Fortunately, there are many resources out there to help study radiation oncology and keep afloat of new data. In this list, I’ve tried to compile my go-to resources for studying radiation oncology. I usually forward this list to any medical student or junior resident that I work with. I’ve used all of these myself (and still do). And the great news is that most of these are completely free!

• Essential accounts:

  • www.nccn.org

    • Lists evidence-based guidelines for every disease site.

    • Can click on disease-specific guidelines, review staging, and click through the algorithm to see NCCN management recommendations.

    • These algorithms can be long and confusing, oftne with a few different options, but it is always a good starting point to get a sense of what is considered acceptable standard of care.

  • www.econtour.org

    • Has examples of cases contoured for each disease site with links to the appropriate contouring guidelines and atlases. Great starting point to learn how to contour.

• Books

  • Essentials of Clinical Radiation Oncology

    • Written and edited by residents and faculty at Cleveland Clinic.

    • This book has amazing background info on each disease site as well as summaries of all the major studies that justify why we do what we do.

    • As a student, this is a great resource to have a quick background and summary for management of each disease site. As a resident, the evidence section is extremely helpful to understand the landscape of current literature.

  • Pocket Radiation Oncology

    • Like Pocket Medicine but for radiation oncology. You can look up any disease site and see the workup, staging, simulation set up, prescription doses, plan parameters, and dose constraints.

    • This was made at MD Anderson (so it’s the Anderson way). Other institutions may do things differently, but this is a good guidebook of one way to do things right.

• Online videos

  • ROECSG (pronounced “rock-sig”): Intro for Med Student videos

    • These lectures were given by Dr. Dan Golden while he was at University of Chicago. They are an introductory curriculum for medical students specifically rotating through radiation oncology.

    • These videos go through fundamental basics to help understand workflow, how radiation works, basic physics & rad bio concepts.

  • ROECSG: IROC curriculum for incoming residents

    • These videos came from the same group as above, but they have more in-depth explanations that are helpful to junior rad onc residents.

    • Session 4 in particular on plan evaluation is super helpful.

  • Radiation Oncology Virtual Education Rotation (ROVER)

    • This website features case-based, disease site-specific content hosted by expert radiation oncologists around the country. Topics cover management of both oncologic and benign conditions.

    • Additional professionalism videos cover topics such as networking in residency, family planning, and alternate radiation oncology career paths.

  • Rad Onc Talks

    • This is a lecture series designed for students and residents of radiation oncology. Lectures attempt to break down complex topics in radiation oncology in an easy, approachable, and evidence-based manner.

    • Paid members have access to Q&A style videos that are meant to review disease site sites in a mock oral board style format.

    • I created this resource, and I am grateful that it has received very positive reviews from the radiation oncology community.

• Podcasts

  • At the Beam

    • This podcast was started residents at Stanford and UCLA.

    • Their episodes cover different disease sites in an oral board style format.

  • Accelerators Podcast

    • This podcast focuses on providing oncology news and views.

    • Episodes are versatile but usually feature interviews with prominent physicians and other professionals in the oncology world. They do a great job of providing novel, pragmatic, and holistic information which is often not found in textbooks or tested on exams, but nonetheless incredibly important in radiation oncology.

  • Two Onc Docs

    • This podcast is created by medical oncologists and is meant to be a board review tool for heme/onc fellows.

    • Episodes are short, and they cover various treatment paradigms in 15-20-minute segments with frequent updates posted around the time of key oncology conferences with practice-changing studies.

  • The Fellow on Call

    • Another podcast designed for heme/onc trainees that does a great job of providing basic knowledge across various disease sites.

    • These episodes may be particularly useful for understanding nuances of systemic therapy that radiation oncologists need to know too.

• Other websites

  • ARRO Educational Resources

    • This site compiles several useful resources for studying clinical radiation oncology, radiation biology, and radiation physics.

    • Includes ARROCases, which are resident-created powerpoints that go through different disease sites and review workup, treatment plan, and evidence base.

  • ACRO Resident Corner

    • Another list of several useful resources, including ACRODeck, which has disease site-specific review slides.

    • Includes list of annual grants that ACRO offers to promote resident and medical student research and engagement.

  • Rad Onc Review

    • Links to Google Documents with disease-site specific notes that are highly evidence based and regularly updated with new literature.

  • Rad Onc Tables

    • Also available as an app. Summarizes key trials (inclusion criteria, arms, results, conclusions) in radiation oncology.

Caveat #1: There is such a thing as information overload. Realistically, you will probably commit yourself to a handful of these and cherry pick content from the rest.

