
OF
ACTION
Inasmuch as the need for research training for some residents in Radiation Oncology is immediate, and the establishment of broad-scale federal support for research
May 1990, Volume 18, Number 5
oriented training programs is unlikely in the near future, research oriented training programs must be established now with currently available resources (Table 1). The success of such pilot programs could encourage broad scale funding from sources such as the NCI, the American Cancer Society and philanthropic foundations. The number of physicians needed in academic radiation oncology and, consequently, the number of research track trainees required, is unmeasured at present. However, it is likely that at least one to two research trained Radiation Oncologists could be accommodated on most medical school faculties within the next few years. The real need for such trainees, and their support, must be separated from the need for clinical trainees, inasmuch as the current requirements for the management of patients in the community appears to be satisfied. Pilot research oriented residency programs need to be initiated now by those academic Departments of Radiation Oncology where there is interest by the faculty, the chairman, and the medical school administration, using any available support of the resident for the years assigned to research. Such support, from research funds of the selected mentors, the faculty professional partnership, the American Cancer Society, or other sources, may support only one candidate annually. Collectively, a few such programs could establish the viability of the concept of a research oriented residency track and document the commitment of Radiation Oncologists currently in academic medicine.
REFERENCES 1. Burns, T. W. Physician investigators for academic medicine. Ann. Intern. Med. 101:708-709; 1984. 2. Cox, J. D.; Donaldson, S.; Perez, C.; Order, S. Intersociety Council for Radiation Oncology: subcommittee report on research training in radiation oncology. 3. Crisis in radiation therapy training and practice. Final report to the National Cancer Institute from the Subcommittee for Training of the Committee for Radiation Therapy Studies, 9/O 1/ 72. 4. Davis, L. W.; Cox, J.; Diamond, J.; Flynn, D.; Halbey, F.; and Moss, W. T. The manpower crisis facing radiation oncology. Int. J. Radiat. Oncol. Biol. Phys. 12: 1873-1878; 1986. 5. Day, S.; Cook, E. F.; Nesson. H. R.; Wolf, M. A.; Goldman, L. A learning curve approach to the self assessment of internal medicine trainees. J. Med. Ed. 59:672-675; 1984. 6. de1 Regato, J. A. Training centers in therapeutic radiology. Postgrad. Med. 14:161-162; 1953.
de1 Regato, J. A. Membership directory of the American Society for Therapeutic Radiology and Oncology; 1987. de1 Regato, J. A.; Ralston Paterson. Int. J. Radiat. Oncol. Biol. Phys. 13:1081-1091; 1987. Goldman, L.; Shea, S.; Wolf, M.; Braunwald, E. Clinical and research training in parallel: the internal medicine research residency track at the Brigham and Women’s Hospital. Clin. Res. 1:1-6; 1986. 10. Kligerman, M. M.; Cassady, J. R.; Coleman, C. N.: Fitzgerald, T. J.: Fu. K. K.; Pistenmaa, D. A.; Weichselbaum, R. R. Committee to review crisis in academic radiation oncology; report of 8/30/85. 11. Meeting of Radiation Oncology Training Program Directors, Chicago, IL: 1988. 12. Special requirements for programs in radiation oncology, essentials of accredited residencies. Directory of graduate medical education. 1988-89: 104- 106.
I& pp. 1245-1248 Copyright
0360-3016190 $3.00 t 00 B 1990 Pergamon Press plc
??Special Feature
TRAINING IN ACADEMIC RADIATION ONCOLOGY IN THE U.S.: A REPORT TO THE INTER SOCIETY COUNCIL FOR RADIATION ONCOLOGY
ROBERT G. PARKER,M.D. B3- 109, Center for Health Sciences, UCLA, Los Angeles, CA 90024 This paper will discuss the need for research oriented training of physician scientists in Radiation Oncology, possible training program structure and curricula, likely need for changes in accreditation of training programs and certification of trainees, potential sources of support for trainees and junior faculty, and a suggested plan of action. Research training; Radiation oncology residents. BACKGROUND
Council for Graduate Medical Education through the Residency Review Committee for Radiology to a maximum of 105 in 1980. This number has decreased to 85 in 1989. The maximum number of positions offered was 546 in 1986; this is currently reduced to 488 in 1989 (Armbruster, J. personal corn. 1989).
