Vol. 3, Issue 4 Digital Edition of Oncology Fellow Advisor

ONCOLOGYFellow

Vol. 3, Issue 4

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

Fellowship Training

TRIBUTE

We remember the work of writer, media personality, and oncologist 2 Robert Buckman, MD, PhD. FELLOWSHIP TRAINING

Academia or private practice?

Seasoned oncologists offer guidance.

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FELLOWSHIP TRAINING

Experts discuss what to expect in 6 the second year of fellowship

advisor

Mentor Memos

Survey Says

Physician Finance

Board Exam Preparation Is Key

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hen it comes to examinations, oncology fellows have been through the gamut: all the way from kindergarten spelling tests to the SATs, the MCATs, and the USMLE. But as training winds down, there’s one more exam to prepare for in order to become a fully fledged, practicing, board-certified oncologist: the oncology boards.

Most oncologists receive board certification from either the American Board of Internal Medicine (ABIM), which certifies medical oncology as a subspecialty, or from the American Board of Radiology, which certifies radiation oncology. The American Board of Surgery certifies surgical see Exams, page 7

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For the latest oncology fellow–related information, please visit www.oncologyfellowadvisor.com

Reflective Practice Leadership

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or many fellows, training to be an oncologist has been a trial by fire, especially when it comes to interpersonal issues in the hospital. Young oncologists often find themselves looking to senior faculty members while navigating the ins and outs of the hospital system, gaining the trust of patients and their families, and overcoming conflicts that arise. One group in Texas has developed an evidencebased model using a Socratic approach to fill this gap in training.

Psychologist Ernest Frugé, PhD, and his colleagues are training pediatric hematology–oncology fellows at Texas Children’s Hospital in Houston in the

art of leadership and reflection. That is, they are teaching fellows how to analyze the thinking, emotion, motivation, and social context of themselves and others to manage complicated professional situations and relationships.

The group trains fellows to apply the same disciplined reasoning approach they use to think through complicated biological phenomena to the psychological, social, and institutional dimensions of their work, said Dr. Frugé, associate professor in the Department of Pediatrics’ Section of Hematology–Oncology at Baylor College of Medicine in Houston and director of see Reflective, page 4

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CAREER PATH

Oncology Fellow Advisor • Vol. 3, Issue 4

A Tribute to Robert Buckman, MD, PhD

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ncology Fellow Advisor presents its Tribute series. In each segment, we remember a prominent thought leader who changed the face of oncology and paved the way for future legions of oncology fellows.

In this issue, we remember and honor the work of Robert Buckman, MD, PhD, renowned oncologist, writer, and media personality. Dr. Buckman died unexpectedly in his sleep aboard a plane en route from Canada to London on October 9, 2011.

Oncology Fellow Advisor invited Walter F. Baile, MD, professor, Department of Behavioral Science; director, Program for Interpersonal Communication And Relationship Enhancement (I*CARE); and professor, Department of Psychiatry at the University of Texas MD Anderson Cancer Center, Houston, Texas, with whom Dr. Buckman collaborated on a library of teaching videos for health professionals, to share thoughts and memories of his friend and colleague.

“Rob was an incredible person. What I remember most is that he brought a sense of humor— an appropriate sense of humor—to everything he did,” said Dr. Baile. “He had a way of engaging patients with incredible humanism and a lightheartedness that made some of the most awful situations somehow bearable for cancer patients.”

Dr. Buckman practiced medical oncology at Princess Margaret Hospital in Toronto, Canada, and worked as a consultant for I*CARE at the Robert Buckman, MD, PhD (left), pictured with Walter F. Baile, MD (right).

University of Texas MD Anderson Cancer Center.

His achievements were vast and varied. A prolific writer, Dr. Buckman penned at least 14 books, many endeavors include working with the actor and comedian of which were literary in style and geared toward helpJohn Cleese in Great Britain. “Rob started his career as a ing patients understand and survive their cancer. Magic or comedian, actually, and had his own TV show in London Medicine?, an investigation into complementary medicine, that was actually watched by several million people.” Dr. was turned into a TV series that won a Gemini, the CanaBaile said. “He brought this ability to connect with people dian equivalent of an Emmy. into his interactions with patients and their families.”

