|
|
|
Gynecologic oncology is a subspecialty of gynecology within the discipline of obstetrics and gynecology directed to the diagnosis and management of female genital tract cancers. Gynecologic oncology interrelates multiple modes of therapy, to improve the whole care of women presenting with genital cancer. The purpose of this document is to provide program directors, surveyors and residents with an interpretation of the general standards of accreditation as they relate to the accreditation of programs in gynecologic oncology. GOALS
AND OBJECTIVES:
There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. The following terminal objectives have been outlined by the Specialty Committee in Gynecologic Oncology. Accredited programs are expected to develop enabling, rotation-specific objectives for the program based on these terminal objectives. Specific Objectives At the completion of residency training, the gynecologic oncologist must demonstrate:
The resident must understand the principles of radiobiology and radiation physics, and the sources, therapeutic methods and complications of radiation therapy in order to permit active participation with the radiation oncologist in treatment planning of patients with gynecological cancers, in the use of intracavitary application and the indications for brachytherapy, and in management of radiation induced complications. This must involve the direct care of inpatients and outpatients undergoing radiation therapy.
The resident must have a basic knowledge of clinical pharmacology as applied to cancer chemotherapy. This includes knowledge of cell biology, classes of chemotherapeutic agents and their mechanisms of action, pharmacology of specific agents and their toxicity. The resident must be able to understand the principles of immunotherapy. The resident must have a knowledge of concepts of drug trials and adjuvant therapy.
The resident must be familiar with the direct visual and microscopic appearances of lesions of the female genital tract that are premalignant and be aware of the features which distinguish them from benign disorders. This should include knowledge of their derivation, biological behaviour and characteristics of disease of the vulva, vagina, cervix, uterine body, fallopian tube, ovary and trophoblastic disease in order to formulate decisions in adequate therapy and prognosis.
The resident must be able to demonstrate knowledge in the design of clinical trials and other basic investigative projects as well as a familiarity with the biostatistical analysis of results and critical interpretation of the literature.
The resident must demonstrate evidence of good interpersonal skills when working with patients, families, and other members of the oncology team. The resident must demonstrate the ability to work effectively with gynecologists, radiation oncologists, medical oncologists, nurses and other health care workers. Comprehensive patient care requires that the resident have an appreciation of the unique psychological, social, and sexual problems that may arise as the patient and her family cope with gynecological cancer and its treatment. The resident must demonstrate the ability to support the morale of the patient with compassion and understanding throughout the disease course and to address issues in terminal care. The program must provide residents with the opportunity to obtain:
All residents must demonstrate the knowledge, skills and attitudes relating to age, gender, culture, and ethnicity pertinent to gynecologic oncology. CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM:
There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty. The following are the minimum educational requirements in the subspecialty of gynecologic oncology. Additional experience may be required by the program director.
Five years of obstetrics and gynecology including a basic clinical year which must be completed prior to entry into the gynecologic oncology program.
Twenty four months of gynecologic oncology. This program must include:
It is desirable that some of the surgical training equivalent of one or two months, should be spent in a surgical intensive care unit where the resident can obtain first-hand knowledge and experience in the management of the critically ill surgical patients. For satisfactory completion of the College requirements in gynecologic oncology a resident must: 3. have successfully completed a two-year program in gynecologic oncology in a Royal College accredited program in which the resident has been enrolled for the full two years; 4. have attained Royal College certification in obstetrics and gynecology; 5. have provided evidence of a publication in a peer-reviewed journal (as submitted or in press) reporting their results of a project of scientific inquiry. Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience. RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents to complete the program and achieve the educational objectives in gynecologic oncology.In those cases where a university has sufficient resources to provide most of the training in gynecologic oncology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training. Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to gynecologic oncology. The education sites available to a gynecologic oncology program must be able to provide the resources to allow the residents to meet the specific learning objectives identified in Standard II.
The teaching staff should have an appropriate nucleus of full time teachers and recognized gynecologic oncologists with acceptable qualifications. The gynecologic oncology service should be under the direction of an obstetrician gynecologist recognized as a specialist in gynecologic oncology. A minimum of two such individuals must be full-time for any gynecologic oncology program to be accredited.
The number and variety of patients available to the program on a consistent basis must be sufficient to meet the educational needs of the residents. The gynecologic oncology service must have an adequate number of beds organized for teaching the investigation and treatment of gynecologic oncology. These beds must be under the supervision of a gynecologist oncologist who holds Royal College certification in obstetrics and gynecology and who fulfills the qualifications of a gynecologic oncologist.
