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  1. 1. OMFS Oncology Fellowship Manual 2008 OMFS ONCOLOGY FELLOWSHIP MANUAL/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 1
  2. 2. OMFS Oncology Fellowship Manual 2008 UC San Francisco Oral and Maxillofacial Oncology Fellowship ProgramThe University of California San Francisco Department of Oral and Maxillofacial Surgery offersan advanced education program in Oral and Maxillofacial Oncology. The fellowship is 12months in length and leads to a certificate upon successful completion. The purpose of theUniversity of California San Francisco Oral and Maxillofacial Oncology Fellowship is toeducate and train academic leaders in oral and maxillofacial oncology. The Department of Oraland Maxillofacial Surgery is a busy oncology service that offers the full scope of oral andmaxillofacial surgery services, including the surgical management of malignant oral andmaxillofacial pathology. The program is designed to provide the trainee with sufficient didacticand clinical training to provide comprehensive surgical treatment for patients with oral andmaxillofacial cancer. Trainees are encouraged to develop skills in teaching and research inpreparation for a full-time academic position. Trainees are trained to meet and evaluated basedupon the following proficiency statements: UC San Francisco Oral and Maxillofacial Oncology Proficiency StatementsThe UC San Francisco Oral and Maxillofacial Oncology Fellow will be proficient and able to: 1. Demonstrate ethical and professional behavior in interactions with patients and colleagues. 2. Evaluate the medical status of oncology patients and determine their ability to tolerate surgical treatment. 3. Develop appropriate differential diagnoses and establish a diagnostic plan for the oral and maxillofacial oncology patient. 4. Develop a comprehensive treatment plan and provide surgical treatment for the management of oral and maxillofacial oncology. 5. Understand the role of radiation therapy and chemotherapy in the treatment and management of malignant tumors of the oral and maxillofacial region. 6. Develop a reconstructive treatment plan and provide surgical reconstruction for the oral and maxillofacial oncology patient./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 2
  3. 3. OMFS Oncology Fellowship Manual 2008 UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SCHOOL OF DENTISTRY DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY MISSION STATEMENT AND GOALS TO CARE, TO EDUCATE, TO DISCOVER. OUR GUIDING VALUES ARE SERVICE, COMPASSION INTEGRITY, RESPECT AND LEADERSHIP THROUGH EXCELLENCE PREDOCTORAL We will teach enrolled dental students the scope of the profession of Oral and Maxillofacial Surgery. We will give them personal instruction and bring them to a level of competence to carry out oral and maxillofacial surgery procedures, which are within the scope of the general practitioner. We will attempt, by example, to encourage dental students to receive further training in surgery and for some to train as oral and maxillofacial surgeons. POSTDOCTORAL We will administer an accredited oral and maxillofacial surgery training program, which will train oral and maxillofacial surgeons who are competent to carry out the full scope of the profession, and are able to participate in total management of patients. We will encourage trainees to become board certified in oral and maxillofacial surgery, and to continue a lifetime commitment to continuing education. We will encourage trainees to maintain a faculty appointment and be academically active. CLINICAL We will maintain a high level of quality care and clinical activity, and will serve as a resource and tertiary care center for practitioners at all levels of training. RESEARCH We will encourage and support research in oral and maxillofacial surgery in the basic sciences and clinical sciences. We will encourage faculty members, fellows, residents and interested dental students to engage in research under our supervision. ADMINISTRATIVE We will maintain an efficient administration for our department. We will participate in the governance and management of the School of Dentistry, and the University of California, San Francisco and its affiliated institutions and medical center, as well as the University of California system wide. We will participate, and assume positions of responsibility in local, regional, national and international organized dentistry and Oral and Maxillofacial Surgery. ETHICS We will maintain the high ethical and moral standards which are expected from health care professionals, in all aspects of our mission, including clinical care and research. We will treat patients, students, staff, fellows, residents and colleagues with respect and dignity at all times. Fellowship Evaluations Fellows will be evaluated in the following areas:1) Clinical Performance/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 3
