Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Module 16: Oncology
Dr. Peter Ferguson
Learning
CanMEDS
Learning
Source Doc(s)
Specific
Context
Role (s)
Outcomes:
Competencies
Goals/Objectives
This module will Medical Expert KNOW:
A Clinical Guide to
Be competent in
require a teamObtain
Primary Bone
assessing the following:
based
appropriate
Tumors, Jerome
• Size of the tumour and
environment in
history and
Levesque et al,
its relationship to Fascia
order to acquire
perform physical
Williams & Wilkins,
• Neurovascular and
the CanMEDS
examination
1998.
articular involvement
Chapter 1
competencies of
relating to a
• Lymphatic involvement
Manager,
tumour
• Sites of metastatic
Power Point
Scholar and
potential for primary
Presentations on
Professional,
MSK tumours
PORTAL –
and to meet the
• Organs systems likely
1) Staging of Bone to metastasize to the
Royal College
and Soft Tissue
Objective of
MSK system
Sarcomas
Training and
• Tumour characteristics
2) Soft Tissue
Specialty
including issues specific
Sarcomas
Training
to age and gender
Requirements
(appendix 3) by
leading the
oncology team.
Evaluation will
be via a specific
ITER for
oncology, as
well as the
existing multisource feedback
tool for formal
evaluation of the
CanMEDS roles
of Manager,
Scholar and
Professional.
20Jan15 Version
Learning/Teaching
Evaluation
Strategies
Method or Tools
Source Document
Review
Keep daily surgical
log book
Direct observation
of supervising
surgeon modeling
competencies
- observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
MCQ exam to
assess cognitive
knowledge.
Structured orals
to assess applied
knowledge
Review of daily
surgical log
Clinical STACER
(Observed history
and physical
exam)
- regular
supervision time
with supervising
staff, with
opportunity to
discuss diagnosis
and evidencebased treatments
- case
presentations and
review during team
rounds
- ongoing self-study
- consultation notes
1
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Medical Expert Describe the
different bone
tumour classes
and their
behaviour:
Source Doc(s)
Orthopaedic
Knowledge Update:
Musculoskeletal
Tumors 2, Herbert
S. Schwartz, MD,
Editor, AAOS,
August 2007.
Chapter 3, 8
Specific
Competencies
Be competent in
describing:
• Primary lesions
• Benign
• Benign Aggressive
• Malignant
• Metastatic lesions
MCQ exam to
assess cognitive
knowledge.
Structured orals
to assess applied
knowledge
- case
presentations and
review during team
rounds
Power Point
Presentations on
PORTAL
1)Seven Questions
to Ask
2)Location
3)The Biological
Spectrum
Orthopaedic
Knowledge Update:
Musculoskeletal
Tumors 2, Herbert
S. Schwartz, MD,
Editor, AAOS,
with feedback from
supervisor
- observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
Evaluation
Method or Tools
- regular
supervision time
with supervising
staff or senior, with
opportunity to
discuss diagnosis
and evidencebased treatments
A Clinical Guide to
Primary Bone
Tumors, Jerome
Levesque et al,
Williams & Wilkins,
1998.
Chapter 2, 3
Medical Expert Describe the
presentation,
radiologic
characteristics
and natural
history of the
Learning/Teaching
Strategies
- ongoing self-study
- consultation notes
with feedback from
supervisor
Be competent in
describing:
• Chondroid lésions
(enchondroma,
osteochondroma,
chondrosarcoma)
- observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
MCQ exam to
assess cognitive
knowledge.
Structured orals
to assess applied
2
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
most common
primary bone
tumour types
Source Doc(s)
August 2007.
Chapter 3, 13, 16,
17, 18
A Clinical Guide to
Primary Bone
Tumors, Jerome
Levesque et al,
Williams & Wilkins,
1998.
