Self Study

Self Study
Self Study
For
Accreditation by the
Commission on Accreditation of
Medical Physics Education Programs
(CAMPEP, Inc.)
by the
Radiation Oncology
Physics Residency Training Program
Scott & White Hospital and Clinic
Temple, Texas
Arthur L. Boyer, Ph.D.
Program Director
First Submission March 1, 2008
Revision October 27, 2008
Page 1 of 69
CONTENTS
I. PROGRAM GOAL AND OBJECTIVES...................................................................... 4
II. PROGRAM EVOLUTION AND HISTORY............................................................... 4
III. PROGRAM STRUCTURE AND GOVERNANCE ................................................... 5
IV. TRAINING REQUIREMENTS ................................................................................. 7
A. Requirements for Successful Program Completion ................................................... 7
B. Design and Content .................................................................................................... 8
C. Sample Training Plans ............................................................................................. 12
D. Evaluation of the Curriculum ................................................................................... 12
V. RESIDENTS .............................................................................................................. 12
A. Admissions .............................................................................................................. 12
B. Recruitment Efforts .................................................................................................. 14
C. Enrollment ................................................................................................................ 14
D. Evaluation of Resident’s Progress ........................................................................... 14
E. New Resident Orientation ........................................................................................ 16
F. Safety ........................................................................................................................ 16
VI. PROGRAM ADMINISTRATION ........................................................................... 16
A. Structure within Scott & White ................................................................................ 16
B.1 Role of Program Director ....................................................................................... 17
B.2 Role of Program Co-Director ................................................................................. 18
C. Committees and Meetings ........................................................................................ 18
D. Records Available for Review ................................................................................. 19
VII. RESOURCES .......................................................................................................... 20
A. Staff .......................................................................................................................... 20
B. Finances .................................................................................................................... 20
C. Facility ...................................................................................................................... 21
VIII Future Plans ............................................................................................................ 23
A Summary of Strengths and Needs ............................................................................. 23
B Further Developments and Improvements ................................................................ 23
Attachment 1: Program Supervision and Reporting Structure ........................................ 25
Attachment 2A: Letter of Support from Department ...................................................... 28
Attachment 2B: Letter of Support from Institution ......................................................... 29
Attachment 2C: EAC Approval ...................................................................................... 30
Attachment 3: Data on Clinical Medical Physics Residents Trained/Training to Date... 31
Attachment 4A: AAPM Placement Service Ad .............................................................. 32
Attachment 4B: Scott & White Medical Physics Residency Program Web-Site ............ 33
Attachment 5: Description/Application Materials Provided Prospective Candidates ..... 34
Attachment 6A: Example Interview Schedule ................................................................ 38
Attachment 6B: Clinical Medical Physics Residency Candidate Evaluation Form ........ 39
Attachment 7: Letter of Appointment from Scott & White ............................................ 40
Attachment 8: Resident Orientation Schedule ................................................................ 41
Attachment 9A: Resident Probation and Dismissal Policy ............................................. 43
Attachment 9B: Summary of Resident Policies .............................................................. 45
Attachment 9C: Compensation and Benefits .................................................................. 48
Attachment 10: Typical Radiation Oncology Physics Resident Rotation Schedule ....... 55
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Attachment 11: Radiological Physics Lecture Series Schedule. ..................................... 57
Attachment 12: Medical Physics Didactic Lecture Series .............................................. 61
Attachment 13: Physics Instruments ............................................................................... 62
Attachment 14A: Faculty Oral Examination Evaluation Form ....................................... 65
Attachment 14B: Resident Clinical Rotation Evaluation Form ...................................... 66
Attachment 15: Program Director’s Resident Evaluation Form ..................................... 67
Attachment 16: Resident Evaluation of Faculty ............................................................. 68
Attachment 17: Key Divisional Faculty .......................................................................... 69
Attachment 18: Faculty Biographies............................ Error! Bookmark not defined.71
Attachment 19: Competency-Based Rotations ............ Error! Bookmark not defined.87
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I. PROGRAM GOAL AND OBJECTIVES
The Scott & White Hospital Radiation Oncology Physics Residency Training Program is
intended to provide training in clinical radiation oncology physics. The targeted applicant
will have an appropriate M.S. or a Ph.D. and will be committed to preparing for a
clinically oriented career. Major objectives of the program include:
1. Provide a broad based, in depth training that will permit the graduate to
contribute immediately and independently to the quality of medical care received
by the radiation oncology patient. The residents will be assigned full time to
clinical training and educational activities.
2. Provide the graduate of the program with a Certificate of Completion from the
Scott & White Memorial Hospital and Scott, Sherwood and Brindley Foundation
and The Texas A&M University System Health Science Center College of
Medicine certifying that the graduate has satisfactorily completed a 24 months
residency in a CAMPEP accredited Radiation Oncology Physics Residency
Training Program.
3. Prepare the graduate for certification in the specialty of Therapeutic
Radiological Physics by American Board of Radiology.
Training will take place under the close supervision of an Administration Subcommittee
of the Medical Physics Education Committee of the Residency Program, comprised of
experienced radiation oncology physicists, dosimetrists, and radiation oncologists. The
program emphasizes all areas of training and experience that will be needed by a
radiation oncology medical physicist in a “state-of-the-art” radiation oncology treatment
facility.
II. PROGRAM EVOLUTION AND HISTORY
The Chair of the Radiology Department, Dr. Gill Naul, agreed to fund the initiation of the
program when Dr. Boyer joined Scott & White in 2005. On November 29, 2006 Dr.
Bruce Gerbi confirmed that CAMPEP would entertain an application from Scott &White
for a Physics Residency. The Senior Staff and Staff of the Physics Division began
planning the program. It was agreed that both diagnostic and therapy physicists would
participate in the program in recognition of the strong imaging emphasis in the current
practice of radiation oncology. An initial outline and draft of the Self-Study was
initiated. On May 17, 2007, the Scott & White Education Advisory Committee approved
the program and on May 22, 2007 the Scott & White Leadership Council and Board of
Directors approved the program. An invitation to apply for admission to the Residency
Program was listed in the AAPM Placement Service in May 2007. During the summer of
2007 candidates were interviewed for the first Residency position. Rebecca Weinberg
was selected by the Residency Review Committee from a pool of twenty applicants. On
August 31, 2007, The American Society for Therapeutic Radiology and Oncology
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(ASTRO) in conjunction with the American Association for Physicists in Medicine
(AAPM) selected the Scott & White Radiation Oncology Physics Residency Program to
receive the 2007 Radiation Oncology Physics Residency Training Award. A Program
Administrator, Alexandria Smiley, was recruited to Scott & White in September 2007.
The Radiation Oncology Physics Residency Training Program at Scott & White began
under the direction of Dr. Arthur Boyer in the Fall of 2007. Dr. Weinberg began her
residency on October 1, 2007.
III. PROGRAM STRUCTURE AND GOVERNANCE
The Radiation Oncology Physics Residency Training Program is an official program
under the auspices of the Texas A&M Health Science Center College of Medicine
Graduate Medical Education Program, the Scott & White Foundation entity that is
responsible for supervising and administering all residencies at Scott & White Hospital.
The Scott & White Director of Education reports to the Vice-Dean of the Texas A&M
College of Medicine who resides at Scott & White. At Scott & White, residency training
programs, both ACGME and non-ACGME, serve at the pleasure of the Department
Chairs. With the support of the Radiology Department Chair, the Physics Division’s
educational programs have received approval by the Scott & White Educational Advisory
Committee (Don Wilson, M.D., Chair). These programs include: (1) the Radiation
Oncology Physics Residency Training Program (2 year duration with 2 Scott & White
funded positions); and the Radiation Oncology Medical Dosimetry Training Program (2
year duration, one current student). The Education Advisory Committee duly considered
and approved the Physics Residency proposal May 17, 2007 and submitted it to the
Research & Education Council of the Scott & White Research and Education Department
for discussion and approval (see Attachment 2C). The request was approved by the
Research and Education Council was forwarded to the Scott & White Clinic Board and
Leadership Council where it was approved on March 22, 2007.
A formal letter from the requesting CAMPEP evaluation of the program is the cover
letter to this document (included as Attachment 2A).
The Radiation Oncology Physics Residency Program works alongside the Department of
Radiology Residency Program. The Radiology Residency Program accepts six new
physician residents per year and currently has 30 residents on staff. The Radiation
Oncology Physics Resident attends all physics lectures delivered to the Radiology
Residents. The Radiation Oncology Physics Resident attends appropriate selected noontime presentations for the Radiology Residents. There is no Radiation Oncology
Residency program at Scott & White. Radiobiology training is provided as distant
learning by John Ford, Ph.D. who holds a tenured appointment at the rank of Associate
Professor in the Department of Nuclear Engineering, Texas A&M University.
Scott & White began 105 years ago as the care provider for the Santa Fe Railroad. It
evolved into a state of the art diagnostic and surgical referral center serving most of
Central Texas. The Texas A&M University System College of Medicine became
affiliated with Scott & White in 1977, resulting in the excellent clinical training of a
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generation of physicians. The Scott & White Health Plan was born in 1981, and has
grown to serve over 186,000 members. Scott and White has had a strong Radiation
Oncology program throughout its history. It acquired a linear accelerator before the M.D.
Anderson Cancer and Tumor Institute. Scott & White Hospital and Clinic’s Radiation
Oncology Division provides services to patients in Bell County, Texas as well as patients
in six surrounding counties (outpatient as well as hospitalized patients). There is a total
of 4 staff radiation oncology positions allocated as follows: Temple, Texas (3) and
Killeen, Texas (1). Total external beam patient treatments range from 63-75 per day.
Brachytherapy and special procedures are provided in Temple. The Radiation Oncology
Division participates in national protocols including the Radiation Therapy Oncology
Group (RTOG).
The Physics Division includes 6 radiation oncology physicists (3 Ph.D. clinical and 3
M.S.), 3 dosimetrists, 3 diagnostic physicists, a technician, and 2 radiation oncology
physics residents. The Physics Division provides support for the Radiation Oncology
Division of the Radiology Department as well as support for all diagnostic equipment in
the Radiology Department. Services are provided at the main hospital in Temple, Texas
as well as in twenty regional clinics spread over a six county area. One of the senior
physicists (Philip Bourland, Ph.D.) serves as the Radiation Safety Officer for the Scott &
White Hospital as well as the regional clinics. The senior physicist along with three M.S.
physicists and the three dosimetrists support the Radiation Oncology Division of the
Radiology Department. An additional three M.S. physicists serve the diagnostic divisions
of the Radiology Department in Temple as well as in Scott & White hospitals and clinics
in surrounding counties. The Physics Division provides radiation oncology clinical,
educational and development services for Scott & White Hospital as well as the Killeen
regional practice. The physics residents have access to all personnel, equipment and
institutional resources, the same as any member of the physics staff. Statements of
support for Accreditation of the Scott & White Radiation Oncology Clinical Medical
Physics Residency are included (Attachment 2A and 2B).
The Radiation Oncology Physics Residency Program is supervised by a Medical Physics
Residency Education Committee composed of members of the Physics Division, the
Radiation Oncology Division, and the Radiology Department administration. The
Residency Education Committee provides general over-sight of the program. Its
members include the chairs of three subcommittees responsible for specific parts of the
Program (see further VI program Administration C. Committees and Meetings).
The Certificate of completion for the Residents completing the program is issued by the
Radiology Department. The Certificates are signed by the Vice-Dean of the Medical
School at Temple, Texas, the Chief Executive Officer of Scott & White Hospitals and
Clinics, the Director of the Radiation Oncology Division, and the Director of the
CAMPEP-accredited Radiation Oncology Physics Residency Training Program.
The curriculum follows the recommendations presented in AAPM Report Number 90,
"Essentials and Guidelines for Hospital-Based Medical Physics Residency Training
Programs." The Scott & White curriculum is built around ten competency-based
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rotations suggested by the AAPM Guidelines. The rotations focus on clinically relevant
processes. How the rotations are structured is described in Section IV. TRAINING
REQUIREMENTS: B. Design and Content. The review process for the Program is
described in Section IV. TRAINING REQUIREMENTS: D. Evaluation of the
Curriculum. The mechanism of recruitment and admissions of the Residents is described
in Section V. RESIDENTS: A. Admissions and B. Recruitment Efforts.
The Residents have access to the Scott & White Radiation Oncology Division facilities as
well as access to the Scott & White Radiology Department facilities under the
supervision of their rotation mentors. The mentors will be responsible for allowing the
Residents increased freedom to use clinical equipment, such as linear accelerators and CT
scanners, only in proportion to their ability to operate equipment without endangering the
equipment, themselves, or patients.
The Scott & White Radiation Oncology Physics Residency Programs is under the
supervision of a Program Director. The Program Director is responsible for coordinating
the faculty, recruiting and advising the residents and evaluating and promoting the
program. A description of the Program Director’s duties and role in the program
administration is described in Section VI PROGRAM ADMINISTRATION: B. Role of
Program Director.
IV. TRAINING REQUIREMENTS
A. Requirements for Successful Program Completion
The clinical training is designed to cover the major training for Radiation Oncology
Physics as outlined in AAPM Report No. 90, “Essentials and Guidelines for Hospitalbased Medical Physics Residency Training Programs” published in August 2006. The
twenty-four month program consists of activities intended to provide the Residents the
following training:
1. The Resident is expected to become competent in all areas related to the safe and
efficacious use of ionizing radiation for the evaluation, planning, and treatment of human
disease; this is accomplished in part through structured and evaluated clinical rotations.
2. The Resident is expected to complete structured rotations that include written
summaries/reports quarterly and at the completion of the rotation. Evaluations will occur
throughout each rotation in one to one and group settings. The faculty will attest by their
signature that the Resident has achieved proficiency in each Radiation Oncology Physics
process in the rotations.
3 The Resident will present, review and defend his/her knowledge of a given rotation
subject in quarterly (i.e., three month intervals) oral based sessions with the residency
program faculty.
4 Pass or fail grades will be based on the results of ongoing irregularly scheduled
informal oral evaluations and formal oral evaluations scheduled every three months. If
the Resident obtains an unsatisfactory performance rating in a specific area during a three
month oral examination, they will be given the opportunity to be reexamined during the
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next three month exam. A “Satisfactory” score will be required from the faculty
examiners at the three months formal oral examinations on all rotations. A “Satisfactory”
score in the Program Director’s evaluation in all rotations will be required to obtain a
Certificate.
5 The Resident is expected to obtain an appropriate mastery of the physical principles
(e.g. interactions of radiation with matter, radionuclide decay therapy, etc.) associated
with the use of radiation in treatment of human malignancy.
6 The Resident is responsible for obtaining a level of training in anatomy (see description
of on-line Dosimetry Training Tool in the Didactics paragraph below), computer
technology (see course outline of Diagnostic Radiology lecture series) and diagnostic
imaging (see Imaging Rotation) appropriate for a position as a Therapeutic Radiological
Physicist. This is primarily accomplished during the clinical dosimetric treatment
planning rotation and didactic courses on these topics.
