Competency-Based Curriculum
Educational Rationale
The primary goal of this rotation will be to provide the general internist
a basis for the diagnostic evaluation and the initial management of patients
with oncologic conditions.
The basic pathophysiology of disease principles and the complications
of treatment will be highlighted. General internists must have knowledge
of patterns of spread and prognoses of common tumor types. They must also
know the general treatment options (surgery, radiation therapy, chemotherapy)
that are effective in specific clinical situations and they should also
be comfortable with palliative methods for these patients. The resident
will be involved in discussions with patients and their families with
the goal of avoiding aggressive life support methods in patients whose
quality of life is no longer satisfactory to them. The resident will participate
in discussion of the value of treatments with excessive toxicity where
the only reasonable goal is prolongation of life by a few months. Residents
will be exposed to information regarding environmental toxins predisposing
to other oncological or neoplastic disorders, including chemotherapy and
cigarette smoking.
Goals
A. Knowledge
Upon completion of training, we expect our residents to learn the following:
1. Understand the pathophysiology and natural history of commonly encountered
oncologic disorders.
2. Understand staging of common cancers.
3. Recognize and manage oncologic emergencies
4. Understand the toxicities of commonly used treatments
5. Understand the role of adjuvant therapies such as radiation therapy
6. Management of a patient presenting with fever and neutropenia.
7. Diagnosis and management of a patient with brain metastases.
8. Evaluation and management of nausea in a cancer patient.
B. Skills
1. Clinical assessment using history, physical examination and appropriate
laboratory, radiographic and pathologic evaluation to evaluate oncologic problems.
2. Prompt diagnosis and treatment of a patient with spinal cord compression.
3. Evaluation and treatment of a patient with osseus metastases including
pain control and referral for radiation therapy Oncology Curriculum Updated 2015
4. Counseling a young woman with a family history of breast cancer.
5. Participating in a discussion with a patient and family who is, considering
"no code" or "palliative care only" status.
C. Attitudes:
Upon completion of training, we expect our residents to appreciate those
attitudes valued
and nurtured by hematologists, including:
1. Viewing medicine as humane science.
2. Balancing art with science.
3. Recognizing the limitations of technology and the value of clinical insight.
4. Understanding that testing, no matter how advanced or sophisticated,
rarely substitutes for thorough, thoughtful evaluation by an informed
clinician.
5. Balancing intervention with patience.
6. Recognizing limitations of our interventions.
7. Appreciating the unique circumstances of caring for patients with chronic,
usually incurable diseases.
Educational Experience
A. General
The monthly oncology elective for residents is presented by division faculty.
Residents will be responsible for seeing oncology in-patient consultations
and will also participate in the outpatient activities and practices of
division staff/faculty.
B. Clinical Activities
1. The Inpatient Experience (IP)
a. Inpatient consultations are called to residents by faculty or their
offices. Oncology residents are paged upon receipt of each consultation.
b. All consultations are seen upon the day of their receipt. In each instance,
the consultation is discussed with referring housestaff or attending physician,
as applicable.
c. Consultations are presented on rounds to the consulting hematologist,
at times to be mutually arranged. Usual practice is for the resident to
join the consulting physician for hospital rounds each morning and evening,
as applicable.
d. It is expected that at the time of presentation to the consulting physician,
the residents are totally familiar with the patient's problem(s),
have read and reviewed pertinent literature, and are prepared to knowledgeably
discuss the problem at hand. Literature references are available to all
residents rotating through the service.
2. The Ambulatory Experience (AM)
a. Residents are expected to attend all sessions, outpatient activities,
and practices.
b. Patients are assigned in clinics and offices by the attending physicians.
Every effort is made to select patients of "interest". Depending
on numbers of individuals on the rotations and clinic/office loads attempts
are made to permits residents to spend the first few experiences seeing
patients together with ttending physicians, so as to better introduce
them to the hematologic/oncologic evaluation.
c. New patients and consults undergo a complete history and physical examination
with emphasis on their oncological problem(s).
d. Chart notes are pertinent and succinct, and need not restate information
already recorded. For certain clinical circumstances, standardized forms
may be used for recording information.
