The First Non-University Based CAMPEP AdidRid PAccredited...

The First Non-University Based CAMPEP A di d R id PAccredited Residency Program

Brian Wichman MS DABRBrian Wichman MS DABRBrian Wichman, MS, DABRBrian Wichman, MS, DABRKansas City Cancer CenterKansas City Cancer Center

ABR 2012/2014 Eligibility Changes

You know the changesYou know the changes –– you know the dilemma.you know the dilemma.You know the changes You know the changes you know the dilemma.you know the dilemma.

However for those who have been under a rock orHowever for those who have been under a rock orHowever, for those who have been under a rock or However, for those who have been under a rock or just don’t subscribe to Medphys listserver:just don’t subscribe to Medphys listserver:

“Beginning in 2012, in order to take the American Board of Radiology Part 1 examination in oa d o ad o ogy Pa t e a at oRadiologic Physics, candidates must be enrolled in or have graduated from a CAMPEP accredited education program”


For those under rocks, part II:For those under rocks, part II:For those under rocks, part II:For those under rocks, part II:

“Beginning in 2014 in order to take the AmericanBeginning in 2014, in order to take the American Board of Radiology Part 1 examination in Radiologic Physics, candidates must be enrolled in g y ,or have completed a CAMPEP accredited residency program”

Medphys listserver, an aside

FYI for any students out there:FYI for any students out there:FYI for any students out there:FYI for any students out there:

11 ThereThere areare more than 10more than 10--15 physicists with15 physicists with1.1. There There areare more than 10more than 10 15 physicists with 15 physicists with strong opinions out therestrong opinions out there

2.2. Most of us don’t have time to post regularlyMost of us don’t have time to post regularly2.2. Most of us don t have time to post regularlyMost of us don t have time to post regularly3.3. Don’t categorize us all by those who postDon’t categorize us all by those who post44 Your success in graduate schoolYour success in graduate school αα (time you(time you4.4. Your success in graduate school Your success in graduate school αα (time you (time you

spend on World of Warcraft)spend on World of Warcraft)--11 **to be **to be published soon**published soon**pp


So what does it all mean?So what does it all mean?

The sky is falling – already has fallen for some recent gradsWe’re a bunch of masochists – well maybe, but physicists didn’t instigate the ABR changesWe’d better get to work definitely we’reWe d better get to work – definitely, we re (arguably) 100 CAMPEP accredited residency positions shortWe have an opportunity to grasp – YES! Let’s give our future patients (you, me?) the best trained physicists we can while reaping the benefits.p y p g

Residency Benefits

Enthusiastic workers ready to learnEnthusiastic workers ready to learnEnthusiastic workers ready to learnEnthusiastic workers ready to learnPromote continual learning in the clinicPromote continual learning in the clinicSecond year residents ≈ junior physicistsSecond year residents ≈ junior physicistsSecond year residents ≈ junior physicistsSecond year residents ≈ junior physicistsHalf the salary of junior physicistsHalf the salary of junior physicistsVery motivated to do well and graduateVery motivated to do well and graduateVery motivated to do well and graduateVery motivated to do well and graduateBuiltBuilt--in recruiting base of wellin recruiting base of well--trained people trained people for future vacanciesfor future vacanciesfor future vacanciesfor future vacanciesSending wellSending well--trained people into independent trained people into independent practice to better serve patientspractice to better serve patientspractice to better serve patientspractice to better serve patients

