Medical Oncology Education in Europe: Equipping Medical Oncologists to Provide the Best Care for Patients with Cancer

BACKGROUND

High-quality, evidence-based, and practice-relevant education is essential to equip medical oncologists to provide high-quality care for patients with cancer. The need for medical oncology education is growing due to a rapid development of new therapies with novel mechanisms of action. Moreover, the number of patients with cancer is increasing with the rising in incidence and improved survival for some cancers. Access to medical oncology education and training opportunities, particularly in research, varies considerably in different countries and regions.

SUMMARY

The European Society for Medical Oncology (ESMO), the European School of Oncology (ESO), and other relevant associations have developed a wide range of opportunities, resources, and measures to increase access to high-quality medical oncology education. Initiatives that are helping to achieve effective and consistent medical oncology education include the ESMO/ASCO (American Society of Medical Oncology) global curriculum in medical oncology.

KEY MESSAGES

There is great value in providing wider educational opportunities than local and national training to increase access and, potentially, quality and scope and reduce variations in medical oncology education. Pan-European and global educational initiatives open up the expertise, knowledge, and best practice on different tumour types and cross-sectional topics, such as supportive and palliative care that can be shared between medical oncologists from other countries.

Where are all the surgeons in clinical academia?

INTRODUCTION

High-quality research into surgical disease will benefit surgical patients. Whereas nearly one-fifth of National Health Service (NHS) England consultants are surgeons, less than 5% of the government's health research funding supports surgical research.

METHODS

Using an observational study, we identified surgeons in active research fellowships and on selection panels for the three largest pan-specialty medical funding bodies in the UK. We quantified the proportion of editorial board members that are surgeons, and the proportion of surgical research published over a 1-year period in the New England Journal of Medicine, The Lancet and the British Medical Journal.

RESULTS

Some 185/1,579 (12%) of research fellowships held by clinicians were awarded to surgeons, with relatively fewer surgeons holding senior fellowships compared with predoctoral fellowships. Across the three research funding bodies, 9/165 (5%) of the clinical panel members were surgeons, whereas for the three pan-specialty journals, 5/84 (6%) of the clinical editorial board members were surgeons. Of the 541 original articles published by the same three journals, only 45 (8%) were classified as surgical.

CONCLUSIONS

We show that surgeons were underrepresented across differing domains of clinical academia. The causes of this are likely multifactorial; there are fewer senior surgeons occupying decision-making positions, fewer role models in senior fellowship positions and surgical training may leave less time to engage in research. We propose further qualitative research within the surgical community, funding bodies and journals to understand the origins of the problem and begin to form evidence-based solutions.

Enhancing International Cancer Organization Collaborations: King Hussein Cancer Center and Princess Margaret Cancer Centre Model for Collaboration

Collaborative partnerships, which link two health organizations with shared characteristics to achieve common goals and to improve healthcare quality, are becoming increasingly common in oncology. The purpose of this study is to review the collaboration between King Hussein Cancer Center (KHCC) and Princess Margaret Cancer Centre (PM). The context, input, process, and product (CIPP) model, a quasi-experimental form of program evaluation, has been applied to the KHCC-PM collaboration. This model is well suited to evaluate complex collaborations as it does not assume linear relationships. Data sources include stakeholders' judgements of the collaboration, assessment of achievements, and informal interviews with key participants involved in the program. KHCC and PM are recognized as high-caliber comprehensive cancer centers, with a common goal of delivering high-quality care to patients. Through personal relationships among faculty in the centers and the perceived opportunities for mutual benefit, KHCC and PM signed a memorandum of understanding in 2013 to enter into a formal partnership. This partnership has been an evolving process that started with collaboration on education and grew to include clinical care. Research is an area for potential future collaboration. Enabling factors in the collaboration include dedication of individuals involved, trusting relationships amongst faculty, and the reciprocal nature of the relationship. Challenges have been financial, competing interests, and the absence of a successful collaborative model to follow. The KHCC and PM collaboration has been successful. A strategic plan is being developed and followed to guide areas of expansion.

Evaluation and Analysis of Fellow Learning and Education Curriculum in a Regional Anesthesiology and Acute Pain Medicine Fellowship: A Prospective, Observational Pilot Study

BACKGROUND

Since 2017, several regional anesthesiology and acute pain medicine fellowship programs throughout the country have developed various educational didactic curriculums to address the core medical knowledge requirements as set by the Accreditation Council for Graduate Medical Education. Given the paucity of existing literature regarding the medical knowledge acquisition of regional anesthesiology and acute pain medicine fellows, this study aimed to determine how quickly these fellows learn during their fellowship year, with a secondary aim of analyzing a new educational didactic curriculum in its goal of delivering the required medical knowledge.

