Outpatient Oncology

I. Overview:

The Medical Oncology elective is designed to provide the house officer the knowledge and skills necessary for the diagnostic evaluation and management of patients with neoplastic disorders. It will allow the house officer to interact with hematologists/oncologists, surgeons, radiation oncologists, palliative care physicians, social workers and others in the multidisciplinary management of cancer patients.

The oncology elective consists of one block of four weeks and is available to all internal medicine PG-Y2’s and PG-Y 3”s. The elective includes participation in the in-patient consult service but will primarily be an out-patient experience involving the multidisciplinary clinics at the Montefiore Einstein Center for Cancer Care and the medical oncology clinics at either the Moses or MMP campus. The out-patient clinics are site specific (i.e. breast, lung, hematologic malignancies) and will allow the house officer exposure to both the more common malignancies and/or to select those that are of particular interest to them. Patients are very diverse ethnically and socioeconomically, and are representative of the neighboring Montefiore communities.

II. Level based Rotation Goals and Objectives:

PGY2/PGY3:

Patient Care: Prioritize the daily “work”; recognize the relative significance of cancer patients’ problems; recognize the oncological emergencies; explain 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 evidence-based data 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 and Communication Skills: Write understandable and legible notes and consultation reports;illustrate the ability to listen to patients and staff; communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.

Practice Based Learning and Improvement: Recognize one’s limitations of knowledge; use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed. recognize limitations of responsibilities.

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

III. Areas Covered During Oncology

1) Principles, Physiology and Basic Sciences:

a) Molecular biology of cancer

b) Epidemiology of cancer

c) Principles and pharmacology of chemotherapy and biologic therapy

d) Cancer Prevention

e) Cancer Screening

2) Practical skills unique to Oncology

a) History and physical examination with attention to constitutional complaints and organ dysfunction

b) Analyze and correlate clinical information with cytology, histology and immunodiagnostic tests

c) Explain and justify the indications for and application of imaging studies in patients with neoplastic

disorders;

d) Critically appraise and analyze Oncology literature using Recist criteria

d) Symptom control in terminal cancer patients

e) Coordinate multidisciplinary team management of patients

3) Approach to clinical problems in cancer patients:

a) Analyze signs and symptoms in patients with a cancer diagnosis

b) Prioritize and probabilistically differentiate clinical data as related to a cancer diagnosis

c) Use appropriate modalities to stage and treat patients with cancers

4) Specific Diagnoses in Oncology:

a) thoracic (lung, thymus, pleural)

b) breast cancer

c) gastrointestinal tract (esophagus, stomach, colon, rectum, anus)

d) hepatobiliary tumors

e) genitourinary tract cancers

f) endocrine including MEN syndromes and carcinoid tumors

g) head & neck cancer

h) central nervous system

i) hematologic malignancies including lymphoma and leukemia

j) skin, including melanoma

k) gynecologic malignancies

l) HIV-related malignancies

m) neutropenic fever and infection

n) paraneoplastic syndromes

5) Treatment Modalities in Oncology:

a) Chemotherapy

b) Targeted therapies

c) Radiation therapy

d) Surgery

e) Immunotherapy

6) Technical Skills specific to Oncology:

a) Bone marrow aspiration and biopsy

7) Emergencies encountered in cancer patients:

a) Neutropenic fever

b) Pericardial effusion with tamponade

c) Metabolic emergencies

d) Electrolyte disorders

e) SVC syndrome

f) Neurologic emergencies (spinal cord compression, brain metastases)

IV. Schedule of Activities

The following lists of scheduled activities are available during the elective. It is expected that the majority of time will be spent in the outpatient setting. New patients are seen in the multidisciplinary clinics at the Montefiore Einstein Center for Cancer Care and Medical Oncology patients are seen both at the Moses Campus and MMP. All clinics and Tumor Boards are specific to a site (breast, lung, GI, GU, sarcoma etc.) The elective is structured to allow the PGY-2/PGY-3 flexibility in planning their participation.

1) Morning rounds with oncology fellow and oncology attending (Moses or Weiler)

2) Afternoon consultation rounds with oncology fellow and oncology attending (Moses or Weiler)

3) Outpatient clinics-site specific (i.e. breast, thoracic, GI, GU)

4) Tumor Board conferences-site specific

5) Weekly core curriculum lectures

6) Medical Grand Rounds

All absences must be cleared through the Chief residents.

V. Methods of Evaluation and Assessment

The house officer is evaluated continuously during their four weeks of service on the Oncology elective. Importantly, formative feedback is given to the rotating house officer throughout the rotation experience. The final evaluation is entered through www.new-innov.com and a summary performance assessment is discussed in a meeting with the house officer. This evaluation will assess overall clinical competence as reflected by the following subcategories: clinical judgment, medical knowledge, clinical skills, humanistic qualities, professionalism, medical care and scholarship.

House officers will have the opportunity to evaluate both the rotation and the specific faculty with whom they worked most closely.