Medical Oncology Curriculum

Egyptian Fellowship Board

Medical Oncology Curriculum

Preface

T he Egyptian Fellowship board and the Medical Oncology scientific council worked collabora-

tively 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 has already defined and published its standards for the general

and professional competencies expected from our graduates in different specialties upon success-

ful completion of training. These expectations are clearly reflected in the 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 in

the selection of their readings and in the choice of learning activities. To maximize benefits, we

also provided tables in the logbook for required cases and procedures at various training stages.

In addition, We provide access for the curriculum and logbook through the fellowship website and

we recommend that our trainees and trainers regularly check the site for updates and important

announcements . We hope that all our trainees, trainers and educational supervisors will use the

curriculum as a guide for their teaching and learning and cooperate with The Egyptian Fellowship

Board and Medical Oncology Scientific Council to implement the curriculum in the best ways. XáÅtà T{Åxw f{xut

Secretary General Higher Committee of Medical Specialties

Acknowledgement

This curriculum has been created through collaboration between The Medical Oncology Sci-

entific Council and The Egyptian Fellowship Curriculum Committee. The following members

of the Medical Oncology Scientific Council have made substantial contribution to the cur-

riculum 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 medical on-

cology. The external references for the development of this curriculum are:

1. The medical oncology curriculum approved by the Joint Royal Colleges of Physicians Training Board 2007

2. The previous Egyptian board curriculum in Adult oncology

3. The Egyptian Board Guidelines for curriculum development 2007

4. Postgraduate Medical Education and Training Board UK (Guidelines for curriculum development 2006)

• Professor Dr Hussein Khalid, Professor of medical oncology, Dean of the National

Cancer Institute and Head of the medical oncology scientific council

• Professor Dr Mustafa El Serafy, Professor of medical oncology, National Cancer In-

stitute

• Dr Ola Khorshid, Lecturer of medical oncology, National Cancer Institute

• Professor Dr Eman Abd El Raouf, Professor of Pediatric Hematology, Cairo Univer-sity and Educational consultant to The Egyptian Fellowship Board

The Egyptian Fellowship Board

7

Table of contents

Preface and acknowledgement ……………………………………………………………………………………….3

Entry requirements and training rotations ………………………………………………………………………....9

Regulations of training and trainees obligations…………………………………………………………………10

Rationale statement …………………………………………………………………………………………………..14

Intended learning outcomes ………………………………………………………………………………………...15

Training themes……………………………………………………………………………………………………….16

Stage 1 training contents ………………………………………………………………………………………..…..17

Stage II training contents …………………………………………………………………………………………..22

Practical Medical oncology ……………………………………………………………………………..26

• Head and neck cancer …………………………………………………………………...28

• Lung cancer ………………………………………………………………………………...29

• Mediastinal tumors ………………………………………………………………………..30

• GIT tumors…………………………………………………………………………………..31

• Genitourinary tumors……………………………………………………………………...35

• Breast cancer……………………………………………………………………………….39

• Female genital tract malignancies ……………………………………………………...40

• CNS tumors………………………………………………………………………………....44

• Soft tissue and bone tumors…………………………………………………………….…45

• Skin tumors………………………………………………………………………………….46

• Neuroendocrine malignancies …………………………………………………………...47

• Lymphomas …………………………………………………………………………………48

• Leukemias……………………………………………………………………………………49

• Plasma cell neoplasms……………………………………………………………………..51

• Myeloproliferative disorders……………………………………………………………...52

• BMT…………………………………………………………………………………………..53

• Oncological emergencies…………………………………………………………………..54

• Palliative care ……………………………………………………………………………...55

• Pain management in cancer patients……………………………………………………..56

Regulations and methods of assessment …………………………………………………………………………..57


8


9

The Egyptian Fellowship Board requires three years of supervised training program that must

be conducted in accredited oncology hospitals and centers before sitting for the final examination.

The Board will announce a list of accredited training centers yearly. Entry to the medical oncology-

training program has the following requirements for trainees who are affiliated to MOHP:

• Graduation from medical school and successful completion of the pre-registration

house officers' year

• Master in General Medicine or higher qualifications (within five years)

• M.R.C.P. or equivalent with evidence of recent training in general internal medicine

satisfactory to the Egyptian Board requirements

• Fellowship of Egyptian Board of General Medicine (At least the 1st two years of fel-

lowship with successful pass of the first part exam and evidence of training in the

logbook denoting that the candidates has completed training requirements as clari-

fied in the general internal medicine curriculum)

During the entire training program, the candidate must be dedicated full time. He or she must get

gradually increasing responsibilities for patient care according to the stage of training and available

supervision.

Training Rotations

Medical oncology trainees must spend their training period in the following services:

a. Hematological malignancies service (12 months)

b. Solid tumor service (18 months)

c. Bone marrow transplantation service (6 months)

d. In addition, attendance to radiotherapy department, oncology surgery wards, clinical pharmacol-

ogy 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.

To be noted that the rotation between solid tumor service and hematological malignancy services are

flexible and candidate may start by any of them and rotate to the other according to service needs.

However candidates should have spent the above mentioned durations by the end of training.

• Bone marrow Transplanation rotation must be accomplished in a dedicated bone mar-

row transplantation center as a full time rotation for the whole mentioned period of

training (6 months)

The Structure and Regulations of Medical Oncology Training


10

Trainees duties and obligations

1. Trainees must attend at least 75% of lectures on medical oncology subjects.

2. They should pass successfully through the first part exam before being eligible for the final

exam.

3. Trainees should be actively involved and responsible for patient care including sharing in

making decisions about diagnosis and management under supervision 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 full time residents in the training specialty and they must fulfill 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.

Specific Requirements and Obligations

Obligations towards the Admitted Patients:

1. The trainees will be responsible for supervised admission of patients from the outpatient

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 supervisors

• 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.


11

2- Obligations in the outpatient Clinics:

The trainees should attend various medical oncology outpatient clinics and clinics related to

the rotation in radiotherapy, nuclear medicine and surgical oncology and BMT as requested

by trainers and supervisory staff. They should participate in different patients' interviews and

share in management according to stage of training.

3- Mandatory Clinical and Academic Activities:

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 num-

ber 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

4. The Log Book: The trainees must keep and update their logbook where they record all ac-

tivities 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 assis-

tant or participant. The trainer and finally the educational supervisor should counter sign each

activity registered in the Logbook. The Trainer and educational supervisor must sign the com-

pleted Log Book. The trainers must revise the logbook weekly. Educational supervisors must

revise the logbook and provide feedback on monthly basis.

5. The Research project: 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 completed satisfacto-

rily the rotations described in the structure of the program, performed him/herself, and as-

sisted in the various requested procedures.