Caveat #2: This list is not all inclusive, because my knowledge of resources is not all inclusive! This is really meant to be a starting point. If you have other rad onc resources that you find helpful, please feel free to comment and share!

I hope this list serves as a useful starting point for the many resources that are available in the radiation oncology world. This world can be especially overwhelming to medical students and junior residents, and one of my goals with this Substack is to help make things a little more approachable.

Thank you for reading!

Studying for radiation oncology residency, especially as a junior resident, is overwhelming. When I started radiation oncology residency, I was overwhelmed. (I have since finished radiation oncology residency, and I am still sometimes overwhelmed.) It is not easy to keep up with any topic in modern medicine, let alone oncology where things are changing at a mile a minute.

Through this guide, I hope to share some advice I have gleaned from my time as a rad onc resident. I hope it gives you the confidence and enthusiasm to keep working hard, and the reassurance that no one at any level in radiation oncology knows every single thing there is to know.

We are physicians. We are constantly humbled. We are always learning.

Did you get that?

We are physicians. We are constantly humbled. We are always learning.

No one at any level in radiation oncology knows every single thing there is to know.

It might feel like they do when they are grilling you in front of everyone during resident conference, but I assure you there must be some speck of knowledge out there that even your most senior, most intelligent, most intimidating attending does not know.

You cannot know everything. The goal is to know enough things to get through each stage of residency, and eventually all of those things add up to one big accomplishment. You graduate, you pass your boards, and finally you have tangible proof that yes, you know enough things.

But when you are a resident, you don’t need to focus on knowing all the things you need to know to graduate. You need to know enough things to survive a day in clinic, a specific rotation, or a conference presentation.

And this requires you to set some reasonable expectations for yourself.

Everyone has a different approach to goal setting. Some people set goals for a set amount of time, others aim to have things complete by a certain time. I find that tacking time constraints stresses me out very much, so I measure my productivity very differently. However it is that you set goals, make sure they are reasonable for you.

Here are some possible examples for goals you might set for your breast cancer rotations:

• First Day of Breast Rotation: Know where/what time to report, know who you are working with (yes—ask your coresidents what they like/don’t like), know that breast cancer is treated with surgery and adjuvant RT and systemic therapy, vaguely remember the pre-rotation readings you were assigned.

• Second Day of Breast Rotation: Remember the indication for postmastectomy radiation (because we talked about it yesterday!). Try and memorize T staging for breast cancer.

• End of PGY-2 Breast Rotation: Know staging and general treatment paradigm for breast cancer, know various dose fractionation schemes, and generally know how to contour and plan breast radiation.

See how the goal of the first day is to just survive? You are not trying to astound anyone with your brilliance. You are not trying to push forward any novel innovations. You are just trying to get through the first day by showing interest and attentiveness. By the second day, you have already learned something. You are just trying not to forget that thing. And maybe you can supplement the thing your attending taught you with something else that you decided to learn yourself. On the third day, you might forget it again. But that is okay! It’s all about repetition, and eventually you start to remember enough things. And that’s the goal right?

Be kind to yourself. Set reasonable expectations.

Hopefully by residency, you have figured out how you study best. Some people just read, others use flash cards, some listen to lectures, some just show up every day and the knowledge seeps into their brains like magic. I have a very un-magical approach to studying which is to first absorb information through lectures and papers, break it down into bite size pieces that can fit and stay in my mind, and then synthesize it into my own study material from scratch, often at a glacially slow pace (this is how Rad Onc Talks was born).

I envy those that can learn more quickly. But this is what it takes for me.

We are lucky to be in an era where there are so many different types of resources for medical students. We have books, lecture videos, lecture slides, podcasts, flashcards, question banks, and so much more. It is definitely too much to commit yourself to all these tools.

You need to find what works for you and stick to it. If it’s not working, try something else.

I remember attending resident conference as a PGY-2, where we discussed topics like glioblastoma or pediatric rhabdomyosarcoma or head and neck cancer before I had rotated through their respective disease sites. I remember feeling so overwhelmed because here I was on my GU rotation, trying to lock down prostate cancer risk stratification, the moderately hypofractionated regimens, and the definition of a biochemical recurrence, but then on a random day I would have to put all that aside to study for a case conference on grade 3 astrocytoma.

As it turned out, I retained very little info from the case conferences on disease sites that I had not yet rotated through. I would prepare for them in a rush (admittedly late at night the day before), pretty clueless about the most important clinical trials and their major takeaways. This type of studying sometimes helped me to not look like a complete idiot at case conference the next morning (I emphasize the word sometimes), but it was not the type of studying that made me feel good about the subject, like I had really learned something, like I could teach it to someone else.

