- Email: [email protected]
Numerical Analysis on Thermal Characteristics of an Open Loop Geothermal System in a Single Well
Volume 105 Number 1S Supplement 2019 Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA Purpose/Objective(s): There has been widespread adoption of stereotactic radiosurgery (SRS) for treatment of brain metastases and stereotactic body radiation therapy (SBRT) for a wide range of indications. We sought to determine temporal trends in exposure to SRS and SBRT for graduating radiation oncology residents (GRORs). Materials/Methods: Summarized, de-identified case logs for all GRORs in the US, between 2007 and 2018 were obtained from the ACGME. All cases were self-logged as having performed the procedure. Variables collected included number of GRORs per year, average number of procedures per resident and standard deviations. SRS was intracranial, while SBRT included all extracranial disease sites, including spine. Number of cases by percentile (10th, 30th, 50th, 70th, and 90th), was evaluated per year. Analysis of Variance (ANOVA) was used to determine statistical significance, linear regression to create trendline, and strength of association using Pearson correlation. A GROR case volume of 30 or more cases, for both SRS and SBRT, was defined as high volume. For SBRT, 5 cases per identifiable subsite (liver, lung, or spine, only collected from 2015-2018) was defined as sufficient volume. Results: The number of GRORs increased per year, from 114 in 2007 to 189 in 2018 (pZ0.001, rZ0.88). There was a 298% increase in total number of SRS cases performed in which residents participated, from 3,181 cases in 2007 to 9,511 in 2018 (p<0.001, rZ0.95). SRS exposure per GROR increased, from average of 27.9 cases in 2007 to 50.3 in 2018 (p<0.001, rZ0.96). High volume in SRS was achieved by the top 30% of GRORs in 2007 and top 70% of GRORs in 2018. For SBRT, there was a 1,536% increase in total number of cases performed with resident participation, from 684 cases in 2007 to 10,508 cases in 2018 (p<0.001, rZ0.98). There was an increase in SBRT volume per GROR, from an average of 6 cases in 2007 to 55.6 cases in 2018 (p<0.001, rZ0.99). High volume in SBRT was achieved by less than 10% of GRORs from 2007 to 2009. In 2010, the top 10% of GRORs achieved high volume, increasing to top 30% by 2013, and top 50% by 2015. By 2018, top 70% of GRORs had high volume. Complete subsite data, only available for 2018 GRORs, demonstrated that the top 90% of GRORs had sufficient volume for lung SBRT. However, only 30% of residents had sufficient volume in liver and spine SBRT. Conclusion: There has been a significant increase in the case volume per GROR in both SRS and SBRT over the past decade. Continued increase in use of stereotactic based radiation is expected with potential for expanding indications or replacing current fractionation schemes. What was once a treatment primarily performed at high-volume and/or academic centers has now become mainstream. Future ACGME requirements may consider evaluation of a minimum number of site-specific cases, given less exposure in liver and spine SBRT compared to lung SBRT. Author Disclosure: A. Shinde: Independent Contractor; RadOncQuestions. R. Li: None. A. Amini: None. N. Vapiwala: Employee; University of Pennsylvania. Honoraria; Varian Medical Systems. Consultant; Magellan HealthRx. Travel Expenses; Varian Medical Systems; ACGME Residency Review Committee, ADROP, ASTRO GU Resource Panel. S. Beriwal: None. S.M. Glaser: Honoraria; Reflexion.
