This study provides valuable insights into the current state of RO education at four German medical schools and their associated university hospitals. The findings highlight both strengths and areas for improvement, particularly concerning curriculum structure, teaching formats, and practical exposure. While students acknowledged the benefits of small-group learning and hybrid teaching models, they also identified significant shortcomings, including the absence of structured learning objectives, limited patient contact, and insufficient differentiation between RO and related disciplines (e.g., radiology, nuclear medicine). These results are consistent with previous studies indicating that early exposure, interactive teaching methods, and structured curricula play a crucial role in enhancing students’ knowledge and interest in RO [29]. While the small sample size warrants cautious interpretation and highlights the need for further longitudinal research to assess the generalizability of our findings, this study also emphasizes that structured student surveys are a valuable tool for aligning teaching content and formats with learner needs and for informing curriculum development.

One of the central challenges identified in this study is the lack of structured learning objectives, an issue that has been highlighted in previous research on medical curricula [30, 31]. ABCD students reported difficulties in identifying key takeaways and understanding the daily routine of a radiation oncologist, which could limit their engagement with RO and reduce its perceived relevance [28]. While Dapper et al. highlight the importance of expanding key knowledge areas, future DEGRO recommendations could further enhance clarity by incorporating clearly defined learning objectives and competency-based benchmarks to better align with student needs and ensure a more structured learning experience [25]. In this context, a clearer prioritization of learning content—differentiating between core curriculum elements and supplementary knowledge—could help to guide students more effectively and improve the overall educational framework.

Kandiko Howson et al. reported similar findings, where unclear curricular goals were linked to lower student satisfaction and engagement [32]. A previously published study by the medical education research team at the University of Cologne by Linde et al. found that students struggle to distinguish RO from related fields, such as radiology and nuclear medicine, leading to confusion regarding the specialty’s role in patient care, which is further exacerbated by the shared structural framework within QB 11 in Germany, although the interdisciplinary approach should be positively emphasized [15]. These results suggest that improving curricular transparency and defining specific competencies could significantly enhance learning outcomes. A structured feedback mechanism should be introduced, allowing student representatives to actively participate in curriculum planning committees.

The study also underscores the importance of interactive teaching formats, aligning with competency-based medical education models. Seminars and practical sessions were rated more effective in terms of generating interest in RO compared to lectures. Students expressed strong support for PbL, simulation-based training (SBT), and quiz-based learning, which are known to enhance problem-solving skills and student motivation [33,34,35]. A multicenter study conducted by the Radiation Oncology Educational Collaborative Study Group (ROECSG) demonstrated that structured workshops and hands-on practical sessions significantly improve students’ understanding of RO concepts [36]. Similarly, research on interactive contouring modules found that such methods increased students’ awareness of radiotherapy processes and side effects, reinforcing the need for modernized, practically oriented teaching approaches [32]. However, it should also be acknowledged that experiential learning formats—such as patient-centered teaching, interdisciplinary tumor boards, and extensive practical sessions—require increased personnel, time, and organizational resources, which vary significantly between faculties. While DEGRO’s recommendations serve as a gold standard, their implementation may be hindered by such disparities: not all faculties have the staff or structural conditions needed to fully realize these goals. Our findings further reveal that students frequently experience unmet needs—such as clearer differentiation between RO, radiology, and nuclear medicine—that may be underappreciated in guideline-based planning. This gap highlights that curriculum delivery (i.e., how content is structured and taught) may weigh more heavily than the number of teaching hours alone. In sum, innovative formats are strongly supported by students, but their successful integration depends not only on educational intent, but also on their feasibility within local institutional frameworks.

In line with previous studies, students in this study favored hybrid learning models, with those who participated in both in-person and online instruction rating RO education more favorably than those who experienced only one teaching modality [7, 15, 37, 38]. This finding aligns with broader research demonstrating that blended learning strategies optimize engagement by accommodating different learning styles [39]. Digital learning, which extends beyond merely recording lectures, e.g., in the form of virtual reality-based simulations, offers flexibility and allows students to revisit course materials at their own pace. However, students also emphasized the importance of interactive elements, structured feedback, and faculty engagement [40,41,42,43]. Although our data were collected during the pandemic-driven shift to digital formats (2020–2022), some changes—such as hybrid teaching models and the expectation of flexible access to on-demand lectures—may persist beyond COVID-19. These findings underscore the need for well-structured hybrid teaching approaches that integrate interactive digital modules with essential in-person training to ensure both accessibility and engagement.

A further key issue concerns curriculum structure and interdisciplinary integration. While the use of a longitudinal distribution of RO teaching is supported, students in this study preferred consolidating all RO-related courses into a single semester, arguing that time gaps between lectures, seminars, and practical sessions contribute to knowledge loss. This discrepancy is inconsistent with findings in evidence-based RO medical education [44, 45].

Research in curriculum development suggests that improved integration across disciplines—e.g., linking radiation oncology with medical physics, anatomy, or biology through case-based learning—could enhance conceptual clarity and interdisciplinary understanding [46, 47]. This aligns with findings that young oncology professionals in Germany see a strong need for interdisciplinary collaboration despite practical barriers [48]. Another promising approach to fostering interdisciplinary learning is the implementation of a student tumor board. This format, recently piloted, engages students in simulated multidisciplinary oncology meetings, enhancing their understanding of how different specialties (including RO) collaborate in patient care [49]. These findings highlight the need for careful consideration of longitudinal curriculum design, balancing student preferences with pedagogical best practices while also taking into account the specific context, objectives of the medical education program, and learner expectations [50]. A further important aspect to consider is whether an early introduction to RO can serve not only as a connecting element to the (preclinical) curriculum but also foster long-term enthusiasm for the field among medical students [51].