Dr. Buckman also wrote numerous scholarly articles; Although his approach to work and life was characterisin the past 15 years, much of this work focused on doctic of one with boundless energy, Dr. Buckman’s physical tor–patient communications and breaking bad news. His health was fragile at times. At the age of 31 he was diagundergraduate course on the latter subject received the nosed with dermamyositis, a congenital autoimmune disUniversity of Toronto Aikins Teaching Award in 1989. Dr. ease condition that nearly killed him. In recent years, he Buckman was named Canadian Humanist of the Year in was hospitalized more than once for severe pneumonia, 1994 and received the Fleming medal of the Royal Canapossibly the sequelae of a small stroke that left one of his dian Institute for the Advancement of Science in 2003. vocal chords paralyzed.

A bibliophile, Dr. Buckman collected first-edition vol“Sometimes he tired easily, but there was never a time umes, of which he had a treasured library. He also had when a 15-minute nap in the office wasn’t able to revive his a penchant for all things Italian; when he and Dr. Baile enthusiasm,” Dr. Baile said. “He had a great passion for his reached an impasse in the work they were doing, Dr. Buckwork and a great confidence in his own talent without the man was given to quoting, in Italian, from Dante’s Divine arrogance that you sometimes see in brilliant people. In Comedy, “‘in the middle of the journey of our life I came our work together, his ability to write scenarios portraying communication dilemmas and work with actors and be in to myself within a dark wood where the straight way was these films himself was really extraordinary.” lost,’” Dr. Baile recalled.

Although Dr. Buckman was perhaps most distinHad Dr. Buckman not gone into medicine, he may guished to patients, readers, and other audiences by his well have had a career as an actor; his early theatrical Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

Vol.3, Issue 4

CAREER PATH

• Oncology Fellow Advisor

Editorial Board communications skills and theatrical capacity, his colleagues respected him also as an outstanding oncologist.

“I think it’s easy to forget that he was a medical scholar in addition to being a compassionate doctor and a prolific writer,” Dr. Baile said. “He was a great doctor originally trained in lab science, and he got his PhD from the University of London. In recent years, he was pursuing a project where he showed that low-dose anticoagulant can cause tumor regression in some patients with advanced cancer.

This ability to be both a compassionate doctor and an accomplished researcher is part of Dr. Buckman’s legacy: One does not necessarily preclude the other. A commentary published in fall 2011 in The New York A prolific writer, Times addressed concerns that the recent Dr. Buckman penned emphasis of medical at least 14 books, schools on compasmany of which sion and communication skills might were literary in style diminish the imporand geared toward tance of physician helping patients excellence in the technical aspects of mediunderstand and cine.1 Dr. Buckman survive their cancer. exemplifies those 2 components of a physician’s endeavor working in tandem. “Rob was the epitome of showing that it’s really about the balance,” Dr. Baile said.

Another lesson to be learned from Dr. Buckman’s work is the recognition that although extroversion and ease in communicating come naturally to some, for others communication is a skill that requires study and practice, and that it can be learned. Hence, the library of films on which Drs. Baile and Buckman collaborated at the University of Texas MD Anderson Cancer Center.

“He and I worked together in producing the material.

Remarkably, none of this was done with a script. It was generated through role-play with actors. He had a tremendous way of taking their talent and molding it into simulated patients who demonstrated key communication challenges that oncologists and other clinicians caring for cancer patients often face,” Dr. Baile said.

The films address everything from the fundamentals of communication, including nonverbal communication, to managing highly specific difficult situations, such as informing family of a patient’s death.