2357 How Important Are “Away” Rotations for Matching in Radiation Oncology? An Applicant Survey B.U. Sidiqi, E.F. Gillespie, and A.J. Wu; Memorial Sloan Kettering Cancer Center, New York, NY Purpose/Objective(s): It is common for radiation oncology (rad onc) applicants to perform visiting (“away”) rotations. Though the nominal purpose of such rotations is educational, for competitive specialties like rad onc they are often perceived as an “audition” for particular residency programs. Away rotations entail financial costs (travel and board) and also consume limited elective time. We surveyed rad onc applicants regarding
Poster Viewing Q&A Sessions E157 the perceived value, opportunities, and barriers presented by away rotations for medical students seeking to enter the field. Materials/Methods: An anonymous survey was emailed to all applicants to a single rad onc program from 2015-2017. Questions assessed number of away rotations, funding, motivations, and barriers, along with perceived impact on match results. Away rotations were defined as any rad onc rotation outside of the student’s own medical school. Results: The overall response rate was 39% (nZ194). The vast majority (89%) reported at least 1 away rotation. Among respondents, 39% (nZ67) matched to a program where they did an away rotation. The median number of away rotations was 2. The vast majority felt that away rotations were extremely important (71%) or important (22%) to applying in rad onc; only 8% felt they were unimportant. Most (56%) felt the optimal number of away rotations was 2, while an additional 28% preferred 3 away rotations. The most common motivations were interest in a specific program (44%) and to obtain recommendation letters (31%). 9% did away rotations because they did not have a home program. Of those who did not do away rotations (nZ22), 50% believed that it would not improve match chances, while 7 (32%) reported barriers such as costs (nZ1), family responsibilities (nZ3), and lack of opportunities (nZ3). Sources of financial support for away rotations included personal savings (29%), family support (26%), or additional loans (22%). 67 respondents (35%) reported that costs were a limiting factor, stating they would otherwise have done more away rotations. Conclusion: These survey results confirm that most rad onc rotations perform away rotations, and do so in an effort to increase chances of matching successfully. A significant proportion of respondents matched at a program where they did an away rotation, and most respondents felt that 2 or 3 away rotations were optimal. This perceived importance of away rotations should be weighed against the costs, as many applicants reported being limited in doing away rotations due to finances. This suggests a role for measures to reduce barriers to access, such as flexible scheduling, 2week rotations, and/or offering interviews at rotation’s end. It could also be considered whether the pressure to use limited elective time during medical school to perform “audition” rotations is ultimately in the best educational interest of medical students and the next generation of radiation oncologists. Author Disclosure: B.U. Sidiqi: None. E.F. Gillespie: None. A.J. Wu: Research Grant; CivaTech Oncology, Inc. Consultant; AstraZeneca. Travel Expenses; AlphaTau Medical.
2358 A Novel Radiation Oncology Residency Training Leadership Curriculum: Baseline Attitudes of Past and Current Residents E. Song,1 J.M. Frakes,2 T.J. Dilling,2 J.F. Quinn,3 L.B. Harrison,4 and S. Hoffe2; 1University of South Florida Morsani College of Medicine, Tampa, Florida, Tampa, FL, 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 3University of South Florida, Tampa, FL, 4H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL Purpose/Objective(s): Ongoing healthcare changes, with new models of delivery, administrative burdens, and the increasing care complexity challenge radiation oncologists in their daily practice. A new program has been established at our center to enhance the leadership abilities of Radiation Oncology (RO) trainees to meet these new challenges. The objective of the present study was to determine baseline attitudes towards the need for, and components of, a leadership development curriculum. Materials/Methods: A Qualtrics survey of 46 questions addressing baseline attitudes towards leadership in healthcare, emotional intelligence (EI) competencies, and leadership training interests was sent to current and past residents who completed/are completing Radiation Oncology residency training at our institution. A completed sample of 21 (nZ11 who are now attending physicians, 10 current residents) anonymous responses were recorded for a response rate of 21/24 (84%) and analyzed on SPSS.
E158
International Journal of Radiation Oncology Biology Physics
Results: Both past and current residents had high rates of understanding how their feelings affected what they say and do, but much less selfmanagement measured by how frequently they check in with how they are actually feeling (36% vs. 40%, pZ0.85). Past residents are more likely to be affected by setbacks (82% vs. 40%, pZ0.055) and distracted by new projects (36% vs. 10%, pZ0.17). The ability to lead and work in teams were both rated as a top attribute between past and current residents (73% vs. 80%, pZ0.71). Both past and current residents are demonstrably high performers with an achievement mindset; however, some reported difficulties with managing emotional impulses (18% vs. 10%, pZ0.61) or emotions in the face of setbacks (9% vs. 0%). Compared to attending physicians, residents reported more difficult patient encounters (60% vs. 27%, pZ0.14) and more often would stay up late to catch up on work (70% vs. 27%, pZ0.054). Leadership training during residency was rated as extremely useful by past and current residents (73% vs. 70%, pZ0.88). Top training interests included leading clinical teams (100% vs. 70%), effective communication strategies (100% vs. 90%), and conflict management (82% vs. 100%). Both groups agreed that 6-8% of residency should be dedicated towards leadership training. Conclusion: RO practicing physicians and residents strongly agreed that leadership skills, along with EI, play a very important role in medicine. With our leadership training program, there is the potential to improve resident resiliency with EI strategies to optimize the individual’s selfawareness and capacity for self-management. Leadership training is perceived as a desired experience during residency, with leading self, leading clinical teams, effective communication strategies, and conflict management as top training interests. Future studies include gauging multi-institutional interest towards developing a standardized leadership curriculum for RO residents. Author Disclosure: E. Song: None. J.M. Frakes: Employee; WellCare Health Plans Inc. T.J. Dilling; NCCN. J.F. Quinn: None. L.B. Harrison: None. S. Hoffe: Research Grant; Varian. Honoraria; Varian, Reflexion, UpToDate. Travel Expenses; IBA; ASCO Annual Meeting Scientific Program Committee.
