Pediatric Oncology Curriculum

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Pediatric Oncology Curriculum

  1. 1. Pediatric Oncology Curriculum
  2. 2. Preface The Egyptian Fellowship Board and the Pediatric Oncology scientific council worked collabo- ratively to make this curriculum available for trainees’ guidance and support. Postgraduate medical education world wide are now governed by sets of academic standards that describe the qualities and abilities of graduates. In addition, there are standards for the training processes , trainers’ selection and methods of assessment. standards ensure transparency and clarify expectations. The Egyptian fellowship board had defined and published its standards for the general and profes- sional competencies expected from our graduates in different specialties upon successful comple- tion of training. These expectations has been reflected in the pediatric oncology curriculum. The curriculum describes what trainees will know and be able to do upon completion of training. In additions, methods of teaching and learning needed to deliver the curriculum are listed . The curriculum also describes in details, expectations from trainees during their rotations in “The training rules and regulations section”. Methods of assessment and examination regulations are also available in the last section of the curriculum. All topics covered during practical and theoretical studies are outlined. This will help trainees to guide their readings and their choice of learning activities. The scientific council also recommends that trainees and trainers refer frequently to the logbook, where they will find requested clinical cases and practical procedures. The logbook will also serve as the source of evidence that pediat- ric oncology trainees have attended required rotations and achieved requested competencies. The trainees, trainers and Educational supervisors will get significant benefits from regular check- ing of the Egyptian Board website. All announcements related to training and exam will be avail- able there. In addition, you will find many useful electronic resources that we hope it will be bene- ficial in your preparation for the exam and continuous professional development. Esmat Ahmed Sheba Secretary General The Higher Committee of Medical Specialties
  3. 3. Acknowledgement This curriculum has been created through collaboration between The Pediatric Oncology Scientific Council and The Egyptian Fellowship Curriculum Committee. The following mem- bers of the Pediatric Oncology Scientific Council have made substantial contribution to the curriculum development as subject matter experts The Egyptian Fellowship Curriculum Committee has made significant contribution to the cur- riculum through Collaboration with the council in the design and formulation of the educa- tional structure. The member who participated in the work is The Committees consulted international and national curricula in pediatric oncology. The external references for the development of this curriculum are: 1. The pediatric oncology curriculum approved by the Royal College of child health and PMETB 2007 2. The previous Egyptian Board curriculum in pediatric oncology 3. The Egyptian Board Guidelines for curriculum development 2007 4. Postgraduate Medical Education and Training Board UK (Guidelines for curricu- lum development 2006)  Professor Dr Alaa El Haddad, Professor of pediatric oncology and Chair of the Pe- diatric Oncology department at the National Cancer institute, Cairo University  Associate Professor Dr Hany Abd El Rahman, Associate Professor of pediatric on- cology, National Cancer Institute. Cairo University  Professor Dr Eman Abd El Raouf Mohammed ,Professor of pediatric hematology, Cairo University and the educational advisor of the Egyptian Fellowship Board
  4. 4. Pediatric Oncology Curriculum Egyptian Fellowship 7 7 CONTENTS…………………. The structure and regulations of Pediatric Oncology training…... 9 Curriculum aim ……………………………………………………. 13 General intended learning outcomes………………………………. 14 Module I……………………………………………………………... 17 Module II …………………………………………………………… 22 Module III ………………………………………………………….. 27 Module IV…………………………………………………………... 33 Methods of assessment …………………………………………….. 37
  5. 5. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 8
  6. 6. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 9 The Structure and regulations of Pediatric Oncology training The Egyptian Board of pediatric oncology requires two years of supervised training program that must be conducted in accredited pediatric oncology hospitals and centers before sitting for the final examination. The board publish an updated list of accredited centers at its website. Entry to the pediatric oncology-training program has the following requirements for trainees who are affiliated to MOHP: 1. Graduation from medical school and successful completion of the pre- registration house officers' year 2. Successful completion of the Egyptian Fellowship in Pediatrics or equiva- lents (e.g. MRCPCH) with evidence of practical training.  Trainees, who finished their master degree in pediatrics within five years must join the pediatric fellowship training for two years and pass successfully the final certifying exam before joining the pediatric on- cology training program During the entire program, the candidate must work as a full time residents in the training center. He or she must get gradually increasing responsibilities for patient care according to the stage of training and available supervision. 1.Pediatric-Oncology trainees must spent their training period in the following services: a.Pediatric Hematological malignancies services (10 months) b.Pediatric Solid tumor services (10 months) c.Bone marrow transplantation service (3 months). d. In addition, attendance to radiotherapy services, oncology surgery wards, clinical pharmacy and clinical pathology department will be organized by the educational supervisor on part-time basis to allow for the attainment of required intended learning outcomes 2.The first two modules of the curriculum must be completed by the end of the first year of training. However only module one will be the subject for assessment in the first part exam. 3.The third and fourth modules must be covered by theoretical and practical studies during the second year of training and the whole curriculum is a subject for the final exam Any changes to this guidelines would be announced at the board website and we advise trainees to regularly visit the site for announcements and updates Training rotations