12

General Rules and Regulation

Holidays and on call duties:

• According to Ministry of Health and Population regulation

Evaluation Procedures:

• Performance of the trainee must be evaluated on regular and continuous basis. The

evaluation process should involve all aspects of the training including theoretical, 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 sat-

isfactory level of performance acceptable to the responsible trainer and educational su-

pervisor.

Interruption of Training

It is not permissible to interrupt such a structural training program except in major un-

avoidable 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 result in dismissal from the

program and cancellation of the preceding training period.


13


14

• The purpose of this curriculum is to describe the knowledge, skills, behaviors

and attitudes expected from medical oncologists upon completion of train-ing . 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 that are going to be used. The curriculum contents have been formulated through

the following methods:

1. Revision of previous fellowship medical oncology curriculum

2. Revision and benchmarking of international curricula for postgraduate training in medical oncology. We specifically mention the oncology

curriculum approved by the Joint royal colleges of physicians training

board and the PMETB in 2007. 3. Consultation of experts in the field of adult oncology.

• Representatives from the medical 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 May 2008

RATIONALE STATEMENT


15

The aim of the curriculum is to equip Egyptian fellowship trainees in the specialty of medical oncol-

ogy with knowledge, skills & attitudes necessary for efficient & independent practice as oncology

specialists.

By The end of training program fellowship graduates must be able to:

1. Apply a comprehensive knowledge-base that includes basic scientific principles of pathology &

cell biology, basic pharmacology, clinical trials methodology, epidemiology, statistics, radiobiology,

principles of therapy to patients' management & investigations

2. Interpret clinical findings gathered from the clinical history & clinical examination & use the data to

solve patients' diagnostic problems

3. Successfully formulate a diagnosis or differential diagnosis

4. Select the appropriate cost effective investigations

5. Formulate a management plan for both the inpatient & outpatient settings that is evidence-based,

patient centered & addresses all aspects of the health care needs.

6. Recognize the limitation of his own expertise & be obliged to seek assistance from colleagues

where appropriate

7. Effectively communicates with colleagues & patients & work collaboratively with other health care

professionals as a team member or a team leader

8. Develop the necessary skills for life-long learning to keep up-to-date with developments in cancer

medicine

9. Perform competently core procedures appropriate to Medical Oncology

10.Assist in the management aspects for planning & implementation of clinical trials.

11.Use effectively the current methods in Information Technology

12.Efficiently manage time & resources to the benefit of patients & the health care system

13.Identify & take responsibility for his own educational needs & the attainment of those needs

14.Provide health education & health promotion consultations for patients & their care givers. in

addition he should be able to provide educational sessions for junior colleagues on matters re-

lated to oncology practice.

15. Be committed to the highest standards of care & behave ethically & professionally as expected

from medical oncology practitioners.

CURRICULUM AIM

GENERAL INTENDED LEARNING OUTCOMES


16

The medical oncology training program require any of the following qualifications as an entry re-

quirement to the program

• Master in General Medicine or higher qualifications (within five years)

• M.R.C.P. or equivalent with evidence of recent training in general internal medicine satisfactory to

the Egyptian Board requirements

• Fellowship of Egyptian Board of General Medicine (At least the 1st two years of fellowship with

successful pass of the first part exam and evidence of training in the logbook denoting that the

candidates has completed training requirements as clarified in the general internal medicine cur-

riculum)

The training in medical oncology is composed of two stages. The first year of training represents stage

one. In this stage trainees study the following themes & spend their first year of residency in medical

oncology services.

1st year (stage 1)

1. Cancer Biology

2. Clinical pharmacology

3. Pathology

4. Epidemiology and biostatics

The second stage of training is two years in duration. During which the candidate is going to work as

a full time resident in oncology services with specific rotations (clarified in the training rules and regula-

tion section). In addition, he must study the following modules :

ENTRY REQUIREMENTS FOR THE EGYPTIAN FELLOWSHIP OF MEDICAL ONCOLOGY

TRAINING THEMES

First year Mark Total: 200

Cancer biology →→→→ 50

Clinical pharmacology →→→→ 50

Pathology →→→→ 50

Epidemiology & biostatistics →→→→ 50


17

By the end of stage one training in medical oncology, trainees should have adequate knowledge

& deep understanding of:

1. The basic principles of cancer biology

2. The Molecular & genetic characteristics of normal & malignant cells (Genomics & proteoge-

nomics)

3. The principles & methods of molecular biology techniques

4. The growth of normal & malignant cells

5. The characteristics, pharmacokinetics & pharmacodynamics of cytotoxic drugs

6. The principles for clinical use of different chemotherapeutic agents

7. The pathology of tumors & different staging systems

8. The principles of research design & study methodology

9. The basics of medical biostatistics relevant to the practice of medical oncology

Stage II Second year Third year Mark Total: 900

Bases of Diagnostic radiology →→→→ 50

Bases of Surgical oncology →→→→ 50

Bases of radiation oncology →→→→ 50

Cancer chemotherapeutic agents

→→→→ →→→→ 125

Practical Medical oncology →→→→ →→→→ 300

Hematological malignancies

→→→→ →→→→ 200

Bone marrow transplantation

→→→→ 150

Nutrition for cancer patients →→→→ 25

STAGE 1 Applied Basic Sciences

INTENDED LEARNING OUTCOMES


18

Cancer Biology topics Method Of Learning

Method Of Assessment

Expected Year Of Achievement

• Definition of initiation of molecular bases in cancer devel-opment & different growth disorder

• Mechanism of spread, invasion migration & metastasis

Lectures and self study

First part exam

1st year

• Normal chromosomal structure & function, normal gene transcription & its control

• Normal DNA repair mechanisms

• Polymorphism, mini & micro satellites

• Chromatin structure & function

• Methylation, hypo-methylation & methylation reversal

• Chromosomal & genetic changes in malignancy, point mutation, translocations, deletions, gene amplification & over-expression

• Nucleic acid analysis including electrophoresis, hybridiza-tion, blotting, PCR, sequencing, transfect ion

• Micro array

• Transgenic models

• Signal transduction (MAP Kinases) • The role of cyclin Kinases • Gene promoters & their activity in normal & malignant

cells

• Principles of genetic mechanisms of cancer progression • post genome challenge for molecular medicine, proteomics

• Principles of molecular targets in oncology including signal transduction, cell cycle, apoptosis & telomerase

• Principles of invasion & metastasis • Principles of angiogenesis

• Molecular methods in oncology, including amplification tech-niques, RNA interference, cDNA arrays, tissue arrays, cytogenet-ics, bioinformatics


19

Applied pharmacology topics Method Of Learning


Expected Year Of

Achievement

Characteristic of individual Cytotoxic drugs (alkylating agents, Enzymes inhibitors, anti-metabolites, ant micro-tubules, miscellaneous…) this includes the following

