Gynecologic Oncology

This is a two year clinical training program with an optional third year for research or focussed training in robotic surgery.

Program Year

Content and Sequence of Rotations/Number of Months (or 4-week blocks)

First

ICU

G/O

Second

G/O

Med

Onc

Rad

Onc

Elective

First Year:

The first year of training focussed mainly on the care of the critically ill medical and surgical patients and to achieve core competencies in gynaecologic oncology. Formal instructions will also be given in research methodology and critical appraisal skills by didactic lecture series and real world application through regular journal club and mortality and morbidity round presentations. The residents will be expected to fully integrate themselves into the multidisciplinary model of care environment and to function as leader within the team under the supervision of attending staffs.

Graduated goals include competency in the management of inpatient unit/assistance with inpatients consultation/ competencies with radical surgical procedures as applicable to gynaecologic oncology/Tumor Board discussion participation. Active involvement in the evaluation and stabilization of patients presenting to emergency department is expected.

With regard to surgical exposures, the resident in the first year will go through a graduated experience in radical and complex gynaecologic oncology procedures by open and robotic approaches as per program objectives. At present, the division operates five days a week allowing for significant case load variety and volumes .During this year the first year resident is expected to keep a detailed learning portfolio of cases which are linked to programs objectives which are reviewed on a monthly basis by supervising faculties and at the 6 months review with the program director.

Second Year:

The second year consisted of 5 months in non gynaecologic oncology rotations. This includes 2 months of medical oncology, 2 months of radiation oncology and one month of elective time. The remaining time (7 months) will be done in gynaecologic oncology where the resident will assume the role of a junior consultant gynecologic oncologist.

Leadership of the inpatient and outpatient services with primary management of the multidisciplinary team (MDS) and Chemotherapy Day Care unit will be the expectation of the resident for this year. Furthermore, the resident is expected to take on teaching responsibilities in the O.R. to junior residents in general obstetrics and gynecology as appropriate. Within the medical oncology/radiation oncology rotations they will function as residents with staff supervision as per rotation specific objectives.

Weekly Schedule and Duties

The resident weekly activities are described below:

Daily: Surgical, medical, and chemotherapy related issues are addressed by the multidisciplinary team with the resident under the supervision of attending staff gynaecologic oncologist

Weekly: Chemotherapeutic rounds are done once a week in preparation of patients for the following week. For each patient, the clinical history and current status will be reviewed by the fellow in conjunction with the team staffs/pharmacist/nurses prior to making plan for subsequent chemotherapy. At these rounds, the opportunity to review disease natural history and strategies for future management are made in a collaborative setting. Further research ideas are also explored and suggested during these sessions.

Weekly: Patient discharge planning rounds are held every Wednesday with active resident participations. Here all inpatients are reviewed and discharge planning are done with the expanded team including inputs from social workers/ psychologist/ nurses/ APN/ and palliative care physician. This will allow for further integration of the resident into the multidisciplinary environment and foster collaborative care philosophy.

Weekly: Residents are expected to lead gynaecologic oncology/ pathology tumor board presentations on interesting/ challenging patients on Wednesday morning in conjunction with gynaecologic pathologists and radiation oncologists. Discussions are recorded and lessons learnt together with management decisions are posted on the knowledge management system (GOSOCS) for further comments and feedbacks by other team members to sharpen the residents communicator role in the team.

Friday morning: residents participate and eventually lead the surgical oncology/Gynecology teaching rounds for general Obstetrics and Gynecology residents. Here surgical issues and critical care issues as well as specific gynaecologic oncology related topics are reviewed critically with emphasis on evidence based medical practice.
Didactic Teachings

The Gynaecologic Oncology Program is part of the larger Surgical Oncology Program of the Integrated Cancer Program at The Ottawa Hospital and is also a division within the Department of Obstetrics and Gynecology and Newborn care affiliated with the University of Ottawa. This relationship allows for easy access to an expanded structured education offerings and resources from both programs to fulfill the stated goals and objectives.

The course material is based on the objectives of the program

General medical and radiation oncology topics are covered in weekly oncology lecture series of the Integrated Cancer Program regularly held on Wednesdays afternoon with medical and radiation oncology residents

Specific surgical topics as related to surgical oncology are covered in specific days within the Department of Surgery academic schedule that the resident will attend

Issues of embryogenesis/ sexuality/ gynaecologic oncology will be covered by the Department of Obstetrics and Gynecology postgraduate curriculum

Medical ethics and communications skills will be covered by regularly held university hosted lectures series

Issues of palliative care/ symptoms management/ breaking bad news will be covered by the division palliative care physician through a series of lectures and case discussions during the academic year (please see attached curriculum)

Topics on epidemiology/ biostatistics/ research design/ critical appraisals will be covered by faculties in the division with special training in clinical epidemiology through a series of lectures, supervision of journal club presentations, and discussion at teaching rounds occurring on a weekly basis during the academic year .

In addition, the residents knowledge management/transfer strategies will be developed over the course of the training using the objectives and individual resident learning portfolio as a guide. This will be a central part of the residents educational management encouraging life long continuous learning. Here the resident documents active learning using a case-based inquiry-based model that is recorded on a Web-based format and is available to the faculties for review and assessment prior to didactic/tutorial series.
Research

The divisions research strengths are in: ovarian cancer translational and clinical research, health service research, minimal invasive surgery, and knowledge transfer/management. The program has an established strong basic science department and an endowed chair in ovarian cancer research. Three of the five teaching faculties have Masters degree (two in clinical epidemiology, biostatistics and population health and one in lab/science and translational research). In addition, the program has two senior accomplished basic scientists who are very active in basic research and two gynaecologic pathologists. Residents are expected to carry out at least one publishable research project at the end of their training to fulfill the research requirement of the Royal College. The following supports will be available to the residents to assist them in fulfilling these requirements.

There is yearly course in epidemiology, biostatistics, and research methodology organized by Dr. Le and Dr. Hopkins

Monthly Journal Clubs meeting where critical appraisal skills are taught and developed

Resident chooses a research project and mentor (Drs. Le/Hopkins/Weberpals) in the first year to help them develop and complete their research project in a timely manner

The residents are expected to present their research protocols and final results at the department of Obstetrics and Gynecology research day in May of each year
Application Process

Interested applicants should send a personal letter, a complete CV, and 3 reference letters to:

Erica Moore
Program Coordinator,
Postgraduate Clinical Fellowship Programs
Department of Obstetrics and Gynecology
Phone: 613-737-8899 ext. 73254 | E-mail: emoore@toh.ca

The deadline for application is the end of June prior to the commencement of the fellowship program on July 1 of the following academic year.

Fellowship in Gynecologic Oncology

First Year:

Second Year:

The resident weekly activities are described below:

Department of Obstetrics and Gynecology