KCCC DescriptionKCCC Description

5 comprehensive cancer centers5 comprehensive cancer centers5 comprehensive cancer centers5 comprehensive cancer centers2 hospital based departments2 hospital based departments3D IMRT IGRT SRS/SRT Tomo LDR3D IMRT IGRT SRS/SRT Tomo LDR3D, IMRT, IGRT, SRS/SRT, Tomo, LDR, 3D, IMRT, IGRT, SRS/SRT, Tomo, LDR, HDR, TBI, radioimmunotherapy, HDR, TBI, radioimmunotherapy, radiomicrospheresradiomicrospherespp8 accelerators, 3 PET/CT, SPECT/CT, 8 accelerators, 3 PET/CT, SPECT/CT, diagnostic CT, interventional oncology suitediagnostic CT, interventional oncology suiteNo prostate seed program, no TSE, no IORTNo prostate seed program, no TSE, no IORT3 board certified physicists (1 conditioned)3 board certified physicists (1 conditioned)p y ( )p y ( )8 radiation oncologists, 7 dosimetrists8 radiation oncologists, 7 dosimetrists

Why a Residency at KCCC?Why a Residency at KCCC?

We identified the need forWe identified the need forWe identified the need forWe identified the need for1.1. Additional physics manpowerAdditional physics manpower22 A recruitment source (of well trained people)A recruitment source (of well trained people)2.2. A recruitment source (of well trained people)A recruitment source (of well trained people)Originally approved jr physicist position for Originally approved jr physicist position for 2007200720072007US Oncology Medical Physics Development US Oncology Medical Physics Development ProgramProgramgg2012 Initiative2012 Initiative

How to Start a Residency?How to Start a Residency?

No defined pathway at the time for nonNo defined pathway at the time for non--No defined pathway at the time for nonNo defined pathway at the time for nonacademic centersacademic centersAAPM ad hoc committee on medical physics AAPM ad hoc committee on medical physics p yp ytraining led by Larry Reinstein (2004training led by Larry Reinstein (2004--05)05)TGTG--133 Alternative Pathways for Clinical 133 Alternative Pathways for Clinical yyMedical Physics Residency (2006Medical Physics Residency (2006--08)08)

TG 133 PathwaysTG-133 Pathways

1. Start residency independently from scratch1. Start residency independently from scratch1. Start residency independently from scratch1. Start residency independently from scratch

2 Dependent affiliation with CAMPEP program2 Dependent affiliation with CAMPEP program2. Dependent affiliation with CAMPEP program2. Dependent affiliation with CAMPEP program

3 Limited affiliation with CAMPEP program3 Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program


1. Start residency independently from scratch1. Start residency independently from scratch1. Start residency independently from scratch1. Start residency independently from scratch

KCCC does not have all necessary treatmentKCCC does not have all necessary treatment-- KCCC does not have all necessary treatment KCCC does not have all necessary treatment modalities inmodalities in--house to satisfy CAMPEPhouse to satisfy CAMPEP

-- We needed help and advice (hey, no one hadWe needed help and advice (hey, no one hadWe needed help and advice (hey, no one had We needed help and advice (hey, no one had ever done this before)ever done this before)


2. Dependent affiliation with CAMPEP program2. Dependent affiliation with CAMPEP program2. Dependent affiliation with CAMPEP program2. Dependent affiliation with CAMPEP program

An option but we wanted to maintain controlAn option but we wanted to maintain control-- An option, but we wanted to maintain control An option, but we wanted to maintain control of the residents in our facilitiesof the residents in our facilities

-- Wanted to develop a more personalWanted to develop a more personalWanted to develop a more personal Wanted to develop a more personal relationship with residents, rather than just relationship with residents, rather than just “placement”“placement”

-- Third reason I’ll get to laterThird reason I’ll get to later


3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program

Solves problem of providing all necessarySolves problem of providing all necessary-- Solves problem of providing all necessary Solves problem of providing all necessary treatment modalitiestreatment modalities

-- Can use expertise of those with experience inCan use expertise of those with experience inCan use expertise of those with experience in Can use expertise of those with experience in resident trainingresident training

-- Form reciprocal relationship and hopefully a Form reciprocal relationship and hopefully a p p p yp p p ybond with prestigious institutionbond with prestigious institution


3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program3. Limited affiliation with CAMPEP program

Solves problem of providing all necessarySolves problem of providing all necessary-- Solves problem of providing all necessary Solves problem of providing all necessary treatment modalitiestreatment modalities

-- Can use expertise of those with experience inCan use expertise of those with experience inCan use expertise of those with experience in Can use expertise of those with experience in resident trainingresident training

-- Form reciprocal relationship and hopefully a Form reciprocal relationship and hopefully a p p p yp p p ybond with prestigious institutionbond with prestigious institution

Eureka! Now, how do we get this off the ground? Eureka! Now, how do we get this off the ground?

