CLINICAL NEURO–ONCOLOGY ELECTIVE ROTATION

Document Sample
CLINICAL NEURO–ONCOLOGY ELECTIVE ROTATION Powered By Docstoc
					                                   CLINICAL NEURO–ONCOLOGY ROTATION
                                               PGY 3 & 4 only


1.   Introduction
2.   Objectives
     a. General
     b. Specific
3.   Staff
4.   Trainees who may benefit from this elective
5.   Duration
6.   Activities
7.   Procedures
8.   Weekly schedule


1.   Introduction.
     A neuro-oncologist was recruited in 2005 with the aim of providing care to not only patients with primary and metastatic
     brain tumors, but also to any cancer patient with neurological symptoms or complications. We are seeing more of these
     patients in the clinic and at the West Jefferson Medical Center because we are the only institution in the Southern Gulf area
     with a well-assembled neuro-oncology team. This resource offers an enormous learning experience to residents and
     fellows, and at the same time stimulates an environment of interdisciplinary work that interfaces Medicine, Neurology,
     Neurosurgery, Oncology, and Radiation Oncology. Our patients from Louisiana and neighbor states will be the ultimate
     beneficiaries of this effort. We hope it will be a time–intensive yet rewarding rotation.

2.   Objectives.
     a. General:
             i. To introduce trainees to the discipline of Neuro–Oncology
            ii. To help develop in trainees a standardized approach to the cancer patient with neurologic symptoms or
                complications
          iii. To help develop in trainees a standardized approach to the patient with primary brain and spine tumors
           iv. To help develop in trainees a standardized approach to the patient with brain and spine metastases
            v. To prepare residents for neuro-oncology questions in the American Board of Psychiatry and Neurology Board
               Exam
           vi. The residents will receive instruction in appropriate and compassionate methods of end-of life palliative care,
               including adequate pain relief and psychosocial support and counseling for patients and family members about
               these issues.

     b. At the end of this elective, trainees should:
             i. Efficiently evaluate the mental status of patients in the office or at the bedside, and conduct time–efficient,
                focused neurological exams for anatomical localization
            ii. Based on the data collected from the history, physical exam, and ancillary studies, formulate a diagnosis, make
                treatment recommendations, and establish a prognosis
           iii. To become familiar with the Karnofsky Performance Score (KPS) as the most commonly used performance
                scale used in Neuro–Oncology, and the recursive partitioning analysis (RPA) classes for prognosis in brain
                metastases
           iv. To be familiar with the pathology, radiology, prognosis, and current treatment options for:
                    1. Glioblastoma multiforme
                    2. Anaplastic astrocytoma
                    3. Anaplastic oligodendroglioma
                    4. Low grade gliomas (astrocytomas, oligodendrogliomas, or mixed)
                    5. Meningiomas: benign, atypical, malignant
                    6. Brain metastases
                    7. Leptomeningeal disease
                    8. Other tumors: skull base, head and neck, primary CNS lymphoma
            v. To break bad news to patients and families in a compassionate, human, and empathetic way
           vi. To promptly recognize and treat the following emergencies or complications:
                    1. Intracranial hypertension, with or without brain herniation
                    2. Seizures
                    3. Spinal cord compression
                    4. Delayed neurotoxicity from radiation therapy
                    5. Polyneuropathy from chemotherapeutic agents
                    6. Neuropathic pain

3.   Staff: Ivo W. Tremont, M.D., Frank Culicchia, M.D.
   4.        Trainees who can benefit from this rotation: Neurology, Medicine, Hematology–Oncology, Radiation Oncology, and
             Neurosurgery residents or fellows

   5.        Duration: One month at least

   6.        Activities: Clinic, inpatient consults, inpatient rounds, family conferences (if applicable), operating room (OR, optional),
             tumor board.

   7.        Procedures (when indicated): Lumbar puncture, intrathecal administration of chemotherapy; Puncture of Ommaya
             reservoirs and intraventricular administration of chemotherapy

   8.        Weekly schedule

    Time          Monday            Tuesday          Wednesday          Thursday          Friday
    AM            Rounds,           Rounds          Tumor Board         Consults          Rounds
                   Clinic            Clinic            Clinic            Rounds           Clinic
        PM         Clinic            Clinic           Consults             -              Clinic
                                                      Rounds



References
We will follow the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology, v.1.2006 on CNS
Cancers, and the World Health Organization textbook on the Pathology of Tumors of the Nervous System IARC Lyon, 2000

SUB-SPECIALTY: Neurology
ROTATION EXPERIENCE: Inpatient Neurology Service
PATIENT CARE
Neuro-Oncology Patient Care
Objectives                                                      Teaching Methods                    Assessment Strategy

Introduce the trainee to the basic principles & desiplines of   Clinical Teaching                   Global ratings
Neuro-oncology                                                  Review of guidelines

Gather essential patient history and data to formulate a        Clinical Teaching/Patient Care      Global ratings
diagnostic differential
Develop a standardized approach to the patient with primary     Clinical Teaching                   Global ratings
brain & spine tumor                                             Direct Patient Care                 Case Conference Evaluations

MEDICAL KNOWLEDGE
Neuro-oncology Medical Knowledge
Objectives                                                                      Teaching Methods           Assessment Strategy
Familiar with the Karnofsky Performance Scale (KPS)                             Clinical Teaching          Global ratings
                                                                                                           End of Rotation Quiz
Familiar with the pathology, radiology, prognosis and current treatment         Required Reading           End of Rotation Quiz
options for:                                                                    Clinical Teaching
                             1. Glioblastoma multiforme                         Case Conference
                             2. Anaplastic astrocytoma
                             3. Anaplastic oligodendroglioma
                             4. Low grade gliomas (astrocytomas,
                                oligodendrogliomas, or mixed)
                             5. Meningiomas: benign, atypical, malignant
                             6. Brain metastases
                             7. Leptomeningeal disease
                             8. Other tumors: skull base, head and neck,
                                primary CNS lymphoma
INTERPERSONAL AND COMMUNICATION
Neuro-oncology- Interpersonal and Communication
Objectives                                                             Teaching Methods     Assessment Strategy
Learn to break bad news to patients & families in a                    Patient Care         Global ratings
compassionate, human and empathetic way
Present Cases in a organized and detailed manner                       Case Conference      Global rating
                                                                       Modeling
Demonstrate the ability to compassionately relate to the family of     Clinical Practice    Global ratings
a patient                                                              Modeling


PRACTICE BASED LEARNING AND IMPROVEMENT
Neuro-oncology Practice Based Learning and Improvement
Objectives                                                             Teaching Methods     Assessment Strategy
Research clinical questions regarding potential treatments for their   Case presentations   Global ratings
patients, using information technology to access on-line medical                            End of Rotation Quiz
information
Familiar with published clinical care guidelines                       Case presentations   Global ratings
                                                                       Clinical Care        End of Rotation Quiz

PROFESSIONALISM
Neuro-oncology Professionalism
Objectives                                                             Teaching Methods     Assessment Strategy
Interact responsibly and compassionately with patients, families       Clinical care        Global ratings
and co-workers                                                         Modeling
SYSTEM BASED PRACTICE
Inpatient Neurology Service (PGY1 or 2) System Based Practice
Objectives                                                           Teaching Methods      Assessment Strategy
Develop an understanding of cost effective health care               Modeling              Global ratings
                                                                     Clinical Teachings
Advocate for patients when dealing with resource allocation issues   Direct patient care   Global ratings
and complex payer system problems                                    Clinical Teachings

				
DOCUMENT INFO