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Purpose: To survey the current postoperative recommendations for radiotherapy (RT) in patients with endometrial cancer, with an emphasis on vaginal brachytherapy (VBT)., Methods and Materials: In August 2003, a 32-item questionnaire was mailed to a random sample of 2396 members of the American Society for Therapeutic Radiology and Oncology and the American Brachytherapy Society. The sample excluded members-in-training, physicists, and non-U.S. members. A follow-up mailing was conducted in November 2003. Those who had not treated any patient in the previous year for endometrial carcinoma were instructed to indicate so at the beginning of the questionnaire and return it without responding to any other item. Responses were tabulated to determine the relative frequency distribution., Results: of the 2396 surveys sent out, 757 were returned, for a response rate of 31.6%. Of those who responded, 551 (72.8%) had performed postoperative irradiation for endometrial cancer and were included in this study. Of the 551 respondents, 99.8% had delivered external beam RT to some endometrial cancer patients. An increasing trend was found toward referrals for VBT; 91.5% of those who treated endometrial cancer performed VBT. The vaginal target most often irradiated was the upper vagina in 40.7%, upper 4-5 cm in 54.5%, and the entire vagina in 4.9%; 21.3% placed clips at the vaginal apex for applicator verification. The maximal dose to the bladder and rectum was recorded in 78.3% and 80.2% of patients, respectively. Of the respondents, 40% did not use low-dose-rate (LDR) VBT. The two most common LDR applicators were Delclos cylinders (29.7%) and Fletcher colpostats (29.3%). The mean boost dose delivered with LDR VBT when prescribed to the surface was 29.9 Gy and when prescribed to 0.5 cm was 23.8 Gy. When LDR therapy was used without external beam RT, the mean dose when prescribed to the surface was 56.8 Gy and when prescribed to 0.5 cm was 47.9 Gy. In 2002, 69.1% of respondents treated patients with high-dose-rate (HDR) VBT. Of the respondents, 90.6% used a single-channel vaginal cylinder, and 83.3% of cylinder users followed the curve of the cylinder to optimize dose, 67.9% adjusted the applicator position based on localization films, and 47% adjusted the applicator to be horizontal. The most common fractionation scheme when using HDR VBT as a boost was 5 Gy in three fractions prescribed to 0.5 cm (42.9%). The most common fractionation scheme used with HDR without external beam RT was 7 Gy in three fractions prescribed to 0.5 cm (41.8%)., Conclusion: VBT is a common recommendation for postoperative adjuvant therapy for endometrial cancer. HDR appears to be the most popular approach, with a wide variety of dose fractionation schemes reported. Additional study is warranted to help define the ideal use of VBT.

Rationale and Objectives: We surveyed program directors to determine current radiology program practices in evaluating their residents, faculty, and program., Materials and Methods: In January 2003, a 52-item Web-based survey was made available to program directors of accredited core radiology programs. Responses to the items were tabulated to determine relative frequency distribution. Two-tailed Pearson chi-square tests were used to compare proportions and assess the association between variables., Results: A total of 99 (52%) of 192 program directors responded. Programs were largely in compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements. Noncompliance was related to the requirements to evaluate residents at least four times per year in at least 22 (22.2%) of 99 programs and annually evaluate the program in 20 (20.2%) of 99 programs. New program directors (<1-year tenure) were less likely than those with >/=1-year tenure to be using the Association of Program Directors in Radiology Education Committee global rating form (41.2% versus 68.8%, P =.03). Programs that used this form, compared with those that didn't, were more likely to evaluate resident competence in systems-based practice (88.5% versus 44.0%, P =.001). Being a program director for 1 or more years versus less than 1 year was associated with using a computerized evaluation system (35.8% versus 11.8%, P =.05)., Conclusion: In general, there is a high degree of compliance among radiology programs in meeting ACGME evaluation requirements. However, some programs do not comply with requirements for frequency of resident evaluation or annual program evaluation. The percentage of new program directors is high and related to not using or knowing about useful evaluation resources. Use of computerized evaluation systems, which have the potential to decrease the work associated with evaluations and provide more dependable and reliable data, is minimal.

Background: Approximately 1,000 individuals complete graduate surgical education in general surgery each year. Their subsequent career pathways have not been described but may have relevance to the supply of general surgeons available to provide a broad range of surgical care to the population of the USA., Study Design: Data for this study were obtained from the American College of Surgeons's Surgery Resident Masterfile, developed for the annual Longitudinal Study of Surgery Residents, and the American Board of Medical Specialties's Official Directory of Board Certified Medical Specialists. For verification purposes, the American Medical Association's Physician Masterfile and the American Board of Surgery's certified database were searched. Yearly analyses of certified general surgery graduates from 1983 to 1990 were conducted, and rates of certification between US or Canadian medical school graduates and international medical school graduates (IMG) were compared., Results: Ten to 18 years after completion of a residency program in general surgery, 93.6% of graduates had been certified in general surgery or by another American Board of Medical Specialties board. A total of 43.7% of the 8,068 graduates were certified, in addition, in a general surgery-based specialty. Overall, evidence of certification was not available for 6.4% of graduates. The certification rate for US or Canadian graduates was 95.8% of general surgeons and increased for IMG surgeons from 69.4% for 1983 graduates to 94.7% for 1990 graduates. The number of IMGs in general surgery residency programs declined from 19.7% of 1983 graduates to 7.8% of 1990 graduates. The rates of American Board of Surgery certification are 96.1% for male and 93.6% for female US or Canadian graduates; 79.2% of male IMG graduates and 83.7% of female IMG graduates became certified., Conclusions: Most surgeons who completed a general surgery residency program from 1983 to 1990 are certified and presumably have met high standards for knowledge and experience. More than half of the graduates specialize further.

