Educational Curriculum
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The Internal Review Board extends guidance and support to fellows with their research activities. A designated Research Director is available to guide and assist fellows. The Medical Center sponsors an annual Research Day that welcomes presentation from faculty and fellows. On site librarians offer personalized assistance with literature searches, inter library loan and reference services. Well-appointed computer terminals are available to faculty, fellows and employees. Fellows receive a generous educational stipend for conference attendance and reimbursement for books, journals, dues and technology.
PGY 4
PATIENT CARE
- Is able to demonstrate during inpatient rotations compassionate care concerning problems (pain, nutrition, depression).
- Management of Leukemic Patients
- To identify which patients need treatment.
- To understand the different treatments for different Leukemias
- To know the induction chemotherapy and consolidation therapy of ALL and ANLL.
- To know indications of bone marrow transplant in various Leukemias
- To be able to manage emergencies like Tumor Lysis Syndrome
- To manage complications of chemotherapy in Leukemic patients
- To be able to give intrathecal chemotherapy
- To understand the indications for transfusion support and the appropriate blood products to utilize in patients with leukemia
- General Evaluation of Lymphomas
- To be able to evaluate patients with Lymphadenopathy
- Know the pitfalls of fine needle aspiration and the importance of obtaining an excisional biopsy in the diagnosis of lymphoma
- Understand the difference between Hodgkin’s Disease (HD) and Non-Hodgkin’s Lymphomas (NHL) in presentation, diagnosis and treatment
- Oncologic Emergencies
a. Recognize the signs and symptoms of hypercalcemia and be able to treat
- Understand the symptoms and the appropriate diagnostic procedures for diagnosing spinal cord compression
- Understand which patients should receive emergent radiotherapy and which patient should undergo laminectomy for treatment of spinal cord compression
- Be able to recognize Tumor Lysis Syndrome and know how to manage
- Recognize the signs and symptoms of Superior Vena Cava Syndrome, and utilize appropriate diagnostic testing and management
MEDICAL KNOWLEDGE
- Understanding of Molecular Biology of Cancer (Lectures, molecular Biology Rotation).
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- Molecular Biology and Gene Regulation:
- Understand the structure of DNA
- Understand the techniques for DNA analysis and their applications e.g. PCR
- Understand what oncogenes are and their role in tumorigenesis
- Know how gene expression is controlled
- List known tumor suppressor genes and their associated tumors
- Cell Proliferation:
- Know the different phases of the cell cycle
- Know what oncogenes are involved in cell cycle progression
- Know how tumor suppressor genes effect the cell cycle
- Epidemiology of Cancer (Lecture Series, Clinics)
- Carcinogenesis:
- Describe the genetic and environmental factors and their interactions which lead to the development of cancer
- Cancer Prevention:
- Describe what types of primary prevention are currently available.
- Understand situations where there might be a role for prophylactic surgery
- Understand the strategy of chemoprevention trials
- Demonstrate knowledge of current screening procedures and their sensitivity, specificity and cost effectiveness
- Counsel patients in their risk for development of cancer
- Clinical Pharmacology (Basic Science Lectures, Oncology Inpatient and Clinics)
- Pharmacokinetics:
- Understand the absorption, distribution and elimination of chemotherapeutic agents
- Methods of Delivery:
- Demonstrate the administration of intravenous chemotherapy
- List chemotherapeutic agents which are vesicants and explain how to manage drug extravasation
- Demonstrate use of in-dwelling catheters, e.g. porta Cath, Hickman
- Demonstrate the delivery of intrathecal chemotherapy and describe toxicity
- Understand the expected short toxicities of individual agents
- Manage toxicities in patients receiving chemotherapy including emesis, cytopenias, etc.
- List the long term toxicities of single and combined chemotherapeutic regimens.
- New agents
- Drug Resistance
- Radiation Therapy – See RT Elective Goals and Objectives
- Bone Marrow Transplantation – See BMT Elective Goals and Objectives
- Leukemia (Ward experience, blood bank and flow cytometry rotations, morphology
sessions).
