Skin radiotherapy training programme for dermatology specialty trainees - an unmet need

Abstract

Purpose or Objective Radiotherapy is an important modality for the treatment of skin malignancies. Although an integral part of the dermatology curriculum, exposure and knowledge in skin radiotherapy is limited amongst dermatology specialty trainees. The dermatology UK national curriculum specifies competency in the principles, indications, risks and benefits of radiotherapy and ability to construct a treatment plan for primary skin malignancy. Trainees are currently independently responsible for arranging means of fulfilling this requirement, which may be through independent study, observerships or courses as agreed with their educational supervisor. Quality of training in this field can therefore be varied and often becomes a boxticking exercise. This can in turn affect quality of referrals made to radiotherapy clinics and limit treatment choices offered to patients. Material and Methods To address this gap in training, an innovative programme to deliver radiotherapy training in skin malignancies was designed for the UK North-Western Dermatology Deanery. The training programme consisted of a radiotherapy training day at the Christie Hospital, Manchester and participation in at least two skin radiotherapy clinics. The radiotherapy training day consisted of interactive lectures covering curriculum objectives, followed by small group practical sessions exploring radiotherapy equipment, procedures and patients’ experience. This was delivered by a multi-disciplinary team involving radiotherapy doctors, radiographers and medical physicists. The clinics included new and follow-up patients with skin cancer, skin marking planning sessions and on-treatment reviews. Results Feedback was obtained through anonymised survey responses (observership in clinics) and feedback forms (study day). Responders rated their knowledge in radiotherapy as ‘below average’ prior to the programme and as feeling ‘confident’ after the programme. Learning objectives fulfilled by the teaching programme according to the responders included indications and contraindications for skin radiotherapy, optimal patients to refer for radiotherapy, methods of delivering radiotherapy, patient compliance, management of skin toxicities, radiotherapy planning and shielding, geriatric assessment, dealing with patients who lack capacity and patients’ involvement in the decision making process. Conclusion Overall, feedback received indicated that this programme succeeded in sufficiently increasing knowledge and confidence amongst dermatology specialty trainees in skin radiotherapy. Subsequent incorporation of this programme into dermatology training and addition of regular radiotherapy clinics into the dermatology registrar rota have now streamlined training dermatology trainees receive in this field, ensuring that curriculum objectives are properly met and patient care and referral practice is improved.