3. Didactic Conferences (DC)
Numerous monthly conferences are held for the residents throughout the
month. They cover a variety of topics in all the major medical subspecialties.
Residents will be required to attend each of the conferences that do not
conflict with their clinical duties.
EVALUATIONS
Assessment Methods (of Resident)
The evaluation methods that apply to these rotations include some or all
of the following:
- Evaluation of resident competence by faculty attendings (AE)- Formal formative
evaluations should occur at the completion of the specific rotation. It
is to be based on direct observation on rounds, at conferences, and at
the bedside. All faculty members are encouraged to complete the form prior
to the completion of the rotation and review their impressions directly
with the resident. All completed evaluation forms are returned to the
Program Director for review and placed in the resident's permanent file.
- Mini CEXs may be used when warranted, particularly in the beginning of
the academic year.
- Self-evaluation by In-service training examination scores
- MKSAP study plan (MKSAP)
- Participation and presentations at didactic conferences (DC)
- Multi Source evaluations by patients and staff (MS)
Assessment Method (of Program)
Residents have the ability to evaluate teaching faculty and experience
at the end of each rotation. They are encouraged to use this opportunity
to give constructive feedback.
Residents are encouraged to maintain a high level of communication with
the Program Director and faculty. These informal meetings can be used
to disseminate information, receive timely feedback, and for other purposes.
Annually, all residents are required to complete and return an evaluation
form of the faculty and the program. Evaluations are collected in a fashion
to assure the anonymity of the resident. The feedback received during
informal meetings, formal meetings, and the semi-annual evaluation form
will be used to make programmatic change.
Competency Based Goals & Objectives:
1) Medical Knowledge
| Goals and Objectives-PGY1 |
Learning Activities* |
Assessment |
| Describe the epidemiology, genetics, natural history, clinical expression
of related disorders encountered in the inpatient and outpatient setting. |
IP, AM, DC |
AE, DC, MKSAP |
| Describe the screening recommendations for colon, cervical, and breast cancer |
IP, AM, DC |
AE, DC, MKSAP |
| Describe the management of patients with neutropenic fever |
IP, AM, DC |
AE, DC, MKSAP |
| Describe the epidemiology, genetics, natural history, clinical expression
of related disorders encountered in the inpatient and outpatient setting. |
IP, AM, DC |
AE, DC, MKSAP |
| Goals AND Objectives-PGY2/3 (In addition to above) |
Learning Activities* |
Assessment |
| Summarize an approach to the evaluation and staging of common cancers (lung,breast, colon) |
IP, AM, DC |
AE, DC, MKSAP |
| List the indications, techniques, contraindications, and complications
of bone marrow biopsy |
IP, AM, DC |
AE, DC, MKSAP |
| Interpret diagnostic tests used in the staging of malignancies |
IP, AM, DC |
AE, DC, MKSAP |
| Demonstrate ability to critically appraise and cite literature pertinent
to the evaluation of outpatients and inpatients with oncologic disorders. |
IP, AM, DC |
AE, DC, MKSAP |
2) Patient Care
| Goals and Objectives-PGY1 |
Learning Activities* |
Assessment |
| Effectively perform a comprehensive history and complete physical examination
in patients with symptoms affecting this system |
IP, AM, DC |
AE, DC, MKSAP |
| Appropriately select and interpret laboratory, imaging, and pathologic
studies used in the evaluation of disorders affecting this system |
IP, AM, DC |
AE, DC, MKSAP |
| Goals AND Objectives-PGY2/3 (In addition to above) |
Learning Activities* |
Assessment |
| Construct a comprehensive treatment plan and assess response to therapy. |
IP, AM, DC |
AE, DC, MKSAP |
| Counsel patients concerning their diagnosis, planned diagnostic testing
