Skip to main content

Quality of training in radiation oncology in Germany: where do we stand?

Results from a 2016/2017 survey performed by the working group “young DEGRO” of the German society of radiation oncology (DEGRO)

Qualität der Facharztweiterbildung in der Radioonkologie in Deutschland: Wo stehen wir heute?

Ergebnisse einer Erfassung aus den Jahren 2016/2017 der Arbeitsgruppe „junge DEGRO“ der Deutschen Gesellschaft für Radioonkologie e. V. (DEGRO)

Abstract

Purpose

To evaluate the current situation of young radiation oncologists in Germany with regard to the contents and quality of training and level of knowledge, as well as their working conditions and professional satisfaction.

Methods

From June 2016 to February 2017, a survey was conducted by the young DEGRO (yDEGRO) using an online platform. The questionnaire consisted of 28 items examining a broad range of aspects influencing residency. There were 96 completed questionnaires

Results

83% of participants stated to be very or mostly pleased with their residency training. Moderate working hours and a good colleagueship contribute to a comfortable working environment. Level of knowledge regarding the most common tumor sites (i.e. palliative indications, lung, head and neck, brain, breast, prostate) was pleasing. Radiochemotherapy embodies a cornerstone in training. Modern techniques such as intensity-modulated radiotherapy (IMRT) and stereotactic procedures are now in widespread use. Education for rare indications and center-based procedures offers room for improvement.

Conclusion

Radiation oncology remains an attractive and versatile specialty with favorable working conditions. Continuing surveys in future years will be a valuable measuring tool to set further priorities in order to preserve and improve quality of training.

Zusammenfassung

Zielsetzung

Ziel ist die Erfassung der gegenwärtigen Situation junger Radioonkologen in Deutschland hinsichtlich der Inhalte und Qualität ihrer Facharztausbildung, ihres Wissensstands sowie der Arbeitsbedingungen und Zufriedenheit.

Methoden

Im Zeitraum von Juni 2016 bis Februar 2017 wurde durch die Arbeitsgruppe „junge DEGRO“ (AG jDEGRO) eine Onlineumfrage durchgeführt. Anhand von 28 ausgewählten Fragen sollten wesentliche Aspekte der Facharztweiterbildung abgebildet werden. Es wurden 96 komplette Fragebögen ausgewertet.

Ergebnisse

Von den Teilnehmern gaben 83 % an, mit ihrer Ausbildung sehr oder überwiegend zufrieden zu sein. Moderate Arbeitszeiten und eine gute Kollegialität tragen zu einer angenehmen Arbeitsatmosphäre bei. Der Wissenstand hinsichtlich häufiger Tumorlokalisationen (u. a. palliative Indikationen, Lunge, Kopf-Hals-Region, Gehirn, Mamma und Prostata) ist zufriedenstellend. Die Radiochemotherapie ist ein wesentlicher Pfeiler in der Weiterbildung. Moderne Techniken wie die intensitätsmodulierte Radiotherapie (IMRT) oder stereotaktische Anwendungen haben eine weite Verbreitung gefunden. Die Wissensvermittlung hinsichtlich seltener Entitäten und zentrenbasierter Prozeduren sollte verbessert werden.

Schlussfolgerung

Die Radioonkologie bleibt eine attraktive und vielseitige Fachdisziplin. Regelmäßige wiederholte Umfragen in künftigen Jahren können ein wertvoller Gradmesser sein, um den Erhalt der Ausbildungsqualität zu sichern.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Smith BD, Haffty BG, Wilson LD, Smith GL, Patel AN, Buchholz TA (2010) The future of radiation oncology in the United States from 2010 to 2020: will supply keep pace with demand? J Clin Oncol 28(35):5160–5165. https://doi.org/10.1200/JCO.2010.31.2520

    Article  PubMed  Google Scholar 

  2. 2.

    Datta NR, Samiei M, Bodis S (2014) Radiotherapy infrastructure and human resources in Europe – present status and its implications for 2020. Eur J Cancer 50(15):2735–2743. https://doi.org/10.1016/j.ejca.2014.06.012

    Article  PubMed  Google Scholar 

  3. 3.