implementation of a formal mentorship program with tool development to facilitate faculty-trainee matching, mentor bios, suggested guidelines for mentorship relationships, and a template for individualized career plan discussion. The Leadership component comprises key topics including interpersonal and leadership styles, teamwork, negotiation and conflict management. A leadership speaker series was initiated on some of these topics, and tailored workshops will address the remainder. Well-Med was introduced to residents in February 2019 and will be implemented in a step-wise roll-out during protected academic time. Conclusion: We present a strategy for developing a formalized, multifaceted program supporting radiation oncology trainee wellness. This may serve as a framework for other post-graduate training programs. Further research will include an evaluation of the curriculum and consideration for expansion to other programs. Author Disclosure: I.S. Voruganti: None. B. Millar: None. I. Ackerman: None. M.J. Follwell: None. J.M. Croke: None.
2359 Well-Med: A Multidisciplinary Approach to Supporting Radiation Oncology Resident Wellness I.S. Voruganti,1 B.A. Millar,1,2 I. Ackerman,1,3 M.J. Follwell,1,4 and J.M. Croke1,5; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada, 3Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 4Royal Victoria Hospital, Barrie, ON, Canada, 5Princess Margaret Cancer Centre, Toronto, ON, Canada Purpose/Objective(s): Wellness has emerged as an important area within post-graduate medical education. Our objective was to identify the wellness needs of radiation oncology residents in our program, and to develop a multifaceted curriculum to develop and support wellness. Materials/Methods: Curriculum development was mapped using Kern’s six-step approach. A literature review was conducted to assess the wellness landscape in postgraduate medical education, in general, and radiation oncology, specifically, and to identify gaps. Targeted needs assessments of radiation oncology residents were done in the areas of general wellness, mentorship, and leadership. The results of the literature review and needs assessments were used to inform the design, development and implementation of a wellness curriculum, including goals/objectives and educational sessions. Results: The literature review and needs assessments identified reflection, mentorship and leadership as wellness program pillars, and were combined under the name “Well-Med.” For each component, educational design was undertaken and included a syllabus, lesson plan or guideline development. For the Reflection component, a narrative medicine workshop series (nZ4) was developed exploring themes of identity, work-life balance, uncertainty and creativity in oncology. The Mentorship component includes
2360 Resident Engagement in Global Health: Results of the First Decade (2009-2019) of the Association of Residents in Radiation Oncology (ARRO) Global Health Initiative D.V. Wakefield,1 A. Lee,2 B. Li,3 C. Freese,4 C.R. Nwachukwu,5 S.A. Castaneda,6 S.N.C. Elmore,7 L.K. Dad, Jr,8 M.M. Shah,9 M.R. Farmer,1 N.A. VanderWalde,1 and D.L. Schwartz1; 1University of Tennessee Health Science Center - West Cancer Center, Department of Radiation Oncology, Memphis, TN, 2SUNY Downstate Medical Center, Forest Hills, NY, 3University of California San Francisco - Department of Radiation Oncology, San Francisco, CA, 4Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, 5Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, 6Department of Radiation Oncology, Cancer Center, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA, 7 Massachusetts General Hospital, Boston, MA, 8Anne Arundel Medical Center, Annapolis, MD, 9Henry Ford Health System, Detroit, MI Purpose/Objective(s): To evaluate current United States radiation oncology (RO) resident engagement in global health (GH) education opportunities relative to 2009 benchmarks. Materials/Methods: National web-based GH surveys were sent to all resident trainees actively enrolled in U.S. RO training programs in 2009 and 2018 using questionnaires developed by the ARRO Global Health subcommittee. Statistical analyses were performed using Chi-square and multivariate logistic regression. Results: A total of 139 (22.1%) of 627 current residents responded, similar to 2009 (nZ 115/566, 20.5%). 83% of responders were interested in a RO GH educational experience. 83% of those interested desired short term (<1 month) and 28% desired extended (>1 month) exposure. 