By Jean M. Moran, PhD, and William Small Jr., MD, FASTRO
In a continued effort to encourage discussion around gender equity on the ROhub, we would like to share our perspectives on equity, diversity and inclusion (EDI) for women and underrepresented minority professionals. For decades, we as leaders have sought different ways to support the success of women and underrepresented minority professionals in radiation oncology. At the root of many problems in medicine is a paucity of underrepresented minorities in the pipeline, specifically medical school. For women in medicine, this problem has largely been corrected by women applying, entering and graduating from medical school in similar proportions to men since 2003.1
Although medical student matriculation is an issue in many underrepresented demographics, the problem starts long before medical school. There are significant deficits in education for populations with lower socioeconomic status. To overcome this deficit, more professionals need to advocate for equity in educational opportunities. In addition, mentorship of elementary through high school students, especially for science, is a responsibility that we should all prioritize.
The Loyola University Stritch School of Medicine (SSOM) in Chicago believes in creating an environment that fosters equity, inclusion and excellence. SSOM has been the leader in matriculating DACA (Deferred Action for Childhood Arrivals, also known as DREAMer) students and is the only medical school in the country to have accepted DACA students for seven consecutive years. The university’s administration works closely with the Office of Diversity, Equity and Inclusion and regularly meets with medical student leaders of White Coats for Black Lives to further understand the challenges facing Black students and to establish paths for expansion of underrepresented students and faculty. In addition, the SSOM dean serves as the chief diversity officer, and the president of our university has created a new role of vice president of Institutional Diversity, Equity and Inclusion.
Once in medical or graduate school, recruitment of talented women and underrepresented minorities to radiation oncology and medical physics should be a major goal of all training programs. Many societies and institutions have developed summer fellowships specifically designed to expose underrepresented populations to our profession. Despite these efforts, exposure to our field can be a struggle, as radiation oncology is rarely given much time in the first two years of the curriculum in medical school. The American College of Radiology (ACR) is currently advocating for radiology to be a core medical student rotation, incorporating all the radiological specialties, including radiation oncology. Until such changes to the core curriculum occur, outreach to medical students for inclusion is crucial.
At Loyola, Dr. Small gives an hour-long lecture to second year medical students, which is often the first time they have been exposed to our specialty. Such advocacy efforts before and during medical school can inspire individuals to pursue careers in our field. Similarly, undergraduate students who may be potential recruits for medical physics programs may also be completely unaware of opportunities available through CAMPEP-accredited graduate or certificate programs to pursue our profession.
Within radiation oncology, chairs and other department leaders can model an open, learning mindset for addressing EDI. We are encouraged to see a growth in awareness of the need to address EDI within our field.2,3 One way to demonstrate a commitment is by allotting dedicated time as well as leadership positions in the department. At the University of Michigan’s Department of Radiation Oncology, Kelly Paradis, PhD, serves in a new senior leadership position as associate chair of Equity and Wellness. One active area this department-wide team oversees is ensuring equity in recruitment, by blinding applications, revising the wording of postings and being mindful of the interview structure. Dr. Moran held a clinical physics team meeting focused on lessons learned on implicit bias in the medical physics residency process4 prior to interviews by the team. Educational activities are scheduled with consideration of the availability of all employees to attend.
Leaders are able to support EDI for individual trainees as well. At the beginning of a career, we encourage leaders to explain and reinforce performance expectations while also taking time to understand the career goals of their new employees. Leaders are able to guide women and underrepresented groups in avoiding the well-known phenomenon of heavier committee service load. We both enjoy and are fueled by our relationships with mentees, whether formal or informal. Loyola University in Chicago has a formal program where faculty mentees meet at least twice per year with their primary faculty mentor, an institutional mentor and an outside mentor to report on progress. Leaders are also well positioned to seek and direct their employees to resources that support their goals for professional growth, whether they are departmental, institutional or national.
Another way leaders support employees is at critical intersections between their work and home lives, such as for the birth or adoption of a child. For individual employees, it is beneficial for the leader to direct the individual to institutional policies. At institutions that lack parental leave policies, leaders are uniquely situated to advocate for such policies and ensure support for employees. Leaders also help establish a team-focused culture that supports both women and men using the available benefits. Employees about to take parental leave are encouraged to list their active duties and projects then work together with their leader to identify which items require coverage during leave and which can be paused. Similarly, leaders should check in with the employee after leave to ensure that expectations are reasonable, and the employee should have the same opportunities for advancement as others. Unconscious and conscious biases need extra monitoring at this juncture so that assumptions are not made about an employee stepping back after the birth or adoption of a child.