and recommended therapies. |
IP, AM, DC |
AE, DC, MKSAP |
| Utilize validated instruments in the assessment of function and quality
of life to monitor and adjust therapy. |
IP, AM, DC |
AE, DC, MKSAP |
3) Practice-Based Learning and Improvement
| Goals and Objectives-PGY1 |
Learning Activities* |
Assessment |
| Identify and acknowledge gaps in personal knowledge and skills in the care
of hospitalized and ambulatory patients with related diseases |
IP, AM, DC |
AE, DC, MKSAP |
| Develop and implement strategies for filling gaps in knowledge and skills
of patients related diseases |
IP, AM, DC |
AE, DC, MKSAP |
| Integrate and apply knowledge obtained from multiple sources to the care
of inpatients and outpatients |
IP, AM, DC |
AE, DC, MKSAP |
| Demonstrate ability to critically assess the scientific literature |
IP, AM, DC |
AE, DC, MKSAP |
| Goals AND Objectives-PGY2/3 (In addition to above) |
Learning Activities* |
Assessment |
| Effectively use technology to manage information, support patient care
decisions, and enhance both patient and physician education. |
IP, AM, DC |
AE, DC, MKSAP |
| Demonstrate ability to critically assess the scientific literature |
IP, AM, DC |
AE, DC, MKSAP |
| Set and assess individualized learning goals |
IP, AM, DC |
AE, DC, MKSAP |
| Analyze clinical experience and employ a systematic methodology for improvement |
IP, AM, DC |
AE, DC, MKSAP |
| Develop and maintain a willingness to learn from errors, and use errors
to improve the system or processes of care |
IP, AM, DC |
AE, DC, MKSAP |
4) Interpersonal Skills and Communication
| Goals and Objectives-PGY1 |
Learning Activities* |
Assessment |
| Apply empathy in all patient encounters |
IP, AM, DC |
AE, DC, MKSAP |
| Demonstrate effective skills of listening and speaking with patients, families
and other members of the health care team |
IP, AM, DC |
AE, DC, MKSAP |
| Present patient information concisely and clearly, verbally and in writing |
IP, AM, DC |
AE, DC, MKSAP |
| Goals AND Objectives-PGY2/3 (In addition to above) |
Learning Activities* |
Assessment |
| Reliably and accurately communicate the patient's and his/her family's
views and concerns to the attending |
IP, AM, DC |
AE, DC, MKSAP |
| Compose clear and timely admission and progress notes and consultations |
IP, AM, DC |
AE, DC, MKSAP |
| Counsel patients, families and colleagues regarding side effects and appropriate
use of specific medications, providing written documentation when appropriate |
IP, AM, DC |
AE, DC, MKSAP |
| Teach colleagues effectively |
IP, AM, DC |
AE, DC, MKSAP |
5) Professionalism
| Goals and Objectives-PGY1 |
Learning Activities* |
Assessment |
| Be prompt and prepared for all clinical duties |
IP, AM, DC |
AE, DC, MKSAP |
| Recognize the importance of patient primacy, patient privacy, patient utonomy,
informed consent, and equitable respect and care to all |
IP, AM, DC |
AE, DC, MKSAP |
| Respect patients and their families, staff and colleagues |
IP, AM, DC |
AE, DC, MKSAP |
| Goals AND Objectives-PGY2/3 (In addition to above) |
Learning Activities* |
Assessment |
| Model ethical behavior by reporting back to the attending and referring
providers any key clinical findings |
IP, AM, DC |
AE, DC, MKSAP |
| Demonstrate integrity |
IP, AM, DC |
AE, DC, MKSAP |
| Respond to phone calls and pages promptly |
IP, AM, DC |
AE, DC, MKSAP |
6) Systems-Based Practice
| Goals and Objectives-PGY1 |
Learning Activities* |
Assessment |
| Demonstrate effective collaboration with other health care providers, including
nursing staff, ancillary staff, therapists, primary care physicians, and
consultants in the care of patients with related diseases |
IP, AM, DC |
AE, DC, MKSAP |
| Develop an understanding of the hospital resources available to the evaluation
and management of patients with problems encountered by the subspecialty. |
IP, AM, DC |
AE, DC, MKSAP
|
Demonstrate a knowledge of and commitment to the rules governing confidentiality
of patient information.
