Medical Students

  • Thinking about a career in radiation oncology? Learn more about the field and explore application and interview frequently asked questions. Also take advantage of the helpful resources for medical students interested in radiation oncology.

  • What is radiation oncology?

    Radiation oncology is a field in medicine that uses ionizing radiation to treat patients with cancer and other benign conditions such as trigeminal neuralgia and keloids. The goal is to deliver radiation precisely to a defined target while providing minimal damage to surrounding normal tissue.

    How long is residency?

    Residency is a total of five years. Some institutions have a built in first year of general medicine, while others ask that you apply to a separate internship. The internship can be a pure medicine, pediatric or surgery preliminary year or a combination of fields called a transitional year.

    Are there fellowships following residency?

    There are numerous fellowships across the country including those in pediatrics, research, brachytherapy, protons and individual sub-sites or combinations of sub-sites within radiation oncology.

    Is applying to radiation oncology competitive?

    Though there is no absolute cutoff as to scores needed to apply in the field, most programs look favorably at above average board scores, research both in the field and outside the field, class rank and recommendation letters from radiation oncologists.

    What if I don't love physics?

    You don’t have to love the subject material. Most residency programs in the country teach a formal physics course. Physicians work with physicists to ensure that treatment is delivered accurately to patients.

    What is a typical week like in radiation oncology?

    A resident's day varies from day to day. As a resident you will typically see consults, follow-ups, throughout the day and be involved in the treatment planning and delivery for a significant portion of your day. On some days, you will perform brachytherapy procedures in your department or in the operating room. Treatment planning typically entails simulating the patient prior to treatment in the appropriate position, outlining tumor volumes and normal structures to plan treatment fields and reviewing treatment plans with dosimetry/physics. In addition throughout the week, you will also approve port films to ensure patients are treated in the right position. Typically departments operate Monday through Friday as primarily an outpatient practice.

    What is call like for a radiation oncology resident?

    Typically call is taken in week long segments from home. Residents on call do not stay in-house, but are available by pager for patient issues and emergency consults. Commonly called emergencies are spinal cord compressions and superior vena cava syndrome which may warrant urgent radiation therapy. The frequency of call depends upon the size of your department.

    What is the job market like?

    Like most fields, the job market varies from year to year. Many often say it goes in phases. Currently, graduating residents have a wide range of opportunities including faculty positions across the country and as well as private practice opportunities.

    Where is the field going?

    The field is constantly growing and the technology is amazing. We are constantly working to increase the accuracy of the treatment while decreasing the toxicities of our treatment through the use of new technology (e.g., IMRT, Protons, etc.) and radioprotectors. It is an exciting time to be in the field and watch it change to improve patient care.

    Are my kids going to have three eyes and four ears if I go into the field?

    Studies have revealed that in the modern age of radiation oncology in the United States that there is no increased risk for a cancer or increased risk birth defects to progeny. In addition, all of the staff that works in the department wears film badges to track the amount of radiation exposure.

    Who governs the specialty?

    Radiation oncologists receive board certification from the American Board of Radiology. Historically radiologists who received additional training in radiation oncology delivered radiation. As radiation oncology expanded, the specialty created a completely separate residency.

    How many boards must a radiation oncologist take to become board certified?

    In total radiation oncology residents take four different board examinations. Radiation oncology residents take physics and radiobiology boards after their fourth year of residency, clinical written boards after their fifth year of residency and oral clinical boards one year after completing residency.

    Who should write my letters of recommendation?

    Many programs recommend that you get at least one letter from a radiation oncologist. Like most specialties we value the opinion of our colleagues. Rotating within your home institution, away electives and research give medical students ample opportunity to connect with individuals within the field who can write letters of recommendation for them during the application process. Getting letters from other fields is not discouraged and may provide a balanced view of applicants.

    How many programs should I apply to?

    There is no set amount of programs one should apply to. The most important thing is that you are comfortable with how many programs you applied to. When completing the residency matching process, you don't want to have any regrets.

    Are people happy in the field?

