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Gynecologic Oncology

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Gynecologic Oncology Gynecologic Oncology Document Transcript

  • EDUCATIONAL GOALS AND OBJECTIVES GYNECOLOGIC ONCOLOGY PGY 4 Gynecologic Oncology Overview: The gynecologic oncology team is made up of one PGY 4 and either one PGY3 or PGY2 resident. PGY4 residents are assigned to the gynecological oncology service for four months. PGY3 residents are assigned to the gynecological oncology service for two months. PGY2 residents are assigned to the gynecological oncology service for two months. One full- time sub-specialty board certified gynecologic oncologist and two part time sub-specialty board certified gynecologic oncologists share supervisory duty. The full time faculty member is primarily responsible for the service. The teams develop diagnostic and therapeutic management plans in collaboration with the attending physician of record. Residents, medical students, nursing staff and the attending physicians will work together to provide the best patient care possible. Principle Teaching/Learning Activities: Morning Rounds (MR)– Residents and Medical Students work together to coordinate all patient data, prepare management plans and finish all necessary patient paperwork. Service Meeting (SM) – Residents, nursing staff, support staff and attending physicians meet weekly to assess patient needs, scheduling issues, and administrative issues. Principle Educational Goals by Relevant Competency: In the tables below, the principle educational goals for the Gynecological Oncology Service rotations are indicated for each of the 6 ACGME competencies. The second column of the table indicates the most relevant principle teach/learning activity for each goal, using the legend below: *Legend for Learning Activities (See above for description) DPC – Direct Patient Care EC – Education Conferences MR – Morning Rounds SM – Service Meeting CML – Computer Model Lab 1. Patient Care Principle Educational Goals Learning Activites* Interview patients more skillfully DPC, MR Examine patients more skillfully DPC, MR Define and prioritize patients’ medical DPC, MR, SM problems Improve surgical skill and judgment in the DPC Operating Room Generate and prioritize differential diagnoses DPC, MR Develop rational, evidence-based management DPC, MR, EC strategies
  • 2. Medical Knowledge Principle Educational Goals Learning Activities* Expand clinically applicable knowledge base of DPC, MR, EC the basic and clinical sciences underlying the care of patients Access and critically evaluate current medical DPC, MR, EC information and scientific evidence relevant to patient care 3. Interpersonal Skills and Communication Principle Educational Goals Learning Activities* Communicate effectively with patients and DPC, MR, EC families Communicate effectively with physician DPC, MR, EC, SM colleagues at all levels Communicate effectively with all non- DPC, MR, SM physician members of the health care team to assure comprehensive care of patients Present patient information concisely and DPC, MR, EC, SM clearly, verbally and in writing Teach colleagues effectively DPC, MR, EC 4. Professionalism Principle Educational Goals Learning Activities* Behave professionally towards patients, All familes, colleagues, and all members of the health care team 5. Practice-Based Learning and Improvement Principle Educational Goals Learning Activities* Identify and acknowledge gaps in personal DPC, MR knowledge and skills in the care of gynecological patients Develop and implement strategies for filling DPC, EC gaps in knowledge and skills 6. Systems-Based Practice Principle Educational Goals Learning Activities Understand and utilize the multidisciplinary DPC, MR, SM resources necessary to care optimally for gynecologic oncology patients Collaborate with other members of the health DPC, MR,SM care team to assure comprehensive patient care Use evidence-based, cost-conscious strategies in DPC, MR, SM the care of gynecologic oncology patients At the conclusion of the PGY 4 year, the resident should have developed competency in the gynecologic oncology goals and objectives for the third year as well as proficiency in the gynecologic oncology goals and objectives outlined for PGY 2 and PGY3 .
