Surgical Oncology — City of Hope PGY4

Goals and Objectives

Description of Peritoneal Surface Malignancy Rotation

The Peritoneal Surface Malignancy PGY4 rotation at City of Hope offers an intensive experience in

the care of patients with epithelial cancers such as gastric, colorectal, and gynecologic cancers that spread to the peritoneal surface. In particular, the rotation will provide an in-depth clinical and operative experience in the diagnosis, workup, and multidisciplinary treatment of malignancies in these disease sites. Residents will spend one month on the peritoneal surface malignancy surgical oncology service.

City of Hope Site Director: Dr. Lily Lai
Rotation Faculty: Dr Mustafa Raoof

Patient Care

Goal/Core Competencies

To develop competency in preoperative assessment and evaluation, operative technique, and postoperative care of gastrointestinal and gynecologic and other diseases resulting in peritoneal surface spread.

Objectives

I. Learn the perioperative assessment and risk stratification of patients requiring peritoneal debulking operations and hyperthermic intraperitoneal chemotherapy(HIPEC).

II. Gain exposure and understanding of multimodality treatment of cancers including systemic treatment given before and/or after surgery, and chemotherapies given during the operation.

III. Gain exposure and understanding of the multimodality treatment of peritoneal surface malignancies.

IV. Develop competency in inpatient management of the patients who undergo radical debulking procedures with and without HIPEC therapy.

V. Gain exposure to advanced open and minimally invasive operative skills in complex surgery by working closely with the Surgical Oncology faculty and the Surgical Oncology fellow.

Instructional Activities

I. Teaching by the faculty in outpatient clinics, inpatient walk rounds, didactics, and operating room

II. Teaching by the Surgical Oncology fellows in inpatient care (daily work rounds), clinic, and operating room

III. Didactic conferences: Preoperative Surgical, Fellow Education, Grand Rounds, M+Ms

IV. Multidisciplinary treatment conference (Tumor Board)

V. Independent Reading

Medical Knowledge

Goal/Competencies

To acquire knowledge of the pathophysiology of their cancer patients including basic science and its translation to patient care. To acquire an understanding of the clinical and tumor factors important in optimizing treatment for patients with peritoneal surface malignancies.

Objectives

I. Gain understanding of mechanisms of the pathophysiology of the organ systems involved

II. Identify molecular and cellular pathways involved with tumorigenesis of peritoneal cancers

III. Identify mechanisms of action of common systemic and intraperitoneal therapies used in the treatment of these cancers

IV. Develop knowledge of the peritoneal anatomy

V. Understand indications and use of selective imaging modalities to identify and stage peritoneal cancers

Instructional Activities

I. Teaching by the faculty in outpatient clinics, inpatient walk rounds, didactics, and operating room

II. Teaching by the Surgical Oncology fellows in inpatient care (daily work rounds), clinic, and operating room

III. Didactic conferences: Institutional Basic Science and Translational Science Conferences, Preoperative Surgical, Fellow Education; Journal Clubs

IV. Multidisciplinary treatment conference (Tumor Board)

V. Independent reading

Practice-Based Learning and Improvement

Goal/Competencies

To critically evaluate their own performance. To appraise and assimilate scientific data to manage patients using evidence-based guidelines.

Objectives

I. Work with the Surgical Oncology Fellow and faculty as a member of the team

II. Identify complications and determine the impact on the patient’s recovery

III. Present at M+Ms as needed

IV. Use information technology to rapidly assimilate current medical literature as it relates to patient care and to cancer treatment

V. Master cancer staging for cancers and the peritoneal carcinomatosis index(PCI)

VI. Apply recommendations regarding the treatment of cancers based on published guidelines and/or evidence-based literature

Instructional Activities

I. Teaching by faculty in outpatient clinics, inpatient walk rounds, didactics, and operating

II. Teaching by the Surgical Oncology fellows in inpatient care (daily work rounds), clinic, and operating room

III. Didactic conferences including M+Ms, multidisciplinary treatment conferences

IV. Independent reading

Systems-Based Learning and Improvement

Goal/Competencies

To understand how care practices affect health care costs.

Objectives

I. Differentiate the costs of different imaging tests and treatment modalities

II. Work with members of the treating team to ensure cost-conscious delivery of care to patients

Instructional Activities

I. Teaching by faculty in outpatient clinics, inpatient walk rounds, didactics, and operating

II. Teaching by the Surgical Oncology fellows in inpatient care (daily work rounds), clinic, and operating room

III. Independent reading

Effective Interpersonal and Communication Skills

Goal/Competencies

To effectively communicate in a way that leads to effective information exchange in the care of the cancer patient.

Objectives

I. Discuss the care plan of the patient with the Surgical Oncology Fellow, faculty and members of the care team

II. Provide patient and family members updates on the patient’s clinical status

III. Interact constructively with consultants in the multidisciplinary management of the patient

IV. Work effectively with nursing staff in the delivery of care

Instructional Activities

I. Teaching by the faculty in outpatient clinics, inpatient walk rounds, didactics, and operating room

II. Teaching by the Surgical Oncology fellows in inpatient care (daily work rounds), clinic, and operating room

III. Attend teaching conferences on communication skills when available

Professionalism

Goal/Competencies

To demonstrate commitment to professional responsibilities and adherence to ethical principles.

Objectives

I. Dress appropriately

II. Complete work assigned in a timely fashion (e.g. signing charts, dictations)

III. Interact professionally with nurses, patients, family members

Instructional Activities

I. Teaching by the faculty in outpatient clinics, inpatient walk rounds, didactics, and operating

II. Teaching by the Surgical Oncology fellows in inpatient care (daily work rounds), clinic, and operating room

III. Attend professional development conferences when available

Evaluation

I. Frequent (at least weekly) feedback by the Surgical Oncology Fellow and the faculty.

II. Final rotation evaluation by the faculty

III. Final summation of evaluations by the Program Director at the end of the rotation