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Oncology

2006; Updated 2015

 

ALBERT EINSTEIN COLLEGE OF MEDICINE

MONTEFIORE MEDICAL CENTER

 

INTERNAL MEDICINE RESIDENCY PROGRAM: CURRICULUM

 

Rotation:   HEMATOLOGY/ONCOLOGY

 

Educational Purpose and Goal: Cancer is second leading cause of death in the US. Internists must be familiar with diagnosis and care of cancer patients. This rotation will prepare residents to diagnose, evaluate, stage or treat patients with hematological malignancies, solid tumors, oncological and hematological emergencies, and to provide supportive/palliative care.

 

Residents (PGY IIs and IIIs) will work in teams under the supervision of an oncology fellow and attending; teaching is divided between one supervising Solid Tumor attending and one supervising Hematologic attending. All patient care is supervised by the responsible faculty. 

 

A.     Competency-based level-specific objectives:

 

 

PGY 2

Patient Care

-          recognize the acuity levels of illness;

-          list the indications, contraindications and risks of common procedures;

-          work with all providers to provide patient-focused care

 

Medical Knowledge

-          utilize literature and reference sources to increase knowledge base;

-          demonstrate basic knowledge in the areas of underlying pathophysiology and the clinical aspects of basic disease states;

-          apply knowledge in the treatment of patients. 

-          recognize and manage appropriately oncological emergencies

-          provide adequate symptom control and demonstrate knowledge for control of pain, nausea, and anxiety

 

Practice-Based Learning and Improvement

-          recognize limitation of knowledge;

-          use references and literature to improve practice patterns;

-          accept feedback and change behavior;

-          ask for help when needed

-          apply evidence-based strategies to prevention, diagnosis, and disease management;

 

Interpersonal and Communications Skills

-          communicate effectively  with  patients, families, and other members of health team;

-          write understandable notes;

-          appreciate roles and interaction of the multiple disciplines in the care of oncology patients

 

Professionalism

-          demonstrate compassion, integrity and altruism in relationships with cancer patients, families and colleagues;

-          explain moral and ethical issues encountered in hematology/oncology practice and in conducting clinical trials

 

Systems-based practice

-          identify the role of ancillarypersonnel including nurses, social worker, hospice personnel, payors and regulatory bodies;

-          advocate for quality patient care and assist patients in dealing with system complexities

 

 PGY 3

Patient Care:

·         manage patients with cancer including appropriate diagnostic and therapeutic approaches;

·         explain the safe use of chemotherapy and treatment-related complications;

·         list the indications and techniques to safely and effectively perform invasive diagnostic/therapeutic procedures including paracentesis, thoracentesis, and lumbar puncture, bone marrow biopsy

 

Medical Knowledge

·         practice appropriate management strategies for hematologic/solid tumors;

·         explain the  scientific principles underlying recent molecular genetic advances;

·         recognize and manage appropriately oncological emergencies;

·         describe the basic principles of major modalities of cancer treatment including

o   Chemotherapy

o   Biological treatment

o   Surgical treatment

o   Radiation therapy

o   Immunotherapy

o   Targeted therapies-personalized medicine;

·         provide adequate symptom control and demonstrate knowledge for control of pain, nausea, and anxiety

 

 

Practice-Based Learning and Improvement

·         analyze and interpret clinical trials;

·         acquire knowledge to choose diagnostic studies in an orderly and effective way to improve patient care

·         practice evidence-based strategies to prevention, diagnosis, and disease management;

 

Interpersonal and Communications Skills

·         communicate effectively with patients, families, and other members of health team;

·         write understandable notes;

·         identify roles and interaction of the multiple disciplines in the care of oncology patients

 

Professionalism

·         demonstrate compassion, integrity and altruism in relationships with cancer patients, families and colleagues;

·         work competently with patients regarding advanced care planning, futility, and withholding or withdrawing therapy;

·         gain an understanding of moral and ethical issues encountered hematology/oncology practice and in conducting clinical trials

 