Getting StartedGetting Started

•• Set your goalsSet your goals –– what do you want towhat do you want to•• Set your goals Set your goals what do you want to what do you want to achieve?achieve?1 Produce well trained physicists1 Produce well trained physicists1. Produce well trained physicists1. Produce well trained physicists2. The residents have positive 2. The residents have positive

d id iproductionproduction3. Assist with departmental projects3. Assist with departmental projects4. Recruitment for open positions4. Recruitment for open positions5 Improve patient care5 Improve patient care5. Improve patient care5. Improve patient care

The AffiliationThe Affiliation

•• Discussions with Mike Herman duringDiscussions with Mike Herman duringDiscussions with Mike Herman during Discussions with Mike Herman during TG133 writing processTG133 writing process

•• Directors develop the framework to anDirectors develop the framework to anDirectors develop the framework to an Directors develop the framework to an agreementagreement

•• Draft agreement taken to administrationsDraft agreement taken to administrationsDraft agreement taken to administrations Draft agreement taken to administrations at both institutionsat both institutions

•• Final changes made to accommodateFinal changes made to accommodateFinal changes made to accommodate Final changes made to accommodate both sidesboth sides

•• ApprovalApproval –– now the real work beginsnow the real work beginsApproval Approval now the real work beginsnow the real work begins

Selling a Physics Residency to Selling a Physics Residency to Ad i i iAd i i iAdministrationAdministration

Or: How I learned to stop worrying and Or: How I learned to stop worrying and l h id ll h id llove the resident salary structurelove the resident salary structure

Ph i i i i b d d f $90Ph i i i i b d d f $90Jr Physicist position budgeted for $90Jr Physicist position budgeted for $90--95K95KR id l f $45R id l f $45 50K50KResident salary of $45Resident salary of $45--50K50KSweet music to administrative earsSweet music to administrative earsOther training costs (est $5K/yr)Other training costs (est $5K/yr)AAPM/ASTRO grantAAPM/ASTRO grantgg

Selling a Physics Residency to Selling a Physics Residency to g y yg y yAdministrationAdministration

Part IIPart IIPart IIPart II

Need implicit trust from administration Need implicit trust from administration ppthat a training program can be run that a training program can be run successfullysuccessfullyyyNeed to show that resident can be Need to show that resident can be productive member of physics staffproductive member of physics staffproductive member of physics staffproductive member of physics staffNeed physician buyNeed physician buy--ininN d l l bN d l l b iiNeed legal buyNeed legal buy--inin

CAMPEP Resources and GuidelinesCAMPEP Resources and Guidelines

Specific guidelines for affiliate residenciesSpecific guidelines for affiliate residenciesSpecific guidelines for affiliate residencies Specific guidelines for affiliate residencies spelled outspelled out

CAMPEP Resources and GuidelinesCAMPEP Resources and Guidelines

The self study is the best place to startThe self study is the best place to start

Self Study Self Study –– A Plan to SucceedA Plan to Succeed

The self study is the roadmap to creating, The self study is the roadmap to creating, running, and improving a residencyrunning, and improving a residencyThe CAMPEP template is very thorough The CAMPEP template is very thorough and specific to the information that is and specific to the information that is ppneededneededCAMPEP can provideCAMPEP can provideCAMPEP can provide CAMPEP can provide examples of self studies examples of self studies for accredited residenciesfor accredited residenciesfor accredited residenciesfor accredited residencies