- To know the difference between various types of leukemia.
- Diagnosis:
- To make a peripheral smear and identify different types of leukemia’s by morphology
- To be able to do a bone marrow aspiratory, bone marrow biopsy and touch preparation and core biopsy of the bone
- To know what special studies need to be done on peripheral blood or bone marrow aspirate samples of Leukemia patients i.e. cytogenetics, flow cytometry, etc.
- To do spinal tap and interpret CSF cytology for diagnosis of Leukemic Meningitis
- Clinical Features:
- To know and identify clinical syndromes associated with specific leukemia’s e.g. DIC in APL, hemolytic anemia in CLL, etc.
- To identify the Prognosis of various leukemia.
- Lymphomas (Oncology inpatient, clinics, tumor board, lectures)
- Pathology
- Be able to identify Reed Sternberg cells.
- Know the importance of flow cytometry and cytogenetics in establishing the diagnosis and prognosis of lymphomas.
- Staging
- Be able to stage lymphomas according to Ann Arbor classification
- Know the Cotswold modification of the Ann Arbor staging
- Know the appropriate use of radiographic and radio nucleotide studies for staging purposes.
- Know the indications for lumbar puncture in patients with NHL.
- Treatment
- Know the standard chemotherapeutic regimens used for treatment of HD and NHL
- Demonstrate appropriate management of patients with massive mediastinal HD
- Know the indications of treatment of NHL
- Be able to diagnose and manage Tumor Lysis Syndrome.
- Demonstrate administration of intrathecal chemotherapy
- Carcinoma of the Breast (Oncology rotations, clinics, radiation elective)
- Epidemiology:
- State the risk factors for the development of breast cancer
- Be able to counsel patients about their risk factors for future breast cancer and other cancers
- Be able to counsel family members about their risk
- Diagnosis:
- State the ACS recommendations for the use of screening mammography.
- Describe the role of ultrasonography for diagnosis of breast mass
- Be able to demonstrate physical examination of the breast and axilla. Teach patient self-breast examinations
- Discuss the indications for biopsy of breast mass
- Discuss the indications for fine needle aspiration of a breast mass
- Staging and Prognostic Features:
- State the staging utilizing in the TNM classification
- Describe the different prognostic features which identify and increased risk for recurrence of breast cancer
- Demonstrate the use of appropriate diagnostic tests for staging of breast cancer including pre surgical evaluation
- Gastrointestinal Cancers (Inpatient and outpatient rotations, RT elective)
- Colorectal Cancer:
- Discuss the staging of colorectal cancer and risk factors for development, environmental and genetic
- Understand the use of CEA in follow of patient
- Demonstrate the appropriate staging work up
- Describe the role of post-operative RT in rectal cancer
- Know which patient benefit from adjuvant chemotherapy and the regimens employed
- Know the chemotherapeutic regimens utilized for treatment of metastatic disease
- Esophageal Cancer:
- Understand the benefits and toxicities of combine modality therapy
- Understand the importance of nutritional support in esophageal cancer and the techniques employed, e.g. Hyper alimentation with PEG, gastrostomy, TPN, PPN
- Gastric Cancer
- Describe the risk factors for development of gastric carcinoma
- Understand the pattern of spread
- Utilize the appropriate non-invasive tests for diagnosis and staging
- Understand the surgical management of primary disease
- Understand the role of chemotherapy in advance disease
- Pancreatic Cancer:
- Utilize the appropriate non-invasive procedures for diagnosis
- Describe the role of the Whipple’s procedure in primary management
- Understand the use of radiation therapy in management
- Describe palliative surgical procedures
- Discuss the use of 5FU as a radiation sensitizer and its use a primary treatment
- Understand new chemotherapeutic agents in management of pancreatic cancer
- Hepatocellular Cancer:
- Define the risk factors for the development of hepatocellular cancer
- Understand which patients may benefit from surgery
- Describe the use of hepatic artery infusion
- Know what chemotherapy is active in treatment of hepatoma
- Renal Cancer:
- List the risk factors for the development of renal cancer
- Recognize the clinical presentation of kidney cancer and the common sites of metastases
- Describe the radiographic tool utilized to diagnose hyper leproma
- Know the staging and prognosis of kidney cancer
- Recognize which patients are surgical candidates
- Describe role of radiation therapy in the management
- Understand the role of biologic response modifiers in treatment
- Gynecologic Malignancies (Gyn elective, oncology inpatients, clinics, RT elective)
- Ovarian Cancer:
- Epidemiology: Know the risk factors for ovarian cancer – isolated and familial
- Diagnosis and Staging:
- Know the signs and symptoms
- Know the significance of tumor markers and the role of CA-125 in screening.
