Training in Radiation Oncology: Missing Leadership and Advocacy Development

By Justin D. Anderson, MD; Sarah A. Dooley, MD; Austin J. Sim, MD, JD


The Accreditation Council for Graduate Medical Education (ACGME) considers being an “effective member or leader of a health care team or other professional group”1 an essential milestone for residency training; however, formalized curricula in leadership development in residency training programs across specialties are lacking. Several radiation oncology residency programs have developed independent curricular content surrounding leadership,2,3 but in general, the greater acquisition of leadership competency remains unmet.

Many specialties in medicine are designed around health care teams that grant residents a gradual increase in leadership responsibilities as they mature from junior to senior residents. However, the apprenticeship model in radiation oncology limits opportunities to develop these skills, including team management and conflict resolution. This increases the need for investments in leadership training in radiation oncology.

Additionally, the ACGME notes that residents should be able to “advocate for quality patient care and optimal patient care systems.” One such avenue lies in political advocacy. Recent legislation for prior authorization and reimbursement portends significant changes in our field, but only a few physicians are engaged in this process. A dedicated introduction to the legislative process has shown to increase physician understanding and willingness to participate in political advocacy in other specialties.4 The American Society for Radiation Oncology (ASTRO) Advocacy Day serves as one opportunity for trainees to engage and participate in political advocacy early in their careers and should be more widely supported.

As the current pandemic has exposed flaws in our health care system and spurred significant change, becoming an effective advocate and leader is more important than ever. Developing these skills in young practitioners is important to ensure our field continues working with legislators to improve patient care and curate positive change. Implementing a standardized core curriculum in radiation oncology that includes education on leadership development and effective advocacy is a great place to start.


  1. The Radiation Oncology Milestone Project. A Joint Initiative of the Accreditation Council for Graduate Medical Education and the American Board of Radiology. 2015, Accessed December 31, 2020.
  2. Berriochoa C, Amarnath S, Berry D, Koyfman SA, Suh JH, Tendulkar RD. Physician leadership development: a pilot program for radiation oncology residents. Int J Radiat Oncol Biol Phys. 2018;102(2):254-256.
  3. Song E, Frakes JM, Dilling TJ, Quinn JF, Harrison LB, Hoffe SE. A novel radiation oncology residency training leadership curriculum: baseline attitudes and of past and current residents. Int J Radiat Oncol Biol Phys. 2019;105(suppl):E157-E158.
  4. Joseph N, Huang J, Som A, et al. The impact of physician exposure to organized political advocacy in the Society of Interventional Radiology. J Vasc Interv Radiol. 2021;S1051-0443(20)30966-30970.


Anderson JD, Dooley SA, Sim AJ. Training in Radiation Oncology: Missing Leadership and Advocacy Development. Appl Radiat Oncol. 2021;(1):5.

March 30, 2021