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Medical Oncology Program

Medical Oncology Program

Overall Goals of the Residency Program

The Western University Medical Oncology Postgraduate Training Program is a two-year program of approved training that meets the requirements of the Royal College of Physicians and Surgeons of Canada for subspecialty certification in Medical Oncology.  The program is organized into 18 blocks of core medical oncology, 1 block of Palliative Care, 2 blocks of Hematology with emphasis on malignant hematology and stem cell transplantation, 2 blocks of radiation oncology and 3 blocks of electives in Pathology, Radiation Oncology, Genetics, Paediatrics, Basic/Clinical Research, Community Oncology, Medical Oncology, Palliative Care, Geriatric Oncology or Psychosocial Medicine.

The core medical oncology training consists of ambulatory care rotations orientated to specific disease sites i.e. breast cancer, gastrointestinal malignancies, lung cancer, head and neck cancer and genitourinary cancer.  Clinics involving less common disease sites are included in the rotations e.g. malignant melanoma, central nervous system malignancies and head and neck cancer.  One block is dedicated to Palliative Care and Pain Services.  During the core medical oncology training, trainees will assume direct patient care under the supervision of the attending physicians.  It is assumed that trainees will spend up to 70% of their time with supervised patient care.  Trainees are expected to acquire knowledge of the indications for procedures associated with medical oncology including lumbar punctures, thoracenteses, paracenteses, bone marrow biopsies and Ommaya reservoir taps. Technical expertise in these techniques while of value, is not mandatory.

The five-block elective period is usually taken in the second year.  It may be taken to complete a research project or to start a research project for trainees wishing to take further training in research or pursue graduate studies.  Trainees may take electives in areas as provided above that are approved by the RPC Committee.

The ambulatory experience in core medical oncology is supplemented with inpatient ward rotations.  The trainees work as part of the inpatient team along with two hospitalists and under the supervision of the inpatient attending medical oncologist.  During this time, trainees may also have the opportunity to assess patients in the Emergency room, and inpatient consultations Each trainee beginning in the 4th block of training conducts a half-day longitudinal clinic.  In the longitudinal clinic new consultations are seen by the trainee and then followed by that trainee for their ongoing management.  An attending medical oncologist who is also identified to the patient reviews the management of these patients. The clinic is supervised by a set group of attending medical oncologists who provide direct observation and evaluation.  As experience progresses and competence is demonstrated, the supervision becomes increasingly peripheral.

The goals and objectives of the training program and the performance of the each trainee are discussed every 3 blocks with the program director.  Increasing professional responsibilities are given to the trainees throughout the training.  Trainees are expected to discuss career goals so that the program can be adjusted to their needs.   Flexibility is a hallmark of the Medical Oncology training program.  The focus is always on clinical competence, professionalism and academic excellence.

Residents and Fellows

  • Dr. S. Hussaini - PGY4
  • Dr. P. Stewart - PGY5
  • Dr. D. Breadner - PGY5
  • Dr. V. Panuganty - PGY5
  • Dr. A. Batra - Fellow

Application and Appointment of Trainees

Applications are made to the Program Director through CaRMS for positions beginning July 1 of the following year.  The London Regional Cancer Program will host their interviews on September 20, 2018.

Medical Staff: London Regional Cancer Program

  • Dr. P. Blanchette
  • Dr. S. Ernst
  • Dr. R. Fernandes
  • Dr. K. Hahn
  • Dr. S. Kuruvilla
  • Dr. J. Lenehan
  • Dr. D. Logan
  • Dr. D. R. MacDonald
  • Dr. M. MacKenzie
  • Dr. E. Morgan
  • Dr. K. Potvin
  • Dr. J. Raphael
  • Dr. M. Sanatani
  • Dr. T. Vandenberg
  • Dr. M. Vincent
  • Dr. S. Welch
  • Dr. E. Winquist
  • Dr. J. Younus

Training Requirements for Entry into Program

Applicants should have completed an internship recognized by the College of Physicians and Surgeons of Ontario. In addition, applicants must have completed three years of training in Internal Medicine under Section 2(a) of the Training Requirements in Internal Medicine of the Royal College of Physicians and Surgeons of Canada. It should be noted that trainees are required to be certificated by the Royal College of Physicians and Surgeons of Canada in Internal Medicine in order to be eligible for the Certificate of Special Competence in Medical Oncology.

Location of Training Program

Most of the ambulatory training is done in the outpatient clinics of the London Regional Cancer Program (LHSC-VH). The LRCP is a contiguous part of Victoria Hospital, London Health Sciences Centre where there is a 40-bed oncology inpatient unit and inpatient consultations are done. The London Health Sciences Centre provides pathology and imaging services. Consultations may also be done at University Hospital, London Health Sciences Centre. The Children’s Hospital of Western Ontario is also located at the Victoria Hospital site.