The KCCC Self StudyThe KCCC Self Study

Program goal and objectivesProgram goal and objectivesA d b fA d b f1.1. As stated beforeAs stated before

2.2. These should be clearThese should be clear3.3. Residency is NOT for primary research Residency is NOT for primary research

purposespurposesp pp p4.4. Residency is NOT for “cheap labor” onlyResidency is NOT for “cheap labor” only


Program evolution and historyProgram evolution and history1.1. As stated beforeAs stated before2.2. This section may be brief, depending This section may be brief, depending

upon history training junior physicistsupon history training junior physicistsp y g j p yp y g j p y3.3. Need to show a commitment to resident Need to show a commitment to resident

education even if lacking historyeducation even if lacking historyeducation, even if lacking historyeducation, even if lacking history


Program structure and governanceProgram structure and governance1.1. Program Director Program Director –– Brian WichmanBrian Wichmangg2.2. Steering committee responsibilitiesSteering committee responsibilities33 Roles of other physicists radiationRoles of other physicists radiation3.3. Roles of other physicists, radiation Roles of other physicists, radiation

oncologists, dosimetrists, administration, oncologists, dosimetrists, administration, other staffother staffother staffother staff

4.4. Describe affiliation, any other Describe affiliation, any other l ti hil ti hirelationshipsrelationships


Training requirementsTraining requirements1.1. What does resident need to do to What does resident need to do to

graduategraduate2.2. Description of curriculumDescription of curriculumpp3.3. Training plans Training plans –– how are rotations how are rotations

structuredstructuredstructuredstructured4.4. How is curriculum evaluated and How is curriculum evaluated and

i di dimprovedimproved


ResidentsResidents1.1. Admissions and recruitment processAdmissions and recruitment process2.2. Evaluation of resident progress Evaluation of resident progress –– one of one of

the most important itemsthe most important itemspp3.3. New resident orientationNew resident orientation44 S f tS f t4.4. SafetySafety

KCCC R id tKCCC R id t Wh W ’Wh W ’KCCC Residents KCCC Residents –– Who We’re Who We’re TargetingTargeting

MUST have MS or PhD from formal MUST have MS or PhD from formal medical physics graduate programmedical physics graduate programmedical physics graduate programmedical physics graduate programCAMPEP graduate program preferredCAMPEP graduate program preferredNot looking for someone targeting Not looking for someone targeting research careerresearch career

KCCC Residents KCCC Residents –– RecruitmentRecruitment

Opened recruitment October 1Opened recruitment October 1All li i d J 15All li i d J 15All application documents January 15All application documents January 15Interview final 3 in FebruaryInterview final 3 in FebruaryOffers first Friday in MarchOffers first Friday in March

We pay for interview travel (no frills)We pay for interview travel (no frills)

KCCC Residents KCCC Residents –– CredentialingCredentialing

End of 1End of 1stst year year –– resident credentialed resident credentialed for:for:for:for:1. Chart checks1. Chart checks2. EBRT plan reviews2. EBRT plan reviews3. Routine QA (linac, IMRT)3. Routine QA (linac, IMRT)4. Brachytherapy (maybe, or later)4. Brachytherapy (maybe, or later)5 Special procedures (maybe or later)5 Special procedures (maybe or later)5. Special procedures (maybe, or later)5. Special procedures (maybe, or later)


Program AdministrationProgram Administration1.1. Structure within hospital/organizationStructure within hospital/organizationgg2.2. Role of program directorRole of program director33 Committees and MeetingsCommittees and Meetings3.3. Committees and MeetingsCommittees and Meetings4.4. Records available for review Records available for review –– keep keep

thi !thi !everything!everything!