1. Chemical & structure 2. Mechanism & mode of actions 3. Drug resistance mechanism & its modifications 4. Doses & administration 5. Phases of drug development & screening at pre-

clinical levels 6. Main indications in clinical use


First part exam 1st year

Pharmacokinetics & dynamics 1. General principles 2. Route & timing of administration 3. Plasma concentration & its relationship to drug ac-

tion 4. Area under the curve (AUC) 5. Drug activation, metabolism & clearance 6. Protein & tissue binding 7. Drug concentration at the target site

Principle of clinical use 1. Dose response curves 2. Dose intensity& dose density 3. Single agents & combination therapy 4. Adjuvant & new adjuvant therapy 5. High dose chemotherapy 6. Regional & infusion therapy


20

Tumor Pathology topics Method Of Learn-ing

Method Of Assess-ment

Expected Year Of Achieve-

ment Introduction to general pathology


First part exam 1st year

The range of tumors that can develop from normal tissue components Etiology, incidence & epidemiology ( international & national ) of malignant tumors A brief morphology of common tumors (macro & micro), grading & differentiation of tumors

The natural history of the malignant disease, pres-entations, characteristics of their growth & spread Staging systems classifications i.e. TNM, FIGO….

Use of specialized pathology techniques e.g. Im-muno-histochemistry, Phenotype, cluster of differ-entiation ( CD) classifications FISH & CISH, micro array & geneprint

The use of clinicopathological data in multidiscipli-nary approach for patients management


21

Epidemiology & biostatistics topics Method Of Learning


Expected Year Of Achievement

Design & interpretation of retrospective (case control) & prospective (cohort) studies

Lectures, workshop and self study

First part exam

Odds ratio & relative risks mortality rates & standardized mortality rates Cancer registration & follow up Trends in cancer incidence & mortality for major cancers Meta analysis of clinical trials Type of data :(individual variables & ordinal data, numerical, Bar charts & histograms, central tendency & spread) Sampling :( concept of a source population, random sam-pling. Estimation of population statistics, stander error, refer-ence range) Principles of statistical inference:( hypothesis testing & esti-mation, Type I & II errors, interpretation of p value & confi-dence intervals, statistical & clinical significance) compare 2 or more groups:(T-test, Chi square with correc-tion) Measure & test association between variables:( correlation & regression, scatter plots, screening tests; sensitivity specificity positive & negative predictive value) Survival analysis: (Type of time-to -event data, presentation of survival data, Kaplan-Meier & actuarial survival curves, log rank test, Cox's proportional hazards regression model, haz-ard ratio)

1st year


22

STAGE 2

Module 1 Bases of diagnostic radiology

ILO

Code

Description

Meth

od f Learn

ing

Meth

od of A

s-sessm

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge

By the end of the module the candidate will have adequate knowledge & deep understanding of :

Final w

ritten an

d clinical exam

s

Second year of train

ing

Imaging modalities including radiography, ultra sound, CT & PET scan, MRI, H spectroscopy & nuclear medicine methodology& intervention radiology

Pretreatment imaging ,therapeutic response assessment, follow up

Understanding of RECIST & BIRAD criteria

Intellectual & professional skills

Interpretation of x-rays, mammograms, CTs, MRI, pet scans, bone scans

Interpretation of RECIST & BIRAD criteria

• Lectu

res

• Radiolog

y roun

ds •

On

the job train

ing

Module 1 Bases of diagnostic radiology Module 2: Bases of radiation oncology Module 3: Bases of surgical oncology Module 4: nutrition in cancer patients

Module 5: Cancer chemotherapeutic agents Module 6: Practical medical oncology Module 7: Hematological malignancies Module 8: Bone marrow transplantation


23

Aim of module: to fully understand the principles of the biological, physical & clinical aspects of radiation oncology

Module 2 Bases of Radiation Oncology

ILO C

ode

Description

Meth

od f

Learnin

g

Meth

od of

Assessm

ent

Exp. Year of A

chievem

ent

Know

ledge

By the end of the module the candidate will have adequate knowledge & deep understanding of:

• Lectu

res •

Self study

Final w

ritten an

d clinical exam

s

Principles of radiation biology & normal tissue tolerance

Principles of radiation physics, fractionation & dosing, Brachytherapy, focused therapy (gamma knife, IMRT….)

Clinical aspects of radiation oncology & toxicity, interaction with chemo-therapy, Potentiation & protectors

Skills and attitu

des

Demonstrate an analytical & scientific approach & shows a range of problem-solving skills

• su

pervised practice •

Rotations in radia-

tion on

cology de-

partmen

t

Recognize indications for radiotherapy and liaise appropriately with colleagues from radion oncology department

Anticipate and recognize toxicities related to radiotherapy and manage them appropriately


ing

Aim of module: to fully understand the general principles of surgical oncology

Module 3 Bases of Surgical Oncology

ILO C

ode

Description

Meth

od f

Learnin

g

Meth

od of

Assessm

ent

Exp. Year of A

chievem

ent

Know

ledge an

d skills

Discuss the role of surgery in diagnosis & staging of different types of cancer including surgical endoscopies

• Lectu

res •

Self-directed learnin

g •

Atten

dance to su

rgical on

cology depart-

men

t and ou

tpatients

Final w

ritten an

d clinical exam

s


ing

• Outline different types of surgery & their indications in cancer treatment and expected complications

• Discuss the methods of venous access , management & maintenance

• Define the principles of organ preservation and the role of medical oncologists in the preoperative evalua-tion of cancer patients

• Recognize the indications for interventions from surgi-cal oncologists and be able to liaise with colleagues in surgical oncology department

By the end of the module the candidate will be bale to


24

Aim of module: To be able to manage nutritional disorders in cancer patients

ILO C

ode

Description

Meth

od of Learn

ing

Meth

od of A

ssessmen

t

Exp. Year of A

chievem

ent

Know

ledge

By the end of the module the candidate will have adequate knowledge & deep understanding of:

• Lectu

re, •


g •

Final exam

part 2&3

• Th

ird year of trainin

g

• Calories, protein, CHO, fat , fluid & electrolyte require-ments

• Parental & tube feeding

Intellectu

al & professio

nal skills

Take nutritional history in a detailed, reliable & accurate method & clinically examine & formulate a differential diagnosis for possibilities of nutritional problems

• on

the job rain

ing

• Log

book •

OSC

E •

Short &

long

case exams

• Th

ird year of training

plan, implement & interpret appropriate cost-effective diagnostic investigations for identification of problems related to nutrition

Plan for and follow nutritional support both enteral and parenterally for indicated cases

Communicate effectively with nutrition specialists and consult them in indicated cases

Attitu

des

Demonstrate an analytical & scientific approach to problem-solving & shows a range of problem-solving skills

• O

n th

e job trainin

g

• D

etailed observation •

Logbook

• O

SCE

• Sh

ort & lon

g case exam

s

• Th

ird year of training

Use drugs & non-pharmacological treatments appropriately

work within a multidisciplinary team & recognize the need & make appropriate referrals to other health care professionals