  7. 7. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 10 1. Trainees must attend at least 75% of lectures on pediatric oncology subjects. 2. They should pass successfully through the first part exam before being eligible for the final exam. Trainees who failed the first part exam twice may be asked for additional period of training up to one year and successful pass of the first part exam before being allowed to sit for the final certifying exam 3. Trainees should be actively involved and responsible for patient care including sharing in making decisions about diagnosis and management under supervi- sion of the consultants. 4. They must attend 75% of weekly meetings including clinical rounds, tutorials and journal clubs 5. Their performance will be monitored and evaluated by trainers and a report made of their performance on monthly basis to the Egyptian Fellowship Board. 6. All trainees will work as residents in the training specialty and they must ful- fill all residents jobs defined by supervisors and trainers 7. They should be responsible under supervision for outpatient and in patients' routine work. 8. They must take supervised shifts according to the hospitals requirements and regulation. Important notice  Trainees must pass successfully all the seven foundation courses before being promoted to the second year of training. Full information about foundation courses is available at the EF website and administration office.  Trainees who finished their foundation courses during their pediatric fellow- ship will not repeat the courses. Trainees duties and obligations
  8. 8. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 11 Specific requirements and obligations The trainees will be responsible for supervised admission of patients from the out- patient department or emergency. They will share in the completion of the following documents under supervision  Complete history and physical examination form.  Investigation requests, (laboratory, radiology, pathology, etc.).  Reporting and documenting the results of the investigations  Writing the plan of management after consultation and approval from supervi- sors  Daily progress notes.  Order and medication sheets  Orders of the necessary diagnostic procedures  Discharge summaries.  Sick leaves and medical reports The Trainee should inform the senior staff of any high-risk patient admission. The trainees should attend various pediatric oncology outpatient clinics and clinics related to the rotation in radiotherapy, nuclear medicine and surgical oncology as requested by trainers and supervisory staff. They should participate in different pa- tients' interviews and share in management under supervision. The trainees must attend and participate in the mandatory academic and clinical activities of the department. Attendance and participation should not be less than 75% of the total number of activities within any training rotation / period including.  Daily morning patients' rounds and meetings  Clinical round and staff round presentation  Journal club meeting  Interdepartmental Meetings/ morbidity and mortality meetings  Grand staff rounds 1- Obligations towards the Admitted Patients 2- Obligations in the outpatient Clinics 3- Mandatory Clinical and Academic Activities
  9. 9. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 12 The trainees must keep and update their logbook where they record all activities and skills performed and learned during the training program. The activities should be dated and categorized to whether been performed by the trainee him/ herself or as an assistant or participant. The trainer and finally the educational supervisor should counter sign activities registered in the logbook. The Trainer and educational supervisor must sign the completed Log Book. Trainers must revise the logbook weekly. Educational supervisors must revise the logbook and provide feedback on monthly basis. The trainees shall undertake at least one research or audit project during the training program under the guidance and supervision of their trainers. Such pro- ject should be written and presented to a committee from the scientific council before the trainee is accepted for admission to the final certifying examination. The scientific council will announce topics and themes for the research or audit projects. Before the completion of the training program, the trainee should have com- pleted satisfactorily the rotations described in the structure of the program, per- formed him/herself, and assisted in the various requested procedures. According to Ministry of Health and Population regulation Performance of the trainee must be evaluated on regular and continuous basis. The evaluation process should involve all aspects of the training including theo- retical, clinical and investigative procedures skills as well as the attendance and participation. The trainers who are required to write confidential reports on the performance of each trainee should evaluate the trainee periodically. The trainee should not be allowed to proceed in the training program and move to the next year unless he/ she attains a satisfactory level of performance acceptable to the responsible trainer and educational supervisor. 4. The Log Book 5. The Research project General rules and regulations 1.Holidays and on call duties 2.Evaluation Procedures:
  10. 10. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 13 Interruption of training It is not permissible to interrupt such a structural training program except in major unavoidable circumstances. Such circumstances should be convincing and approved by the Secretary General. The Interruption once approved should not be for more than one year. Interruption of the training program for more than one year shall re- sult in dismissal from the program and cancellation of the preceding training period. Curriculum aim The aim of this curriculum is equip Egyptian fellowship trainees in the specialty of pediatric oncology with knowledge, skills and attitudes necessary for efficient, inde- pendent and safe practice as pediatric oncology specialists. It gives you - as a fellow- ship trainee - a clear picture of what you have to achieve by the end of this fellow- ship program. Therefore, when it comes to your assessment at the end of the train- ing, we will want to know how well you have achieved the program objectives and be confident that you are fit to practice as a pediatric oncology specialist with com- petence. Rational Statement The purpose of this curriculum is to describe the competencies expected from pediatric oncologists upon completion of training . The curriculum also describes the methods of teaching and learning that will be used to facilitate the delivery of the curriculum. In addition, it highlights the different methods of trainee's performance evaluation. The curriculum contents have been for- mulated through the following methods: 1. Revision of previous Fellowship pediatric oncology curriculum 2. Revision and benchmarking of international curricula for postgraduate training in pediatric oncology. 3. Consultation of experts in the field of pediatric oncology. Representatives from the pediatric oncology scientific council have partici- pated in the process of curriculum development in collaboration with repre- sentatives from the Egyptian Board curriculum Committee. The curriculum was finally approved by the council in July 2008