- Understand the evaluation and management of an adnexal mass
- Know the FIGO staging of ovarian cancer
- Management:
- Know the standard surgical treatment and importance of debunking
- Know the stages which require chemotherapy and which
Chemotherapeutic agents to use
- Know the indications of radiation treatment for different stages of disease
- Know the significance and importance of a second look laparotomy
- Know the management of recurrent disease
b. Endometrial Cancer:
1. Know the importance of different risk factors and the association
between tamoxifen and endometrial cancer.
- Describe the clinical presentation and the appropriate diagnostic
procedures
- Know the FIGO staging
- Understand the management of the different stages and the role of surgery, radiation therapy and chemotherapy
- Understand the management of recurrent disease
- Know the management of uterine sarcoma
- Lung Cancer (Tumor boards, outpatient and inpatient rotations, RT elective)
- Non-small Cell Carcinoma:
- Know how to evaluate a solitary pulmonary nodule
- Know the appropriate methods for obtaining a tissue diagnosis
- Describe the TMN staging of NSCLC
- Understand which patients are primary surgical candidates
- Understand the role of radiotherapy in the management of NSCLC
- Know which chemotherapeutic agents are active in lung cancer
- Discuss the role of neoadjuvant chemotherapy in NSCLC
- Know the prognosis of patients after primary therapy
- Be able to provide palliative care for patients with metastatic disease
- Small Cell Carcinoma:
- Demonstrate the use of appropriate diagnostic and staging procedures
- Discuss the prognostic differences between limited and extensive disease
- Understand the role of multimodality therapy, i.e. radiotherapy and chemotherapy
- Discuss the controversy about the role of prophylactic cranial irradiation
- Complications of Malignancy (Lecture series, oncology rotation)
- Complications of Treatment:
- Demonstrate understanding of acute toxicities of chemotherapeutic agents and the management of toxicities
- Describe how combined radiation and chemotherapy lead to enhanced toxicities
- Describe the situations in which secondary hematologic malignancies and myelodysplastic syndromes arise
- Describe situations in which secondary solid tumors occur
- Understand late effects that occur after whole brain irradiation
- Pain Management – See Pain Management Elective Goals and Objectives
- Neutropenic Fever:
1. Understand the common organisms which cause infection in the febrile neutropenic patient
- Know when and which antibiotics to start
- Understand the use of growth factors in the management of the neutropenic patient
- Know when to utilize antifungal therapy
PRACTICE BASED LEARNING
- Regularly self-assesses his opinion on new patients and the opinion of the teaching faculty.
- Looks at literature to decide on controversial issues
INTERPERSONAL SKILLS AND COMMUNICATIONS
- Be aware of community support groups
- Understand when patients require medical treatment to manage depression, etc.
PROFESSIONALISM
- Be able to demonstrate a commitment to patients from diverse ethnic and educational levels
- Responds appropriately to constructive criticism
- Demonstrates on “360” evaluations a thorough commitment to ethical
principals for our demographically diverse patient population
SYSTEM BASED PRACTICE
- Actively participates in rounds with the attending hematology/oncologists and Inter Hospital Conferences