Trends in Program Satisfaction and Perceived Confidence Levels Among United States Radiation Oncology Residents: A 5-Year Aggregate Analysis of the 2020-2024 Association of Residents in Radiation Oncology Graduating Resident Survey

Abstract

Purpose: Transitioning from radiation oncology (RO) training to independent practice is often challenging. Understanding resident attitudes related to program satisfaction and comfort with treatment modalities is essential for improving resident experience.

Methods and materials: Between 2020 and 2024, the Association of Residents in Radiation Oncology conducted web-based surveys of graduating RO residents in the United States. Likert-style scales were used to capture responses and summarized using descriptive statistics. χ² tests assessed differences in response rates and nominal variables. Kruskal-Wallis H and Kendall's tau-b tests evaluated ordinal variable distributions and correlations, respectively. Ordinal logistic regression estimated the associations between variables.

Results: A total of 820 graduating residents (of 952 invited) completed the surveys, representing a median response rate of 86.5% (range, 77.8%-93.7%). Ninety-one percent of residents were satisfied or very satisfied with their program (range, 89.6%-94.0%). Dissatisfaction with clinical didactics (odds ratio [OR], 5.34; P < .001) and higher numbers of training sites (OR, 5.73; P = .01) were associated with program dissatisfaction. Compared with the 2014-2015 Association of Residents in Radiation Oncology survey, satisfaction improved in treatment planning (85%) and biostatistics (61%) domains but declined in physics (76%) and radiation biology (68%) didactics. Compared with small programs (<6 residents), residents in larger programs reported greater satisfaction with training (eg, clinical didactics, mentorship). More than a third of residents reported excessive (7.9%) or moderate (31.0%) noneducational tasks, which decreased over survey years (adj P = .049). Confidence levels varied between treatment modalities, with high confidence for lung stereotactic body radiation therapy (96.1%) and nonspine bone stereotactic body radiation therapy (87.7%) and low confidence for high-dose-rate (25.7%) and low-dose-rate (22.6%) prostate brachytherapy.

Conclusions: Graduating RO residents in this analysis were satisfied with their training programs, albeit with low confidence in certain treatment modalities. These data highlight the areas of strength within RO training programs and identify opportunities for improvement to produce graduates ready to enter independent practice with the full scope of RO techniques.