  11. 11. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 14 General intended learning outcomes By the end of training in Pediatric Oncology, trainees should have acquired the following knowledge, skills, attitudes and be able to: 1. Describe the Incidence and mortality rates for various childhood cancers with emphasis on ethnic and geographical variabilities. 2. Explain the etiological background of childhood cancer both the facts and theories. 3. Distinguish between national , regional and international cancer registration policies. 4. Explain the role of clinical trials in pediatric oncology and recall the history of evolution of current clinical trials and treatment outcomes. 5. Discuss the normal and abnormal mechanisms of cellular growth control. 6. Explain the genetic basis of malignant disease. 7. Discuss the features and clinical presentations of different childhood malig- nancy. 8. Discuss the role of biological factors as diagnostic and prognostic aids. 9. Describe the indications and techniques of biopsy and optimal methods for tissue handling for diagnosis and biological studies. 10.Discuss the principles and strategies of various modalities of treatment for all stages of solid tumors and hematological malignancies that affect children. 11.Discuss the principles of cancer treatment with chemotherapy and the ration- ale of combination chemotherapy regimens. 12.Discuss the principles and applications of high dose therapy and the rationale for bone marrow transplantation in various childhood malignancies. 13.Discuss various techniques for bone marrow support including the use of growth factors. 14.Summarize the basics of radiobiology and different planning techniques used in the delivery of radiotherapy to children. 15.Recall the principles of less commonly used radiotherapy techniques, includ- ing brachytherapy and targeted therapy. 16.Outline the role of onco surgery in the diagnosis and management of various childhood cancers. 17.Discuss the acute toxicities of cancer treatment (individual drugs and radio- therapy). 18.Discuss the late side effects and consequences of therapy, including effect on learning, endocrine consequences, major organ toxicities and their causative agent. Knowledge and understanding
  12. 12. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 15 19.Outline the importance of tumor and DNA banking for future research. 20.Outline the basic principles of biological and novel therapies for the management of pediatric malignancy. 21.Explain the working structure, aims and functions of the pediatric oncology ser- vices in the country. 22 Take full and focused clinical history and perform complete and organ targeted clinical examination for children presented with various malignancies. 23 Request appropriate diagnostic studies and formulate a rational differential diag- nosis. 24 Interpret the results of investigations correctly (laboratory, radiological imaging and pathology) and modify his differential diagnosis list accordingly. 25 Timely recognize and manage various oncological emergencies such as septic shock, tumor lysis, SVC obstruction, spinal cord compression, and raised ICP. 26 Perform independently bone marrow aspiration and trephine biopsy. 27 Prescribe and administer safely intrathecal drugs according to local and national policies. 28 Prescribe, handle and administer chemotherapy safely 29 Timely recognize and manage acute drug reactions to chemotherapy and manage the extravasation of chemotherapy agents appropriately. 30 Manage competently fever with neutropenia , including management after the failure of first line antibiotic therapy. 31 Investigate and manage fungal and viral infections in the immune-compromised child. 32 Organize and participate in long-term follow up programs for children with vari- ous malignancies. 33 Participate as a team member in surveillance of survivors using national guide- lines. 34 Manage pain related to cancer appropriately and recognize the different patterns of pain and their different therapeutic interventions including non pharmaceutical approaches. 35 Identify and control other symptom such as breathlessness and bowel obstruc- tion. 36 Perform complete nutritional assessment for children with cancer and prescribe. appropriate nutritional support during and after chemotherapy. 37 Consult appropriately nutrition specialists and seek their advice when indicated. Skills
  13. 13. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 16 Communication skills, ethics and professional attitudes 38 Appreciate the concept of ‘Good Clinical Practice' 39 Communicate effectively and empathetically with children and families and be able to convey bad news in appropriate manner 40 Discuss the concept of phase I, II and III trial and be able to explain this to patients and parents 41 Discuss with patients and care givers various treatment options and gain in- formed consent for treatment and for enrollment in clinical trial 42 Be confident in discussing these issues with adolescents and their families and in making appropriate referrals 43 Educate families and patients about fertility preservation techniques for ado- lescents who will receive treatment that may impair fertility in the long term 44 Work within multidisciplinary teams to manage various oncological prob- lems 45 Collaborate with neuropsychiatric specialists in the management of learning and psychological consequences of cancer treatment 46 Communicate both verbally and in written concerning the impact of treat- ment on learning, patients school education and other possible short and long term effects.
