Corona virus disease 2019 (COVID-19) affected medical student clerkships and education around the country. A virtual medical student clerkship was created to integrate didactic education with disease specific lectures for medical students, contouring, and hands on learning with telehealth. Twelve medical students in their 3rd and 4th year were enrolled in this 2 week elective from April 27, 2020 to June 5, 2020. There was significant improvement of overall knowledge about the field of radiation oncology from pre elective to post elective (P < .001). Feedback included enjoying direct exposure to contouring, telehealth, and time with residents. Overall this 2 week rotation was successful in integrating radiation oncology virtually for medical students. This is now being expanded to multiple institutions as an educational resource and future rotations for medical students.
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Medical student education in radiation oncology traditionally takes place in-person during 3 rd or 4 th year of medical school. Due to the COVID-19 pandemic, onsite clerkships were placed on hold, leading to virtual medical student clerkships in radiation oncology which incorporated didactics and hands-on learning. We sought to implement this virtual medical student clerkship in radiation oncology at multiple institutions and analyze the impact and utility of this platform. Materials/Methods: An IRB-approved virtual clerkship was created and implemented at 7 institutions. Students enrolled in home or away rotations. Clerkships offered general and disease subsite-specific oncology topics through recorded didactics geared towards medical students on www. radoncvirtual.com, as well as clinical vignettes, telehealth visits, chart rounds, contouring, and capstone presentations. Surveys were given preand post-clerkship to assess baseline comfort and knowledge. At the end of each clerkship, a course exam was given consisting of 48 questions. Clerkship directors were given a survey to assess comfort and ease of implementing the virtual clerkship. Surveys and course exams were analyzed using Wilcoxon Signed rank test and t-test, 2-sided. Results: Seventy-two (72) students enrolled at 7 institutions between 4/ 2020 and 2/2021. Survey response rates were 100% pre-and post-clerkship as well as from course directors. The majority of students were MS4 (57%) and MS3 (33%) with equal distribution in gender. Each institution's median number of total medical students doing an away rotation was 4 (range 3-9) and home rotation number of students 2 (range 0-36). The median length of each virtual rotation was 2.5 weeks (range: 1-4 week). 71% (n = 51) of medical students had never previously enrolled in a radiation oncology elective. Improvements in the overall knowledge of radiation oncology, as well as specific knowledge in the scope of radiation oncology, roles of radiation physicist, dosimetrist and therapist, contouring, treatment planning, and training path to the field (all P < 0.001). There was no significant difference in course final exam scores between students who had attended a radiation oncology elective before enrollment and those who had not (P = 0.27). Course directors reported spending an additional 5-10 hours per week with students. The survey revealed 100% were satisfied with content and delivery of this virtual elective, and 83% (n = 6) indicated they would utilize the material for future rotations. Conclusion: Implementation of a multi-institutional virtual radiation oncology elective was successful at improving knowledge for medical students at all levels, even those that had exposure previously. This virtual elective platform can be utilized to improve access to multiple institutions, resources, mentors, and networking opportunities. Resources in the virtual rotation platform can also be integrated into traditional educational paradigms to increase exposure in the field.