• Nutritional disorders in cancer patients

Module 4 Nutrition & hyperalimentation


25

Module 5 Cancer Chemotherapeutics

ILO C

ode

Description

Meth

od f

Learnin

g

Meth

od of

Assess-

men

t

Exp. Year o

f A

chieve-

men

t

Know

ledge

By the end of module, candidates should have ade-quate knowledge and deep understanding of :

• Lectu

re, •


g

• Jou

rnal clu

b

• Part 2 exam

• Secon

d year of trainin

g

• Cancer drug development & assessment of efficacy in vivo & in vitro— Mode of action of cytotoxic drugs , phases of the cell cycle,

• Mechanisms of intrinsic & acquired drug resistance & pos-sible strategies for its circumvention

• Principles of pharmaco kinetics & pharmacodynamics

• Clinical use of cytotoxic drug, by understanding the dose response curves, dose intensity & dose density,

• The indications & goals of chemotherapy in primary & metastatic cancer, including both adjuvant & neoadjuvant therapy, & as radiation sensitizer, intra-cavitary therapy, Hyperthermia

• Methods of assessment of a patient's comorbid medical conditions to determine the risk/benefit ratio of chemo-therapy for that individual

• Clinical application & evaluation of cytotoxic drugs, endo-crine therapies & biological agents

• Principles of adverse effects of cytotoxic drugs & their man-agement

• Combination & sequential therapy, metronomic chemo-therapy

• Role of dose intensification & indications, complications & adverse effects of high dose therapy

• Clinical pharmacology of antiemetics, biologic & targeted therapy ( monoclonal antibodies, TKI, tumor vaccines, cel-lular therapy, antiangiogenesis, cytokines)

• Clinical pharmacology of bisphosphonates,

• Clinical pharmacology of analgesics including drug combi-nations & different formulations

• Central Venous access devices

Intellectual &

pro-fession

al skills

Competent Cannulation, & handling CVL and intrathecal injections

• O

n th

e job train

ing

• C

linical ph

ar-m

acy observa-

tion

• Lectu

re

• Self directed learn

ing

• Preparation

of

flow ch

art of m

anag

emen

t of each

• Part 2 exam

• O

SCE

• log

book

• Secon

d year

Safe Drug preparation, administration & handling of chemotherapeutic drugs

Manage acute and late complications of chemotherapy

Aim of module: - To enable trainees to define basic principles in pharmacokinetics, pharmacodynamics. Also to define the mode

of action of drugs, drug development, principles of clinical use, toxicity of chemotherapy, clinical pharmacol-ogy of drugs used in supportive care, bases of endocrinal therapy & biological & novel therapy.

- To enhance their abilities to critically evaluate new methods of treatment


26

A-Specific diseases: module 1-13

B– BMT, Palliative and supportive care

1. Head and Neck Cancer (including lip, oral cavity, hypopharynx, nasopharynx, supraglottic, vocal

cord, subglottic middle ear, nose and nasal sinuses, orbit and optic nerve, lacrimal gland, salivary

gland, glomus jugulare tumors and carotid body tumors)

2. Lung Cancer (Non Small Cell Lung cancer, small cell lung cancer)

3. Mediastinal tumors: (including thymoma, mesothelioma)

4. Gastrointestinal ( including esophageal, gastric, Colorectal Cancer and anal carcinoma, liver ,

pancreas, biliary tract an gall bladder cancers)

5. Genitourinary: (including renal carcinoma, Cancer Bladder, Cancer Prostate, testicular tumors

(germ cell tumors)

6. Breast cancer

7. Female genital: Cancer Ovary, Cancer cervix, endometrial carcinoma, Gestational trophoblastic

diseases, cancer vulva, cancer vagina

8. Central nervous system Tumors (including brain, spinal cord, craniopharyngioma, chordoma,

acoustic neuroma and meningeal tumor)

9. Soft tissue and Bone tumors

10. Skin (melanoma, basal cell carcinoma, squamous cell carcinoma)

11. Endocrinal (medullary thyroid, parathyroid, pituitary, suprarenal, adrenal medulla, pancreatic, car-

cinoid)

12. Metastasis of unknown Primary

13. Lymphoproliferative and myeloproliferative disorders (lymphoma (HD, NHL) acute and chronic

leukemia, MDS, Multiple myeloma, Polycythemia Vera, essential thrombocytosis, agnogenic mye-

lofibrosis)

14. Bone Marrow Transplantation

15. Oncological emergencies

16. Palliative care

17. Pain management in cancer patients

Practical Medical Oncology

Specific diseases in oncology


27

General description of all modules Aim of each module: is To enable trainees to manage cancer patients within a multidisciplinary team

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge

By the end of the module the candidate will have adequate knowl-edge and deep understanding of

• Lecture,

• Self-directed learnin

g

• Case-based stu

dies with

discussion

& problem

-solvin

g

• Journ

al club

• Final exam

part 2 and 3

• Second an

d third years of train

ing

Epidemiology (incidence & mortality), screening & risk factors

Anatomical considerations, pathogenesis and tumor biology

Pathology and natural pattern of spread

The clinical picture , requested investigations and plan of management

The principles for staging each disease

The principles for Screening and prevention of cancer

Role of surgery in localized & advanced disease & results, morbidity & mortality

Role of chemotherapy & radiation therapy in the adjuvant or neoadju-vant setting & for locally advanced or metastatic disease & results

The principles for Management of relapsed disease

Intellectu

al & profession

al skills

Determine the risk of each cancer • C

linical case rou

nds an

d on th

e job trainin

g

• Log

book

• O

SCE

• Sh

ort & lon

g case exam

s and oral exam

• 2

nd part exam

• D

urin

g all th

e trainin

g period

Take history in a detailed, reliable and accurate method and clinically examine & formulate a differential diagnosis with the recording of ap-propriate details in the patient’s record sheet

plan, implement & interpret appropriate cost-effective diagnostic and prognostic investigations ‐ reason accurately all diagnostics

Consider of the patients age, status and social circumstances when determining treatment

Interpret results of staging investigations & define the prognostic fac-tors,

Discuss, plan and institute appropriate therapy within the setting of a multidisciplinary team and plan for followup

Identify and manage side effects of treatment

Assess the patients’ understanding of their condition and provide edu-cation & information appropriate to the clinical situation

Attitu

des

Demonstrate an analytical and scientific approach to problem-solving and shows a range of problem-solving skills

• On

the job train

ing

• Detailed observation

• Patients feed back • Log

book • Final exam

• All th

roug

h train

ing

Consider the patients age, status, cultural and social circumstances when determining treatment

Use drugs and non-pharmacological treatments appropriately

work within a multidisciplinary team and recognize the need for refer-ral & make appropriate referrals to other health care professionals


28

Aim of the module: To enable trainees to manage patients with H&N cancer within a multidisciplinary team