Chapters 2, 3
Power Point
Presentations on
PORTAL
1)Benign Cartilage
2)Benign Bone &
Fibrous
3)Benign
Aggressive
Tumors
4)Osteosarcoma
5)Chondrosarcoma
6)Ewing’s Sarcoma
Medical Expert Describe the
presentation,
radiologic
characteristics
and natural
history of different
primary soft tissue
tumour types
Orthopaedic
Knowledge Update:
Musculoskeletal
Tumors 2, Herbert
S. Schwartz, MD,
Editor, AAOS,
August 2007
Chapter 21, 29, 30,
31
Power Point
Presentation on
Specific
Competencies
• Osteoid lésions
(osteoid osteoma,
osteosarcoma)
• Fibrous lesions
• Others- unicameral
bone cyst,
hemangioma,
histiocytosis, lipoma,
eosinophilic granuloma,
giant cell tumour,
aneurysmal bone cyst,
ewings sarcoma,
adamantinoma,
chordoma,
hemangiopericytoma
Learning/Teaching
Strategies
Evaluation
Method or Tools
knowledge
- regular
supervision time
with supervising
staff or senior, with
opportunity to
discuss diagnosis
and evidencebased treatments
- case
presentations and
review during team
rounds
- ongoing self-study
- consultation notes
with feedback from
supervisor
Be competent in
describing:
• Fibrous lesions
• Lipoid lesions
• Muscle lesions
• Vascular lesions
• Nerve lesions
• Others – myxoma,
fibrosarcoma, malignant
fibrous histiocytoma,
pigmented villonodular
synovitis, giant cell
- observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
MCQ exam to
assess cognitive
knowledge.
Structured orals
to assess applied
knowledge
- regular
supervision time
with supervising
staff or senior, with
opportunity to
3
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Source Doc(s)
PORTAL
1)Soft Tissue
Sarcomas
Specific
Competencies
tumour of tendon
sheath, myositis
ossificans, tumoral
calcinosis
Learning/Teaching
Strategies
Evaluation
Method or Tools
discuss diagnosis
and evidencebased treatments
- case
presentations and
review during team
rounds
- ongoing self-study
Medical Expert Formulate a plan
of investigation
and management
of patients
presenting with
musculoskeletal
neoplasia
Orthopaedic
Knowledge Update:
Musculoskeletal
Tumors 2, Herbert
S. Schwartz, MD,
Editor, AAOS,
August 2007.
Chapter 1, 9, 14,
20, 33, 34, 35, 40,
41, 42
A Clinical Guide to
Primary Bone
Tumors, Jerome
Levesque et al,
Williams & Wilkins,
1998.
Chapter 4
Power Point
Presentations on
PORTAL
1)Staging
Be competent in
describing:
• a differential diagnosis
and stage the tumour
(according to the
Enneking
Musculoskeletal Tumour
Society (MSTS)
System)
• the appropriate biopsy
principles of MSK
tumours.
• a treatment plan for
the different tumour
types
• the multidisciplinary
approach to
o curative treatment
o palliative care
- consultation notes
with feedback from
supervisor
- observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
MCQ exam to
assess cognitive
knowledge
Structured orals
to assess applied
knowledge
- regular
supervision time
with supervising
staff or senior, with
opportunity to
discuss diagnosis
and evidencebased treatments
- case
presentations and
review during team
rounds and
multidisciplinary
cancer conference
4
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Source Doc(s)
Specific
Competencies
2)The Biopsy
3)Osteosarcoma
4)Soft Tissue
Sarcoma
Medical Expert Formulate
treatment plans
for complications
in MSK oncology
surgery
Power Point
Presentations on
PORTAL
1)Metastatic Bone
Disease
2)Soft Tissue
Sarcoma
Learning/Teaching
Strategies
Evaluation
Method or Tools
- ongoing self-study
- consultation notes
with feedback from
supervisor
Be able to describe and
undertake initial
management of early
and late complications
including
hypercalcemia,
intraoperative bleeding,
surgical site
infections/complications,
deep vein thrombosis,
nerve injury, local
tumour recurrence,
systemic recurrence
- observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
- regular
supervision time
with supervising
staff or senior, with
opportunity to
discuss diagnosis
and evidencebased treatments
MCQ exam to
assess cognitive
knowledge.
Structured orals
to assess applied
knowledge
Review of daily
surgical log
- case
presentations and
review during team
rounds
- staff feedback on
management of
complications
occurring in
inpatients and
ambulatory clinics
- ongoing self-study
- consultation notes
5
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Source Doc(s)
Specific
Competencies
Learning/Teaching
Strategies
Evaluation
Method or Tools
with feedback from
supervisor
Medical Expert DO:
To be able to
perform with
proficiency:
• Open biopsy of
bone and/or softtissue lesion
• Stabilization of
metastatic
disease
• Treatment of
common benign
tumours
Orthopaedic
Knowledge Update:
Musculoskeletal
Tumors 2, Herbert
S. Schwartz, MD,
Editor, AAOS,
August 2007.
