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A SWRO Series! Radiation Oncology and Medical Physics Training Across The Globe. 1st Edition.

By Danielle Cerbon, MD.


SWRO, as an organization born in the US, historically had a majority of American members and supporters. However; over the years, we successfully reached the goal of creating a safe space for all women and gender minorities in Radiation Oncology and Medical Physics around the world; and as we continue to expand, we will continue promoting their representation and their growth in our field.

Through our global work, we have realized that most trainees have at least once wondered what training programs are like in other countries, and have been curious about their structure, quality, similarity, and size, amongst other things. This is why we bring to you the new blog series: Radiation Oncology and Medical Physics Training Across The Globe. Where members from around the world answer questions describing their training and experience in their country.




1st Ed. "Radiation Oncology Training in Canada & Romania"

Our DEI Committee vice-chair Amanda Kahn MD, and member Andrada Turcas MD, tell us about Radiation Oncology residency training in their countries, Canada and Romania respectively.

CANADA

Is radiation oncology training combined with another specialty like med-onc or radiology?

  • No, it is a direct entry 5 year residency program but we do rotate in medical oncology and radiology.

What is the pathway to becoming a radiation oncology resident/trainee?

  • In Canada, you normally get a Bachelor's degree prior to medical school. After finishing medical school, you apply via CaRMS to match into an established 5-year program: https://www.carms.ca/match/r-1-main-residency-match/program-descriptions/ (then click on Radiation Oncology to view each university’s program description and requirements).

How long is the training?

  • 5 years, some trainees will do a 1 year fellowship afterward.

How big are training programs generally (how many trainees)?

  • Some programs take a single resident a year (Dalhousie) while bigger programs like at the University of Toronto may take 4-5.

Do you know how many radiation oncology training programs or training spots are available in your country?

  • This changes yearly but in 2022 there were 22 spots across Canada (in both English and French-speaking programs combined.

What are the technologies available in your center? (LINAC, Cobalt, Proton, Carbon)

  • LINAC – Tom Baker Cancer Center.

Does your training offer the opportunity to train abroad/other institutions for technologies unavailable in your center?

  • You are able to organize short 1-2 month electives but to become proficient you would need to officially do a fellowship if you wanted to train in a field that Canada doesn’t have available i.e. go to the US for a proton fellowship.

If so, are the expenses (budget) covered by your program?

  • Some elective expenses are covered i.e. your community elective may have free housing and gas paid for to/from the community.

What do you think are the most commonly used technologies for radiation in your country?

  • LINAC, Cobalt.

How many centers do you think offer brachytherapy in your country?

  • Most major cities with a cancer center do in Canada.

Is learning brachytherapy a requirement for your training?

  • Yes

Is performing research a requirement or part of your training?

  • Yes

Do you have paid time off (vacation and sick leave) offered by the program?

  • Yes

If so, how many days?

  • All residents belong to a residents association which negotiates a contract on your behalf. Here is the contract for the province of Alberta: https://www.para-ab.ca/uploads/source/Agreement_January_1_2022_to_June_30_2024(FEB)_-_no_signatures.pdf “Resident Physicians shall be provided paid leave and health benefits, as defined in Article 32: Health Benefits, for illness or non-occupational injury for a total of up to ninety (90) days for each Appointment Year. Coverage under this Article shall commence on the first day the Resident Physician carries out the duties of their appointment.”

Is it mandatory?

  • Yes.

Is the gender gap large, can you feel a difference in your day-to-day work life?

  • There is a disparity in gender in both trainees and staff in Canada.

Do you have parental leave?

  • Yes.

If so, how long?

  • According to the PARA contract: “A Resident Physician who is pregnant shall be granted a maximum of seventeen (17) weeks of maternity leave. Such leave may commence up to eight (8) weeks prior to the predicted date of birth and shall commence no later than the date of delivery. The Resident Physician shall receive up to seventeen (17) weeks of sufficient pay inclusive of the Employment Insurance one (1) week waiting period to match ninety percent (90%) of her salary when combined with Employment Insurance benefits for maternity leave".