Systems-based practice

·         gain knowledge of the health care delivery system including the role of ancillarypersonnel including nurses, social worker, hospice personnel, payors and regulatory bodies;

·         advocate for quality patient care and assist patients in dealing with system complexities

 

 

Educational content:

·         Biology and genetics of cancer

·         Epidemiology of cancer

·         Cancer screening guidelines

·         Prevention

·         Diagnoses, staging, prognosis, and treatment of common malignancies

·         Lung cancer

·         Breast cancer

·         Prostate cancer

·         Colorectal cancer

·         Pancreatic cancer

·         Esophageal cancer

·         Head & Neck cancer

·         Pancreatic cancer

·         Gastric cancer

·         Lymphoma

·         Acute and chronic leukemia

·         Chronic myeloproliferative disorders

·         Ovarian cancer

·         Uterine cancer

·         Cervical cancer

·         Brain tumors

·         HIV related malignancies

·         ?VTE in cancer patients

Paraneoplastic syndromes

 

·         Administration and side effects of Chemotherapy, immunotherapy, and targeted therapies

·         Oncological 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   Neurological emergencies

·         Spinal cord compression

·         Seizures

·         Brain metastases

·         Leptomeningeal metastases

o   Supportive care

·         Symptom control including pain

·         Giving patients bad news

o   Radiation therapy

·         Indications

·         Mechanisms of radiation therapy

o   Diagnostic procedures: Indications, and limitations as well as technical aspects of common diagnostic procedures

·         Bronchoscopy/ Mediastinoscopy

·         Bone marrow aspiration and biopsy

·         PET scan

 

Principal Teaching Methods/Learning Venues

  • Starting on December 20, 2015, oncology in-patient unit will have three services. BMT transplant unit (NW200 A to NW210), Hematological oncology unit (NW211 to NW221) and Solid tumor service NW811 to NW819).
  • The latter two will support a two-week rotation as follows: There will be one fellow and two residents from Montefiore IM program on NW 8, and 3 residents (one from Wakefield IM program) and 2 fellows on NW2.
  • BMT service will be covered by PAs and hematological oncology attending. On the weekends the NW2 BMT unit will be covered by a PA.

 

Schedule for daily activities:

  • NW 8: rounds will start at 8:00 AM and IDT rounds at 9:30 AM
  • NW 2: IDT rounds at 9:00 AM and rounds start 9:30 AM
  • On the weekend, NW8 and NW2 Hematological Oncology units will EACH be covered by one Montefiore medicine resident, one fellow and one attending.  The resident and fellow will split writing the notes. 
  • We will do at least 2 noon reports per week with house staff covering different topics. We can ask fellows or residents to prepare talks also.

 

·         Noon lectures will occur approx. 2 times/week covering different topics. Fellows or residents may also be asked to prepare talks.

·         Noon conference topics

o   Psychosocial aspect of cancer

o   Oncological emergencies

o   Lung cancer

o   Prostate cancer

o   NHL

o   Screening and prevention

o   Breast cancer

o   Acute leukemias

o   Colon cancer

o   Principles of Chemotherapy/ Agents (general)

o   Cervical Cancer

 

Other available conferences:

·         Research conference (monthly)

·         Journal Club (monthly)

·         Science lecture (monthly)

·         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)

 

 

Methods of Teaching Competencies and Assessment

 

                                                Venues                                    Assessment

Patient Care                           Admissions                             Ongoing and end-of- rotation

                                                Attending rounds                                evaluation

                                                Tumor Board

 

Medical Knowledge              Attending Rounds                  Ongoing and end-of-rotation

                                                Noon Conference                                evaluation

                                                Tumor Board

                                                Journal Club

 

Practice Based                       Attending rounds                    Ongoing and end-of-rotation


Learning/Improvement            Journal Club                            evaluation

                                               

 

Professionalism                      Attending rounds                    Ongoing and end-of-rotation 

                                                                                                            evaluation

 

System-Based Practice          Attending rounds                    Ongoing and end-of-rotation

                                      Multidisciplinary rounds                     evaluation

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