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R4 Objectives

Oncology

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

Medical Knowledge

  • Develop core knowledge of critical care for oncology patients
  • Expand core knowledge of:
    • Risk factors associated with gynecological malignancies
    • Historical and physical findings associated with a gynecological malignancy
    • Screening tests for gynecological malignancies
    • 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 and how it relates to treatment and inheritance of cancer
    • Abdominal surgery principles
    • Preoperative evaluation
    • Postoperative care
    • Intraoperative complications

Patient Care

  • Determine the cancer stage of gynecologic cancers and correlate stage with prognosis
  • Operate more comfortably in the retroperitoneal space
  • Identify the ureter from the kidney to the bladder
  • Perform:
    • Ovarian cancer debulking
    • Radical hysterectomy
  • Manage intraoperative complications:
    • Cystotomy
    • Enterotomy
    • Hemorrhage
  • Manage postoperative complications
    • Fistulas
    • Pelvic abscess
    • Bowel obstruction
  • Coordinate critical care for oncology patients

Interpersonal and Communication Skills

  • Develop skills in counseling:
    • Medical, legal, and ethical implication of do not resuscitate order
    • Recognize and know how to deal with the durable power of attorney for patients and the legal rights of this individual
    • Counsel patients regarding burial options
    • Counsel patient regarding autopsy and understand how to obtain an autopsy consent
    • Understand who can consent for an autopsy in this state

Professionalism

  • Demonstrate a sensitivity to health care members who take care of terminally ill patients
  • Recognize how family dynamics impact the care of a terminally ill individual
  • Develop leadership skills that help your team cope with the stress of taking care of dying patients

Practice Based Learning

  • Investigate the impact palliative care has on quality of life
  • Investigate psychosocial issues of dying patients

System Based Practice

  • Recognize how long-term health care insurance works
  • Recognize the impact the care of the terminally ill patient has on the Medicare budget
  • Develop an awareness of how the cost of screening tests compare to the cost of treatment of a cancer patient
  • Recognize the importance of GOG protocols
  • Recognize the difference between Phase I, II and III trials

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.