The Holman Pathway presents an alternative residency structure for selected residents in radiation oncology.  In this Pathway, residents are 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 Holman Pathway is primarily designed for residents with an M.D./Ph.D. or an M.D. with a strong research background who have excellent clinical skills such that clinical competence can be achieved in this abbreviated time period.  Prospective candidates should have a documented history of research, ie, a specific research plan with a suitable research mentor and environment.  More information is available on the ABR website at http://www.theabr.org/

During a 2004 meeting of the Association of Directors of Radiation Oncology Programs (ADROP), several questions and concerns were raised about how the RRC interprets the residency guidelines when reviewing and monitoring programs with Holman Pathway residents.  Specifically, ADROP members asked 'how the Holman Pathway residents were viewed when the RRC assessed a program's approved resident complement', and whether Holman Pathway residents were expected to participate in the same number of procedures as residents enrolled in a traditional pathway.  The members of ADROP asked for clarification from the RRC regarding these issues. At the January, 2005 Residency Review Committee meeting these issues were discussed/debated.  Below is a consensus summary that was reached during the RRC's deliberations.  The information is also included as part of the RRC's FREQUENTLY ASKED QUESTIONS document.  (www.ACGME.org)

Resident Complement

The Committee believes that Holman Pathway residents should be included in the program's approved complement of residents throughout their four years of training, during both clinical and laboratory educational experiences.  The RRC has 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 determines it is in the best interest of the program to increase the resident complement during this time, the program director may request from the RRC a temporary increase in the resident complement.  In this situation, the program director should follow the usual procedures for requesting a temporary increase, providing the RRC with a written request (via the ADS system), justification, and necessary medical data as specified.  This information should be submitted at least six months in advance of the anticipate increase.  As with other temporary increases, the period of time should not exceed two years.  It is the responsibility of the program director to state the length of time for the increase, and to outline a plan for returning to the original approved complement.  Such requests should be endorsed by the Designated Institutional Official (DIO) prior to submission.

Procedure and Case Load Requirements

For the traditional resident, current program guidelines for radiation oncology mandate a maximum of 250 cases per year for each resident, with a total minimum of 450 external beam cases simulated over four years of the educational program.  The minimum number of intracavitary cases required is 15, to be performed over the four years of the program.  The minimum number of interstitial cases is five, performed over the four years of the program.  The resident is also expected to participate in no fewer than 12 pediatric cases.  A recent requirement addition is the participation of residents in a minimum of six cases of radiopharmaceuticals, radioimmunotherapy or unsealed sources over the four years of the program, and ten stereotactic radiosurgery cases.  In the coming year (pending approval of an effective date in 2011) a requirement for five stereotactic body radiotherapy cases will be added to the program requirements for Radiation Oncology residencies.

The Committee believes that all residents, including Holman Pathway residents, should be required to meet the minimum numbers of specified procedures (interstitial, intracavitary, stereotactic radiosurgery and stereotactic body radiotherapy, unsealed sources, and 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 cases.