Radiation Oncology Residency Training in Latin America: A Call to Attention

Abstract

Purpose: Despite the call to increase the number of radiation oncologists in Latin America, the quality, similarity, and number of residency training programs are unknown. We seek to describe the current state of residency programs in radiation oncology in Latin America.

Methods and materials: Latin American Residents in Radiation Oncology performed a cross-sectional analysis of universities and training centers for radiation oncologists in Latin America. Latin American Residents in Radiation Oncology members identified and contacted current residents and specialists at each center to obtain information and documents that described their training curricula.

Results: As of 2020, 13 of 23 (56.5%) Latin American countries have radiation oncology training. Seventy-three training centers were identified (59 active and 14 inactive), associated with 28 universities. On average, each active center trains 2.6 new residents per year, and in total, 156 residents are trained annually. The average length of training programs is 3.6 years. Brazil and Mexico comprise 31 (52.5%) and 7 (11.9%) of active programs, respectively, and 64 (41.8%) and 50 (32.7%) residents, respectively. Training is available in 38 cities in 13 countries, and outside Brazil and Mexico, only 13 cities in 11 countries (9 capitals and 4 noncapital cities). Individualized curriculum documents were provided by 20 (83.3%) of 24 non-Brazilian programs, while 1 standardized guideline was provided for Brazilian training programs. These demonstrated variation between subjects taught, their devoted time, outside specialty rotations, and experiences in modern techniques. Seventy-five percent include volumetric modulated arc therapy, 70% stereotactic radiosurgery, and 55% stereotactic body radiation therapy training. One-hundred percent include gynecologic brachytherapy education and <50% brachytherapy education in other disease sites.

Conclusions: Training is highly centralized in capital cities. The number of trainees is insufficient to close the current human resource divide but is limited by available job openings. Over 50% of training programs now include technological training in stereotactic radiosurgery, stereotactic body radiation therapy, or volumetric modulated arc therapy; however, substantial variation still exists. The development of radiation oncology specialists must be improved and modernized to address the escalating demand for cancer care.

Fig. 1

Map of active and inactive radiation oncology residency training in Latin America. Shown in blue pins are cities with active radiation oncology residency training programs. Shown in black pins are cities with inactive residency training programs. Pins correspond to geographic program locations.

Fig. 2

Training in external rotations. The time in months dedicated to full-time training in external rotations (yellow = imaging, gray = pathology, blue = medical oncology, and black = surgical oncology) is shown for different residency programs. Programs are listed according to country of origin along the x-axis. *Program includes longitudinal part-time rotations.

Fig. 3

Training in brachytherapy. The portion of residency training programs that include brachytherapy education in different disease sites is shown. Disease site categories included gynecologic, prostate, skin, breast, intraocular, and intraoperative radiation therapy.

Fig. 4

Training in advanced radiation therapy techniques. The portion of residency training programs that include education in different modern radiation therapy techniques is shown. Techniques included volumetric modulated arc therapy, stereotactic radiosurgery, and stereotactic body radiation therapy.