Radiation Oncology Pathway Introduction Sites and Personnel Goals and Objectives Description of Pathway Pathway Summary Table Radiation Oncology Course Description Elective Course Descriptions Textbooks and Learning Resources Evaluations Other Faculty Curriculum Committee

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Each year the overall incidence of newly diagnosed cancer cases is increasing. Well over 1,300,000 new cases are diagnosed annually with Radiation Oncology making a very significant contribution to the management of these patients. Between 50 and 60 percent of all patients diagnosed with cancer are candidates for radiation therapy. Approximately half of these patients will be treated for cure. Radiation oncology is a very comprehensive specialty that overlaps with many disciplines. Malignancies can occur in every location within the body. Therefore, students who are interested in pursuing a career in radiation oncology need to have a very comprehensive knowledge of most medical and surgical specialties. This knowledge should be not only textbook knowledge but also clinical experience as well. The clinical qualification of a radiation oncologist include: 1. broad and specific diagnostic and physical exam skills. 2. Ability to formulate a complex treatment plan. 3. Ability to communicate and coordinate care with other specialists. 4. Critical life and death decision-making. 5. Three-dimensional spatial thinking. 6. Computer skills. 7. Empathy. 8. Communication skills. The basic science involved in radiation oncology can relate to every organ system in the body and includes both normal tissue and cancer biology with a special emphasis on their response to radiation.

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Pathway Director:
Drexel University College of Medicne
Jaganmohan Poli, M.D.
Hahnemann University Hospital
Department of Radiation Oncology
(215) 762-8834 Phone
(215) 762-8523Fax
e-mail: jpoli@drexelmed.edujpoli@drexelmed.edu

Course Coordinator:
Eleanor Michele
215-762-8834 Phone
215-762-8523 Fax
e-mail: emichele@drexelmed.edu

Associate Directors, Site Coordinators and Teaching Sites:

Site	Associate Director	Site Coordinator
HUH	Jaganmohan Poli, M.D. Hahnemann University Hospital Department of Radiation Oncology Broad & Vine, Mail Stop 200 Philadelphia, PA 19102-1192 (215) 762-8834Phone (215) 762-8523 Fax	Eleanore Michele

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When a student completes the pathway for radiation oncology, the following knowledge base and skills are expected to be achieved:

1. Basic understanding of radiation oncology.
2. Development of overall management skills for the oncologic patient, both the hospitalized sick patients, as well as ambulatory outpatients.
3. Basic understanding of the biology of cancer.
4. To develop history taking and physical examination skills.
5. Special clinical emphasis on breast , rectal, prostate, head and neck examination including direct laryngoscopy and pelvic examination.
6. Basic understanding of radiology including interpretation of chest x-rays, CT scans, ultrasound and MRI's.

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Click here for summary table of Radiation Oncology Pathway

Radiation Oncology Course Description (must be approved by course director)

1. General introductory knowledge of the range and scope of radiation oncology.
2. Patient care in the ambulatory clinic and on hospital rounds.
3. Site specific examination, i.e. prostate, breast, ENT, bi-manual pelvic examinations.
4. General understanding of the techniques employed in radiation therapy including external beam irradiation, brachytherapy, stereotactic irradiation, and hyperbaric oxygen use. Treatment simulation, exposure to CT based 3-D treatment planning and sterotactic radiation/radiosurgery, and management of radiation oncology emergencies.
5. General interpretation of diagnostic plain x-rays, MRI and CT scan as related to radiation oncology.
6. General understanding of radiation normal tissue toxicities.
7. General understanding of some of the basic principles involved in radiation biology and physics.
8. Opportunity for original research that may lead to publication.
9. Exposure to national clinical trials.

Elective Course Description
Strongly Recommended Electives
The student is strongley encouraged to select at least one surgical and one non-surgical rotation from the following:

1. Surgery: general surgery, surgical oncology, otolaryngology, urology, gynecologic oncology, orthopaedics.
2. Medicine: hematology-oncology, pulmonary, ICU, gastroenterology, pathology, emergency medicine, pediatrics, geriatrics, women's health.