  14. 14. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 17 Module I This module aims to equip trainees with essential knowledge and problem solving skills in the following domains:  Cancer biology  Pathology & molecular biology  Clinical Pharmacology  Chemotherapeutic agents  Epidemiology & Biostatistics  Basics of Surgical Oncology  Basics of Radiation Oncology  Radio-diagnosis  Basics of Cancer Intended learning outcomes By The end of the module, trainees will be able to: 1.Discuss the principles of cancer biology, genomics & proteomics, molecular targets and explain the processes of invasion, metastasis, angiogenesis & cancer immunology. 2.Describe the Molecular and genetic characteristics of normal & malignant cells (Genomics & proteogenomics). 4.Describe the principles of various epidemiologic studies , types of re- search designs and principles of biostatistics including survival analysis and mortality indices. 5.Discuss the indications for and role of surgery in diagnosis, staging and management in different types of childhood malignancies. 6.Discuss the indications for and role of radiation oncology in the manage- ment of childhood cancer. In addition, they must identify and initiate man- agement for its expected side effects. 7.Recognize the indications for and interpret the results of different imaging modalities including radiography, Ultrasound, CT, MRI, PET scan and nuclear medicine (these include their use for the diagnosis, staging and follow up of pediatric cancers). 8.Discuss the Classification, mode of action, toxicities, basis of combination therapy and precautions of the use of chemotherapeutic agents including late effects and teratogenicity. 9.Prescribe judiciously various chemotherapeutic agents through various routes of administration. 10.Monitor children on chemotherapy, recognize the toxicities of chemo- therapeutic agents and manage it appropriately.
  15. 15. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 18 Caner biology Topics Method Of Learning Method Of Expected Year Of Achievement Normal chromosomal structure & func- tion, gene transcription, DNA repair mechanisms Lecturesandself-study Firstpartexam 1st year Molecular basis of Cancer Transformation of normal cells into cancer cells Chromosomal & genetic changes in malignancy, point mutation, transloca- tions, deletions, gene amplification & over-expression Mechanism of spread, invasion migration & metastasis Tumor markers Basics of caner virology Oncogenic viruses Laboratory diagnosis of viral infection Micro array Surgical Oncology Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Role of surgery in diagnosis and staging of pediatric tumors Lecturesandrotationsin SurgicalOncology Firstpartexam 1st year Different types of surgery Role of surgery in management of disease complications Role of surgery in Palliation Common post operative complications Venous access, management and maintenance
  16. 16. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 19 Pathology Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Lectures Selfstudy practicalattendanceofpathologylab Firstpartexam 1st year Introduction to general pathology Morphologic criteria of malignancy The range of tumors that can develop from normal tissue components Classification of malignant tumors Morphology of common tumors (macro & micro), grading & differentiation of tumors The natural history of malignant dis- eases, presentations, characteristics of their growth & spread Principles and application of ad- vanced techniques in tumor diagnosis Use of specialized pathology tech- niques e.g. Immuno-histochemistry, phenotype, cluster of differentiation ( CD) classifications, FISH & CISH, micro array & gene print Use of clinic-pathological data within multidisciplinary approach for pa- tients management
  17. 17. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 20 Pharmacology Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Classification and mode of action of cyto- toxic drugs Lectures Firstpartexam 1st year Drug resistance, doses & administration Phases of drug development & screen- ing at pre-clinical levels Pharmacokinetics & pharmacodynam- ics: general principles, plasma concen- tration, AUC Protein & tissue binding, drug concen- tration at the target site Principle of clinical use: dose intensity, combination therapy, new adjuvant therapy High dose chemotherapy Cancer Chemotherapy Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Mode of action of cytotoxic drugs , phases of the cell cycle, Lecturesandonjobtrainingrotationsin ClinicalPharmacology Firstpartexam 1st year Mechanisms of intrinsic & acquired The indications & goals of chemo- therapy, adjuvant & neoadjuvant Clinical use of cytotoxic drugs Principles of adverse effects of cy- totoxic drugs & their management Antiemetics and targeted therapy ( monoclonal antibodies, TKI, tu- mor vaccines, cellular therapy, antiangiogenesis, cytokines) Dose intensification: indications, complications & adverse effects
  18. 18. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 21 Radiation Oncology Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Principles of radiation biology & normal tissue tolerance Lecturesand rotationsin RadiationOncology Firstpartexam 1st year Principles of radiation physics, fractionation & dosing Clinical aspects of radiation oncol- ogy & toxicity, interaction with chemotherapy, potentiation & protectors Diagnostic Radiology Topics Method Of Learning Method Of Expected Year Of Achievement Imaging modalities: indications and cost/benefit Lecturesandsmallgroup sessionson Radiologicfilm Firstpartexam 1st year Radiography, U/S CT & PET MRI nuclear medicine: indications intervention radiology Interpretation exercises Biostatistics Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Introduction to epidemiology Lectureswith handson training Firstpart exam 1st year Measuring occurrence of disease Surveillance and overview Study designs Basic statistics
