Goals
The goal of the program is to provide surgical oncology fellows with the education and skills needed to provide multi-disciplinary care of patients with solid tumors. Upon completion of the program, fully trained surgical oncologists will be proficient in complex surgical cancer care including a deep understanding of malignant disease biology, diagnosis, staging evaluations, treatment options, and expected response. While surgical management is often important, non-surgical cancer management is heavily emphasized in both potentially curative and palliative situations. In this regard, fellows are trained to provide care with confidence, evidence, and compassion. The concepts of survivorship, pain control, nutrition support and honest discussion about end-of-life are all critical to the development of a surgical oncologist.
Objectives
The primary objective of the surgical oncology fellowship is an advanced understanding of the multidisciplinary care of solid tumors. Surgical oncology fellows will undergo an intense patient care experience including ambulatory clinics, hospital inpatient care, tumor boards and other research and administrative experiences. The importance of understanding the differences between curative and palliative intent will be emphasized. As fellows advance in the program, they will have multiple opportunities to participate in high level cancer education for both general surgery residents and medical students.
Mentorship
Within the first two months of fellowship, fellows will meet with the program director or associate program director to explore and attain mentorship. If a mentor is not identified by the fellow an initial mentor will be assigned to assist fellows in career development as well as clinical and research goals; more than one mentor can be chosen depending on the needs and goals of the fellows. Fellows can change their mentors as their career goals evolve. Fellows will be required to meet at least quarterly to evaluate current progress with their clinical and career development goals – these meetings will be reported and monitored by the program director and associate program director.
Professional Development
Fellows will receive instruction on activities that will promote their academic and clinical development and how to document these items in their CV and/or academic dossier. The importance and impact of teaching/curriculum development, scholarly activities (publications, clinical trials, and funded proposals), service to the discipline and surgical community and national reputation will be covered as will strategies to increase one’s effectiveness in each of these areas. The optimal format and structure of the CV will be discussed, and each fellow will be tasked with creating an up to date and modifiable CV. The components that go into a formal academic dossier will be reviewed, and the promotion and tenure process will be explained. This instruction will take place using a format of 2-3 interactive instructional lectures each year.
Research Objectives
A total of 4 months in the fellows’ schedule will be dedicated to research endeavors-2 months in first year and 2 months in second year. Fellows will have the opportunity to participate in research tracks to facilitate the foundations and skillsets needed for their academic career goals. This time is intended to be utilized to address gaps in investigative techniques that will be important for future research success. This includes didactic courses and seminars as well as mentorship to develop hypotheses, research aims, experimental techniques, potential pitfalls and alternative options, relevance towards overarching goals, and collaborators that will contribute expertise. As a deliverable, all fellows will be required to submit at least one first-author paper to a peer-reviewed journal and one abstract to a national professional meeting per year. Based on the type and scope of the fellow’s research interests, additional research metrics will be determined by the fellow and the fellowship/associate fellowship director. Quarterly meetings will be conducted to ensure that these research goals are met.
Clinical Objectives
Fellows are evaluated on their surgical technique, skills, intraoperative judgement and their ability to complete the core operations. The outpatient experience is dedicated to the proper diagnosis, work-up, treatment planning and follow-up of various cancers. As part of this training, the fellows are expected to attend and actively participate in multidisciplinary tumor board conferences dedicated to each individual disease type. Through these tumor boards, fellows will learn and participate in multidisciplinary discussions that involve disciplines including surgery, medical oncology, radiation oncology, radiology, pathology, and gastroenterology among others. This affords them the opportunity to interact with other oncology disciplines in order to become well rounded in the non-surgical management of cancers.
Fellows also have the opportunity to continue their surgical skill development by participating in dedicated robotic surgery as part of our large robotic surgery program. This includes didactics and lab experience with simulators and large animals. Fellows are expected to learn all aspects of robotic surgery including robot setup, docking, troubleshooting, bedside assist, and primary console surgeon. At the completion of their training, fellows are expected to actively participate in robotic operations on patients under the direct guidance of experienced robotic surgeons. It is expected that faculty will allow progressive robotic operative autonomy.
Weekly Schedule
OR schedule assignments are made a week at a time in collaboration with the fellows and senior residents on service. It is the expectation that fellows and senior residents will cover their service’s cases, and that medical students and junior residents, if not in clinic, post-call, covering the floor, or otherwise assigned, will doublescrub more complex cases on their service. Chief and senior residents are responsible for notifying the fellows on service, and their attendings, if they will be post-call on an operative day, so that appropriate case coverage can be identified. Attending surgeons, at their discretion, can request a fellow cover a case outside of their service if the attending requires fellow-level assistance.
1st Year Objectives
In the first year of fellowship, the fellows are expected to participate in the care of various inpatient services. These include: Gastrointestinal Oncology, Endocrine, Breast, and Melanoma/Sarcoma. Each service is also made up of General Surgery Residents as well as physician extenders. While on rounds, fellows are expected to oversee the general cancer principles and make a plan for each day for the care of the patient. In addition, they oversee the post-operative management of their patients including the management of postoperative complications. This includes working with non-surgical consulting services in order to best coordinate the care including palliative services for patients with incurable cancers. The fellow is expected to guide the daily management of the patients on service and provide education for the residents and medical students. The fellow assists with planning the staffing of the OR schedule each day, as well as assigning trainees to attend the necessary outpatient clinics each day. The fellow is required to attend clinic each week associated with their individual rotation and/or attending.