78% expressed interest in connecting remotely with GH opportunities during residency. From 2009 to 2018, there was three-fold increase in reporting of formal GH educational opportunities offered by residency programs (9% v 27%, respectively, pZ<0.001). Perceived availability of faculty guidance (44% v 37%, pZ0.215) and program director support (26% v 22%, pZ0.473) remained stable. However, perceived barriers to funding (35% v 76%, pZ<0.001) and elective time (28% v 59%, pZ<0.001) more than doubled. Outside of lower interest in GH work among residents with children (OR 0.36, 95% CI 0.13-1.01, pZ0.052), no other demographic or training factor was predictive of GH interest in this self-selected sample. 43% of respondents stated dedicated time for GH work in their future job was a higher priority than salary. Conclusion: There has been durable interest in GH opportunities among U.S. RO residents across the past 10 years. Our self-selected resident sample appears to represent a dedicated pool of trainees committed to expand the global impact of U.S. radiation oncology and who recognize the need for resources to ensure successful follow through. This
2357 How Important Are “Away” Rotations for Matching in Radiation Oncology? An Applicant Survey B.U. Sidiqi, E.F. Gillespie, and A.J. Wu; Memorial Sloan Kettering Cancer Center, New York, NY Purpose/Objective(s): It is common for radiation oncology (rad onc) applicants to perform visiting (“away”) rotations. Though the nominal purpose of such rotations is educational, for competitive specialties like rad onc they are often perceived as an “audition” for particular residency programs. Away rotations entail financial costs (travel and board) and also consume limited elective time. We surveyed rad onc applicants regarding
Poster Viewing Q&A Sessions E157 the perceived value, opportunities, and barriers presented by away rotations for medical students seeking to enter the field. Materials/Methods: An anonymous survey was emailed to all applicants to a single rad onc program from 2015-2017. Questions assessed number of away rotations, funding, motivations, and barriers, along with perceived impact on match results. Away rotations were defined as any rad onc rotation outside of the student’s own medical school. Results: The overall response rate was 39% (nZ194). The vast majority (89%) reported at least 1 away rotation. Among respondents, 39% (nZ67) matched to a program where they did an away rotation. The median number of away rotations was 2. The vast majority felt that away rotations were extremely important (71%) or important (22%) to applying in rad onc; only 8% felt they were unimportant. Most (56%) felt the optimal number of away rotations was 2, while an additional 28% preferred 3 away rotations. The most common motivations were interest in a specific program (44%) and to obtain recommendation letters (31%). 9% did away rotations because they did not have a home program. Of those who did not do away rotations (nZ22), 50% believed that it would not improve match chances, while 7 (32%) reported barriers such as costs (nZ1), family responsibilities (nZ3), and lack of opportunities (nZ3). Sources of financial support for away rotations included personal savings (29%), family support (26%), or additional loans (22%). 67 respondents (35%) reported that costs were a limiting factor, stating they would otherwise have done more away rotations. Conclusion: These survey results confirm that most rad onc rotations perform away rotations, and do so in an effort to increase chances of matching successfully. A significant proportion of respondents matched at a program where they did an away rotation, and most respondents felt that 2 or 3 away rotations were optimal. This perceived importance of away rotations should be weighed against the costs, as many applicants reported being limited in doing away rotations due to finances. This suggests a role for measures to reduce barriers to access, such as flexible scheduling, 2week rotations, and/or offering interviews at rotation’s end. It could also be considered whether the pressure to use limited elective time during medical school to perform “audition” rotations is ultimately in the best educational interest of medical students and the next generation of radiation oncologists. Author Disclosure: B.U. Sidiqi: None. E.F. Gillespie: None. A.J. Wu: Research Grant; CivaTech Oncology, Inc. Consultant; AstraZeneca. Travel Expenses; AlphaTau Medical.