  19. 19. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 22 Module II This module aims to equip trainees with comprehensive knowledge , problem solving and patients' management skills in the following domains: 1.Oncologic Emergencies 2.Infectious diseases 3.Clinical pathology and blood banking 4.Hematologic Malignancies:  Acute Lymphoblastic Leukemia (ALL)  Acute Myeloid Leukemia (AML)  Chronic Myeloid Leukemia (CML)  Myelodysplastic Syndrome (MDS)  Non-Hodgkin's Lymphoma (NHL)  Hodgkin's disease (HD). Intended learning outcomes 1.Discuss emergency situation related to cancer development, treatment side ef- fects or organ dysfunction. 2.Discuss the Principles of antimicrobial treatment in febrile neutropenic cancer patients. 3.Identify the role of clinical pathologists in diagnosing hematological malig- nancies and in supporting the transfusion management of cancer patients. 4.Discuss the indications for, precautions and procedures of blood product trans- fusion in children with cancer. 5.Discuss the etiology, Incidence, epidemiology, clinical presentation, prognostic factors, differential diagnosis and different strategies of management of child- hood hematologic malignancies. Knowledge
  20. 20. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 23 Skills 1.Timely recognize and properly manage various types of oncological emergencies e.g. tumor lysis syndrome, cord compression, septic shock, fever and neutropenia, bleeding ….etc 2.Prevent, anticipate and competently management febrile neutropenic cancer patients, with emphasis on diagnostic work up, early wide spectrum antibiotics coverage and proper introduction of antifungal and antiviral treatment 3.Classify malignant hematologic disorders using different investigations and for- mulate a rationale differential diagnosis and reach a final correct diagnosis 4.Use blood product transfusion judiciously in the management of hematological malignancies 5.Anticipate, prevent and manage reactions related to blood product transfusions 6.Make appropriate evidence based decision-making regarding the choice of treatment strategy, dealing with treatment complication, follow up during chemo- therapy and early identification of relapsing and/or resistant cases needing second line chemotherapy or BMT. Oncological emergencies Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Identification of causes, clinical presentation, and management of oncologic emergencies Lectures Attendanceofoutpatients Attendanceofinpatients Secondpartexam 1st year Septic Shock, bleeding, coagulation disorders Tumor lysis syndrome Cord Compression, increased intrac- ranial tension, encephalopathy Dyspnea, massive effusion, ascites Fever and neutropenia SVC syndrome, cardiac tamponade
  21. 21. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 24 Infectious diseases Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology, strategies for managing of infectious diseases in pediatric oncology patients Lectures Attendanceofoutpatients Attendanceofinpatients Secondpartexam 1st year Risk assessment and clinical manifestations of fever in children withand neutropenia cancer Prevention of infections in children with cancer Antibacterial treatment of febrile neutropenic patients Antifungal agents Antiviral agents Clinical pathology and blood banking Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Classification of malignant hematologic disorders Lectures Attendanceofoutpatients Attendanceofinpatients Secondpartexam 1st year IPT Cytogenetics in acute leukemia Molecular biology HLA typing Uses of blood components in hematologic malignancies Management of transfusion reaction
  22. 22. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 25 Acute leukemia Topic Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology of infant and child- hood acute leukemia Lecturesandonjobtrainingin hematologicalmalignancywards Secondpartexam 1st year Etiology and genetic associations incidence, clinical presentations of ALL, AML Diagnostic investigations, prognos- tic factors and risk stratification. Treatment protocols and monitoring the response Minimal residual disease Role and indications for bone marrow transplant Role and indication of radiotherapy management of rarer forms of childhood leukemia management of testicular, CNS and bone marrow relapse Chronic myeloid leukemia and myelodysplastic syndromes Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology; incidence and molecular abnormalities of childhood CML and MDS Lecturesandonjobtrainingin hematologicalmalignancywards Secondpartexam 1st year Classification, clinical presentations Laboratory and prognostic features of CML, and MDS Chemotherapy for CML, MDS Monitoring of response and treatment outcome Role of bone marrow transplant in the treatment of myelodysplasia and chronic myeloid leukemia in
  23. 23. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 26 Hodgkin’s Lymphoma Topics Method Of Learning Method Of Expected Year Of Achievement Epidemiology, clinical presentation, and laboratory features Lecturesandonjobtrainingin hematologicalmalignancy wards Secondpartexam 1st year Histological subtypes and their ef- fects on prognosis Ann-Arbor staging system Diagnostic work up current treatment strategies includ- ing the role of radiotherapy FDG-PET scan complications and late effects of chemotherapy and radiotherapy Non-Hodgkin's Lymphoma Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Histological subtypes of NHL in chil- dren and adolescents Lecturesandonjobtrainingin hematologicalmalignancywards Secondpartexam 1st year Clinical presentation Cytogenetic and molecular genetic Association of EBV and HIV with NHL investigations and diagnostic work up Prognostic features Current treatment strategies accord- ing to immunophenotype and patho- Management of the acute presenta- tions: SVC obstruction, airway compression, spinal cord compres- Indications and role of BMT in Management of relapsed NHL
  24. 24. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 27 Module III This module aims to equip trainees with comprehensive knowledge , problem solving and patients' management skills in the following themes: 1-Solid Tumors:  Renal Tumors.  Neuroblastoma.  Germ cell Tumors.  Hepatic Tumors.  Retinoblastoma  Bone Tumors.  Soft Tissue Sarcoma.  Central Nervous System Tumors. 2-Practical Procedures & Investigations 3-Therapeutic Procedures:  Lumbar Puncture  Bone Marrow Aspiration & Biopsy  IV Fluids  Infusion pumps 1. Discuss the etiology, incidence, clinical presentation, differential diagnosis, pathological subtypes and management guidelines of pediatric solid tumors 2. Discuss the indications and steps of performance for different practical proce- dures used during the course of diagnosis or treatment of cancer patient e.g.; col- lection of blood sample, LP, BM aspiration& biopsy and tapping of ascetic fluid 3. Outline the contraindications and expected complications of various procedures Intended learning outcomes Knowledge
