AbstractPurpose

The number of U.S. fourth year medical students applying to radiation oncology has decreased over the past few years. We conducted a survey of fourth year medical students in order to examine factors that may be impacting the decision to pursue radiation oncology.

Methods and Materials

An anonymous online survey was sent to medical students at nine participating U.S. medical schools.

Results

Two hundred and thirty-two medical students completed the survey. Of the 153 students who were never interested in radiation oncology, 77 (51%) reported never having been exposed to the specialty as their reason for not pursuing radiation oncology. The job market was the most commonly cited factor having an impact on those students who were once interested, but ultimately chose not to pursue radiation oncology. Conversely, the recent low board pass rates and a perception of a lack of diversity within radiation oncology had the least impact.

Conclusions

Despite discussion of potential measures to address this disquieting trend, there have been minimal formal attempts to characterize and address potential causes of a decreasing interest in radiation oncology. These data support previous research regarding the trend of decreased medical student interest in radiation oncology and may be utilized as part of ongoing introspective assessment to inform future change within radiation oncology.

Summary

There has been a recent increase in unmatched positions among radiation oncology residency programs within the U.S., likely driven both by increased number of residency spots and decreased medical student interest. Our study sought to further characterize the perceptions of senior medical students towards radiation oncology. We found the job market was the most commonly cited factor having an impact on those students who were once interested, but ultimately chose not to pursue radiation oncology.

Introduction

There has been a recent increase in unmatched positions among radiation oncology residency programs within the United States (U.S.). In 2020 the proportion of unmatched residency positions rose to 19%, compared to 14% in 2019 and approximately 4% during 2010-20181-3. Additionally, the number of U.S. senior medical students applying to radiation oncology has continued to decline, with 0.4% of all U.S. senior medical students in 2020, 0.52% (163 students) in 2019 and an average of 0.66% of all U.S. senior medical students applying to radiation oncology between 2010-20181-4.

A number of factors may be contributing to the increase in unmatched programs, including decreased medical student interest4,5. Wu et al. recently published a survey of senior medical students, finding that students who were once interested in radiation oncology, but ultimately opted against it, were most influenced by the job market6. Our study sought to further characterize the perceptions of senior medical students towards radiation oncology within the U.S.

Methods

An anonymous online survey was sent to fourth year U.S. medical students post-match in the Spring of 2020 using Qualtrics (SAP, Provo, UT). The survey was distributed at XXX, XXX, XXX, XXX, XXX, XXX, XXX, XXX, and XXX. There was minimal overlap of only 1 institution included in both this survey and Wu et al.’s survey. The total number of students receiving the survey was approximated at 1000, with an estimated response rate of 23%, however due to the COVID-19 pandemic, many students graduated early and e-mail correspondence was lost at the time of graduation. The survey remained open for 5 weeks and 10 $25 Amazon gift cards were distributed randomly as incentives. The study was deemed exempt by our Institutional Review Board. Descriptive statistics and Spearman's correlation coefficient were utilized for data interpretation. Attempts at Face Validity testing were made based on gender with 51.7% female and 45.7% male in our study, similar to 2019 data from U.S. medical school enrollment consisting of 50.5% female and 49.4% male.

ResultsA total of 232 (215 with complete data) fourth-year medial students participated in the survey, with demographic characteristics summarized in Table 1. Most students did not pursue radiation oncology in the 2020 match (93%).

Table 1Characteristics of respondents (n=232)

The majority of respondents reported never being interested in radiation oncology (70%). Of those not ever interested in radiation oncology, the most commonly reported reason for such was never having been exposed to the specialty (50%), followed by interest in a more traditional specialty (19.6%) and not wanting to pursue a physics/math heavy specialty (19%) Table 2.

Table 2Summary of reasons for never being interested in radiation oncology (n=153)

Twenty-three percent of respondents (n=50) reported once being interested in radiation oncology but ultimately not choosing to pursue radiation oncology in the match. When queried regarding the impact of specific variables influencing the decision not to pursue radiation oncology, the job market was the factor cited as having the most impact with 30% reporting an impact of either a “great deal” or “a lot” (Figure 1). Conversely, board exams/pass rates and a perceived lack of diversity within radiation oncology had the least impact. Seventy-nine percent reported board exams and a lack of diversity as having no impact at all or being unaware that this was even an issue within radiation oncology (Figure 1).

Figure 1Summary of factors affecting decision not to pursue radiation oncology among those who were once interested radiation oncology but did not apply (n=48 for those with non-missing answers). The job market was the most frequent factor that had “a great deal” of impact on the decision not to pursue radiation oncology among those who were once interested in radiation oncology but did not ultimately apply. The lack of diversity and low boards pass rate had the highest frequency of medical students not aware this was an issue.