7 The Resident will demonstrate knowledge sufficient to ensure she/he can manage the
radiation safety aspects of a Radiation Oncology practice (see Radiation Safety Rotation).
8 The Resident is expected to attend selected Radiology Department conferences, all
scheduled Radiation Oncology chart rounds, and all Physics Division meetings.
9 The Resident will understand the potential uses of and hazards associated with ionizing
radiation and high voltage electronics as used in the practice of radiation oncology.
10 The Resident will understand radiobiological principles of the use of radiation through
both didactic and practical training. An on-line training course will be taken by the
Resident that will contain a final examination.
During the first week of orientation, a skills assessment examination will be administered
to the resident. The Resident will take the pre-tests in the on-line Dosimetry Training
Tool (DTT). The first 22 modules of the DTT cover sufficient material to provide an
assessment of the new Resident’s grasp of fundamentals. The DTT program scores the
Resident’s responses. The scores are available on-line to the Director. The scores in
each area will be used to set the amount of directed reading, web-based training, and oneon-one tutoring for the duration of the residency.
B. Design and Content
Rotations
The elements of the clinical training in the residency are consistent with
recommendations presented in AAPM Report Number 90, “essentials and Guidelines for
Hospital-Based Medical Physics Residency Training Programs.” The training program
structures the twenty-four month experience into ten one-on-one mentored rotations
(Attachment 19) that are designed to provide clinical training and produce a series of
reference documents that are evaluated by the graduate faculty through oral exams during
each rotation.
1
2
3
Rotation Topic
Detectors and Dosimeters
Radiation Safety
Treatment Equipment
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4
5
6
7
8
9
10
Imaging
Conventional Simulation
CT Simulation
Patient Treatment
IMRT
Brachytherapy
Other Duties
In this revision, the fine structure of the rotations is based on clinical procedures and
processes carried out routinely at Scott & White. Objectives and sign-off documents for
the rotations are provided to the Resident during the Resident Orientation. Throughout
the program, the Residents rotate with medical physicists for evaluated clinical
experience. As the Resident moves through the structured training in each major
category, a number of activities will be occurring in parallel. This is done to best suit the
needs of the individual Resident and to coincide with major clinical activities such as
machine installation and commissioning and presentation of a tumor at a particular site.
For example, a Resident might be working on dosimeters and treatment planning for a
specific site, while also getting 1-2 days per week exposure to a special procedure such as
HDR or prostate implants. Concomitant rotations lead to some scheduling and evaluation
challenges, but provide an opportunity for the Resident to learn skills and process in an
incremental and holistic fashion. Material learned in one rotation augments and
compliments material in other rotations. The Resident is afforded opportunities for
remediation of weaknesses in the acquisition of skill sets throughout the Residency.
Rotation Outline and Structure
There will be three essential phases of mentoring in each rotation:
I) Initial observation, discussion and reading. A bibliography will be provided for
the resident to read consisting of book chapters, salient papers, and web-based
instruction. At the same time the Resident will observe and receive explicit
instruction on why, how, what with attention to making sure the resident
understands the fundamental aspects of the current rotation. There will be a
meeting with at least one of the Physics Faculty members at the end of Phase I to
review/document assessed resident progress. The Resident’s rotation log will be
signed by the mentor, documenting progress.
II) Engaged in the rotation, but closely supervised, the resident will work hand in
hand with the mentor, performing the tasks under direct supervision. This phase
develops the confidence in the resident’s ability to carry out the process. There
will be a meeting with at least one of the Physics Faculty members at the end of
Phase II to review/document assessed resident progress and sign the Resident
rotation log.
III) During the final phase of each process within a rotation, the resident will
perform the duties as an independent medical physicist, using the mentor as a
consultant for questions. It is our policy not to allow persons to perform clinically
significant duties without some documentation of competence. The three-phase
rotations provide a means by which one or more senior physicists examine the
candidate with the goal of determining competency to carry out the technical
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necessities as well as understanding their basis. The mentor will evaluate the
resident on the level of competence developed at this stage of the residency. For
many rotations, a deliverable in the form of a written report or document,
formatted data, or computer print-outs will be specified. The Resident’s rotation
log will be signed and annotated as above at the end of Phase III.
The Residents will be evaluated at three month intervals as described in SECTION V.
RESIDENTS. D. Evaluation of Resident’s Progress
The Resident and the Program Director will agree upon an order in which the Resident
will carry out each Phase of each Process in each Rotation. In some instances all Phases
of a Process may be completed in a given quarter. In other instances, a separate Phase
may be carried out in separate quarters. For example, the Resident will study the Scott &
White Radiation Safety Regulations and take an exam on them in the first quarter. On
the other hand, since the annual linac QA process only occurs one a year on each
machine, the Resident will not be scheduled to perform Phase III of that process (carrying
out an annual QA on their own) until about the sixth quarter, depending on the scheduling
of the annual linac QA procedures. In general Radiation Safety, Detectors and
Dosimeters, Brachytherapy, and Treatment Equipment Processes are scheduled toward
the first half of the Residency, and Patient Treatment, IMRT, and Other processes are
loaded toward that latter half of the Residency. Imaging and Simulation processes tend
to be evenly distributed. The schedule us reviewed each week by the Program Director
and the Resident. The Program Director adjusts the schedule in response to the
Resident’s progress, opportunities to engage in Processes, and other factors such as
availability of the Faculty, illnesses, annual meetings, and unanticipated difficulties the
Resident may be having.
The program requires teaching and seminar presentation. These include teaching 3-4
lectures per year in the medical dosimetrist training program, teaching 5 lectures per year
in the diagnostic radiology medical resident physics program and the preparation of webbased training material.
Didactic Education
The one-on-one mentoring structure offers an excellent opportunity for “tutoring” with
the faculty of the Physics Division. Additional didactic opportunities include:
1) Anatomy for Treatment Planning – Offered on-line through the Medical Dosimetrists’
Training Tool. The Resident will take a set of pre-quizzes before working through the
anatomy material on-line. When the Resident has completed the material, they will take
a post-quiz. If the resident scores less than 75% correct answers on the post-quiz, they
must repeat working through the material and take the post-quiz until they score a postquiz grade of greater than 75%.
2) Radiation Biology – offered annually as distant learning provided by the Department
of Nuclear Engineering of the Texas A&M University. The Residents must receive a
Pass score. Residents failing to pass the radiobiology test will be given oral exams until
the examiners are satisfied with their performance.
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3) Radiation Oncology Physics for residents – a two-year long course taught to physics
residents by the Physics Division staff. One lecture is given each week. Each lecture is
scheduled for one hour. This course consists of a series of approximately 100 lectures
(Attachment 12). At present, the Program Director is the primary lecturer. Other faculty
give lectures on specialty areas. The lectures follow the Review of Radiation Oncology
Physics: A Handbook for Teachers and Students, developed by Ervin Podgorsak for the
International Atomic Energy Agency. The lectures amplify and augment the material in
the IAEA curriculum. Comprehension on this material will be tested during the oral
exams. The Program Director will pose questions to the Resident that come directly from
the lectures.
7) Oncology Core curriculum – Offered on-line through the Medical Dosimetrists’
Training Tool. A post-quiz score of 75% will be required.
8) Imaging physics for Radiology residents. A series of 46 lectures on basic physics for
each imaging modality based on “The Essential Physics of Medical Imaging” by
Bushberg et. al. taught by the Physics Division staff. The Resident will take the same
post-lecture quizzes as are taken by the Diagnostic Radiology Residents. An average
post-quiz score of 70% will be required. If Residents fail to achieve this goal, they will
be required to review the material before taking a remedial test. If the Resident cannot
pass the diagnostic radiology test, an oral examination group composed of Program
faculty will test the Resident and make recommendations for further study. After a
second oral exam the group will make a recommendation to the Program Director on the
Resident’s suitability for certification.
Each resident will be given an external disk drive with which to build their own library of
documents and computer programs. File on the Scott & White intranet dedicated to the
Residency Program contains material to be used to prepare for the lectures and rotations.
At the end of the Residency Program each Resident’s disk drive is expected to provide
the Resident with a set of tools for their professional careers and a foundation for lifelong learning continuing education.
The Residents are required to acquire Khan’s “Physics of Radiation Oncology” and Van
Dyk (Editor) “The Modern Technology of Radiation Oncology”.
Scott & White provides oncology management through Tumor Boards. These Boards
meet weekly. The Residents will be scheduled to attend these conferences as part of the
“Patient Treatment” rotation, and to author written reports to their advisors on cases
discussed and terminology used.
The departments engaged in cancer management have available regularly scheduled
seminars and conferences which the residents attend. These include:
• Journal clubs. The residents will attend journal clubs in Radiology, Medical Oncology,
and Radiation Oncology a minimum of 8 times per year. Once every six months, under
the mentorship of the medical physics faculty, a physics resident will present an article in
journal club.
• Physics Division meetings – 2 meetings per month scheduled depending on holidays.
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C. Sample Training Plans
The rotation descriptions and sign-off forms are included in Attachment 19 for all ten
rotations. In addition, a typical schedule for a two year rotations is included in
Attachment 10.
D. Evaluation of the Curriculum
The initial structure and content of the residency at Scott & White was developed using
the CAMPEP “Guidelines for Accreditation of Residency Education Programs in
Medical Physics” Revised: November 2006 and AAPM Report Number 90, “Essentials
and Guidelines for Hospital-Based Medical Physics Residency Training Programs.”
After each set of two oral exams at the end of the three month intervals, the Program
Director will review the exam reports prepared by the Faculty and the Residents. The
Program Director will prepare a report for the Administration Sub-Committee in which
he will summarize the stated strengths and weaknesses of the program contained in the
comments in the oral exam reports. The Administration Sub-Committee will convene to
review the Program Director’s report. The Program Director will propose modifications
to the residency Program with the intent to improve the Program. After appropriate
discussion and consideration, the Program Director and the Administration SubCommittee will chose feasible modifications. These modifications will be implemented
in the next three month period and/or documented for other periods of the Program.
Current Residents will be informed of any changes in the completion requirements. Any
changes in the completion requirements will be put in the description of the Program
provided for incoming Residents.
V. RESIDENTS
A. Admissions
The Radiation Oncology Physics Residency Program applicants must demonstrate having
have acquired a strong foundation in basic physics. This shall be documented by a
Master’s or Doctoral degree in medical physics, physics, engineering, mathematics, or
other science with physics training equivalent to a minor in physics (upper level courses
in electricity and magnetism, quantum mechanics, atomic structure, statistical mechanics
and mechanics). Recruiting will begin in the first calendar quarter (see C.2. Recruitment
Efforts). Following a response to recruiting advertisements, the Program Director will
contact applicants and discuss the program, their interests and what information they
might need. Subsequent to this conversation, the resident applicant will receive the
following (Attachment 5).
1.
2.
3.
4.
Prospective Candidate Program Description (see below)
Application Form (see below).
The AAPM document “The Medical Physicist”
The AAPM document “The Roles, Responsibilities, and Status of the Clinical
Medical Physicist”
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5. The AAPM Report No. 90 “Essentials and Guidelines for Hospital-Based Medical
Physics Training Programs”
The application and supporting materials are returned to the Radiation Oncology Physics
Residency Program Administrator for gathering of all support information. When an
application is considered complete (including letters of recommendations and transcripts
of graduate school work) by the Radiation Oncology Physics Residency program
Administrator, it is forwarded to the Radiation Oncology Physics Residency Director and
members of the Candidate Selection Sub-Committee (Attachment 1) for review. The
Candidate Selection Sub-Committee meets to select a short list of three to four
candidates. These selected candidates are invited to come to Temple, Texas with Scott &
White Clinic providing one nights lodging.
The Candidate interviews with key members of the Radiation Oncology Division and the
Physics Division (Attachment 6A). The Program Director will spend 60 minutes
reviewing the Scott & White Program. The interviewers will each spend a minimum
one-half hour to interview and to rank the candidates. Evaluation is done using a
standardized form (Attachment 6B) filled out by each of the interviewers. Each
candidate has lunch with current and/or past residents and junior staff (Attachment 6A) if
possible. At the completion of the interview process (in the second calendar quarter), the
Program Administrator distributes packets to the Candidate Selection Sub-Committee
containing the information on the Candidates on the short list and the Candidate’s
evaluation forms. The Candidate Selection Sub-Committee meets to rank the candidates.
Resident selection is done consistent with the Scott & White Graduate School of
Medicine stated policy, i.e., “Programs must select from among eligible applicants on the
basis of their preparedness, ability, aptitude, academic credentials, communication skills,
and personal qualities such as motivation and integrity. Programs must not discriminate
with regard to sex, race, age, religion, color, national origin, disability, or veteran status”.
The Program Director contacts the highest ranked candidate to make a verbal offer. If the
Candidate makes a verbal commitment to accept the offer, the recommendation is
forwarded to the Scott & White Graduate School of Medicine who reviews the material
and issues the official offer letter (Attachment 7). The Candidate is given an “acceptance
by” date. When the position is filled, the remaining candidates are notified. Our policy
is to answer forthrightly inquiries from the non-top candidates if they need to know their
status. The new resident is expected to report at Scott & White in near the end of June.
Should a Candidate be selected whose background does not meet the requirements in
medical physics, they would be notified that they would be required to engage in a course
of remedial didactic training during an initial six months probationary period of the
residency. The Candidate would be required to read The Physics of Radiation Therapy
by Kahn. In addition the candidate would be required to review Radiation Oncology
Physics: A Handbook for Teachers and Students that can be accessed over the internet at:
http://www-naweb.iaea.org/nahu/dmrp/slides.shtm
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At the end of the probationary period, the Program Director will administer a written
examination on the material in these sources. Should the Candidate score below 75% on
this examination, they would not be admitted into the Residency Program and their
employment at Scott & White would be terminated.
The Radiation Oncology Physics Residency program at Scott & White was initiated with
a single student in October 2007. As of the date of this self-study, no students have
finished the program.
B. Recruitment Efforts
Recruitment is utilizes an ad in the AAPM Placement Bulletin (Attachment 4A). This is
accessible from the AAPM website and is e-mailed to AAPM members. The Scott &
White Graduate School of Medicine website has the Radiation Oncology Physics
Residency listed (Attachment 4B). A third way of publicizing the Program has been to
write letters to Medical Physics Graduate Program Directors and chairs of physics
departments at selected universities.
C. Enrollment
The Radiation Oncology Physics Residency has two Scott & White positions funded for
the academic years 2007-2008 and 2008-2009 by the Radiology Department. The intent
is to have overlapping two year residencies. The current status of our residency positions
are:
•Position 1: Rebecca Weinberg, Ph.D. began October 1, 2007. She completed her Ph.D.
at the Graduate School of Biomedical Science at the M.D. Anderson Cancer Center. Dr.
Weinberg has begun the rotations of the Physics Residency under the supervision of
mentors listed in the rotation documents.
•Position 2: Junfang Gao, Ph.D., began July 1, 2008. Dr Gao completed a Ph.D. in
Physics at the University of Missouri in Rolla and a Post-doctoral Fellowship at the M.D.