ILO C

ode

Description M

ethod of

Learnin

g

Meth

od of A

ssessmen

t

Exp. Year of A

chievem

ent

Know

ledge

By the end of the module the candidate will have adequate knowledge and deep understanding of

• Lecture,


g

• Case-based stu

dies

• Journ

al club

• Final exam

part 2 and 3

• Second an


ing

Epidemiology and risk factors

Anatomy


The clinical presentations and methods of diagnosis

The interpretation of staging investigations and prognostic factors

Role of surgery in localized and advanced disease and results

Role and results of chemotherapy and radiation therapy in the adjuvant or neo-adjuvant setting and for metastatic disease

The principles of followup

Intellectual &

professional skills

Determine the risk of Head and neck cancer • C

linical case rou

nds

• O

n th

e job trainin

g

• Log

book

• O

SCE

• Sh

ort & lon

g case exam

s and oral exam

• 2

nd part exam

• D

urin

g all th

e trainin

g period

Take History in a detailed, reliable and accurate method and clinically examine and formulate a differential diagnosis with the recording of appropriate details in the patient’s record sheet

plan, implement and interpret appropriate cost-effective diagnostic & prognostic investigations— Accurate diagnostic reasoning

discuss, plan and institute appropriate therapy within the setting of a multidisciplinary team


Assess the patients understanding of their condition and provide education and information appropriate to the clinical situation

Attitudes


• Clin

ical cases and on

the

job trainin

g


• Patients feed back

• Final exam

• 3rd years Consider the patients age, status, cultural and social circumstances when

determining treatment

Use drugs and non-pharmacological treatments in an appropriate way

work within a multidisciplinary team and recognize the need & make appro-priate referrals to other health care professionals

The principles for management of relapsed cases

Module 1 Head and Neck Cancer


29

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge

By the end of the module the candidate will have adequate knowl-edge and deep understanding of

• Lecture,


g

• Case-based stu

dies

• Journ

al club

• Final exam

part 2 and 3

• Second an


ing


Anatomy




Role of surgery in localized and results

Role of chemotherapy and radiation therapy in the adjuvant or neoad-juvant setting and for locally advanced or metastatic disease and results

Indications for CNS treatment and prophylaxis in SCLC



Intellectu

al & profession

al skills

Determine the risk of Lung cancer • C

linical case rou

nds

• O

n th

e job trainin

g

• Log

book

• O

SCE

• Sh

ort & lon

g case exam

s and oral exam

• 2

nd part exam

• D

urin

g all th

e trainin

g period

Take a detailed, reliable and accurate history and clinically examine and formulate a differential diagnosis with the recording of appropriate details in the patient’s record

plan, implement & interpret appropriate cost-effective diagnostic & prognostic investigations with accurate diagnostic reasoning

Consider the patients age, status and social circumstances when de-termining treatment

discuss, plan and institute appropriate therapy within the setting of a multidisciplinary team


assess the patients’ understanding of their condition & provide educa-tion & information appropriate to the clinical situation

Attitu

des


• Clin

ical cases and on

th

e job trainin

g



• Final exam

• 3rd years Make the appropriate use of drugs & non-pharmacological treatments

for the diagnosis

Work within a multidisciplinary team in a calm and systemic approach and recognize the need and make appropriate referrals to other health care professionals

Module 2 Lung Cancer

Aim of the module: To enable trainees to manage patient's bronchogenic carcinoma within a multidisciplinary team


30

Aim of the module: to enable trainees to manage patient's mediastinal tumors within a multidisciplinary team

Module 3 Mediastinal Tumors

ILO C

ode

Description

Meth

od of Learn

ing

Meth

od of A

ssessmen

t

Exp. Year of A

chieve-

men

t

Know

ledge


• Lecture, • Self-directed learning

• Case-based stu

dies with

discussion an

d problem-

solving

• Final written and clinical exam

• 3rd year Epidemiology and risk factors

Anatomy




Role and results of surgery

Role of chemotherapy and radiation therapy in the adjuvant or neoadju-vant setting and for locally advanced or metastatic disease and results



Intellectu

al & profession

al skills

The ability to determine the risk of mesothelioma • Clinical cases and on the job training

• Final clin

ical and oral exam

• 3rd years

Detailed, reliable and accurate history taking and clinical examination and ability to formulate a differential diagnosis with the recording of appropriate details in the patient’s record sheet

Ability to plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations and accurate diagnostic reasoning

Ability to discuss, plan and institute appropriate therapy within the setting of a multidisciplinary team

Identification and management of side effects of treatment

Ability to assess the patients understanding of their condition and to provide education and information appropriate to the clinical situation

Attitu

des


• Clinical cases and on th

e job train

ing


• Logbook

• Final exam




work within a multidisciplinary team and recognize the need and make ap-propriate referrals to other health care professionals


31

Module 4 GIT tumors: Colorectal Cancer and anal carcinoma

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge



• Case-based stu

dies with

discussion an

d problem-

solving

• Final written and clinical exam

• 3rd year


Anatomy




Role of surgery in localized and advanced disease and results, morbidity &mortality

Role of chemotherapy and radiation therapy in the adjuvant or neoadju-vant setting and for locally advanced or metastatic disease and results

The principles of management of anal carcinoma patients with HIV

The principles of management of relapsed disease


Intellectu

al & profession

al skills

Determination of the risk of CRC cancer, anal carcinoma • Clinical cases and on the job training

• Final clin

ical and oral exam

• 3rd years


Ability to plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations and accurate diagnostic reasoning


Ability to assess the patients understanding of their condition & to provide education & information appropriate to the clinical situation

Attitu

des


• Clinical cases and on

the job train

ing


• Logbook

• Final exam

• 3rd years


Use drugs & non-pharmacological treatments appropriately

work within a multidisciplinary team and recognize the need and make appropriate referrals to other health care professionals


Aim of the module: To be able to manage patients with colorectal cancer and anal carcinoma within a mul-tidisciplinary team


32

Aim of the module: be able to manage patient's GIT tumors within a multidisciplinary team

Module 5 GIT tumors: Esophageal and Gastric carcinomas

ILO C

ode

Description

Meth

od of Learn

ing

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge

By the end of the module the candidate will have adequate knowledge and deep understanding of :


• Case-based stu

dies with

discussion an

d problem-solvin

g • Final w

ritten and clinical exams


Anatomy




Role of surgery in localized and advanced disease and results, morbidity &mortality

Role of chemotherapy and radiation therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease and results



Intellectu

al & profession

al skills


• Clin

ical cases and on

the job train

ing

• Final exams

• 3rd years

Ability to plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations



Attitu

des



e job train

ing



• logbook







33

Module 6 GIT tumors: Hepatocellular carcinoma and biliary tumors

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge



• Case-based stu

dies with

discussion an

d problem-solvin

g • Final w



Anatomy




The principles of screening and prevention

The role of surgery indications and results, morbidity and mortality

The Indications, technique and results of intrahepatic chemoembolization

The Indications, technique and results of radiofrequency, PEI, cryo-ablation

The role of systemic therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease and results