I realized I needed the experience of rotating through sites, a lot of time to read papers and listen to podcasts and talks on the topic, and dedicated time out of clinic during my PGY-4 research year to properly study the way I needed to study.

So how do we figure out what to focus on studying? In medicine, we triage. The most urgent things have to happen first, and the less urgent things can wait. If you need to study something that directly impacts patient care—prioritize that first. If you are starting a new rotation in a new disease site, study for that. The night before case conference with your most intimidating attending who will publicly shame you for ignorance? Prioritize studying for that. (Yes, even if you won’t be able to commit everything to long-term memory, even if it feels rushed and things don’t fully make sense, I think it’s important to show that you are trying, even when it’s inconvenient to have to learn about astrocytoma in the middle of your GU rotation).

It is not perfect. It will never be perfect. There will always be interruptions and distractions and more pressing deadlines that impede whatever it is you are studying.

But eventually, the pieces you know, even if scattered and arranged haphazardly, will come together like a puzzle. And your understanding of a given topic will start to feel whole.

Conclusions

This is not a guide of what to study in radiation oncology. This is a guide of how to study.

My suggestions?

1. Set reasonable expectations. Temper your outrageous ambitions.

2. Study the way you need to study. Do what works. Don’t do what doesn’t work.

3. Prioritize. Patient care first. Avoid getting shamed second.

It is not perfect. It will never be perfect. You will never know everything. Nobody ever knows everything.

I hope these words provide some comfort and motivation to any resident who is drinking from the firehose that is radiation oncology residency.

Best of luck, and if you ever feel like you don’t know enough, just remember we have all been there.

As a PGY-2, this structure can be incredibly intimidating. My greatest weakness when I started residency was a near constant sense of self-doubt. I feared that I was inadequate. The thought process went something like this - Am I supposed to know this? I probably should know this already. I didn’t get to finish all my reading last night and I’m sure the answer was in there. If I ask now, I’ll look stupid or underprepared. Better to stay quiet. I was even afraid to ask my senior residents questions at times! I’m sure they knew this when they were in my shoes. I really don’t want to seem dumb.

I made so many excuses to avoid advertising my lack of knowledge. This is probably easily Google-able. I shouldn’t bother anyone with a question so trivial. Or, I’m sure this’ll come up eventually in lecture. In clinic, I constantly swept my ignorance under a rug and faulted myself for lousy preparation.

Here are some examples of questions that I had that I was afraid to ask:

⁃ What is flash?

⁃ How do you know how much bolus to apply?

⁃ How do I contour literally everything?

⁃ What exactly is image registration?

⁃ How do I tell if a patient is being treated with 3D or IMRT?

As the years went on, I realized something I wish I knew back then. These things are in fact not completely obvious. Sure, they are all probably Google-able, or self-teachable if you read the right literature. But there are only so many things you can remember to look up at the end of a clinic day. And to be honest, there is so much literature, I still don’t always know the complete list of papers that apply to a particular topic. Our field is hard! And there is an incredible amount of nuance that is quite frankly not written anywhere.

Only when I became a senior resident did I realize that for all my fear of coming off as stupid, the stupidest thing I did was let myself feel insecure. When junior residents and even medical students asked me questions, I never once thought worse of them. It was always - You know what, that’s a good question. Here’s what I know about this.

And as I got to know the people in my department, I realized that even the most brilliant attendings who once so intimidated me are truly invested in teaching and always happy to help.

As I got more comfortable, I started to ask more questions. And what I realized is how many doors this opens. Attendings would explain things and suddenly everything made sense. Sometimes they would refer me to specific papers, and I learned more from reading them. Sometimes they would say “I don’t know.” And that made me feel so good! It still makes me feel good. It is impossible to know everything. Isn’t that a weight off your shoulders?

If I could go back in time, here is what I would tell my PGY-2 self:

It’s okay that you don’t know this! Now is the time to ask and learn.

And don’t just ask your attending. Ask your fellow residents. Ask your dosimetrist. Your physicist. Your therapist. Your nurse. If you don’t understand the why behind something, always ask. (And you know, read the room to ask at the appropriate time.) The way I see it, residency is the time to ask questions. In a short time, you will be the attending and your staff will turn to you to ask how you want things done. So ask questions and understand things now, while you’re in training!

And more importantly, don’t feel bad for not knowing something. We’ve all been there (believe me I’ve said some pretty erroneous things during chart rounds). It is natural to feel ashamed, especially when you make a mistake among accomplished peers and mentors. But learning anything takes time and practice and repetition. Don’t be hard on yourself if something doesn’t make sense or come to you right away. We face too much pressure in medicine to let our own insecurities weigh on us too.