Background: Pyramidal surgical residency programs, in which more residents are enrolled than can complete the program, have gradually declined in number in recent years. In 1996, the Residency Review Committee for Surgery established a policy that the number of residents appointed to a program must be consistent with the number who will complete the program. Even so, there is still attrition in the ranks of surgical residents, some of whom hold undesignated preliminary positions and have no guarantee of a position that will lead to completion of the program. This study examined the 1993 entering cohort of surgical residents to determine the rate of attrition as of 1998., Study Design: Data were collected from the AMA's Medical Education Research Information Database, the American College of Surgeons Resident Masterfile, and the Association of American Medical Colleges GME Tracking Census database. The data were examined by specialty, gender, ethnic background, and type of medical school attended., Results: The overall attrition rate from surgical GME was 12%; the rate for international medical graduates was 33%; and the rate for osteopathic residents was 28%. African-American United States and Canadian graduates had attrition rates of 16% for men and 8% for women, and Hispanic United States and Canadian graduates had attrition rates of 14% for men and 15% for women. General surgery residents had an attrition rate of 26%, which included residents in undesignated preliminary positions. Gender was not a risk factor except for the significantly higher attrition rate of African-American men. Most (81%) of the residents who dropped out of surgical GME enrolled in GME in other specialties., Conclusions: The attrition rate from surgical GME is low, and most residents who drop out reenter GME in another specialty. Of concern is the high rate of attrition of African-American men who are United States or Canadian graduates. The highest rate of attrition, by far, is in the group of international medical graduates, many of whom are likely to have held undesignated preliminary positions.

Background: The American College of Surgeons (ACS) has conducted a detailed annual survey of residents enrolled in surgical graduate medical education (GME) programs since 1982 and has regularly published the resulting data as the Longitudinal Study of Surgical Residents. This report documents surgical resident enrollment and graduation for the academic years 1994-95 and 1995-96., Study Design: The Medical Education Research and Information Database of the American Medical Association was supplemented by the existing ACS Resident Masterfile and by personal contact with program directors and their staffs to verify accuracy and completeness of reporting. Each resident was tracked individually through surgical GME., Results: The total number of surgical residents graduating from surgical GME in 1995 and 1996 has not changed since 1982. Most graduates of surgical residency programs are in obstetrics and gynecology, followed by general surgery; demographic analysis of the graduating cohort shows that most are Caucasian male graduates of US or Canadian medical schools, and that their age at graduation is 33 to 35 years. International medical graduates (IMG) make up 8.9% of entering surgical residents and 6% of graduates. Osteopathic medical school graduates account for 1.2% to 1.3% of entering and graduating surgical residents. Women represent 27% of entering and 23% to 24% of graduates of surgical GME. The largest number and proportion of women in surgical GME are enrolled in obstetrics and gynecology residency programs, where they make up the majority of entering and graduating classes. When all other surgical residency program enrollments are considered together, women make up 17% and 16% of entering residents in 1994 and 1995, respectively, and 13% and 14% of graduates in those years., Conclusions: Surgical GME enrollment and graduation is stable. Few women and ethnic minorities are enrolled in surgical residency programs. IMG enrollment and graduation in surgical GME is low.

Background: The American College of Surgeons (ACS) has collected comprehensive data about surgical residents for the past 12 years and has published an annual report, the Longitudinal Study of Surgical Residents. In 1994, the ACS and the American Medical Association (AMA) agreed to collaborate in collecting data about surgical residents. We report the analysis of these data for residents enrolled in graduate medical education (GME) in surgery during the 1993 to 1994 academic year., Study Design: Data about residents and fellows during the 1993 to 1994 academic year, including the 1994 graduates from 13 surgical specialties, were obtained from the AMA. Through additional mailings and telephone contact by the ACS, data were obtained and verified from each of the 1,500 accredited surgical residency programs. The resulting data set was analyzed to derive a count of residents and fellows and graduates for the 1993 to 1994 academic year. The ACS Resident Masterfile was analyzed separately to compare the 1993 to 1994 results with those from previous years., Results: The total number of surgical residents enrolled in GME has changed little since 1982. Since 1987, the number of graduates has increased 2.1 percent. More general surgery graduates are enrolling in advanced specialty GME than were enrolling in 1982. The average age of graduates from core residency programs is 33 years, of advanced program graduates is 35 years, and of international medical graduates is 36 years. International medical graduates represent 7.1 percent of all surgical residents and fellows and 5.5 percent of graduates. Women and ethnic minorities are underrepresented in surgical GME., Conclusions: Surgical GME enrollment has been stable since 1982, and graduates of general surgery residencies are increasingly likely to enroll in advanced specialty residency programs.