    Lievens Y, Defourny N, Coffey M, Borras JM, Dunscombe P, Slotman B, Malicki J, Bogusz M, Gasparotto C, Grau C, Kokobobo A, Sedlmayer F, Slobina E, Coucke P, Gabrovski R, Vosmik M, Eriksen JG, Jaal J, Dejean C, Polgar C, Johannsson J, Cunningham M, Atkocius V, Back C, Pirotta M, Karadjinovic V, Levernes S, Maciejewski B, Trigo ML, Šegedin B, Palacios A, Pastoors B, Beardmore C, Erridge S, Smyth G, Cleries Soler R, Consortium H (2014) Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol 112(2):178–186. https://doi.org/10.1016/j.radonc.2014.08.034

    Article  PubMed  Google Scholar 

  4. 4.

    Bölling T, Seegenschmiedt H, Semrau R, Rödel C (2009) Training in radiation oncology in Germany. Current status and necessary developments. Strahlenther Onkol 185(5):275–281. https://doi.org/10.1007/s00066-009-2003-y

    Article  PubMed  Google Scholar 

  5. 5.

    Filippi AR, Alongi F, Ciammella P, De Bari B, Franco P, Livi L (2012) A strategy for young members within national radiation oncology societies: the Italian experience (AIRO Giovani group). Rep Pract Oncol Radiother 17(5):259–261. https://doi.org/10.1016/j.rpor.2012.07.011

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Spanish Young Radiation Oncology Group (SYROG). http://grupojovenseor.blogspot.de. Accessed 8 May 2017

  7. 7.

    Bibault JE, Fumagalli I, Diaz O, Faivre JC, Leroy T, Pichon B, Riou O, Thureau S, Rivera S (2012) The French Society of Young Radiation Oncologists: history, goals and perspective. Rep Pract Oncol Radiother 17(5):255–258. https://doi.org/10.1016/j.rpor.2012.07.006

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Meredith RF, Eisert DR (1987) 1986 Association of Residents in Radiation Oncology Survey. Int J Radiat Oncol Biol Phys 13(12):1893–1895

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    yESTRO committee. http://www.estro.org/about/governance-organisation/scientific-council/committees/young-estro-committee. Accessed 8 May 2017

  10. 10.

    Semrau R, Hansemann K, Adam M, Andratschke N, Brunner T, Heinzelmann F, Hildebrandt G, Vordermark D, Zips D (2008) Quality of training in radiation oncology in Germany. Results of a 2006 survey. Strahlenther Onkol 184(5):239–244. https://doi.org/10.1007/s00066-008-1821-7

    Article  PubMed  Google Scholar 

  11. 11.

    Krug D, Baumann R, Rieckmann T, Fokas E, Gauer T, Niyazi M (2016) Situation of young radiation oncologists, medical physicists and radiation biologists in German-speaking countries: results from a web-based survey of the Young DEGRO working group. Strahlenther Onkol 192(8):507–515. https://doi.org/10.1007/s00066-016-1003-y

    Article  PubMed  Google Scholar 

  12. 12.

    Krause M, Supiot S (2015) Advances in radiotherapy special feature. Br J Radiol 88(1051):20150412. https://doi.org/10.1259/bjr.20150412

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Nakamura K, Sasaki T, Ohga S, Yoshitake T, Terashima K, Asai K, Matsumoto K, Shioyama Y, Honda H (2014) Recent advances in radiation oncology: intensity-modulated radiotherapy, a clinical perspective. Int J Clin Oncol 19(4):564–569. https://doi.org/10.1007/s10147-014-0718-y

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R, Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716. https://doi.org/10.1016/S0140-6736(11)61629-2

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Vujovic O, Perera F, Dar AR, Stitt L, Yu E, Voruganti SM, Truong PT (1998) Does delay in breast irradiation following conservative breast surgery in node-negative breast cancer patients have an impact on risk of recurrence? Int J Radiat Oncol Biol Phys 40(4):869–874

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rödel C (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30(16):1926–1933. https://doi.org/10.1200/JCO.2011.40.1836

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A, Group C (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084. https://doi.org/10.1056/NEJMoa1112088

    Article  PubMed  Google Scholar 

  18. 18.

    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups, National Cancer Institute of Canada Clinical Trials Group (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996. https://doi.org/10.1056/NEJMoa043330

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Bundesärztekammer (2011) Evaluation der Weiterbildung 2011. http://www.bundesaerztekammer.de/aerzte/aus-weiter-fortbildung/weiterbildung/evaluation-der-weiterbildung/fachrichtungen/. Accessed 24 June 2017

    Google Scholar 

  20. 20.