Intellectu

al & profession

al skills

Determination of the risk hepatobiliary tumors

• Clin

ical cases and on

the job train

ing

• Final exams

• 3rd years


Ability to plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations— Accurate diagnostic reasoning




Attitu

des



e job train

ing



• logbook

• 3rd years



work within a multidisciplinary team and recognize the need and make ap-propriate referrals to other health care professionals

Aim of the module: To be able to manage patients with HCC or Biliary tract tumors within a multidisciplinary team


34

Aim of the module: be able to manage patient's wit Cancer Pancreas within a multidisciplinary team

Module 7 GIT tumors: Cancer Pancreas

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge



• Case-based stu

dies with

discussion an

d problem-solvin

g • Final w



Anatomy





The role of surgery in localized and advanced disease and results, morbidity and mortality

The role of chemotherapy and radiation therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease and results



Intellectu

al & profession

al skills

Determine of the risk cancer pancreas

• Clin

ical cases and on

the job train

ing

• Final exams

• 3rd years

Take history in a detailed, reliable and accurate method and clinically examine and formulate a differential diagnosis with the recording of appropriate details in the patient’s record sheet

plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations—Reason accurately all diagnostics

Discuss, plan and institute appropriate therapy within the setting of a multidisciplinary team


Assess the patients’ understanding of their condition and provide education and information appropriate to the clinical situation

Attitu

des



the job train

ing



• logbook






35

Module 8 Genito-Urinary Tumors: Prostate Cancer

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge



• Case-based stu

dies with

discussion an

d problem-solvin

g • Final w



Anatomy





The role of surgery and radiotherapy in localized disease

The role of androgen blockage, in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease and results, role of chemotherapy and radiation therapy in the palliative setting

The management of relapsed disease and hormone refractory disease

The principles of follow up

Intellectu

al & profession

al skills

Determine of the risk of cancer prostate

• Clin

ical cases and on

the job train

ing

• Final clin

ical and oral exam

s

• 3rd years


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations



Assess the patients’ understanding of their condition and provide education and information appropriate to case

Attitu

des



the job train

ing



• logbook

• 3rd years




Aim of the module: To be able to manage patients with Prostate Cancer within a multidisciplinary team


36

Aim of the module: be able to manage patient's with Cancer Bladder within a multidisciplinary team

Module 9 Genito-Urinary Tumors: Cancer Bladder

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge

By the end of the module the candidate will have adequate knowl-edge and deep understanding of :

• Lecture,

• Self-directed learning

• C

ase-based studies w

ith discussion

and problem

-solving

•

Final w

ritten , clinical and oral exam

s

• 3rd year


Anatomy



The interpretation of staging investigations and prognostic fac-tors


The role of surgery and radiotherapy in localized & advanced dis-ease

Intravesical chemotherapy, indications, technique and results

Role of chemotherapy and radiation therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease



Intellectu

al & profession

al skills

Determine of the risk of cancer bladder • C

linical cases and on th

e job train-in

g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• O

ral exam

• 3rd year

Take history in a detailed, reliable and accurate method and clini-cally examine and formulate a differential diagnosis with the re-cording of appropriate details in the patient’s record sheet

plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations




Attitu

des



the job train

ing



• Logbook

• 3rd year





37

Aim of the module: be able to manage patient's wit Testicular Tumors within a multidisciplinary team

Module 10 Genito-Urinary Tumors: Testicular Tumors (Germ Cell Tumors)

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge



• Case-based stu

dies with

discussion an

d problem-solvin

g

• Final w

ritten and oral exam

• 3rd year


Anatomy





The role of surgery in localized disease and results, morbidity and mortality

The role of chemotherapy and radiation therapy in the adjuvant setting and for advanced or metastatic disease



Intellectu

al & profession

al skills

Determine of the risk of testicular cancer and risk stratify patients • C

linical cases and on th

e job training

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3rd year


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations and reason accurately all diagnostics




Attitu

des



the job train

ing



• Logbook

• 3rd year





38

Aim of the module: be able to manage patient's with Renal cell carcinoma within a multidisciplinary team

Module 11 Genito-Urinary Tumors: Renal cell carcinoma (RCC)

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solvin

g

• Fin

al exam w

ritten an

d oral

• 3rd year


Anatomy




The role of surgery in localized and advanced disease and results, mor-bidity and mortality

The role of chemotherapy ,radiation therapy, biological & targeted therapy

The management of relapsed disease

The principles of follow up

Intellectu

al & profession

al skills

Determine the risk of RCC and risk stratify patients • Clin

ical cases and on the job trainin

g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


Plan, implement & interpret appropriate cost-effective diagnostic and prognostic investigations— reason accurately all diagnostics




Attitu

des



the job train

ing



• logbook

• 3rd year





39

Aim of the module: be able to manage patient's with Breast Cancer within a multidisciplinary team

Module 12 Breast Cancer

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge



• Case-based stu

dies with

discussion an

d problem-solvin

g • Fin

al written an

d oral exam

• 3 rd year


Anatomy




The methods for screening and prevention

The role of surgery in localized and advanced disease and results, mor-bidity and mortality

The role of chemotherapy, hormonal treatment, targeted therapy and radiation therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease

The principles for management of relapsed disease


Intellectu

al & profession

al skills

Determine of the risk of breast cancer, stage and risk stratify patients • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


Plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations and reason accurately all diagnostics




Attitu

des


• Clinical cases and

on th

e job trainin

g

• Detailed observa-

tion • Patien

ts feed back • Log

book

• 3 rd year





40

Aim of the module: be able to manage patient's with Ovarian Cancers within a multidisciplinary team

Module 13 Ovarian Cancers

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral

• 3rd year


Anatomy





The role of surgery in localized and advanced disease ( results, morbidity and mortality)

The role of chemotherapy therapy in the adjuvant or neoadjuvant set-ting and for locally advanced or metastatic disease

The principles for management of relapsed disease

The Management of borderline, sex cord and germ cell ovarian tumors


Intellectu

al & profession

al skills

Determine of the risk of ovarian cancer, stage and risk stratify patients • Clin

ical cases and on the job train-

ing

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year





Assess the patients’ understanding of their condition and provide educa-tion and information appropriate to the clinical situation

Attitu

des



the job train

ing



• logbook

• 3rd year





41

Aim of the module: To be able to manage patients with GTD within a multidisciplinary team

Module 14 Gestational Trophoblastic disease

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral


Anatomy




The staging and risk stratification of GTD

Role of chemotherapy therapy in the low, intermediate and high risk patients



Intellectu

al & profession

al skills

Determine of the risk of GTD and stage different cases • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


plan, implement and interpret appropriate cost-effective diagnostic & prognostic investigations— reason accurately all diagnostics