METHODS

An 89-question, multiple-choice examination was administered to the 2020-2021 regional anesthesiology and acute pain medicine fellows at the University of Pittsburgh Medical Center during orientation and again at 4 months and 8 months into the fellowship. A secondary analysis of anonymous deidentified answers was completed.

RESULTS

Fellows averaged 64%, 74%, and 79% correct responses on the orientation, 4-month, and 8-month exams, respectively. An analysis of the orientation exam revealed that the most commonly incorrect answers stemmed from topics including lower extremity nerve blocks, truncal blocks, and neuraxial anesthesia. The 4-month exam showed overall marked improvement; however, truncal blocks remained the most missed topic. Topics with 100% correct response rates in all examinations were local anesthetic pharmacology and systemic opioids.

CONCLUSIONS

The results of this study indicate that a large portion of learning occurs during the first 4 months of the fellowship and slows thereafter. Using this simple form of fellowship evaluation, changes to an educational didactic curriculum can be implemented to reach medical knowledge goals more effectively and efficiently as required by the Accreditation Council for Graduate Medical Education.

Optimising UK training in aesthetic surgery: A prospective national study using operative logbooks and questionnaires to determine factors associated with trainee participation

INTRODUCTION

We aimed to determine the proportion of UK aesthetic surgery training taking place in the independent sector, how this experience is gained, and factors associated with trainee participation. We also aimed to draw comparisons between training in the National Health Services (NHS) and independent sectors.

METHODS

Plastic Surgery Trainees were asked to complete a 10-item questionnaire, in addition to their usual operative entry on eLogbook, when logging a procedure with an aesthetic operative code, prospectively over a 6-month period. Anonymised data was exported and analysed using SPSS.

RESULTS

A total of 285 questionnaires were completed; all UK training regions were represented. The majority were for NHS procedures (88%), of which 56% were for breast surgery, 23% facial surgery, 19% body contouring, and 2% non-surgical. Trainees were significantly more likely to participate in procedures when they were performed in the NHS (odds ratio, OR, 9.7, p < 0.01) or when they were body contouring surgery (OR 1.5, p < 0.01). Trainees were more likely to participate in perioperative care in an NHS setting (p < 0.01). When trainees attend the independent sector, it was usually within contracted training hours (57%) with their consultant trainer with whom they are working in the NHS (63%).

CONCLUSIONS

The majority of aesthetic surgery training occurs in the NHS but this is not representative of UK aesthetic practice. There is a need to engage the independent sector to provide formal aesthetic surgery training as part of the plastic surgery training programme, including procedural participation and perioperative care. Additional aesthetic fellowships and mechanisms for mentorship by established consultants should be developed.

Insights into career prospects after post-graduation in ophthalmology

Postgraduate ophthalmic education in India has taken considerable strides and improved tremendously over the last decade. Career options have improved manyfold and trainee residents and fellows are often required to make key trade-off decisions when choosing a particular option. This leads many toward anxiety, fear, and dissatisfaction toward the decision-making process, and eventually even toward their career in ophthalmology. Candidates often seek guidance from mentors to aid in driving clarity of thought. To help candidates with a solid foundational knowledge of key ophthalmic education and training programs in our country and abroad, we have documented many career opportunities available after post-graduation and fellowship in this article. We have also added insights on various international fellowship and job opportunities along with notes on various national/international ophthalmic exams a post-graduate can consider.

Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day, which debuted online on May 7, 2021. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection of Scholar Day abstracts is presented here.

Clinical Case Presentation and Discussion During ESO-ESMO Masterclass: a 10-Year Interactive Educational Experience

In this article, we report on the clinical case presentations that have been delivered during the ESO or ESO-ESMO Masterclasses in Clinical Oncology in the last 10 years. Masterclasses have been held in three different geographical continents including Europe, Middle East, and Latin America, in which participants had to submit a clinical case and present it either in front of a tumor board (multidisciplinary-like sessions) or in small groups. Clinical case presentation is a unique part of the educational program preparing young oncologists to present and discuss their own patients with distinguished experts. In each Masterclass, between 40 and 55 clinical cases-depending on the number of participants-are presented. All presentations are assessed and evaluated by faculty members as well as by the rest of the participants.

