Future of Radiation Oncology Education: Transforming Scholarly Teaching Into Medical Education Scholarship REVIEW Applied Radiation Oncology March 2023 REVIEW SA–CME SPECIAL FEATURE mentorship, 31 and education. 50 Cur- rently, there are few widely available resources to develop proficiencies in plan review 51,52 or image verification, while resources provided by individual programs can vary significantly, or more oſten are lacking altogether. 53 Scholarship of simulation-based teaching has shown substantial impact in acquisition of practical skills and, to date in radiation oncology, simula- tion-based teaching has been created for plan review 40 and image verifica- tion, 54 although it has broad appli- cability for other radiation oncology skills, including treatment planning and toxicity management. As part of a collective effort through ROECSG, a series of workshops to structure the teaching of the basic components of plan evaluation – called the Radiation Oncology Plan Evaluation School (ROPES) – is in progress. 55 This project draws on expert consensus from mul- tiple institutions to develop a practical educational tool to evaluate several acceptable plans in the same patient scenario. Likewise, select programs are aimed at enhancing leadership 56-58 and teaching 59 skills to utilize best practices in individual environments. Another ongoing ROECSG effort is the Teaching Mentoring in Radiation On- cology (TEAMRO) program designed to develop mentoring talents among residents, 60 with a multi-institutional pilot program underway investigating whether formalized mentoring of students by residents can impact a resident’s mentorship relations and education overall. In addition to individual inter- ventions targeting specific deficien- cies, another approach would be to augment resident autonomy overall. For example, continuity clinics and “transition-to-practice” services are experiences designed to position residents as the primary care pro- vider with appropriate supervision. While these are common across the medical field, 61-64 few programs in radiation oncology have been described. Of the published expe- riences, the most comprehensive resident-led rotations include the senior resident rotation at Mayo Clinic 65 and the Veterans Affairs Medical Center rotation in Duke’s ra- diation oncology residency training program; 66 however; there is a need for more robust and longitudinal scholarship demonstrating benefi- cial translation of these experiences into clinical practice. Both programs facilitate autonomy by allowing the resident to assume responsibility for most patient care tasks, including clinical encounters, management recommendations, documentation, directing radiation therapy plan- ning and delivery (ie, simulation, contouring, plan evaluation, image verification), and interdisciplinary communication and collaboration. While there is attending oversight, the attending assumes a consultant role for the trainee, allowing the res- ident greater independence and re- sponsibility, mimicking independent practice. Another option to promote autonomy is a continuity clinic for follow-up visits, as at the University of Southern California. 67 These clin- ics have been reported to improve resident confidence while addressing core issues during early indepen- dent practice. 67 Widespread use of resident-led follow-up clinics may be limited because of institutional and ACGME supervision policies but warrant additional consideration. Continuing Medical Education With the continuing technical advances and evidence-based clinical practice shiſts in radiation oncolo- gy, the need for education does not end aſter residency training. With practice-changing clinical trials in radiation oncology, medical oncology, and surgery, the standard of care in any disease site continues to evolve. Although states differ in the number and type of CME credits required (for example AMA category 1, vs AMA category 2, vs self-assessment or SA-CME), CME credits are required for state licensing, American Board of Radiology (ABR) certification and maintenance of certification (MOC). AMA Category 2 credit is self-desig- nated, allowing physicians to claim credit for educational activities such as peer review, provided the activity meets AMA standards. Radiation oncologists may already engage in these activities at their practices. Self-assessment CME (SA-CME) is a subtype of CME that includes content followed by related questions. SA- CME has been historically required for physicians to maintain certifi- cation with ABR. Recently, the ABR announced that participation in MOC and online longitudinal assessment (OLA) would fulfill the SA-CME requirement, removing the need to complete additional self-assessment modules to meet ABR requirements. 68 It is unknown if this change will im- pact quality or utility of CME. Outside of self-assessment, CME enables radiation oncologists to stay current on treatments, planning techniques, and toxicity management. Annual meetings for radiation oncology professional societies provide CME opportunities. In addition, many in- stitutions offer oncology-specific CME courses. Virtual access to these meet- ings during the COVID-19 pandemic enabled learning without travel, and continued virtual opportunities may improve future CME access. Educational needs for practicing ra- diation oncologists also may be driven by changes in practice throughout a career, such as treating new disease sites, or by a practice acquiring new technology. Web-based contouring tools such as eContour provide a resource for ongoing contouring edu- cation for radiation oncologists across the world. 69,70 On-the-job mentorship in brachytherapy was encouraged through the American Brachytherapy Society #NextGenBrachy initiative. 71 9