Attitu

des



e job train

ing



• logbook

• 3rd year Consider the patients age, status, cultural and social circumstances when determining treatment




42

Aim of the module: To be able to manage patients with endometrial carcinoma, cervical carcinoma within a multidisciplinary team

Module 15 Endometrial and uterine cervix carcinoma

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral

• 3rd year


Anatomy




The principles of staging endometrial and cervical carcinoma



The role of chemotherapy ,hormonal and radiation therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease and results



Intellectu

al & profession

al skills

Determine of the risk of endometrial and cervical cancers • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations ‐ Reason accurately all diagnostics



Assess the patients’ understanding of their condition and provide edu-cation and information appropriate to the clinical situation

Attitu

des


• Clinical cases and

on the job training

• Detailed observa-

tion • Patien

ts feed back • log

book

• 3rd year





43

Aim of the module: To be able to manage patient's gynecological tumors within a multidisciplinary team

Module 16 Cancer Vulva, Cancer Vagina

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral

• 3rd year


Anatomy




The principles of staging vulvar and vaginal carcinoma



The role of chemotherapy and radiation therapy in the adjuvant or neoadjuvant setting and for locally advanced or metastatic disease and results



Intellectu

al & profession

al skills

Determine risk factors and stage cancer vulva and cancer vagina cases

• Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year






Attitu

des



the job train

ing



• logbook

• 3rd year





44

Aim of the module: To be able to manage patients with CNS tumors within a multidisciplinary team

Module 17 Central Nervous System Tumors

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral

• 3rd year


Anatomy





Role of surgery in localized and advanced disease and results, morbidity and mortality

Role of chemotherapy and radiation therapy in the adjuvant or neoadju-vant setting and for metastatic disease

Dehydrating measures and anticonvulsants



Intellectu

al & profession

al skills

Determine the risk of CNS tumors • Clin

ical cases and on the job train-

ing

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations reason accurately all diagnostics




Attitu

des



the job train

ing



• logbook

• 3rd year





45

Aim of the module: be able to manage patients STS or Bone tumors within a multidisciplinary team

Module 18 Soft tissue & Bone tumors

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral

• 3rd year


Anatomy




The principles of staging STS and bone tumors

Role of surgery in localized and advanced disease ( results, morbid-ity and mortality)

Role of chemotherapy and radiation therapy in the adjuvant or neoadjuvant setting and for metastatic disease



Intellectu

al & profession

al skills

Determine of the risk of STS and bone tumors • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations & reason accurately all diagnostics




Attitu

des



the job train

ing



• logbook

• 3rd year





46

Aim of the module: To be able to manage patients with skin tumors within a multidisciplinary team

Module 19 Skin Tumors (melanoma and non melanoma)

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solvin

g

• Fin

al exam w

ritten an

d oral

• 3rd year





The principles of staging skin tumors

Methods of screening and prevention

Role of surgery in localized and advanced disease (results, morbidity and mortality)

Role of biological, chemo and radiation therapy in the adjuvant or neoadjuvant setting and metastatic disease



Intellectu

al & profession

al skills

Determine of the risk of skin cancer • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations— reason accurately all diagnostics




Attitu

des



the job train

ing



• logbook

• 3rd year


Use drugs & non-pharmacological treatments in an appropriate way



47

Aim of the module: To be able to manage patients Neuroendocrine malignancies within a multidisciplinary team

Module 20 Neuroendocrine malignancies

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solvin

g

• Fin

al exam w

ritten an

d oral

• 3rd year




The principles of staging neuroendocrine tumors

Role of surgery in localized & advanced disease (results, morbidity & mortality)

Role of chemotherapy & radiation therapy in the adjuvant or neo -adjuvant setting & for locally advanced or metastatic disease & results

Supportive care



Intellectu

al & profession

al skills

Determine the risk for and stage endocrinal cancers • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year






Attitu

des



the job train

ing



• logbook

• 3rd year





48

Aim of the module: To be able to manage patient's lymphoma within a multidisciplinary team

Module 21 Lymphoproliferative disorders: Lymphomas (Hodgkins & NHL)

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solvin

g

• Fin

al exam w

ritten an

d oral


Pathophysiology and molecular pathogenesis



The principles of staging lymphomas and identification of IPI

Role of chemotherapy and radiation therapy, immune therapy, targeted therapy, high dose chemotherapy and stem cell transplantations in the management of lymphoma



Intellectu

al & profession

al skills

Determine of the risk for and stage HD and NHL • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year






Attitu

des



the job train

ing



• logbook

• 3rd year





49

Aim of the module: To be able to manage patient's acute & chronic leukemia & MDS within a multidisciplinary team

Module 22 Acute leukemias and MDS

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and

problem-solvin

g •

Final exam

written

and oral


Molecular pathogenesis

The classification and types of prognostic factors

The clinical presentations and diagnostic techniques

Role and results of chemotherapy, radiation therapy, target therapy and BMT for newly diagnosed and recurrent disease


Intellectu

al & profession

al skills

Determine of the risk of acute leukemia and MDS • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year






Attitu

des



e job train

ing



• logbook





50

Aim of the module: To be able to manage patient's chronic leukemia within a multidisciplinary team

Module 23 Chronic Myeloid & chronic lymphatic leukemia

ILO C

ode

Description

Meth

od s of Learn

ing

Meth

ods of A

ssessmen

t

Exp. Year of A

chievem

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and

problem-solvin

g •

Final exam

written

and oral



The methods of staging of CLL and how to differentiate between the different phases of CML

The clinical presentations, methods and interpretation of diagnostics and prognostic factors

Role and results of chemotherapy, target therapy and BMT for newly diagnosed and recurrent disease


Intellectu

al & profession

al skills

Determine of the risk of CLL and CML • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year






Attitu

des



e job train

ing



• logbook





51

Aim of the module: To be able to manage patients Plasma cell neoplasm within a multidisciplinary team

Module 24 Plasma cell neoplasm

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and

problem-solvin

g •

Final exam

written

and oral

• 3rd year



staging and prognostic factors

The clinical presentations, methods and interpretation of diagnostics

Role and results of chemotherapy, radiation therapy, target therapy and BMT for newly diagnosed and recurrent disease


Intellectu

al & profession

al skills

Determine of the risk of plasma cell neoplasms • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year






Attitu

des



e job train

ing



• logbook





52

Aim of the module: To be able to manage patients MPD within a multidisciplinary team

Module 25 Myeloproliferative Disorders

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies w

ith discussion

and

problem-solvin

g •

Final exam

written

and oral

• 3rd year



Risk stratification and prognostic factors

The clinical presentations, methods and interpretation of diagnostics

The treatment of MPD according to risk stratification


Intellectu

al & profession

al skills

Determine the risk of MPD • Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year


plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations. Reason accurately all diagnostics




