Standardized Onboarding Checklists for Radiation Oncology Teams
Raymond Mak, MD, and Wesley Talcott, MD, MBAStandardization is a key tenant of high-quality and safe practice and that extends to all reoccurring activities like staff onboarding. All new employees, whether they have recently completed training or are highly skilled experts coming from another practice, need a comprehensive orientation to an unfamiliar facility. A structured and standardized onboarding process ensures that new hires understand and follow the practice’s specific procedures, supporting a smooth transition, staff integration and consistent patient care. As a new resource to support practices, especially during times of staffing challenges, ASTRO’s Multidisciplinary Quality Assurance Subcommittee has developed sample orientation checklists.
These documents are only samples; they do not contain any formal recommendations and are not prescriptive guidelines. The resources are available in Word format to allow for easy customization of the individual practice’s unique needs, equipment and workflows. Checklists are organized by role but share a consistent framework and overlapping content to promote multidisciplinary alignment. Sample checklists are available on ASTRO’s website for radiation oncologists, nurses, therapists, and dosimetrists, with a physicist checklist currently in development.
Regularly reviewing and standardizing the onboarding process supports both safety and quality. Additional resources, such as the RO-ILS themed report on training and education, provide data and examples illustrating the impact of comprehensive onboarding. Likewise, APEx Accreditation Standard 5 emphasizes staff qualifications and ongoing training including onboarding processes.
The following is an excerpt from the Radiation Oncologist Onboarding Checklist. A section on disease-site information includes topics that practices may want to cover as they pertain to the facility’s processes for a certain disease site, if applicable. Reproduced below is a sample for thoracic indications.
Simulation:
Standard simulation imaging (e.g., 4D CT with free breathing CT with or without contrast)
Motion management options and patient eligibility criteria (e.g., breath hold versus gating versus compression)
Conventions for use of IV and oral contrast
Contouring:
Conventions for defining iGTV, CTV and PTVs
Thoracic OARs are the responsibility of the dosimetrist except specialized OARs such as cardiac sub-structures
Understand the reference imaging for planning (e.g., 4D-CT average intensity projection versus breath-hold CT)
Responsibility and techniques for 4D-CT and PET registration
Planning:
Indications for the use of planning technologies (e.g., 3D vs. IMRT vs. protons)
Treatment:
Motion management options on the machine (compression, breath hold and gating)
Thresholds for contacting doctor or replanning (e.g., abnormal respiratory motion or tumor shift on setup imaging)
Other:
Preferred treatment approaches of the multi-disciplinary team (e.g., neoadjuvant chemotherapy-immunotherapy for borderline resectable versus chemoradiation or local conventions on defining medically inoperable stage I NSCLC)
Lung cancer screening and tobacco cessation programs and resources locally