Purpose/Objective(s): There is no standard simulation training geared towards interstitial brachytherapy (IS BT) for gynecologic malignancies. Most residents perform few IS cases during residency. However, IS BT is an integral part of care for locally advanced gynecologic malignancies. We developed and implemented a workshop curriculum for IS BT with: 1) lecture on equipment, workflow, and guidelines, 2) hands-on ultrasound-guided IS BT workshop, and 3) treatment planning workshop. Materials/Methods: The cost of each gynecologic phantom was approximately $70; phantoms were composed of an acrylic vase cube, rigid PETG tubes, modeling clay, agar, glass microspheres, a custom molded cervix/ uterus structure, and a water-filled condom to mimic the bladder. A handson ultrasound-guided IS BT workshop was performed with residents in two small groups, where they imaged the gynecologic phantom using a transabdominal ultrasound probe. Participants alternated roles of sonographer or brachytherapist, implanting the phantom using custom stainlesssteel needles machined in-house. A second workshop with hands-on treatment planning was performed in planning software using a L-Q spreadsheet with the following objectives: coverage goal of D90, meeting D2cc constraints of bladder and rectum, and minimizing V200 to qualitatively involve a small volume. All residents filled out a pre-and post-survey with subjective (4 demographics; 12 Likert-style) and objective knowledgebased (13) questions about GYN IS-BT. Paired subjective data were compared with the Wilcoxon signed ranks test. Paired objective data were compared with the McNemar's test of paired proportions. All statistical analysis was performed with a 2-sided P-value at the 0.05 significance level. Results: Four residents had prior IS BT experience. After the workshop, residents reported significantly improved comfort with skills and knowledge regarding GYN IS BT equipment and procedure, evaluating GYN anatomy using ultrasound, and CT Simulation, contouring, and plan review (median pre-session Likert score 2 [1-3] vs post session 3 [3-4], P < 0.05). The overall rate of percent correct items assessing objective radiation oncology knowledge at baseline was 44%, Following completion of the curriculum, the overall percent correct items was 88% (P < 0.0001). All residents "Agree" (2/7) and "Strongly Agree" (5/7) the session was an effective learning experience. Qualitative feedback primarily asked for more time with treatment planning and educational content beforehand. Conclusion: Residents participating in phantom training with an ultrasound curriculum and a treatment planning session is both feasible and effective. Similar strategies should be considered to enhance and standardize radiation oncology education initiatives for gynecologic IS BT training.
e12578 Background: Ductal carcinoma in situ (DCIS) is a preinvasive breast cancer typically excised and treated with adjuvant therapy. While there is consensus that this results in overtreatment, there is little agreement on who may avoid radiation or endocrine therapy. Two freely available prediction models, Van Nuys Prognostic Index (VNPI) and Memorial Sloan Kettering Nomogram (MSK-N), are commonly used to identify low-risk DCIS based on standard clinicopathological features. Oncotype DCIS is a newer commercially available tissue-based multigene assay also used to assess risk, but its use is limited due to cost and unclear value over VNPI and MSK-N. We sought to compare these tests’ agreement in determining DCIS ipsilateral breast recurrence (IBR) risk and potential to de-escalate therapy. Methods: In this subanalysis from a prospective single center clinical trial, we analyzed 38 patients with newly diagnosed pure DCIS confirmed at excision. Each risk assessment tool presents risk in a different manner. Oncotype DCIS provides multiple assessments: a raw score (0-100), a DCIS Score Category (low, intermediate, high), and a Refined Score incorporating clinical features (10-year IBR risk). The VNPI calculates a raw score (4-12) and assigns a risk category (low, intermediate, high). MSK-N calculates a 10-year IBR risk. The tests were dichotomized as low vs. not-low risk categories using these thresholds: DCIS Score Category = low, DCIS Refined Score ≤ 10% IBR risk, VNPI risk category = low, MSK-N ≤ 10% IBR risk. Agreement of the 4 models (DCIS Score Category, DCIS Refined Score, VNPI, MSK-N) were compared using Spearman’s rank correlation for continuous data; percent agreement and Cohen’s kappa (k) were used to compare categorized data. Results: There was poor agreement of continuous risk assessments across the 4 models, with only VNPI and DCIS Refined Score showing significant but moderate correlation (r = 0.53, p = 0.001; others ranged r = 0-0.27, p > 0.1). The number of cases identified as low-risk for each assay was DCIS Score Category = 14 (37%), DCIS Refined Score = 3 (8%), VNPI = 1 (3%), and MSK-N = 0. Percent agreement of low vs. not-low risk categorizations between DCIS Refined Score, VNPI, and MSK-N was 92-97%, but each assay classified 3 or fewer cases as low-risk and kappa was not significant (k = 0-0.48, p > .1). DCIS Score Category demonstrated 63-71% agreement with the other 3 assays (k = 0-0.26). Only 1 case was classified as low-risk DCIS on multiple tests. Conclusions: DCIS risk models have poor agreement for determining IBR risk. DCIS Score Category initially identified many low-risk lesions; however, inclusion of clinical features to create a Refined Score decreased this substantially, providing very few additional low-risk cases for de-escalation over VNPI or MSK-N. Additional studies are needed to determine precise IBR rates when these models are used for adjuvant therapy decision-making. Clinical trial information: NCT03495011 .
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