Medical Oncology. Rotation Goals & Objectives for rotating residents. General Objectives THE UNIVERSITY OF BRITISH COLUMBIA

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1 THE UNIVERSITY OF BRITISH COLUMBIA Department of Urologic Sciences Faculty of Medicine Gordon & Leslie Diamond Health Care Centre Level 6, 2775 Laurel Street Vancouver, BC, Canada V5Z 1M9 Tel: (604) Fax: (604) Medical Oncology Rotation Goals & Objectives for rotating residents General Objectives a) Rotating Residents should develop a familiarity with and competence in the diagnosis and management of patients with common neoplasms. b) Rotating Residents should familiarize themselves with the various treatment modalities and have a working understanding of the mechanism of action and side effects of broad classes of systemic therapies. c) The Rotating Residents should understand the principles of palliation and symptom control in the oncology patient.

2 Specific competencies Medical Expert: Upon completion of a two-month rotation in Medical Oncology, the resident will: Be able to conduct a thorough assessment of an oncology patient by eliciting a careful history (including presenting symptoms, risk factors for malignancy, co-morbidity, and careful family history); Be able to recognize presenting signs elicited on physical examination; Have knowledge of the staging investigations necessary to work-up a cancer patient; Be able to choose a specific treatment modality based on stage. Furthermore the resident will be able to understand relevant issues in the ongoing follow-up and management of patients with the following common malignancies (or uncommon but potentially curable malignancies): a) Breast cancer. Work-up of a breast lump, familiarity with adjuvant treatment in the pre and post menopausal setting, treatment of metastatic disease. b) Lung cancer. Distinction between small cell and non-small cell histology, combined chemo and radiotherapy for lung cancer. c) Colorectal cancer. The need for adjuvant treatment, treatment for metastatic disease. d) Prostate cancer. Diagnosis and management including hormonal maneuvers for metastatic disease. e) Testicular cancer. Distinction between seminoma and non-seminoma, indications for chemotherapy. f) Bladder cancer. Management of muscle invasive and metastatic disease. g) Myeloma. Complications and treatment. h) Lymphoma. Distinction between Non-Hodgkin s and Hodgkin s lymphoma, management at initial diagnosis and relapse. i) Knowledge of other tumour sites by applying basic principles. j) The diagnosis and management of oncological emergencies such as superior vena cava syndrome, spinal cord compression, and metabolic emergencies (hypercalcemia, tumour lysis syndrome and SIADH). k) Familiarity of procedures such as bone marrow biopsy, thoracentesis, paracentesis, and lumbar puncture (including intrathecal chemotherapy). l) Familiarity with the principles of systemic therapy including the basic mechanism of action and major side-effects of major classes of anti-neoplastic agents including hormonal agents, cytotoxic agents, and newer targeted treatments (example monoclonal antibodies). m) A proficiency of the management of acute side-effects of these agents (with special emphasis on the management of nausea and vomiting and febrile neutropenia). n) An ability to assess response to treatment. o) The principles of the palliative management of symptoms in the oncology patient such as pain control, shortness of breath, constipation, and bowel obstruction, brain metastases, pleural effusions, malignant ascites, bone metastases and biliary obstruction. p) The proper use of laboratory data including pathology review, interpreting cytology, tumour marker and diagnostic imaging results.

3 These competencies will be taught and assessed in the following ways: 1. Assignment to high quality clinical services with new patient consult, inpatient management and ambulatory (follow-up and active treatment) components. 2. Attendance at hospital based rounds (including weekly Medical Oncology noon rounds, noon rounds, as well as specific team focused didactic and ward rounds). 3. The teaching of procedural skills through supervision by a more senior member of the team. 4. The availability of core reference material such as The Basic Science of Oncology, Tannock and Hill, 3 rd edition; Cancer Principles and Practice of Oncology, Devita, Hellmon, Rosenberg, 5 th edition, as well the web-based BC Cancer Agency Care Provider Information System and the Intranet BC Cancer Agency Systemic Therapy file. 5. In-training evaluation reports will be completed.

4 Communicator: Upon completion of a two-month rotation in Medical Oncology, the core resident will be able to do the following: a) Establish a therapeutic relationship with a patient characterized by trust, empathy and confidentiality which is adequate to enable the physician to effectively gather information and guide therapy. b) Appreciate the impact of cancer on patients and their families. c) Learn to communicate effectively and efficiently with colleagues both verbally and through written and dictated records. 1. Daily observation of trainee performance by clinical supervisors and ongoing feedback. 2. A review of the written record by the attending physician and ongoing feedback. 3. Observation of resident staff interactions during the rotations.

5 Collaborator: Upon completion of a two-month rotation in Medical Oncology the core resident will be able to do the following: a) Know when to consult other caregivers appropriately. b) Describe the role, areas of expertise and limitations of all members of an interdisciplinary team and to work effectively within such a team. 1. Observation of the daily practice patterns of attending staff. 2. Daily observation of trainee performance by attending staff and interdisciplinary staff 3. Feedback through in-training evaluation.

6 Manager: Upon completion of a two-month rotation in Medical Oncology the core resident will be able to: Utilize resources effectively to balance patient care and healthcare economics. Understand the interplay between governments and the healthcare sector in allocating finite healthcare resources. Work to develop effective and efficient patient management systems by avoiding duplication of services, involving other caregivers, obtaining appropriate patient information from other healthcare sources. Demonstrate knowledge of resources available in the community to assist individuals with cancer. 1. Observation of the daily practices of attending staff. 2. Ongoing feedback both formally and through in-training evaluation.

7 Health Advocate: Upon completion of a two-month rotation in Medical Oncology resident will be able to do the following: a. Identify important determinants of patient s health. b. Work to develop effective preventative medicine strategies for patients. c. Intercede on behalf of their patients as the patient weaves their way through the complex healthcare institutions and services. d. Recognize and respond to those issues where advocacy is important. 1. Didactic lectures and observation of the practices of attending physicians and other members of the interdisciplinary team.

8 Scholar: Upon completion of a two-month rotation in Medical Oncology the core resident will be able to: a. Demonstrate an understanding of the fundamentals of the basic sciences related to Medical Oncology. b. Demonstrate an understanding of the fundamentals of critical analysis of the scientific literature in Medical Oncology commensurate with his/her level of training. c. Demonstrate and ability to teach Medical Oncology to students and allied health professionals commensurate with his/her level of training. d. Demonstrate the ability to assess deficiencies in their own knowledge base and to develop and implement a strategy for continuing medical education. 1. Specific recommendations for reading material will be given at the beginning of the rotation. 2. Ongoing participation in the weekly Journal Club (September June only) and weekly Medical Oncology rounds. 3. Ongoing assignment to high quality clinical services.

9 Professional: Upon completion of a two-month rotation in Medical Oncology the core resident will be able to: a. Demonstrate an understanding of the ethical issues that arise as a result of the diagnosis and management of cancer. b. Understand the professional obligations to patients and colleagues. c. Exhibit appropriate personal and interpersonal professional behaviours. d. Act with integrity, honesty and compassion in the delivery of the highest quality healthcare. 1. Observation of the daily practice patterns of attending physicians and other healthcare workers. 2. Daily observation of the trainees by the attending physicians.

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