Original Article Transition to practice in radiation oncology: Mind the gap Lara R. Best a,b,⇑ , Arpita Sengupta a,b , René J.L. Murphy c , Catherine de Metz d,e , Theresa Trotter f , Shaun K. Loewen g , Paris-Ann Ingledew h , Joan Sargeant b,c a Department of Radiation Oncology, Nova Scotia Cancer Center, Halifax; b Dalhousie University, Halifax; c Acadia University, Wolfville; d Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston; e Queen’s University, Kingston; f University of Calgary, Calgary; g Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary; and h Department of Radiation Oncology, Vancouver Centre, BC Cancer Agency, Vancouver, Canada article info Article history: Received 25 March 2019 Received in revised form 3 June 2019 Accepted 8 June 2019 Keywords: Medical education Radiation oncology Transition to practice abstract Introduction: Physicians entering independent practice often express apprehension in managing the non- clinical aspects of practice. This study examined the perceived preparedness of radiation oncology (RO) residents for independent practice, identified education gaps, and discussed how these deficiencies could be addressed. Materials and methods: Focus groups with senior RO residents, fellows, new-to-practice radiation oncol- ogists (ROs), and residency program directors were conducted. Data were coded using the Canadian Medical Education Directives for Specialists (CanMEDS) competencies using thematic analysis. Results: Commonly reported gaps in the transition to practice (TtP) for ROs were lack of experience with: practice management, understanding the structure and function of the health care system and how it var- ies by jurisdiction, financial planning, effective communication and collaboration with other health care team members, creation of accurate and timely documentation, and radiotherapy problem-solving related to treatment planning and evaluation. Suggestions to address these challenges included use of mentorship, educational resources, courses, simulation-based medical education, improved graded responsibility, resident longitudinal clinics, and formal curricula in radiation therapy planning and eval- uation. Conclusion: There are gaps in TtP education for RO trainees with opportunities for enrichment through the forthcoming implementation of a competency-based medical education framework in 2019. The gap in perceived competency in physician-related radiotherapy tasks may be caused by the complex interaction of clinical workflow processes, people and technology that has led to ineffective integration of trainees. The data are informative to medical education leaders for the development of comprehensive TtP curricula. Crown Copyright Ó 2019 Published by Elsevier B.V. All rights reserved. Radiotherapy and Oncology 138 (2019) 126–131 The transition from residency, a trainee role, to that of an inde- pendent medical specialist is referred to as the transition to prac- tice (TtP) in medical education. The TtP represents a process rather than a single point in time, of moving from senior resident to independent specialist [1]. It involves a significant difference in the level of work and responsibility of the physician [2]. It is associated with feelings of both achievement for completing train- ing, and apprehension especially regarding non-clinical skills (i.e. teaching, financial and business management, supervision of learn- ers) which many report are not adequately addressed during resi- dency [2–4]. This transition is also associated with emotive distress, feelings of isolation, with up to 30% of new to practice spe- cialists demonstrating symptoms of burnout [2,5,6]. Provision of optimal preparation can aid in coping with the transition [7]. Suggestions for addressing these concerns during residency include provision of increased responsibility to senior residents to more closely mirror a specialist’s workload within an authentic workplace environment, provision of leadership training, increased health advocacy experience and use of mentoring [1– 3,8–13]. However TtP curricula have not been a formal component of Canadian training programs, and thus were incorporated using diverse methods and lengths, when implemented at all. Many societies including the European Board of Radiotherapy of the Union of European Medical Societies (UEMS) with the Euro- pean Society for Radiotherapy and Oncology (ESTRO) have moved to medical education frameworks such as Competency Based med- ical Education (CBME), that incorporate non-clinical skills that https://doi.org/10.1016/j.radonc.2019.06.012 0167-8140/Crown Copyright Ó 2019 Published by Elsevier B.V. All rights reserved. ⇑ Corresponding author at: Department of Radiation Oncology, Nova Scotia Cancer Center, 5820 University Ave, Halifax, NS B3H1V7, Canada. E-mail address: Lara.Best@nshealth.ca (L.R. Best). Radiotherapy and Oncology 138 (2019) 126–131 Contents lists available at ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.com