“I’m so glad we did the videos together. The videos will endure because, while some of the technical aspects of things he talked about may be surpassed by new data and

Karin Hahn, MD Associate Program Director, The University of Texas MD Anderson Hematology/Oncology Fellowship Chief of Medical Oncology Associate Professor Lyndon B. Johnson General Hospital Houston, Texas Jamal Rahaman, MD Fellowship Director Division of Gynecologic Oncology Associate Clinical Professor of Obstetrics, Gynecology, and Reproductive Science Mount Sinai School of Medicine New York, New York Andrew D. Seidman, MD Attending Physician, Breast Cancer Medicine Service Memorial Sloan-Kettering Cancer Center Professor of Medicine Weill Cornell Medical College New York, New York

Marc Stewart, MD Program Director, Hematology/Oncology Fellowship University of Washington/Fred Hutchinson Cancer Research Center Medical Director, Seattle Cancer Care Alliance Professor of Medicine, University of Washington Seattle, Washington Copyright © 2011

545 West 45th Street, New York, NY 10036. Printed in the USA. All rights reserved, including the right of reproduction, in whole or in part, in any form. December 2011

information, the style and the skills in communicating will always be there,” Dr. Baile said. “But the world is a sadder place, a less complete place without him.

To view the videos on which Drs. Baile and Buckman collaborated, please visit www.oncologyfellowadvisor.com.

Reference 1. Rosenbaum, L. (2011, November 1.) The downside of doctors who feel your pain. The New York Times. http://www. nytimes.com/2011/11/01/health/views/the-downside-of-doctors-who-feel-your-pain.html. Accessed November 21, 2011.

Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

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FELLOWSHIP TRAINING

Reflective

Oncology Fellow Advisor • Vol. 3, Issue 4

family to help them better understand the risks and benefits of choosing an alternative treatment.

Dr. Allen began attending the seminars as a first-year fellow at Texas Children’s, continued with the program volcontinued from page 1 untarily afterward, and now serves as one of the faculty members who guide each session. “I thought it was a usepsychosocial programs at Texas Children’s Cancer and ful forum both for specific issues that I had and for hearing Hematology Centers. “Being able to figure out how to get other people’s challenges. It’s a place where people can the best out of the ensemble of professionals around you, take an observation, validate it as a pattern, identify what to serve the best interest of the patient, to advance scito do to improve it, and then think through the next steps. ence, or to get the best educational approach possible It’s almost like a thought laboratory where you can think requires effectively working with and leading people in things through and come up groups.” with a well-developed packThe Reflective Pracage to present to leadership tice and Leadership semTable. Steps for Reflective Practice when you’re trying to recominars have been offered at 1. Distill each difficult situation presented into mend systematic changes.”

Texas Children’s Cancer a question that represents a leadership chalThe reflective practice sesand Hematology Centers lenge for the physician; sions involve 6 main steps for more than 15 years.

(Table).1 Currently, it is manda2. “Reflect” on and outline what the circumtory for first-year fellows Although it may sound like stances are and all the factors involved; to attend the confidential mentoring, the faculty who seminars for 90 minutes lead these seminars gener3. Formulate a working hypothesis to describe every 2 weeks. Dr. Frugé ally avoid providing their own what may be generating or maintaining the and 3 or 4 other faculty assessments or advice. The problem; members lead groups of goal is to help fellows develop 4. Develop a plan of action by considering the about 12 fellows in each the ability to effectively and feasibility and consequences of different session. In surveys colindependently reason through options; lected over the past 6 complicated psychosocial years, participating felscenarios. As such, reflective 5. Summarize the “diagnosis and plan”; and lows reported a signifipractice is best taught like 6. Review how the session itself went and if cant improvement in their everything else in graduate there are any general learning points on ability to manage a multimedical education, Dr. Frugé leadership that should be highlighted. tude of complicated psysaid—case-based and in a chosocial factors involved group format with experienced Adapted from reference 1. in their relationships with physicians guiding junior colpatients and the medical leagues in thinking through team.1 When the seminar difficult situations. To establish a similar program elsewhere, it would be important to is no longer mandatory, 75% of fellows choose to conhave the full support of the department’s leadership so feltinue attending it, Dr. Frugé said. lows are given protected time to attend; the participation In the sessions, fellows are encouraged to bring up diffiof experienced and well-respected faculty; and consistent cult clinical, educational, research, or administrative issues use of the 6-step method, he added. that they have encountered. These are not, however, ther“We just want our fellows to have an opportunity apeutic sessions to help fellows cope with the emotional to apply that same discipline [that they use to reason burdens of specializing in oncology. “While it certainly is through biological problems] to these other dimensions available for people who have personal issues or want to of their role until it becomes a habit, it gets in their bones deal with emotional reactions to those issues, it’s really a so to speak,” Dr. Frugé said. minority of what gets discussed,” said Carl Allen, MD, PhD, A comprehensive description of the program, sample assistant professor in the Department of Pediatrics’ Secsessions, and alternative formats for the seminar are availtion of Hematology–Oncology at Baylor. “It’s really more able at www.reflectivepracticeleadership.org. thinking about academic medicine and oncology or the team that you’re working in as a system and then how References you can optimize your functioning within that system.”

