MEDICAL ONCOLOGY

 

GENERAL OBJECTIVES:Only candidates certificated in Internal Medicine may be eligible for the Certificate of Special Competence in Medical Oncology.

During the course of training in medical oncology the resident must acquire a high degree of clinical competence in the investigation and management of patients with the spectrum of neoplastic diseases and their complications, together with an understanding of the basic scientific principles which relate to cancer and its treatment, particularly the chemical, hormonal and immunologic approaches. The resident must develop the ability to function as a specialist consultant in an inpatient and ambulatory setting and as a part of a multidisciplinary team in cancer management. Development of expertise in the relevant investigative methods, technical skills and communicative interpersonal relationships is essential, together with skill in the collection and interpretation of data and decision making.

Some of the specific aspects of knowledge with which the resident should become familiar include the following:

  1. the natural history oŁ cancer including risk factors, patterns of growth, spread and prognostic variables;
  2. assessment and investigation of patients with cancer, including the history, physical examination, laboratory and imaging techniques;
  3. indications for and complications of the various treatment modalities alone or in combination, together with an appreciation of their curative or palliative potential;
  4. management of medical emergencies and complications which may arise as a result of cancer or its treatment and palliative symptomatic treatment;
  5. basic scientific knowledge including growth kinetics, molecular biology, biochemistry, pharmacology, endocrinology and immunology as they relate to the understanding of cancer and its treatment;
  6. epidemiology and biostatistics, including the conduct and evaluation of clinical trials;
  7. nutritional needs and methods including hyperalimentation;
  8. psychologic aspects of treating patients with cancer and communicating with patients and their families;
  9. specific technical skills including aspiration of effusions, lumbar puncture, bone marrow biopsy, maintenance of vascular access, special examination techniques for all systems and their interpretation.

Residents must develop a scholarly attitude toward continuing self-education and critical judgment. Participation in clinical and basic research is encouraged, as is the teaching of students, residents and allied health care personnel. 

 

Specific Guidelines for Accreditation of Residency Programs in Medical Oncology

A university wishing to have a program in medical oncology accredited must also sponsor an accredited program in internal medicine. It is desirable that there also be accredited programs in hematology, radiation oncology, general surgery and in obstetrics and gynecology. Hospitals with a major role in the medical oncology program should also be engaged in the teaching of undergraduate medicine, including medical oncology.

The resident must develop the cognitive knowledge, clinical skills, personal attributes and professional attitudes appropriate for an internist competent to practice medical oncology, both as a primary physician and as a consultant. Thus, the training program must provide the resident with the opportunity to:

  1. become knowledgeable in the diagnosis, assessment and management of cancer in all its phases and to acquire particular expertise in the systemic treatment of malignant diseases and its complications.
  2. develop skills in communication with the patient and family and in providing continuing care for the patient with progressive illness and psychosocial problems.
  3. obtain experience in the interdisciplinary management of cancer patients and the interaction with other health professionals contributing to the total care of the patients.
  4. participate in clinical trials and their formulation and the evaluation of results.

Residents must be provided with a graduated increase in personal responsibilities, appropriate to their level of competence, in the management of patients in all areas of medical oncology. There must be at least two qualified medical oncologists to supervise residents and provide teaching in the basic and clinical sciences related to medical oncology. The teaching staff should have an appropriate nucleus of geographic full-time teachers.

Through the facilities of the university and the participating institutions, the overall training program must satisfy the following requirements:

1. CLINICAL PROGRAM

Clinical training must be based on adequate resources to ensure full training for each resident in all aspects of medical oncology. The description of the integrated program should specify how the responsibility for each of the components of the program is shared by the participating institutions. The major components are as follows:

  1. Hospital Facilities. The program must apply the principles basic to the concept of the clinical teaching unit set down by the Royal College, with special reference to an organized team with graded responsibility under the direction of the head of service. There must either be an organized clinical teaching unit limited to medical oncology patients, or a unit with a minimum number of designated beds for patients receiving complicated treatment regimens, plus access to an adequate number of assessment beds for medical oncology patients on the general medical or surgical clinical teaching units of the hospital.

There should be adequate numbers of patients available for teaching to provide experience in all types of cancer in all stages, and to allow the residents to come in contact on a day-to-day basis with all the other disciplines involved in the investigation and management of these cancers. The residents should thereby gain experience in the primary, secondary and tertiary care of cancer patients. In addition to assuming appropriate and progressive responsibilities for the care of patients the residents should take an active part in providing a consulting service. Concurrent with this there should be opportunities to continue the development of skills in internal medicine.