And the learning doesn’t stop after you graduate. I still ask my team questions every single day, and I expect I’ll do so for the rest of my career.

We are all constantly learning. It’s the only way to make progress

.

I’ve been an attending radiation oncologist for three months so far, and I keep coming back to these top three lessons from the job.

These are all lessons I’ve inherited from my mentors, but independent practice has heavily reinforced them. In case it is helpful to any residents or rising attendings, I thought I would share!

1. Independently evaluate every case.

Colleagues often refer patients with a perfect, bow-tied plan for what they’d like the us to do, sometimes down to the number of fractions. Of course, we want to be respectful and courteous to our colleagues, helping them as much as we can.

At the same time, it is our job to carefully evaluate each case ourselves—verify the patient’s diagnosis, stage, performance status, and wishes. Based on the patient’s pathology and imaging, does the plan make sense, will radiation help, is it safe? Does the patient need further imaging or work up before treatment? And how does the patient feel, what are their concerns?

Although we undoubtedly want to help our colleagues, our greatest responsibility is to our patients. We therefore owe it to them to thoughtfully evaluate each case ourselves before recommending a course of action.

2. There is no need to rush.

Everything in clinic often feels like a rush—three different patients are waiting to be seen, the therapists are paging for a verify and treat, and a medical oncology colleague is asking if they can send an add-on consult. Not to mention the long list of contours waiting on our task pad.

In moments like these, we have just to breathe. And then triage. We can each only do one thing at a time, and every patient deserves our undivided attention. If asked a question, it’s okay to not know the answer right away. It’s okay to tell our colleagues and our patients that we need a minute. We can think about the answer and get back to them later.

Rushing through things while juggling many tasks at once is a sure way to err. And luckily, true emergencies are rare in radiation oncology. Even when things feel very urgent, there is always an extra minute to pause, to breathe, and to think through things carefully.

3. Listen and learn from the patients.

Our patients are more in tune with their bodies than anyone else. Sometimes, the imaging looks concerning, but the patient feels fine. Listen to that patient. Sometimes, the imaging looks fine, but the patient has a complaint. Listen to that patient too! Especially in radiation oncology, we know so much about a patient before we meet them face to face. All that knowledge is valuable, but it does not compare to the knowledge we get from talking with and evaluating our patients in person. When they talk to us, we must listen and adapt our plans accordingly.

***

Every day on this job is a learning experience, and for the lessons I haven’t yet learned, I rely on the advice of my seniors. I suppose there’s an extra piece of advice in there—ask when you don’t know! We are lucky to be in a strongly connected medical community where help is always available, often just a call or text away. I’m grateful to be a part of it.

I hope these lessons resonate. What is your top lesson from the job?

I can hear my mentors groaning. Physicians do a lot of writing! Papers. Grants. Notes. Emails. More notes. And I love my job! (Not so much the notes.)

But I still want to be a writer. Not an academic writer. A creative writer.

“You can still be a writer!” many people have told me. “You can do both!”

And I know I can. But there is always an excuse. Medical school. Residency. Marriage. Life.

These are good productive excuses, but they are also quite dishonest excuses. Let me be real about what actually stops me from writing.

I come home from work with the very best creative intentions, but the minute I sit on my sofa, I unlock my phone. I scroll through Instagram for up to an hour sometimes, consuming content until my brain is pulverized. Then I open my laptop and stare at a blank Word document until it’s time to eat dinner while watching a bigger screen.

I know it is terrible. But it also seems unstoppable.

The paradoxical thing? Writing is one of the only remedies that I have found. It is a meditation, and it is a therapy.

In an era of frenzied screens and short-form content, words provide a stillness in which in our thoughts can rest.

But if I want to find that stillness, I need to write. And if I want to write seriously, diligently, (sometimes humorously), and consistently, I need to be held accountable.

Hence, my new Substack.

I know there are many professionals out there whose creative hobbies have taken a backseat to the demands of career and family. I know that everyone is susceptible to the same screen-related distractions that stop me from writing. But I also believe that writing (and reading!) is a remedy to that. And the screen does not have to be our enemy.

Through my writing, I hope to create a community where busy professionals are inspired to stay connected with their creativity and their humanness. I’ll be sharing creative writing prompts, and I encourage anyone and everyone to engage with them and respond.

Let’s find stillness together, one word at a time.

Today, I challenge you to turn on a timer and write for five minutes. Where do you find stillness?

Write it on paper, on your laptop, or on your phone. And comment your reply! I would love to read your writing, even if it is just a word or a sentence.

Subscribe and write with me.

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