For instance, Dr. Frugé said potential topics could be how 1. Frugé E, Mahoney DH, Poplack DG, Horowitz ME. Leadership: to get the nursing service to deliver medications on time “They never taught me this in medical school.” J Pediatr Hemawhen there is a staffing shortage or how to work with a tol Oncol. 2010;32(4):304-308.

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FELLOWSHIP TRAINING

Vol. 3, Issue 4 • Oncology Fellow Advisor

Career Crossroads? Experts Offer Advice

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ometimes the best advice comes from people who have years of experience under their belt. To gather some pearls of wisdom, Oncology Fellow Advisor talked to 2 seasoned oncologists. Cathy Eng, MD, is associate professor and associate director of the Colorectal Center, Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.

Robin Zon, MD, is vice president and partner at Michiana Hematology-Oncology, PC, a practice with 15 oncologists and 6 locations in Indiana.

Although Dr. Eng went straight to MD Anderson after her fellowship 9 years ago, she recommends that fellows explore all opportunities, including private practice, even if they feel set on an academic career. “If they have any hint of interest in private practice or pharma, they should also look at those jobs,” she said. If a fellow ultimately chooses the academic path, he or she should shop around. “You won’t know until you actually go visit,” Dr. Eng said.

During an interview, an employer is sizing up a candidate, but fellows also should be gauging whether an institution is appropriate for them. For example, is a center going to provide adequate clinical and scientific mentorship? Ask the people you are interviewing with whom they have mentored, and ask who transitioned out of the department and why, Dr. Eng noted. Fellows should find out how many days of clinic they will have per week, how many patients they are expected to see, if they are going to be supported by a mid-level provider or nurse practitioner, and what type of cancer the institution treats. All fellows also should get perspective on whether doctors at the academic institution have a well-rounded life and are able to balance a successful academic career. “If it is your second or third interview, you are allowed to ask those questions,” Dr. Eng said.

“To have more than 2 full days of clinic a week can be challenging for an academic career,” Dr. Eng said. Successful academicians need time to work on their research project, educate others, network, and fulfill other institutional commitments. “Do not overcommit early on,” Dr Eng said.

She cautioned against being misled by clinic half-days— they might turn out to be almost a full day, depending on the size of the practice.

Private practice is another ballgame, and Dr. Zon said a lot has changed since she completed her fellowship nearly 14 years ago. “When I came out of my fellowship, 90% of the practices were independent and there were very few that were wholly affiliated with hospitals, but the landscape of the community practice has changed,” Dr. Zon said. Nowadays, small, 2- to 3-person practices are rare, and private community practices that have a relationship with a hospital are bountiful. Hospital affiliations provide practices with the purchasing power and business management acumen

they need to survive, and before choosing a practice, fellows should be aware of these relationships.1 Young oncologists should ask themselves how much autonomy they want.

“If the answer is they want complete autonomy, they are going to have to accept the risk that comes with that decision and consider an independent, stand-alone, private practice group,” Dr. Zon said. “If you don’t want the headaches of running a business, but you are willing to relinquish some authority, then you are probably best served by seeking an employed position affiliated with an institution such as a community hospital.”

Dr. Zon also believes in assessing work–life balance opportunities before an oncologist enters a practice. Does a practice allow physicians to request specific weeks off? “It was important that I have spring breaks off with my girls,” said Dr. Zon, pointing out that this type of benefit should be discussed with the hiring practice before signing a contract.

Whether fellows enter a private or an academic setting, leaving a fellowship and suddenly being in charge can be daunting. Drs. Zon and Eng think that fellows should seek opportunities at the end of their fellowship for more autonomy. Dr. Eng said that as a third-year fellow, she was allowed to complete a half-day of clinic and weekly inpatient rounds as an attending. This gave her confidence in her first year as a faculty member.