These are strongly recommended for the following reasons:

1. General Surgery and Surgical Subspecialties are recommended due to the need to have a good understanding of basic surgical and surgical subspecialty techniques as many radiation oncology patients will undergo surgery as part of their therapy and because many brachytherapy procedures are invasive and done in the operating room. It is, therefore, essential that good surgical technique and understanding of basic surgical procedures be obtained.
2. Hematology Oncology is strongly recommended as chemotherapy is a large part of cancer management. A basic understanding of the risks and benefits of chemotherapy and management of these patients is essential in radiation oncology.
3. The Medical Sub Specialists often encounter the cancer patient first and play a large part in the diagnostic work up or management of the patient. Many cancer patients require complex medical management that is important for the radiation oncologist to understand and participate in.

Recommended Electives
The other electives which are strongly recommended include:

1. Gastroenterology for basic understanding of both the normal and pathologic functions of the gastrointestinal tract. Special emphasis should be placed on the diagnosis of both upper and lower GI malignancies including their diagnosis and follow-up.
2. Urology: Prostate cancer is one of the most common malignancies treated with radiation therapy definitively today. A good understanding of prostate examination, diagnosis of cancer and follow-up management are essential. The endocrinological treatment of prostate cancer will also be studied.
3. Diagnostic radiology is important as much of radiation oncology treatment planning is based on diagnostic imaging and its interpretation. We not only read reports but must review these films and, therefore, have a basic understanding of diagnosis of pathology and identification of normal structures.
4. ENT is important as radiation oncologists are required to be able to perform a good head and neck examination including direct laryngoscopy both for on-treatment and follow-up examinations. The risk factors for development of ENT malignancies will also be studied. A good understanding of what is done at the time of oncologic ENT surgery will also be stressed.
5. Pediatrics is important as we manage both adult and pediatric malignancies. This elective would most appropriately be done at a institution outside HUH such as at St. Christopher's.
6. Emergency Medicine is important as much of our specialty is performed in an ambulatory setting. Our patients are seen frequently and fairly often present with situations such as chest pain, acute abdominal symptoms, falls, etc. We feel this type of ambulatory urgent care can best be learned in the emergency room.
7. Pulmonology is important as lung cancer continues to be a very common form of cancer. Chest irradiation is utilized in the management of this as well as for lymphomas, esophageal carcinomas, mediastinal tumors, etc.
8. Pathology is pivotal in the radiation oncologists practice. It is important to understand how specimens are handled, processed and interpreted. One should become familiar with the cancer pathologic (as opposed to clinical) staging process involving examination of the gross specimen, as well as the microscopic details. The radiation oncologist is constantly comparing the radiographic, physical exam, and pathologic findings.

Specific student course requirements
Radiation Oncology - The elective would include learning to perform complete outpatient and inpatient consultations for oncologic patients, becoming able to present a case comprehensively, to present articles at a Journal Club, and to assist in simulations and brachytherapy procedures.

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Required
Management Decisions in Radiation Oncology, Chao KSC, Perez CA, Brady LW, JB Lippincott Co., Philadelphia, PA, 1998.

Recommended
Principles and Practice of Radiation Oncology, 3rd Edition, Perez CA, Brady LW, JB Lippincott Co., Philadelphia, PA 1996.

Cancer: Principles and Practice of Oncology, 4th Edition, DeVita VT, Hellman S, Rosenberg SA, JB Lippincott Co., Philadelphia, PA 1995.

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Evaluation of Student Performance by Faculty and Resident
Standard department forms will be used.

Evaluation of Clinical Faculty and Residents by Students
A form will be completed and submitted to the Pathway Director at completion of the rotation. The Pathway Director will meet with the student to review the evaluation. See the enclosed form.

Evaluation of Clinical Site by Student
The student will complete a form at the end of his rotation. This will be submitted to the Pathway Director and follow-up interview will occur at a mutually agreed upon time within 2 weeks of completion of the rotation. See form for clinical site.

Exit Evaluation of Complete Pathway at End of Year
A form will be provided.

Other

Faculty Curriculum Committee of the Department

This would consist of the Department Chairman, Residency Director, Doctor of Physics and Radiobiology. The function of each department will be for the Chairman and Vice Chairman to set the clinical curriculum for the student and complete the evaluations. The function of the Radiobiology and Physics is to establish exposure to these components. They are also to assure that students are exposed to their various components.