    Bundesärztekammer (2009) Evaluation der Weiterbildung 2009. http://www.bundesaerztekammer.de/aerzte/aus-weiter-fortbildung/weiterbildung/evaluation-der-weiterbildung/ergebnisse-2009/auswertung/. Accessed 24 June 2017

    Google Scholar 

  21. 21.

    Lunau T, Bambra C, Eikemo TA, van der Wel KA, Dragano N (2014) A balancing act? Work-life balance, health and well-being in European welfare states. Eur J Public Health 24(3):422–427. https://doi.org/10.1093/eurpub/cku010

    Article  PubMed  Google Scholar 

  22. 22.

    Nabavizadeh N, Burt LM, Mancini BR, Morris ZS, Walker AJ, Miller SM, Bhavsar S, Mohindra P, Kim MB, Kharofa J, Committee AE (2016) Results of the 2013–2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States. Int J Radiat Oncol Biol Phys 94(2):228–234. https://doi.org/10.1016/j.ijrobp.2015.10.014

    Article  PubMed  Google Scholar 

  23. 23.

    Rolston AM, Hartley SE, Khandelwal S, Christner JG, Cheng DF, Caty RM, Santen SA (2015) Effect of doximity residency rankings on residency applicants’ program choices. West J Emerg Med 16(6):889–893. https://doi.org/10.5811/westjem.2015.8.27343

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Doximity Residency Navigator 2015/16. https://blog.doximity.com/articles/residency-programs-is-there-a-personalized-prescription. Accessed 9 May 2017

  25. 25.

    Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K (2016) Working time of neurosurgical residents in Europe – results of a multinational survey. Acta Neurochir (wien) 158(1):17–25. https://doi.org/10.1007/s00701-015-2633-z

    Article  Google Scholar 

  26. 26.

    Oker N, Escabasse V, Pensky H, Alotaibi N, Coste A, Albers AE (2014) Training satisfaction and work environment in otorhinolaryngology, head and neck surgery: a comparison between France and Germany. Eur Arch Otorhinolaryngol 271(9):2565–2573. https://doi.org/10.1007/s00405-014-3046-y

    Article  PubMed  Google Scholar 

  27. 27.

    Parikh JR, Harolds JA, Bluth EI (2017) Workplace bullying in radiology and radiation oncology. J Am Coll Radiol. https://doi.org/10.1016/j.jacr.2016.12.021

    Google Scholar 

  28. 28.

    Trad M, Johnson J (2014) Bullying among radiation therapists: effects on job performance and work environment. Radiol Technol 86(2):122–131

    PubMed  Google Scholar 

  29. 29.

    Frenzel T, Krüll A (2015) The use of IMRT in Germany. Strahlenther Onkol 191(11):821–826. https://doi.org/10.1007/s00066-015-0832-4

    Article  PubMed  Google Scholar 

  30. 30.

    Weber HE, Dröge LH, Hennies S, Herrmann MK, Gaedcke J, Wolff HA (2015) Volumetric intensity-modulated arc therapy vs. 3‑dimensional conformal radiotherapy for primary chemoradiotherapy of anal carcinoma: effects on treatment-related side effects and survival. Strahlenther Onkol 191(11):827–834. https://doi.org/10.1007/s00066-015-0859-6

    Article  PubMed  Google Scholar 

  31. 31.

    Petereit DG, Frank SJ, Viswanathan AN, Erickson B, Eifel P, Nguyen PL, Wazer DE (2015) Brachytherapy: where has it gone? J Clin Oncol 33(9):980–982. https://doi.org/10.1200/JCO.2014.59.8128

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Patel S, Ragab O, Demanes DJ, Chen AM, Kamrava M (2016) Brachytherapy: where has it gone … again? J Clin Oncol 34(10):1155. https://doi.org/10.1200/JCO.2015.65.0267

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Guedea F, Venselaar J, Hoskin P, Hellebust TP, Peiffert D, Londres B, Ventura M, Mazeron JJ, Limbergen EV, Pötter R, Kovacs G (2010) Patterns of care for brachytherapy in Europe: updated results. Radiother Oncol 97(3):514–520. https://doi.org/10.1016/j.radonc.2010.09.009

    Article  PubMed  Google Scholar 

  34. 34.

