PGY-1 Radiation Oncology – University of Toronto
Hi there! My name is Gordon Locke and I am a PGY-1 in radiation oncology at the University of Toronto. I grew up in the Toronto neighborhood of High Park. I did my undergraduate degree in medical biophysics at Western University in London, Ont., and subsequently did my medical degree at McMaster University in Hamilton, Ont.
Radiation oncology is a small specialty that many people have never heard of, or at least they don’t know exactly what radiation oncologists do. When I chose to become a radiation oncologist, several factors played into my decision. One important consideration was that the specialty is primarily outpatient-based with very few inpatient responsibilities. This gives me more predictable practice hours and responsibility.
What does a typical day of clinical duties involve?
Residents have 36 months of core radiation oncology rotations, divided into 3-month blocks that focus on a specific disease sites, such as lung, gastrointestinal, head and neck, or breast. During any given week a radiation oncology resident will have 3 or 4 half-day clinics to see new patients, meet patients currently being treated, and follow up with those whose treatment is completed. Outside of clinic time residents plan the treatments for patients who need radiation, attend multidisciplinary rounds to discuss management of patients, and review the treatment plans of other radiation oncologists. We also care for inpatients on weekends and evenings.
What kinds of clinical rotations are required in your program?
Radiation oncology residents do their first 18 months off service. We do a variety of surgical and medical rotations, as well as diagnostic rotations like pathology and radiology. We also do academic education blocks that teach the basics behind radiation, like physics, radiobiology, and math. During 5 years of residency we have 18 months off service and the remainder is on service, doing radiation oncology rotations.
Which of your personality characteristics have been particularly helpful in your field?
Communication is hugely important for radiation oncologists. Every day I have important conversations with patients, whether explaining a patient’s code status, breaking bad news to someone that their cancer has returned, or discussing a case at rounds about the best way to treat a patient’s cancer. Excellent communication is essential to ensure good patient care.
What are the best aspects of your residency?
I really enjoy the combination of medicine and technology in radiation oncology. Our technology has advanced rapidly over the last 30 years and this has translated to significant gains for patient care. I enjoy being able to sit down and work on radiation treatment plans on some days, then switch to a busy clinic the next day. I am able to interact with many different surgical, medical, and diagnostic specialties on a daily basis. Oncologists also develop a unique bond with their patients, which I truly value.
What are the most challenging aspects of your residency?
I have many serious conversations with patients and their families, and they are not always happy conversations. Radiation oncologists treat a large number of palliative patients, so it is important to be able to deal with people near their end of life and engage them in the conversations that go with that.
What is one question you’re often asked about your residency?
“Do I need to love physics?” While we are taught physics during our PGY-2 year, it is not essential to love physics to go into radiation oncology. We are taught physics to help us understand the technology that we use and how radiation works on the cancers that we are treating. But in our day-to-day clinical work, we use little or no physics.
Can you describe the transition from clerkship into residency?
It was certainly a wild ride! It was scary but also very fulfilling. After the first couple of months I found my groove and began to really thrive as a resident. The responsibilities that are added with residency seemed daunting at first, but they really allowed me to blossom into a better clinician.
What are your future practice plans?
It’s too soon to know. A radiation oncologist typically practices on only 2-3 disease sites, like breast, lung, gynecologic, or central nervous system. I hope to discover over the next several years which are the best fit for me.
What are your fellow residents like and how do you interact with each other?
Radiation oncology residents typically work one-on-one with staff, so I don’t see my co-residents while working in clinic. Instead I see them when contouring or hanging out in the residents room. We also have 1 or 2 academic half days each week where all the residents get together for radiation oncology teaching.
What are your academic interests (e.g., leadership activities, research)?
I’m very involved in leadership activities. For the Professional Association of Residents of Ontario (PARO), I’m a General Council representative. I’m also the resident representative for my peers to the program, and a resident representative to the Ontario Medical Association.
Research is also a big focus of radiation oncology, as much of the treatment that we deliver is evidence-based. It is important for residents to be able to critically appraise research that is presented to them.
What is your work-life balance like, and how do you achieve this?
Radiation oncology is a specialty that offers excellent work-life balance. Call is infrequent and tends to be lighter than most medical specialties. The day-to-day work is mainly outpatient or non-clinical, so it’s easier to have predictability. I make sure that I take time to exercise and that I’m not getting too overworked!