Thriving or surviving? A critical examination of funding models for fellowship council fellowships

BACKGROUND

Since 1997, the Fellowship Council (FC) has evolved into a robust organization responsible for the advanced training of nearly half of the US residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable. This study aimed to investigate the current funding models of FC fellowships.

METHODS

Under an IRB-approved protocol, an electronic survey was administered to 167 FC programs with subsequent phone interviews to collect data on total cost and funding sources. De-identified data were also obtained via 2020-2021 Foundation for Surgical Fellowships (FSF) grant applications. Means and ranges are reported.

RESULTS

Data were obtained from 59 programs (35% response rate) via the FC survey and 116 programs via FSF applications; the average cost to train one fellow per year was $107,957 and $110,816, respectively. Most programs utilized departmental and grants funds. Additionally, 36% (FC data) to 39% (FSF data) of programs indicated billing for their fellow, generating on average $74,824 ($15,000-200,000) and $33,281 ($11,500-66,259), respectively. FC data documented that 14% of programs generated net positive revenue, whereas FSF data documented that all programs were budget-neutral.

CONCLUSION

Both data sets yielded similar overall results, supporting the accuracy of our findings. Expenses varied widely, which may, in part, be due to regional cost differences. Most programs relied on multiple funding sources. A minority were able to generate a positive revenue stream. Although fewer than half of programs billed for their fellow, this source accounted for substantial revenue. Institutional support and external grant funding have continued to be important sources for the majority of programs as well. Given the value of these fellowships and inherent vulnerabilities associated with graduate medical education funding, alternative grant funding models and standardization of annual financial reporting are encouraged.

Need for Nurse Practitioner Fellowships in Ophthalmology in the USA

Medical attention to vision impairment and associated eye care complications are a vital component of daily living and overall well-being. In the United States today, the physician to patient deficit places great strain on the availability of medical attention tenable to patients nationwide; in terms of specialty medicine, this deficit is even more widespread. The field of ophthalmology faced the same physician to patient deficit in 2020, a grim reality that has left many states void of ophthalmic care, rending millions of aging individuals without domestic eye care. The implementation of trained, ophthalmic nurse practitioners (NPs) can fill the needs of this deficit; however, efficient, accredited, and board-approved American ophthalmic fellowships and residencies that secure proper ophthalmic NP transitions from academia to clinical practice are non-existent. Though scant, evidence-based literature presents sound findings that support the efficacy and benefit for superior patient outcomes with care provided by ophthalmic-trained NPs, offering a viable, long-term solution to the need for ophthalmic medical providers across all states without mitigating patient care, emphasizing the great need for the implementation of ophthalmic NP residencies and fellowships to ensure the continuity of impeccable ophthalmic care for all populations.

More than learning technical skills: The importance of mentorship and coaching during a brachytherapy fellowship

Brachytherapy exposure during residency varies between residency training programs. As a result, many graduating radiation oncology residents do not feel competent or confident in performing brachytherapy procedures. A brachytherapy fellowship encompasses hands-on procedural skills in addition to clinical decision-making, radiotherapy treatment planning, as well as post-treatment care. During this time, a fellow develops interpersonal relationships with their faculty supervisors in the form of mentorship, sponsorship, and coaching in addition to clinical teaching. The objective of this article is to review these important relationships focusing on brachytherapy fellowship training as an example.

Towards developing a consensus assessment framework for global emergency medicine fellowships

Background

The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees.

Main body

In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments.

Conclusion

There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training.

Uncharted territory: navigating the pediatric urology job market

INTRODUCTION

There is not a structured algorithm, timeline, or resource on how, when, and which programs are looking for a new staff pediatric urologist. We hypothesized that current and future pediatric urology fellows could benefit from the experiences of recently graduated fellows on navigating the urology job market.

OBJECTIVE

The purpose of this study was to survey current and recent pediatric urology fellowship graduates about the process of finding their first job.

STUDY DESIGN

A Research Electronic Data Capture (REDCap) online survey was designed and distributed through email to current fellows and 2012-2017 graduates. Results were evaluated using STATA.