Chapter 1, 9, 40,
41, 42
A Clinical Guide to
Primary Bone
Tumors, Jerome
Levesque et al,
Williams & Wilkins,
1998.
Chapter 4
Demonstrate proficiency
at performing open
surgical biopsy.
Demonstrate proficiency
at performing
prophylactic IM nailing,
arthroplasty and plate
and cement fixation for
metastatic disease of
upper and lower
extremity.
Demonstrate proficiency
at resection of benign
bone and soft tissue
tumors.
Power Point
Presentation on
PORTAL
1)Breaking bad
news
- regular
supervision time
with supervising
staff or senior, with
opportunity to
discuss diagnosis
and evidencebased treatments
- participation in
weekly “pre-op
planning” rounds –
demonstration of
appreciation of
issues around
biopsy and
treatment of
metastatic disease
Power Point
Presentation on
PORTAL
1)The Biopsy
2) Staging
3) Management of
Metastatic Disease
Communicator KNOW:
Deliver
information to
patients and
family in a
humane manner
- observation by
clinical supervisor
with ongoing
feedback around
technical skills
Be able to break bad
news and discussing
end of life in an
informed and
compassionate way.
Direct observation
of supervising
surgeon modelling
competencies
Observation by
Review of
surgical log to
assess ability to
manage
metastatic
disease, benign
bone tumors –
residents may
need to be
responsible for
managing benign
and metastatic
disease at
multiple centers
including MSH,
TWH, SHSC and
SMH and HSC.
Surgical STACER
to assess Biopsy
OSCE to assess
communicator
CANMEDS role –
breaking bad
news, patients
with cancer, end
6
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
so that the patient
and family
understand the
options of care
and are able to
participate in the
decision-making
process
Source Doc(s)
Specific
Competencies
Demonstrate an ability
to listen effectively and
address patients
concerns
Demonstrate strategies
for delivering bad news
and discussing end of
life decisions
Obtain an appropriate
informed consent for
patients undergoing
interventions
Write/articulate
appropriate consultation
notes
Convey pertinent
information in different
circumstances and
settings (over the
phone, during ward
rounds.
Learning/Teaching
Strategies
Evaluation
Method or Tools
clinical supervisor
with ongoing
feedback around
assessment and
formulation of skills
with communication
of life issues, truth
telling
Have opportunity to
discuss
communication
techniques with
supervisor around
breaking bad news.
Observed in clinic
Observation
during time spent
in palliative care
Resident to take
part in ‘multidisciplinary week’
(radiation oncology,
medical oncology,
palliative care for a
day) to observe
communication
styles and practices
in breaking bad
news.
Display ability to explain
procedures and
diagnosis at a level
appropriate for patients
and their families.
Professional
KNOW:
The resident must
Resident will have
360
7
Learning
Context
CanMEDS
Role (s)
Learning
Outcomes:
Goals/Objectives
Demonstrate
ethical practice in
the management
of the oncology
patient including
respect for issues
regarding gender,
ethnicity, religion,
age and cultural.
Demonstrate
honesty, integrity,
commitment,
compassion,
respect and
altruism
Source Doc(s)
Specific
Competencies
Learning/Teaching
Strategies
appreciate the
emotional and ethical
issues surrounding the
patients and the need to
involve family members
and other health-care
givers in certain
situations
opportunity to lead
patient care rounds
The resident must
recognize her/his limits,
make independent
decisions when
appropriate but keep
senior resident and staff
informed.
Resident to take
part in ‘multidisciplinary week’
(radiation oncology,
medical oncology,
palliative care for a
day) to observe
communication
styles to appreciate
complete
multidisciplinary
care for cancer
patients.
Evaluation
Method or Tools
Direct
observation
Formal review
and feedback on
selected
diagnostic
interviews by
patients
Evaluation via
supervisor with
professional
form
Demonstrate effective
consultation services
with respect to patient
care and education.
8