2358 A Novel Radiation Oncology Residency Training Leadership Curriculum: Baseline Attitudes of Past and Current Residents E. Song,1 J.M. Frakes,2 T.J. Dilling,2 J.F. Quinn,3 L.B. Harrison,4 and S. Hoffe2; 1University of South Florida Morsani College of Medicine, Tampa, Florida, Tampa, FL, 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 3University of South Florida, Tampa, FL, 4H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL Purpose/Objective(s): Ongoing healthcare changes, with new models of delivery, administrative burdens, and the increasing care complexity challenge radiation oncologists in their daily practice. A new program has been established at our center to enhance the leadership abilities of Radiation Oncology (RO) trainees to meet these new challenges. The objective of the present study was to determine baseline attitudes towards the need for, and components of, a leadership development curriculum. Materials/Methods: A Qualtrics survey of 46 questions addressing baseline attitudes towards leadership in healthcare, emotional intelligence (EI) competencies, and leadership training interests was sent to current and past residents who completed/are completing Radiation Oncology residency training at our institution. A completed sample of 21 (nZ11 who are now attending physicians, 10 current residents) anonymous responses were recorded for a response rate of 21/24 (84%) and analyzed on SPSS.
E158
International Journal of Radiation Oncology Biology Physics
Results: Both past and current residents had high rates of understanding how their feelings affected what they say and do, but much less selfmanagement measured by how frequently they check in with how they are actually feeling (36% vs. 40%, pZ0.85). Past residents are more likely to be affected by setbacks (82% vs. 40%, pZ0.055) and distracted by new projects (36% vs. 10%, pZ0.17). The ability to lead and work in teams were both rated as a top attribute between past and current residents (73% vs. 80%, pZ0.71). Both past and current residents are demonstrably high performers with an achievement mindset; however, some reported difficulties with managing emotional impulses (18% vs. 10%, pZ0.61) or emotions in the face of setbacks (9% vs. 0%). Compared to attending physicians, residents reported more difficult patient encounters (60% vs. 27%, pZ0.14) and more often would stay up late to catch up on work (70% vs. 27%, pZ0.054). Leadership training during residency was rated as extremely useful by past and current residents (73% vs. 70%, pZ0.88). Top training interests included leading clinical teams (100% vs. 70%), effective communication strategies (100% vs. 90%), and conflict management (82% vs. 100%). Both groups agreed that 6-8% of residency should be dedicated towards leadership training. Conclusion: RO practicing physicians and residents strongly agreed that leadership skills, along with EI, play a very important role in medicine. With our leadership training program, there is the potential to improve resident resiliency with EI strategies to optimize the individual’s selfawareness and capacity for self-management. Leadership training is perceived as a desired experience during residency, with leading self, leading clinical teams, effective communication strategies, and conflict management as top training interests. Future studies include gauging multi-institutional interest towards developing a standardized leadership curriculum for RO residents. Author Disclosure: E. Song: None. J.M. Frakes: Employee; WellCare Health Plans Inc. T.J. Dilling; NCCN. J.F. Quinn: None. L.B. Harrison: None. S. Hoffe: Research Grant; Varian. Honoraria; Varian, Reflexion, UpToDate. Travel Expenses; IBA; ASCO Annual Meeting Scientific Program Committee.
implementation of a formal mentorship program with tool development to facilitate faculty-trainee matching, mentor bios, suggested guidelines for mentorship relationships, and a template for individualized career plan discussion. The Leadership component comprises key topics including interpersonal and leadership styles, teamwork, negotiation and conflict management. A leadership speaker series was initiated on some of these topics, and tailored workshops will address the remainder. Well-Med was introduced to residents in February 2019 and will be implemented in a step-wise roll-out during protected academic time. Conclusion: We present a strategy for developing a formalized, multifaceted program supporting radiation oncology trainee wellness. This may serve as a framework for other post-graduate training programs. Further research will include an evaluation of the curriculum and consideration for expansion to other programs. Author Disclosure: I.S. Voruganti: None. B. Millar: None. I. Ackerman: None. M.J. Follwell: None. J.M. Croke: None.
