The overall goal of the program is to provide surgical oncology trainees with the education and skills to provide advanced management of solid tumors. Upon completion of the program, fully trained surgical oncologists develop a deep understanding of malignant disease biology including 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 their development.
The primary objective of the Surgical Oncology fellowship is advanced understanding of the multidisciplinary care of multiple cancers. Fellows in training 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.
Within the first two months of fellowship, fellows will meet with the program director or associate program director to explore and attain mentorship. Mentors 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 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 fellowship and associate fellowship director.
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
A total of 6 months in the fellows’ schedule will be dedicated to research endeavors-2 months in first year and 4 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. Fellows not reaching their research goals/metrics may lose future research months.
Fellows are evaluated on their surgical skills and their ability to complete the necessary operations. The outpatient experience is dedicated to the proper diagnosis, work-up, 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.
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 Skin/Mixed Tumor Oncology. 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 with the fellow acting as the higher-level consultant in order to guide daily rounds 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 generally acts as 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, perform stereotactic biopsies, understand the reconstruction options of the patients undergoing mastectomy with plastic surgery, learn the multidisciplinary care of Breast Cancer, and participate in the Breast Cancer Tumor Boards.
For the Melanoma rotation, they will learn to perform appropriate resections that may include complex closures, sentinel lymph node biopsies including injections in Nuclear Medicine, as well as both open and minimally invasive lymphadenectomies. They participate in the multidisciplinary program and attend melanoma-specific clinic.
For the Sarcoma rotation, they learn the role of Radiation and Chemotherapy particularly in the neoadjuvant setting 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 the 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.
2nd Year Objectives
During the second year, fellows have the opportunity to develop expertise in certain disease site areas clinical tracks. There will be 6 months in the second year dedicated to one or two disease site areas with participation in a 1-month rotation with medical oncology, radiation oncology, and pathology specific for those malignancies. These rotations are designed to give hands-on experience with practioners in these areas to better to understand the treatment modalities and the toxicities associated with these therapies in order to develop skills for non-surgical management of cancers.
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, melanoma, 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 limitations associated with histopathologic analysis and the benefits of immunohistochemical analysis. Woven into the entirety of the fellowship is an ongoing monthly Gastrointestinal Oncology Pathology conference led by both Pathology and Surgical Oncology faculty. Here several cases with controversial issues (eg margin discrepancy, diagnostic uncertainty, etc.) are selected from the previous month’s case logs and reviewed.
Optional 3rd Year
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 encouraged 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 principle investigator in a Basic Science Laboratory. During this time, the overarching objective is to begin or complete writing a career development award.
A large portion of the didactic component is the Weekly Fellow's Conference (every Friday). This conference will follow a dedicated timeline that alternates between NCCN guideline review, fellow topic presentation, landmark clinical trials session, surgical oncology board preparation sessions, and a quarterly presentation by a Surgical Oncology faculty member. 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. Fellows are also expected to attend the weekly didactic session led by Medical Oncology. These are typically led by non-surgeon faculty members with occasional lectures by members of the division of Surgical Oncology
An additional monthly fellows conference will be held offsite with the surgical oncology staff. 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.).