Just because doctors are leaving a fellowship, however, doesn’t mean they should stop receiving guidance from mentors.2 “Some people have too much pride to ask, and that is when you are going to run into problems,” Dr. Eng said. Dr. Zon suggested asking a senior partner during an interview if he or she would be willing to provide guidance about specific patients if questions arise. Tumor boards are another way for young oncologists to obtain feedback.

Regardless of which path young doctors choose, they should focus on enjoying their careers. “[Fellows] should not lose sight of the fact that they are treating an individual patient who wants to understand his or her disease.

For any oncologist, the best patient is the one who understands why we are making our treatment decisions,” said Dr. Eng.

References 1. Hospital–physician relationships: taking a proactive approach to building mutually successful relationships. JOP. 2008;4(2):72-76.

2. Afrin L. What I have learned since fellowship: tips for professional success and happiness. http://www.onclive.com/ publications/oncology-fellows/2011/April-2011/What-I-HaveLearned-Since-Fellowship-Tips-for-Professional-Successand-Happiness. Accessed November 28, 2011.

Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

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Oncology Fellow Advisor • Vol. 3, Issue 4

Spotlight on Second-Year Fellows

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he first year of an oncology/hematology fellowship often requires fellows to absorb a daunting amount of information; after that, many feel more at ease as they transition into their second year, having gained a substantial amount of clinical knowledge.1 “I think there is a point in your second year when you feel that everything is coming together—at least it was that way for me,” said Yuval Raizen, MD, now in his third year of fellowship at Baylor College of Medicine in Houston, Texas.

That said, the second year of fellowship has its own unique set of challenges, as fellows continue to deepen their understanding of cancer care and treatment while knuckling down to identify the direction all their hard work might take them in.

“Oncology and hematology are such complicated fields, with so much new knowledge you have to pick up after finishing your internal medicine residency, that it does take a while before you really start to feel competent managing patients without guidance every step along the way,” Dr. Raizen said. “During the second year is when I hit the point of feeling that I could competently make decisions on my own without the attending.”

The first-year focus on clinical work is meant to help fellows establish a broad base in general oncology, said Teresa Hayes, MD, who is program director, Baylor College of Medicine Hematology/Oncology Fellowship Program; associate professor, Baylor College of Medicine; and chief, Hematology/Oncology, Michael E. DeBakey VA Medical Center. “In the second year, fellows can pick their electives and go to another institution for extra specialty training.

Or they can use that time to develop a research program.”

With the option to focus on specific electives, Baylor second-year fellows start gaining more experience in subspecialties. “We rotate through gastrointestinal oncology; some people do breast oncology; and the hematology clinics are a bit more specialized as well,” Dr. Raizen added.

At the same time, second-year fellows have the flexibility to increase contact with a mentor and develop a project if they are geared toward a research-oriented career.1,2 “If you have aspirations toward an academic career, that’s the time in our fellowship when you are able to work on that more extensively,” he said.

Because of the high clinical volume, however, working toward a research program can be difficult during the second year. “To not only identify a central project, but also find time to do it—to identify your mentor, put together a research proposal, and carry it out while balancing your clinical responsibilities has been a challenge for a lot of fellows,” Dr. Raizen said.

Of course, fellowship programs vary from institution to institution. “Some programs have all clinical work in the

first 18 months with the next 18 months dedicated to research and academic pursuits, while others have it distributed throughout the 3 years. Some programs require research; others don’t,” Dr. Hayes explained. But they do have in common a challenging discipline that demands its physicians to be both medically competent and capable of caring for patients facing a potentially fatal illness. “The nature of the discipline is that you have to develop not only technical knowledge, but also a lot of people skills,” Dr. Hayes said. “You have to work with patients who are facing death and dying, and to have a lot of compassion and the ability to palliate them while you’re treating their cancers.”

For Dr. Raizen, the biggest challenge of his second year was making a decision between pursuing a career in academic medicine and going into a more practice-based environment.2,3 He decided to pursue a practice-based career after identifying what he really likes doing in oncology. “I do enjoy the teaching and interaction with house staff in an academic environment, but I really want to spend the majority of my time in patient care. Ultimately, I realized that was why I went into this in the first place.”