Our final consideration is to encourage individuals to leverage resources that support their own success. For example, the University of Michigan Medical School has an independent three-year review for each faculty member to reflect upon their achievements and determine if any course corrections are needed to personal career paths. Other resources include the Association of American Medical Colleges (AAMC) workshops for early and mid-career women, the AAPM Medical Physics Leadership Academy and video and workshops from the National Center for Faculty Development & Diversity. Early career individuals are encouraged to apply for the different mentorship programs in ASTRO and AAPM.
We are excited to see more visible efforts in ASTRO, AAPM and other organizations to support EDI. We will continue to look for and act on ways to accelerate progress. Join us in this discussion: What would you like to see your department do to improve equity? What efforts in your department have been successful in improving gender and underrepresented population equity? Join this discussion on the ROhub.
Jean Moran, PhD, is professor and co-director of the Physics Division and associate chair of Clinical Physics in the Department of Radiation Oncology at the University of Michigan.
William Small Jr., MD, FASTRO, is director of the Cardinal Bernardin Cancer Center and chair of radiation oncology at Loyola University Medical Center.
- Holliday EB, Siker M, Chapman CH, Jagsi R, Bitterman DS, Ahmed AA, Winkfield K, Kelly M, Tarbell NJ, and Deville C. Achieving gender equity in the radiation oncology physician workforce [published correction appears in Adv Radiat Oncol. 2018 Nov 02;4(1):210]. Adv Radiat Oncol. 2018;3(4):478-483. Published 2018 Oct 21. doi:10.1016/j.adro.2018.09.003
- Van Zyl M, Haynes EMK, Batchelar D, and Jakobi J. Examining gender diversity growth as a model for inclusion of all underrepresented persons in medical physics. Med Phys. 2020;47(12):5976-5985. doi:10.1002/mp.14524
- Hendrickson K, Juang T, Rodriques A, Burmeister J. Ethical violations and discriminatory behavior in the MedPhys Match. J Appl Clin Med Phys. 2017 Sep;18(5):336-350. doi: 10.1002/acm2.12135
Read previous ASTRO Blog posts from the Gender Equity Community:
Pandemic Health Care Worker and Parent: Considerate Teamwork Vital to Enduring (January 2021)
New Gender Equity Community opens in the ROhub (December 2020)
Posted: February 23, 2021
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By J. Frank Wilson, MD, FASTRO
ROI Trustee and Development Committee Co-chair
Making a legacy gift to the Radiation Oncology Institute (ROI), ASTRO’s Research Foundation, is a way for you to “give back” to your profession. You can plant a seed that will grow to support research that improves patient outcomes and enhances radiation oncology practice into the future. A legacy gift is one that you document now but will benefit the ROI in the future. Your legacy gift will help the best and brightest researchers in radiation oncology continue to advance the field and improve cancer care for years to come.
I am pleased to announce that Timothy Guertin, a former ROI Board member and retired Varian executive, has provided a generous challenge grant of $25,000 to encourage legacy gifts to the ROI in 2021. When you document a legacy gift of $2,500 or more to the ROI, $2,500 of the challenge grant from Mr. Guertin will be designated in your honor in recognition of your commitment to radiation oncology research.
This Legacy Challenge allows you to share your intent to include the ROI in your will or make a legacy gift to the ROI through another vehicle. Simply complete the planned giving intent form and submit it to the ROI. You will be recognized for your generosity today through the challenge grant, while investing in the future of radiation oncology research.
Theodore Lawrence, MD, PhD, FASTRO, is the first person to meet the ROI Legacy Challenge. A sum of $2,500 from the challenge grant has been designated in honor of Dr. Lawrence for his commitment. Fifteen years ago, Dr. Lawrence helped found the ROI and facilitated its growth from concept to creation to become a flourishing research foundation yielding results. Dr. Lawrence served on the ROI Board of Trustees from its beginning until December 2020, when he stepped down. His legacy gift has been one of his many acts of leadership.