    Radiation oncology is an amazing field that constantly challenges you as an individual. You will be constantly rewarded as you work to improve the health of your patients. The rewards far outweigh the work you will put into the field. We encourage you to face the challenge and join us in the exciting and ever-changing field of radiation oncology.

    Who should I have to write my letters of recommendations?

    It is a good idea to have at least one radiation oncologist write you a letter of recommendation, particularly someone that you have worked with. If you do rotations at a particular department, try to work with at least one attending consistently so they can write you a letter with some substance. Speak with residents at the department to find out which attendings are going to be willing to write you a letter. The residents just went through the same process and should be happy to help out. If you have done any research with an attending, they would be good to ask for a letter. Some students feel that they need letters from “big names”. A personal letter written by junior faculty may have as much impact as a form recommendation letter written by a chair or senior faculty. You can submit up to five letters, so one or two of each is a good way to go.

    Should I have non-radiation oncologist write my letter of recommendation?

    It is fine to have someone who worked with you for a long period of time to write your letter of recommendation. It is understandable that medical students do not spend more than a few months with radiation oncologists. Medical school advisors, research mentors or others you have worked closely with may be able to provide a personal letter that helps the Radiation Oncology residency selection committee get to know you better. Remember, you have five letters to submit. The committee may not want to read five generic form letters from radiation oncologists who do not know you very well.

    How many programs should I apply to?

    Apply to as many as you feel comfortable. A good way to narrow down the list is only apply to programs that you would be willing to rank to match. Consider geographic location, program size, academic emphasis, urban/rural setting, weather and other factors when making the initial cut. Remember, you will be living, working and learning there for four years. Some people may prefer to not match in radiation oncology than move to another part of the country, live in heat or cold, or move into or out of a city.

    How many programs should I rank?

    You should rank programs where you are willing to live and work for four years.

    Should I apply to preliminary or transitional programs?

    Either is a good choice. Some people prefer to have a traditional medicine internship year offered by a preliminary medicine year. Many preliminary medicine programs offer time for research or electives which can be used to explore other medical specialties, do a research project, or rotate in medical oncology. Transitional-year programs offer a variety of rotations in other specialties whereas preliminary medicine programs focus on rotations within internal medicine. There are also surgical preliminary years and a few oncology preliminary programs.

    Is it a good idea to submit my application as early as possible?

    Some programs may not look at applications until the Dean’s Letter is out on November 1. There are some programs that have offered interviews before then, so they likely review applications in late September and October. That said, earlier is probably better as programs may begin an initial review before the Dean’s letter is released. Submitting in late October may not be a wise move.

    Do I need research to match in Radiation Oncology?

    Radiation Oncology is an evidence-based medical field and residency programs are often looking for applicants who demonstrate an academic aptitude and motivation to learn and ask questions. However, prior research and publications are not necessary to match. If you are starting your fourth year, talk to residents and attendings at your home program (or somewhere you rotate) and ask about available research projects. Oftentimes there are ongoing projects which can use some extra help or perhaps a small retrospective project which does not have the manpower to move forward. A little motivation and a couple months of diligent work should be enough to do a meaningful project. Then you will have something for your application and hopefully made a contribution to the advancement of cancer care.

    When do programs begin to offer interviews?

    Generally programs wait for the Dean’s Letter to be released on November 1 of the application year. Do not be dismayed if you get rejections before November 1. Some programs will make initial cuts before the Dean’s Letter release date.

    How soon should I schedule my interview once I am offered one?

    Some programs fill up their interview spots the day they begin offering interviews. It is best to contact the program as soon as possible to schedule interviews or you may lose your spot.

    How many interviews do I need to go on?

    A good goal is eight or more interviews. If you look at the match statistics released annually from the NRMP, almost all applicants with eight or more interviews match into a residency position.

    Where should I interview?

    Interview anywhere you will be happy training for four years. If you absolutely know that you Do not want to move to a particular location, then consider not applying/interviewing.

    How should I prepare for my interview?

    Use your travel time to review your research projects, read about the program on their website. Prepare a few stock questions that you will ask at the end of interviews since you will likely be asked, "What questions do you have for me?"