  • Objectives Pharmacology 1. List the major chemotherapeutic agents used for treatment of malignancies of the reproductive organs and breast. 2. Describe the principal adverse effects of the major chemotherapeutic agents. 3. Describe the medications of most value in treatment of complications resulting from chemotherapyand irradiation, such as: a. Marrow suppression b. Nausea and vomiting c. Hemorrhagic cystitis d. Peripheral neuropathy e. Renal toxicity f. Cardiac toxicity Carcinoma of the fallopian tube 1. Describe the epidemiology and pathogenesis of fallopian tube cancer. 2. Describe the typical clinical manifestations of fallopian tube cancer. 3. Describe the histology, FIGO staging, and prognosis of fallopian tube tumors. 4. Perform appropriate tests to diagnose cancer of the fallopian tube. 5. Describe the treatment for fallopian tube cancer based on: a. Type b. Grade c. Stage d. Patient characteristics 6. Perform procedures to treat women with fallopian tube cancer, in consultation with subspecialists when indicated. 7. Manage, in consultation with a subspecialist, the common complications resulting from treatment of fallopian tube cancer. 8. Provide psychosocial support and appropriately palliate women dying of fallopian tube cancer. Carcinoma of the ovary 1. Describe the epidemiology and pathogenesis of ovarian cancer. 2. Describe the inherited syndromes that increase a woman’s likelihood of developing ovarian cancer. 3. Describe the screening protocols that may identify patients who have an inherited form of ovarian cancer. 4. Describe the typical clinical manifestations of ovarian cancer. 5. Describe the histology, staging, and prognosis for: a. Epithelial tumors b. Germ cell tumors c. Stromal tumors d. Sarcomas e. Metastatic tumors f. Tumors of low malignant potential
  • 6. Interpret the following tests to diagnose ovarian cancer: a. Ultrasonography b. Serum tumor markers c. Cytology from paracentesis d. CT scan 7. Describe the treatment of ovarian cancer based on: a. Type b. Grade c. Stage d. Patient characteristics 8. With the assistance of a subspecialist, provide definitive treatment for a patient with ovarian cancer. 9. Describe the indications for secondary cytoreductive surgery. 10. Manage, in consultation with a subspecialist, the common complications resulting from treatment of ovarian cancer. 11. Provide psychosocial support and appropriate palliative therapy for women dying of ovarian cancer. Chemotherapy 1. Describe the general mechanism of action of chemotherapy. 2. Describe the indications for chemotherapy in the treatment of gynecologic neoplasms. 3. Describe the likelihood of response of each common gynecologic malignancy to chemotherapeutic agents. 4. Describe the mechanisms of action and most appropriate indication for chemotherapeutic agents, such as: a. Alkylating agents b. Antimetabolites c. Vinca alkaloids d. Antibiotics e. Hormones f. Heavy metals g. Immunotherapy 5. Describe and manage the potential complications of chemotherapy. 6. Describe the long-term effects of chemotherapy on fertility. Invasive carcinoma of the vagina 1. Describe the epidemiology and pathogenesis of invasive vaginal cancer. 2. Describe the typical clinical manifestations of invasive vaginal cancer. 3. Describe the FIGO staging of invasive vaginal cancer. 4. Describe the differential diagnosis of invasive vaginal cancer. 5. Describe the treatments for invasive vaginal cancer. 6. Describe the prognosis for invasive vaginal cancer. 7. With the assistance of a subspecialist, provide treatment for a patient with invasive cancer of the vagina. 8. Manage, in combination with a subspecialist, the common complications of surgical and radiation treatment for vaginal cancer.
  • Malignant gestational trophoblastic disease 1. Describe the conditions that may precede malignant GTD. 2. Describe the histologic appearance of invasive mole verus choriocarcinoma versus placental site trophoblastic tumor. 3. Diagnose malignant GTD using a combination of physical examination, ?-hCG, chest X-ray, CT scan, and ultrasonography. 4. Classify GTD into good prognosis (low risk) versus poor prognosis (high risk). 5. Describe the medical and surgical management of malignant GTD. 6. Provide, in consultation with a subspecialist, medical and surgical treatment for a patient with malignant GTD. 7. Provide appropriate follow-up at the completion of treatment. 8. Counsel patients regarding risk of recurrence and prognosis for future pregnancies Management of invasive breast cancer 1. Describe the staging of breast cancer and the prognostic significance of histologic type, regional lymph node metastasis, distant metastasis, and receptor status. 2. Describe the conservative and radical surgical interventions for breast cancer and the factors influencing treatment selection. 3. Describe the indications for adjuvant therapy with hormonal treatment, chemotherapy, or radiotherapy. 4. Describe the impact of pregnancy on the treatment and prognosis of breast cancer. Radiation therapy 1. Describe the general principles of radiation therapy. 2. Describe the indications for radiation therapy in the treatment of gynecologic neoplasms. 3. Describe the mechanism of action of: a. Intracavitary irradiation b. External-beam irradiation c. Interstitial irradiation d. Radioisotopes e. Palliative radiation therapy 4. Describe the factors that influence decisions regarding intervention, such as: a. Classification and FIGO staging of disease and histology b. Age of patient c. Underlying medical conditions d. Implications for future fertility e. Concomitant therapy with radiosensitizers or chemotherapy f. Previous abdominal procedures g. Maximal dose tolerance of selected organ systems 5. Describe the potential complications of radiation therapy. 6. In consultation with a subspecialist, manage the complications of radiation therapy.
  • Procedures [Understand/Assist] Resection of large and small bowel Fistula repair - Ureterovaginal Hysterectomy - Radical (with or without bilateral salpingo-oophorectomy) Pelvic exenteration with or without reconstruction Vaginal reconstruction - Gracilis Vaginal reconstruction - Martius Vaginal reconstruction - Transverse rectus abdominis myo-cutaneous flap Venous access device placement Vulvectomy, radical Procedures [Perform] Lymph node biopsy/dissection - Sentinel Lymph node biopsy/dissection - Pelvic Staging laparotomy - Biopsy of pelvic lymph nodes Staging laparotomy - Infracolic omentectomy Venous access device placement Lymph node biopsy/dissection - Inguinal Resident Faculty