Research Resources

  1. Cancer Research Laboratories: The cancer research laboratories of the London Regional Cancer Program and Western University are located within the LRCP.  The CIHR Strategic Training Program in Cancer Research and Technology Transfer (CarTT) offers fellowships to trainees wishing to pursue advanced training in cancer research leading to a PhD.  Translational research fellowships are also available through the Department of Oncology to those completing the required two years of Medical Oncology training.
  1. Western University: Western is one of Canada’s premiere universities with world-class faculty offering research and advanced training opportunities in many areas related to medical oncology e.g. Immunology, Pharmacology, Genetics, Epidemiology and Biostatics.
  1. Clinical Trials Centre:The clinical trials centre of the LRCP is one of the largest oncology clinical trial centres in Canada.  There are Phase II and Phase III clinical trials in progress for many disease sites.  Phase I facilities are being developed in conjunction with the Department of Pharmacology and the Cancer Research Laboratories.

Responsibilities of Residents

In Medical Oncology the trainees work on a one-on-one basis with the medical oncologists.  The multidisciplinary approach to patient care is emphasized by the presence of many different specialties working in close approximation.  All trainees have graded responsibility and are given the opportunity to develop independent diagnostic and therapeutic skills over the two-year training period.

On-call Duties of Residents

Residents in Medical Oncology are not required to do call while on a Medical Oncology rotation. Call is done on a volunteer basis where the trainee will contact the Senior Resident and ask to be put on the call schedule. When on Hematology rotation, trainees take call for the Hematology Service.

Academic Half Days

One half day per week is devoted to didactic/case-based teaching throughout the year. This consists of lectures and seminars primarily by the medical oncology staff but supplemented by experts in other fields. The first month of PGY4 will be devoted entirely to the basic science of oncology and pharmacology. Trainees in both years of training are expected to attend and the topics are rotated on a biennial schedule. Trainees are also expected to attend the Academic Half Days organized by the PGME office on a monthly basis.

Longitudinal Clinic

In order to more fully develop the Collaborator, Professional, and Manager roles as a medical oncologist, residents will have the opportunity to run their own clinic as the primary treating oncologist. This clinic will enhance skills as an Advocate and Medical Expert and increase confidence in independent decision-making. Starting in block 4 of training, residents will attend a half-day clinic on Thursdays which continues for one year to allow residents the opportunity to follow patients through their complete treatment course. In conjunction with a primary nurse, the residents will see one new consult per week as well as a limited number of scheduled follow-up patients. The residents will see the consult first, develop a management plan, and then discuss the case with the designated Medical Oncologist who ultimately remains the most responsible physician (MRP). The MRP will meet the patient, directly observe the resident going through the management plan with the patient and be available to answer any questions the resident is unable to. With the patient’s consent, from that point onward, the patient’s follow-up care will continue in the residents’ clinic, at which point the MRP will remain available to the resident for any issues that arise, but will not come to directly see the patient unless so requested by the patient or the resident. Any major changes in treatment or management will be discussed with the MRP before implementation. Copies of notes from all clinic visits are to be sent to the MRP as well as the family doctor and referring physicians to keep them up to date on the patients’ status. If residents are away on the clinic day for any reason, they are expected to arrange coverage for their patients with another resident or the MRP. The cases for consultation will be selected by the Medical Oncology Program Director and will span the major disease sites. Cases will be “bread and butter” to gain solid expertise in the most common oncologic scenarios. However, residents may also occasionally see rare or interesting cases for the purposes of enhancing their education. At the end of the year of clinic, the patients will be absorbed into the practices of the MRPs in order to ensure seamless continuity of care.

Resident Research

During the two years of training, residents are expected to complete a research project. A poster or oral presentation at a local or national meeting is a minimum expectation. Incoming residents will meet with the Resident Research Committee under the supervision of Dr. Karen Hahn. The purpose of this committee is to help residents define the scope of their project, and connect them with potential mentors. The committee will also meet occasionally with the residents to ensure projects are staying on track, and help with any issues arising. All projects are also subject to the approval of the Program Director to ensure they are of adequate quality and of educational benefit to the residents.

Medical Oncology Ward Services (MOWS)

Most of the ambulatory training is done in the outpatient clinics of the London Regional Cancer Program (LHSC-VH). The LRCP is a contiguous part of Victoria Hospital, London Health Sciences Centre where there is a 40-bed oncology inpatient unit and inpatient consultations are done. The London Health Sciences Centre provides pathology and imaging services. Consultations may also be done at University Hospital, London Health Sciences Centre. The Children’s Hospital of Western Ontario is also located at the Victoria Hospital site.

Site Group Meetings, Rounds, Seminars, Workshops and Other Academic Sessions

Trainees are expected to attend disease site meetings, tumour boards and to participate in these sessions. All available trainees are encouraged to attend other seminars, lectures or rounds. Record of attendance is kept at academic sessions. In order to enhance teaching skills and basic science knowledge, the trainees are expected to give a mandatory lecture as part of the IND (Investigational New Drug) Seminar Series. These run each Wednesday at noon from September to June and are a joint session between a clinician and basic scientist outlining a new potential oncologic therapeutic agent and science behind its mechanism and development.

Journal Club

A Journal Club is held throughout the academic year. Trainees and staff review important recent publications and jointly critique them. These are informal sessions usually held in the evening.