DiscussionWe report an analysis of medical student interest in radiation oncology from the most recently matched medical school class within the U.S. with three key findings:1

70% of medical students reported never being interested in radiation oncology. Importantly, of those never interested in radiation oncology, 50% reported never having been exposed to the specialty as their reason for not pursuing radiation oncology. This is consistent with a perceived under-emphasis of Oncology curriculum within U.S. Medical schools and imbalanced involvement of different clinical sub-specialists as educators7. Further, there is limited exposure of medical students to radiation oncology, with gaps in knowledge critical to understanding the role of radiation oncologists in the multidisciplinary management of cancer8,9.

2

The factor most impacting those once interested in radiation oncology not to pursue the specialty was the job market (30%). In this study, 65% of this sub-set, reported that the job market had some impact on their decision not to pursue radiation oncology. These findings are consistent with a generally reported increasing concern surrounding the job market within radiation oncology as well as maldistribution of jobs5,10. Fifty-three percent of the American Society for Radiation Oncology members surveyed and 91% of radiation oncology residents surveyed expressed concern over a perceived unfavorable job market11,12.

3

A perceived lack of diversity within radiation oncology and board exams/pass rates were not concerns among those initially interested in, but who did not ultimately pursue radiation oncology. Notably, 79% of this subset reported that a lack of diversity and board exams had no impact on their decision not to pursue radiation oncology. This finding is particularly salient, given a recent ASTRO news bulletin suggesting that the lack of diversity may be the primary factor in the decreasing number of applicants in radiation oncology.12

Similar to Wu et al., we found that of those medical students who were never interested in radiation oncology the great majority were never exposed to the specialty6. We also confirmed that of those interested but chose not to pursue radiation oncology, the job market was the most impactful factor. We recommend further investigation into the job market and career satisfaction within our field to help inform changes within radiation oncology training as well as provide ongoing data to medical students considering radiation oncology. Further, board exams/pass rates and a concern of lack of diversity did not impact those once interested in radiation oncology with regard to not pursuing the specialty and in fact was not recognized as an issue of concern by most. We advocate that these data be recognized by stakeholders when deciding how to structure changes within radiation oncology training.

References1

Bates JE, Amdur RJ, Lee WR. Unfilled Positions in the 2020 Radiation Oncology Residency Match: No Longer an Isolated Event. Pract Radiat Oncol. 2020.

2

Program NRM. National Resident Matching Program, Results and Data: 2020 Main Residency Match®. Washington DC.2020.

3

Program NRM. National Resident Matching Program, Results and Data: 2019 Main Residency Match®. Washington, DC. 2019.

4

Bates JE, Amdur RJ, Lee WR. The High Number of Unfilled Positions in the 2019 Radiation Oncology Residency Match: Temporary Variation or Indicator of Important Change? Pract Radiat Oncol. 2019;9(5):300-302.

5

Chowdhary M, Sen N, Marwaha G, et al. A Growing Specialty: A 15-year Profile of US Radiation Oncology Residency Growth and Implications for Workforce Imbalances. International Journal of Radiation Oncology Biology Physics. 2019;105(1).

6

Wu TC, McCloskey SA, Wallner PE, Steinberg ML, Raldow AC. The Declining Residency Applicant Pool: A Multi-Institutional Medical Student Survey to Identify Precipitating Factors. Adv Radiat Oncol. 2021;6(1):100597.

7

Neeley BC, Golden DW, Brower JV, Braunstein SE, Hirsch AE, Mattes MD. Student Perspectives on Oncology Curricula at United States Medical Schools. J Cancer Educ. 2019;34(1):56-58.

8

Zaorsky NG, Shaikh T, Handorf E, et al. What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey. Int J Radiat Oncol Biol Phys. 2016;94(2):235-242.

9

Dennis KE, Duncan G. Radiation oncology in undergraduate medical education: a literature review. Int J Radiat Oncol Biol Phys. 2010;76(3):649-655.

10

Chowdhary M, Chhabra AM, Switchenko JM, et al. Domestic Job Shortage or Job Maldistribution? A Geographic Analysis of the Current Radiation Oncology Job Market. Int J Radiat Oncol Biol Phys. 2017;99(1):9-15.

11

Fung CY, Chen E, Vapiwala N, et al. The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study. 2019;103(3):547-556.

12

Kahn J, Goodman CR, Albert A, et al. Top Concerns of Radiation Oncology Trainees in 2019: Job Market, Board Examinations, and Residency Expansion. Int J Radiat Oncol Biol Phys. 2020;106(1):19-25.

Article InfoPublication History

Accepted: June 9, 2021

Received in revised form: May 5, 2021

Received: March 18, 2021

Publication stageIn Press Journal Pre-ProofFootnotes

Conflict of Interest: None

Funding: None

Data Availability: Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

Acknowledgements: Thank you to the DHO Clinical Trials staff who work tirelessly to support our research.

Identification

DOI: https://doi.org/10.1016/j.adro.2021.100743

Copyright

© 2021 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.

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