Oncology Consults

I. Overview:

The program of the Oncology is designed to provide the house officer a basis for the diagnostic evaluations and the initial management of patients with oncological disorders. The basic epidemiology, genetics, molecular biology of disease, principles and the complications of treatment and cancer will be highlighted. The resident will be involved symptom control and end of life discussions. They interact with palliative care team. Patients are very diverse ethnically and socioeconomically, and are representative of the neighboring Montefiore communities.

The oncology elective consists of one block of four weeks, with a 24/7 coverage by the attending. The oncology elective is available to all Internal Medicine pgy2s and pgy3s.

Residents work in teams under the supervision of the hematology/oncology fellow and the oncology Attending. The Attending physician is responsible for supervision of all patient care. This is a hybrid inpatient/outpatient experience. During consult round (in-patient) and outpatient clinic visit, Current concepts in the diagnosis, clinical and pathologic staging, and management of various types of malignant diseases will be stressed. Resident will actively participate in the multidisciplinary approach to the cancer patient during tumor boards. They will have clinical exposure to the many subspecialties related to Oncology, including principles of Surgical Oncology, pathological correlations, radiological techniques for diagnosis and treatment, radiation therapy, isotopic procedures and standard and experimental chemotherapy programs. In-patient and out-patient (including clinic and private practice) follow up will be available. Active participation in various work and teaching rounds and conferences will be encouraged.

II. Level based Rotation Goals and Objectives:

PGY2/PGY3

- Patient Care: Prioritize the daily “work”; recognize the relative significance of cancer patients’ problems; begin to recognize the oncological emergencies, understand the indications and complications of cancer treatments.

- Medical Knowledge: Use literature and reference sources to increase knowledge base in oncology; demonstrate basic knowledge in the areas of underlying pathophysiology and the clinical aspects of neoplastic diseases; apply knowledge in the treatment of patients.

- Professionalism: Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff; work to fulfill the needs of patients; accept assignments graciously; attend conferences.

- Interpersonal Skills: Write understandable and legible notes and consultation reports; improve ability to listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.

- Practice Based Learning and Improvement: Understand limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed. Do not overstep responsibilities.

- System Based Practice: Learn to be an advocate for cardiac patients; accept and try to apply necessary devised guidelines; to develop understanding about the health care systems/structure and how it relates to patients requiring cardiac procedures.

II. Areas Covered During Oncolgy

1) Principles, Physiology and Basic Sciences:

Screening of various cancers

Prevention of cancer

Molecular biology of various cancer and tailored therapy

2) Practical skills unique to Oncology

a) Breaking bad news

b) Symptom control in terminal cancer patient

c) Coordinate multidisciplinary team in management of different system cancer

d) Pain control

3) Approach to presenting complaints/problems:

To learn to use different modalities to stage and treat patients with cancers

4) Specific Diagnosis in (Discipline):

a) Lung cancer

b) Breast cancer

c) Prostate cancer

d) Colorectal cancer

e) Pancreatic cancer

f) Esophageal cancer

g) Head & Neck cancer

h) Pancreatic cancer

i) Gastric cancer

j) Lymphoma

k) Acute and chronic leukemia

l) Chronic myeloproliferative disorders

m) Ovarian cancer

n) Uterine cancer

o) Cervical cancer

p) Brain tumors

q) HIV related malignancies

5) Treatment Modalities:

r) Chemotherapy

s) Targeted therapies

t) Radiation therapy

u) Surgery

v) Immunotherapy

6) Technical Skills

i. Mammography

ii. Bronchoscopy/ Mediastinoscopy

iii. Bone marrow aspiration and biopsy

iv. Prostatic ultrasound and biopsy

v. Needle aspiration of breast or soft tissue masses

vi. PET scan

vii. Endobronchial ultrasound or esophageal ultrasound guided biopsy for staging of various malignancies

7) Emergencies:

o Neutropenic fever

o Infections in cancer patients

o Pericardial effusion/cardiac tamponade

o Metabolic emergencies

· Hypercalcemia

· Tumor lysis syndrome

· Hypoglycemia

· SIADH

o Superior vena cava syndrome

o Leptomeningeal metastases

o Neurological emergencies

· Spinal cord compression

· Seizures

· Brain metastases

III. Schedule Of Activities

1) Morning teaching rounds by oncology attending/the oncology/hematology fellow. Reading material will be provided at the beginning of rotation.

2) Daily consultation rounds by attending.

3) Out-patient rotation with different attending such as GI, Breast, hematological oncology, thoracic oncology, genitourinary oncology

4) Weekly core curriculum lectures

5) Medical Grand Rounds – weekly

6) Tumor conference/Tumor board

· Gastrointestinal cancer/hepatobiliary cancer Tumor Board (weekly)

· Thoracic oncology Tumor Board (weekly)

· Head & Neck Cancer Tumor Board (weekly)

· Neorooncology Tumor Board (monthly)

· Leukemia-Lymphoma Conference (biweekly

IV. Methods Of Teaching Competency Assessment

The house officers are evaluated continuously during their four weeks of service in the oncology. Importantly, there is continuous feedback to the house officers. The final evaluation is done through www.new-innov.com and the results are discussed in a meeting with the house officers. They are evaluated in terms of their overall clinical competence with the following categories: clinical judgment, medical knowledge, clinical skills, humanistic qualities, professionalism, medical care and continuing scholarships.