  4. 4. OMFS Oncology Fellowship Manual 2008 This includes: • Knowledge of assigned patients • Interest in management of patients • Skill in management of patients • History/physical examination skills • Effective data gathering • Problem identification • Appropriate differential diagnosis • Prioritization of clinical issues • Appropriate use of lab tests, studies, consultants • Performance under emergency conditions • Aware of limitations2) Knowledge This includes: • Clinical fund of knowledge • Basic science fund of knowledge • Ability to integrate and apply knowledge in clinical situations3) Judgment This includes: • Integration of medical facts and clinical data • Evaluation of alternatives • Assessment of risks and benefits • Reasoning in ambiguous situations4) Technical Skills This includes: • Economy of motion • Precision in use of instruments • Selection on instruments/sutures • Dexterity • Effectiveness in basic skills (suturing/knot tying/exposure/traction-counteraction) • Ability to plan the sequence of a procedure5) Teaching/Learning This includes: • Study habits • Independent learning interest/ability • Motivation • Effective supervision6) Professional attitudes and behavior This includes: • Reliability/dependability • Responsibility • Relationship with patients/families • Relationship with other medical personnel • Discharge of administrative duties/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 4
  5. 5. OMFS Oncology Fellowship Manual 2008 • Clear/complete written records • Ability to function as a team member • Appropriate communication with team members, consultants, superiors • Organization and time management skills7) Personal Qualities This includes: • Integrity • Attitude • Interest • Maturity • Leadership Ability • Image8) Overall Overall Assessment. These skills will be evaluated using the following scale: 1. Unsatisfactory: Severe deficits; progress unlikely if not corrected 2. Unsatisfactory: Significant defects; progress threatened if not corrected 3. Satisfactory: Adequate, but marginal; improvement expected 4. Satisfactory: Good 5. Above Satisfactory: Very Good 6. Above Satisfactory: ExcellentADMISSION QUALIFICATIONSApplicants must have completed an oral and maxillofacial surgery training program accreditedby the Commission on Dental Accreditation. Due to University Visa Requirements thefellowship position is restricted to US citizens and permanent residents. Criteria for selection forthe fellowship include: 1) excellent letters of recommendation, 2) potential for an academiccareer based on the applicant’s curriculum vitae and personal interview, 3) clinical experience./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 5
  6. 6. OMFS Oncology Fellowship Manual 2008ADMISSION QUALIFICATIONSInterested applicants should submit the following to the fellowship program director: 1. a curriculum vitae 2. the names of three individuals who can be contacted for letters of referenceAn interview with the fellowship program director and department chairman is required as partof the application process.Application materials should be sent to: Brian L. Schmidt, DDS, MD, PhD, FACS Oncology Fellowship Director Department of Oral and Maxillofacial Surgery 521 Parnassus Avenue, C-522 San Francisco, California 94143-0440/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 6
  7. 7. OMFS Oncology Fellowship Manual 2008 UCSF ORAL AND MAXILLOFACIAL SURGERY REQUIRED READING LIST FOR ONCOLOGY FELLOWSThis reading list was put together by the Fellowship Program Director. The fellow is expectedto be familiar with these articles prior to starting the fellowship. 1. Pogrel MA. The marginal mandibulectomy for the treatment of mandibular tumours. Br J Oral Maxillofac Surg 1989;27(2):132-8. 2. Dierks EJ, Karakourtis MH. Segmental resection of the anterior mandibular arch with fibular microvascular reconstruction. Atlas Oral Maxillofac Surg Clin North Am 1997;5(2):55-73. 3. Helman JI. Maxillectomy. Atlas Oral Maxillofac Surg Clin North Am 1997;5(2):75-89. 4. Lore JM. The Trachea and Mediastinum, Chapter 19. In: Meier AE, editor. An Atlas of Head and Neck Surgery. Philadelphia: W.B. Saunders Co.; 1988. p. 811-18. 5. Ord RA. Radical neck dissection. Atlas Oral Maxillofac Surg Clin North Am 1997;5(2):91-110. 6. Ord RA, Cornella FA. Modified radical and selective neck dissections. Atlas Oral Maxillofac Surg Clin North Am 1997;5(2):111-32. 7. Pogrel MA. Diagnosis and Surgical Management of Salivary Gland Tumors. Head and Neck Tumor Surg 1997;9(3):1997. 8. Worthington P. The surgical approach to the pterygoid region. Br J Oral Surg 1977;15(2):135-46./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 7