ResourcesResources1.1. Facilities Facilities –– as beforeas before2.2. Staff Staff –– as before, with description of time as before, with description of time

commitment to resident trainingcommitment to resident traininggg3.3. FinancesFinances44 E i t il bl f id tE i t il bl f id t4.4. Equipment available for resident useEquipment available for resident use


Future plansFuture plans1.1. Summary of strengths and needsSummary of strengths and needsgg-- Great staff, equipment, Mayo affiliation, Great staff, equipment, Mayo affiliation,

“real life” environment“real life” environment-- Need of online training tools and clinical Need of online training tools and clinical

oncology module (now available)oncology module (now available)oncology module (now available)oncology module (now available)


Future plansFuture plans1.1. Further development and improvementFurther development and improvement-- Integrating new technology Integrating new technology

(TomoTherapy)(TomoTherapy)( py)( py)-- Develop or assist with webDevelop or assist with web--based training based training

toolstoolstoolstools-- Add second resident position (2009)Add second resident position (2009)

ToTo--Do ListDo List

Develop conceptDevelop conceptAdministration approvalAdministration approvalFundingFundingCurriculumCurriculumCurriculumCurriculumSelf studySelf study

ToTo--Do ListDo List

Develop conceptDevelop conceptAdministration approvalAdministration approvalFundingFundingCurriculumCurriculumCurriculumCurriculumSelf studySelf study

OK Let’s Get Moving!OK Let’s Get Moving!

KCCC TimelineKCCC Timeline

•• First discussions with Mike Herman First discussions with Mike Herman –– late 2006late 2006•• Development in early 2007 Development in early 2007 –– Mike shared many Mike shared many

M d d d iM d d d iMayo documents and adviceMayo documents and advice•• Affiliation paperwork completed June 2007Affiliation paperwork completed June 2007•• First resident chosen for July 1, 2007 entryFirst resident chosen for July 1, 2007 entry

Long drawn out visa issues, later took jrLong drawn out visa issues, later took jrphysicist positionphysicist position

•• Start recruitment again Start recruitment again –– first resident started first resident started February 1, 2008February 1, 2008

KCCC TimelineKCCC Timeline

•• Self study submitted to CAMPEP November Self study submitted to CAMPEP November 20082008CAMPEP i i d l M 2009CAMPEP i i d l M 2009•• CAMPEP review team assigned early May 2009CAMPEP review team assigned early May 2009

•• CAMPEP self study document review June 2CAMPEP self study document review June 2•• Responses to review due one week laterResponses to review due one week later•• CAMPEP onCAMPEP on--site review June 11site review June 11--1212•• CAMPEP accreditation in July at AAPM CAMPEP accreditation in July at AAPM

meetingmeeting

Self Study Review RecommendationsSelf Study Review Recommendations

•• Consistent chart rounds throughout all facilitiesConsistent chart rounds throughout all facilities•• Defining didactic training (and further Defining didactic training (and further

d l h d d)d l h d d)development where needed)development where needed)•• Develop resident handbookDevelop resident handbook•• Better access to tumor boardsBetter access to tumor boards•• Better defining role of dosimetristsBetter defining role of dosimetrists•• Add Assistant Residency DirectorAdd Assistant Residency Director•• Secure access to CyberKnife and GKSecure access to CyberKnife and GK

TakeTake--Home MessageHome Message

•• You already do this! Residency means you do it You already do this! Residency means you do it with much better documentation.with much better documentation.Affili i i h CAMPEP di dAffili i i h CAMPEP di d•• Affiliating with CAMPEP accredited program Affiliating with CAMPEP accredited program allows access to those with insight and allows access to those with insight and experienceexperienceexperienceexperience

•• Documentation and CAMPEP accreditation Documentation and CAMPEP accreditation process are becoming less onerousprocess are becoming less onerous –– this is notthis is notprocess are becoming less onerous process are becoming less onerous this is not this is not Mission Impossible!Mission Impossible!

Thank YouThank You

The First Non-University Based CAMPEP AdidRid PAccredited...

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