Clinical Oncology
Liam Welsh
Clinical Research Fellow & Honorary Senior Registrar
Institute of Cancer Research and
Head & Neck Unit, Royal Marsden Hospital
Overview
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My medical training
About Clinical Oncology
Radiotherapy Treatment
Working in Clinical Oncology
Training in Clinical Oncology
Opportunities to gain experience
My Training
• GKT Medical School, 1999-2004
• House Officer, KCH & Lewisham, 2004-05
• SHO Bart’s SHO Rotation, 2005-07
– Elderly Medicine; Endocrinology & Diabetes
– HIV Medicine; Medical Oncology
• ST2 Royal Free Hospital, 2007-08
– Cardiology; Clinical Oncology
• ST3 Clinical Oncology, RMH, 2008-
Clinical Oncology
• “The total non-surgical management of cancer”
– Curative treatment
– Palliative treatment
– Radiotherapy, chemotherapy, biological therapies, combined
treatments
• “Of those cancer patients who are cured it is estimated
that 49% are cured by surgery, 40% by radiotherapy
alone or combined with other modalities and 11% by
chemotherapy alone or combined with other modalities”
– Bentzen et al., (2005) Radiotherapy and Oncology, v75(3),
p355–365
Henk JM. A brief history of British radiotherapy. Int J Radiat Oncol Biol Phys 1996;36(1): 213-8.
Multi-disciplinary Team for
Radiotherapy
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Clinical Oncologists
Medical Physicists
Radiotherapy Radiographers
Radiotherapy Nurses
Administrative Staff
Radiotherapy Planning
Radiotherapy Set-up & Delivery
IMRT
Typical Working Week
Mon
Tues
RT Audit Ward
Meeting Round
Clinic
Weds
Thurs
Fri
MDM
then
Clinic
Clinic
Clinic
RT
RT
Ward
Planning Planning Round
Admin
Clinical Oncology UK
• 2010 RCR Census
– Consultants – 687
– Registrars – 315
– Other grades – 88
• Clinical Oncology Consultants
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10.6 WTE per million population in UK
58% men, 42% women
19% work part-time
Majority of UK cancer centres have 8-14 WTE
Consultant Clinical Oncologists
Training Pathway
Foundation Training - FY1 & FY2
Core Medical Training
CMT1 & CMT2
Acute Care Common Stem
ACCS1-3
Specialty Registrar Clinical Oncology
StR3-7
MRCP
FRCR
MSc
Research – MD/PhD
Clinical Oncology StR
StR 1
First FRCR
ICR MSc Part A
StR 2
ICR MSc Part B
StR3
ICR MSc Part C
StR4
Final FRCR Part A (MCQs)
Final FRCR Part B (Clinical & Vivas)
StR5
(Research – MD or PhD)
CCT
FRCR
• First FRCR Examination
– SBA MCQs – 4 papers over 2 days
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Cancer Biology & Radiobiology
Clinical Pharmacology
Physics
Medical Statistics
• Final FRCR Examination
– Part A
• SBA MCQs – 2 papers over 1 day
– Part B
• Clinical cases
• Vivas
Research
• During Clinical Training
– NIHR Academic Clinical Fellowships
• ICR MSc – Part C Research Project
• Post FRCR
– MD (2years) or PhD (3 years)
Clinical Oncology StR NTN
Competition Ratios
Year
Applicants
Posts
Competition
Ratio
2012 R1
118
33
3.6:1
2011 R1
95
40
2.4:1
2011 R2
30
15
2:1
2010
117
47
2.5:1
http://oncologyrecruitment.nhs.uk/clinical/useful/competition_ratios
http://careers.bmj.com/careers/advice/view-article.html?id=20004464
Elective Opportunities
• UK Centres
– RMH, Mount Vernon, Christie, Beatson
• Johns Hopkins, Baltimore USA
– GKT Elective Exchange Programme
• Mayo Clinic, Rochester USA
– Visiting Medical Student Clerkships
– http://www.mayo.edu/msgme/visiting-medical-student-clerkships
• University of Toronto, Canada
– https://admin.med.utoronto.ca/utme/
– http://www.radonc.utoronto.ca/
Resources
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Royal College of Radiology
– www.rcr.ac.uk
– http://oncologyrecruitment.nhs.uk/clinical/home
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NHS Medical Careers
http://www.medicalcareers.nhs.uk/specialty_pages/radiology/clinical_oncology
.aspx
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London Deanery - http://oncologyrecruitment.nhs.uk/Clinical/london
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NIHR Academic Clinical Fellowships - http://www.nihrtcc.nhs.uk/intetacatrain/
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National Radiotherapy Implementation Group (NRIG) - http://ncat.nhs.uk/
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BMJ Careers - http://careers.bmj.com/careers/advice/view-article.html?id=725
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Institute of Cancer Research - Oncology MSc
– http://www.icr.ac.uk/education/clinical_trainees/msc_oncology/index.shtml
– http://careers.bmj.com/careers/advice/view-article.html?id=20001851
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Clinical Oncology - KCL Oncology Society