    Gill BS, Lin JF, Krivak TC, Sukumvanich P, Laskey RA, Ross MS, Lesnock JL, Beriwal S (2014) National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: the impact of new technological advancements. Int J Radiat Oncol Biol Phys 90(5):1083–1090. https://doi.org/10.1016/j.ijrobp.2014.07.017

    Article  PubMed  Google Scholar 

  35. 35.

    DEGRO-Akademie Curriculum. https://www.degro.org/akademie/curriculum/. Accessed 9 May 2017

  36. 36.

    Kondoh C, Shitara K, Nomura M, Takahari D, Ura T, Tachibana H, Tomita N, Kodaira T, Muro K (2015) Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study. Bmc Palliat Care 14:37. https://doi.org/10.1186/s12904-015-0034-y

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Chow E, Zeng L, Salvo N, Dennis K, Tsao M, Lutz S (2012) Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol) 24(2):112–124. https://doi.org/10.1016/j.clon.2011.11.004

    CAS  Article  Google Scholar 

  38. 38.

    Tsao MN, Lloyd N, Wong RK, Chow E, Rakovitch E, Laperriere N, Xu W, Sahgal A (2012) Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev 4:CD3869. https://doi.org/10.1002/14651858.CD003869.pub3

    Google Scholar 

  39. 39.

    Franco P, Ciammella P, Peruzzo Cornetto A, De Bari B, Buglione M, Livi L, Alongi F, Filippi AR (2013) The STYRO 2011 project: a survey on perceived quality of training among young Italian radiation oncologists. Med Oncol 30(4). https://doi.org/10.1007/s12032-013-0729-y

    PubMed Central  Google Scholar 

  40. 40.

    Hos D, Steven P, Dietrich-Ntoukas T (2015) The situation of residents in ophthalmology in Germany: results of an online survey. Ophthalmologe 112(6):498–503. https://doi.org/10.1007/s00347-015-0030-x

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Eriksen JG, Beavis AW, Coffey MA, Leer JW, Magrini SM, Benstead K, Boelling T, Hjälm-Eriksson M, Kantor G, Maciejewski B, Mezeckis M, Oliveira A, Thirion P, Vitek P, Olsen DR, Eudaldo T, Enghardt W, François P, Garibaldi C, Heijmen B, Josipovic M, Major T, Nikoletopoulos S, Rijnders A, Waligorski M, Wasilewska-Radwanska M, Mullaney L, Boejen A, Vaandering A, Vandevelde G, Verfaillie C, Pötter R (2012) The updated ESTRO core curricula 2011 for clinicians, medical physicists and RTTs in radiotherapy/radiation oncology. Radiother Oncol 103(1):103–108. https://doi.org/10.1016/j.radonc.2012.02.007

    Article  PubMed  Google Scholar 

  42. 42.

    Borgmann H, Arnold HK, Meyer CP, Bründl J, König J, Nestler T, Ruf C, Struck J, Salem J (2016) Training, research, and working conditions for urology residents in Germany: a contemporary survey. Eur Urol Focus. https://doi.org/10.1016/j.euf.2016.12.001

    PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the DEGRO board for their continuous financial and great general support and their trust in the young DEGRO. We thank all members of the yDEGRO and all participants of the survey for contributing to this project.

Author information

Affiliations

Authors

Corresponding author

Correspondence to C. T. Dietzel.

Ethics declarations

Conflict of interest

C.T. Dietzel, K. Jablonska, M. Niyazi, T. Gauer, N. Ebert, C. Ostheimer, and D. Krug declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

C. Ostheimer and D. Krug shared senior authorship.

Caption Electronic Supplementary Material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dietzel, C.T., Jablonska, K., Niyazi, M. et al. Quality of training in radiation oncology in Germany: where do we stand?. Strahlenther Onkol 194, 293–302 (2018). https://doi.org/10.1007/s00066-017-1250-6

Download citation

Keywords

  • Radiotherapy
  • Radiation oncology
  • Training
  • Survey
  • jDEGRO

Schlüsselwörter

  • Radiotherapie
  • Radioonkologie
  • Ausbildung
  • Umfrage
  • jDEGRO