Gynecologic oncology services must have active participation by designated individuals providing such services as nutritional counselling, emotional support programs, and others as deemed appropriate for such a service. Attitude is of the utmost importance. The unit must foster a caring, cooperative, compassionate attitude for patients, their family and friends. There must be integrated involvement with a regional or provincial cancer foundation (institute). Working relationships with other cancer care organizations such as the Canadian Cancer Society is to be encouraged.
In-patient and outpatient gynecologic oncology teaching services should be integrated to provide continuity of observation both in and out of hospital. Organized clinics and additional appropriate facilities must be available to provide for instruction in the broad range of gynecologic oncology disorders that can be managed on an ambulatory basis as well as for appropriate preadmission investigation and post-hospital discharge follow-up. In addition to regular gynecologic oncology evaluation and follow-up clinics, specialty clinics under the supervision of appropriate obstetricians and gynecologists and/or gynecologic oncologists in colposcopy must be available for residents in the program. There must be an organized ambulatory care facility and provincial cancer foundation (institute) for utilization by the residents in conjunction with the in-patient gynecologic oncology unit. Residents in gynecologic oncology must be assigned responsibilities in relevant ambulatory clinics on a regularly scheduled basis. These ambulatory clinics may comprise:
The program must provide residents with the opportunity to obtain experience in the provision of a consultant service in gynecologic oncology to primary care physicians and other specialists.
There must be meaningful access to a surgical and/or medical intensive care unit.
There must be an appropriate experience in relating to the community in which the gynecologic oncologists functioning including referring physicians, obstetricians and gynecologists and other professionals.
There must be an appropriate liaison with a teaching service in medical oncology and radiation oncology that would facilitate the training of the resident in gynecologic oncology. In addition, there must be appropriate liaison with teaching services in anatomical pathology or general pathology, in anesthesia, diagnostic radiology, hematology, internal medicine, general surgery, and urology. There must be meaningful access to para-medical support groups including nutrition (dietary services), social services, hospice, physiotherapy, occupational therapy, and community health nurse organizations as appropriate to facilitate supervised training as applied to the practice of gynecologic oncology.
ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM:
The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.
Organized scholarly activities such as journal clubs, research conferences and seminars must be a regular part of every program. Service demands must not seriously interfere with the ability of the residents to follow the academic program.
There must be a sufficient number of qualified teaching staff to supervise residents and provide teaching in the basic and clinical sciences related to gynecologic oncology. There should be organized teaching in the basic sciences of anatomy, embryology, histology, physiology, cytology, pathology, and pathophysiology associated with gynecologic oncology disorders.
The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to gynecologic oncology.
The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.
Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.
Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.
Residents must be given opportunities to develop skills in management as applied to gynecologic oncology such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.
The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments. An opportunity for active participation in the local gynecologic oncology program as well as within the provincial organization should be encouraged. This should provide an understanding of the importance of such programs and of the role the gynecologic oncologist can provide in developing and maintaining standards of care in gynecologic oncology.
There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The program must provide an opportunity to participate in research projects under the supervision of appropriate investigators. All residents must demonstrate an ability to incorporate age, gender, cultural and ethnic perspectives in research methodology, data presentation and analysis. This research may be either clinically orientated or of a basic science nature. If the latter, it should be in a location with adequate space for research and situated close to patient care facilities. One research project must be completed for each year of residency. The resident should also participate in a course of study or lectures, either in a specific time block or throughout the course of training, where the design of clinical trials, biostatistics and basic investigatory skills are developed.
A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.
All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university. As there is no summative evaluation at a national level, it is particularly important that the evaluation of residents in the program be rigorous and well documented. Programs must have a comprehensive assessment plan including assessment criteria and methods, based on the objectives of the program. Assessments of the performance of individual residents in the program are to be kept on file in the office of the postgraduate dean for review at the time of on-site surveys. The final evaluation will also include the investigative paper (s) summarizing the research project (s) carried out by the resident. For each resident deemed by the program director to have completed the program, an "Attestation of Program Completion" form on University letterhead must be filed with the College. These forms will be sent to the program for each resident shown on the Annual Report to have completed the required two years in the program. PROGRAMS (WITH TRAINING REQUIREMENTS): Diplomas(Dip):
Six
months of approved residency training.
Doctor of
Medicine(M.D):
Eighteen months of approved residency training. Doctor of
Philosophy(Ph.D):
Forty eight months(four years)of approved residency training. |