Table 2 Summary of themes from existing literature base

Variation in Training

Inter-role variation

Perspectives on specific issues are role-dependent

There can be a lack of congruence between trainer and trainee accounts of how much time trainees devote to specific activities in some studies

Progression-related variation

Assessment of quality evolves as trainees become more senior

Trainees may have a larger administrative burden in late training, but improve in confidence of radiology

Inter-centre variation

Different centres in the same region may have very different resources for ME

Exposure to certain techniques, funding for external training and ‘on call’ burden may vary between centres

International variation

Resources vary greatly between centres in different countries

Expectations of time spent radiotherapy planning vary considerably between countries and continents

Temporal variation

The multifactorial nature of training leads to changes over time

Adoption of legislation such as new working hours restrictions, may impact on training delivery

Activity-related variation

Strong and weak aspects of training co-exist within centres

Trainees report greater competence for common procedures than techniques used infrequently

Contributing Factors

Collegiality

Collegiality throughout different levels of the hierarchy improves training

Collegiality amongst peer trainees and seniors contributes positively to learning

Mentorship scheme

Mentorship is highly valued by trainees

Value of mentors in RO in learning radiotherapy as well as navigating career

Peripheral units

Create unique learning opportunities but impact on radiotherapy training is uncertain

Less exposure to advanced radiotherapy technologies available outside main cancer hub possibly

Pre-training experience

Dedicated clinical opportunities are useful for acquiring preliminary principles in radiotherapy

Exposure to oncology-related and radiotherapy clinical scenarios prior to securing formal training post beneficial

National curricula

Consensus principles for training have been agreed but uptake is variable

Continental and global collaboratives have been set up with the aim of standardising radiotherapy training

Service provision

Staffing issues directly impact on trainee and trainer educational ambitions

Understaffing is an almost universal problem amongst centres and can affect training quality

Administration burden

An abundance of low-yield administration is commonly reported by trainees

Trainees in some countries spend up to 10 h per week undertaking activities without any educational benefit

Job descriptions

A lack of clarity in the expectations on trainees can affect their efficiency and integration

The duality of training and delivering healthcare complicates the definition of clinical responsibilities

Study-leave budget

Support for educational meetings is not accessible in some institutions

Local/regional policies can restrict some trainees from accessing external training

Underlying scientific principles

Style of radiobiology and physics teaching impacts on trainee uptake of principles

Inadequate delivery of core radiotherapy principles for building more clinical learning

Service evolution

Trainee experience is dependent on available radiotherapy techniques during rotations

Local uptake of emerging trends in clinical practice influence the training experience available to trainees

Trainer-driven curriculum

Involvement of trainees in the organisation of teaching is recognised to be beneficial

International reports have established the gains of involving trainees in the design and delivery of the curriculum

Economic and political

Training in radiotherapy is not protected from national economic events

Countries have reported disrupted practical elements of training during previous national turmoil

Impact of Training Quality

Career progression

Centres where training was undertaken can be important to interviewers for Consultant posts

A graduating trainee’s level of experience carries significant weight at interviews for permanent posts

Recruitment

Reputation for training quality is associated with competition for training positions

Trainees have been shown to rank posts by the reputed quality of training available at a centre

Burnout

Poor training quality is associated with increased rates of burnout

Burnout is more likely in TPDs and trainees where there is insufficient time for their respective educational roles

Fellowship dependence

Trainees may require post-programme training to compensate for inadequate experience

Fellowships may compensate for inadequately covered elements of curriculum or special interests

Academic aspiration

Academic ambition is reduced in those centres with less emphasis on quality of training

Centres with poorer quality radiotherapy training are associated with less academic aspirations amongst trainees

Improving Training

Online training tools

Virtual learning environments are valued by trainees

Online didactic modules and interactive atlases have been shown to be favourable

Anatomy instruction

Formalised Oncology-orientated anatomy training using scans, lectures and cadavers is effective

Integrated anatomical learning with scans, lectures and cadavers is effective

Volume delineation lessons

Dedicated contouring teaching is highly sought after by trainees

Small group and webinar-based are moderately effective, common methods of addressing trainee weaknesses

Trainee societies

Societies provide space for like-minded trainees to benefit from each other’s experience and ideas

Countries with the greatest published outputs in CO/RO medical education have national societies which develop resources

Simulation

Highly applicable in this technology-centric specialty

This costly educational method suits practical elements of radiotherapy such as brachytherapy

Logbooks

Mixed views available, depending on format

Logbooks have been championed in surgical specialties, with which RO/CO can be compared in terms of training styles, but are time-expensive

Leadership training

Increasing emphasis is required in line with other specialties, several model programmes in RO

Online, face-to-face and blended programmes have been established for this increasingly recognised skill in RO/CO clinicians

Programmatic training

Organised themed sessions favourably ranked by trainees, particularly for rarer clinical scenarios

Integrating seminars, lectures, departmental meetings and electronic alerts over a period of time led to sustained retention of learning

Applied physics/radiobiology

Practical demonstrations integrated with lectures on challenging principles are successful

A teaching instrument combining practical and theoretical elements of radiobiology and radiotherapy physics has been designed

Trainee-led continuity clinic

Benefits are available for both trainee learning and patient care due to improved continuity

Patient compliance was increased, trainees reported satisfaction and trainers noted improved workflow and documentation

Inpatient feedback

Ward-based assessment with immediate feedback involving patient commentary insightful

May improve specifically targeted behaviours amongst trainees and improve trainee satisfaction

Induction

Meaningful induction required for trainee to gain maximum benefit from a rotation

Trainers may be unaware of induction processes and under rate their value in comparison to trainees

Device apps

Increasing range of apps available although their clinical validity is often unverified

Apps may be used regularly each day by trainees, especially for more technical tasks such as equivalent dose calculations

Emerging Pedagogical Themes

Interprofessional teaching

Mixed group teaching is widely viewed as appropriate and highly valuable

Concurrent training with Radiation Therapists has been shown to be beneficial from the view of both trainers and trainees

Tailored assessments

Novel, automated, embedded assessment tools are achievable in this technology-centric discipline

Novel planning-based software with integrated feedback components are effective in brachytherapy training

Near-peer teaching

Content delivered by trainees for trainees is regarded is highly valued

Application of near-peer training in simulation-based learning environments has been successfully undertaken