Anderson Cancer Center before entering the Residency program. Dr. Gao has begun the
rotations of the Physics Residency under the supervision of mentors listed in the rotation
documents.
D. Evaluation of Resident’s Progress
Irregularly Scheduled Oral Examinations
Residents are evaluated in a number of ways. The Program Director and rotation mentors
meet one-on-one at least twice per month to help the resident focus and evaluate their
progress. These are informal one-hour meetings that are very useful in providing
guidance (at the beginning) and praise/criticism as the residency progresses. The mentor
attests to the Resident’s progress by initialing a completion status for the Phase I, Phase
II, and Phase III parts of each process in a given rotation (see Section IV. TRAINING
REQUIREMENTS. B. Design and Content).
Page 14 of 69
Report Structure and Oral Evaluation
Major written evaluations occur once every three months. Each resident will maintain a
resident log, where activities for each process in a rotation will be logged. These will be
discussed and reviewed with the primary mentor during day-to-day or weekly meetings.
Once every three months (eight times in the Residency), the Resident and faculty will
hold oral exams on the areas covered during the previous three months of the rotation.
Throughout the three month period the Resident will be preparing a digital document
summarizing and documenting the material covered in each rotation. Since the rotations
are concurrent rather than sequential, the Resident could be preparing digital documents
on as many as 10 topics at once. The digital documents will contain a variable amount of
material depending on the rotation. For example, the document may contain copies of the
results of monthly machine checks, the results of IMRT QA measurements, and copies of
selected print-outs of practice external beam treatment plans. The Program Administrator
will schedule oral exams with the examiners and the Resident. At least one week before
the scheduled examinations, the Resident and the Program Administrator will distribute
copies of the Resident’s digital documents to assigned oral examiners. The Resident will
take two oral exams during last two weeks of each three month period. Each of the two
exams will deal with roughly one-half of the rotation topics covered during the previous
three months. In the oral exams the resident will orally summarize what they
accomplished during the last three months of the rotations. The presentation will be
followed by a 1.5 hour - 2 hour oral exam attended by at least 3 of the Physics Faculty
members. The examiners will include faculty that mentored the Resident during the
rotations as well as faculty that did not. At the conclusion of the examination the
examiners will complete a Resident Oral Evaluation Form (Attachment 14A) and the
Residents will complete a Resident Clinical Rotation Evaluation Form (Attachment 14B)
and a Resident Evaluation of Faculty (Attachment 16). These evaluations provide an
opportunity for the Resident to critique the form and content of the rotation as well as the
mentorship of the faculty. The forms completed by the Faculty and the Resident are kept
on file by the Residency Program Administrator in a secure and confidential location.
The Evaluations will be reviewed by the Program Director who will prepare a three
months summary of the Residents’ progress (Attachment 15). During the course of the
two-year program, a Resident will prepare eight digital documents each containing as
many as 10 topic sections. In practice the number of topics in each document will be
lower since some rotations will be dormant in a given six month period.
Should a Resident receive “Unsatisfactory” scores on two consecutive oral examinations,
the Program Director would call a meeting of the Residency Administration SubCommittee to review and discuss the Resident’s performance. The Administration SubCommittee would determine whether remedial actions would be undertaken or whether
termination of the Resident should be considered. Should a majority of the
Administration Sub-Committee elect to terminate the Resident, Scott & White
institutional disciplinary procedures for failing residents would be followed that are given
in Attachment 9A.
From its inception, the program has implemented a reverse evaluation process whereby
the resident can evaluate both the form and content of the Physics Residency (Attachment
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14B) and the Resident’s mentors (Attachment 16). These evaluations are reviewed and
integrated into the Program Directors three months progress report. Revisions of the
Residency form and content proceed from discussions of these reports by the
Administration Sub-Committee.
E. New Resident Orientation
Orientation for a new Resident covers three days. It would be inappropriate for Radiation
Oncology Physics Residents to participate in the Scott & White Graduate Medical
Education orientations for physician residents. Instead, the Physics Residents attend a
day-long orientation for non-medical staff provided by the Scott & White Human
Resources department. The orientation covers such areas as Healthy Back, Risk
Management & Basic Patient Rights, Corporate Compliance, Identifying Victims of
Abuse, Employee Handbook Overview, Health Benefits, and Employee Health Services,
and Infection Control. Also, a series of operational aspects (library card, Employee ID,
film badges, access cards) are simultaneously carried out. The Program Director spends
two hours briefing the Resident on program’s requirements, Resident administrative
procedures, all training expectations, and all behavioral expectations. A written test is
administered to the resident to assess their knowledge of medical physics going into the
Residency. The Resident spends time with each of the mentors responsible for the ten
rotation subjects. Additional administrative actions are taken such as initiation of the
Resident’s account on the Scott & White network and integration of the Resident’s
security profile into the network user groups.
F. Safety
As part of their orientation, Residents are issued a personal radiation exposure monitor.
The personal monitor issuance includes a radiation safety overview. Extensive radiation
safety issues are covered during the Radiation Safety Rotation. During orientation,
Residents are required to read the basic safety warnings provided by the medical linear
accelerator vendor. Residents are required to read the Clinac Safety Manual (Varian
Medical Systems P/N: 01104957-01) and review its contents with a mentor. Working
with high voltages, hazardous materials, and basic safety are covered in this training.
The Residents are introduced to the emergency exit maps during orientation and
participate in routine fire drills.
VI. PROGRAM ADMINISTRATION
A. Structure within Scott & White
The Radiation Oncology Physics Residency Training Program is an official program
under the auspices of the Texas A&M Health Science Center College of Medicine
Graduate Medical Education Program, the Scott & White Foundation entity that is
responsible for supervising and administering all residencies at Scott & White Hospital.
The Radiation Oncology Physics Residency Program has been approved by the Scott &
White Educational Advisory Committee. The Education Advisory Committee reports
Page 16 of 69
program requests that it has considered and approved to the Graduate Medical Education
Committee. A duly considered and approved proposal is submitted to the Research &
Education Council of the Scott & White Research and Education Department for
discussion and approval (see Attachment 2C). The request approved by the Research &
Education Council was forwarded to the Scott & White Clinic Board and Leadership
Council that approved the Program on March 22, 2007.
The Radiation Oncology Physics Program Director reports to the Director of Graduate
Medical Education who in turn reports to the Vice Dean of the Texas A&M College of
Medicine and who also serves as Chief Academic Officer for Scott and White. The Scott
& White Graduate School of Medicine routinely conducts audits of all their accredited
programs at a point halfway through the period for which accreditation was granted. This
is conducted by an experienced group of internal examiners and will meet the very high
standards used to audit world-renowned medicine residencies.
Residents’ stipends, benefits and absences are identical to that of medical residencies.
They are officially listed as Ph.D. Fellows in the Scott & White Graduate School of
Medicine. However, this is a bookkeeping terminology and is due to the distinction from
having one-on-one responsibility for patient care decisions. For all intents and purposes,
Physics Residents are treated as “Residents”.
The Physics Division is a division of the Radiology Department. The Physics Division
bears clinical responsibilities to all the Divisions of the Radiology Department including
the Radiation Oncology Division. The faculty of the Radiation Oncology Physics
Residency Program is drawn from the entire Physics Division. Approval to invest time in
teaching the Radiation Oncology Physics Residents is at the pleasure of the Radiology
Department Chair and has been granted. Members of the Physics Division involved in
teaching in the Residency Program have access to all the equipment in the Radiation
Oncology Division as well as access to the diagnostic imaging equipment as part of their
routine clinical responsibilities.
B.1. Role of Program Director
The Program Director is responsible to all reporting entities to conduct the program in
accordance with all Scott & White Graduate Medical Education Program expectations.
The Radiation Oncology Physics Residency Training Program Director is the Physics
Division Director, Arthur L. Boyer, Ph.D. The Program Director is responsible to the
Chair of the Radiology Department who bears ultimate fiscal responsibility for the
Program. Furthermore, the Residency Director is responsible for ensuring that all locally
established guidelines are adhered to. The Resident’s experience must conform to the
training plan and it is the Program Director’s responsibility to ensure that all aspects of
training are given and that the resident achieves the expected level of competencies by
the completion of the Program. Future Residency Program Directors will be selected by
the Steering Sub-Committee with approval by the Radiology Department Chair.
Page 17 of 69
The current Residency Program Director is Arthur L. Boyer, Ph.D. Dr. Boyer has held
appointments in Radiation Oncology Departments at major academic medical centers
since 1971. He has been an active participant in physician Radiation Oncology
Residency Programs at every appointment. Between 1992 and 2007 Dr. Boyer directly
supervised or served on the advisory or supervisory committees of 13 M.S. and Ph.D.
students, and supervised twelve Post-Doctoral Fellows. Dr. Boyer served as PI for NCI
grant R25 - CA 89178 to development a web-based tool for Medical Dosimetrist mentors.
Twenty-four modules were developed. Each module contains between 3 and 26 sessions.
Over 1100 users, including over 800 students have been registered with the dosimetry
training tool, with a steady increase in the number of users throughout the program
development.
B.2. Role of Program Co-Director. A Co-Director will be appointed by the Program
Director with the assent of the Steering Sub-Committee and approval by the Radiology
Department Chair. The duties of the Co-Director will include chairing subcommittee
meetings, signing Time Capture Forms for Medical Physics Residency, and resolving
Resident rotation scheduling problems in the absence of the Director. The Co-Director
will serve as a review editor for the Self-Study document. The Program Co-Director will
be a board-certified medical physicist with at least five years of experience. In order to
facilitate the strong diagnostic component of the Scott & White Radiation Oncology
Physics Residency Program, it would be desirable for the Co-Director to have experience
in diagnostic radiology.
C. Committees and Meetings
Program administration is the responsibility of the Program Director (Arthur Boyer,
Ph.D.) chairing an executive program committee that oversees three subcommittees, the
Physics Residency Steering Sub-Committee, the Candidate Selection Sub-Committee,
and the Residency Administration Sub-Committee.
The Steering Sub-Committee for the Radiation Oncology Physics Residency provides
oversight for strategic and fiscal aspects of the Program. The Steering Sub-Committee is
chaired by the Executive Director of Imaging. Members of the subcommittee are the
Program Director, the Director of the Radiation Oncology Division, the Scott & White
Hospital Radiation Safety Officer, the Assistant Executive Director of Finance
Administration of Scott and White Hospital, and an Associate Radiological Physicist in
the Physics Division. The Steering Sub-Committee meets twice a year to review the
program and the progress of the Residents with the Physics Residency Program
Administrator keeping minutes. The Steering Sub-Committee reviews the financial
structure of the Program and sets the number of Residents the program can accept each
year. If needed the Steering committee will act as a conflict resolution body. All
personnel issues are confidential.
The Candidate Selection Sub-Committee acts as an admissions committee to interview
and evaluate prospective applicants. It meets annually to administer advertising,
evaluation of applications, selection of a short list, interviewers of candidates on the short
Page 18 of 69
list, and final selection of new residents. The number of new positions it will fill is
determined by the Steering Sub-Committee. The Program Administrative Director
records minutes of all meetings. All discussions of candidates are confidential.
Residency Administration Sub-Committee is chaired by the Program Director. Members
are the Physics Residency Administrative Director, and managers of the ten competencybased rotations: Detectors and Dosimeters, Radiation Safety,Treatment Equipment,
Imaging, Conventional Simulation, CT Simulation, Patient Treatment, IMRT,
Brachytherapy, and Other Duties. The Sub-Committee meets informally on an irregular
basis to administer the Program. The Program Director meets with the Rotation
Managers sitting as the Residency Administration Sub-Committee each quarter following
formal oral examinations to review the progress of the students and the results of oral
examinations. The Program Administrative Director records minutes. These minutes are
transmitted to the Steering Sub-Committee. All evaluations and discussions of students
are considered confidential information.
D. Records Available for Review
The following records will be kept by the Resident Program Administrator in locked file
cabinets in the Physics Division office (paper copies). Digital records will be stored on a
secure disk associated with the Program Administrator’s Scott & White personal
computer. Copies of the digital documents will be made as needed on the secure disk
under the control of the Program Director. Paper copies of documents will occasionally
be distributed to the Program Director and (during the Resident selection process) to
members of the Candidate Selection Committee.
(1) Radiation Oncology Physics sub-committee minutes including
i. administrative activities of the Steering Sub-Committee
ii. applicant selection activities of the Candidate Selection
Sub-Committee
iii. residency program development reviewed by the
Administration Sub-Committee
(2) Resident Applications
i. application forms
ii. transcripts
iii. candidate interview evaluations
(3) Residents
i. rotation objectives and expectations
ii. rotation procedure schedules
iii. rotation procedure completion signature sheets
iv. oral examination evaluations
v. didactic training grades
All permanent records are kept in the office of the Program Administrative Director. A
copy of the Self-Study will be accessible through a server on the Scott & White intranet.
The rotation descriptions as well as ancillary documents used during the rotations will be
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accessible to the Residents on the same server. Each Resident will keep a personal copy
of their rotation schedule and their rotation process signature documents.
VII. RESOURCES
A. Staff
The Radiation Physics Division members are deeply committed to this program. The
Residency Administration Committee Members all have appointments at the Scott &
White Hospital and the three senior members (Boyer, Bourland and Mistry) have
appointments at Texas A&M University (MSc and PhD programs) and Texas A&M
University School of Medicine. Most members of the Radiation Physics Division staff
and the Radiation Oncology Division staff are expected to participate in the education of
the Physics Residents. The Residency is organized around Competency-Based Rotations.
Each Rotation is administered by a member of the Residency Administration Committee.
The administrative commitments are as follows:
Chair: Art Boyer, Ph.D., Program Director
Alexandria Smiley, Administrative Director
Vitthalbhai Mistry, Ph.D., Detectors and Dosimeters Rotation
Philip Bourland, Ph.D., Radiation Safety Rotation
Jason Shoales, M.S., Treatment Equipment Rotation
David Jones, M.S., Imaging Rotation
TBN, M.S., Conventional Simulation Rotation
Wei Tang, M.S., CT, Simulation Rotation
Karen Stumph, CMD, Patient Treatment Rotation
Art Boyer, Ph.D., IMRT Rotation
Pasquale Montanaro, M.S., Brachytherapy Rotation
Art Boyer, Ph.D., Other Duties
Resident offices are proximal to the clinical physics staff offices. Attachment 17 lists the
faculty which includes Ph.D. Faculty, clinical Medical Physics staff and Dosimetry staff.
Attachment 18 contains individual Biographies of the associated faculty. All members of
the Division contribute in significant ways to the cumulative education of the Resident.
This is especially true in the horizontal work group atmosphere here at Scott & White.
Physics Division staff members are always accessible and available to discuss issues with
the Resident. In general, there is a faculty-to-resident ratio of about 6:1.