  8. 8. OMFS Oncology Fellowship Manual 2008FELLOWSHIP BENEFITS STIPENDS: The stipend is approximately $57,220 per year for the oncology fellow. HEALTH INSURANCE The oncology fellow is responsible for providing their own health insurance. The oncology fellow has the option of either providing their own health insurance which must provide coverage at a level acceptable to UCSF or obtaining health insurance through the University of California at San Francisco at the University of California at San Francisco rate. Plans and rates are available at The premium for health insurance will be taken out of the stipend based on the University of California at San Francisco rates. VACATION AND SICK LEAVE Vacation and sick leave are granted at the discretion of the head of the department. At the present time, fellows are entitled to two weeks paid vacation per year. PREGNANCY RELATED DISABILITY AND FAMILY LEAVE The Department of OMFS will conform to state and federal law in regard to pregnancy-related disability and family leave. This may necessitate extending the program to complete all requirements. ON-CALL COMMITMENT The fellow is on call for twelve consecutive days and then off for 2 days. Fellows are required to take in house call on the day a patient is admitted to the ICU following an extensive oncologic resection. Additional in house call might be required for critically ill oncology patients. PRACTICE PRIVILEGES AND OTHER ACTIVITIES OUTSIDE THE EDUCATION PROGRAM The Department of OMFS is held to be the fellows primary employer and no outside activities should infringe on the commitment to the program. LICENSE Fellows should have a current dental or medical license on commencement of the program and should have a DEA number at that time./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 8
  9. 9. OMFS Oncology Fellowship Manual 2008 PROFESSIONAL LIABILITY COVERAGE Fellows fall under the umbrella of the University of California Risk Retention Group, a self-insured unit. This provides coverage for malpractice claims and employment related claims, including punitive damages. The latter group must occur under normal circumstances and are examined on a case-by-case basis. ACLS Fellows in the OMFS program must have current certification in ACLS. ACLS certification is mandatory prior to starting the fellowship. CONFERENCES Each fellow will receive up to $1200 to attend either the Annual AAOMS or a meeting focused on oncology. Any other course or meeting which requires a leave of absence must be approved by the Fellowship Director. Fellows who conduct a research project under the direction of a faculty member and who submit an abstract which is accepted for presentation will be considered for funding and leave to present the abstract. DISMISSAL FROM THE PROGRAM Fellows can be terminated for disciplinary or poor performance reasons. Evaluations are normally performed every four months and the results discussed with the fellow. REMEDIATION The Department of Oral and Maxillofacial Surgery has a remediation process in place. The mechanism for remediation depends on the level of urgency for remediation. The three different levels are: 1. Summary suspension. 2. Urgent remediation. 3. Routine remediation. Summary suspension: Summary suspension refers to the need to invoke immediate summary suspension of a fellow. This decision can only be made by the Department Chairperson and the Program Director and usually in response to patient care issues. If this decision is made by one of these individuals, the fellow is immediately removed from patient care. The second step is to immediately inform the Medical Center of the fellow’s suspension at an emergency faculty meeting, which must include preferably both but at least the Chairperson or the Fellowship Director. At that faculty meeting held within 48 hours of the suspension, the issue is discussed and immediate plans are implemented. An example of a scenario that would require summary suspension would include evidence of drug abuse or physical or mental illness. A remediation plan following summary suspension would be devised by the Department Chairperson and the Program Director, in conjunction with the/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 9