We are excited to welcome Dr. Lawrence to the ROI Legacy Circle, the recognition group for those who make legacy gifts to the ROI. He joins me and my wife, Vera, along with Christopher Rose, MD, FASTRO, in making legacy gifts to help ensure that the ROI can continue to fulfill its mission to heighten the critical role of radiation therapy in the treatment of cancer well into the future. We hope you will consider making a legacy gift to the ROI in the way that best fits your estate plans.
Many legacy gifts are revocable, and you can change your mind later if your financial situation changes. These gifts include providing for the ROI in your will or naming the ROI as a beneficiary for your retirement plan, insurance policy or donor-advised fund. These gifts can be specific amounts or percentages and may be contingent on other considerations. Other legacy gifts that are irrevocable have significant tax benefits. Such gifts include Charitable Gift Annuities, Charitable Remainder Trusts and Charitable Lead Trusts, which can provide a stream of income for you or another individual now or in the future.
Making your future gifts with non-cash assets may be another consideration. If you have highly appreciated securities, using the stock to fund any of these gifts can result in tax savings. You can also make a gift of a fully paid life insurance policy that you, perhaps, no longer need. In that case, the ROI becomes the owner and the beneficiary of the life insurance policy, and you receive a tax deduction for the transfer of ownership. More information about each of these options is available on the ROI’s planned giving website.
When you meet the Legacy Challenge by informing the ROI of your intent, you will also become a member of the Legacy Circle and will be recognized on the ROI website, at the ROI booth at the ASTRO Annual Meeting and in publications, if you so choose. We encourage you to allow us to recognize you, because in doing so, you are encouraging others to follow your example. However, if you do not want your name to appear on recognition lists, you can choose to make your commitment anonymously.
Making a legacy gift to the ROI is a way to show your dedication to the future of radiation oncology.
If you have questions or need assistance, please contact Janet L. Hedrick by email or at 703-839-7340.
The information in this article is not intended as legal or tax advice. For such advice, please consult an attorney or tax advisor.
Posted: February 9, 2021
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By Krisha J. Howell, MD, and Penny R. Anderson, MD
As health care providers pre-pandemic, we were all far too familiar with the 10-hour clinic days, parade of administrative documents, barrage of medical calls/emails/texts/pages inevitably delivered during “unplugged time” and the emergencies that pop up at 5:00 p.m. on a Friday. As parents, we each adapted as best we could with our own piecemeal childcare system to maintain the demands of burgeoning clinics and the needs of our family. Minor emergencies happened frequently: school lunches forgotten, pick-up times from sports practice missed. Then there was that one Christmas week when the family dog gulped down a box of chocolates ― that well-intended, beautifully gifted box of malt balls from Uncle Scott ― culminating into a 6:00 p.m. frenetic storm of family crisis and urgent childcare needs amid an on-going Tumor Board. But as unsatisfactory as it was, the system persisted. Conditioned from the moment of that first newborn cry, we gradually progressed into our own individual patchwork system of Dr. Mom/Dr. Dad.
In America, we profess a need for a robust infrastructure ― roads, utilities, communication systems are all worthy investments for the health of our economy. Yet it seems, as a culture, we remain married to the idea that the federal government only need to offer limited childcare assistance outside of the traditional kindergarten to high school model. Along with the nursing, therapy and administrative staff, women now constitute a large portion of our physicians and physicists. A more robust infrastructure would allow these women to make an even greater impact to our patients and our communities.
During the COVID-19 pandemic, we saw our health care workers report to work in the face of inadequate PPE, absent or under-resourced COVID testing and with the oncology cancer patient population quickly infiltrated by the disease. Not only were we consumed with our own safety but the probability of bringing the disease home to our families. One set of friends, both emergency physician parents, made matching living wills. Elsewhere, a physician mother quarantined at a hotel rather than go home to her family after an exposure.1
The pandemic exposed the lack of a countrywide childcare infrastructure. Old sources of support became unavailable, less accessible, or, for many, executed the removal of an elderly family member as caregiver out of concern for their vulnerability. Many health care workers now found themselves in the triple role of essential worker/babysitter/teacher. Each, in itself, would constitute a full-time position. In turn, the daily act of raising children now required a greater investment in time and effort. A 101F degree fever in a baby during the era of COVID translated into an automatic two-week home quarantine from daycare. Baby’s doctor visit meant one parent had to take time off from work to stay home with siblings, as only a single guardian and no siblings were allowed to accompany an underage patient.