B. Finances
The Scott & White’s Radiation Oncology Physics Residency Training Program is funded
for its first two years of operation by the Radiology Department. When the program
becomes eligible for CMS funding by virtue of accreditation by CAMPEP, it will be
funded by CMS by direct requests from the Finance and Operations Department of Scott
& White Hospital. We do not anticipate any problems with continuing indefinitely with at
least two positions as long as the program can attract qualified candidates. Although the
program is approved by the Research and Education Department of Scott & White, the
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R&E Department takes no fiscal responsibility for the program. The current stipend for
Residents is: Training Level – 1 $ 41,601.48; Training Level – 2 $ 42,749.52. In
addition to direct compensation, the Physics Residents are afforded benefits and absences
identical to the medical residents (See Attachment 9C). The Radiology Department
policy is to provide travel and per diem for a professional trip during the residency if the
Resident has had an abstract accepted for oral presentation. The Physics Division pays
for a junior membership in AAPM. The Institution has a variety of other support services
available.
Typical Financial Support / Burden for Medical Physics Residents:
Support: Over $40,000/year
Burden: Over $11,000/year
C. Facility
Resident Offices, Class Rooms and Conference Rooms
Each resident has an office area located within the Physics Division. They are provided
with a computer (with Microsoft Office Suite) with network connections, a Scott &
White email account, storage, telephone, pager and office supplies. The Residents have
access to departmental copying machines and document scanners. The Radiation
Oncology Physics Residency Administrative Director is available to assist them in any
way possible including submitting paperwork for absences and trips. The Resident’s
offices are new, clean, quiet and equipped with modern office furniture. The Division has
access to three areas for conferences and teaching in the Radiology Department. Both of
these are equipped for data projection from networked computers.
Clinical Facilities, Laboratories and Shops
The Radiation Oncology Division Facilities:
Three Clinac 2100 class linacs (6MV/18MV) with millennium multi-leaf
collimators and IMRT interfaces (Varian Medical Systems) Provides
IMRT and stereotactic radiosurgery.
Two Ximatron simulators (Varian Medical Systems).
Two Computerized Radiography Readers (Kodak). Provide digital port films and
patient position verification with Acculoc software.
HiSpeed FX/I spiral CT scanner (General Electric Medical Systems). Network
interfaces to PACS system and Eclipse servers.
Maximar superficial x-ray unit (General Electric Medical Systems)
Multi-ACCESS information management system accessible through 25 floating
licenses (IMPAC Medical Systems). Provides support for IMRT
including patient-specific QA.
Eclipse Treatment Planning Systems supported on 6 planning workstations, 4
physician workstations, and 2 servers (Varian Medical Systems). Provides
treatment planning for IMRT and brachytherapy.
Plato Brachytherapy workstation and HDR after-loader (Version 14.3.3)
(Nucletron Corporation). Provides treatment planning for HDR.
Page 21 of 69
X-knife RT and Image Fusion workstation (Integra Radionics, Inc.). Provides
treatment planning for stereotactic radiosurgery.
Variseed seed implant workstation (Varian Medical Systems). Provides treatment
planning for prostate seed implants.
Small dedicated instrument workbench with tools.
The Radiology Department:
CT Scanners:
Siemens Definition Dual Energy CT
Siemens Somatom Definition Dual Source 128
Siemens Sensation Cardiac 64 Siemens Sensation 64
Siemens Sensation 16
MRI Scanners
Siemens Magnetom Trio, 3.0T with TIM Technology
Siemens Magnetom 1.5T Avanto
Siemens 1.5T Espree System
Nuclear Medicine
Phillips PRISM 3000
Phillips PRISM 2000(2)
Phillips AXIS(3)
Phillips Meridian
Siemens Biograph 16 PET/CT
R&F
four general purpose R/F rooms,
three Phillips Digital Easy Diagnost Systems
one Siemens Digital Multipurpose Systems
Mammography
Siemens Mammomat 3000 Nova (x3)
Lorad M IV
Lorad Stereoguide DSM Biopsy
Siemens Sequoia 512 Ultrasound
PACS
General Electric Centricity V.1.0
Siemens Kinet-dx Ultrasound PACS V2.8.3
The Division has a small physics “lab” for dosimetry equipment storage and use (150 sq.
ft.) and a small cerrobend block shop (500 sq. ft.). Scott & White support is highly
centralized so machine maintenance and IT technical support is done outside the footprint
of the Department. The Division has state-of-the-art dosimetric equipment, phantoms,
etc. (see Attachment 13). The Physics Division contracts for maintenance support on
instrumentation used for clinical services. Residents have access to all equipment and are
expected not to use the equipment unless properly trained. They are also expected to
leave
all
equipment
in
a
clinical
ready
mode
when
done.
Page 22 of 69
Publication/Presentation Support
Scott & White Clinic has had a long record of encouraging publication. The Section of
Publications offers services in support of manuscript preparation. Additionally, the
Section of Visual Communications offers graphic support as well as poster design,
integration and fabrication. Posters are printed from Power Point or PDF files at no
charge. The Division of Radiation Oncology will support use of these services as needed
and appropriate.
Libraries
The resident has access to the Richard D. Haines Medical Library. The Library is located
on the third floor of the A&M Health Science Center College of Medicine Education
Center at Scott & White. This includes access to electronic versions of many journals
through PubMed as well as various searching mechanisms (e.g. Medline). The Physics
Section maintains a specialty library containing most major medical physics text books as
well as the journals Medical Physics (1974 to present), Physics in Medicine and Biology
(1970 to present), and the International Journal of Radiation Oncology, Biology, and
Physics (1983 to present). The Radiology Department has an extensive library including
Radiology with additional physics reference texts.
VIII Future Plans
A Summary of Strengths and Needs
The Radiation Oncology Physics Residency Program is a new venture for the Physics
Division at Scott & White. Because the Physics Division serves both Radiation
Oncology and Diagnostic Radiology, the Program can draw heavily upon the
participation of diagnostic physicists and can structure rotations in association with
diagnostic equipment. The graduates of the program should therefore be in a strong
position to participate in the implementation of Image Guided Radiation Therapy. The
program is supported by Ph.D. physicists each having over thirty years of experience.
The participating MS physicists have between three and ten years of experience, and are
bright and promising people with excellent training. Over the next decade Scott & White
will need to recruit quality senior staff to replace the Ph.D. physicists as they retire. Scott
& White will also need to retain their junior staff. The entire faculty is inexperienced at
running a Residency Program, but is eager to obtain the experience. The future
development of the Program will depend on the strategy adopted by Scott & White for
the development of the Radiation Oncology component of its Cancer Center. If Scott &
White invests in additional satellite facilities in surrounding counties, the Residency
Program will take on a distributed rotation nature. If Scott & White funds and builds a
Cancer Center facility in Temple with state-of-the-art radiation oncology assets, the
Residency Program will be less dependent on external rotations to provide residents
exposure to technology such as electronic portal imaging devices.
B Further Developments and Improvements
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The Radiation Oncology Physics Residency Program is in a position to develop remote
learning components of its program. The current Program Director is involved in remote
learning activities within the AAPM and through his affiliations with Stanford and Texas
A&M. Specifically, the radiobiology distant learning program could become a major
asset to the Residency. Other opportunities may develop.
The Program is structured to improve continuous quality improvement of the operation
and documentation of the Program. The evaluations of the faculty and students every six
months will be assimilated and translated into action items for the Administration SubCommittee to consider and implement. Issues concerning finance and structure will be
submitted to the Steering Sub-Committee for consideration by the Radiology Chair and
Administration.
Further ties with Texas A&M University are being discussed. These discussions may
lead to a graduate program in Medical Physics in one of the University Departments or in
the Medical School. These discussions are still preliminary, but promising.
Page 24 of 69
Attachment 1: Program Supervision and Reporting Structure
Dean, Texas A&M College of Medicine
Christopher Colenda, M.D.
Vice Dean, Texas A&M College of Medicine
Chief Academic Officer, Scott and White
Donald Wesson, M.D.
Director, Graduate Medical Education
E. Eugene Terry, M.D.
Medical Physics Residency
Education Committee
Arthur L. Boyer, Ph.D., Chair
Steering Sub-Committee
Wayne Stockburger, Chair
Candidate Selection
Sub-Committee
Philip Bourland, Ph.D., Chair
Residency Administration
Sub-Committee
Arthur L. Boyer, Ph.D., Chair
Page 25 of 69
Medical Physics Residency
Education Committee
Arthur L. Boyer, Ph.D., Chair
Philip Bourland, Recruitment
Vitthalbhai Mistry, Medical Physicist
Wayne Stockburger, Radiology Administration
Alexandria Smiley, Program Administrator
Medical Physics Residency
Steering Committee
Wayne Stockburger, Chair
Arthur L. Boyer
Philip Bourland
Alan Cheung, MD
Jason Shoales
Linda Burke
Alexandria Smiley
Page 26 of 69
Residency Administration
Sub-Committee
Arthur L. Boyer, Ph.D., Chair
Philip Bourland, PhD
Vitthalbhai Mistry, PhD
Jason Shoales, MS
Karen Stumph, CMD
David Jones, MS
Lute Oas, MD
Candidate Selection
Sub-Committee
Philip Bourland, Ph.D., Chair
Arthur L. Boyer, PhD
Vitthalbhai Mistry, PhD
Bing Fang, MS
Lute Oas, MD
Karen Stumph, CMD
Page 27 of 69
Attachment 2A: Letter of Support from Department
February 1, 2008
Bruce Gerbi, Ph.D.
Chair, CAMPEP Residency Education Program
Therapeutic Rad. - Rad. Oncology
University of Minnesota
Mayo Mail Code 494
420 Delaware St SE
Minneapolis , MN 55455
Dear Dr. Gerbi,
The Administrative and Educational Leadership in the Radiology Department and the
Division of Radiation Oncology at Scott & White Clinic supports this application for
accreditation of our Radiation Oncology Physics Residency. Since its inception we have
encouraged its existence and excellence.
We feel this program compliments our education mission and we are highly desirous that it
achieve the designation “Accredited by CAMPEP, Inc” as an assurance that the program has
achieved the level of excellence we strive for.
Sincerely,
Gil Naul, M.D.
Chair, Department of Radiology
Alan Cheung, M.D.
Director, Radiation Oncology Division
SCOTT & WHITE CLINIC
An Association Affiliated
With Scott and White
Memorial Hospital
and Scott. Sherwood
a n d Brindle' Foundation
THE TEXAS A&M UNIVERSITY SYSTEM
HEALTH SCIENCE CENTER
COLLEGE OF MEDICINE,
TEMPLE CAMPUS
DEPARTMENT OF
RADIOLOGY
2401 South 31st St.
Temple, Texas 76508
254-724-2412
Internet Home Page: http://www.sw.org
Page 28 of 69
Fax: 254-724-0502
Attachment 2B: Letter of Support from Institution
February 1, 2008
Bruce Gerbi, Ph.D.
Chair, CAMPEP Residency Education Program
Therapeutic Rad. - Rad. Oncology
University of Minnesota
Mayo Mail Code 494
420 Delaware St SE
Minneapolis , MN 55455
Dear Dr. Gerbi,
We formally invite the Commission on Accreditation of Medical Physics Education
Programs (CAMPEP) to visit and review the Scott & White Radiology Department’s
Radiation Oncology Physics Residency Program. Attached you will find the self-study
prepared by Dr. Arthur L. Boyer, the program director. The Scott & White Graduate
Medical Education takes responsibility for the creation, implementation, and ongoing quality
maintenance of graduate medical education training programs. We require that all of our
residency and fellow training programs that are eligible be accredited. We applaud your
efforts to set standards for quality training in medical physics programs and are willing to
assist you in whatever you need to review the Scott & White Radiation Oncology Physics
program. Please let us know if we can help any further.
Sincerely,
Donald E. Wesson, M.D.
Vice-Dean Temple campus
Texas A&M College of Medicine
Chief Academic Officer, Scott & White
E. Eugene Terry, M.D.
Director, Graduate Medical Education
SCOTT & WHITE CLINIC
An Association Affiliated
With Scott and White
Memorial Hospital
and Scott. Sherwood
a n d Brindle' Foundation
THE TEXAS A&M UNIVERSITY SYSTEM
HEALTH SCIENCE CENTER
COLLEGE OF MEDICINE,
TEMPLE CAMPUS
2401 South 31st St.
Temple, Texas 76508
Internet Home Page: http://www.sw.org
Page 29 of 69
DEPARTMENT OF
RADIOLOGY
254-724-2412
Fax: 254-724-0502
Office of the Chairman
DATE:
May 21, 2007
TO:
Don Wesson, M.D.
Vice Dean, Temple Campus, Chief Academic Officer, Scott &
White
FROM: —
Don P. Wilson, M.D.
Chairman, Department of Pediatrics
SUBJECT:
COPY
Medical Physics Residency Training Program
At the May 17th meeting of the Education Advisory Committee, Dr. Art Bayer
requested approval for a new residency training program in medical physics. This
program is very unique, since it is not ACGME accredited. Rather accreditation is
through the Medical Physics Education Program (CAMPEP).
Dr. Boyer gave a very thoughtful presentation, outlining the scope of the
training program, availability of applicants, and the need for additional
trainees in medical physics nationally. Following the presentation, the
Education Advisory Committee strongly endorsed approval of the program.
Initial funding will be provided by the Department of Radiology, with future
funding from CAMPEP. The EAC hopes that you agree to the merit of this
worthy program.
Dr. Gene Terry will be bringing this as an informational item to the graduate
medical education committee. Should you have any questions in regard to this
proposal or the committee's review/approval, please feel free to contact me.
CC: Art Boyer, Ph.D., Radiation Therapy
Gill Naul, M.D., Radiology
Robert Pryor, M.D., CMO, Scott & White
Paul Dieckert, M.D., Chair, Scott & White Board of Directors
DPW Ahg
Page 30 of 69
Attachment 3: Data on Clinical Medical Physics Residents
Trained/Training to Date
Name:
Start Date:
Graduation:
Email:
Rebecca Weinberg, Ph.D.
October 2007
September 2009 (expected)
[email protected]
Name:
Start Date:
Graduation:
Email:
Junfang Gao, Ph.D.
July 2008
June 2010 (expected)
[email protected]
Page 31 of 69
Attachment 4A: AAPM Placement Service Ad
POSITION:
LOCATION:
RADIATION ONCOLOGY CLINICAL MEDICAL PHYSICS
RESIDENCY (2 years)
Scott & White Clinic
Temple, Texas
A position is available for Residency training in Radiation Oncology Clinical Medical
Physics at Scott & White Clinic, Temple, Texas. The Physics Division of the Radiology
Department has a single position open for two years beginning July 1, 2008. The
applicant must have an earned Ph.D. in Physics or Medical Physics at the start of the
residency. Training will be a mix of didactic course work (as needed and appropriate)
and competency-based rotations documented through report generation followed by oral
examination by the faculty. The Scott & White Program follows the AAPM Report No.