  25. 25. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 28  Take appropriate evidence based decisions regarding treatment strategy,  Discuss the indication of surgery and/or radiotherapy  Deal with treatment complication appropriately  Follow solid tumor pediatric patients during chemotherapy and early identify relapsing and/or resistant cases needing 2nd line chemotherapy and/or autologous BMT  Communicate effectively and in a simple way to patients the indications and techniques of invasive procedures and be able to take informed consent  Perform the following therapeutic procedures independently and safely: Lumbar puncture, BM aspiration and biopsy, needle thoracocentesis for pleural effusion or pneumothorax, tapping of ascetic fluids.  Interpret results of investigations requested and respond appropriately  Record results and document procedures legibly and accurately  Explain the investigation results to parents and/or the child  Recognize complications of procedures and be able to respond appropriately  Supervise and teach junior colleagues the performance of the above mentioned procedures Skills Hepatic tumors topics Method Of Learning Method Of Assessment Expected Year Of Achievement Congenital conditions associated with hepatoblastoma Lecturesandonthejobtraining duringsolidtumorrotations Finalwritten,clinicalandoralexami- nation 2ndyear Differential diagnosis of right upper quadrant masses, anatomy and histology of the liver Tumor markers in primary liver tumors Pre-treatment staging system Prognosis of hepatoblastoma and hepatocellular carcinoma and factors that determine it Surgical resection of primary tumor Role of liver transplantation in the management of hepatic tumors Late effects of treatment
  26. 26. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 29 Renal tumors topics Method Of Learning Method Of Assessment Expected Year Of Achievement Classification and pathological subtypes of renal tumors including incidence of Wilms tumor Lectures Outpatientrotations Inpatientrotations Finalwritten,clinicalandoralexamination 2ndyear Clinical presentation and differential diagnosis of a renal mass Prognostic significance of histology Staging Wilms tumor pre- and post-surgery Principles of treatment for all stages of tumor according to different patients’ groups Principles of treating bilateral Wilms tumor management of a patient with recurrent Wilms tumor Role of surgery and radiotherapy Complications and late effects of treatment Retinoblastoma topics Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology, genetic, and clinical features of unilateral and bilateral retinoblastoma Lecturesandonjobtraining duringsolidtumorrotations Finalwritten,clinicalandoralexami- nation 2ndyear Clinical presentation of retinoblastoma Trilateral retinoblastoma Imaging modalities to determine extent and metastatic spread Staging of retinoblastoma Treatment modalities: surgery, irradiation, chemotherapy and photocoagulation Screening and follow-up for patients and siblings Complications, rehabilitation and late effects
  27. 27. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 30 Neuroblastoma topics Method Of Learning Method Of Assessment Expected Year Of Achievement Etiology and clinical presentation by age Lecturesandonjobtraining duringsolidtumorrotation Finalwritten,clinicalandoralexamination 2ndyear Management of common clinical problems associated at presentation: hypertension, spinal cord compression, Horner's Radiological investigations for diagnosis and staging International staging system (INSS) Prognostic factors and prognosis according to age and stage, histology and MYCN Laboratory findings: VMA, NSE, ferritin, LDH, MIBG Treatment strategies according to risk stratification, role of surgery and Principles of managing relapsed NBL Germ cell tumors topics Method Of Learning Method Of Assessment Expected Year Of Achievement Embryogenesis and histogenesis of Lecturesandonjobtraining Finalwritten,clinical andoralexamination 2ndyear Genetic Characteristics of Adolescent Testicular Tumors Clinical presentation Diagnostic work up Pathological subtypes Clinical markers: H-CG,AFP, LDH Principles of treatment: Treatment complication, Late effects and follow up after end of
  28. 28. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 31 Bone tumors topics Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology, predisposing factors and genetic predispositions Lecturesandonjobtraining Finalwritten,clinical andoralexamination 2ndyear Pathological subtypes Ewing family of tumors and their effect on prognosis Clinical presentations and potential metastatic sites Differential diagnoses for plain x-ray appearances Imaging modalities and their indication Neoadjuvant and adjuvant chemotherapy in the management of bone tumors Role and limitations of surgery Rehabilitation for limb sparing, joint sparing and amputation Late effects of bone tumor Soft tissue sarcoma topics Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology, predisposing factors and Lecturesandonjobtraining duringsolidtumorrotation Finalwritten,clinical andoralexamination 2ndyear Classification of STS: RMS /Non RMS Cytogenetic and molecular genetic abnormalities associated with soft tissue sarcomas Histological subtypes and patterns of Clinical presentation Staging of soft tissue sarcomas Role of surgery, chemotherapy and radiotherapy