In dual income families, the typical parental dynamics may have altered. Many women conceded that it was no longer possible to be all roles at once. In general, women are more likely to be in part-time employment, more likely to be the lower earner in straight couples and likely to already have the greater expectation of doing household chores and meeting child-rearing obligations. If both parents had the pressure of working, then it more often than not resulted in women leaving the workforce.2,3 Beyond this struggle, we do not even elaborate on those hurdles faced by single-parent households (9 out 10 headed by women) or those with separated households wherein child custody time may have been threatened by a parent’s role as a health care provider.
From a child’s perspective, understandably, the pandemic has caused a departure in their physical and social support. Their previous social outlets of friends, sports and school are not accessible or have been reimagined in a less intimate, virtual manner. Children of frontline health care workers have demonstrated increased anxiety and worrying. “The electronic media did come to their rescue during home confinement but not without its own drawback….”4 It is easy to imagine the paramount role a parent need play at this time as an accessible and reassuring figure to a child.5
A large-scale survey conducted by Athenahealth in 2017 found that the majority of physicians under age 44 were women.1 Given the onset of COVID in early 2020, it would make sense that this population would be especially vulnerable to the aforementioned stresses. And, indeed, a drop in publications by female authors was demonstrated during the pandemic period.5
At our department, we realized early on many of these consequences and how they could impact our physicians. And, beyond them, the dosimetrists, physicists, nurses and therapists would experience similar, if not worse, upheaval in their lives at home. We set out to increase communication and strive to optimize safety and support throughout the department. As with the majority of health care clinics, we quickly integrated virtual days. This reduced risk of transmission and gave many parents greater freedom when children needed at-home care. A “buddy” system was created to optimize coverage so as not to compromise patient care and protect against surprise physician absences due to emergencies. This facilitated collaborative efforts regarding consents, simulations and SBRTs. Fortunately, our center already had in place an on-site daycare, similar to what companies did during World War II.6 Holidays were matched to the clinic holiday schedule, and the hours mirrored that of the clinic hours to optimize effective care. Furthermore, we tried, and ultimately succeeded, to honor all requested vacations despite months of upheaval. To take advantage of time away, we strove to improve communication among long-standing professional silos so that an attending’s physical clinic closure could translate to staffing the exact number of required support staff. Thus, a nurse with children being home-schooled could make appropriate plans to be home. Male colleagues, who in the past would rarely if ever admit to needing help, now approached me with requests for cross-coverage due to family needs or consideration of a father’s help being needed at home. This has caused a visible stress in my colleagues, culminating in an evident need for an improved work-life integration. Hopefully, this will continue to manifest into the future in a way to facilitate consideration and willingness to collaborate with other colleagues.
I wonder, were there ― and are there ― other solutions employed elsewhere? Going forward, as the pandemic subsides, will this awareness abate? And, finally, are there opportunities here that we will want to carry forward beyond the pandemic? Join us in this discussion on the ROhub.
Dr. Krisha Howell is an assistant professor and clinical director of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. She is actively involved in ASTRO as the Gender Equity Community Champion and in the American Association for Women Radiologists (AAWR) along with other virtual platforms promoting mentoring in the space of gender equity.