90 guidelines and includes newer technologies (IMRT, VSIM, SRS/SRT, HDR) as well
as extensive diagnostic radiology exposure. The residency program will be applying for
CAMPEP accreditation during the tenure of this residency. The candidate’s application
must include a detailed resume, three letters of reference and a copy of an official
transcript detailing Ph.D. and undergraduate work. Applications will be accepted until
April 30th when they will be evaluated. An on-site interview (in Temple, Texas) at the
applicant’s expense (except hotel) is required. For more information on Scott & White,
please visit its web site at medphysics.sw.org.
Scott & White is an equal opportunity/affirmative action educator.
CONTACT: Alexandria Smiley. ([email protected])
Division of Physics
Scott & White Clinic
Temple, TX 76508
(254) 724-4051
(254) 724-6061 (FAX)
Page 32 of 69
Attachment 4B: Scott & White Medical Physics Residency Program
Web-Site
Page 33 of 69
Attachment 5: Description/Application Materials Provided Prospective
Candidates
Program Description
The two-year Radiation Oncology Physics Residency Training Program at Scott & White
is designed for candidates with doctoral degrees in the relevant physical sciences who are
interested in careers as clinical medical physicists in radiation oncology. This program
concentrates on the medical uses of physics in clinical treatment of cancer patients; it
does not focus on training in theoretical physics or basic research. Upon successful
completion of the program the Resident will receive a Certificate of Completion from
Scott & White and from the Texas A&M University School of Medicine. The program is
intended to qualify the Resident to apply for examination by the American Board of
Radiology for certification as a Therapeutic Radiological Physicist.
Clinical Training. During the 24 months of the residency, the Resident will take clinical
rotations through the following subspecialty areas:
• Detectors and Dosimeters
• Radiation Safety
• Imaging
• Conventional Simulation
• CT Simulation
• Treatment Equipment
• Patient Treatment
• IMRT
• Brachytherapy
• Other Duties
In addition, clinical training will include work on department projects, carried out under
the supervision of the medical physics faculty.
Didactic Training
Clinical conferences, seminars, small discussion groups, journal clubs and one-on-one
instruction are all an integral part of the program. The Resident will participate in the
following:
Physics Division Meetings
Tumor Boards
Diagnostic Radiology Physics Lectures
Radiation Oncology Physics Didactic Lectures
Clinical competency is evaluated by oral exams and reports generated in association with
each of the clinical rotation areas.
Research Experience
During the latter part of the Resident’s second year of training and depending upon the
Resident’s progress in learning the clinical aspects, there may be an opportunity to
concentrate on a particular area of interest, and design and execute a research project.
Page 34 of 69
Opportunities exist for collaborative research with staff members from other departments.
The Resident would submit the results of their research project for presentation at a
scientific meeting and prepare a manuscript for publication in a scientific journal.
Appointments and Applications
To be eligible to apply, the candidate must have a Ph.D. or M.S. (or equivalent degree)
in medical physics or in a related physical science or engineering field. If the candidate is
considered for entry into the program, they will be asked to visit Scott & White in
Temple, Texas for an interview with the Program Director and selected faculty. Attached
is an Application Form. To apply, the attached form should be completed with
information about the candidate and names and contacts of references, and sent it along
with a copy of the candidate’s CV by email, regular mail, or both to:
Alexandria Smiley
[email protected]
Radiology Department
Scott & White Clinic
2301 South 31st Street
Temple, TX 76508
(254) 724-4051
Inquiries
For more information or to address specific questions, please contact:
Arthur L. Boyer, Ph.D.
Program Director
Radiology Department/Physics Division
Scott & White Clinic
2301 South 31st Street
Temple, TX 76508
[email protected]
254 725-7866
Page 35 of 69
Application Form
Radiation Oncology Physics Residency Program
Scott & White/ Texas A&M University School of Medicine
Please provide the following information a completely as possible.
Full Name:
Degree:
School:
Department:
Subject:
Date Received:
Current Address:
City:
State:
Zip:
Country:
Citizenship:
Visa Status:
Email:
Telephone (W):
Telephone (H):
Telephone (Cell):
Date Available:
Page 36 of 69
References
Reference 1 Name:
Institution:
Department:
Email:
Telephone:
Address:
City:
State / Zip:
Country:
Reference 2 Name:
Institution:
Department:
Email:
Telephone:
Address:
City:
State / Zip:
Country:
Reference 3 Name:
Institution:
Department:
Email:
Telephone:
Address:
City:
State / Zip:
Country:
Page 37 of 69
Attachment 6A: Example Interview Schedule
Resident Name
Date
7:00 a.m.
Breakfast
Dr. Art Boyer
8:00 a.m.
Alan, Cheung, M.D.
Director, Radiation Oncology Division
Dr. Cheung’s Office
Ground Floor, Radiation Oncology, Room CO10B
8:30 a.m.
Lisa Zang, RTT
Supervisor, Radiation Oncology
Ground Floor, Radiation Oncology, Room CO11LL
9:00 a.m.
David Jones, MS
Diagnostic Physicist
Building 30, Room 109
10:00 a.m.
Vitthalbhai Mistry, Ph.D.
Physicist
Dr. Mistry’s Office
Building 30, Room 106
11:00 a.m.
Karen Stumph, CMD
Chief Dosimetrist
Building 30, Room 109
Noon
Presentation
Radiology Conference Room
1:00 p.m.
Lunch
Jason Shoales, MS
Bing Fang, MS
Pasquale Montanaro, MS
2:30 p.m.
Lute Oas, MD.
Radiation Oncologist
S&W Cancer Center
Killeen, Texas
4:00 p.m.
Arthur Boyer, Ph.D.
Director, Physics Residency Program
Page 38 of 69
Attachment 6B: Clinical Medical Physics Residency Candidate
Evaluation Form
Radiation Oncology Physics Residency Training Program
Candidate Evaluation Form
Name of Candidate:
____________________________________________________________
Date of Interview:
_____________________________________________________________
Scores:
________Interest, reasons for candidacy for this residency
________Knowledge of Radiation Oncology Medical Physics
________Technical skill set including experimental experience
________Application (references, transcripts, etc.)
________Communication and interaction skills
________Initiative and Productivity
Scale
1 = outstanding
2 = excellent
3 = good
4 = satisfactory
5 = unacceptable
Overall Score: ____________
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Interviewer Name: _____________________________
Interviewer Signature: _______________________ Date: __________________
Page 39 of 69
Attachment 7: Letter of Appointment from Scott & White
Date
Dear Resident Name:
It is with great pleasure that we offer you an appointment to our two-year residency program in
Radiation Oncology Physics beginning 1 October 2007 in the Department of Radiology, Division
of Physics.
We are offering you a salary of $1,600.05 per pay period (2 week period). Benefits including
health insurance coverage and retirement funds are in addition to the base salary. In addition, a
moving allowance up to $1,000 will be provided.
Please note that this offer is contingent upon the successful completion of the placement medical
history and evaluation, which includes a drug screen, and continuation and completion of the
program are dependant upon satisfactory progress in education, performance of all duties, and
compliance with the policies of the Department of Graduate Medical Education, Research and
Education Division, Scott and White. In addition, all new employees must furnish proof of their
legal right to be employed in the United States. If you have any questions regarding the
acceptable proof, please do not hesitate to contact Patricia Balz, Recruitment Manager, at 254724-1632.
We hope that you will accept this position and continue your career at Scott & White. Please sign
below to indicate your acceptance of this offer and return the original to us. Note that this letter
does not constitute a contract of employment for a definite period of time.
We look forward to hearing from you soon. Please let me know if there are questions that I may
answer for you.
Sincerely,
Arthur Boyer PhD
Director, Division of Radiologic Physics
Department of Radiology
Scott & White Clinic
Accepted: __________________________
(Name)
Page 40 of 69
_________________________
Date
Attachment 8: Resident Orientation Schedule
SCOTT & WHITE
Radiation Oncology Physics Resident
Orientation Schedule
Thursday June 26, 2008
7:30-8:00
Sign-in, Meet & Greet
8:00-9:00
Welcome, Announcements &
Icebreaker
9:00-9:15
“What Makes S&W Unique?”
9:15-9:50
Employee Development
9:50-10:30
Employee Health Services, Infection
Control & Nursing Announcements
10:30-10:40
Break
10:40-11:25
Environment of Care & Patient
Safety
11:25-11:45
Security Management
11:45-11:50
Break
11:50-12:30
Lunch & A Movie
12:30-1:00
Healthy Back
1:00-1:15
Risk Management & Basic Patient
Rights
1:15-1:55
Corporate Compliance
1:55-2:10
Identifying Victims of Abuse
2:10-2:15
Break
2:15-2:30
Employee Recognition
2:30-3:15
Employee Handbook Overview
3:15-3:20
S&W 403(b) Savings Plan
3:20-3:30
Break (PRN Staff are Released)
3:30-4:45
Health Benefits
4:45-4:55
Q&A
4:55-5:00
Conclusion
Tara Moore
[email protected]
(254) 724-0535
Fax: (254) 724-6931
Page 41 of 69
SCOTT & WHITE
Radiation Oncology Physics Resident
Orientation Schedule
Friday, June 27, 2008
8:00 – 10:00
10:00 – 10:15
10:15 – 11:45
12:00 – 1:00
1:00 – 3:00
Introduction to the Radiation
Oncology Physics Residency
documents
Break
Resident Entry Assessment
Examination
Lunch Break
COMPUTER TRAINING
Physics Division
Program Director
Room 116
Physics Division
312 & 313 – Conf Ctr
Monday June 31, 2008
8:00 – 8:30
8:30 - 9:00
9:00 – 9:30
9:300 - 10:00
10:00 – 10:30
10:30 – 11:00
11:00 – 11:30
11:30 – 12:00
12:00 – 1:00
1:00 – 2:00 pm
Meet with Rotation I Mentor
Meet with Rotation II Mentor
Meet with Rotation III Mentor
Meet with Rotation IV Mentor
Meet with Rotation V&VI Mentors
Meet with Rotation VII Mentor
Meet with Rotation VIII Mentor
Meet with Rotation IX Mentor
Lunch Break
OR Orientation
Alexandria Smiley
[email protected]
Radiology Department
Scott & White Clinic
2301 South 31st Street
Temple, TX 76508
(254) 724-4051
Page 42 of 69
Mayborn Auditorium
Attachment 9A: Resident Probation and Dismissal Policy
DISCIPLINARY ACTION/DUE PROCESS
1) Process
Residents whose professional competence or conduct is not satisfactory will be subject to
disciplinary action initiated by the Program Director and endorsed by the Division
Director and/or Department Chairman.
The Resident in question will meet with at least two senior staff members of the
department responsible for his/her training. One of the departmental representatives
should be the Program Director, unless prohibited by extenuating circumstances. During
the meeting, a written document including a detailed, itemized description of the issues
regarding professional conduct and any prior evaluations of the Resident will be supplied
to the Resident. If the issues of concern predate the last scheduled written evaluation,
those issues should be documented in that evaluation. The written material(s) should
describe:
a. Nature of concern about either professional competence or conduct
b. Disciplinary action taken which could include:
Remediation
Probation
Non-advancement in academic year
Suspension
Dismissal
c. The duration of disciplinary action if other than dismissal or effective date if
dismissal
d. Required remediation (see below) by the Resident, if other than suspension or
dismissal
e. Description of methods and conditions of enhanced monitoring of the resident’s
clinical and/or academic activities if his/her performance suggests inability to
render an appropriate level of patient care or and/or exhibit appropriate personal
or professional conduct. By definition, “enhanced monitoring” should include (1)
specific goals/objectives developed for the Resident and (2) periodic, written
assessments of the Resident during the specified time period.
Discussions and written documents pertaining to the issues regarding professional
conduct should center on specific behaviors.
A copy of documentation supplied to the Resident shall be marked “CONFIDENTIAL”
and forwarded to the Scott & White Chief Academic Officer and the Director of Graduate
Medical Education. The Chief Academic Officer and/or the Director of Graduate Medical
Education may initiate a review process of the disciplinary action if the action is felt to be
inappropriate. For the review, the Chief Academic Officer and/or Director of Graduate
Medical Education may appoint a committee that consists of a program director from
another program, a department head from a different department, a chief resident from
another program, and the GME Ombudsperson to review both the merit and the
procedures and make recommendations. The role of the Ombudsperson is to ensure fair
treatment for the Resident. The committee may request that the Resident, the program
director or others involved in the case meet with the committee to discuss the issues
Page 43 of 69
before a recommendation is made. The decision of the involved program and the
committee recommendations will be reported to the Director of GME and the Chief
Academic Officer for final approval.
Suspension of the Resident from program activities for the duration of the disciplinary
process may be initiated by the Program Director. Suspension may also be reviewed by
the committee described above.
If a Resident is dismissed, he/she will not be eligible for unused vacation upon
termination.
2) Appeal
At the request of the named Resident, an ad hoc review committee, composed of the
membership of the committee described above, will be appointed by the Chief Academic
Officer, who will coordinate the appeal process and function as a non-voting member of
the various committees or councils involved. The ad hoc committee will be charged with
reviewing the circumstances of the disciplinary action to assess both the merits and the
procedures (i.e., the extent to which the action followed appropriate procedures and
whether the house officer was treated in a fair manner). The review committee may
request related documentation and invite testimony from the Resident and Program
Director involved. The ad hoc review committee will make recommendations to the
Director of Graduate Medical Education who will review the recommendations of the ad
hoc committee and with agreement from the Chief Academic Officer to take action if
necessary. The Chief Academic Officer will serve as the final authority.
Page 44 of 69
Attachment 9B: Summary of Resident Policies
GRIEVANCE/ PROBLEM-SOLVING PROCEDURE
TAMHSC-COM/Scott & White encourages residents to bring to the attention of Program
Directors concerns or complaints about work-related conditions. In order to aid in prompt
and constructive problem solving, residents shall be provided with the opportunity to
present such information through a formal procedure.
Many problems result from misunderstandings or lack of information and can generally
be solved by discussing them with the Program Director. If formal discussion with the
Program Director does not result in a satisfactory solution to the issue, the Resident
should submit the problem in written form to the Program Director as soon as possible.
The Program Director will meet again with the Resident to discuss the issue and will
present a written reply to the Resident as soon as possible.
If the Resident is not satisfied after receiving the Program Director’s reply, the Resident
should request a meeting with the Department Chairman and provide (1) the original
description of the issue, (2) the Program Director’s reply, and (3) a written explanation as
to why the Program Director’s reply was not satisfactory. This process must be
accomplished within two weeks from the date of the written Program Director’s reply.
The Chairman will respond in writing after interviewing the Resident. The Chairman may
choose to interview other individuals including the Program Director.
If the issue is not satisfactorily resolved at this point, the Resident may pursue further
action by providing copies of all written material and a written response to the
Chairman’s letter to the Director of Graduate Medical Education within two weeks of the
Chairman’s reply. The Director will further evaluate the complaint and, if he so chooses,
forms an ad hoc committee of the GMEC. The committee membership should include the
Resident Ombudsperson. The committee shall review all pertinent information and
conduct interviews necessary to reach a decision about the grievance. The committee’s
recommendations will be forwarded to the Director of GME and the Chief Academic
Officer for final resolution.