  29. 29. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 32 Central nervous system tumors topics Method Of Learning Method Of Assessment Expected Year Of Achievement Epidemiology, predisposing factors and Lecturesandonjobtraining Finalwritten,clinical andoralexamination 2ndyear Classification, pathological subtypes and Clinical presentations Types and interpretation of neuro-images Planning of treatment through neuro- Role of surgery, irradiation and chemotherapy in the treatment of CNS Monitoring the response to treatment Complications and late effects of CNS Rehabilitation Practical Procedures and investigations Method Of Learning Method Of Assessment Expected Year Of Achievement Appropriate indications for practical procedures and investigations Lecturesandonjobtraining Finalwritten,clinical andoralexamination 2ndyear Local and national guidelines for obtaining informed consent for investigations or Contraindications and complications of Anatomical markers for invasive The principles for the practice of The steps of performance of various techniques
  30. 30. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 33 Requested procedures 1. Administer SC, IM & IV injections 2. Tapping of ascites 3. Thoracocentesis for pleural effusion or pneumothorax 4. Lumbar puncture and intrathecal administration of chemotherapy 5. BM aspiration and biopsy 6. Arterial blood gas analysis Module IV This module aims to equip trainees with essential knowledge , problem solving and patients' management skills in the following themes: 1. Endocrine Malignancies 2. Rare Tumors 3. Hematopoietic Stem Cell Transplantation (HSCT) 4. Pain Management 5. Late Effects of Chemotherapy 1. Outline the physiological background, Incidence, classification, and associated syndromes of the commonly seen endocrine malignancies 2. Discuss the clinical presentation, staging and treatment strategy for different en- docrine malignancies 3. Explain the importance of consultation with colleagues in adult oncology 4. Outline the role of high dose therapy with autologous stem cell rescue in the management of malignant disorders in children and young adults 5. Discuss the indications and role of allogeneic hemopoietic stem cell transplanta- tion (HSCT) in children, including the indications for HSCT from other than a matched sibling donor 6. Explain the principles of HLA (human leucocyte antigen) typing and donor se- lection, including the different potential sources of HSCT, and HSCT collection and cryopreservation 7. Describe the complications of HSCT and their management, including graft-vs.- host disease, veno-occlusive disease and graft failure 8. Outline the late effects of HCST in children, including growth, fertility and sec- ond malignancy 9. Discuss the Pathophysiology of pain in cancer patient 10.Explain the drug treatment of pain and the analgesic ladder 11.Describe different Pain syndromes 12.Outline practice guidelines for providing sedation and pain relief for practical procedures Intended learning outcomes Knowledge
  31. 31. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 34 Skills 1. Recognize, diagnose and manage late effects of malignancy, chemotherapy and radiotherapy toxicity 2. Develop follow-up plans for cancer survivors and counsel them appropri- ately 3. Manage patients with neuro endocrine tumors as a member within multidis- ciplinary team 4. Participate as a team member in HSCT for children with hematological ma- lignancies 5. Clinically assess, and identify patients who are not fit for further active can- cer treatment, or at the terminal stage of life 6. Attend to Quality of life issues and provide psychological support to the pa- tients and their family 7. Assess the patients pain score, stratify the different types of pain and measure their intensity 8. Choose treatment modality and use appropriately non-pharmacological treat- ments 9. Identify and manage side effects of pain treatment Neuroendocrine malignancies topics Method Of Learning Method Of Assessment Expected Year Of Achievement Classification of Neuro-endocrine tumors Lecturesandonjobtraining Finalwritten,clinical andoralexamination 2ndyear Clinical presentations and methods of diagnosis Staging and prognostic factors Role of surgery in localized & advanced disease Role of chemotherapy & radiation therapy for different disease stages side effects of treatment The principles of follow up The management of relapsed disease
  32. 32. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 35 Hemopoietic stem cell transplantation (HSCT) Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Role of high dose therapy with autologous stem cell rescue in the management of malig- nant disorders in children and young adults Lecturesandonjobtraining Finalwritten,clinical andoralexamination 2ndyear Indications for allogeneic HSCT in children Advantages of allogeneic HSCT and donor lymphocyte infusion in some non-malignant disorders Role and indications of allogeneic HSCT in the treatment of leukemia in children and young adults Principles of HLA typing and donor selection Complications of HSCT and their management Conditioning regimens used in HSCT and their side effects Role and complications of TBI in HSCT Principles and types of immunosuppression used in HSCT Infectious complication Late effects of HCST in children Rare tumors topics Method Of Learning Method Of Assessment Expected Year Of Achievement Types of adult malignancies that could occur in children Lecturesandonjob training Finalwritten,clinical andoralexamination 2ndyear The role of adult oncologists in the manage- ment of rare childhood tumors the diagnosis, staging, treatment & relation to adults' protocols The Clinical presentation and diagnosis of rare tumors Role of Chemotherapy, Surgery and radiother- apy
  33. 33. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 36 Pain management and palliative care Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Principles of palliative care and quality of life Lecturesandonjob training Finalwritten,clinical andoralexamination 2ndyear Pathophysiology of pain in cancer patient Drug treatment of pain and the analgesic ladder Pain syndromes Evidence based practice guidelines for the management of pain in cancer patients Complications and side effects of pain management Late effects of Chemotherapy Topics Method Of Learning Method Of Assessment Expected Year Of Achievement Delivering survivorship care Lecturesandonjob training Finalwritten,clinical andoralexamination 2ndyear Growth and neurocognitive sequelae of chemotherapy Systemic function abnormalities Second malignant neoplasms Hormonal function abnormalities Late mortality among childhood cancer survivors