RESULTS

153 participants were emailed, and 94 (61%) completed the survey. The plurality of applicants (44%) began the job search at the Spring American Urological Association meeting, 14 months before finishing (Figure). Of those who started 14 months before finishing, 33% wished they started earlier and 61% would have started at the same point. The median number of programs contacted for a position was 3-4 and the median number of programs visited and offers received was two. After the offer, 40% reported having >8 weeks to decide. Less than half (38.5%) hired an attorney for contract negotiation. Of those who hired an attorney, 68% felt it provided benefit. Regarding contract negotiation, 22% did not negotiate and 35% negotiated for salary. Unsurprisingly, 28% of those who took academic jobs thought negotiating for protected research/educational time was most important compared with only 4% of those who took non-academic jobs (P = 0.02). When asked how they learned about the job they accepted: 28% were contacted by the program, 25% cold called the program, 30% accepted where they did residency or fellowship, and 18% learned through society websites. The plurality (50%) thought the number of desirable positions during the process were as they expected. 41% however, thought the number of desirable positions were expectedly or surprisingly low. Regarding quality of life and satisfaction with job/career choice, 98% stated that they would still choose to subspecialize in pediatric urology.

CONCLUSIONS

The results from this survey should provide guidance to fellows on how to approach the job search with respect to timing, expectations, contract negotiation, and initial job satisfaction.

Factors influencing the choice of practice location among Canadian otolaryngologists

OBJECTIVES

Little is known about what shapes the choice of employment location in a competitive surgical specialty like otolaryngology - head and neck surgery. This study aimed to identify factors important in determining practice location among Canadian otolaryngologists METHODS: An online survey was distributed nationally to active members of the Canadian Society of Otolaryngology - Head and Neck Surgery. The survey collected data on general demographics, current practice description, training location, factors deemed important in practice location decisions, and job satisfaction.

RESULTS

A total of 122 survey responses were collected, with a similar proportion of participants in academic versus community practice. The majority of respondents (73 per cent) practised in the same province as their residency training. Participants identified job vacancy, colleague interaction, spouse opinion and hospital services as important in the decision of practice location.

CONCLUSION

Key determinants of practice location among Canadian otolaryngologists include job vacancies, spouse opinion, and colleague interactions. Overall, Canadian otolaryngologists report high satisfaction with current employment.

Time Out of General Surgery Specialty Training in the UK: A National Database Study

OBJECTIVE

General surgery specialty training in the United Kingdom takes 6 years and allows trainees to take time out of training. Studies from the United States have highlighted an increasing trend for taking time out of surgical training for research. This study aimed to evaluate trends in time out of training and the impact on the duration of UK general surgical specialty training.

DESIGN, SETTING, AND PARTICIPANTS

A cohort study using routinely collected surgical training data from the Intercollegiate Surgical Curriculum Program database for General surgery trainees registered from August 1, 2007. Trainees were classified as Completed Training or In-Training. Out of training periods were identified and time in training calculated (both unadjusted and adjusted for out of training periods) with a predicted time in training for those In-Training.

RESULTS

Of the trainees still In-Training (n = 994), a greater proportion had taken time out of training compared with those who had completed training (n = 360; 54.5% vs 45.9%, p < 0.01). A greater proportion of the In-Training group had undertaken a formal research period compared with the Completed Training group (35.1% vs 6.1%, p < 0.01). Total unadjusted training time in the Completed Training group was a median 6.0 (interquartile range 6.0-7.0) years compared with a predicted unadjusted training time in the In-Training group, with an out of training period recorded, of a median 8.0 (interquartile range 7.0-9.0) years.

CONCLUSIONS

Trainees are increasingly taking time out of surgical training, particularly for research, with a subsequent increase in total time of training. This should be considered when redesigning surgical training programs and planning the future surgical workforce.

The current standard of Foot and Ankle Fellowship in the UK

BACKGROUND

The aim of this study was to evaluate the current standards of Fellowship training in Foot and Ankle Surgery Fellowship in the UK.

METHODS

Thirteen UK post-FRCS (Tr&Orth) or equivalent Fellows completed a questionnaire detailing their outpatient, surgical, teaching and research experience, along with documenting their supervision and terms of employment.

RESULTS

A Fellow attended a mean of 2.5 (0.5-4) clinics and 3.84 (2-7) theatre sessions per week. 62% of Fellows had independent clinics. The three largest sub-specialty areas experienced were forefoot surgery, mid or/hindfoot arthritis and deformity correction. 82% of Fellows had a regular MDT meeting. All were involved in both teaching and research, but only 64% had timetabled research sessions. All Fellows were satisfied with their experience and would recommended the Fellowship.

CONCLUSIONS

The current standard of a post FRCS (Tr&Orth) Fellowship in Foot & Ankle surgery in the UK has been defined. Further improvement will require all Fellows to be involved in a regular MDT meetings, work in an independent clinic, have guaranteed timetabled research time and a ring fenced study leave budget.