There will be no unfavorable action on the part of Scott & White against any Resident as
a result of the submission of a complaint or problem. All information concerning a
Resident’s problem/complaint should be received in confidence, and the issue should be
discussed only with those involved in the process or who can provide necessary
information.
Complaints of discrimination or harassment may be addressed through this procedure or
by contacting the Director of Employee Relations section of Human Resources.
CONFIDENTIAL GRIEVANCE PROCEDURE
At times, the Resident may have concerns that are outside the Program Director’s
jurisdiction or for which the Resident wishes to not include the Program Director or
Department Chairperson. The Resident may communicate these concerns to the
Ombudsperson who may take the problem directly to the Director of GME. The Director
of GME may follow the aforementioned procedure of choosing an ad hoc committee to
review the concerns and reach a solution.
NON-DISCRIMINATION AND SEXUAL HARASSMENT
Page 45 of 69
Staff members and their work environment should be free from all forms of unlawful
harassment and intimidation. Scott & White does not and will not permit staff members
to engage in unlawful discriminatory practices, sexual harassment, or harassment based
on race, color, religion, sex (gender), national origin, age, disability or status as a veteran.
Unlawful harassment by any staff member, supervisor, department head or person doing
business with Scott & White is strictly prohibited.
Harassment is verbal or physical conduct that denigrates or shows hostility toward an
individual because of their race, color, religion, gender, national origin, age, disability, or
status as a veteran. Sexual harassment consists of unwelcome sexual advances, requests
for sexual favors and other verbal or physical conduct of a sexual nature that creates an
offensive or hostile work atmosphere.
Staff members who believe that they are being sexually harassed, or harassed on the basis
of race, color, religion, gender, national origin, age, disability, or status as a veteran
should immediately report their concerns to their Program Director, the Director of
Graduate Medical Education, the Vice Dean, Temple Campus, TAMHSC-COM Scott&
White, or the Assistant Administrator of Human Resources at Scott & White. The
complaint will be promptly investigated and, if it is determined that harassment has
occurred, Scott & White will take appropriate disciplinary action, up to and including
discharge of the offending staff member. No staff member will suffer retaliation for filing
a complaint. All complaints will be handled in confidence.
PHYSICIAN IMPAIRMENT/SUBSTANCE ABUSE
The abuse of controlled substances by physicians and especially residents in training
looms as a major concern for Graduate Medical Education Programs as this problem
leads to the destruction of professional careers, personal and family life and even to the
loss of life itself.
It is the responsibility of TAMHSC-COM/Scott & White Graduate Medical Education
programs to inform house staff:
• about the facts and problems associated with chemical dependency,
• about programs of intervention, support and treatment for the individual and their
families suffering from this problem
• about follow-up support after the acute treatment program has been completed.
Chemical dependency is a disease that can be treated and from which the chemically
dependent professional can recover.
Re-entry of these highly trained medical professionals into the active practice of medicine
may be in the best interest of the physicians as well as society as a whole.
Scott & White perform routine drug screening at the beginning of residency training. As
part of the orientation process at the beginning of training, information about the Scott &
White substance abuse policy and the Employee Assistance Program is presented to
residents.
A resident with a substance abuse problem who wants help can contact his/her Program
Director, Department Chairman, Coordinator or the GME office. The individual who is
contacted will notify both the Program Director and Department Chairman and will also
directly notify the Employee Assistance Coordinator. An appropriate referral for
examination and treatment will be made according to Scott & White procedures.
Alternatively, a resident may be identified as or suspected of performing professional
duties under the influence of legally or illegally obtained stimulant or sedative or other
Page 46 of 69
psychoactive drugs through the gathering and submission of evidence to the Program
Director. The Program Director may then consult the Employee Assistance Coordinator
and the Director of Human Resources regarding the best plan of action. If sufficient
evidence has been obtained to justify an intervention, the Program Director, Department
Chairman, representative from Human Resources and the Employee Assistance
Coordinator will determine the evaluations that should take place according to guidelines
outlined in the Scott & White Supervisory Guide. Should a substance abuse problem be
proven, the resident may be referred to the most appropriate level of treatment.
After the acute treatment program is completed, depending upon the recommendations of
the treating clinician, the resident may or may not be reinstated as an active member in
the residency program. Should a decision be made to reinstate the resident, reintroduction
into the clinical work place will be done in a controlled fashion. It is recognized that the
greatest chance for successful treatment and rehabilitation occurs when the recovering
resident returns to a warm and supportive environment. The Employee Assistance
Program will assist in the continuing care and follow-up with a specific rehabilitative
discharge plan. This process will be specified by a written agreement involving the
resident, the treating clinician, the involved GME Program Director and the Director of
GME. The contract will include such details as access to controlled substances, random
drug testing and regular attendance at self-help programs such as Alcoholics Anonymous.
Any failure on the part of the resident to adhere to the contract may result in disciplinary
action up to and including discharge.
Any GME Program’s specific policy on substance abuse or the impaired professional will
be more relevant to the unique program and will supersede this policy. Also the
Americans with Disabilities Act (http://www.usdoj.gov/crt/ada) may be applicable if
specific requirements are met.
Additional references: Scott & White Employee Handbook (2004) Drug Free Workplace
(pg. 36).
COUNSELING SUPPORT SERVICES
Scott & White recognizes that increasing responsibilities of residents require sustained
intellectual and physical effort. On occasion, these responsibilities result in stresses on
the individual or family requiring extra support. This support is provided through
multiple resources. The Health Plan Psychiatric coverage includes acute and situational
evaluation and therapy, as well as long-term care by psychiatrists, psychologists and
social workers. Comprehensive medical care is provided by the Scott & White Health
Plan. Referral for services not connected with Scott & White (for confidentiality reasons)
can be obtained through the Designated Institutional Official in the Graduate Medical
Education Administrative Office. Neuropsychological testing can be offered when
professional conduct or academic performance has resulted in consideration of
Disciplinary Action. The Physician Impairment Policy deals specifically with support for
physicians who are identified as being compromised due to substance abuse.
VISA STATEMENT
Institutional Policy regarding visas: Texas A&M Health Science Center College of
Medicine/Scott & White accepts J-1 visas only.
Page 47 of 69
Attachment 9C: Compensation and Benefits
STIPENDS/PAYROLL
Residents are paid by Scott & White Memorial Hospital, Scott, Sherwood, and Brindley
Foundation at two-week intervals. The gross amount of each biweekly paycheck is
calculated by dividing the annual stipend stated in a resident's appointment letter into 26
pay periods.
There is an increase for each additional level of training. Any increase in base rate
granted by the hospital during an academic year will be allocated to residents on the
effective date regardless of stipend quoted in his/her current appointment letter.
Pay levels are determined by the following guidelines:
1. Resident or Fellow stipends are defined by the level of training in their current
program (their functional level of their current training).
2. Benefits and privileges are defined by the stipend level.
3. An exception of up to one year’s credit is possible for service performed as
chief resident in the TAMHSC-COM/Scott & White graduate education training
system.
4. The pay schedule increases to a PGY-7 level. Any training beyond PGY-7 is
paid at the PGY-7 level.
5. Pay scales are reviewed annually by the Educational Advisory Committee and
GMEC by way of its Benefits Committee.
Direct deposit is utilized for distribution of payroll. Direct deposit is implemented upon
employment and terminated with employment termination. Payroll information may be
accessed electronically on the Scott & White Intranet (“BUZZ”). NOTE: For IRS
purposes, the remuneration to a Resident is considered salary.
LEAVE POLICIES
LEAVE
All leave must be documented with a completed Absence Request Form. Absence
Request forms is available from the Program. For completion, Absence Request Forms
require signatures of the Program Director to provide verification of approval of leave.
Absence request forms are used for preparation of payroll and are maintained by the
Administrative Director of the Medical Physics Residency as part of the resident
personnel file.
Prolonged leave from the graduate medical education program may result in inadequate
time in the program to fulfill education requirements. Absence from the program for
more than 21 days must be reported to the TMB (171.6). These issues must be discussed
and approved by the individual Program Director. When additional time is needed to
fulfill Board requirements, a new appointment letter must be issued with the new dates.
Other insurance premiums may not continue during intervals of leave without pay.
Consultation with Human Resources is necessary to delineate these issues and address
other benefits.
VACATION
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Page 48 of 69
Three weeks (15 week days) per academic year are granted to all residents and fellows.
Vacation allotments on external rotations at institutions other than Scott & White are
included.
Paid vacation leave for residents is available from the start date of a training program.
Vacation unused during one year may be carried forward to the next year upon approval
of the Program Director. The number of days carried forward may not exceed the number
of days allotted for the academic year. Paid vacation leave may not be “borrowed” from
subsequent years. Residents are not eligible for the PTO (Paid Time Off) Cash-In
program or pay for unused vacation upon termination.
SICK LEAVE
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Residents are granted 13 days paid sick leave per year for personal illness, illness of
immediate family members (spouse, children, and parent), non-employment related
injuries, pregnancy or other disabilities. Justification from a health care provider may be
required in these circumstances. During an approved absence to care for an immediate
family member, sick leave hours may be used for five (5) consecutive workdays. If
additional time off beyond five (5) consecutive workdays is required, residents must use
PTO hours.
Paid sick leave may not be “borrowed” from subsequent years. Residents that are ill
and/or cannot work due to circumstances described above are to notify their Program
Coordinator and the service on which they are scheduled as soon as possible.
Upon exhausting available paid leave, sick and vacation, residents needing additional
leave time will be placed on leave without pay and may be required to make up training
time lost at the end of the medical training program if so determined by his/her Program
Director. Unused sick leave will automatically be carried over to subsequent training
years. Residents will not be compensated for unused sick leave upon termination.
MATERNITY LEAVE
All leave must be approved by the house officer’s Program Director. All leave must be
supported by a completed Absence Request Form.
Maternity leave is to be arranged with the Program Director and the GME office. Paid
maternity leave will be a combination of accrued sick and vacation leave. All available
sick leave and vacation benefits must be used before a resident takes leave without pay.
Leave without pay may necessitate payment by the Resident for medical insurance
coverage during the stipulated period of leave. Arrangements should be made with the
Human Resources Benefits office prior to beginning the leave, if necessary, for the
resident to pay premiums.
The Family Medical Leave Act may be applicable if specific requirements are met.
Prolonged leave from the program may result in inadequate time in the program to fulfill
Education requirements. These issues must be discussed and approved by the individual
Program Director.
PATERNITY LEAVE
All leave must be approved by the house officer’s Program Director. All leave must be
supported by a completed Absence Request Form.
After childbirth or adoption, it is anticipated that residents may request up to three days
of sick leave. Further sick leave days may be approved by a Program Director for medical
Page 49 of 69
complications requiring the presence of the resident (up to the maximal annual sick leave
of 13 days). Vacation days may also be used. Should additional time off be needed or
requested, the Family Medical Leave Act, may be applicable if specific requirements are
met.
FAMILY MEDICAL LEAVE ACT
All leave must be approved by the house officer’s Program Director. All leave must be
supported by a completed Absence Request Form.
According to the Family Medical Leave Act of 1993, employees who have worked at
least 12 months and have completed at least 1250 hours of work during the 12 months
preceding the effective leave of absence date are entitled to 12 weeks of “job protected”
leave per year for qualified medical leave (birth/adoption of a child; spouse, child or
parent with serious health condition; or serious health condition of employee). Notice
should be provided to employer in writing 30 days in advance for foreseeable leave to
avoid undue disruption of operations and as soon as practical for unforeseeable leave.
The written notice includes the Absence Request Form and the Scott & White FMLA
Medical Certification Form. Married employees with both husband and wife working for
Scott & White, are eligible for a combined total of 12 weeks of FMLA leave for Parental
Leave. An employee must use all available sick leave and vacation benefits before being
placed on unpaid leave status. Vacation (PTO) and sick leave do not accrue during leave
of absence.
Health insurance benefits remain in effect if employee pays his/her share of premium; if
employee fails to return to work, premiums paid by employer during the leave of absence
may be charged to the employee for reimbursement to Scott & White.
The employee is entitled to the same or an equivalent position when returning from leave.
Residents should, however, be aware that leave in excess of that allowed by their training
program may result in extension of training time beyond the projected completion date.
BEREAVEMENT LEAVE
In the event of a death in the immediate family, up to three (3) days leave may be paid
from a resident’s sick leave balance.
Immediate family members for bereavement purposes include: spouse, parent, child(ren),
brother, sister, stepchild(ren), stepparent, father-in-law, mother-in-law, grandparent,
grandparent-in-law, and grandchild(ren) . Time off for bereavement of other family
members and friends granted by the Program Director or time off in excess of three (3)
days for immediate family will be paid from vacation leave or will be leave without pay.
INTERVIEW LEAVE
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Each upper level resident is allowed ten (10) total days of leave with pay during the
course of training at Scott & White for the purpose of interviewing for fellowships or
practice opportunities. Interview leave is available only during the second year of training
and must have prior approval of the Program Director. Additional interview leave may be
granted at the discretion of the program director.
This leave is expressly intended for only fellowship or job interviews. Other related
activities are not applicable to this leave.
Page 50 of 69
EDUCATIONAL LEAVE
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Five (5) days of educational leave are granted to all residents annually to attend
educational conferences or meetings of their choice. Additional time may be granted by
program director for attendance at meetings of professional organizations in which
residents occupy official positions as officers or representatives.(i.e. official
representative to the TMA resident section). Attendance must have prior approval of the
Program Director and be supported by documentation describing the meeting/conference,
i.e., brochure, registration, etc.
Unused educational leave may not be carried forward to the next year except by special
request from the Program Director
MISCELLANEOUS TIME
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Absences for the following types of requests are not charged to vacation or educational
leave but must be requested on the Absence Request Form for appropriate approval:
o Presenting papers at professional conferences/meetings
o Presenting poster exhibits at professional conferences/meetings
o Time off to take a licensure examination
o Participation in non-required conferences provided at Scott & White
o Attendance at courses required by training program
o Attendance at meetings of professional organizations in which residents occupy
official positions as officers or representatives (e.g. official representative to the
TMA resident section).
Such leave must have documentation of acceptance of presentation and date(s) of
required attendance. Leave granted a maximum of two times total for the presentation of
the same paper at different meetings. Travel funding for research papers should be
requested at the time of the RFP when applicable.
PERSONAL LEAVE OF ABSENCE
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Requests for leaves of absence will be evaluated on the merits of the request and will be
granted or denied in accordance with applicable state and federal laws and accreditation
requirements. A leave of absence may be comprised of paid leave and/or leave without
pay. When the leave of absence is requested for medical reasons (including pregnancy),
the leave must be compliant with FMLA, as applicable. Paid sick leave may be utilized
only if the leave is for medical reasons.
The total length of a leave of absence must be consistent with satisfactory completion of
training (credit toward specialty board qualification) which will be determined by the
individual programs. Leave without pay may necessitate payment by the resident for
medical insurance coverage during the stipulated period of leave. Arrangements should
be made with the Human Resources Benefits office prior to beginning the leave, if
necessary, for the Resident to pay premiums.