Dr. Raizen suggested that oncology fellows think about their long-term goals and try as early as possible to establish a way to achieve them.4 “If you’re interested in an academic career, the second year of fellowship is an important time to identify a mentor you would like to work with and see if you can create some research opportunities. It’s a little hard to complete something during the third year.”

Dr. Hayes concurred. “It is not easy to find jobs in oncology these days, so in the second year they need to be thinking about their lifetime goals: where they want to practice, whether they want to go into private practice or academia, and if research-oriented, what kind of research they would like to do.”

She recommended making contacts and getting things in order at this point, “because it may take a year or more [for fellows] to develop their ultimate career path.”

References 1. Kircher S, Feliciano J, Ahmed S. A year-by-year look at a fellowship program. http://www.onclive.com/publications/ oncology-fellows/2010/August-2010/A-Year-by-Year-Lookat-a-Fellowship-Program. Accessed November 9, 2011.

2. Todd RF. A guide to planning careers in hematology and oncology. Hematology Am Soc Hematol Educ Program.

2001:499-506.

3. Shanafelt T. A career in surgical oncology: finding meaning, balance and personal satisfaction. Ann Surg Oncol.

2008;15(2):400-406.

4. Melnick A. Transitioning from fellowship to a physicianscientist career track. Hematology Am Soc Hematol Educ Program. 2008:16-23.

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FELLOWSHIP TRAINING

Vol. 3, Issue 4 • Oncology Fellow Advisor

Exams

Prep Courses continued from page 1

oncologists, although there has been increasing pressure within the field to create its own specialty certification.1 How do you prepare? What should you expect? Do you need to attend a review course or will books and other preparation materials be enough? How much time should you allot to studying? The questions are myriad, and there’s no one-size-fits-all answer.

Many oncology fellows will choose to take a board preparation course, either one offered internally by their own training institution or one of a number offered by large academic medical centers.

In addition to live and recorded preparation courses, there are a number of review books, guides, and notes to help fellows prepare for the medical and radiation oncology boards.

Within medical oncology, probably the best known is ASCO’s Self-Evaluation Program (ASCO-SEP).2 “I did all the questions in ASCO-SEP multiple times, and I really found it helpful,” said Elizabeth Comen, MD, medical oncologist at Memorial Sloan-Kettering Cancer Center in New York. “I went section by section: I’d do lung one week, and then read all the answers and see what I got wrong and right, and then redo the whole thing.”

Robert Den, MD, assistant professor of radiation oncology at Thomas Jefferson University Hospital in Pennsylvania, who is now preparing for the fourth and final stage of his boards—the orals, coming up in spring 2012—used several review books and materials for radiation oncology.

The most helpful, he said, were the infamous “Caggiano notes” (by physicist Joseph A. Caggiano) for radiophysics,3 and Radiobiology for the Radiologist by Eric Hall (“It’s a rather short read”) on the radiobiology side.4 Another text that many radiation oncologists cite (sometimes with bleary eyes and aching heads) is Faiz Khan’s Handbook of the Physics of Radiation Therapy.5 With so much material to cover, what should the prospective board examinee focus on? The medical oncology boards focus a significant amount of time on the see Exams, page 8

The American Society of Clinical Oncology (ASCO) lists several such preparatory courses in hematology and medical oncology, usually held annually in September2: • Hematology & Medical Oncology Best Practices, The George Washington University Medical Center, Washington, DC. This 5- or 8-day program devotes 3 days each to hematology and medical oncology, and 2 days to the joint topics. DVDs also are available from www.CMEinfo.com.

• Comprehensive Oncology Review Course, The Seattle Cancer Care Alliance, University of Washington and Fred Hutchinson Cancer Research, Seattle, Washington. A 4-day intensive review of hematology and medical oncology topics.

• Comprehensive Board Review in Hematology and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. This 8-day program starts with 3 days on benign and malignant hematology, followed by 5 days of solid tumor review.

If you can’t make it to Texas, DVDs, CDs, and the syllabus can be purchased directly from MD Anderson.

