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The HOLMAN PATHWAY Submitted by Bruce G. Haffty, MD, RRC Radiation Oncology The Holman Pathway presents an alternative residency structure for selected residents in radiation oncology. In this Pathway, residents can become eligible to be Board certified after 21 months of research and 27 months of clinical training. The traditional pathway requires 48 total months of residency in radiation oncology with a minimum of 36 months in clinical radiation oncology. The Pathway is primarily designed for residents with an M.D./Ph.D. who have strong clinical skills such that clinical competence can be achieved in this abbreviated time. Prospective candidates for the Holman Pathway should have a documented history of research, a specific research plan with a suitable research mentor and environment. More information is available from the ABR website at http://www.theabr.org/ At a recent meeting of the Association of Directors of Radiation Oncology Programs (ASTRO, 2004), several questions and concerns were raised regarding how the RRC interpreted the residency guidelines when reviewing and monitoring programs with Holman Pathway residents. Specifically questions were raised regarding how the Holman Pathway residents were viewed when assessing the approved resident complement, and whether Holman pathway residents were expected to participate in the same number of procedures as residents in the traditional pathway. The members of ADROP asked for clarification from the RRC regarding these issues. At the January meeting of the Residency Review Committee in Radiation Oncology, these issues were debated. Below is a summary of the consensus reached at the RRC meeting. The information is also presented in the format of Frequently Asked Questions (www.ACGME.org). Resident complement The Committee felt that Holman pathway residents should be included in the total approved resident complement throughout their 4 years of training, during both clinical and laboratory training. The RRC acknowledged that some programs, depending on their structure and schedule, may have difficulty in maintaining an appropriate clinical training program for the remainder of the residents during a portion of the time a Holman pathway resident is in the laboratory. If the program director feels it would be in the best interest of the training program to increase the resident complement during this time, the program director may request from the RRC a temporary increase in resident complement. The program director should, in this situation, go through the usual channels for a temporary increase in resident complement, supplying the RRC with a written request, justification and the necessary medical data. This should be done at least 6 months in advance of the anticipated increase in complement. As with other temporary increases, the period of time should not exceed two years. It is the responsibility of the program director to outline specifically the length of time for the increase, and to outline the plan for returning to the original approved complement. Such requests should be endorsed by the institution’s designated director of the graduate medical education. Procedure and case load requirements For the traditional resident, current program guidelines for radiation oncology mandate a minimum of 150 external beam cases per year and a maximum of 250 cases per year for each resident, with a total minimum of 450 external beam cases simulated over the 4 years of training. The minimum number of intracavitary cases established is 10 cases performed and 10 additional cases observed over the 4 years of training. The minimum number of interstitial cases is 5 performed and 5 additional cases observed over the 4 years of training. A recently added requirement is the participation in a minimum of 6 cases of radiopharmaceuticals, radioimmunotherapy or unsealed sources over the 4 years of training. The resident is also expected to participate in no fewer than 12 pediatric cases. The Committee feels that all residents, including Holman pathway residents, should be required to meet the minimum requirements in the special procedures (interstitial, intracavitary and unsealed sources), as well as pediatric cases. For external beam cases over the course of the 27 months of clinical training, the committee has modified the minimum total number of external beam cases for Holman pathway residents to 350, with the same annual maximum of 250. |
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