Page 51 of 69
PROFESSIONAL LEAVE OF ABSENCE
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Occasionally unique educational opportunities arise for which a Resident may wish to
interrupt the usual course of training; for example, a year of research training. Although
this concept is supported by The TAMHSC-COM/Scott & White Graduate Medical
Education in general, the decision to grant extended leave from a training program rests
with the individual program and department with which the resident or fellow is
associated.
Program Directors should consider the long-range effects of such leave on educational
and budgetary planning. Professional leave of absence may be comprised of vacation
and/or leave without pay. Before any leave without pay may begin, all accumulated
vacation leave must be exhausted.
The total length of a leave of absence must be consistent with satisfactory completion of
training. Leave without pay may necessitate payment by the resident for medical
insurance coverage during the stipulated period of leave. Arrangements should be made
with the Human Resources Benefits office prior to beginning the leave, if necessary, for
the resident to pay premiums.
MILITARY LEAVE
All leave must be approved by the resident’s Program Director. All leave must be
supported by a completed Absence Request Form.
Participation in the National Guard or military reserve activities is allowed but must be
coordinated with and approved by the resident’s Program Director. Absences for
participation in this activity are charged to leave without pay or may be charged to
vacation leave, if desired. When benefit time is depleted, they will be placed in a leave
without pay status.
A resident inducted, ordered, or enlisted into active service will be placed on leave of
absence status effective the date of written orders to report. When released from military
obligations, resident has 90 days to notify program director to request reinstatement into
training program.
During the leave of absence, medical and dental coverage may be continued. When in an
unpaid status, resident is responsible for full payment of premium.
INSURANCE POLICIES/EMPLOYEE BENEFITS
HEALTH AND DENTAL INSURANCE
Health insurance coverage is provided for the residents at no cost to the resident. The
plan is a self-insured, comprehensive, medical plan called the Scott & White Employees
Medical Plan (SWEMP) administered through the Scott & White Health Plan, Inc.
Dependent coverage (parent/child(ren)), couple, family) is available at reduced rates. An
opportunity to enroll in the SWEMP is available during New Resident Orientation.
Coverage commences the first day of employment; there is no waiting period. In
addition, coverage for resident has no ‘pre-existing conditions’ clause.
Eligibility for enrollment extends through the first thirty (30) days of employment. If a
resident does not enroll during the first thirty (30 days) days of employment, the resident
may be a late enrollee and the coverage would not commence until the first day of the
month following 90 days from the date the application/enrollment form was received in
Page 52 of 69
Human Resources. Otherwise, enrollment will not be allowed until the open enrollment
period in the fall each year. No coverage is provided before that enrollment period.
New dependents (spouses and/or children, step-children, etc) may be added to Health
Plan coverage by notifying the Employee Benefits office in the Scott & White Human
Resource department no later than 30 days after the legal date of the event (marriage,
adoption, etc.). Coverage will begin on the first day of the next month. Sixty (60) days
are allowed to add newborn children to your Health Plan coverage.
Group Accident Income Plan coverage is provided to residents covered by the SWEMP
through Scott & White at no additional cost. Coverage is for the resident employee only.
Claim is filed with the Scott & White Health Plan after discharge from the inpatient stay.
A Prescription Drug benefit is included in the SWEMP coverage.
Dental insurance is an optional benefit in which you may enroll. In-Network and Out-ofNetwork benefits are available.
Detailed information on health benefits coverage and premium rates is available through
the Scott & White Human Resources Department.
ACCIDENTAL DEATH AND DISMEMBERMENT
Optional ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) coverage may
be purchased on a voluntary basis with amounts of coverage ranging from $25,000 to a
maximum of $400,000. Coverage may include spouse and children. Amounts in excess
of $150,000 cannot exceed ten times annual salary. Details on AD&D benefits coverage
and premium rates are available through Human Resources.
TERM LIFE
Term life insurance coverage through Texas Medical Association Insurance Trust
(TMAIT) in the amount of their annual salary is provided for all non-physician residents.
Coverage is effective on the start date of a training program. Benefits are described in
certificates/policies provided to insured individuals by TMAIT. Additional term life
coverage up to $500,000, as well as spouse and dependent coverage up to $50,000, is
available through TMAIT. Benefits may be continued or increased upon completion of
training, without evidence of insurability, as long as membership in the TMA and Texas
licensure are maintained.
PAYFLEX
The Scott & White Pay Flex Plan is an employee benefit that allows payment of health
and dental insurance premiums, out of-pocket medical/dental care, and dependent child
care expenses with tax-free dollars, i.e., these expenses are deducted from gross pay
before federal income and Social Security taxes are paid. Participation is voluntary. An
opportunity to enroll in the plan is initially presented at orientation. Pre-tax deductions
for health and dental premiums are automatic after the initial year of enrollment,
however, enrollment in the medical/dental and child care reimbursement account must be
renewed annually. Elections made at the time of enrollment cannot be changed during the
year except in the event of change in employment or family status. Additional
information is available from Human Resources.
LONG-TERM DISABILITY
Long-term disability insurance is provided by Scott & White to non-physician residents
at no cost through Texas Medical Association Insurance Trust (TMAIT). The benefit will
pay $3,000 per month maximum in the event of total disability with a 180-day waiting
period. Scott & White provides salary continuation for disabled resident for 150 days,
Page 53 of 69
reducing the Resident encumbrance to 30 days. Residents must enroll within 60 days
from date of employment or be required to submit evidence of insurability. Benefits are
described more fully in certificates/policies provided to insured individuals by TMAIT.
PROFESSIONAL ORGANIZATION MEMBERSHIPS
Scott & White provides membership in American Medical Association for residents.
Resident membership in the Texas Medical Association and the Bell County Medical
Society is paid in conjunction with TMAIT disability and life insurance coverage. A
membership application must be completed at orientation for TMAIT coverage.
PROFESSIONAL LIABILITY
Scott & White fully provides professional liability insurance for resident which covers
their activities at Scott & White and when on educational assignment in affiliated
hospitals and clinics. The program of self-insurance covers up to $1,000,000 for each
occurrence/$3,000,000 aggregate per annum.
Coverage for training activities will continue upon program completion on condition that
the physician shall cooperate fully, return to Temple for conferences, depositions and
trial, and be available in Temple as needed in the judgment of Scott & White defense
counsel. Failure to cooperate as set forth above shall be grounds for denying defense and
for denying coverage on the claim, at the sole options of Scott & White.
TUITION REIMBURSEMENT
Scott & White established the tuition assistance program to provide staff members a
means to broaden their knowledge through approved educational programs.
Full-time residents in good standing are eligible for tuition reimbursement up to a
maximum of $900 per semester. Tuition assistance (tuition and required fees only) is
granted for successful completion of approved course work with a grade of “B” or better
for undergraduate and/or graduate programs.
All courses must be pre-approved by the Designated Institutional Office and the Program
Director. A completed tuition assistance request form (available through Scott & White
Human Resources) must be submitted to Human Resources prior to registration. After
pre-approved course work has been completed, a copy of the registration receipt and
grade report should be submitted to the Human Resources Department. Reimbursements
are processed every pay period; payment is received on resident’s paycheck.
Page 54 of 69
Attachment 10: Typical Radiation Oncology Physics Resident Rotation
Schedule
Rotation Calendar for
NNNNNNNNNN
200X
Task Color Legend:
Blue'= Complete
Red= In Progress
Black= Scheduled
Q1
Processes
10
9
7
3
4
8
200X
200Y
Q2
Q3
1. Detectors and Dosimeters
1
Calibrate an ionization chamber and electrometer through an ADCL
2
Perform and report constancy checks between standard and field instruments
3
Disassemble and assemble an ionizaton chamber
4
Compute parameters for TG-51 calibration procedures
5
Perform and report TLD exposures for RPC checks
6
Measure and report in vivo dose with MOSFETs
7
Measure and report relative dose with diodes
8
Characterize film a for quantitative measurements
2. Radiation Safety
1
Take Scott & White Radiation Regulation Exam
Establish and maintain a mock personnel monitoring process
Establish and maintain mock radiation safety training for staff
5
Perform linac vault survey
6
Mock survey instrument calibration report
7
Report primary calibration and QA checks of a GM system
8
Write mock incident report
9
Write mock Radioactive Materials License
Fluoroscopy
3
Perform and report calibration of CT
4
Perform and report calibration of MRI
5
Perform and report calibration of PET
6
Perform and report calibration of US
7
Measure and report MTF
Perform and report a conventional simulator acceptance test
3
Perform and report monthly conventional simulator QA
Perform and report a CT simulator acceptance test
3
Perform and report monthly CT simulator QA
4
Acquire data set with radiation oncology protocols
Perform and report Monthly QA.
3
Perform and report Annual QA.
4
Design and Document a Linear Accelerator Vault
5
Linac Acceptance/Commissioning
6
Calibration of Dose/MU
7
Write a mock license application to register a linear accelerator
2
3
3
Q2
3
Q3
Q4
Q5
Q6
1,2,3
1,2,3
1,2,3
1
1,2,3
2,3
1
1,2,3
Q1
Q2
Q3
Q4
1
2,3
1
1
2
2
3
3
1
Q1
Q2
Q3
Q4
Q5
2,3
1
Q5
Q6
2
1
1
Q6
1,2,3
1,2,3
1
2,3
Q1
Q2
Q3
Q4
Q5
Q6
1,2,3
6. Treatment Equipment
1
Daily linac output check system
2
3
Q6
1,2,3
5. CT Simulation
1
Design and document a CT simulator room
2
1,2
1,2
Q1
4. Conventional Simulation
1
Design and document a conventional simulator room
2
3
1,2,3
3. Imaging
1
Radiographic Imaging (CR system)
2
200Y
1,2,3
Measure and report GM measurements before an HDR treatment
4
1,2
1,2
Measure and report x-ray and neutron dose levels around a linear accelerator
3
Q5
1,2,3
1,2,3
1
10
Radioactive Materials On-line training
200Y
Q4
1,2,3
9
2
200Y
Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec
Q1
Q2
Q3
1,2,3
1
1
1
1
2
2,3
2
3
1,2,3
2
1
Q4
Q5
Q6
2
1,2,3
3
3
1,2,3
Page 55 of 69
1
24
5
8
6
7. Patient Treatment For a typical set of treatment sites (e.g. lung, breast, GYN, …)
1
Compute mock treatment plan for Breast
2
Compute mock treatment plan for Prostate
3
Compute mock treatment plan for Thoracic
4
Compute mock treatment plan for Head & Neck - Larynx
5
Compute mock treatment plan for Head & Neck - Base of Tongue
6
Compute mock treatment plan for Head & Neck - Paranasal Sinus
7
Compute mock treatment plan for Pancreas
8
Compute mock treatment plan for GYN
9
Compute mock treatment plan for Esophagus
10
Compute mock treatment plan for Lymphoma
11
Compute mock treatment plan for CNS
12
Compute mock treatment plan for Cranial-Spinal Axis - Pediatrics
13
Compute mock treatment plan for Rectum
14
Compute mock treatment plan for Bladder
15
Physics Check of Treatment Plan
16
Chart Checking
17
Portal Imaging
18
Electron cut-out calibration
19
TBI, IORT, electron arc, and Respiratory Gating
20
Compute mock treatment plan for stereotactic radiosurgery
21
Tissue Compensation and Bolus
22
Perform and report QA of treatment planning system
23
Commission a Treatment Planning System
24
Linac and cerrobend safety
Q1
Verify the commissioned linac
3
Compute mock IMRT inverse plan for Prostate
4
Compute mock IMRT inverse plan for Head & Neck
5
Compute mock IMRT inverse plan for Mesothelioma
Leak test Cs-137 sources
3
Discharge patient with implanted radioactive material
4
Shipping and receiving RAM and survey
5
Compute mock LDR Cs-137 treatment plan
6
Compute HDR mammosite breast treatment
7
Perform and report monthly HDR QA
8
Perform and report prostate seed implant.
Q4
Q5
Q6
1
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1,2,3
1
1
1
1,2,3
2
2
1
2
3
3
2
3
3
1
2
1
2
Q5
Q6
1
2,3
Q5
Q6
Q5
Q6
1,2,3
Q1
Q2
Q3
Q4
1,2,3
1,2,3
1,2,3
9. Brachytherapy
1
Calibrate Ir-192 source
2
Q3
1,2,3
8. IMRT For a typical set of treatment sites (e.g. prostate, head & neck, …)
1
Commission dummy linac for IMRT
2
Q2
CT Simulation
Q1
Q2
Q3
Q4
1,2,3
1
2
3
1
1
2
2
2
3
3
3
1
Q1
Q2
Q3
1,2,3
1,2,3
10. Other Duties
1
Teach classes to physician Residents
Q4
1,2,3
2
Make journal club style presentation
3
Review and revise CPT billing profiles for specific clinical procedures
4
Prepare to maintain certification
5
Review and revise Policy and Procedure documents for ACR compliance
6
Time permitting, carry out and report on a small research project.
1,2,3
1
Total Processes
84
processes phases scheduled:
processes completed:
Page 56 of 69
252
29
33
32
37
38
31
0
0
0
0
0
0
0
Attachment 11: Radiological Physics Lecture Series Schedule.