INFORMATION
Although certification in Therapeutic Radiology was offered by the American Board of Radiology from its inception in 1934, at the onset of World War II less than 50 physicians limited their professional activities to Radiation Therapy. The first professional organization, the American Club of Therapeutic Radiologists, was officially founded on November 18, 1958 by 54 members (7). Training programs were slow to develop in the U.S. Although separate sections of Diagnostic Roentgenology, Therapeutic Radiology, and Radium Therapy were established at the Mayo Clinic in the early 1920s (8) it was not until 3-4 decades later that the first training programs in Therapeutic Radiology were accredited by the Residency Review Committee (Armbruster, J. personal corn. 1989). In 1960, there were only 25 residents in training in Therapeutic Radiology in the U.S. (7). Funding usually was on an individual, rather than a programmatic basis. The primary sources of financial support were the American Cancer Society and the National Cancer Institute, which offered 1 year fellowships. In February 1952 at the Nineteenth Annual Conference of Teachers of Radiology sponsored by the American College of Radiology, J. A. del Regato documented the need for the establishment of training programs in Therapeutic Radiology in the U.S. (6). This need was recognized by the National Cancer Advisory Board resulting in the establishment of competitively awarded training grants funded by the National Cancer Institute. The initial awards were to the Penrose Cancer Hospital, Colorado Springs, Stanford University and Yale University in 196 1. This action was followed by an increase in the number of training programs accredited by the Accreditation
Accepted
for publication
16 November
The phase out of federal support for training programs has altered the current pattern of financial support of residents and has been a major factor in suppressing a previously continuing increase in the number of training positions available. The perceived shortage of physicians trained in Therapeutic Radiology, expressed in the 1972 document, ‘Crisis in Radiation Therapy Training and Practice (3) has been replaced by a concern that currently there is an oversupply of trainees and practitioners (4). With infrequent exception, training to-date has been clinically oriented with little, if any, requirement for a meaningful research component. Although a great need for clinical care has been met, for the moment, the paucity of research training is ominous, because the essential generation of pertinent new information is greatly restricted and the development of physicians qualified to compete for peer reviewed grant/contract support and succeed in academic medicine is crippled. Currently, the recruitment and retention of faculty in academic Radiation Oncology is inadequate to fill available positions. A major reason is the difficulty of promotion to senior, tenured positions of physicians who are not prepared to develop research programs and to successfully compete for peer reviewed support. RECRUITMENT Currently,
tivated
1989. 1245
there is an excess of intelligent,
candidates
for the 488 residency
highly mopositions in Ra-
1246
1. J. Radiation Oncology 0 Biology 0 Physics
diation Oncology in the U.S. (11). Many of these young physicians have exceptional qualifications, including limited research training. Although such candidates with previous research experience, or those graduates of NIH sponsored Medical Scientist Training Programs, which combine M.D. and Ph.D. degrees, may enter research oriented training programs and remain on medical school faculties, the number is not sufficient to fill the current need in all departments. Therefore, training programs must be designed to develop research oriented scientists from candidates who lack previous research experience. MODELS Difficulties in the recruitment and training of research oriented physicians for medical school faculties is not unique to Radiation Oncology. It has been estimated that over 1,100 new clinical investigators are needed annually for academic medicine faculty positions in the U.S. (1). Model programs have been developed for other medical specialties. One such program is the Internal Medicine Research Residency Track at the Harvard Medical School Department of Medicine at the Brigham and Women’s Hospital, Boston (9). After 12 years of operation, 20 of 23 (78%) of those completing the program remained in full-time faculty or full-time research positions. Sixteen of 18 (89%) of those eligible received extramural grant support, including 11 Research Career Development Awards. The small number of graduates of this unusual program illustrates the problem. Common ingredients of this research oriented training program include: (a) identification of candidates expressing an interest in research while still in medical school: (b) entry of applicants into the program through the standard application process, although recruitment in pairs may be advisable for scheduling purposes; (c) identification of a research preceptor for each candidate; (d) design of a program in which the clinical and research training are in parallel, rather than in series, to avoid long absences from either the laboratory or the clinic; (e) continuing clinical responsibilities, such as participation in one clinic weekly and attendance at conferences during the period of laboratory assignment; (f) establishment of financial support unrelated to clinical activity during assignments to the laboratory. PROGRAM
AND CURRICULA
DEVELOPMENT
Two recent papers, one by the Subcommittee on Research Training in Radiation Oncology of the Intersociety Council for Radiation Oncology (2) and the other by a Committee to Review the Crisis in Academic Radiation Oncology for The American Society for Therapeutic Radiology and Oncology (ASTRO) (lo), have addressed many of the issues in developing programs and curricula for training Radiation Oncologists for careers in academic medicine.