  10. 10. OMFS Oncology Fellowship Manual 2008 Dean’s Office and Medical Center. Within 72 hours of the fellow’s summary suspension the fellow would meet with the Program Chairperson and/ or Fellowship Director to discuss the plans and possible remediation. Urgent remediation: Urgent remediation would be instituted if a fellow’s performance though not thought to be an immediate threat to patient care, however, required attention. In this case, the fellow’s performance would be discussed at the next scheduled faculty meeting. The Chairperson and/ or Fellowship Director would be required to be present. The issue regarding fellow performance would be discussed amongst the faculty. The problem would be identified and appropriate remediation process would be put in place. If it was decided at the end of that faculty meeting that the fellow should not be allowed to administer patient care, the fellow would be contacted immediately and the plan listed above for summary suspension would be instituted. However, if it was felt that the fellow could continue patient care under direct attending supervision, an appropriate mentor/attending would be identified. This attending surgeon would be directly responsible for the fellow’s administration of patient care at all times. The length of time needed for direct fellow observation would be determined at the faculty meeting. Following that appropriate time the faculty would meet again and discuss the fellow’s progress in remediation. Routine remediation: Routine remediation would be the consequence of the routine quarterly faculty meeting where fellow evaluations are discussed. The problem would be identified by the appropriate attending and plans for remediation would be discussed. It would be required that the Department Chairperson and/ or Fellowship Director be present at the faculty meeting. It is anticipated that routine remediation would be reserved for clinical deficiencies in fellowship performance. A remediation plan appropriate to the problem would be designed and approved by the faculty members. A mentor would be appropriately assigned for the specific problem. The mentor would be responsible for the fellow’s administration of care. For example, a fellow would not be allowed to start a surgical case without the mentor physically present. The mentor would be responsible for reporting to the faculty at the scheduled faculty meetings every three months or at the mentor’s discretion. Based on the fellow’s performance during the remediation process, the fellow would either be released from routine remediation or a further routine remediation plan would be implemented. DUE PROCESS POLICY Procedures informal: A fellow who believes that the University or any administrative subdivision thereof has discriminated against them and that such action has resulted in injury to the student is encouraged to resolve the matter informally with either the party alleged to have committed the violation, with the head of the Department or Unit in which the alleged violation occurred, or both. An informal resolution of the grievance can occur at any time and is to be encouraged./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 10
  11. 11. OMFS Oncology Fellowship Manual 2008 Procedures formal: In the event that information resolution is unsuccessful, the fellow may lodge a formal grievance as follows: 1. Within 30 days of the time at which the fellow could be reasonable expected to have knowledge of the alleged violation, the fellow may request the Fellowship Director in OMFS of the desire for a review. Should this not bring about successful resolution of the problem, a formal grievance may be lodged in writing to the Chief of OMFS within 10 days of unsatisfactory outcome with the Fellowship Director. 2. In the event that the Fellowship Director and the Chief of Service are one and the same person, the same administrative channel should be followed. 3. In the event that this does not give successful resolution to the problem, the same formal written procedure may be carried forward to the head of Department, within 10 days of unsuccessful resolution with the Chief of Service. The head of the Department may, at their discretion, set up an ad hoc committee to examine the complaint. 4. In the event that the Fellowship Director and the Head of the Department are one and the same person, the same administrative channel must be followed. 5. In the event that the problem cannot be resolved at the Department level, the Fellows may appeal to the Postdoctoral Affairs Committee administered through the Office of Graduate Medical Education, Room MU-250E, (415) 476-4561 and the Dean’s office of the School of Dentistry, Room S-640, (415) 476-1323. 