Emergency medicine physicians' perspectives on subspecialty training: A national survey

BACKGROUND

Subspecialty training (sST) is an accepted educational model for the branches that have completed the maturation period. At the end of a rapid growth and reaching its limits, we wanted to determine the emergency medicine (EM) physicians' thoughts about subspecialty training in EM in Turkey.

METHOD

This is a national cross-sectional survey study conducted in November 2017. Participants were physicians who were receiving or who had completed emergency medicine education.

RESULTS

The response rate was 32% (n = 607) in the study. The rate of attending physicians was 45.1%, resident physicians were 40.2%, and academic staff were 14.7%. Among all the EM physicians, 85.2% noted the need for sST, 9.6% were uncertain about the need, and 5.3% found the need unnecessary. The most frequently requested trainings were toxicology (72.5%), traumatology (71.3%), and critical care (67.4%). After sST, 48.9% of EM physicians requested to work both in the emergency department and in the other relevant department, 36.1% requested to work full-time in the emergency department, and 14.9% requested to work full-time in the other relevant department.

CONCLUSION

The great majority of EM physicians believed in the need for sST in Turkey. There were two primary reasons for wanting to apply for sST: first, and most frequently, was the contribution to advanced training, and second, was avoiding problems in the daily practice of EM.

Pharmacy student awareness, aspiration, and preparation for post graduate education (PGE) fellowship in US: A cross-sectional study

INTRODUCTION

Fellowship opportunities are seen by pharmacy students and graduates as an option to assist in furthering pharmacy knowledge in a specific field or area of interest. Pharmaceutical industry fellowships are the most common pharmacy fellowship available to students. There has been little research on what motivates students to pursue a fellowship and what student characteristics may help predict interest in a fellowship.

METHODS

A survey was distributed to P1, P2, and P3 students. The survey took 10-15 min to complete and contained 28 questions. The difference in students' characteristics between fellowship interested students and non-fellowship interested students were examined using chi-square tests and t-tests for categorical variables and continuous variables, respectively. Logistic regression was used to examine predictors of pursuing a fellowship.

RESULTS

Age, work experience, and attendance during a fellowship roundtable were all found to be statistically significant predictors of pursuit of a fellowship. Financial obligations, family obligations, and feeling unprepared were the most common reasons for not pursuing a fellowship.

DISCUSSION AND CONCLUSIONS

Students earlier in the curriculum were more likely to express interest in pursuing a fellowship. Overall, students felt ill-prepared for the fellowship application process. In addition, fellowship roundtables may be useful for pharmacy programs to help students in their pursuit of fellowships.

Redefining Ladd's path

Inspiration and innovation go hand in hand. Throughout history tragedies, including those personal and life altering, have inspired susceptible minds to find innovative ways to educate and tackle difficult problems. This address is first about origins. It weaves the story of how incredible individuals and events have shaped similar circumstances into not only our profession of pediatric surgery beginning with William E. Ladd, but also the emergency and trauma care system in this country. The address circles back to look at the past and future of our profession of pediatric surgery. Predictive models forecast that we are training too many pediatric surgeons in the traditional sense. The address describes how we might envision a paradigm shift in training using a different model and capitalizing on the talents of more young surgeons who want to take care of children. We are an incredible profession, but many have abdicated a need to include trauma patients and critical care in their practice of pediatric surgery. The model would include different pathways of training, enable more surgeons to be capable in aspects of children's surgical care, and provide optimal general surgical care for more children in the United States. This is an opportunity to redefine Ladd's path.

Perceptions of the Professional Development Value of Honorary Fellowship Award Experiences

OBJECTIVE

Professional societies engage in activities with the aim of nurturing highly talented early career members of their field. Little is known about the value of honorary fellowship awards given annually by professional societies. Following up on the only known prior study of this topic, authors queried fellowship awardees in one psychiatric society to better understand the perceived value of honorary fellowships and other outcomes, such as subsequent involvement in professional societies.

METHODS

The authors queried former participants in the Laughlin and Psychiatry Resident-In-Training Examination® (PRITE®) Programs regarding their fellowship experiences and their subsequent involvement in The American College of Psychiatrists and other psychiatry membership organizations. The authors obtained frequency data and analyzed responses using t-tests and chi-squared tests. Associations between the outcomes and demographic characteristics such as age, gender, and fellowship type was tested.