May 1990. Volume 18, Number 5
Common characteristics suggested for such programs include: (a) targeted recruitment of young physicians, who have documented potential for research careers: (b) development of programs in institutions where there are critical masses of scientists, outstanding clinical facilities, an adequate number and diversity of patients, strong cancer programs, including those in basic sciences, Medical Oncology, Surgical Oncology, Pediatric Oncology, Gynecologic Oncology, and Head and Neck Surgery, and documented institutional support and commitment; (c) organization of curricula which will intersperse laboratory research training, under a mentor, with basic clinical training, to include 30 months in Radiation Oncology and 6 months in other disciplines, such as Medical Oncology, after at least 12 months of general clinical training (Post Graduate Year 01). The clinical training in Radiation Oncology should include experience in clinical trials. Clinical responsibilities, such as participation in one patient care clinic weekly and attendance at pertinent conferences, should be continued during the assignments to the laboratory. Laboratory assignments should not be separated by more than 6 months and may be bolstered by a continuity through attendance at research conferences and interactions with laboratory personnel during the assignments to the clinic. ACCREDITATION
AND CERTIFICATION
The special requirements for the accreditation of clinical training programs in Radiation Oncology recently have been revised ( 12) with the approval of U.S. program directors, the Residency Review Committee, and the Accreditation Council for Graduate Medical Education. These requirements include: (a) programs must offer at least 3 years of graduate medical education in Radiation Oncology; (b) a faculty should consist of at least three Radiation Oncologists, one full-time Medical Physicist, and one Radiation Biologist/Basic Scientist, who must be engaged in scholarly activities; (c) the ratio of residents to faculty Radiation Oncologists can not exceed 1.5 to 1: (d) at least 125 patients should be treated annually by each resident; (e) a total of at least 600 patients, with a satisfactory variety of cancers, needs to be irradiated annually in the integrated hospitals. After initial and recurring review, adequate programs are accredited for 3 years of clinically oriented training. If trainees were to be recruited to a research residency track in pairs such that only one of the residents would have full-time clinical assignment at any time, current accreditation requirements would not be violated. Currently, the American Board of Radiology certifies candidates from residency programs accredited for 3 years of training. Starting with those entering programs on or later than July 1, 1987, residents will not be eligible for the written exam until they have completed 4 years of approved training including 3 years of Radiation Oncology, or the oral exam until nearly 4 years of training/
Training in Academic Radiation Oncology 0 R. G.
experience in Radiation Oncology have been completed. Practically, this means that if the times of the examinations are not changed, residents will have a minimum of 3$ years of training in Radiation Oncology prior to the written exam and 3% years of training/experience in Radiation Oncology prior to the oral exam. Research oriented residency programs must provide participants with clinical skills and backgrounds equivalent to their colleagues in the regular residency track. Although a third full year of traditional clinically oriented training may contribute only a small increment to the clinical skills of residents in some specialties (5), the recent addition of a fourth year to many training programs in Radiation Oncology implies a need for skills not easily acquired in 3 years of training. Twelve months of research training would seem the maximum available during this expanded 4%month training period. A longer program to accommodate more than 1 full year of research training in addition to the required 36 months of clinical training might seriously impair recruitment of candidates to the recently expanded programs.
SUPPORT
OF JUNIOR
FACULTY
The most difficult career step for full-time academic faculty in medical schools is promotion to tenured positions, usually at the level of associate professor. This implies a long-term commitment of the school to the faculty member and supports the faculty member’s choice of an academic career. At medical schools where academic reviews of individuals are controlled by committees with members chosen from the entire university faculty, performances are likely to be judged on accomplishments in research, documented by peer reviewed grant support and scientific publications, rather than on accomplishments in teaching or service, including patient care. At most schools, this decision point for tenure is 6-8 years after appointment at the assistant professor level. This short schedule necessitates research training prior to initial academic appointment and during the early years as a junior faculty person to allow adequate time for the establishment and maturation of a research program. It is likely that promising young faculty will need temporary support for research activities from sources such as the department chair, the professional partnership, the dean, or others outside the school, such as the American Cancer Society, the National Cancer Institute, professional societies or philanthropic foundations until their programs can generate continuing support.
FUNDING During the clinical assignments, the research track resident can be supported in the same manner as other residents, usually directly or indirectly from fees generated by patient care.