  1. Supporting Facilities and Services. The following facilities and services must be available for the training of residents and be closely coordinated with the overall program:
    1. Surgical Specialties. There should be an active general surgery service preferably with surgeons having a special interest in oncology. Other surgical specialties must be represented including gynecology, urology, thoracic, otolaryngology and neurosurgery.
    2. Medical Specialties. All the major sub-specialties should be represented including hematology, immunology and infectious diseases. There should be access to related disciplines such as pediatric hematology, oncology and clinical epidemiology.
    3. Radiation Oncology. This department must be active in teaching and research as well as patient care.
    4. There must be a tumor registry and records should be kept of all patients with appropriate data collection for the evaluation of extent of disease, treatment and outcome.
    5. There should be adequate support facilities for the management of acutely ill cancer patients (in particular those with hematologic and infectious problems), patients with nutritional problems and those requiring rehabilitation to facilitate recovery and return to normal activities (e.g. stomal care, prosthetics and physical therapy).
    6. There should be demonstrated functioning patient support organizations within the training program directed towards the psychological, social and spiritual needs of the patient. This should be directed from the time of diagnosis to the end stages of the patient's illness with due attention to methods of palliation and symptom control.
    7. There should be adequate and comprehensive clinical laboratory, microbiologic, pathologic, radiologic and other imaging diagnostic facilities.
  2. Ambulatory Care Facilities. In-patient and out-patient teaching units should be integrated as far as possible, in order to provide continuity of observation of patients both in and out of hospital. Organized clinics or other ambulatory care facilities must be available to provide opportunities for pre-admission, investigation and post-discharge follow-up of cancer patients, including continuing home care. There should be out-patient facilities for the administration of chemotherapy and the performance of simple diagnostic or therapeutic procedures. The clinics should be, if at all possible, multidisciplinary or take place in a multidisciplinary environment.

Community Health Care Systems. There must be access to community health care systems or institutions that serve the cancer patient such as palliative care units (hospice), home care, visiting nurse surveillance and care, community physicians etc., to provide the resident with experience in working with other health professionals in marshalling community resources for the continuing care of the cancer patient.

2. EDUCATIONAL PROGRAM

  1. Organization of Learning. A coordinated education program must be provided in medical oncology and associated fields. This should include teaching in the basic and clinical sciences essential to the practice of the specialty, including biochemistry, epidemiology, etiology, natural history of cancer, cell kinetics, chemotherapy, clinical pharmacology, biostatistics, cytogenetics, endocrinology and metabolism, hematology, hemopathology and pathology, immunology, microbiology, psycho-social aspects and the principles of symptom control. The program may include didactic lectures and seminars, teaching rounds, multidisciplinary conferences, specific assigned reading, journal clubs, and special lectures from visiting speakers. The milieu of scholarship should be enhanced, whenever possible, by close association between residents and active investigators on the staff. Attendance at the pathology conferences, radiology conferences, and general medical and surgical conferences is to be encouraged, with particular attention to those presenting problems relating to the diagnosis and management of neoplastic diseases. The residents should thus develop an awareness of the importance of participation in post-graduate and/or continuing education programs. The learning process should assure skills in the administration of chemotherapy, sigmoidoscopy, pelvic examination, and head and neck examination to supplement the other practical skills usually learnt by a general internist.
  2. Teaching. Residents should be encouraged to develop teaching skills through participation where appropriate in undergraduate and postgraduate teaching and the teaching of allied health professionals and the public in matters pertaining to cancer.
  3. Research. It is essential that the medical oncology unit be engaged in research activities related to the various aspects of cancer and be participants in cooperative clinical trials on a local, national and/or international basis. The training program should have an investigational component. Residents should learn the design and interpretation of research studies, evaluation of investigative methods, and interpretation of data and should develop competence in critical assessment of new therapies and the medical literature. Their research experience should include participation in ongoing clinical research protocols, the formulation and activation of a new clinical protocol, and a clinical study in which the resident reviews case records and assembles clinical data.

The organization of each program must include a mechanism for the ongoing evaluation of the competence and progress of each resident. Records of such evaluation should be maintained with appropriate counselling of each resident.

PROGRAMS (WITH TRAINING REQUIREMENTS):

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.