|
IP, AM, DC |
AE, DC, MKSAP
|
| Goals AND Objectives-PGY2/3 (In addition to above) |
Learning Activities* |
Assessment |
| Discuss how the health care system affects the management of inpatients
with related diseases. |
IP, AM, DC |
AE, DC, MKSAP |
| Determine cost-effectiveness of alternative proposed interventions. |
IP, AM, DC |
AE, DC, MKSAP |
| Design cost-effective plans based on knowledge of best practices |
IP, AM, DC |
AE, DC, MKSAP |
| Demonstrate awareness of the impact of diagnostic and therapeutic recommendations
on the health care system, cost of the procedure, insurance coverage,
and resources utilized |
IP, AM, DC |
AE, DC, MKSAP |
Teaching Methods
All residents participate in patient care duties, didactic conferences
and independent reading. They will learn at the bedside from attendings,
nurses and physician extenders, pharmacists, social workers, case managers,
peers, and patients.
Level of Supervision
Interns are supervised in their care of patients by more senior medical
house staff (PGY- 2/3 and Chief Residents) and faculty.
PGY2/3 residents have direct and indirect supervision by Chief Resident
and Faculty
Educational Resources
a. Supervising clinicians-didactic and bedside rounds and concurrent patient care
b. Medical literature including assessment of knowledge using the MKSAP
c. Bedside rounds with team and faculty.
d. Medical Grand Rounds weekly.
e. Scheduled didactic conferences including: medicine morning report,
journal club, ambulatory care conference, EBM conference
f. Saint Barnabas Medical Center library, librarians, and online references/resources.
REFERENCES
JOURNALS
1. MKSAP 14, Oncology Section, text and questions.
2. Current Literature as assigned by the supervising faculty
3. Chute JP, Chen T, et al. Twenty Years of Phase III Trials for Patients
with Extensive Stage Small Cell Lung Cancer: Perceptible Progress. Journal
of Clinical Oncology 1998;17:1794-1801.
4. Hainsworth JD, Greco FA. Treatment of Patients with Cancer of Unknown
Primary Site. NEJM 1993;329:257.
5. Coblieghm Vogel CL, et al. Multi-Institutional Study of Efficacy and
Safety of Humanized Anti-HER2 Monoclonal Antibody in Women with HER2 Overexpressing
Metastatic Breast Cancer that has Progressed After Chemotherapy for Metastatic
Disease. Journal of Clinical Qncology 1999;12:2639.
6. Theriaultrl Lipton, A, et al. Pamidronate Reduces Skeletal Morbidity
in Women with Advanced Breast Cancer and Lytic Bone Lesions. Journal of
Clinical Oncology 1999;17: 846-854.
7. Jordan, Craig T., Guzman, Monica L., Noble, Mark Cancer Stem Cells.
N Engl J Med 2006 355: 1253-1261
8. Copelan, Edward A. Hematopoietic Stem-Cell Transplantation N Engl J
Med 2006 354: 1813-1826
9. Oncologic Emergencies: Diagnosis and Treatment. Mayo Clinic Proceedings.
2006; 81: 835-848.
TEXTS
1. Cancer: Principles and Practice of Oncology; Vincent De Vita, Samuel
Hellman and Steven Rosgenburg.
2. Diseases of the Breast; J.R. Harris, Mark E. Lipman, Monica Morrow
and Samuel Hellman
FACULTY
Jennifer Wagmiller, M.D, Education Coordinator
Andrew Brown, M.D.
Miguel Conde, M.D.
Robert Grossman, M.D.
Stuart P Leitner, M.D.
Richard A Michaelson, M.D.
Maithili Rao, MD
Michael Scoppetuolo, M.D.