6. In the event that a fellow feels that the fellowship training program may not be in substantial compliance with the Commission on Dental Accreditation a complaint can be directed to: Commission on Dental Accreditation, 211 East Chicago Avenue, Chicago, IL 60611 or by calling 1/800-621-8099, extension 4653.OPERATIVE LOGFellows are required to keep a surgical log of all cases. The surgical log should include the dateof operation, the name of the patient, medical record number, diagnosis, ICD-9 code, proceduresperformed, CPT code, attending surgeon and role of the fellow on the case. It is recommendedthat fellows keep both an electronic, as well as a hard copy, of the operative log. The chieffellows at each of the sites should forward numbers at the end of the month to the FellowshipDirector.TRAVEL REIMBURSEMENTThis is to clarify the travel reimbursement process. For Marcie Louie to properly andexpeditiously process your travel and entertainment reimbursement there are several, relevant,points to keep in mind. In addition, any request for an advance does not in any way alter theseprocedure(s).Only those travel expenses that are ordinary and necessary to accomplish the officialbusiness purpose of a trip/entertainment are eligible for reimbursement./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 11
  12. 12. OMFS Oncology Fellowship Manual 2008TRAVEL Submit the travel receipt or e-ticket receipt plus all boarding passes forreimbursement of airline travel.SUBSISTENCE expenses incurred within the vicinity of an employees campus or residencewill not be reimbursed. Original receipts must be submitted for all lodging expenditures and foreach meal and incidental expenditure of $50.00 or more within the United States, on countriesoutside of the US refer to the web page below. Maximum rates for entertainment not included inthis ceiling. For reference on entertainment reimbursement, again, go to the web site providedbelow.RECEIPTS Attach the original of all receipts, credit vouchers, ticket and stub, hotel folios.Each attachment should be clearly identified or referenced. Lost or unavailable receipts must beadequately explained in remarks or with an attachment memo.AGAIN, IF THE DEPARTMENT DEFRAYS THE COST OF YOURTRAVEL/ENTERTAINMENT IN ADVANCE, MARCIE LOUIE STILL NEEDS ALLORIGINAL(S) RECEIPTS, TICKET STUB, HOTEL FOLIOS ETC., SUBMITTEDWITHIN 10 DAYS AFTER THE COMPLETION OF THE TRIP.I realize that some of you may have question(s) I have not address on this memo. Therefore, Ihave listed two web sites that will help you with some of your question(s). 1. Policy Governing Travel: 2. Policy Governing Entertainment: All didactic continuing education courses given on campus through our Department are available to our fellows and faculty FREE of charge. Other UCSF CDE courses except study groups and hand on courses are $25.PAGERS: Fellows are responsible for the care and maintenance of their pagers. Lost pagers will be charged at cost.STAFFMEMBERS: Fellows should not give the appearance of taking sides in any negotiations between a clinic manager or clinic director and a staff member. In particular, fellows should not write letters of recommendation for staff members as this is normally undertaken by members of the faculty who in general, know a staff member better and have access to the full details of a staff member’s employment record. In general, fellows should not write prescriptions for staff members of their families when they are not the normal treating physician. This is a matter of common sense and should not require further discussion.ABSENCEFROM/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 12
  13. 13. OMFS Oncology Fellowship Manual 2008A ROTATION: All absences from a rotation must be approved by the program director and attendings directly involved. If fellows wish to observe or help with a procedure at another location this must also be approved by the appropriate attending at the second institution.CERTIFICATE: Upon successful completion of the fellowship, the fellow will receive a Certificate of Completion of Fellowship in oral and maxillofacial oncology from the University of California, San Francisco./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 13