- Dawar R, Rodriguez E. Chronicles of a Physician Mom in a Pandemic: When Doing It All Is No Longer Possible! Accessed January 25, 2021. https://connection.asco.org/blogs/chronicles-physician-mom-pandemic-when-doing-it-all-no-longer-possible
- Lewis H. Don’t Build Roads, Open Schools. The Atlantic. Accessed January 25, 2021. https://www.theatlantic.com/international/archive/2020/06/child-care-infrastructure-britain-boris-johnson/613672/
- Edwards K. Women Are Leaving the Labor Force in Record Numbers. The Rand Blog. Accessed January 25, 2021. https://www.rand.org/blog/2020/11/women-are-leaving-the-labor-force-in-record-numbers.html
- Mahajan C, Kapoor I, Prabhakar H. Psychological Effects of COVID-19 on Children of Health Care Workers. Accessed January 25, 2021. Anesth Analg. 2020;131(3):e169-e170. doi:10.1213/ANE.0000000000005034
- Andersen JP, et al. eLife. 2020;9:e58807. doi: 10.7554/eLife.58807
- North A. Vox. Elizabeth Warren made a crucial point at the Democratic convention: Child care is “infrastructure for families”. Accessed January 25, 2021. https://www.vox.com/2020/8/20/21376792/elizabeth-warren-dnc-convention-child-care-biden
Posted: January 26, 2021
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By Rehema Thomas, MD candidate, Class of 2022
Going into medical school, I knew that treating cancer was what I was called to do. With my eyes set on oncology, I was aware that there were still options when it came to choosing a specialty. There was surgical oncology, medical oncology and radiation oncology. What road would I choose in the end? As my first year of medical school went along, our preclinical curriculum covered aspects of medical oncology, chemotherapies and surgical techniques. However, I realized I was not getting much exposure to radiation oncology, and I wanted to know more. With that and a growing love for imaging, I knew I wanted more experience in “rad onc” and decided to find out how I could secure it. With a simple internet search for summer research opportunities in radiation oncology, the ASTRO Minority Summer Fellowship (MSF) was the first result I saw. It was perfect! I reached out to my mentor, Curtiland Deville, MD, via email, scheduled a meeting with him, completed the application and ― the rest is history.
Being a recipient of the ASTRO MSF Award provided me with one of the most rewarding experiences in my medical training that I have had to date. My summer experience truly cemented my choice to pursue radiation oncology as a specialty. Throughout my summer working at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center with Dr. Deville, I was exposed to many different facets of radiation oncology. I was able to witness firsthand what goes into a complete course of treatment ― from the consultation to treatment planning, to treatment delivery. I had the opportunity to spend time with nurses, dosimetrists, physicists, therapists and physicians and see just how much each member of the team contributes to patient care. I sat in on several consultations with Dr. Deville for his prostate and sarcoma patients. I really appreciated how much patient education goes into consultations and how there is a visible alleviation in the uncertainty patients feel after having a conversation with the physician and getting a better understanding of their options.
Not only did I get to observe prostate and sarcoma consultations, but I was able to sit in on breast, lung and gynecologic consultations with other radiation oncologists in clinic. In my observation of on-treatment visits, I was able to gain more insight into the radiation-associated side effects that patients experience throughout treatment and how they are managed. Patient simulations, treatment set-up and treatment delivery were also exciting elements of my clinical exposure. Although the majority of my experience was in Washington, D.C., I did get the chance to travel to Baltimore and participate in Johns Hopkins’ Prostate Cancer Multidisciplinary Clinic. I thoroughly enjoyed that experience, as I value the shift medicine is taking toward multidisciplinary individualized care. Outside of the clinical visits and research, I had the opportunity to contour volumes for patient organs at risk and through that, gain familiarity with treatment planning systems used by the team.
Most importantly, I was able to foster a meaningful mentorship and complete significant research throughout the eight weeks of the fellowship. Dr. Deville was and continues to be an excellent mentor. I am very proud of how much I was able to learn and what we produced in the eight weeks. My poster, “Comparative in Silico Analysis of Pre-operative Scanning Beam Proton Therapy, Intensity-Modulated Photon Radiation Therapy, and 3-D Conformal Photon Radiation Therapy in Adult Soft Tissue Sarcoma,” was presented at the 2020 ASTRO Annual Meeting.
I enjoyed all aspects of the fellowship, and it confirmed my choice to pursue radiation oncology as a specialty. I extend my sincerest thanks to the ASTRO Committee on Health Equity, Diversity and Inclusion for the invaluable opportunity.
Share this opportunity with medical students and colleagues. See the eligibility requirements and access the application for the ASTRO 2021 Minority Summer Fellowship.
Rehema Thomas is an MD candidate in the Class of 2022 at the George Washington University School of Medicine and Health Sciences. She is a METEOR Research Fellow and president of the GW SMHS Women in Radiology.