  34. 34. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 37 Methods of assessment Regulations The general rules and regulations of assessment approved by the Egyptian fellow- ship board and published at the training handbook and the board web site applies for the pediatric oncology specialty. In addition to the successful completion of the training program, all candidates must successfully pass three exams in order to get the fellowship certificate.  First part Exam The first part exam is a written exam. Trainees will sit for the first part exam after completion of the first year of training. Each candidate has two chances to pass the exam. Failure for two times or more in the first part will result in request for repeti- tion of a specific period of training. The scientific council will determine the dura- tion of training extension. Candidates will not sit for the final certifying exam unless they pass successfully the first part exam and completed the required period of training  Second part exam The second part exam is a written exam. Trainees are allowed to sit for the second part exam after passing successfully the first part and after completion of the train- ing period. In addition, each candidate must submit his logbook for final assess- ment. The logbook requirements must all be completed and signed by the trainer and educational supervisor. Each candidate has three chances to pass the exam and one more additional chance may be granted in special approved circumstances.  Clinical Exam (third part) The third part exam is a clinical and oral exam. Candidates who pass successfully the second part are allowed to sit for the third part. Again, each candidate has three chances to pass the clinical exam and an additional fourth chance may be granted in special approved circumstances. Pre-requisite for entering the first part exam Trainees should pass the following courses in order to be eligible for the first part exam 1.Local TOEFEL with a score of at least 500 2.Computer courses in word processing, PowerPoint and internet Trainees who passed these courses during their pediatric fellowship training are not required to repeat it
  35. 35. Pediatric Oncology curriculum Egyptian Fellowship Board ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. ……………………. 38 Components and structure of examination The first part exam aims to test trainee's knowledge in module one of their cur- riculum. The following themes are subject for the first part examination 1. Cancer biology 2. Pathology & molecular biology 3. Chemotherapeutic agents 4. Clinical Pharmacology 5. Epidemiology & Biostatistics 6. Basics of Surgical Oncology 7. Basics of Radiation Oncology 8. Radio-diagnosis 9. Basics of Cancer Please revise the curriculum for details of topics and required learning outcomes PART I examination consists of two papers:  Paper I (2 hours): Multiple choice questions with a single best answer format.  Paper II (2 hours): short answer and /or problem solving questions Both papers will ensure coverage of the above-mentioned themes The second part exam aims to test trainees' knowledge and skills in the whole curriculum of pediatric oncology. In this exam, the scientific council will ensure coverage of the whole curriculum. Part II examination consists of four papers: 1- Two MCQ papers each two hours in duration  In both papers, facts, problem solving and management skills are going to be assessed. You will choose one best answer in each question 2- Two short assay papers each two hours in duration  Questions will assess Trainees' knowledge about various pediatric oncol- ogy problems and their management. In addition, it will test trainees' diag- nostic and problem solving skills. The structure of the first part exam The structure of the second part exam
  36. 36. Pediatric Oncology Curriculum Egyptian Fellowship Board …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. …………………… ………………….. 39 part III exam is a clinical and oral exam and is composed of the following compo- nents: Clinical exam The clinical exam remains the most important part of the examination as the long case evaluate the potential performance of the candidate in clinical practice while short cases assess clinical examination skills in various system. Passing this compo- nent of the exam independently is essential for certification.  Long Clinical Case : the candidate is observed in silence for the first part of the examination by two examiners where he/she is taking the history from the parent or the child and performing a physical examination and then The examiner asks him to present his findings in the history and examination and discuss the manage- ment of the case . Examiners give marks according to a predetermined weighting of the components of the exam.  Short case examination: Each candidate examines 2-3 patients. The examiners evaluate his abilities to correctly elicit and interpret physical signs or his abilities to take focused clinical history. An agreed marking system is used to ensure objec- tivity and fairness of the exam.  OSPE: A 10-20 station examination including radiological imaging/ laboratory data results / photographs / cytogenetics or pathology slides, simulated patients and procedural stations. Each station is five minutes and they test candidate diag- nostic, interpretative, procedural, management and communication skills  VIVA: The oral exam is composed of two oral examination stations. Each station is a committee of two examiners who will spend 20 minutes with the candidate (10 minutes for each examiner). They will test the candidates’ ability to manage vari- ous pediatric oncological problems and explores his/her abilities for making sound differential diagnosis. They will also assess his attitudes and interpersonal commu- nication skills. the exam is based on a set of topics with opening and supplemen- tary questions. The questions cards are prepared in advance together with the ex- pected ideal answer and allocated marks. This allows a good objective basis for marking. The structure of the third part exam

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