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R3 Objectives

Oncology

The oncology rotation is six to seven weeks in length. The R3 first or second assists on appropriate cases. The R3 takes several Friday or Saturday calls at Highland Hospital during this rotation. The R3 shares home phone call with the R4 as backup for the in house resident covering the oncology service. The R3 will attend oncology clinic approximately once a week.

Medical Knowledge

  • Develop a core knowledge:
    • Vascular, lymphatic and nerve supply to the pelvic organs
    • Gynecological cancer staging
    • Surgical treatment for gynecological cancer
    • Alterations in immune mechanisms that result from cancer and chemotherapy
    • Genetics of cancer
    • Intraoperative complications in the oncology patient
  • Expand core knowledge of:
    • Risk factors associated with gynecological malignancies
    • Historical and physical findings associated with a gynecological malignancy
    • Screening tests for gynecological malignancies
    • Abdominal surgery principles
    • Preoperative evaluation to patients with operative risk factors
    • Postoperative management of complications

Patient Care

  • Determine the gynecological cancer stage of cervical, ovarian, and endometrial cancer and correlate stage with prognosis
  • Describe the histology of gynecologic malignancies and how the histological features relate to prognosis
  • Be familiar with pelvic side wall anatomy including opening the sidewall to identify the ureter and its course
  • Perform:
    • TAH/BSO for endometrial cancer
    • Appropriate ovarian staging cases
    • Assist on radical hysterectomy, radical vulvectomy and pelvic lymph node sampling
  • Coordinate critical care for the patient with cancer

Interpersonal and Communication Skills

  • Counsel patients in regard to:
    • Palliative care
    • Quality of life issues
    • Sexual function after cancer surgery
    • Options for patients who desire to die at home

Professionalism

  • Increase sensitivity and awareness to patients who have limited income and resources for home health care
  • Increase awareness how to incorporate medical students into the health care team of an individual with a chronic and terminal illness
  • Refine ethical principles in patient care

Practice Based Learning

  • Develop an understanding of how to fill out and sign a death certificate
  • Recognize untoward complications in the treatment of cancer
  • Describe the hospital policy for restraints for the patient with confusion

System Based Practice

  • Describe how a living will works and understand how to implement one
  • Describe how a do not resuscitate order works and how to implement one

Learning Resources

  • The Resident Room has major gynecology textbooks and further oncology literature is available in the oncology office including slides
  • The team rounds with the oncology attending on a daily basis for bedside teaching and directed patient care
  • Residents attend Thursday morning Grand Rounds followed by protected teaching time from 9-11am.
  • Each resident prepares a “E-Tumor Board”, a short case presentation for distribution to the residency and to post on the internet

Evaluations

  • Faculty and resident colleagues are encouraged to provide direct verbal feedback so that resident performance can be commended or improved during the rotation.
  • Residents are evaluated via a Web-based evaluation system at MyEvaluations.com at the end of each rotation using a standardized evaluation form given to supervising OB/GYN attendings and upper-level residents. Attending evaluations are available for immediate review by the resident once completed.
  • Problems, which appear to be of a more urgent nature, will be brought immediately to the attention of the resident and residency program director for discussion
  • Residents will receive a form at the end of each rotation via MyEvaluations.com soliciting feedback regarding the rotation, upper-level residents, and faculty. This information is shared anonymously and used for course/faculty improvement activities.