• Board Review in Hematology (Home Study), 1008 Astoria Blvd., Suite A, Cherry Hill, New Jersey, www.CMEinfo.com.

The radiation oncology boards involve 3 steps: radiation oncology physics and biology exams taken at the beginning of the fourth year of training, then written clinical radiation oncology boards at the end of the fourth year. The final step: oral clinical radiation oncology boards taken during the middle of the first year post-training. Each step is dependent on passing the prior. For this process, there are 2 leading preparation programs: • University of Maryland School of Medicine, Department of Radiation Oncology, Baltimore, Maryland.

The 4-day course provides a comprehensive review of radiobiology and physics.

• Radiation Oncology Review Course and Radiation Oncology Mock Oral Review Course, the Osler Institute. The review course takes 4 days, while the mock oral review is 3 days. Materials are also available in DVD and mp3 formats.

JOIN THE CONVERSATION To obtain more educational information for oncology practitioners, please visit www.oncologyfellowadvisor.com or scan the bar code 2-D Bar Code for Oncology Fellow Advisor 1. Get the FREE Microsoft Tag Reader application through your smartphone browser by going to http://gettag.mobi and follow the steps to download. (There may be a charge from your wireless provider for the data services.)

2. Open the Tag Reader and focus on the Oncology Fellow Advisor bar-code image to instantly access related materials and/or Web sites.

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ONCOLOGYFellow S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Oncology Fellow Advisor • Vol. 3, Issue 4

Exams Both Drs. Den and Comen began preparation for the board exams months in advance, a little at a time. For 2 continued from page 7 months, Dr. Den allotted his train commute to and from work (20 minutes each way) to studying; during the last most common cancers, said Dr. Comen. “You have a limmonth before the exam, he ramped that up to 2 or 3 hours ited amount of time and you can’t focus on everything, so daily. Dr. Comen adopted a similar schedule, then studied you need to realize that you must know common maligall weekend immedinancies like breast, colon, ately before the boards. lung, and prostate in and “Your institution may try a particular “Slow and steady out. If you get the bread wins the race,” she said. and butter and the bigexperimental therapy, but that’s not what the “Could someone pass gest cancers down well, board is asking. You need to know not what by cramming? Yes. But and you know how to your institution does or your department head at the end of the day, treat the different stages it’s an opportunity to and the mechanisms of does in a particular case, but what is standard.” synthesize everything the drugs, you’ll be fine. I —Elizabeth Comen, MD you’ve learned durgot caught off guard with ing your fellowship and some very specific quesgive yourself a foundational knowledge. If I’m going to say tions about lung and colon cancers—things they did say I’m board certified, I want to be able to back that up.” ahead of time you have to know in and out—including the mechanisms of action of certain chemotherapy drugs and References targeted therapies and where they’re metabolized.”

By contrast, Dr. Den thinks that the radiation oncology 1. Pollock R. Surgical oncology at the crossroads: the future is now. Ann Surg Oncol. 2008;15(3):661-669. boards are broader in scope. “I felt like the gamut was cov2. American Society for Clinical Oncology. Board Review ered,” he said. “I don’t remember that many prostate and Course. http://www.asco.org/ascov2/Education+&+Training/ breast questions; I felt like it was a wide variety of cancers.

Training/Resources+for+Fellows/Board+Review+Courses.

Some questions surprised me on some of the rarer tumors.”

Accessed November 28, 2011.

Dr. Comen warns fellows at leading-edge academic 3. Caggiano AJ. A Review in Radiation Oncology Physics. institutions like Memorial Sloan-Kettering to bone up on Vienna, Austria; IAEA; 2011. what is the standard of care. “Your institution may try a 4. Hall EJ, Giaccia A. Radiobiology for the Radiologist. 7th ed. particular experimental therapy, but that’s not what the Philadelphia, PA; Lippincott Williams & Wilkins; 2011. board is asking. You need to know not what your institu5. Khan FM. Gibbons J, Mihalidis D, Alkhatib H, eds. Khan’s Lectures: Handbook of the Physics of Radiation Therapy. tion does or your department head does in a particular Lippincott Williams & Wilkins; Philadelphia, PA; 2011. case, but what is standard.”

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