RESULTS

Responses were gathered from 143 individuals who had participated in the Laughlin Fellowship and 22 in the PRITE Fellowship. Respondents felt that that the fellowship experience had been helpful professionally. Laughlin fellows were older and more likely to have assumed a leadership role in professional organizations (60 % vs 36 %, p = 0.04). Laughlin fellows also more strongly endorsed professional recognition as a benefit at the time of receiving their award. Survey respondents reported increased participation in professional organizations and assumed leadership roles in The College and other professional organizations subsequent to the fellowship experience.

CONCLUSIONS

On the whole, fellows were generally positive about their experiences. Many respondents became involved with The College subsequent to their fellowship, but a larger proportion became involved with other organizations, including in leadership roles. Professional societies with early career programs such as the Laughlin Fellowship and the PRITE Fellowship appear to identify and support future leaders as intended, but these leaders may engage more with other professional societies.

Increasing support for the next generation of clinical trials leaders

The National Institute for Health Research (NIHR) has identified a gap in the number of people it funds who are on a pathway to become future leaders of clinical trials, compared to how much the NIHR invests in clinical trials. In order to support the clinical trials of tomorrow, it is vital that the right people are supported now to lead these trials. To address this issue, NIHR organised a workshop with key stakeholders to understand the barriers to embarking on a clinical trials career and explore initiatives to increase capacity and capability in clinical trials. The output from the workshop was a set of recommendations which NIHR is now considering to shape future support.

The impact of The Royal College of Surgeons of England research fellowship scheme

Introduction The research fellowship scheme for surgeons in training run by The Royal College of Surgeons of England (RCS) had its 20th anniversary in 2013. A survey was undertaken to assess outcomes of the scheme during those 20 years. Methods Fellowship recipients were invited to complete an online 20-item questionnaire about their fellowship research and research activities since its completion. The questionnaire covered type of research undertaken, higher research degree enrolment, publications resulting from the fellowship research and subsequent research career. Results Of the 502 RCS fellowship recipients, 361 responded (72%). Their research covered a broad array of topics, Almost two-thirds (62%) undertook laboratory-based research and most of the remainder conducted patient-based clinical research. The vast majority (96%) of respondents had enrolled for a higher degree, with a high completion rate: 91% of fellowship recipients in the first 15 years of the scheme obtained their degree. Of the fellowships from the first 15 years of the scheme, between a fifth and a third of recipients subsequently held an academic position. The median number of peer reviewed articles and presentations per recipient was 3 and 6 respectively. Almost two-thirds (60%) of respondents had obtained funding for further research, with over half of these receiving grants from national research funding bodies. Conclusions The RCS research fellowship scheme has helped trainee surgeons to undertake research towards the start of their career. Most trainees used RCS fellowships as part of their funding towards a higher degree and this was regularly achieved, along with a number of peer reviewed publications. A significant proportion of fellowship recipients progressed into academic positions in surgery.

SU-E-T-441: A Feasibility Study to Replace Electron Cutouts with a Motorized Electron Multileaf Collimator

PURPOSE

Fabrication of electron beam cutouts not only is a time consuming process but also involves the handling of cerrobend which is a toxic material. Hospital workers involved in cutout construction can actually be exposed to toxic fumes that are usually generated during the process. The aim of this work is to study the feasibility of replacing electron cutouts with our prototype motorized electron multileaf collimator (eMLC).

METHODS

Electron beams collimated by an eMLC have very similar penumbra to those collimated by applicators and cutouts as we already demonstrated in a previous study. However undulation of the isodose curves is expected due to the finite size of the eMLC. This may be a problem when the field edge is close to critical structure. Thus ten different breast cases that were previously treated with an electron boost were selected from our database. An inhouse Monte Carlo based treatment planning system were used for dose calculation using the patients CTs. For each patient two plans were generated one with electron beams collimated using the applicator/cutout combination and the other plan with beams collimated only by the eMLC. Treatment plan quality was compared for each patient based on dose distribution and dose volume histogram. In order to determine the optimal position of the leaves, the impact of the different leaf positioning strategies were investigated.

RESULTS

Results have shown that target coverage and critical structure sparing can be effectively achieved by electron beams collimated by eMLC. Preliminary results have shown that the out-of-field strategy is most conservative and would be the recommended method to define the actual leaf position for the eMLC defined field.

CONCLUSION

The eMLC represents an effective time saving and pollution free device that can completely eliminate the need for patient specific cutouts. This work has been supported by a UICC American Cancer Society Beginning Investigators Fellowship funded by the American Cancer Society.