  14. 14. OMFS Oncology Fellowship Manual 2008SAMPLE SCHEDULESample Fellow Schedule MON TUES WED THURS FRI 8:00-10:00am 7:00- 9:00 am 7:30-9:30 am UCSF Operating room 7:00-8:00amAM Pathology slide review Departmental Multidisciplinary entire day. Morning trauma with General Path/Oral Conferences (Medical Tumor Board conference, San Path (General Sciences S-719) Conference at UCSF Mt Francisco General Pathology M580) 10:00-11:00 am Zion Cancer Center Hospital UCSF Operating room 10:00-11:00 am (Conference room, 10:00-12:00 am Clinic in Medical 2nd floor) Radiology/pathology in Sciences S-738 Medical Center or UCSF Operating UCSF Operating Room room Radiology/pathology in Clinic in Medical UCSF Operating room UCSF OperatingPM Medical Center. One UCSF Operating room Sciences S-738 entire day. room month Radiation Oncology entire day (UCSF Mt Zion Cancer Center) On Call On Call On Call On Call On Call*Fellow will be on home on-call for 12 consecutive days and then will have 2 days off.Oral and Maxillofacial Surgery Oncology Fellow Rotation on Radiation Therapy ServiceThe objectives for this rotation will be:1. To observe patients at all stages through the radiation therapy process from initial consultation, initial simulation, through the course of radiation therapy and necessary follow- up care to become more sensitive to the requirements for these patients.2. To become familiar with the equipment and protocols utilized for radiation therapy including proton beam, intensity modulated radiation therapy and brachytherapy.3. To become familiar with patient responses to radiation therapy including physical and psychological responses.4. To become familiar with the measures taken to minimize complications and side effects from radiation therapy.Oral and Maxillofacial Surgery Oncology Fellow Rotation on the Oral Pathology ServiceThe objectives for the oral pathology rotation will be:1. To review the principles involved in preparing a pathology specimen.2. Review of the histopathologic features diagnostic of oral and maxillofacial pathology, both benign and malignant.3. A review of the molecular pathology diagnostic techniques.Departmental Service MeetingThe service meeting is held every Tuesday morning. This is a one-hour conference attended bythe oral and maxillofacial surgery residents on rotation, the oncology fellow, the general surgeryresidents on the oral and maxillofacial surgery rotation, selected dental students, and medicalstudents. The purpose of this conference is for the chief and senior resident to presentpreoperative as well as postoperative cases. Case management is discussed amongst the faculty,residents, and students.Clinicopathological CorrelationThis is a one-hour teaching session held once per month with the oral and maxillofacial surgeryfaculty, oncology fellows, and residents. The conference is chaired by an oral and maxillofacialsurgeon, and a faculty member from the division of oral pathology (Dr. Richard Jordan and Dr.Darren Cox). This session discusses, in structured fashion, the diagnosis and management ofpathological lesions of the maxillofacial regions, and illustrates this with cases recently treated in/home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 14
  15. 15. OMFS Oncology Fellowship Manual 2008the Department of Oral and Maxillofacial Surgery. In a structured fashion, the course coversinfections, odontogenic and nonodontogenic cystic lesions, odontogenic and nonodontogenicbenign tumors, odontogenic and nonodontogenic malignant tumors, and also the range of oralmedicine lesions, including white, red, and blue lesions.The objectives of this course are to acquaint residents with the presentation, diagnosis,management, risk complication and long-term follow-up required for the management ofpathological lesions of the maxillofacial region.UC San Francisco Head and Neck Tumor BoardThe UC San Francisco Head and Neck Tumor Board is held at the ComprehensiveCancer Center. The Comprehensive Cancer Center is accredited by the National CancerInstitute. The conference is held each week on a Wednesday morning. The conference isroutinely attended by the Department of Oral and Maxillofacial Surgery,Otolaryngology, Head and Neck Surgery, Plastic and Reconstructive Surgery,Maxillofacial Prosthodontics, Radiation Oncology, Medical Oncology, Radiology,General Pathology, and Oral Pathology. The oral and maxillofacial oncology fellow isresponsible for presenting all of the cases that are treated within the Department of Oraland Maxillofacial Surgery. The fellow is responsible for the preoperative evaluation aswell as the presentation during the Conference. The fellow is also responsible forpresenting the recommended treatment and defending that treatment based on theavailable literature. The oral and maxillofacial oncology fellow is called on by otherservices to comment on surgical issues pertinent to the discipline of oral andmaxillofacial surgery./home/pptfactory/temp/20101208105948/omfsdocdocdocdoc456.doc 15