Radiation oncology: the new deal.

Radiation oncology is a relatively young specialty that has evolved as a subspecialized discipline over the past 30 years. Although the use of radiation for therapeutic purposes has been studied for the last century, it has only been relatively recently that the formal specialty has been recognized. Originally, training in the use of radiation for therapeutic purposes was included as part of diagnostic radiology residency. Just over 35 years ago, an initiative was put forward to develop specified training programs in the United States in radiation oncology. Currently, as of 2002 to 2003, there are approximately 75 programs that are approved by the Accreditation Council for Graduate Medical Education (ACGME) for training in radiation oncology. The current training environment in the specialty covers a broad range of clinical and scientific material relating to general oncology, application of therapeutic radiation modalities to oncologic disorders, radiobiology, and physics. The residency is currently four years in length following the post-graduate-I year (PGYI)b. Fellowships offering continued sub-specialty specific training in clinical areas such as brachytherapy are completed during the PGY-6 year. Currently, residency programs provide a broad base of training in clinical radiation oncology, supported by formal course work in physics and radiobiology. Exposure to diagnostic imaging, pathology, and medical oncology, through specific rotations or participation in multi-disciplinary tumor boards, are also required in the residency experience. Board certification is rigorous with a written examination required at completion of training, which is then followed by an oral examination for those who are successful on the written examination. The written examination consists of a clinical portion, radiobiology, and physics. All three sections must be passed in order for the candidate to qualify for the oral examination. The oral examination consists of eight parts given by examiners who individually interact with the candidate for approximately 25 to 30 minutes. Each section is scored independently by the section examiner, and again, all sections must be passed for the candidate to be board-certified by the American Board of Radiology. In 2001, the first-time candidate pass rate