1247
PARKER
During the research assignments, support needs to be generated from nonpatient-care funds. Although this support may be available from the grants or contracts of the carefully selected research mentors, often such sources are not available and other sources must be identified. The development of a vigorous research residency track depends on the continuing availability of such external funding sources. Reliable financial support for research-oriented residency training can be provided by governmental, medical societal, and philanthropic sources. Although clinical residency training was generously supported for many years by the National Cancer Institute, no broad support targeted for research training programs in Radiation Oncology is currently available or anticipated. National Research Service Awards (NIH) are available to support M.D.s for 2 years of research training. It is highly possible that a program analogous to the Surgical Oncology Research Training Grant (T32) could be developed for the support of research training for Radiation Oncologists. This requires at least 2 years of research training correlated with the clinical training. The American Society for Therapeutic Radiology and Oncology recently instituted a Research Fellowship Program which provides support for I year, and may be renewable for an additional year, to support a resident or recent graduate to engage in a meaningful laboratory/ clinical research project. The Radiological Society of North American supports Fellowship and Scholarship Programs through the RSNA Research and Education Fund. The American Cancer Society has Clinical Oncology Fellowships. Physician’s Research Training Fellowships and Postdoctoral Fellowships. Potential sources of support for residents during the research component of a research oriented residency are listed in Table 1. Support of research oriented junior faculty is likely to be more unstructured with components from many sources. The Federal Government currently offers Physician Scientist Awards (Kl I), Clinical Investigator Awards (K08), and Research Career Development Awards (K4). Table 1. Financial
support
for residents/fellows
Federal Government (NIH. NCI) National Research Service Award Surgical Oncology Research Training Grant (T32) American Society for Therapeutic Radiology and Oncology Fellowships Radiological Society of North American Fellowships Scholarships American Cancer Society Clinical Oncology Fellowship Physician’s Research Training Fellowship Postdoctoral Fellowship
1248
I. J. Radiation Oncology 0 Biology 0 Physics
Table 2. Financial support for junior faculty Federal Government (NIH, NCI) Physician Scientist Award (K 11) Clinical Investigator Award (K08) Research Career Development Award (K4) Radiological Society of North America Fellowship Seed Grant Scholarship American Cancer Society Clinical Oncology Career Development Award Faculty Research Award Scholar in Cancer Research Award Junior Faculty Research Award
The Radiological Society of North America sponsors Fellowships, Seed Grants and Scholarships. The American Cancer Society offers Clinical Oncology Career Development Awards, Faculty Research Awards, Scholar in Cancer Research Awards, and Junior Faculty Research Awards. These potential sources of support for junior faculty are listed in Table 2.
PLAN
OF
ACTION
Inasmuch as the need for research training for some residents in Radiation Oncology is immediate, and the establishment of broad-scale federal support for research
May 1990, Volume 18, Number 5
oriented training programs is unlikely in the near future, research oriented training programs must be established now with currently available resources (Table 1). The success of such pilot programs could encourage broad scale funding from sources such as the NCI, the American Cancer Society and philanthropic foundations. The number of physicians needed in academic radiation oncology and, consequently, the number of research track trainees required, is unmeasured at present. However, it is likely that at least one to two research trained Radiation Oncologists could be accommodated on most medical school faculties within the next few years. The real need for such trainees, and their support, must be separated from the need for clinical trainees, inasmuch as the current requirements for the management of patients in the community appears to be satisfied. Pilot research oriented residency programs need to be initiated now by those academic Departments of Radiation Oncology where there is interest by the faculty, the chairman, and the medical school administration, using any available support of the resident for the years assigned to research. Such support, from research funds of the selected mentors, the faculty professional partnership, the American Cancer Society, or other sources, may support only one candidate annually. Collectively, a few such programs could establish the viability of the concept of a research oriented residency track and document the commitment of Radiation Oncologists currently in academic medicine.
REFERENCES 1. Burns, T. W. Physician investigators for academic medicine. Ann. Intern. Med. 101:708-709; 1984. 2. Cox, J. D.; Donaldson, S.; Perez, C.; Order, S. Intersociety Council for Radiation Oncology: subcommittee report on research training in radiation oncology. 3. Crisis in radiation therapy training and practice. Final report to the National Cancer Institute from the Subcommittee for Training of the Committee for Radiation Therapy Studies, 9/O 1/ 72. 4. Davis, L. W.; Cox, J.; Diamond, J.; Flynn, D.; Halbey, F.; and Moss, W. T. The manpower crisis facing radiation oncology. Int. J. Radiat. Oncol. Biol. Phys. 12: 1873-1878; 1986. 5. Day, S.; Cook, E. F.; Nesson. H. R.; Wolf, M. A.; Goldman, L. A learning curve approach to the self assessment of internal medicine trainees. J. Med. Ed. 59:672-675; 1984. 6. de1 Regato, J. A. Training centers in therapeutic radiology. Postgrad. Med. 14:161-162; 1953.
de1 Regato, J. A. Membership directory of the American Society for Therapeutic Radiology and Oncology; 1987. de1 Regato, J. A.; Ralston Paterson. Int. J. Radiat. Oncol. Biol. Phys. 13:1081-1091; 1987. Goldman, L.; Shea, S.; Wolf, M.; Braunwald, E. Clinical and research training in parallel: the internal medicine research residency track at the Brigham and Women’s Hospital. Clin. Res. 1:1-6; 1986. 10. Kligerman, M. M.; Cassady, J. R.; Coleman, C. N.: Fitzgerald, T. J.: Fu. K. K.; Pistenmaa, D. A.; Weichselbaum, R. R. Committee to review crisis in academic radiation oncology; report of 8/30/85. 11. Meeting of Radiation Oncology Training Program Directors, Chicago, IL: 1988. 12. Special requirements for programs in radiation oncology, essentials of accredited residencies. Directory of graduate medical education. 1988-89: 104- 106.
