Oncology

Contact person:

Priscilla DeLuca

priscilla.deluca@lhsc.on.ca 

Practice Profile

The Medical Oncology Rotation is a four-week elective that Family Practice Residents may choose during their training in Family Medicine.

KEY FEATURES OF MEDICAL ONCOLOGY ROTATION

  1. The Medical Oncology Rotation is an ambulatory care experience with the resident attending clinics at the London Regional Cancer Program. No inpatient care is requested and call is done as part of the Family Medicine on-call schedule. However, residents are expected to follow-up on patients seen by them in the outpatient clinic who require admission to the Medical Oncology inpatient unit at Victoria Hospital
  2. Each half-day the resident is assigned to a clinic where they participate in the management of patients of one member of the Medical Oncology active staff; the resident reviews each patient with the staff doctor and has physical findings checked. Residents have the opportunity to see consultations, returning patients with cancer-related problems and patients on active treatment. They are expected to dictate notes and letters on all patients seen and write orders (the exceptions are for chemotherapy and immunotherapy).
  3. Residents rotate through as many clinics as possible in the 4-week period to give them as broad exposure as possible to Oncology. Clinics are site-specific e.g. breast cancer, lung cancer, etc. The resident’s schedule each day is different and during a single week trainees will typically spend each day with a different consultant.
  4. The medical clinics at the LRCP are either multidisciplinary or operate in close proximity with those of other specialities e.g. Radiation Oncology, Oncological Surgery, Neurology and Palliative Care permitting the resident to participate in multidisciplinary care.
  5. Because the wide spectrum of disease seen by medical oncologists, there is an opportunity for a broad overview of the care of patients with cancer.
  6. At least 80% of the resident’s time on the Medical Oncology Rotation is spent in supervised direct patient care. Residents are expected to attend and to participate in the various site group rounds and are free to attend any of the many rounds and seminars that are a regular feature of life at the LRCP.
  7. Residents may also have an opportunity to attend clinics in malignant haematology, oncologic neurology and pain management.

GOALS OF THE MEDICAL ONCOLOGY ROTATION

The goal of the Medical Oncology rotation is to provide the resident with an overview of the management of patients with cancer that will form a basis for further reading and study. The rotation emphasizes the importance of continuing multidisciplinary care for patients with cancer including the role of family physicians. The goals of the Medical Oncology Elective Rotation are imbedded in the COMPETENCIES of the CanMEDS 2005 Physician Competency Framework. It is recognized that not all elements of the competencies can be taught during such a short 4-week rotation. Specific circumstances may arise where there is opportunity for in-depth experience in some area from time to time. Under Medical Expert are listed some of the areas of knowledge that it is necessary for residents to acquire by the end of the rotation.

EVALUATION OF MEDICAL ONCOLOGY TRAINEES

Evaluation is done electronically using the One45 program. Each medical oncologist with whom a student has worked is asked to complete an electronic evaluation. These are summarized by the Coordinator for Medical Oncology Education and reviewed with the resident before he or she completes the rotation. Residents are asked to sign-off on their evaluation.

CanMDS COMPETENCIES AS APPLIED TO MEDICAL ONCOLOGY ROTATION

  1. MEDICAL EXPERT
    1. Demonstrate the skills to do a comprehensive medical consultation including plans for further investigation and treatment, to communicate with referring and consulting doctors and to communicate information to patient and family.
    2. Demonstrate knowledge of the natural history of the commonest forms of cancer e.g. lung cancer, gastrointestinal cancer and breast cancer. Understand the importance to patient care of collaborative and multidisciplinary treatment plans in the management of these malignancies.
    3. Demonstrate awareness and urgency of the management of the common cancer-related emergencies e.g. spinal cord compression, febrile neutropenia, superior vena caval obstruction, tumour lyses syndrome, etc.
  2. COMMUNICATOR
    1. The attending staff will demonstrate to the resident the development of rapport, trust and ethical therapeutic relationships with patients and their families. Resident is expected to initially observe this aspect of patient care and then actively participate in discussing issues, plans and problems with patients.
    2. Whenever possible the resident will be asked to participate with the staff physician in disclosure of adverse results, in the breaking of bad news and in end-of-life discussions.
    3. The resident is expected to provide concise verbal reports of patient encounters and keep clear and accurate records (electronic). The latter will be monitored and reviewed with the resident from time to time.
  3. COLLABORATOR
    1. Within a multidisciplinary environment the resident has the opportunity to observe and participate in the process of reaching a consensus regarding patient management.
    2. Nursing care is an essential component of the care provided by medical oncologists. Residents must demonstrate they understand the importance of this to patient care and that they respect and work collaboratively with primary care nurses and nurse practitioners.
    3. Demonstrate the ability to work with pharmacists, social workers, community physicians and other health care workers.
  4. MANAGER
    1. Residents will be expected to demonstrate efficient time management skills to maximize their time with patients and their learning time (this includes time for discussion of facets of the case with the staff physician and others e.g. nurses).
  5. HEALTH ADVOCATE
    1. Residents will have the opportunity to identify the diversity of physician involvement with individual patients and the fundamental role of the physician in ensuring that the patient navigates successfully through the health care system. They should have an enhanced appreciation of the leadership and organizational skills required of physicians for practice in the modern medical community.
  6. SCHOLAR
    1. Residents will observe multidisciplinary and collaborative care delivered based on evidence-based medicine. Strong emphasis is placed on evidence-based medicine in all the oncology disciplines but especially medical oncology where many patients are on clinical trial.
    2. The importance ongoing professional development is emphasized as diagnostic policies and treatments are under frequent revision in keeping with new research and clinical information.
    3. Participation in multidisciplinary rounds is mandatory to demonstrate continuing medical education by interaction with colleagues.
  7. PROFESSIONAL
    1. Residents will have the opportunity to observe the commitment of physicians to their patients and colleagues through the highest standards of clinical practice.

Scheduling: Space is limited.