    What should I wear?

    Dress professionally.

    How long is the interview day?

    Most programs will use an entire day. You can expect to interview with several attendings and residents. Do not be surprised if you interview with physics, radiobiology or physics staff. Some programs use a panel style interview rather than many individual interviews. Programs will generally inform you prior to your interview day of what to expect.

    If a program offered a pre/post-interview social, does this mean I have to attend?

    This is a good chance to get to know a program well and interact with residents. Keep in mind, this may be a place you will work for four years. Most programs make decisions based on the actual interviews, so missing the dinner to catch a flight is likely OK. Programs understand how hectic the interview season can be.

    Should I send thank you notes?

    Aaah, the great thank you note dilemma. Although certainly the polite thing to do, decisions on ranking applicants likely are not affected by thank you notes. Unless a program specifies whether or not to send thank you notes, there is no right or wrong answer. With electronic communication, hand-written thank you notes may be overkill. Also, certainly do not hesitate to e-mail any of the residents or attending with whom you interviewed if you have questions about the program that were not answered. If you are still unsure, consider a second-look interview.

    Compiled by
    Abigail T. Berman, MD, University of Pennsylvania
    Jordan Kharofa, MD, Medical College of Wisconsin
    Nihkil Thaker, MD, MD Anderson Cancer Center
    Amanda J. Walker, MD Johns Hopkins University

    Review Articles

    • Recent Advances in Radiation Therapy by David E. Gerber, MD, University of Texas Southwestern Medical Center, Dallas, Texas and Timothy A. Chan, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, New York. Am Fam Physician. 2008 Dec 1;78(11):1254-62. PMID: 19069018
    • Radiotherapy for Management of Extremity Soft Tissue Sarcomas: Why, When, and Where? Rick L. M. Haas, MD, PhD, Department of Radiotherapy, The Netherlands Cancer Institute. Int J Radiation Oncol Biol Phys, Vol. 84, No. 3, pp. 572e580, 2012 PMID: 22520481
    • Radiation therapy modalities in prostate cancer. Pugh TJ, Nguyen BN, Kanke JE, Johnson JL, Hoffman KE. J Natl Compr Canc Netw. 2013 Apr 1;11(4):414-21. PMID: 23584344
    • Stereotactic ablative radiotherapy for non-small cell lung cancer: rationale and outcomes.Iyengar P, Timmerman RD. J Natl Compr Canc Netw. 2012 Dec 1;10(12):1514-20. PMID: 23221789
    • Stereotactic radiosurgery for the management of brain metastases. Suh JH. N Engl J Med. 2010 Mar 25;362(12):1119-27. doi: 10.1056/NEJMct0806951. Review. PMID: 20335588
    • What the diagnostic radiologist needs to know about radiation oncology. Terezakis SA, Heron DE, Lavigne RF, Diehn M, Loo BW Jr. Radiology. 2011 Oct;261(1):30-44. doi: 10.1148/radiol.11101688. PMID: 21931140
    • Radiation Oncology: a Primer for Medical Students. Berman AT, Plastaras JP, Vapiwala N. J Cancer Educ. 2013 Jun 27. PMID: 23807599

    Websites

    Books

    • Hansen, E; Roach, M. Handbook of Evidenced-based Radiation Oncology. 2nd Edition, 2010
    • Haffty, B; Wilson, L. Handbook of Radiation Oncology, Basic Principles and Clinical Protocols. 2008
    • AJCC Cancer Staging Manual. 7th Edition.
    • Abraham, Gulley, and Allegra. Bethesda Handbook for Clinical Oncology. 3rd Edition, 2009.
    • DeVita, Lawrence, Rosenberg. Cancer: Principles and Practice of Oncology. 9th Edition, 2011.
    • Gunderson and Tepper. Clinical Radiation Oncology. 3rd Edition, 2011.

    Presentations

    • Introduction to Radiation Oncology for Medical Students. Editors: Abigail T. Berman, MD, University of Pennsylvania and Jordan Kharofa, MD, Medical College of Wisconsin.