2359 Well-Med: A Multidisciplinary Approach to Supporting Radiation Oncology Resident Wellness I.S. Voruganti,1 B.A. Millar,1,2 I. Ackerman,1,3 M.J. Follwell,1,4 and J.M. Croke1,5; 1Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 2Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada, 3Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 4Royal Victoria Hospital, Barrie, ON, Canada, 5Princess Margaret Cancer Centre, Toronto, ON, Canada Purpose/Objective(s): Wellness has emerged as an important area within post-graduate medical education. Our objective was to identify the wellness needs of radiation oncology residents in our program, and to develop a multifaceted curriculum to develop and support wellness. Materials/Methods: Curriculum development was mapped using Kern’s six-step approach. A literature review was conducted to assess the wellness landscape in postgraduate medical education, in general, and radiation oncology, specifically, and to identify gaps. Targeted needs assessments of radiation oncology residents were done in the areas of general wellness, mentorship, and leadership. The results of the literature review and needs assessments were used to inform the design, development and implementation of a wellness curriculum, including goals/objectives and educational sessions. Results: The literature review and needs assessments identified reflection, mentorship and leadership as wellness program pillars, and were combined under the name “Well-Med.” For each component, educational design was undertaken and included a syllabus, lesson plan or guideline development. For the Reflection component, a narrative medicine workshop series (nZ4) was developed exploring themes of identity, work-life balance, uncertainty and creativity in oncology. The Mentorship component includes
2360 Resident Engagement in Global Health: Results of the First Decade (2009-2019) of the Association of Residents in Radiation Oncology (ARRO) Global Health Initiative D.V. Wakefield,1 A. Lee,2 B. Li,3 C. Freese,4 C.R. Nwachukwu,5 S.A. Castaneda,6 S.N.C. Elmore,7 L.K. Dad, Jr,8 M.M. Shah,9 M.R. Farmer,1 N.A. VanderWalde,1 and D.L. Schwartz1; 1University of Tennessee Health Science Center - West Cancer Center, Department of Radiation Oncology, Memphis, TN, 2SUNY Downstate Medical Center, Forest Hills, NY, 3University of California San Francisco - Department of Radiation Oncology, San Francisco, CA, 4Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, 5Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, 6Department of Radiation Oncology, Cancer Center, Hahnemann University Hospital and Drexel University College of Medicine, Philadelphia, PA, 7 Massachusetts General Hospital, Boston, MA, 8Anne Arundel Medical Center, Annapolis, MD, 9Henry Ford Health System, Detroit, MI Purpose/Objective(s): To evaluate current United States radiation oncology (RO) resident engagement in global health (GH) education opportunities relative to 2009 benchmarks. Materials/Methods: National web-based GH surveys were sent to all resident trainees actively enrolled in U.S. RO training programs in 2009 and 2018 using questionnaires developed by the ARRO Global Health subcommittee. Statistical analyses were performed using Chi-square and multivariate logistic regression. Results: A total of 139 (22.1%) of 627 current residents responded, similar to 2009 (nZ 115/566, 20.5%). 83% of responders were interested in a RO GH educational experience. 83% of those interested desired short term (<1 month) and 28% desired extended (>1 month) exposure. 78% expressed interest in connecting remotely with GH opportunities during residency. From 2009 to 2018, there was three-fold increase in reporting of formal GH educational opportunities offered by residency programs (9% v 27%, respectively, pZ<0.001). Perceived availability of faculty guidance (44% v 37%, pZ0.215) and program director support (26% v 22%, pZ0.473) remained stable. However, perceived barriers to funding (35% v 76%, pZ<0.001) and elective time (28% v 59%, pZ<0.001) more than doubled. Outside of lower interest in GH work among residents with children (OR 0.36, 95% CI 0.13-1.01, pZ0.052), no other demographic or training factor was predictive of GH interest in this self-selected sample. 43% of respondents stated dedicated time for GH work in their future job was a higher priority than salary. Conclusion: There has been durable interest in GH opportunities among U.S. RO residents across the past 10 years. Our self-selected resident sample appears to represent a dedicated pool of trainees committed to expand the global impact of U.S. radiation oncology and who recognize the need for resources to ensure successful follow through. This