Posted: January 19, 2021
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By Thomas Eichler, MD, FASTRO, ASTRO Chair
After more than a decade of enjoying the prestige of being one of the most highly sought-after specialties in the medical student match process, there have been troubling signs in the past few years that something was amiss. In 2019, the number of medical students who initially matched into radiation oncology declined with multiple slots unfilled. At the time, there was speculation about whether this was an anomaly or the beginning of a trend that had been forecast years before. In 2020, the field saw a larger decline in the number of medical students who matched, coupled with an increase in the number of people who then entered the field through the Supplemental Offer and Acceptance Program (SOAP) process. In fact, radiation oncology had the highest percentage of spots filled through the SOAP of any medical specialty.
From a treatment perspective, many factors, including the decreased use of radiation for some disease sites and an increased use of hypofractionation, bring into question the long-term viability of our specialty. Despite the many positive aspects of radiation oncology, there are growing concerns about the future of the workforce. There has been an increase in the number of available trainee positions despite the apparent decline in medical student interest and concern regarding patient volume projections. These issues contribute to forecasts of declining income streams and anxieties about the future given the recently proposed ― and now delayed ― radiation oncology alternative payment model. The worrisome trend in the SOAP percentages for radiation oncology underscores some of these negative perceptions about the field among students and residency applicants, which are in turn amplified on social media platforms. Not surprisingly, many students are confused about what career path to choose and may be discouraged to pursue radiation oncology before they even truly explore it.
ASTRO leaders have sought to be forthright with our members about challenges in the field (see previous blog posts below) and ASTRO’s role in addressing them. While there are strict anti-trust principles ASTRO must abide by, the Board of Directors felt compelled to issue a definitive statement so that there is no ambiguity about our position.
ASTRO Position Statement on the U.S. Radiation Oncology Workforce
- Radiation oncology has long been a critical component of multidisciplinary cancer management, driven by clinical and scientific innovation. Recent advances in technology and our understanding of cancer biology have allowed radiation oncologists to offer more accurate and effective therapies, often in fewer total treatments than before, resulting in improved patient care. ASTRO has observed growth in residency training positions over the past two decades. With more efficient treatment delivery, fewer radiation oncologists may be needed in the coming years. Residency training positions should be reserved for those who are enthusiastic about the field and should reflect the anticipated societal need for radiation therapy services. As we prepare the next generation of radiation oncologists for independent practice, we encourage stakeholders to carefully consider these aspects affecting our specialty as they review the size and scope of their training programs.
Additionally, ASTRO acknowledges the continued need to grow and nurture diversity within the next generation of our workforce. We serve diverse peoples, and our trainees and faculty should reflect that diversity. We are committed to addressing all aspects of bias as we seek to ensure equity and inclusion within our specialty and to improve health outcomes for all our patients.
While we acknowledge that this statement will not magically solve the issues impacting the field, we do want to be clear with our current and future members about ASTRO’s stance on this critical issue. We also strive to keep the lines of communication open with all members, including our residents. We listen to and appreciate the insights and perspectives from Association of Residents in Radiation Oncology (ARRO) to better understand their perceptions and experiences. Results from a survey of the class of 2020 found that residents had an average of five job interviews, received at least two job offers and, perhaps most significantly, 89% of residents were satisfied with the offers they received. While there are some vocal naysayers on social media, the direct response from residents gives us confidence and hope about the current realities in the field.
Radiation oncology has always sought the best and the brightest minds for our field because we know it is a truly rewarding area of cancer treatment. That will not change. We have deeply meaningful interactions with our patients, curing many of their cancers, alleviating suffering and extending life. Technology continues to play a large role in the field with novel and groundbreaking synergies between radiation and systemic agents, including immunotherapeutics, and many contemporary research questions are emerging, ripe for exploration and clinical trials. The field is also expanding due to innovations in radiopharmaceuticals and theranostics, offering radiation oncologists exciting new ways in which to help patients. While the future is unpredictable, we unequivocally believe in the continued impact and relevance of our specialty going forward, and perhaps more importantly, have unshakeable faith in the dedicated professionals who have made radiation oncology fundamental in the fight against cancer.
Read previous posts:
A Commitment to the Field - Dr. Theodore DeWeese, March 10, 2020
The Residency Training Landscape, Continued - Dr. Paul Harari, May 28, 2019
The Residency Training Landscape - Dr. Paul Harari, March 20, 2019
Posted: January 5, 2021
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