The study findings further confirm the strong correlation between student engagement and positive course evaluations. Students who regularly attended lectures assigned higher ratings to RO education, supporting the argument that active participation enhances learning outcomes [28]. These trends are consistent with previous studies in different fields such as internal medicine or radiology, where greater exposure to the field correlated with increased interest in the specialty [52, 53]. Furthermore, mentorship was identified by Marsiglio et al. as a critical factor in guiding students toward careers in RO, yet formal mentorship opportunities remain limited [54]. Enhancing early mentorship programs could help to close this gap and inspire more students to pursue a career in RO, both during medical school and in postgraduate training [9, 52, 55]. Furthermore, strategically placed initiatives, such as social media campaigns in medical education, can help to reshape the image of RO and dispel common urban myths [56].

Seven recommendations for enhancing RO education

Based on the findings of this study, the following key recommendations, actionable steps, and focal takeaways are proposed to enhance RO education and address the student-identified gaps from our survey (Table 2):

1.

Implement hybrid teaching models for greater accessibility

Recommendation: Hybrid teaching formats should be formally integrated into RO education, as they provide flexibility and maintain high participation rates.

Actionable step: Faculties should balance prerecorded lectures, live online discussions, and in-person sessions to optimize engagement.

2.

Improve learning materials for better structure and comprehension

Recommendation: Teaching materials should be revised to be more structured and accessible.

Actionable step: Institutions should provide well-organized lecture slides, summary sheets, and digital resources to facilitate student preparation and review.

3.

Adopt interactive and case-based teaching methods

Recommendation: Transition from traditional lectures to PbL and interactive case discussions to enhance student engagement.

Actionable step: Develop standardized case studies that integrate clinical decision-making exercises into the curriculum, e.g., case-based tumor boards.

4.

Expand small-group and hands-on learning opportunities

Recommendation: Increase small-group seminars and practical sessions, which students find more effective than traditional lectures.

Actionable step: If SWS are expanded, prioritize practical, discussion-based learning rather than increasing lecture hours.

5.

Strengthen practical relevance through direct clinical exposure

Recommendation: Increase bedside teaching, patient interactions, and hands-on experience with radiation therapy procedures.

Actionable step: Introduce mandatory clinical rotations in RO departments to expose students to real-world applications.

6.

Establish and communicate clearer learning objectives for RO

Recommendation: Clearly define RO as a distinct discipline and improve differentiation from radiology and nuclear medicine.

Actionable step: Develop standardized competency-based learning objectives, ensuring consistency across medical schools.

7.

Expand semester hours and consider mandatory key sessions

Recommendation: Increase RO teaching hours, as students who attended more courses showed greater interest and gave higher evaluations.

Actionable step: Implement mandatory attendance for core RO sessions while offering elective advanced modules and RO research tracks and mentorship for interested students.

By implementing these evidence-based improvements, medical faculties and RO departments can enhance the quality of RO education, increase student interest, and ultimately support the development of future radiation oncologists. Expanding the study to include a larger, multi-institutional sample would enhance the generalizability of these findings and provide a more comprehensive understanding of best practices for RO education.

Limitations

Several methodological limitations may impact the interpretation of this study’s findings. One primary concern is the low response rate of 4%, which may not fully represent the target population. However, this rate could be underestimated due to limitations in survey distribution, as it remains unclear whether all eligible students received the questionnaire. Consequently, the actual response rate might be higher than reported. We also explicitly acknowledge the possibility of self-selection bias: for example, students with strong opinions about RO (either positive or negative) might have been more likely to respond, which could skew the results.

The absence of inferential statistical analyses prevents identification of statistically significant relationships between the examined variables. While such analyses would have been desirable to strengthen the validity of the findings, they were not feasible due to the limited sample size and response rate. As a result, the study relies solely on descriptive statistics, which further restricts the generalizability of the results. Due to our sample size, we may not have detected subtle benefits of a broader curriculum (e.g., better factual knowledge), so this question warrants further study, too. To enhance the robustness of future research, a larger and more representative sample should be obtained to allow for inferential statistical testing. Given this limitation, the reported trends should be interpreted with caution, as observed differences between groups may not necessarily indicate causal relationships.

Additionally, the categorization of qualitative responses into major themes introduces a potential interpretation bias. Despite using predefined categories and employing two independent reviewers for classification, subjective judgment in assigning free-text responses remains a limitation.

A notable discrepancy was observed in the reported availability of supplementary courses. Although all universities offered these courses, only 61% of respondents acknowledged them. This inconsistency suggests that some students may not have recognized specific events as being part of the RO curriculum or may have forgotten about them. This issue is likely exacerbated by the integration of RO into cross-sectional blocks with other disciplines (e.g., radiology, nuclear medicine, pathology), making course attribution more challenging.

Lastly, the COVID-19 pandemic significantly impacted teaching methods, forcing a shift from in-person to digital instruction. This transition may have reduced practical skill development and interactive learning opportunities, leading to a possible decline in student engagement and understanding of clinical applications.

Despite these limitations, the study provides valuable perspectives on student experiences and recommendations for improving radiation oncology education.