Text:
The Essential Physics of Medical Imaging
Bushberg, Siebert, Leidholdt, Boone
Lippincott Williams & Wilkins
2nd Edition
Section I: Basic Concepts
Chapter 1: Introduction to Medical Imaging
1.1 The Modalities
1.2 Image Properties
Chapter 2: Radiation and the Atom
2.1 Radiation
2.2 Structure of the Atom
Chapter 3: Interaction of Radiation with Matter
3.1 Particle Interactions
3.2 X- and Gamma Ray Interactions
3.3 Attenuation of X- and Gamma Rays
3.4 Absorption of Energy from X- and Gamma Rays
3.5 Imparted Energy, Equivalent Dose, and Effective Dose
Chapter 4: Computers in Medical Imaging
4.1 Storage and Transfer of Data in Computers
4.2 Analog Data and Conversion between Analog and Digital Forms
4.3 Components and Operation of Computers
4.4 Performance of Computer Systems
4.5 Computer Software
4.6 Storage, Processing, and Display of Digital Images
Section II: Diagnostic Radiology
Chapter 5: X-ray Production, X-ray Tubes & Generators
5.1 Production of X-rays
5.2 X-ray Tubes
5.3 X-ray Tube Insert, Tube Housing, Filtration, and Collimation
5.4 X-ray Generator Function and Components
5.5 X-ray Generator Circuit Designs
5.6 Timing the X-ray Exposure in Radiography
5.7 Factors Affecting X-ray Emission
5.8 Power Ratings and Heat Loading
5.9 X-ray Exposure Rating Charts
Chapter 6: Screen-Film Radiography
6.1 Projection Radiography
6.2 Basic Geometric Principles
6.3 The Screen-Film Cassette
6.4 Characteristics of Screens
6.5 Characteristics of Film
6.6 The Screen-Film System
6.7 Contrast and Dose in Radiography
Page 57 of 69
6.8 Scattered Radiation in Projection Radiography
Chapter 7: Film Processing
7.1 Film Exposure
7.2 The Film Processor
7.3 Processor Artifacts
7.4 Other Considerations
7.5 Laser Cameras
7.6 Dry Processing
7.7 Processor Quality Assurance
Chapter 8: Mammography
8.1 X-ray Tube Design
8.2 X-ray Generator and Phototimer System
8.3 Compression, Scattered Radiation, and Magnification
8.4 Screen-Film Cassettes and Film Processing
8.5 Ancillary Procedures
8.6 Radiation Dosimetry
8.7 Regulatory Requirement
Chapter 9: Fluoroscopy
9.1 Functionality
9.2 Fluoroscopic Imaging Chain Components
9.3 Peripheral Equipment
9.4 Fluoroscopy Modes of Operation
9.5 Automatic Brightness Control (ABC)
9.6 Imaging Quality
9.7 Fluoroscopy Suites
9.8 Radiation Dose
Chapter 10: Image Quality
10.1 Contrast
10.2 Spatial Resolution
10.3 Noise
10.4 Detective Quantum Efficiency (DQE)
10.5 Sampling and Aliasing in Digital Images
10.6 Contrast-Detail Curves
10.7 Receiver Operating Characteristics Curves
Chapter 11: Digital Radiography
11.1 Computed Radiography
11.2 Charged-Coupled Devices (CCDs)
11.3 Flat Panel Detectors
11.4 Digital mammography
11.5 Digital versus Analog Processes
11.6 Implementation
11.7 Patient Dose Considerations
11.8 Hard Copy versus Soft Copy Display
11.9 Digital Image Processing
11.10 Contrast versus Spatial Resolution in Digital Imaging
Chapter 12: Adjuncts to Radiology
Page 58 of 69
12.1 Geometric Tomography
12.2 Digital Tomosynthesis
12.3 Temporal Subtraction
12.4 Dual-Energy Subtraction
Chapter 13: Computed Tomography
13.1 Basic Principles
13.2 Geometry and Historical Development
13.3 Detectors and Detector Arrays
13.4 Details of Acquisition
13.5 Tomographic Reconstruction
13.6 Digital Image Display
13.7 Radiation Dose
13.8 Image Quality
13.9 Artifiacts
Chapter 14: Nuclear Magnetic Resonance
14.1 Magnetization Properties
14.2 Generation and Detection of the Magnetic Resonance Signal
14.3 Pulse Sequences
14.4 Spin Echo
14.5 Inversion Recovery
14.6 Gradient Recalled Echo
14.7 Signal from Flow
14.8 Perfusion and Diffusion Contrast
14.9 Magnetization Transfer Contrast
Chapter 15: Magnetic Resonance Imaging (MRI)
15.1 Localization of the MR Signal
15.2 k-space Data Acquisition and Image Reconstruction
15.3 Three-Dimensional Fourier Transform Image Acquisition
15.4 Image Characteristics
15.5 Angiography and Magnetization Transfer Contrast
15.6 Artifacts
15.7 Instrumentation
15.8 Safety and Bioeffects
Chapter 16: Ultrasound
16.1 Characteristics of Sound
16.2 Interactions of Ultrasound with Matter
16.3 Transducers
16.4 Beam Properties
16.5 Image Data Acquisition
16.6 Two-Dimensional Image Display and Storage
16.7 Miscellaneous Issues
16.8 Image Quality and Artifacts
16.9 Doppler Ultrasound
16.10 System Performance and Quality Assurance
16.11 Acoustic Power and Bioeffects
Page 59 of 69
Chapter 17: Computer Networks, PACS & Teleradiology
17.1 Computer Networks
17.2 PACS and Teleradiology
Section III: Nuclear Medicine
Chapter 18: Radioactivity and Nuclear Transformation
18.1 Radionuclide Decay Terms and Relationships
18.2 Nuclear Transformation
Chapter 19: Radionuclide Production and Radiopharmaceuticals
19.1 Radionuclide Production
19.2 Radiopharmaceuticals
19.3 Regulatory Issues
Chapter 20: Radiation Detection and Measurement
20.1 Types of Detectors
20.2 Gas-Filled Detectors
20.3 Scintillation Detectors
20.4 Semiconductor Detectors
20.5 Pulse height spectroscopy
20.6 Non-Imaging Detector Applications
20.7 Counting Statistics
Chapter 21: Nuclear Imaging – The Scintillation Camera
21.1 Planar Nuclear Imaging: The Anger Scintillation Camera
21.2 Computers in Nuclear Imaging
Chapter 22: Nuclear Imaging – Emission Tomography
22.1 Single Photon Emission Computed Tomography (SPECT)
22.2 Positron Emission Tomography (PET)
Section IV: Radiation Protection, Dosimetry, and Biology
Chapter 23: Radiation Protection
23.1 Sources of Exposure to Ionizing Radiation
23.2 Personnel Dosimetry
23.3 Radiation Detection Equipment in Radiation Safety
23.4 Radiation Protection and Exposure Control
23.5 Regulatory agencies and Radiation Exposure Limits
Chapter 24: Radiation Dosimetry of the Patient
24.1 X-ray Dosimetry
24.2 Radiopharmaceutical Dosimetry: The MIRD Method
Chapter 25: Radiation Biology
25.1 Interaction of Radiation with Tissue
25.2 Cellular Radiobiology
25.3 Response of Organ Systems to Radiation
25.4 Acute Radiation Syndrome
25.5 Radiation-Induced Carcinogenesis
25.6 Hereditary effects of Radiation Exposure
25.7 Radiation Effects in Utero
Page 60 of 69
Attachment 12: Medical Physics Didactic Lecture Series
Scott & White
Radiation Oncology Physics Residency
Didactic Lecture Series
Year 1
Chapter 1. BASIC RADIATION PHYSICS
Chapter 2. DOSIMETRIC PRINCIPLES, QUANTITIES AND UNITS
I.
Basic Physics
Chapter 3. RADIATION DOSIMETERS
Chapter 4. RADIATION MONITORING INSTRUMENTS
Chapter 5. MACHINES FOR EXTERNAL BEAM RADIOTHERAPY
II.
Linear Accelerators
Chapter 6. EXTERNAL PHOTON BEAMS: PHYSICAL ASPECTS
III.
Anatomy
Chapter 7. CLINICAL TREATMENT PLANNING IN EXTERNAL
PHOTON BEAM RADIOTHERAPY
Chapter 8 ELECTRON BEAMS: PHYSICAL AND CLINICAL ASPECTS
Year 2
Chapter 9. CALIBRATION OF PHOTON AND ELECTRON BEAMS
IV.
Ionization Chambers
Chapter 10. ACCEPTANCE TESTS AND COMMISSIONING
VI.
Image Quality
Chapter11. COMPUTERIZED TREATMENT PLANNING SYSTEMS
FOR EXTERNAL BEAM RADIOTHERAPY
Chapter 12. QUALITY ASSURANCE OF EXTERNAL BEAM RADIOTHERAPY
Chapter13. BRACHYTHERAPY: PHYSICAL AND CLINICAL ASPECTS
IX.
HDR
Chapter 14. BASIC RADIOBIOLOGY
Chapter 15. SPECIAL PROCEDURES AND TECHNIQUES IN
RADIOTHERAPY
VII
IMRT
VIII.
IGRT
Chapter 16. RADIATION PROTECTION AND SAFETY IN RADIOTHERAPY
V.
High Energy Shielding
Note: “Chapter 1, …” refers to lectures from the IAEA “Radiation Oncology Physics:
A Handbook for Teachers and Students”
Roman Numeral “I, II, …” refers to original lectures
Page 61 of 69
Attachment 13: Physics Instruments
Ion Chambers – Ion chambers are used to measure the magnitude of ionization created
by ionizing radiation. The charge is collected by the chamber and then measured by an
electrometer.
0.2cc NEL 2503/3 s/n 1875 – Used for IMRT QA
0.6cc NEL 2505/3A s/n 1874 – Used for monthly QA, electron cutouts
0.125cc - PTW233643 S/N 083 - Used for annual machine QA
0.125cc – PTW 233643 S/N 084 - Used for annual machine QA
0.2cc PTW N30002 s/n 2320
0.6cc PTW N23333 Farmer Chamber s/n 1715
Parallel plate Ionization chamber – PTW N23343 s/n 369
Welhoeffer Chambers
0.03cc – WD IC-04 s/n 3465
0.03cc – WD IC-04 s/n 3463
0.125cc – WD IC-15 s/n 3688
0.125cc – WD IC-15 s/n 3577
Backup Ion Chambers
PTW N30012 - 0.6cc – s/n 0186
PTW N30010.2 - 0.2cc– s/n 0555
Killeen
PTW 0.2cc N30002 s/n 2320 – Used for IMRT QA
PTW 0.6cc N23333 s/n A-214 – Used for monthly QA
Electrometers – In radiation oncology, an electrometer is used for measuring electric
charge originating from the creation of ions caused by radiation originating in an ion
chamber.
Keithley Model 35614 s/n 13250 – Used for monthly QA
Keithley Model 35614 s/n 54109 – Used for IMRT QA
Standard Imaging Max 4000 – s/n E073315
Victoreen Model 530 S/N 98191 – Standard Electrometer, used for HDR monthly
Page 62 of 69
Killeen
Inovision 135040 s/n 99218 – Used for monthly and IMRT QA (CIII)
Survey Meters – Survey meters are used to measure exposure in an area where
radioactive materials are or may be present. They can also be used to survey a general
area where radiation is being produced.
Nuclear Associates Minimonitor III – Model 05-575, s/n 000555
Nuclear Associates Minimonitor 125 – Model 05-572, s/n C 495
Victoreen – Model 407A – s/n 1205
Standard Imaging – Seed Finder – Ref. 90065, s/n G001041
Phantoms – media for providing mass for buildup and attenuation when taking ion
chamber measurements.
Wellhoffer Blue Water Tank s/n 157 – Used for commissioning data
Wellhoffer Lift Table s/n 234
Med Tec Water Tank – Used for annual QA
Plastic Water – Used for monthly and annual QA
Polystyrene – Used for backscatter and electron cut out measurements
Killeen
Med Tec Water Tank – Used for annual QA
Small Wellhoffer Water Tank
Well Counters - Well counters are used to assess the radioactivity of radioactive
isotopes for HDR and LDR Brachytherapy procedures.
Precision Radiological Measurements – Model WC-2 – Used for assessing seed activity
for LDR procedures
Standard Imaging HDR 1000+, S/N A032029 – Used for HDR monthly
Detector Arrays – A series of multiple detectors to measure a change across an axis or
plane.
Page 63 of 69
Mapcheck – Model 1175, s/n 3844850 – Used for IMRT QA and monthly flatness and
symmetry checks
Tracker (2) – Used for daily constancy measurements for specified tests.
CI – Display s/n 107431
CII – Display s/n 107584, Array s/n 105255
Killeen
Profiler
Tracker
Other
Field size, Laser and coincidence tool – Med Tec MT-IAD-V, s/n 505
Killeen
Field size, Laser and coincidence tool – Med Tec MT-IAD-V
Page 64 of 69
Attachment 14A: Faculty Oral Examination Evaluation Form
Resident ___________________________________
Date ________________
Oral Examiner ________________________________________________________
Comments On Resident
1. Rotation Topic: ________________________________________
____________________________________________________________________
____________________________________________________________________
___________________________________________ Satisfactory
Unsatisfactory
2. Rotation Topic: ________________________________________
____________________________________________________________________
____________________________________________________________________
Unsatisfactory
___________________________________________ Satisfactory
3.Rotation Topic: ________________________________________
____________________________________________________________________
____________________________________________________________________
___________________________________________ Satisfactory
Unsatisfactory
4. Rotation Topics: ________________________________________
____________________________________________________________________
____________________________________________________________________
Unsatisfactory
___________________________________________ Satisfactory
5. Rotation Topics: ________________________________________
____________________________________________________________________
____________________________________________________________________
___________________________________________ Satisfactory
Unsatisfactory
Comments on Program
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Faculty Signature
____________________________________________________________________
Page 65 of 69
Attachment 14B: Resident Clinical Rotation Evaluation Form
Rotation Topics:
1. _______________________________________________________
2. _______________________________________________________
3. _______________________________________________________
4. _______________________________________________________
5. _______________________________________________________
Resident ___________________________________
Date ________________
Oral Examiners _______________________________________________________
Comments On Faculty
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Comments on Program
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Resident Signature
___________________________________________________Date:__/__/__
Page 66 of 69
Attachment 15: Program Director’s Resident Evaluation Form
**Confidential Report on Resident for Current Quarter**
RESIDENT NAME: ______________________ Quarter/Year: ________
RESULTS OF ROTATION ORAL EXAMS
Rotation Topic
1 Detectors and Dosimeters
2 Radiation Safety
3 Treatment Equipment
4 Imaging
5 Conventional Simulation
6 CT Simulation
7 Patient Treatment
8 IMRT
9 Brachytherapy
10 Other Duties
Pass
Comments
GENERAL GRADE FOR QUARTER
DIDACTIC
DATES
Satisfactory Unsatisfactory
__________________________
________________
__________________________
________________
__________________________
________________
COMMENTS (OPTIONAL):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
DATE:________________________ SIGNED:________________________________
PRINTED:
Page 67 of 69
Arthur Boyer, Ph.D.
Program Director
Attachment 16: Resident Evaluation of Faculty
Medical Physics Resident Faculty/Rotation Evaluation
Rotation______________________________
Dates________________________________
Mentor_______________________________
Evaluation:
The rotation achieved the training objectives outlined
Yes
No
The mentor participated actively and effectively in the training
Yes
No
Sufficient time was devoted to this rotation
Yes
No
Additional comments
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Signed
Date
Page 68 of 69
Attachment 17: Key Divisional Faculty
Radiation Oncology Clinical Medical Physics Residency
Physics Faculty
Board
Certification
Year
Appointed
Philip D. Bourland, Ph.D.
ABR - 1978
1971
Arthur L. Boyer, Ph.D.
ABR - 1978
2005
Vitthalhbai Mistry, Ph.D.
ABR - 1979
ABMP - 1991
1998
David M. Jones, M.S.
ABR – 1998
ABHP - 1995
1990
ABMP - Passed Part I 2004
2005
Wei Tang, M.S.
Audra Coker, M.S.
2005
TBN, M.S.
Jason Shoales, M.S.
ABR- expected 2009
2005
ABMP – 2006
2007
Sandra Suter, A.A.S.
n/a
1992
Karen Stumph, CMD
CMD - 1988
1986
Pasquale J. Montanaro, M.S.
Radiation Oncology Physician (M.D.) Faculty
Alan Cheung, M.D.
Teresa Boyle, M.D.
Lute Oas, M.D.
Board
Certification
Year
Appointed
ABR – 1981
ABR – 1996
1987
2001
ABR
2001
Page 69 of 69
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