Attitu

des



e job train

ing



• logbook





53

Aim of the module: To be able to understand the principles of high dose chemotherapy and BMT

Module 26 Bone Marrow Transplantation

ILO C

ode

Description Candidates must be able to

Meth

ods of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge

Discuss the transplantation types and procedures

• Lecture,


• C

ase-based studies w

ith discussion

and problem

-solving

• Fin

al exam w

ritten an

d oral

• 3rd year

Outline the principles for evaluation of the patient and donor

Explain the Indications of BMT and results

Outline the cytoreduction therapy

Explain the MHC and HLA typing

Describe engraftment and minimal residual disease

Describe the pathogenesis of GVHD, Its methods of diagnose and management of AGVHD & CGVHD

Outline the principles for management of acute and chronic complications

Recall the principles of followup

Intellectu

al & profession

al skills

Perform bone marrow aspirate and bone marrow biopsy

• Clin


g du

ring

rotation in BM

T un

it

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year Assists in and participate in stem cell collection

Order and interpret all the pretransplant investigations required for recipient and donor

Read and match HLA typing

Write and prescribe orders for conditioning regimens

Supervise Stem cell infusion

Manage acute and chronic GVHD (under supervision)

Manage acute and chronic toxicities (under supervision)


54

Aim of the module: : To be able to manage patients with oncological emergencies

Module 27 Oncological emergencies

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture,


• C

ase-based studies

with

discussion an

d problem

-solving

• Fin

al exam w

ritten

and oral

• 3rd year

Determine the causes and discuss the clinical picture , investigations and treatment for septic shock, febrile neutropenia, cord compression, superior vena caval obstruction, cardiac tamponade, fits, encephalopa-thy, renal failure, hypercalcemia, tumors lysis syndrome and bleeding

Intellectu

al & profession

al skills


• Clin


g

• Log

book

• O

SCE

• Sh

ort and lon

g case exam

s

• W

ritten exam

• 3 rd year

plan, implement and interpret appropriate cost-effective diagnostic and prognostic investigations - Reason accurately all diagnostics

Discuss, plan and timely institute appropriate therapy within the setting of a multidisciplinary team


Attitu

des


• Clin

ical cases and on

the job train

-in

g



• logbook

• 3rd year





55

Aim of the module: To be able to care for cancer patients who are not fit for further active therapy

Module 28.1 Palliative supportive care & end of life care

ILO C

ode

Description

Meth

od s of

Learnin

g

Meth

ods of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge an

d Skills

By the end of the module the candidate will be able to:

• Lecture • Self-directed learning

• Case-based stu

dies with

discussion

and problem

-solving

• Clin

ical on th

e job trainin

g

• Oral exam

• Logbook

• Written exam

• 3 rd year

Clinically assess, and identify patients who are not fit for further active cancer treatment, or at the terminal stage of life

Attend to Quality of life issues and psychological support to the pa-tients and their family


56

Aim of the module: To be able to manage pain in cancer patients within a multidisciplinary approach

Module 28.2 Supportive and palliative care : pain control

ILO C

ode

Description

Meth

od of

Learnin

g

Meth

od of A

ssess-m

ent

Exp. Year of

Ach

ieve-m

ent

Know

ledge


• Lecture • Self-directed learning

• Final w

ritten and oral exam

• 3rd year

Discuss the pathophysiology of pain in cancer patient

Explain the drug treatment of pain and the analgesic ladder

Describe different Pain syndromes

Intellectu

al & profes-

sional skills

Assess the patients pain score, stratify the different types of pain and measure their intensity

• On the job train-

ing

• OSC

E • clinical exam

• Logbook

• 3 rd year Choose treatment modality and use appropriately non-pharmacological treatments

identify and manage side effects of treatment

Attitu

des


• Clin

ical cases and on

the job train

-in

g



• logbook

• 3 rd year





57

Regulations & Methods of assessment

Regulations The general rules and regulations of assessment approved by the Egyptian fellowship board and

published at the training handbook and the board web site applies for the medical 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 three chances to pass the exam and

one more additional chance may be granted by the secretary general of the higher committee

of medical specialties in special approved circumstances.

It is to be noted that Candidates will not be allowed to 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 training pe-

riod. In addition, each candidate must submit his logbook for final assessment. The logbook re-

quirements 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 ap-

proved circumstances.

Pre-requisites 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 internal medicine fellowship training are not required to repeat it


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The components and structure of the examination

s knowledge in the following modules as clarified in 'test traineeThe first part exam aims to

the curriculum

1. Cancer Biology

2. Clinical pharmacology

3. Pathology

4. Epidemiology and biostatics

Please revise the curriculum for details of topics and required learning

outcomes

The structure of the first part exam

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

medical oncology. In this exam, the scientific council will ensure coverage of all curriculum

topics.

The structure of the second part exam

Part II examination consists of four papers:

• Two MCQ papers each two hours in duration: In both papers, facts, problem solving

and management skills are going to be assessed and you will choose one best answer

in each question

• Two short essay papers each two hours in duration: Questions will assess Trainees'

knowledge about various pediatric oncology problems and their management. In addi-

tion, it will test trainees' diagnostic problem solving skills.

The structure of the third part exam

part III exam is a clinical and oral exam and is composed of the following components:


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Clinical exam

The clinical exam remains the most important part of the examination as the long case evalu-

ate the potential performance of the candidate in clinical practice while short cases assess

clinical examination skills in various system. Passing this component of the exam independ-

ently is essential for certification.

• Long Clinical Case : the candidate is observed in silence for the first part of the examina-

tion by two examiners where he/she is taking the history from the patient and perform-

ing a physical examination and then The examiner asks him to present his findings in

the history and examination and discuss the management of the case . Examiners give

marks according to a predetermined weighting of the components of the exam.

• Short case examination: Each candidate examines 2-4 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 objectivity and fairness of

the exam.

• OSPE (Objective Structured Practical Exam) : A 10-20 station examination including ra-

diological imaging/ laboratory data results / photographs / cytogenetics or pathology

slides, simulated patients and procedural stations. Each station is five minutes and they

test candidate diagnostic, interpretative, procedural, management and communication

skills

VIVA: The oral exam

• The oral examination is composed of three oral examination stations. Each station is a

committee of two examiners who will spend 20 minutes with the candidate (10 min-

utes for each). They will test the candidates’ ability to manage various medical oncologi-

cal problems and explores his/her abilities for making sound differential diagnosis. They

will also assess his attitudes and interpersonal communication skills. the exam is based

on a set of topics with opening and supplementary questions. The questions’ cards are

prepared in advance together with the expected ideal answer and allocated marks. This

allows a good objective basis for marking.


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Medical Oncology Curriculum

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Transcript of Medical Oncology Curriculum