Is parental leave paid?

  • Yes.

Would parental leave interfere with the length of your training?

  • Yes.

Do you get paternal leave?

  • Yes, from the PARA contract: “In the event of the birth or adoption of a child, where a Resident Physician has not been granted maternity leave, a Resident Physician shall be granted a maximum of two (2) weeks leave of absence with full pay and benefits to be taken within the first fifty-two (52) weeks following the birth or adoption of a child. In addition, a Resident Physician shall receive at their request additional leave without pay or benefits as follows: i. Maternity Leave granted – total leave of up to seventy-eight (78) weeks inclusive of any leave taken under Article 11.03(b), or ii. No Maternity Leave granted – total leave of up to sixty-two (62) weeks inclusive of any leave taken under Article 11.04(a)".

Do they offer access to childcare?

  • No.

Do they offer access to fertility preservation (egg harvesting)?

  • No.

If so, is it fully covered? How much do you have to pay?

  • N/A

What is the most common career path once you graduate? (Public vs private healthcare, academic vs community medicine)

  • Academic Center (no private oncology healthcare in Canada).


ROMANIA

Is radiation oncology training combined with another specialty like med-onc or radiology?

  • No, but 3 months of med-onc and 6 of radiology are included in the 4-year training.

What is the pathway to becoming a radiation oncology resident/trainee?

  • Get a BCS/MCS in general medicine, take the national residency exam, and choose (in the order of the grade got in the exam) what specialty you wish to pursue: in this case, radiotherapy.

How long is the training?

  • 4 years.

How big are training programs generally (how many trainees)?

  • Depending on the center- there are roughly 6 centers in Romania, with the biggest in Bucharest (around new 10-15 trainees/year) and second in Cluj-Napoca (around 7-10 new trainees/year); the other are smaller centers with <5 trainees/year.

Do you know how many radiation oncology training programs or training spots are available in your country?

  • Six.

What are the technologies available in your center? (LINAC, Cobalt, Proton, Carbon)

  • LINAC only (all across the country; last cobalt machines were decommissioned in 2019; no hadron facilities).

Does your training offer the opportunity to train abroad/other institutions for technologies unavailable in your center?

  • Yes, but most trainees choose to go to other photon centers.

If so, are the expenses (budget) covered by your program?

  • No.

What do you think are the most commonly used technologies for radiation in your country?

  • IMRT/VMAT and still 3DCRT in some centers.

How many centers do you think offer brachytherapy in your country?

  • Around 7.

Is learning brachytherapy a requirement for your training?

  • Yes.

Is performing research a requirement or part of your training?

  • No.

Do you have paid time off (vacation and sick leave) offered by the program?

  • Yes- 21 days paid vacation; sick leave is paid as per national law (75%) but needs to be recuperated- missed time adds up to the total length of residency.

If so, how many days?

  • 21 days paid vacation.

Is it mandatory?

  • By law yes, but unused days could be used in the next 18 months (as per national law).

Is the gender gap large, can you feel a difference in your day-to-day work life?

  • No, pretty balanced.

Do you have parental leave?

  • Yes, as per national laws.

If so, how long?

  • 2 years.

Is parental leave paid?

  • Yes, 85% of the base salary, as per national law.

Would parental leave interfere with the length of your training?

  • Yes. Everything adds up (the amount spent on leave needs to be worked as a resident after return).

Do you get paternal leave?

  • Yes, same rules as for mothers; but only 1 can benefit at a time.

Do they offer access to childcare?

  • Not related to work. Public daycare and kindergarten are for everybody but are hardly accessible in big cities.

Do they offer access to fertility preservation (egg harvesting)?

  • Maybe, not a really usual topic discussed.

If so, is it fully covered? How much do you have to pay?

  • No; some IVF procedures are reimbursed.

What is the most common career path once you graduate? (Public vs private healthcare, academic vs community medicine)

  • Private, usually. Public centers are hard to get in.

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