In the operating room the fellow initially acts as the first assistant to the attending surgeon but is expected to complete varying levels of the operation with a graded increase of responsibility with each operation. This includes observing more complex portions of the operation while becoming facile in completing these tasks independently. Fellows are always under observation even when given independence to complete the operation themselves. Support is always available for the fellows in the operating room by the attending surgeon and they are encouraged to seek help for the efficient and safe completion of the operation. Each rotation in the first year is a one-month block rotating back and forth between the various disease-specific services. During that time the fellows work with the attendings within those specialties to attend their clinics, multidisciplinary conferences, and procedures in the OR.
- Fellows are expected to learn how to properly work up, diagnose, manage and follow the cancers associated with these diagnoses within each disease-site service.
- For the Breast rotation, they are expected to spend time at the Stefanie Spielman Comprehensive Breast Center, where they will learn to read mammograms, understand the reconstruction options of the patients undergoing breast cancer surgery with plastic surgery, learn the multidisciplinary care of Breast Cancer, and participate in the Breast Cancer Tumor Boards. For the Melanoma/Sarcoma rotation they will learn the complex management of skin and soft tissue sarcoma malignancies. In regard to cutaneous malignancies, they will learn to perform appropriate resections that may include complex closures, sentinel lymph node biopsies including injections in Nuclear Medicine, both open and minimally invasive lymphadenectomies, and mastectomy. They will participate in the cutaneous surgical oncology clinic and multidisciplinary cutaneous tumor board meetings. For sarcoma they learn the role multimodality care and the timing of radiation and chemotherapy relevant to surgical resection and participate in the multidisciplinary conferences. They learn about the pathology associated with the various types of sarcoma and the multidisciplinary approach to the treatment of both retroperitoneal and extremity sarcomas.
- For the Endocrine rotation, they learn to perform diagnostic ultrasounds of the neck, perform ultrasound guided biopsies of neck lesions, perform complex operations of the neck, including modified radical neck dissections. They are expected to understand the work-up of adrenal masses, as well as minimally invasive resection of adrenal masses. They will learn multidisciplinary treatment options for endocrine cancers.
- On the Gastrointestinal rotation, fellows learn about complex GI malignancies, including palliative management, liver, pancreas, neuroendocrine, gastric and various other gastrointestinal malignancies. Fellows are expected to understand the various modalities that are used to treat gastrointestinal and HPB malignancies as well as participate in the multidisciplinary conference.
- On the MRP rotations fellows are assigned to medical oncology, radiation oncology, and pathology clinics covering the broad range of surgical oncology.
- While on Medical Oncology, fellows are expected to learn about the different classes of chemotherapeutic agents and their application. They learn about the toxicities associated with chemotherapy and how to manage these toxicities. They will also learn about surgical complications associated with chemotherapy and the timing of management. Fellows who have developed a focused interest in one or more areas of oncology will be able to focus their rotations with practioners in that area, such as focusing on breast cancer, cutaneous, soft tissue, and GI cancers.
- On the Radiation Oncology rotation, fellows are expected to learn the indications of radiation treatment for various cancers and the associated toxicities. They are expected to gain an understanding of the limitations of radiation with regard to non-target organ dosing and how this impacts surgical outcomes. In addition, fellows gain experience with intraoperative radiation to learn indications for its application.
- During their Pathology rotation, fellows are expected to spend time in the frozen section lab to learn about the indications for frozen section analysis, the process by which specimens are evaluated, and the limitations inherent to frozen sections. They are also expected to spend time in the gross room to see how main surgical specimens are processed. Finally, they spend time with pathologists reading slides to understand the histopathologic analysis and the benefits of immunohistochemical analysis.
2nd Year Objectives
During the second year, fellows have the opportunity to develop expertise in certain disease site areas clinical tracks. There will be 4 months in the second year dedicated to one or two disease site areas of interest with a second MRP month focusing on these diseases. This rotation is designed to reinforce the broad experience from first year and allow the fellows to better understand the treatment modalities and the toxicities associated with these therapies in order to develop skills for non-surgical management of cancers. Additionally, early during the beginning of their first year, fellows have the opportunity to apply for the OSU Hepatobiliary Fellowship. The Hepatobiliary Fellowship is comprised of focused second year clinical rotations. Dr. Jordan Cloyd is the Program Director of the OSU Hepatobiliary Fellowship; interested fellows should reach out early to learn more about the program and how to apply.
Optional 3rd Year Objectives
Fellows have the opportunity to participate in an optional third year of fellowship. This is dedicated to basic science, translation science, or clinical outcomes/quality research on The Ohio State University campus. It is required that the fellows going this route seek out additional funding for support. The goal of this optional third year is to prepare the fellows for a career in academic Surgical Oncology, where they have a dedicated interest in becoming a principal investigator. During this time, the overarching objective is to begin or complete writing a career development award.
Didactic Objectives
A large portion of the didactic component is the Weekly Fellow's Conference (every Wednesday). This conference will follow a monthly disease site specific rotation of faculty lecture, landmark clinical trials session, surgical oncology board preparation sessions, and journal club. Fellows are expected to prepare for discussion of the surgical and non-surgical management of the cancer type being presented/discussed. This is attended by the Surgical Oncology faculty with the addition of various non-surgeon faculties as the topic dictates.
An additional monthly fellows conference will be held offsite with the surgical oncology faculty; this is called the Unofficial Fellows Conference. This conference is designed to assist in “real-world” aspects of a surgical oncology practice (i.e., Interviews, job search, promotion, funding opportunities, marketing etc.) and the topics are selected each month by the fellows.